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Home My WebLink About11-05-14 REV-1500 EX(02-11) 1505610143 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po 60x.280601 INHERITANCE TAX RETURN 21 13 0893 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 06 28 2013 06 11 1934 Decedent's Last Name Suffix Decedent's First Name MI MIXELL KATHRYN E (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW x❑ 1. Original Return 2. Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 4a.Future Interest Compromise(date of death after 12-12-82) 5. Federal Estate Tax Return Required 6 Decedent Died Testate ❑ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of W ill) (Attach Copy of Trust) 9. Litigation Proceeds Received 10,spousal Poverty Credit Date of Death 11.Election to tax under Sec.9113(A) between 12-31-91 and T-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIR4GTED TO: Name Daytime Telephone Number ROGER B IRWIN ESQ 717 cz9 63 -1 Fri n REGISTOFR`OF1WILL iiSE OtlLt._� First Line of Address - Ln " C-1) CJ 354 ALEXANDER SPRING RO t 7n Second Line of Address 1 ry ,= C-3 � City or Post Office State ZIP Code DATE FILW CARLISLE PA 17015 orr rident's e-mail address: rogerbirwintiD_salzmannhughes.com nder enalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is tru ,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT RE OF PERSON RESPONSIBLE FOR FI N TURN DATE Ronald M. Mlxell ADDR S 110 Hoy Road, Carlisle, PA 17013 SIGNATURE OF PREP RER OTHER THAN REPRES TATIVE DATE -3. , Roger B. Irwin Esq. i � ADDRESS 354 Alexander Opring Road, Suite 1, Carlisle, PA 17015 Side 1 1505610143 1505610143 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21-13-0893 Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has a knowled Signature#2 Name Christopher J.Orth Address1 110 Hoy Road Address2 City, State,Zip Carlisip,PA 17013 Date 1 `�' 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Mixell, Kathryn E. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 227 , 000 . 00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 22 , 861 . 41 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 22 , 545 . 36 6. Jointly Owned Property(Schedule F) ❑ Separate Billinq Requested............ 6. 7. Inter-Vivos Transfers&MiscellaneousProbate Property (Schedule G) It Separate Billing Requested............ 7. 439, 605 . 79 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 712 , 012 . 56 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 48 , 069. 04 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 1, 958 . 74 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 50 , 027 . 7 8 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 661, 984 . 78 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 661, 984 . 78 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 661 984 . 78 16. 29, 789. 32 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 29, 789. 32 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-13-0893 Decedent's Complete Address: DECEDENT'S NAME Mixell, Kathryn E. STREET ADDRESS 991 N. Middleton Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 29,789.32 2. Credits/Payments A. Prior Payments 26,000.00 B. Discount 1,368.42 Total Credits(A +13) (2) 27,368.42 3. Interest (3) 44.47 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 2,465.37 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ x c. retain a reversionary interest;or............................................................................................................... ❑ x d. receive the promise for life of either payments,benefits or care?............................................................ ❑ x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ M 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑x ❑ 4. Did decedent own an individual retirement account,annuity,or other non-probate property which containsa beneficiary designation?.................................................................................................................. ❑x ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev-1502 EX+(01-10) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mixell, Kathryn E. 21-13-0893 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate situate at 991 North Middleton Road,Carlisle, North Middleton Township, 227,000.00 Cumberland County, PA-At proceeds of sale-see HUD 1 attached TOTAL(Also enter on Line 1, Recapitulation) 227,000.00 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10) Rev-1503 EX+(6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21-13-0893 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH Deutsche Asset&Wealth Management Account No.3883575 1 DWS Managed Municipal Bond Fund-A 8.91783 22,861.41 TOTAL(Also enter on Line 2, Recapitulation) 22,861.41 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.6-98) Rev-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21.13-0893 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Foot Locker Inc.