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HomeMy WebLinkAbout01-26-15 (2) 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 BOX.280601 INHERITANCE TAX RETURN 21 14 0165 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 02 05 2014 03 04 1959 Decedent's Last Name Suffix Decedent's First Name MI MENTZER KIMBERLY A (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 I—XI1. Original Return 2. Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 4a,Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date ofdeath after 12-12-82) g Decedent Died Testate T• (Atte hecopyinl Mainlined a Living Trust D 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) p 9. Litigation Proceeds Received 10.between 12 er%1 r ditjDa�, f Death 11.Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DOUGLAS H GENT ESQ 717 632 4040 REGISTER OF WILLS USE ONLY ,v First Line of AddressrTy C) c rrl n 1157 EICHELBERGER STREErTJ Second Line of Address -� f;.i SUITE 4 DATE FIL-ED-- Jri rt City or Post Office State ZIP Code - :71 HANOVER PA 17331 ►—• r= � ry can CD ry "T] Correspondent's e-mail address: 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. SIGNATOR OF PERSON RESPONSI LE F R FILING RETURN DATE 6- Sue E.Gilbert ADDRESS 11-1 430 Cedar Road New Oxford PA 17350 SP"AT OF EPA ER OTH15R THAN R PRESENTATIVE DATE Douglas H. Gent Esq ADD ES 1157 Eichelberger Street, Suite 4, Hanover, PA Side 1 L 1505610143 1505610143 �o I (���3 � '\\` � 1505610243 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 89, 790 . 41 2. Stocks and Bonds(Schedule B)............................................................................. 2. 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. 17 , 445 . 43 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneoust�oq Probate Property (Schedule G) u Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 107 ,235 . 84 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 33 , 951 . 43 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 52 , 675 88 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 86, 627 . 31 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 20, 608 . 53 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. 20 , 608 . 53 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 20 , 608 . 53 16. 927 . 38 at lineal rate X .045 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. 927 . 38 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-14-0165 Decedent's Complete Address: DECEDENT'S NAME Mentzer, Kimberly Anne STREET ADDRESS 132 N. Pitts Street CITY - STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 927.38 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4.26 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) 931.64 Make Check Pa able to: REGISTER OF WILLS, AGENT. s ° -� '' , 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;................................................................................ ❑ ❑x 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?........................:................................... ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑x _ 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 contains a beneficiary designation?....................................................................................:............................. 0 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+(12-12) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mentzer, Kimberly Anne 21-14-0165 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-132 N. Pitt Street,Carlisle, PA 17013 89,000.00 2 Real Estate-132 N. Pitt Street,Carlisle, PA 17013-Tax Proration 790.41 TOTAL(Also enter on Line 1, Recapitulation) 89,790.41 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev. 12-12) Rev-1508 EX+(08.12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Mentzer, Kimberly Anne 21-14-0165 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 Automobile-Sale of 2013 Ford Fiesta Titanium; Mileage 26,893 12,500.00 2 Automobile-Refund of Unused Warranty on 2013 Ford Fiesta Titanium 1,189.26 3 Geico-Refund of Insurance Premium 156.01 4 Personal Property-Sale of Jewelry 147.00 5 PSECU-Savings Account#7154001344468; Reference#S1 1,595.78 6 PSECU-Savings Account#7154001344468; Reference#S1;Accrued Interest(2/1/14-2/5/14) 0.03 7 PSECU-Checking Account#7154001344468; Reference#S4;Accrued