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11-12-14 (2)
J REV-1500 EX (02-11)(FI) 1505610140 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 3 7 8 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 2 3 0 2 0 1 3 1 2 0 5 1 9 1 7 Decedent's Last Name Suffix Decedent's First Name MI W Y R I C K S R H A R R Y L (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 1.Original Return 2.Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) 0 4. Limited Estate ❑ 4a.Future Interest Compromise(date of 5. Federal Estate Tax Return Required death after 12-12-82) ❑X 6. Decedent Died Testate r 7.Decedent Maintained a Living Trust 1 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) 9. Litigation Proceeds Received 10. Spousal Poverty Credit(Date of Death El 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number W I L L I A M A - D U N C A N 7 1 7 2 4 9 7 7 8 0 REGISTER OF WILLS USE ONLY r^v c� � M First Line of Address C p _ M 1 I R V I N E R 0 Wc= ca rn s c'') --i , Second Line of Address � N h' rpt M Tr vj t7 Q City or Post Office State ZIP Code CDATE FIL -' Rt C A R L I S L E P A 1 7 0 1 3 = C M ` r en Correspondent's e-mail address: bill@duncanhartmanlaw com 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 any knowledge. SIG'RATURE OF PERSON ESPON IBLE FO,R FILING RETURN DATE ADD (E 871 MT - ROCK ROAD, CARLISLE, PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 \ 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: H A R R Y L • W Y R I C K i SR RECAPITULATION 1. Real Estate(Schedule A) . . . . .... . . . . . . . . . . . . . . . . ... . . . . . . . . . ... . . . . . . . 1. 7 8 0 0 0 , 0 0 2. Stocks and Bonds(Schedule B) . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 2• 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 4. Mortgages and Notes Receivable(Schedule D) 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property 4 9 . 8 3 1 . 8 6 p p rty(Schedule E). . . . . . . 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested . . . . . . . 7. 0 . 0 0 8. Total Gross Assets(total Lines 1 through 7) . . .. . . . . . . . .. . . . . . . . . . . . . . . 8. . 1 2 7 8 3 1 , 8 6 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . .. . . . . . . . . . 9• 1 3 3 4 1 . 6 8 10. Debts of Decedent,Mortgage Liabilities,"and Liens(Schedule 1) .. . . . . . .. . ... . 10. 8 2 4 1 . 4 8 11. Total Deductions(total Lines 9 and"10) . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 11. 2 1 5 8 3 . 1 6 12. Net Value of Estate(Line 8 minus Line 11) . . . . :. . . . . . . . . . . . ... . ... ... . . . . 12• 1 0 6 2 4 8 . 7 0 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. 1 0 6 2 4 8 . 7 0 TAX CALCULATION-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.0 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.045 1 0 6 2 4 8 . 7 0 16. 4 7 8 1 1 9 17. Amount of Line 14 taxable at sibling rate X.12 ' 0 . 0 0 17. 0.. 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 • 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . 19. 4 7 8 1 • 1 9 20. FILL IN THE OVAL IE YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 REV-1502 EX+(12-12) pennsylvania, SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HARRY L. WYRICK, SR 21 _14 0378 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. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 59 WEST MAIN STREET 48,000.00 WALNUT BOTTOM, PA 17266 [SEE HUD SHEET ATTACHED] 2. 7 1/2 ACRES MOUNTAIN LAND 30,000.00 NORTH DICKINSON TOWNSHIP, CUMBERLAND COUNTY, PA [SEE HUD SHEET ATTACHED] i TOTAL(Also enter on Line 1,Recapitulation.) $ 78 000.00 If more space is needed,use additional sheets of paper of the same size. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: HARRY L. WYRICK SR 21 14 0378 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PROCEEDS CITIZENS BANK TRUST ACCOUNT#6100795128 15,212.54 [SEE DOD LETTER ATTACHED] 2. YARD SALE PROCEEDS 1,505.31 3. YARD SALE PROCEEDS 2,203.36 4. PRORATED CITY/TOWN TAXES 6/10/14-12/31/14- HOUSE 173.61 [SEE HUD SHEET ATTACHED] 5. PRORATED SCHOOL TAX 6/10/14 -6/30/14 - HOUSE 65.39 [SEE HUD SHEET ATTACHED] 6. PRORATED CITY/TOWN TAXES - LAND 44.87 [SEE HUD SHEET ATTACHED] 7. PRORATED SCHOOL TAX- LAND 700.84 [SEE HUD SHEET ATTACHED] 8. BANKERS LIFE AND CASUALTY COMPANY POLICY-ANNUITY 26,836.17 CONTRACT#7863366 & POLICY#8322373 9. BANKERS LIFE AND CASUALTY COMPANY POLICY-ANNUITY. 