-monthly payment 510.63 2 M&T Classic Checking w/interest Account No.428914 3,271.81 Accrued interest on Item 2 through date of death 0.02 3 M&T Classic Relationship Savings Account No.15004200931019 6,003.84 Accrued interest on Item 3 through date of death 0.02 4 1990 Ford F-150 Pickup-VIN 1 FTEF14N7LLA24637,appraisal attached 3,400.00 5 2000 Ford Crown Victoria -VIN 2FAP74W2YX21121;appraisal attached 2,500.00 6 Household goods taken in kind-appraisal attached 5,092.00 7 Avalon Insurance Company-refund 63.80 8 Capital Blue-refund 660.15 9 The Sentinel 3.09 10 U.S.Treasury-2013, 1040 income tax refund 1,040.00 TOTAL(Also enter on Line 5, Recapitulation) 22,545.36 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Mixell, Kathryn E. 21-13-0893 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE INCLUDE NAME OF NUMBER HE DATE OF RANSFERS ATTACH A COPY OF THEDETHEIR IED FOR REAL ESTATE VALUE OF ASSET DECEDENT AND INTEREST (IF APPLICABLE) VALUE 1 Allianz,Annuity Contract Number DAD38929- 36,851.46 100.000% 36,851.46 Beneficiaries: 50%Ronald M. Mixell,son; 50%equally to Christopher J.Orth,Cory A.Osborne and Nicholas R.Orth,grandsons 2 John Hancock,Annuity Contract Number 55100967- 66,944.13 100.000% 66,944.13 Beneficiaries: 50%Ronald M. Mixell, son; 50%equally to Christopher J. Orth,Cory A. Osborne and Nicholas R.Orth,grandsons 3 Santander,Annuity Contract Number QG2-925516- 57,844.91 100.000% 57,844.91 Beneficiaries: 50%Ronald M. Mixell,son; 50%equally to Christopher J. Orth,Cory A. Osborne and Nicholas R.Orth,grandsons 4 Scudder Destinations, IRA Contract Number 203,076.40 100.000% 203,076.40 K111015809-Beneficiaries: 50%Ronald M.Mixell, son;50%equally to Christopher J. Orth, Cory A. Osborne and Nicholas R.Orth,grandsons 5 The Hartford,Annuity Contract Number 711566611 - 54,150.01 100.000% 54,150.01 Beneficiaries: 50%Ronald M. Mixell,son; 50%equally to Christopher J.Orth,Cory A. Osborne and Nicholas R. Orth,grandsons 6 WRP Investments,Account No. BX6-233331 -Transfer 20,738.88 100.000% 20,738.88 on death Account; Beneficiaries: 50%Ronald M. Mixell,son; 50%equally to Christopher J.Orth,Cory A.Osborne and Nicholas R.Orth,grandsons TOTAL(Also enter on Line 7, Recapitulation) 439,605.79 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) REV•1511 EX+(10.09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DEC ENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21-13-0893 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT UMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 12,562.57 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2, Attorney's Fees 16,325.00 See continuation schedule(s) attached 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD RelationshiD of Claimant to Decedent 4. Probate Fees 403.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 18,777.97 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 48,069.04 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21-13-0893 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex ep nses 1 Christopher J.Orth -reimbursement for payment to Osiris Holding of PA, Inc.,funeral 210.00 services 2 Christopher J.Orth-reimbursement for payment to Osiris Holding of PA, Inc.,funeral 1,906.00 services 3 Hoffman-Roth Funeral Home-funeral services 2,273.24 4 Hoffman-Roth Funeral Home-balance of funeral services 8,173.33 H-A 12,562.57 Attorney Fees 5 Irwin&McKnight-attorney's fees 5,000.00 6 Salzmann Hughes, P.C.-Attorney's fees 11,325.00 H-132 16,325.00 Other Administrative Costs 7 Advanced Disposal Services-refuse service 41.97 8 Advanced Disposal Services-refuse service 41.97 9 Advanced Disposal Services-refuse service 46.98 10 Advanced Disposal Services-refuse service 41.97 11 Anson T.and Ellen K. Myers-seller assistance to sell real estate in order to administer the 8,771.97 estate Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21-13-0893 ITEM NUMBER DESCRIPTION AMOUNT 12 Anson T.and Ellen K.Myers-balance due for seller assistance to sell real estate in order to 3,228.03 administer the estate 13 Century Link-phone service 54.48 14 Century Link-phone service 16.82 15 Comcast-final cable service 44.22 16 Cumberland Law Journal-Legal advertising 75.00 17 Patricia A. Rosendale, CPA-2013, 1040/PA40 income tax preparation 100.00 18 PP&L-electric service 126.14 19 PP&L-electric service 232.96 20 PP&L-electric service 57.81 21 PP&L-electric service 134.25 22 PP&L-electric service 253.88 23 PP&L-electric service 456.44 24 PP&L-electric service 365.01 25 PP&L-electric service 268.83 26 PP&L-electric service 210.70 27 PP&L-electric service 111.26 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21-13-0893 ITEM NUMBER DESCRIPTION AMOUNT 28 PP&L-electric service 59.28 29 PP&L-electric service 119.38 30 PP&L-electric service 83.46 31 Recorder of Deeds-1%realty transfer tax paid to sell real estate in order to administer the 2,270.00 estate 32 Register of Wills -short certificate 5.00 33 Roy D.Gottshall-appraisal of personal property 110.00 34 S.W.Barrett Real Estate-appraisal of real estate 750.00 35 Salzmann Hughes, P.C.-closing costs and final fees for income tax preparation,postage 500.00 and miscellaneous contingencies in order to administer the estate 36 The Sentinel-Legal advertising 200.16 H-137 18,777.97 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21-13-0893 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Allied Waste Service-refuse service 49.73 2 AT&T-cell phone service. 37.31 3 AT&T-final cell phone service 39.29 4 Century Link-phone services 106.30 5 Comcast-cable service,check written prior to death and cleared after death 80.74 6 Comenity Card-credit card payment 29.97 7 Discover-credit card payment 35.00 8 Discover-balance due on account 844.34 9 Kohl's-credit card payment 63.93 10 Kohl's-balance due 19.42 11 PP&L-electric service,check written prior to death and cleared after death 142.08 12 The Bank of New York as Trustee for Foot Locker Retirement-reimbursement for 510.63 overpayment of July retirement pay TOTAL(Also enter on Line 10, Recapitulation) 1,958.74 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule 1(Rev. 12-08) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Mlxell, Kathryn E. 21-13-0893 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENTDo Not ss (Words) ($$$) I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Ronald M. Mlxell Son 50%Schedule G 330,992.40 110 Hoy Road 50%Residue Carlisle, PA 17013 2 Christopher J.Orth Grandson 16.667% 111,072.06 110 Hoy Road Schedule G Carlisle, PA 17013 17%Residue 3 Cory A.Osborne Grandson 16.667% 111,072.06 1001 N. Middleton Road Schedule G Carlisle, PA 17013 17%Residue 4 Nicholas R.Orth Grandson 16.666% 109,848.26 120 Hoy Road Schedule G Carlisle, PA 17013 16%Residue Total 662,984.78 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) LAST WILL AND TESTAMENT 1, KATHRYN E. MIXELL, of North Middleton Township, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. I 1. 