Interest(2/1/14-2/5/14) 0.02 8 PSECU-Checking Account#7154001344468; Reference#S4 1,455.28 9 The Clark Group, Inc. -Reissue of Payroll Check 302.05 10 United Healthcare-Refund of Insurance Premium 100.00 TOTAL(Also enter on Line 5, Recapitulation) 17,445.43 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12) REV-1511 EX+(08.13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Mentzer, Kimberly Anne 21-14-0165 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 6,860.68 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Sue E. Gilbert Street Address 430 Cedar Road City New Oxford State PA zip 17350 Year(s)Commission Paid 2015 5,000.00 See continuation schedule(s) attached 2. Attorney's Fees 4,000.00 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 Relationship of Claimant to Decedent 4. Probate Fees 404.00 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 18,186.75 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 34,451.43 Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mentzer, Kimberly Anne 21-14-0165 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Funeral Expenses-Feiser Funeral Home, Inc. 3,470.68 2 Funeral Expenses-Marburg Memorial Gardens 3,290.00 3 Funeral Expenses-Pastor Shoop 100.00 H-A 6,860.68 Personal Representative Commissions 4 Executrix Fee-Sue Gilbert 5,000.00 H-131 5,000.00 Attorney Fees 5 Legal Fees-Law Offices of Douglas H.Gent 4,000.00 H-62 4,000.00 Probate Fees 6 Probate Fees-Cumberland County Register of Wills-Letters Testamentary,Short 128.50 Certificates, Inventory Filing Fee and PA Inheritance Tax Return Filing Fee 7 Probate Fees-Cumberland County Orphan's Court-Family Settlement Agreement 60.50 8 Probate Fees-Cumberland County Register of Wills-Additional Probate 215.00 H-134 404.00 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 Mentzer, Kimberly Anne 21-14-0165 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 9 Closing Costs-132 N. Pitt Street,Carlisle, PA 17013 12,227.54 10 Cumberland Tax Bureau 36.00 11 Home Repairs-Terminix-Termite Treatment at 132 N. Pitt St.,Carlisle,PA 205.36 12 Home Repairs-Terminix-Termite Treatment at 132 N. Pitt St., Carlisle,PA 2,034.64 13 Home Repairs-Daniel Deatrick-Labor 500.00 14 Income Tax Preparation-Parcel Plus 85.00 15 Lititz Mutual Insurance Company-Homeowner's Insurance 131.50 16 Members 1st-Automobile Loan-2013 Ford Fiest Tatanium -Interest(February, March,April 187.21 &May 2014) 17 Members 1st-Automobile Loan-2013 Ford Fiest Tatanium -Interest(June 2014) 29.17 18 Members 1 st-Automobile Loan-2013 Ford Fiest Tatanium -Interest(July 2014) 38.36 19 Miscellaneous Expenses-Notary Fees 15.00 20 Miscellaneous Expenses-Costs of Advertising Vehicle for Sale 64.50 21 Miscellaneous Expenses-Dale and Pauline Deatrick-Labor,Cleaning&Repairs at Personal 320.00 Residence in Preparation of Sale of Home 22 Miscellaneous Expenses-Brian and Cathy Deatrick-Labor,Cleaning&Repairs at Personal 480.00 Residence in Preparation of Sale of Home 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 Mentzer, Kimberly Anne 21-14-0165 ITEM NUMBER DESCRIPTION AMOUNT 23 PNC Bank-Estate Checking Account-Bank Service Fee 2.00 24 PNC Bank-Estate Checking Account-Bank Service Fee 9.00 25 PNC Bank-Estate Checking Account-Bank Service Fee 15.00 26 PNC Bank-Estate Checking Account-Bank Service Fee 2.00 27 PSECU -Home Equity Line of Credit-Interest 221.95 28 Repair and Maintenance-Cleaning Supplies 54.52 29 Repair and Maintenance-Materials and Supplies to Fix Porch and Posts 138.28 30 Utilities-Borough of Carlisle-Water/Sewer 68.14 31 Utilities-Borough of Carlisle-Water/Sewer 67.53 32 Utilities-Borough of Carlisle-Water/Sewer 75.82 33 Utilities-PPL-Electric(February, March,April 2014) 158.57 34 Utilities-PPL-Electric(May 2014) 27.02 35 Utilities-PPL-Electric(May 2014) 27.02 36 Utilities-PPL-Electric(June 2014) 26.13 37 Utilities-PPL-Electric(July 2014) 45.89 38 Utilities-PPL-Electric(August 2014) 46.81 39 Utilities-PPL-Electric(September 2014) 35.92 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 Mentzer, Kimberly Anne 21-14-0165 ITEM NUMBER DESCRIPTION AMOUNT 40 Utilities-UG Utilities, Inc. -Gas Service(February 2014) 224.49 41 Utilities-UG Utilities,Inc.-Gas Service(March 2014) 156.97 42 Utilities-UG Utilities, Inc. -Gas Service(April 2014) 102.88 43 Utilities-UG Utilities, Inc.