3,089.77 CONTRACT#8544261 TOTAL(Also enter on Line 5,Recapitulation) $ 49,831.86 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER HARRY L. WYRICK SR 21 14 0378 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) JANET L. KUTZ 6,391.59 Street Address 871 MT. ROCK ROAD City CARLISLE State PA zip 17015 Year(s)Commission Paid: 2. AttomeyFees: DUNCAN & HARTMAN, PC 6,391.59 3, Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 258.50 5 Accountant Fees: 6. Tax Return Prepares Fees: 7. HELD IN RESERVE 300.00 8. TOTAL(Also enter on Line 9,Recapitulation) $ 13 341.68 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania_ SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER HARRY L. WYRICK SR 21 14 0378 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. HARRY L. WYRICK, JR. -97 HRS. X $12/HR. TRASH REMOVAL/DUMPING/CLEANING 1,164.00 2. SANDRA MORRISON - PERSONAL PROPERTY PREPARED FOR SALE 650.00 65 HRS. X#10/HR 3. TRASH HAULING/DUMPING 112.00 4. CAREY TRUCKING BROUGHT DUMPSTER 475.00 5. CAREY TRUCKING EMPTIED DUMPSTER 180.00 6. CAREY TRUCKING EMPTIED DUMPSTER 297.00 7. CAREY TRUCKING EMPTIED DUMPSTER 180.00 8. CAREY TRUCKING EMPTIED DUMPSTER 136.76 9. CAREY TRUCKING TOOK AWAY DUMPSTER 336.00 10. HAULING &TRASH EMPTY COST 540.00 11. TIMMONS OIL 574.50 12. TIMMONS OIL 861.75 13. HOOVERS FUR:NANCE REPAIR 267.12 14. HOOVERS FURNACE REPAIR 155.46 15. HOOVERS FURNACE REPAIR 90.60 TOTAL(Also enter on Line 10,Recapitulation) $ 8,241.48 If more space is needed, insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent HARRY L.WYRICK, SR 21 14 0378 Decedent's Name Page 1 File Number Schedule 1 - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. PPL 14.34 17. PPL 23.96 18. PPL 24.46 19. PPL 21.63 20. TAXES HOUSE- SOUTH NEWTON TWSHP. 310.62 21. TAXES - MOUNTAIN LAND - DICKINSON TWSHP. 176.12 22. THE SENTINEL 12.21 23. DEATH CERTIFICATES 90.00 24. COUNTRY STORE- CLEANING SUPPLIES 28.00 25. KELSO- LABOR 100.00 26. LOST SAFE DEPOSIT KEY-CITIZENS BANK 25.00 27. SETTLEMENT CHARGES -HOUSE 500.00 [SEE HUD SHEET ATTACHED] 28. SETTLEMENT CHARGES - LAND 865.00 [SEE HUD SHEET ATTACHED] 29. DELUXE CHECKS 29.95 SUBTOTAL SCHEDULE 1 2,221.29 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HARRY L. WYRICK SR 21 14 0378 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. JANET L. KUTZ Lineal 871 MT. RICK ROAD 1/13 SHARE CARLISLE, PA 17015 2. SANDRA C. MORRISON Lineal 158 STONEHOUSE ROAD 1/13 SHARE CARLISLE, PA 17015 3. HARRY L. WYRICK, JR. Lineal 290 FARM ROAD 1/13 SHARE NEWVILLE, PA 17241 4. JERRY E. WYRICK Lineal 454 WEST MAIN STREET 1/13 SHARE WALNUT BOTTOM, PA 17266 5. MARY L. GRIMES 120 BIG SPRING TERRACE 1/13 SHARE NEWVILLE, PA 17241 6. NANCY M. HOCKENBERRY 40 SUMMER BREEZE LANE 1/13 SHARE CHAMBERSBURG, PA 17201 SEE LIST OF HEIRS#7 -# 13 1/13 SHARE EACH ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. Page 2 - Estate of Harry L. Wyrick, Sr. Ronald E. Jumper 10 Wilt Shower Way Carlisle, PA 17015 Ph: 717-218-1068 SS#: DOB: 01-29-1950 Delores J. Wyrick 454 West Main Street Walnut Bottom, PA 17266 Ph: 717-530-5301 SS#: DOB: 10-04-1951 Clarence W. Jumper P.O. Box 88 Walnut Bottom, PA 17266 Ph: 717-860-8813 SS#: DOB: 09-14-1953 Robert L. Jumper 117 Meals Drive Carlisle, PA 17015 Ph: 717-385-9621 SS#: DOB: 07-03-1954 Page 3 - Estate of Harry L. Wyrick Sr. Barbara A. Ward (Kymer) 8 Thompson Creek Drive Shippensburg, PA 17257 Ph: 717-532-8895 SS#: DOB: 05-08-1956 Patsy D. Jumper 454 West Main Street Walnut Bottom, PA 17266 Ph: 717-530-5301 SS#: DOB: 07-22-1959 Donald R. Jumper 4 Kuntz Drive Gardners, PA 17324 Ph: 717-448-1438 SS#: DOB: 11-12-1960 rn a C> � M � LAST WILL AND TESTAMXNT rn = n cn (Pour-Over Rdil!) a ��, f-► rn M'r' Cn --I '`� OF u> c' CD HARRY L.WYRICK,SR. © c- ., o - -1 n C-3 c n r� r- M IDENTITY > � coo s o I, HARRY L. VVYRICK, SR., residing in the County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my fast Will and Testament, and I do hereby