1 direct my Co-Executors to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Co-Executors of my estate, 2. My Co-Executors may, at their discretion, compromise claims, borrow money, retain property for such length of time as they may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as they may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. 3. 1 authorize and empower my Co-Executors to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My Co-Executors are authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems:expedient to said Co-Executors. 3-- 4. 1 give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: a. Fifty Percent (50%) to my son, RONALD M. MIXELL; b. Seventeen Percent(17%) to my grandson, CHRISTOPHER J. ORTH; c. Seventeen Percent(17%)to my grandson, CORY A. OSBORNE; and d. Sixteen Percent(16%)to my grandson, NICHOLAS R. ORTH. 5. If any beneficiary entitled to share in any distribution under the terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest the probate of this Last Will and Testament, such beneficiary shall forfeit his entire interest inherited hereunder and all provisions in favor of such beneficiary shall be declared void and of no effect. The share of such beneficiary so forfeited shall be distributed as part of the residue pursuant to Paragraph No. 4. hereof, except that if such beneficiary is entitled to share in the said residue, that interest shall be distributed proportionately to the other residuary beneficiaries. 6. 1 nominate and appoint RONALD M. MIXELL and CHRISTOPHER J. ORTH to be the Co-Executors of this my Last Will and Testament. 7. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. 8. No Co-Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 2 9. No beneficiary may assign, anticipate or pledge his interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 10. I hereby suggest that my personal representatives retain the services of Irwin & McKnight, P.C. as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 31 day of March 2010. (SEAL) T YN E. MI Signed, sealed, published and declared by KATHRYN E. MIXELL, the above-named Testatrix, as and for her Last Will and Testament, in our presence, who, at her request, in her presence and in the presence of each other have hereunto set our names as subscribing witnesses. 3 ACKNOWLEDGMENT AND AFFIDAVIT WE, KATHRYN E. MIXELL,KAREN S. NOEL and SHARON L. SCHWALM,the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. KAT YN E.MIXE11 kAREN S. NOEL SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by KATHRYN E. MIXELL, the Testatrix herein, and subscribed and sworn to before me by KAREN S. NOEL and SHARON L. SCHWALM,witnesses, this 31-0 day of March 2010. Nt Public '�t Commo WtF , OF PENNSYLVANIA Notarial Seal Roger B.Irwin,Notary Public Carlisle Bora,Cumberland County My Commission Expires Oct.3,2012 Member,Pennsylvania Association of Notaries QTP�NExra, OMB Approval No.2502-0265 NT A. Settlement Statement HUD-1 II�II�II ( ) G98aro oe�c�°S B. Type of Loan 1.OX FHA 2.Q RHS 3.QConv.Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4 Ej VA 5.Q Conv.Ins. 15083.2 8000088752 446-2217050-703 C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked"(p.o.c.)"were paid outside the closing,they are shown here for informational purposes and are not included in the totals. D. Name and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender: Anson T.Myers and Estate of Kathryn E.Mixell CBC National Bank Ellen K.Myers 991 North Middleton Road 3010 Royal Blvd.,South,Suite 230 42.6 North College Street Carlisle,PA 17013 Alpharetta,GA30022 Carlisle,PA 17013 G. Property Location: H. Settlement Agent: 1. Settlement Date: 991 North Middleton Road Mattson Law Offices Carlisle,PA 17013 10 East High Street October 27,2014 Cumberland County,Pennsylvania Carlisle,PA 17013 Ph. (717)2433341 Place of Settlement: 10 East High Street Carlisle,PA 17013 J. Summary of Borrower's transaction K. Summary of Seller's transaction 100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller: 101. Contract sales price 227,000.00 401. Contract sales price 227,000.00 102. Personal property 402. Personal property 103. Settlement Charges to Borrower Line 1400 9,982.13 403. 104. 404. 105, 405. Adjustments for items paid by Seller in advance Adjustments for items paid by Seller in advance 106. County/Twp.Taxes 10/28/14 to 01/01/15 158.11 406. CountfTw .Taxes 10/28/14 to 01/01/15 158.11 107. School Taxes 10/28/14 to 07/01/15 2,464.73 407. School Taxes 10/28/14 to 07/01/15 2,464.73 108. Assessments to 408. Assessments to 109. 409. 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 239,604.97 420.Gross Amount Due to Seller 229,622.84 200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due Seller: 201. Deposit or earnest money 1.00 501. Excess deposit see instructions 202. Principal amount of new loans 22208.00 502. Settlement charges to Seller Line 1400 6,998.22 203. Existing loans taken subject to 503. Existing loans taken subject to 204. 504. Payoff First Mortgage 205, 505. Payoff Second Mortgage 206. 