-Gas Service(May 2014) 24.11 44 Utilities-UG Utilities,Inc. -Gas Service(June 2014) 14.19 45 Utilities-UG Utilities, Inc.-Gas Service(July 2014) 14.27 46 Utilities-UG Utilities, Inc. -Gas Service(August 2014) 13.24 47 Utilities-UG Utilities, Inc. -Gas Service(September 2014) 13.07 48 Utilities-UG Utilities, Inc.-Gas Service(October 2014) 13.24 49 Utilities-UG Utilities, Inc.-Gas Service(Final Bill) 105.10 50 Utilities-PPL-Electric(Final Bill) 71.86 51 Utilities-UG Utilities, Inc.-Gas Service(November 2014) 57.45 H-B7 18,186.75 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-12) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OFMORTGAGE LIABILITIES AND LIENS RET INHERITANCE TAXAXRETURRNN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mentzer, Kimberly Anne 21-14-0165 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 Automobile Repairs-Faulkner Collision Center of Carlisle-Repair-2013 Ford Fiesta 500.00 Titanium 2 Credit Card-Sheetz VISA;Account#4680169233109364 94.50 3 Credit Card-Discover;Account#XXXX9751 733.68 4 Geico-Car Insurance Premium 373.50 5 Home Repairs-Brian Deatrick-Repair Balcony 700.00 6 Medical Expenses-Lewin&Associates Cardiology Assoc. 9.65 7 Medical Expenses-Jackson Siegelbaum Gastroente 830.00 8 Medical Expenses-Spirit Physicians Services 662.73 9 Medical Expenses-Holy Spirit Hospital 1,685.72 10 Medical Expenses-Quantum Imaging and Therapeutic Associates 183.01 11 Medical Expenses-Kantor&Tkatch Associates 14.88 12 Medical Expenses-Capital Cardiovascular Associates 19.01 13 Medical Expenses-Carlisle Regional Medical Center 1,263.30 14 Medical Expenses-Lewin&Nadar Cardio Associates 9.65 15 Medical Expenses-Camp Hill Emergency 141.00 16 Medical Expenses-Dr. R.Modi 241.00 17 Members 1st-Automobile Loan(principal)-2013 Ford Fiest Tatanium 18,282.95 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 10, Recapitulation) 52,175.88 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12) Rev-1512 EX+(12-12) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Mentzer, Kimberly Anne 21-14-0165 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 18 PSECU-Home Equity Line of Credit 26,027.80 19 Utilities-Borough of Carlisle-Water/Sewer 103.99 20 Utilities-PPL-Electric(January 2014) 71.86 21 Utilities-UG Utilities, Inc.-Gas Service(January 2014) 227.65 TOTAL(Also enter on Line 10, Recapitulation) 52,175.88 Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Mentzer, Kimberly Anne 21-14-0165 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENTDo Not List tee (Words) ($$$) ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] See attached schedule Total 20,608.53 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) SCHEDULE J BENEFICIARIES (Part I,Taxable Distributions) ESTATE OF: Kimberly Anne Mentzer 02/05/2014 177-54-6693 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Sue Ellen Gilbert Mother One Hundred Percent 20,608.53 430 Cedar Road New Oxford, PA 17350 Total 20.608.53 1 REGISTER OF WILLS CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA No. 2014- 00165 PA No. 21- 14- 0165 Estate Of: KIMBERL Y MENTZER (First,Middle,Last) alkla: KIMBERLY PAULEY KIMBERL Y GILBERT Late Of: CARLISLE BOROUGH CUMBERLAND COUNTY Deceased Social Security No: WHEREAS, on the 24th day of February 2014 an instrument dated April 21st 2010 was admitted to probate as the last will of KIMBERL Y MENTZER (First,Middle.Last; a/k/a KIMBERLY PAULEY KIMBERLY GILBERT la to of CARLISLE BOROUGH, CUMBERLAND County, who died on the 5th day of February 2014 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, 1, LISA M. GRAYSON, ESQ. . Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: SUE E GILBERT who has duly qualified as .EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE, CA RL IsL E, PENNS n VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 24th day of February 2014. Reg/M Deputy "NOTE" ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) laa Vill arab Ttaament of ` - � Rimberlp Offine fHent3er I, KIMBERLY ANNE MENTZER, of the County of Cumberland and Commonwealth of Pennsylvania, being of sound mind and memory, do make,publish and declare this to be my Last Will and Testament, hereby revoking and declaring null and void any and all Wills or Codicils by me at any time heretofore made. FIRST: I direct my Executrix