revoke all other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 197-03- 5217. I have the following children: Janet L.Kautz, born February 18, 1940,Sandra C.Morrison,born _ February 9, 1946,Hanay L Wyrick,born August 27, 1948,and.Terry E Wyrick,born May 1, 1952. DEBTS,TAXES AND AD1IIINISTRATION EXPENSES I have provided for the payment of all my debts,expenses of administration of property wherever situated passing under this Will or otherwise,and estate, inheritance,transfer, and succession taxes, other than any tax on a generation-shipping transfer that is not a liability of my Estate (including interest and penalties, if any)that become du-by reason ofwy death,under THE HARRY L. WXRICK,SP,AND AULDREID E. Wl'RICK REVOCABLE LIVING TRUST executed on October 9, 2003 (the "Revocable Trust"). If the Revocable Trust assets should be insufficient for these purposes,my Executor shall pay any unpaid items from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the alternative,my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary to pay all or part of these items, plus claims, pecuniary legacies,and family allowances by court order. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to the Revocable,Trust as a result of the Declaration of Intent signed on October 9, 2003 this date. If there are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me on October 9, 2003 this date in accordance with the provisions of the section titled"Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on October 9, 2003. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before.my death. POUR-OVER WILLS Page 1 (Testator) If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust,as Trustee, and to their substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint JANET L. KUTZ to serve without bond as my Executor of this my Last Will and Testament. In the event the first named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint JERRY E. WYRICK to serve without bond as my Independent Executor. Whenever the word `Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of Illustration and not of limitation and in addition to any inherent, implied or statutory Powers granted to executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect,compromise claims,contract with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to,take possession of, pledge, receive, release, repair, sell, sue for,make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purpose of this my Will,without being limited in any way by the specific grants or power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my POUR-OVER WILLS Page 2 (Testator) Executor shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions. CONTESTS AND SPECIFIC OMISSIONS If any beneficiary under this will, singly or in conjunction with any other person or persons, directly or indirectly: 1. contests in any court the validity of this will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 2. contests in any court the validity of the Testator's Will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 3. seeks to obtain an adjudication in any proceeding in any court that this trust or any of its provisions or that Testator's Will or any of its provisions is void; 4. claims entitlement' by way of any written or oral contract to any portion of the Testator's estate, whether in probate or under this instrument; 5. unsuccessfully challenges the appointment of any person named as Executor or successor Executor of the Testator's WiII; 6. objects in any manner to any action taken or proposed to be taken in good faith by the Executor of the Testator's Will; 7. objects to, any construction or interpretation of this Will, or any provision of it,that is adopted or is proposed in good faith by the Executor; 8. unsuccessfully seeks the removal of any person acting as the Executor of the Testator's Will; 9. files any creditor's claim in Testator's estate (without regard to its validity), whether the claim arose before or after the date of this instrument, but excepting claims for cash advanced or paid for expenses of the Testator's last illness or funeral paid by