506. Deposit retained by seller 1.00 207. 507. 208. 508. 2D9. Seller Assistance 8,771.97 509. Seller Assistance 8,771.97 Adjustments for items unpaid by Seller Adjustments for items unpaid by Seller 210. CountfTw .Taxes to 510. County/Twp.Taxes to 211. School Taxes to 511. School Taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid by/for Borrower I 231,660.97 520. Total Reduction Amount Due Seller 15,771.19 300. Cash at Settlement from/to Borrower 600. Cash at settlement to/from Seller 301. Gross amount due from Borrower line 120 239,604.97 601. Gross amount due to Seller line 420 229,622.84 302. Less amount paid by/for Borrower(line 220) ( 231,660.97) 602. Less reductions due Seller(line 520) ( 15,771.19 303. Cash ]From E] To Borrower I 7,944.00 603. Cash [jj-ToFrom Seller 213,851.65 -Paid outside of closing by borrower(B),se Iler(S),Iender(L),or third-pany(T) The undersigned hereby ack ledge receipt of a completed copy of this statement&any attac ents r ggerred to herein Borrower Seller Estale of Kathryn E.Mixell Anson T.Myers Ion ful-tglixel Co-Ex cuter\ Ellen K.Myers BY: Ch .Orth,Co- xecutor The Public Reporting Burden for this collection of information is esfimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not collect this information,and you ere not reouired to complete this form,unless it displays a currently valid 0M Control number.No confidentiality is assured,this disclosure is mandatory.This is designed to Provide the partes to a RESRlcove red trartm coon with information during the settlement process. Page 1 of 3 HUD-1 (15083.2.PFD/15083.2/77) L.Settlement Charges 700.Total ileal Estate Broker Foes Paid From Paid From Division of commission(line 700)as follows: Borrowers Sellers 701.$ t0 Funds at Funds at 702.$ to Settlement Settlement 703.Commission paid at settlement 704. 705. 800.Items Payable in Connection with Loan 801.Our origination charge $ 6,129.42 from GFE#1 802.Your credit or charge(points)for the specific interest rate chosen S-7,977,16 from GFE#2 803.Your adjusted origination charges from GFE#A -1,847.74 804,Appraisal fee to Foote Capital FSO MVS from GFE#3 475.00 805.Credit Report to Foote Capital FBO Credit Plus from GFE#3 28.14 806.Tax service to from GFE#3 807.Flood certification to from GFE#3 808. from GFE#3 809. from GFE#3 1810. from GFE#3 811. (from GFE#3) 900.Items Required by Lender to Be Paid In Advance 901.Daily interest charges from 10/27/14 to 11/01/14 5 $22.899450/da from GFE#10 114.50 902.Mortgage insurance premium for months to HUD (from GFE#3) 3,833.46 903.Homeowner's insurance for 1.0 years to Erie Insurance Company (from GFE#11) 649.00 904. (from GFE#11) 905. (from GFE#11) 1000.Reserves Deposited with Lender 1001.Initial deposit for your escrow account (from GFE#9) 1,553.77 1002.Homeowner's insurance 4.000 months @ $ 54.08 per month $ 216.32 1003, Mortgage insurance months @ $ 244.37 per month S 1004,Property taxes S Count fTw .Taxes months $ per month School Taxes months @ $ per month 1005. $ 1006, Township/County Taxes 10.000 months @ $ 75.50 per month $ 755.00 1007, School Taxes 6.000 months @ $ 310.97 per month $ 1,865.82 1008. $ 1009.Aggregate Adjustment $ -1,283.37 1100.Title Charges 1101. Title services and lender's title insurance (from GFE#4) 2,030.00 1102. Settlement or closing fee $ 1103. Owner's title insurance to Old Republic National Title Insurance Company (from GFE#5) 2.0.00 1104. Lender's title insurance to Old Republic National Title Insurance Company $ 1,665.00 1105. Lender's title policy limit $ 222,888.00 1106. Owner's title policy limit $ 227,000.00 1107. Agent's portion of the total title insurance premium to Martson Law Offices $ 1,432.25 1108. Underwriter's portion of the total title insurance premium to Old Republic National Title Insurance Comp, $ 252.75 1109. Closing Service Letter Old Republic National Title Insurance Conp%ny 125.00 1110, Attorney Fees Martson Law Offices S 150.00 1111. $ 1112. $ 1113. $ 1200.Government Recording and Transfer Charges 1201.Government recording charges to Cumberland County Recorder of Deeds from GFE#7 176.00 1202.Deed $ 81,00 Mortgage $ 95.00 Releases $ Other $ 1203.Transfer taxes to Cumberland County Recorder of Deeds (from GFE#8) 2,270,00 1204.Cit/Count tax(stam s $ 2,270.00 $ 1205.State tax/stamps $ 2,270.00 $ 2,270,00 1206. 1207. 1300.Additional Settlement Charges 1301.Required services that you can shop for (from GFE#6) 680.00 1302. Septic Inspection to Rosenberry's Septic Services $ 680.00 1303, 2014 Twp,/County&School Taxes to Melanie Strickland,Tax Collector $ 29-05-0427-047 4,728.22 1304. $ 1305. $ 1400,Total Settlement Charges(enter on lines 103,Section J and 502,Section K) 9,98213 6,998.22 'Paid out ide of Dosing by borrower(e),selle,(S),tendert L),or third-party(T) P y sgning page 5 of this statement,the signatories acknowledge receiptof a completed copy orpace 2 8 3 of mis three page statement, ..r Manson Law Offices,Settlement Agent Page 2 of 3 HUD-1 (150832PFDt15083.2177) Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Our origination charge # 801 6,129.42 6,129.42 Your credit or charge(points)for the specific rate chosen # 802 -7,977.16 -7,977.16 Your adjusted origination charges # 803 -1,847.74 -1,847.74 Transfer taxes #1203 2,270.00 2,270.00 Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1 Government recording charges #1201 180.00 176.00 Appraisal fee # 804 500.00 475.00 Credit report # 805 60.00 28.14 Mortgage Insurance Premium # 902 3,833.46 3,833.46 Title services and lender's title insurance #1101 2,070.00 2,030.00 Owner's title insurance to Old Republic National Title Insurance #1103 100.00 20.00 Septic Inspection #1302 575.00 680.00 Total 7,318.46 7,242.60 Increase between GFE and HUD-1 Charges $ -75.86 or -1.04 Charges That Can Change Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 4,969.14 1,553.77 oaily interest charges # 901 $ 22.899450/day 114.50 114.50 Homeowner's insurance # 903 794.64 649.00 Loan Terms Your initial loan amount is $222,888.00 Your loan term is 30.00 years Your initial interest rate is 3.7500% Your initial monthly amount owed for principal,interest and $1,276.60 includes any mortgage Insurance is O Principal ❑ Interest 0 Mortgage Insurance Can your interest rate rise? ❑X No ❑ Yes,it can rise to a maximum of %. The first change will be on and can change again every_months after Every change date,your interest rate can increase or decrease by_%. Over the life of the loan,your interest rate is guaranteed to never be lower than %or higher than %. Even if you make payments on time,can your loan balance rise? ❑X No ❑ Yes,it can rise to a maximum of$ Even if you make payments on time,can your monthly ❑X No ❑ Yes,the first increase can be on and the monthly amount owed for principal,interest,and mortgage insurance rise? amount owed can rise to$ The maximum it can ever rise to is$ Does your loan have a prepayment penalty? ❑X No ❑ Yes,your maximum prepayment penalty is$ Does your loan have a balloon payment? ❑X No ❑ Yes,you have a balloon payment of$ due in_years on Total monthly amount owed including escrow account payments ❑ You do not have a monthly escrow payment for items,such as property taxes and homeowner's insurance. You must pay these items directly yourself. ❑X You have an additional monthly escrow payment of$440.55 that results in a total initial monthly amount owed of$1,717.15. This includes principal,interest,any mortgage insurance and any items checked below: ❑X Property taxes X❑ Homeowner's insurance ❑ Flood insurance ❑ ❑ ❑ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Page 3 of 3 HUD-1 HUD-1 Attachment Borrower(s):Anson T Myers and Ellen K. Myers Sellel(s): Estate of Kathryn E. Mixell 426 North College Street 991 North Middleton Road Carlisle, PA 17013 Carlisle, PA 17013 Lender:CBC National Bank Settlement Agent:Martson Law Offices (717)243-3341 Place of Settlement: 10 East High Street Carlisle, PA 17013 Settlement Date:October 27, 2014 Property Location:991 North Middleton Road Carlisle, PA 17013 Cumberland County, Pennsylvania Adjusted Origination Charge Details Origination Charge Loan Origination Fee 6,129.42 to Foote Capital Mortgage Company Total $ 6,129.42 Origination Credit/Charge(points)for the specific interest rate chosen Credit/Charge -7,977.16 to CBC National Bank Total $ -7,977.16 Adjusted Origination Charges $ -1,847.74 Reserves Deposited with Lender Homeowner's Insurance 216.32 4.000 at 54.08 per month Township/County Taxes 755.00 10.000 at 75.50 per month School Taxes 1,865.82 6.000 at 310.97 per month Aggregate Adjustment -1,283.37 Total $ 1,553.77 Title Services and Lender's Title Insurance Details BORROWER SELLER Closing Service Letter 125.00 to Old Republic National Title Insurance Company Electronic Document Production 50.00 to Martson Law Offices Overnight Mail Fee 20.00 to Martson Law Offices Wire Fee 20.00 to Martson Law Offices Attorney Fees 150.00 to Martson Law Offices Lender's title insurance 1,665.00 to Old Republic National Title Insurance Company Total $ 2,030.00 $ 0.00 WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S.Code Section 1001 and Section 1010. (15083.2.PFD/15083.2/77) HUo-1Attachment' Continued Owner's Title Insurance BORROWER osLLsm Owner's Policy Premium 20,00 to Old Republic National Title Insurance Company Tp:"| $ 20.00 $ 0.00 Lender's Title Insurance BORROWER SELLER*fees also shown above in Title Services and Lender's Title Insurance Details Lender's Policy Premium 1.515.00 to Old Republic National Title Insurance company Lender's Endorsement Charges 150M Endorsement Endorsement Charge Endorsement RA1OU(No Apparent Violation of 50,00 Restrictions) Endorsement R83OU(Survey Exception) 50.00 Endorsement Fw000(Environmental Protection Lien) 50.00 Total $ 166500 $ 0.00 ��. ' . \ ^ WARNING: It is a crime to knowingly make false statements to the United States vnthis or any similar form. Penalties upon conviction can include afine and imprisonment, For details se* Title mu��cvu oemmn/oo1�dne�mn1mu ^ �� — �'�— Deutsche Asset & Wealth Management uarterly Account Statement Ll April 1,2013 through June 30, 2013 _u.. . Q 0 AT 02 059805 76244B292 A"3DGT Il�Irlull�Il��I„Ir�,Alli,111„r1�llrllrrtrll„Irlrl„rt,,,llr, �Investment Professional:DANIEL W 570TT HD VEST FINANCIAL SVC 157 S HANOVER ST KATHRYN E MIXELL CARLISLE PA 17013-3437 991 N MIDDLETON RD (717)243-8077 CARLISLE PA 17013-8718 Shareholder Services: (800)728-3337 7a.m.to 7p.m.(CT) Monday through Friday Automated Assistance 24 hours a day t \J International: Call collect(816)435-7177 7 a.m,to 7 p.m.(C) Monday through Friday l c Web Site: vwvw.dws-investments.com / &�o-Your Primary Account Number: 3883575 a Gain more convenience with less paper. Sign up to receive your transaction confirmations and other documents for your DWS fund account(s) electronically. Simply log into your account at dws-investments.com and click on "Go Paperless.” As an added benefit,sign up to receive all fund and account documents by electronic delivery only and your DWS fund account(s) will automatically be exempt from the$20 annual maintenance fee that applies to account balances below $10,000. Need more information or help signing up for"Go Paperless?" Contact Shareholder Services at (800) 728-3337. Period Year to Date , Your Portfolio Value 04101-06/30/2013 01/01 -06130/2013 —' Beginning Portfolio Value $23,849.98 $23,728.67 Purchases/Reinvested Distributions $224.50 $446.73 Redemptions $0.00 $0.00 — Change in Value -$1,213.07 -$1,313.99 — Transfers $0.00 r $0.00 Ending Portfolio Value on 06!30!2013 $22,861.41 $22,861.41 = Your Portfolio by Asset Type Percent of Asset Type Vakie on Chrtnge Value on Talk with your Po7rfalio Tund]Vane 0410112013 + This Period = 0613012013 financial advisor or 100.00% Tax-Free Income Funds earl shareholder 100.00% DWS Managed Municipal Bond Fund-A $23,849.98 -$988.57 $22,861.41 services to learn Total Tax-Free Income Funds $23,849.98 -$988.57 $22,861.41 about managing risk through Total Portfolio Value $23,849.98 -$988.57 $22,861.41 diversification. Page 1 of 4 M M&T Bank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-5024349 F ax (302)934-2955 August 28,2013 Law Offices Irwin & McKnight, P.C. West Pomfret Professional Building 60 West Pomfret Street RMKD Carlisle,PA 17013-3222 AUG 3 1 2013 ;MPPO"T Re: Estate of Kathryn E. Mixell Social Security 171-28-2099 Date of Death: June 28, 2013 Dear Sir or Madam: Per your inquiry on August 19,2013,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking A ccount Account Number 428914 Ownership(Names oj) Kathryn E Mixell Ronald M Mixell(POA) Opening Date 0910111967 Balance on Date of Death $3,271.81 Accrued Interest $ .02 I.. .I.I...'..........-I............... .............-.......... ...... Total $3,271.83 2. Type of Account Savings Account Account Number 15004200931019 Ownership(Names q0 Kathryn E Mixell Ronald M Mixell(POA) Opening Date 0212611990 Balance on Date of Death $6,003.84 Accrued Interest $ .02 Total $6,003.86 I 41h1i 10 11RAIN1 , I CERTIFICATE OF TITLE FOR A VEHICLE .S39 _ . .0�0•$2003,10D�i s91 D01 .. ... - 37.. _. 1..,._ j 0 _ .- _ .. .._........ . .. .•.... �..- ..7-L-6.9,9 5 3 7 Q G.. VEHCE DEfTiFlCATKNNUh1HEA YIEAW Ct MAKE OF VEHICLE TITLE NUMBER (-P • 3/�fllbd f b�5759 0. L100 I oj " BODY T_YPE y-� DUP •I SEAT CAP•� - PR10R TfTLE STATE I ODOM.PROCD.DATE -� ODOM.MILES- •I ODOM.STATUS 21>*1!`i0 f.,.::3/.•28/_00.'� V(r- DATE PA TITLED DATE OF ISSUE UNLADEN WEIGHT GVWR GCWR TITLE BRANDS ,'• _ OOOIAEfFii STATUS O:ACTUAL MILEAGE F I=MM EAGE EXCEEDS THE MECHANICAL 5� Aw LIMITS z=NOT ACTUAL MAGE 9.NOT THE ACTUAL MILEAGE-ODCMETER ---- AMPERING VER. T rI w r'" 5k'� 4•- i .,,� ,�1. ..EXEMPT FROM ODOMETER DISCLOSURE #" rLG• �,X..-,:=.j.,y{?tr,�•sL. TITLE BFL:REGSTERED OWER(S) A=AtTICIE VEHICLE - t,epgr/m�,�a?r.i,l.of�7•�irn�Pw'Lurfi�o,�tr.�4' - C=CLASSIC VEWCLEyri ` D=COLLECTIBLE VEHICLE E yIXELL G ;.:•-,• .'t-r.;�::+...,�- h. F =OUT OF COUNTRY __. WMZa--y"K�'^-'rig -L;. '' 1 ORIGIY-MFGD.-FOR-NONFUS—_ `:!• 8l1 ViJ i_t !1.71M rl� '""'y{+•_ —Eir ,."•---�._�_�..__._ DISTRIBUTION rfX' �- H=AGRICULTURAL VEHICLE '.1C -ISLE'=PA 17013 ° '� ` ` ='� ''&'� 1 .LOGGING VF}IICLE r - P.IS'WAS A POUCE VEHICLE R_RECONSTRUCTED S=STREET ROD • T=RECOVERED iHEFi VEHICLE V=VEHICLE COhTA1NS REISSUED VM W=FLCCO VFEMCLE = FIRST LIEN FAVOR OF: SECONLIENDLIENFAVOROF. X ISWAS A TAXI 4 L _ N a ssoond hertxWer is fisted upon satisfaction of the first Oen, the first y- - - - Serholoec must forvard this Title to the Bureau of Motor Vehicles with the FIRST LIEN RELEASED ' appr-C and fee. - '{1•.•' - DATE 1 x BY Seclom UEN RELEASED AUTHORIZED REPRESENTATIVE DATE MAILING ADDRESS BY • 029207 I AUTHORIZED REPRESENTATIVE KATHRYN E MIXELI' -991 N MIDDLETON RD CARLISLE ' PA 17013 • C • -6 cm*as of the dale of Issue,the official records of the Pennsylvania Department 'v 'r 4L7![AIJL XA L HAL•'l:ORY f act fttnLthe porson(c)or company ru od hwain.Is the IaxrlW�anar--.._._ 6f fire said veMcle.' Secretary of Transportation APPLICATIONTO BE COMPLETED BY PURCHASER WHEN VEHICLE IS SOLD AND THE 1 ' TITLE AND LIEN INFORMATION [ SUBSCRtef�AND SWORN If a co-purchaser other than your spouse is listed and you want the title to TO BEFORE A be listed as'Joint Tenants With Right of Survivorship'(On death of one . DAY 'CAR owner,title goes to surviving owner-)CHECK HERE O.Otherwise,the title will be issued as'Tenants in Common"(On death of one owner,interest of deceased owner goes to his/her heirs or estate). SIGNATURE OF PERSON AIAGNISTEMNG OATH ❑ 1ST LIEN DATE '♦ 1F NO LIEN.CHECK IST UEN14OLDER - STREET t GQ�' •;1i, ,•• I CITY STATE ZIP FINANCIAL INSTITUTION NUMBER 7 r: -: - - 2ND LIEN DATE .♦ IF NO LIEN.CHECK TH»Isidariptad tr.sy nekaa atplkatim tar C r~o of not a h vahke dnaltod ?�'`yf ahora ad.'{.M b the-ft-•n odw Iapd dNm a•k h len. 2NO LIENiHOLDER A:. STREET SMNATIRE OF APMACANr OR AURX)RIZED SIGNER • I. • CIT`/ •.STATE ZIP F"t "4 „2 :sKwATuRE OF cdVmx;ANTmTLE OF AungrrQED SIGNER FINANCIAL INSTITUTION NUMBER • •' • • milli ' v ,. '' ,. '• i xl 911 a 9 Oki I livi-lu 11 CERTIFICATE OF TITLE FOR A VEHICLE . C 313 fy _. O�27r3Dfl?,1Qt1Q�45-1711 . ,::. ,,: .. , . :• .. . .= . .. . .::.. , _., :. .. .. .:• . : .�-. .._.::. ..� •=_ f 2FAF1'74W2YX211121 I 200D I FORD ; I 7860V:M1 �ee Rpprc,'sl�� VEHICLE IDENTIFICATION NUMBER YEAR MAKE OF VEHICLE TITLE NUMBER SON Q8/3l.rQQlOt]080 0 -----_ i -BODY TYPE -� DUP -I SEAT '�OD LAP PRIOR TITLE STATE I ODOM.PROM DATE " OM.MILES I -ODOM.STATUS •' _.,r,�.----.-..—.�. DATE PA TITLED DATE OF ISSUE UNLADEN WEIGHT GVWR GCWR TITLE BRANDS • ODOMETER STATUS ' -.•,'.�,, 0.ACTUAL MILEAGE •. , f 1=MILEAGE EXCEEDS THE MECHANICAC;' . tai. S, _•1 -:•UMITS' .` 2=NOT THE ACTUAL MILEAGE i 3=NOT THE ACTUAL MILEAGE-ODOMETER I ri fir TAMPERING VERIFIED° 4=EXEMPT FROM ODOMETER DISCLOSURE ' REGISTERED OWNER(S) O^(! -�H• .ZY'f•' - Trr E BRANDS A:ANTIQUE VEHICLE C=CLASSIC VEHICLE KATHRYN E MIXELL u�'�t"`r^rtritCrl2 n�Fif �jKrrf i(i,s 11�'E COLLECTIBLE VEHICLE ` •,� _y A7� p.