said claimant; 10. attacks or seeks to invalidate any designation of beneficiaries for any life insurance policy on Testator's life; 11. attacks or seeks to invalidate any designation of beneficiaries for any pension or IRA or other form of qualified or non-qualified asset or deferred compensation account, agreement or arrangement; 12. attacks or seeks to invalidate any will which Testator has created or may create during Testator's lifetime, or any provision thereof, as well as any gift which Testator/Testatrix has made or will made during Testator's lifetime,whether before or after the date of this instrument; 13. attacks or seeks to invalidate any transaction by which Testator sold any assets (whether to a relative of Testator's or otherwise); or 14. refuses a request of Testator's, Executor or other fiduciary to assist in the defense against any of the foregoing acts or proceedings, then that person's right to take any interest given to him or her by this trust shall be determined as it would have been determined if the person had predeceased the execution of this will instrument without issue surviving. The provisions in of the foregoing paragraph shall not apply to any disclaimer by any person of any benefit under this will. In the event that any form of this provision is held to be invalid, void or illegal, the same shall be deemed severable from the remainder of this provision and shall in no way affect, impair or invalidate any other provision in this will; and if such provision shall be deemed invalid due to POUR-OVER WILLS Page 3 tator) its scope or breadth, such provision shall be deemed to exist to the extent of the scope or breadth permitted by law. SIMULTANEOUS DEATH If any Beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. ED-RRY L. CK,SR. Testator This instrument consists of 6 typewritten pages, including the Attestation Clause, Self-Proving Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the ttom of each ie preceding pages. This instrument is being signed by me on this Aay of POUR-OVER WILLS Page 4 (Testator) ATTESTATION CLAUSE The Testator whose name appears above declared to us, the undersigned, that the foregoing instrument was his Last Will and Testament, and he requested us to act as witnesses to such instrument and to his signature thereon. The Testator thereupon signed such instrument in our presence. At the Testator's request,the undersigned then subscribed our names to the instrument in our own handwriting in the presence of the Testator. The undersigned hereby declare, in the presence of each of us, that we believe the Testator to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was signed by the Testator. VVITNESSES: ADDRESSES: (Printed Name of WitneA) ai r (Printed Name of Witness) POUR OVER WILLS Page 5 7 (T—estator) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SELF-PROVING CLAUSE B ORE ME,the tpdersigned authority,ontj�s day person pppeared HARRY L.WYRIM Sp.(Z mily and-.-��e known to me to be the Testator and thWtnesses, respectively, whose names are subscribed to the foregoing instrument 'in their respective capacities, and all of them being by me duly sworn, HARRY L. WYRICK, SR., Testator, declared to me and to the witnesses, in my presence,that the instrument is his Will and that he had willingly made and executed it as his free act and deed for the purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and hearing of the Testator, that the Testator had declared to them that the instrument is his Will and that he executed the same as such and wanted each of them to sign it as a witness; and upon their oaths, each witness stated further that he did the same as a witness in the presence of the Testator, and at his request and that he was at that time eighteen(i 8)years of age or over and was of sound mind, and that each of the witnesses was then at least fourteen(14)years of age. )�SIVAXOWV 11ARR-k L. sic- Testator Witness ApAlorle.-C-. U)V.- (Printed Name ofAss) C, ���,,�.,} Witness S-4-,yQor,4 C-1 (Printed Name of Witness-) SUBSCRIBED AND-ACKNOWLEDGED before me�� L. WYRIC SR., Testator, and subscribed an �ZI-04,'d sworn to before me b WJ�y X-142 and subscribed and itnesses,this the )Aday of COMMONWEALTH OF PENNSYLVAN Notarial Seal �4641ic,Corhm;o;wealth of Pennsylvania Kaye M Rulor.Notary Public Dbdrwn Twp..Cumba-land county My Commission E)Pres Apr-23.2010 Member,Permsytvanla Association of Notaries POUR-OVER WILLS Page 6 REV-485 EX(05-04) 48500041046 SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number � ����h Decedent's Last Name Suffix First Name it'll ©ADDRESS OF DECEDENT STREET CITY: j S�� ZIP`COD ` .5_q cc t n s� k NL, l�U1elAv�/7 [ �rj Z& NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME: J it . is STREET ADDRESS: i r n fOV 1 r CITY:�t ST . ZIP CODE 0 NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING a. NAME: J411 e �J f RELATIONS IP STREET ADDRESS: CITY: STATE: ZIP CODE: b. NAME: RELATIONSHIP: STREETADDRESS: CITY: STATE: ZJP CODE: c. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: GI:I r/� (� 4,3 STREETADDRESS: STAP ZIP CODE: NAME OF PERSON KING j_.AST.E (1 DATE AND TIME&LAST ENTRY U C� Ft DATE OF CO 6 �T RENT BOX N /00 I BOX 1 TITLE UNDER WHICH BOX IS REQUESyD NAME AND ADD SS OF PERSONS)HAVING ACCESS TO BOX LW J a. NAMEf{_ b. NAME STREET ADDRE • STREET ADDRESS: 414/).1 �S-�- _�'�( 141 �1CK Sf, CITY. (1 STATE: ZJP CODE CITY: J STA ZIP CODE: NAME AND TITLE OF Elly OlE TAKJNG TF3�NTORY :j��� WAS A WILL IN THE BOOL/X?cC.❑ YESj P'N/O If yes, a.Date of will: b. Name and address of personal representative,if named in the will NAME: STREETADDRESS: CITY. STATE: ZIP CODE: c. Name and address of attorney,if any NAME: STREETADDRESS: CITY. STATE: ZIP CODE: 48500041046 48500041046 j REV-485 EX SAFE DEPOSIT BOX INVENTORY Page—of— INS RUCTIONS ageofINSTRUCTIONS (1) Cash: Report total only. (2) Stocks:List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government. Number of items,date of issue,face value,names in which registered and type of ownership, i.e.,jointly held,payable on death,etc. (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (5) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing in book,name of bank and branch,and balance. (6) Jewelry,Coins,Stamps,Manuscripts,etc:List and describe as fully as possible. (7) Deeds,Mortgages,Current insurance Policies or other evidences of indebtedness: List and describe as fully as possible_ (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.280601 HARRISBURG,PA 17128-0601 ITEM NO. ITEM.DESCRIPTION - ko� WAJ 0Q(tk -t-S- ;J S1Cox &avov Y�>eA' a 4 40 MAA� osivy 2- It[IT7 tZ Z- Jk- I CERTIFY UN PENA O PERJ THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT OMP XjtST OF MY KNOWLEDGE AND BELIEF SAFE DEPOSIT BOX INVENTORY: SIGNATUR SIGNA PRI /���� PRINT N 0.CH_-CK APPROPRIATE: BELOW. Z_ PRINT TrrLE DATE CHECK �APPROPRIATE BOX: LL +��(J / �ltxecutor(trix) ❑Administrator(ft) +CJ e.—L/[ F]Estate Representative El Joint owner of safe deposit box NOTE:Attach additional 8112"x 11"sheet(s)if necessary or use duplicates of this page of form. The Department is authorized by law,42 U.S.C.§405(c)(2)(C)n,to require disclosure of Social Security numbers in connection with administering state tax laws.The Department uses the Social Security number to identify the decedent and personal representatives of the estate.The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities.The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. yl� A. Settlement Statement (HUD-1) OMB Approval No,2502-0265 B.Type of Loan 1.0 FHA 2.0 RHS 3.0 Conv.Unins 6.File Number: 7.Loan Number. $.Mortgage Insurance Case Number: 4.0 VA 5.0 Conv.Ins I RE14-61 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&Address of Borrower: E.Name&Address of Setter: F.Name&Address of Lender: Clarence W. Jumper Estate of Harry L Wyrick, Sr. Cash Wanda L. Jumper Wyrick Revocable Living Trust P.O. Box 88 59 West Main Street Walnut Bottom, PA 17266 Walnut Bottom, PA 17266 G.Property Location: H.Settlement Agent: TIN: 59 West Main Street Duncan a Hartman, P.C. South Newton Twp 1 Irvine Row Phone: (717) 249-7780 Walnut Bottom, PA 17266 Carlisle, PA 17013 Parcel: 41-31-2232-033 Place of Settlement: I.Settlement Date: 6/10/2014 1 Irvine Row County: Cumberland Carlisle, PA 17013 Funding Date: 6/10/2014 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 48,000.00 401.Contract sales price 48,000.00 102.Personal property 402.Personal property 103.Settlement charges to borrower(line 1400) 1,022.00 403. 