�L_•_t rc+e`�}1 _ 'f:'`�: "r�'• F v OUT OF COUNTRY �N--MI-Oft—t o rl lJ - •'1r - war• '=f. O-=•OReINAt11'-MFOD:FORNOWV..�" �? DISTRIBUTION CARLISLE` PA '1703 °'""r�a' "; H=AGR CULTURAL VEHICLE .. L =LAGGING VEHICLE P=LSIWAS A POLICE VEHICLE R=RECONSTRUCTED S.STREET ROD _— • T.RECOVERED THEFT VEHICLE V VEHICLE CONTAINS REISSUED VIN f, f w=FLOOD VEHICLE ' :FIRST LIEN FAVOR OF: � - SECOND LIEN .IS/WAS A TAXI EN FAVOR OF: •�: - If a second Ilenholder is listed upon satisfaction of the first lion, the first fienholder must forward this Title to the Bureau of Motor Vehicles with the -! 'FIRST LIEN RELEASED - ^ ' appropriate toren and fee. DATE BY SECOND LIEN RELEASED AUTHORIZED REPRESENTATIVE ;� DATE MAILING ADDRESS -- • - BY AUTHORIZED REPRESENTATIVE KATHRYN E MI XELL 991 'N.MIOOLETON Rd CARLISLE 'PA- 17013 • 1 ceroYy as of the date a1 Issue, the official records a1 the Pennsylvania Department BRAOL 15Y L MALLORY of TransPortati«+rMlar�rnnl�rx'RnnlSl a!,Eo�n�'namo!fllereln.IslhC!•]YrtuLownnc_.-`„_. .._�.__--_�..-4V `d --•f^' .--.Nr .. ._ of the sold vehicle. Secrctary of Transpo-don„ APPLICATIONTO BE COMPLETED BY PURCHASER WHEN VEHICLE IS SOLD AND THE 1' TITLE AND LIEN INFORMATION SUBSCRIBED AIf a co-purchaser other than your spouse Is listed and you want the title to AND SWORN - T'O BEFORE be listed as"Joint Tenants With Right of Survivorship"(On death o1 one N DAY - YEAR owner,title goes to surviving owner.)CHECK HERE 0.Otherwise,the title will be issued as*Tenants in Compton"(On death of one owner,Interest of deceased owner goes to hislber heirs or estate). Sr NATURE OF PERSON AWANSTEmHG OATH IST LIEN DATE: - - ♦ IF NO LIEN,CHECK ' IST UENHOLDER STREET _ +.3' . 41;17 .^ .Drive.: C' •.\s7+1 f;.t - - DRY _ , STATE 21P `t f FINANCIAL 1NSTtTUTTON NUMBER • •' 2ND LIEN DATE ♦ IF NO LIEN,CHECK f TI» ,ndersgrd hereby e•kw IOPi<•tkn fp CwLvw*d Tde w a•.dick de=bed _ .bens,.400 b ea encr rtrrrs Sid.*r *0�W m,m here. - t•,t L{ • Y . ,1; k � - _ � •- - 2ND UENHOLDEA . 1+ '• STREET Ash •t ..rr ; ,�� • SWNAIT/REOFAPPUCANTORAUTHOR.r'EDSIGNER CRY STATE ' ZIP y di. FINANCIAL INSTITUTION NUMBER ...._ ..^:.. SIGNATURE OF COAPPNCAUrATTI OF AUTTIDRrZED SIGNER .. K . -• 01 •: • • /�. ti cl J111-- Ar 11 - . 666 __. 4 � r � i ___ w j ATT 4Z,Z�� - 04 _ n ` za a eO f , � ✓�� .-`` / �� ( �! _____ F � ___.� ____ _ _ �!� ��- %��' ��i��G�..�z� c��r�a��:��a`��?est-��_�__ ' _.��r�� ' � _ z�-- �� ► ��-� ��% `�� f -: -� -, i i�,sf7/� a/%"`% �it�T.A--I� � n��Ji/�l " �/��.�Jil:��/faLO �i2ii�� GJ R XPi -------7l�-1ca, 427 ol ,a---"-"---,..—_+� - ..— ..ems — _-,....�� =%u?��!rf^/��C� ✓ � �— r /CEMAllianz PO Box 561 Allianz High Five Minneapolis,MN 55440-0561 A deferred variable annuity Quarterly Statement 03/28/2013 -06/28/2013 Contract Number: DAD38929 Owner: KATHRYN E MIXELL Annuitant: KATHRYN E MIXELL Plan Type: NON-QUALIFIED Issued: 01/09/2007 00 Representative: DANIEL W STOTT #BWBBFZW Rep ID: A75514 KATHRYN E MIXELL Broker/Dealer: H D VEST INVESTMENT SERV 991 N MIDDLETON RD CARLISLE PA 17013-8718 Enroll in eDelivery by visiting ourwebsite at www.allianzlife.com. 'I111111'IIII'II�IIIIIIIIIIIIIIIIII"IIIIII'llll'lIIIIIIII"'I"I Questions about your Contract? Please refer to the Features of your Contract section of this statement or visit our website. Important Notice As detailed in your Prospectus,as of September 17th,2012,we exercised the provision to no longer accept additional purchase payments into your contract,referenced above. Please keep this in mind when considering tax deadlines. Contact your registered representative or tax advisor with any questions or to make alternative arrangements for future contributions Contract Values Features Of Your Contract Prior Contract Value as of 03/28/2013: $36,616.81 Living Guarantee Package: Your contract includes the Living Guarantees package of benefits which includes the Guaranteed Contract Value as of 06/28/2013: $36,851.46 Account Value Benefit,the Guaranteed Minimum Income Benefit Guaranteed Account Value(GAV) and the Guaranteed Withdrawal Benefit. 01/09/2014: - $33,456.02 The Guaranteed Account Value(GAV)provides a guaranteed return of principal or the highest contract anniversary value,each Guaranteed Account Value(GAV) after a five year waiting period and adjusted for any withdrawals. 01/09/2015: $33,456.02 In addition,you may lock in any contract gains by resetting the GAV benefit once every 90 days. A reset delays the availability of Guaranteed Account Value(GAV) the GAV benefit to five years from the next contract anniversary. 01/09/2016: $33,456.02 This GAV reset provision is not available in the states of Alabama, Guaranteed Account Value(GAV) Utah,Pennsylvania and Washington. 01/09/2017: $33,456.02 Guaranteed Account Value(GAV) 01/09/2018: $35,601.63 Traditional Guaranteed Minimum Death Benefit Value as of 06/28/2013: $33,456.02 Purchase Payments to Date: $33,456.02 Withdrawals to Date: $0.00 Phone:800.624.0197 PAGE 1 of Allianz it Website:www.allianzlife.com 2899 15435 7718 895850001 01779060 102284 1 5 OANYPWO XAFN N 000 Scudder Wealthmark ML3 Annuity • Quarterly Statement Issued by John Hancock Life Insurance Company(U.S.A.) For the period of April 01 -June 28, 2013 ' Your Financial Representative: Daniel W Stott Prepared For: H.D.Vest Investment Services 003382 SH UPL2Poo1 KATHRYN E MIXELL 157 S. Hanover St.991 N MIDDLETON RD Carlisle PA 17013 CARLISLE PA 17013 For Questions about your Contract: 1-800-493-8075 www.jhannuities.com Your Account Activity Summary Your Account Information Year to Date Since Inception Account Number: 55100967 Owner: Kathryn E Mixell Value as of December 31,2012 $62,744.98 Annuitant: Kathryn E Mixell Total Premiums $0.00 $36,314.84 Plan Type: Non-Qualified Total Withdrawals $0.00 $0.00 Inception Date: 03/17/2003 Change in Value $4,199.15 Value as of June 28,2013 $66,944.13 Optional Riders Selected p Surrender Value as of June 28,2013"• $66,859.62 •Guaranteed Retirement Income Benefit{GRIB II} Death Benefit Value as of June 28,2013: $66,944.13 *Amount payable upon total withdrawal calculated as Closing Balance, less surrender charges and outstanding loan balance if applicable. �. Your Investment Allocation Your account is currently allocated among the investments and investment styles specified in the legdnd on the right. For o more specific information,visit www.jhannuities.com today. W y N xo 0 35%Aggressive Growth e, 20%JHAM Small Cap Index 15%JHAM Fundamental All Cap Core $ "' 25%Growth 15%JHAM Total Stock Market Index 10%JHAM Mid Cap Index ® 25%Conservative 8 25%JHAM Money Market W 15%Income ' 15%Declaration/JHAM Active Bond 100%Total Value John Hancock Annuities Service Center P.O.Box 55444,Boston,MA 02205-5444 Produced on: 06/28/2013 Account#55100967 Page 1 of 3 i . � ��0 __�� _. .-INVESTMENT SERVICES AccoUrf sta�eme�it . _ *0.0.00889.0_ —01_AV._.-0..360.0.1-._TR._00039..X104PD0:1_000,000-Y...... _ __5ta-temenfP_eriod:_I O/OF17 0.12.-06J30%2013. 'Valtlal011.:c`it-l-�i1111C8 _Tlhis-Period- - Yeorto-0ate4 _ -_---.__._._-__ .___ .___._�--- -._ _ _ _ _ ___-._._. B46fiiit' unfWitie _._ _� _S:o:oo_ __ :..� SO:oo ._.C_E.�Y ---Change in AccountValue THRY. - ICt11N11XELL__- ; It , -lll- -ii-i�--- -- -�----W_~�--N�ote:Inrtcludes.an_n._u..ft_i_e_s_•n_o_t_c_us�to.died a_t-�Per.s�hin..g_-_LL..C�.-. _.-_-..•--._._- nil _._._--..._sdiffieourF .-_.._..-.._—a_--___-_..-...._-_._--_-_=-..._.-._--__••__-_-_;�-_�•_. --EDWARDW TAYLOR _---_ �_- .____...(7.1.7)258-677.7___._ ..__- "Asset=Allocation Annuifies6 - -- --- - 0:00 --_'-^- 57;844:99 �""'100a/o"�"Your-Account-is-100%-Wested-in•Arinufties. - ._._... _ .�.�.�._._$0.00_--_.-_-__$57.844.91 _100%_ aS-6 Wj-e 2,of t}i s statement of_impoitant nfonnation.regarding fie.Asset Allocation .._Page-]-of4 Rated E PAR-02-6-ROLL xcellent Clearing through Pershing LLC,a subsidiary A0096646CSF104DP Cao paperless - Six Years In A Row of The Bank of New York Mellon Corporatlon DAL BAR RATED COMMUNICATIONS • _ ASK ABOUT E-DEIIVERV� +�. .n ..._.....,.. � RorcFi7nollf mom6nr FINRA'NVCF VRf Statement tDestination Account Prepared for: K111015809 AB 01 01142176532 B 56 A - Period 'nll'llnl'lfl'11'Iill'��,�ilu��l�l"�'�nl�llil�llrl�nl'1�� iCATHRYN MIXELL 04/01/2013 through 06/30/2013 991 N. MIDDLETON ROAD CARLISLE,PA 17013-8718 Financial Representative: DANIEL W STOTT H D VEST INSURANCE AGENCY 157 S.HANOVER ST CARLISLE,PA 17013 Owner: Kathryn Mixell Representative Phone Number:(717)243-8077 Annuitant: Kathryn Mixell Ifyou have any questions regarding this statement, Issue Date: 08/01/2000 or need additional service.please call yourfinancial Plan Type: ]RA representative or our Customer Service number at 1400-449-0523. Activity CONTRACT SUN 01ARY Quarter Ending Year-To-Date 06/30/2013 06/30/2013 Inception-to-Date Deposits $224,233.81 Beginning Contract Value $200,847.35 Beginning Contract Value $207,692.32 Withdrawals $6,255.58 Change in Value 4 $8,484.63 Withdrawals $3,129.31 Ending Contract Value $203,076.40 Change in Value* $1,486.61- Ending Contract Value $203,076.40 = Surrender Value $203,076.40 Annuitant Death Benefit Value $322,454.70 s Includes any investment results and/or any interest earnings net of any contract fees or charges. Your Current Allocation This chart is representative of your current allocation as of 06/30/2013. ® Fixed Income 35% ❑ Balanced/Asset Allocation 30% Large Cap Value Equities 20% Small Cap Equities 5% Multi-Cap Equities 5% Large Cap Growth Equities 5% Zurich American Life Insurance Company Administrative Office: PO Box 19097 Greenville,SC 29602-9097 0114211/2 Page 1 of 4 1 THE HARTFORD #BWNGSGR CONTRACT NUMBER 711566611 #\n9ESSCBBBSS2# PURCHASE DATE February 17,2004 AB 01 002296 77254 H 14 A CONTRACT TYPE MA KATHRYN MIXELL OWNER KATHRYN MMLL 991 N MIDDLETON RD ANNUITANT KATHRYN MDMLL CARLISLE PA 17013-8718 O O DIRECTOR SELECT OUTLOOK VARIABLE ANNUITY QUARTERLY STATEMENT APRIL 1, 2013-.LUNE 30, 2013 SUMMARY QUARTER YEAR-TO-DATE SINCE PURCHASE 411/13-6130/13 1/1113-6130/13 2/17104-6130/13 Beginning 55,512.81 54,442.23 7 Premium Payment 0.00 0.00 .56,000.007 Total Surrenders -1,500.00 -3,000.00 -18,530.00 Annuity Performance 137.20 2,707.78 22,680.01 Ending Value $54,150.01 $54,150.01 ----$54,150.01 Total Surrenders include Contingent Deferred Sales Charges and Annual Maintenance Fees,if applicable. FOR ASSISTANCE, CONTACT: Your Investment Professional Jay T Bavlish Wells Fargo Advisors Llc 6416 Carlisle Pike Ste 2 100 Mechanicsburg PA 17050 ENV# CEBBDWFXBBBGJGB_,I2IBBBB WRP INNESTMENTS,INC. 4407BELMONITAVE. YOUNGSTOWN,OHIO 44505 WAS INVESTMENTS ? O7W9468 KATHRYN E MIXELL TOD ON FILE 991 N MIDDLETON RD CARLISLE PA 17013 STATEMENT FOR THE PERIOD APRIL 1,2013 TO JUNE 30,2013 KATHRYN E MIXELL- Individual TOD Account Number:BX6-233331 YOUR ACCOUNT EXECUTIVE is For questions about your accounts: TOTAL VALUE OF YOUR PORTFOLIO 420,73g.88 PATRICK WILLIAMS Local: 330 759 202.4 RR#:Z20 National: 800 589 2023 FOR YOUR INFORMATION CHANGE IN VALUE OF YOUR PORTFOLIO MEMBER FINRA,SIPC $thousands 32.000 24.000 16.000 8.000 0.000 09/10 12/40 03/11 06M 09111 12111 03/12 06/12 09/12 12112 03113 06113 Change 1a Va lue Of YourPordofio it formarian can be found in Mircefianeew Fearnoter at rix end ofthij starement. WRP INVESTMENTS,INC. Account carried with National Financial Services LLC-Member NYSE,SIPC MN -CEBBD\VFXBBBGJGB-BBBBB 20130628 Page I of 6