104. 404. 105. 1405. Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106.City/town taxes:6/10/2014-12/31/2014 173.61 406.City/town taxes:6/10/2014-12/31/2014 173.61 t0 to 107.County taxes: 407.County taxes: to to 108.Assessments: 408.Assessments: to to 109. 409. 110.School Tax 6/10/2014-6/30/2014 65.39 410.School Tax 6/10/2014-6/30/2014 65.39 111. 411. 112. 412. 120.Gross Amount Due From Borrower 49,261.00 420.Gross Amount Due To Seller 48,239.00 200.Amounts Paid By Or In Behalf Of Borrower 500.Reductions In Amount Due To Seller 201.Deposit or earnest money 1,000.00 501.Excess deposit(see instructions) 202.Principal amount of new loan(s) 502.Settlement charges to seller(line 1400) 500.00 203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to 204. 504.Payoff of first mortgage loan 1205. 505.Payoff of second mortgage loan 206. 506, 207. 507. 208. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210.City/town taxes: 510.City/town taxes: to to 211.County taxes: 511.County taxes: to to 212.Assessments: 512.Assessments: to to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220.Total Paid By/For Borrower 1,000.00 520.Total Reduction Amount Due Seller 500.00 300.Cash At Settlement From[To Borrower 600.Cash At Settlement To/From Seller 301.Gross Amount due from borrower(line 120) 49,261.00 601.Gross amount due to seller(line 420) 48,239.00 302.Less amounts paid by/for borrower(line 220) 1,000.00 602.Less reductions in amount due seller(line 520) 500.00 303,Cash 0 From 0 To Borrower 48,261.00 603.Cash ©To 0 From Seller 47,739.00 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. J 2009-2011 Easy Soft.Previous editions are obsolete. Page 1 of 3 HUD-1 L.SettlementCharges File Number:RE14-61 Loan Number: TQQ.Total Real Estate Broker Fees Paid From Paid From Division of Commission line 7001 as follows: Borrower's Seller's 701'$ to Funds at Funds at r704. E to Settlement Settlement aid at settlement Payable In ConnectionWith Loan 801.Our origination charge $ (from GFE#1) 802.Your credit or charge(points)for the specific interest rate chosen $ (from GFE#2) 803.Your adjusted origination charges (from GFE A) 804.Appraisal fee to from GFE#3) 805.Credit report to (from GFE#3) 806.Tax service to (from GFE#3) 807.Flood certification from GFE#3 808. 809, 810. 811. 900,Items Required By Lender To Be Paid in Advance 901.Daily interest charges from 6/10/2014 to 7/1/2014 @ $ /day (from GFE#10) 902.Mortgage insurance premium for 0 months to (from GFE#3) 903.Homeowner's insurance for D years to from GFE#11) 904. 905. 1000.Reserves Deposited With Lender 1001.Initial deposit for your escrow account from GFE#9 1002.Homeowner's insurance months @ per mo $ 1003.Mortgage insurance months @ per mo $ 1004.Property taxes months @ per mo $ 1005.School taxes months @ per mo $ 1006. months @ per mo $ 1007.Aggregate Adjustment $0.00 1100.Title Charges 1101.Title services and lender's title insurance (from GFE#4) 1102.Settlement or closing fee 1103.Owner's title insurance (from GFE#5) 1104.Lender's title insurance 1105.Lender's title policy limit $ 1106.Owner's title policy limit $ 1107.Agent's portion of the total insurance premium $ 1108.Underwriter's portion of the total insurance premium $ 1109. 1110.Attorney fees to Duncan & Hartman 475.00 1111. 1200.Government Recording and Transfer Charges 1201.Government recording charges Recorder of Deeds (from GFE#7) 67,00 1202.Deed$67.00 Mortgage$ Release$ 1203.Transfer taxes (from GFE#8) 480.00 1204.City/County taxistamps:Deed$ Mortgage$480.00 1205.State tax/stamps:Deed$480.00 Mortgage$ 480.00 1206. $ 1207. $ 1300.Additional Settlement Charges 1301.Required services that you can shop for (from GFE#6) 1302, 1303. 1304.tax certification to Donna Hrobst, Collector 20.00 1305, 1306. 1307. 1308. 1400.Total Settlement Charges enter on lines 103,Section J and 502,Section K 1,022.00 500.00 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and sbursements made on my account or by me in this transaction.I further certify that I have received a copy of the HUD-1 Settlement Statement. :larence W. Jumper Buyer/Borrower Estate o Harry L Wyriicpk, Sr. Seller tanda L. Jumper Buyer/Borrower Wyrick A. able Living Trust Seller 'he HUD-1 Settlement StateffwhicImpared is a true and accurate account of this transaction. I have caused or will cause the funds to be isbursed in act dance with ✓_ 6/10/2014 )uncap Har an P. Settlement Agent Date DARNING:It a rime knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine or imprisonment. 2009-2011 as,Soft.Previous edikions are obsolete. Page 2 of 3 HUD-1 A. Settlement Statement(HUD-1) I-AVID 1API'tuval 11- g.T of Loan 111 FHA 2.0 RHS 3.0 Conv. UninsFile Number: 7. Loan Number: Mortgage Insurance Case Number: 4.0 VA 5.0 Conv. Ins r. 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:the v are shown here for informational purposes and are not included in the totals. D. Name&Address of Borrower: E. Name&Address of Seller: F. Name&Address of Lender, Chad D. & Lizabeth A. Bear Estate of Harry L. Wyrick, Sr. 1427 Pine Road c/o Duncan & Hartman, PC Carlisle, PA 17015 1 Tryine Enw, Cnr1jQ1A , PA 17 11 G.Property Location; H.Settlement Agent: TIN: 25-1696377 Duncan & Hartman, P.C. Rear - Pine Road 1 Irvine Row Phone: (717) 249-7780 Dickinson Township' Carlisle, PA 17013 Lot: Place of Settlement: I. Settlement Date: 1 Irvine Row 8/29/2014 Block: Carlisle, PA 17013 Funding Date: J.Summary of Borrower's Transaction I K.Summary of Seller's Transaction 100.Gross Amount Due From Borrower 1400.Gross Amount Due To Seller 101.Contract sales price 'in nnn-On 401. Contract sales price 30,000.00 102, Persona)property 402. Personal property 103.Settlement charges to borrower(fine 1400) -A rn,C; 403. 104. 404. 105. 405. Adiustments for items Paid by seller in advance Adjustments for items paid by seller in advance 1106. Cit /town taxes: 44.87 406. Ci /town taxes: 44.87 to to 107. County taxes: 407.County taxes: to to 108.Assessments: 00. 408.Assessments: 700.84 to to 109. 409. 110. 410. 111. 411. 1 112. 412. 120.Gross Amount Due From Borrower 31,610.71 420.Gross Amount Due To Seller 30,745. 71 200.Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller 201, Deposit or earnest money 501. Excess deposit(see instructions) 202. Principal amount of new Joan(s) 502. Settlement charges to seller(fine 1400) 203. Existing loan(s)taken subiect to 503. Existing loan(s)taken subject to 204. 504. Payoff of first mortgage loan 205, 505. Payoff of second mortgage loan 206, 506, 1207. 507. 1208. 508. 1209. 1 509, Adiustments for items unpaid by seller I Adiustments for items unpaid by seller 210.Cit /town taxes: 1510. Cit /town taxes: to I to 1211. County taxes: 511.County taxes: to to 212.Assessments: 512.Assessments: to to 213. 513. 214, 514. 215. 515, 216. 516. 217. 517. 1218. 518. 219. 519, 220.Total Paid BY/For Borrower 520.Total Reduction Amount Due Seller 300.Cash At Settlement From/To Borrower 600. Cash At Settlement To/From Seller 301.Gross Amount due from borrower(line 120) 601.Gross amount due to seller(line 420) 130,185.71 302. Less amounts paid bv1for borrower(line 220) t 602. Less reductions in amount due seller(line 520) 303.Cash Z From 0 To Borrower 0.00 603.Cash 0 To 11 From Seller 0.00 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB control number.No confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. Q 2009-2011 Easy Soft.Previous editions are obsolete, Page 1 of 3 HUD-1 L.Settlement Charges File Number: Loan Number: 700.Total Real Estate Broker Fees Paid From Paid From Division of Commission line 700 as follows: Borrower's Seller's 701. $ to Funds at Funds at 702. $ to Settlement Settlement 703. Commission paid at settlement 704. 800.Items Payable In Connection With Loan 801. Our origination charge $ from GFE#1 802.Your credit or charge(points)for the specific interest rate chosen from GFE#2 803.Your adjusted origination charges from GFE A 804.Appraisal fee to from GFE#3 805. Credit report to from GFE#3 806.Tax service to from GFE#3 807. Flood certification from GFE#3 808. 809. 810. 811. 900. Items Required By Lender To Be Paid In Advance 901. Daily interest char es from to @ $ /day from GFE#10 902.Mortgage insurance premium for 0 months to from GFE#3 903. Homeowner's insurance for 0 years to from GFE#11 904. 905. 1000.Reserves Deposited With Lender 1001. Initial deposit for your escrow account from GFE#9 1002. Homeowner's insurance months @ per mo $ 1003. Mortgage insurance months @ per mo $ 1004. Property taxes months @ per mo $ 1005. months @ per mo $ 1006. months @ per mo $ 1007.Aggregate Adiustment $0.00 1100.Title Charges 1101.Title services and lender's title insurance from GFE#4 1102. Settlement or closing fee 1103. Owner's title insurance Duncan & Hartman PC from GFE#5 1104. Lender's title insurance 1105. Lender's title policy limit $ 1106.Owner's title policy limit $ 1107.A ent's portion of the total insurance premium $ 1108. Underwriter's portion of the total insurance premium $ 1109. , 1110. 1111. 1200.Government Recording and Transfer charges 1201. Government recording charges from GFE#7 1202. Deed $ Mortgage $ Release $ 90.00 1203.Transfer taxes from GFE#8 1204.Cit /Count tax/stamps: Deed $ Mortgage $ 1205.State tax/stamps:Deed $ Mortgage $ 1206. $ 1207. $ 1300.Additional Settlement Charges 1301. Required services that you can shop for from GFE#6 1302. 1303. 1304. 1305. 1306. 1307. 1308. 1400.Total Settlement Charges enter on lines 103,Section J and 502,Section K I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction.1 further certify that 1 have received a copy of the HUD-1 Settlement Statement~ c"N�am,)b��✓��_ Buyer/Borrower Seller r� C � Buyer/Borrower Seller This Settlement Statement which I've prepay d is a true and accurate account of this transaction.I've caused or will cause the funds to be disbursed in accordance with this statement. %/Z Du can & Hartman, P.C. Settlement Agent Date WARNIT711 It is a crime to knowingly make false stat nts to the United States on this or any other similar form. Penalties upon conviction can include a fine or imprisonment. ©2009-2011 Easy Soft.Previous editions are obsolete. Page 2 of 3 HUD-1 VIC Bank ,- Account Number 6100795128 Account Title HARRY SR/MIILDRED WYRICK LIVING TRUST/UTD 10/09/03/HARRY/MILDRED WYRICK CO-TTEE Date Opened 3/29/1980 Account Type Trust Principal Balance as of DOD $15212.28 Interest from Last Posting to DOD $ .26 Account Balance as of DOD $15212.54 YTD Interest to DOD $3.65 *Account number 6100795128 was an account that we acquired from Mellon bank in 2002. The account was held individually when we acquired it in 2002. On 10/16/2003, the account was changed from individual to a Living Trust account. 0 N 0 0492197094 ALTY COMPANY .- 25 N.'PEMNSYcvxNIA ST., CARMEL THE ZAM(OF NENEN YORK MELLOW- ' PHILADELPHIA, PA 62 -311 ... ....... T HUNDRED THIRTY-SIX AN 7 iPAY TW ...................... . . EN'ry' CHECK AMOUNT TQ THE HARRY L WYRICK SR AND MILDRED E 06f 24f 20 6,836,.17 THE ORDER WYRICK REVOC TRUST AGREEMENT DATED 10/09/2003 OF 871 MT ROCK xcc�'. CARLISLE, PA 17015 mt- ZZ ... ... .. VOID AFTER 180-DAYS -;.AuTH OMZED SIGNAT URE ......... 0009 2 19?091*110 1:03 1 LODO 4 2----969 SS1311, BANKERS LIFE AND CASUALTY COMPANY k-F 06/24/2014] 0092197094 11825 N. PENNSYLVANIA ST., CARMEL, IN 46032 VENDOR#: PAYEE: THE HARRY L WYRICK SR AND MILDRED E POLIAGT#: 7863566 DEATH CLAIM PAYMENT TOTAL26,836.17 BLC /OlOPA/ 5026/ HE CK NO. 84 58 a COMPANY NP :L RY�: ckt BANKERS:,.' .... ....... N. PENNSYLVANIA ST. CARMEL",".4N THE BANK OF NEW M YORK. f.iLON...: PHILADELPHIA, FA Mg� ui PAY THREE, ........... . AND 771100 --------------------- DATE ... ....... C46K AMOUNT HARRY & MILDRED WYRICK REVOCABLE 10/28/201 089. 77 LIVING TRUST DTD 10/9/2003 ORDER 871 MT ROCK or CARLISLE, PA 17015 ....... ... ........... .... . E............ ..... .......... ........ -DAYS ''AUTHORIZE :SjGW, VOID AFTER 180 Q T.URE 118DO 9 2813 413 S8119 1:03 1 X000 47,: 2'x-969 S SIBIll 'T CH .0. BANKERS LIFE AND CASUALTY COMPANY ...... .... .. ...... ....... ... ......... 110/28/2014 0092884858 11825 N. PENNSYLVANIA ST. , CARMEL, IN 46032 VENDOR#: PAYEE: HARRY & MILDRED WYRICK REVOCABLE POL/AGT#: 8544261 Ll /A /V/V TOTAL 3,o89.77 BLC /OlOPA/ 5026/