to pay the expenses of my last illness and funeral from the residue of my Estate. SECOND: I direct that all Estate, Inheritance and other death taxes that may be assessed with respect to property or interest passing under my Will by whatever jurisdiction imposed, shall be paid from my residuary Estate as a part of the expense of the administration of my Estate. THIRD: I give all tangible personal property owned by me at my death and all insurance policies on such property as follows: A. To my stepmother, SUE ELLEN GILBERT, if he survives me by thirty(30) days. B. If SUE ELLEN fails to so survive me, then to my brother, EDWARD ALAN GILBERT, if EDWARD survives me by thirty(30)days. C. SUE ELLEN or EDWARD, whoever shall receive my tangible item,: ...,cant Page 1 of 5 to this Paragraph THIRD may, but is in no way required, to distribute any such items to my siblings as he or she sees fit in his or her sole discretion. D. Any items not so disposed of shall be sold and the proceeds distributed as part of the residue of my Estate as provided for herein. FOURTH: I give the residue of my Estate as follows: A. To my stepmother, SUE ELLEN GILBERT, if she survives me by thirty (30)days. B. If SUE ELLEN fails to so survive me,then I give the residue of my Estate to my brother, EDWARD ALAN GILBERT,if EDWARD survives me by thirty(30)days. C. SUE ELLEN or EDWARD, whoever shall receive the residue of my Estate pursuant to this Paragraph FOURTH, may, but is in no way required, to distribute any portion of the residue to my siblings as he or she sees fit in his or her sole discretion. FIFTH: All principal and income shall be free from anticipation, assignment,pledge or obligation of beneficiaries or remaindermen and, while in the hands of my Executrix the same shall not be liable to any levy, attachment or execution. SIXTH: I name and appoint SUE ELLEN GILBERT to serve as Executrix of this, my Last Will and Testament, to serve without bond in any jurisdiction in which she may act. In the event that SUE ELLEN is unable or unwilling to act as Executrix, then I name and appoint EDWARD ALAN GILBERT to serve as Alternate Executor, also to serve without bond in any jurisdiction in which he may act. Page 2 of 5 SEVENTH: My Executrix and her successors shall have the following powers with regard to the assets and liabilities of my Estate: to retain my investments, invest and reinvest in legal investments, sell, grant options for sale or otherwise convert any real or personal property or interest therein and to deliver good conveyances for the same,borrow money and secure its repayment by mortgage,pledge or otherwise, compromise claims, make distributions in cash or kind or partly in each, lease real estate and other property, file any tax or gift tax returns that may be due on my behalf,retain such agents,accountants, or other advisors and compensate the same from estate assets, associate with them a corporate fiduciary with fiduciary powers in the Commonwealth of Pennsylvania, delegate to said corporate fiduciary the exercise of any powers, exercise all other acts and things necessary or appropriate in the management, administration and distribution of my Estate and exercise any other powers granted to personal representatives pursuant to the applicable laws of the Commonwealth of Pennsylvania, including but not limited to those enumerated in Chapter 33 B and C of the Pennsylvania Probate, Estates and Fiduciaries Code,20 P.S. §§3311-3360. EIGHTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter;and the neuter may be read to include the Page 3 of 5 masculine and feminine. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of 201 (Signature) KBWRLY ANN AV1ENTZV R Signed, sealed and published and declared by KIMBERLY ANNE MENTZER, the Testatrix above-named, as and for her Will, in the presence of us, who, at her request, in her presence and in the presence of each other,have hereunto subscribed our names as witnesses hereto. WITNESSES: Signature: / G1.� c`r� Signature: Print Name: R n P Y, L Print Name: Address: lq**] ECL�t Sootk-,St Address: ACI Page 4 of 5 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYL7 V 14 COUNTY OF CY-LI77 If I, KIMBERLY ANNE MENTZER, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed Md acknowledged before me by'KIMBERLY ANNE MENTZER, the Testatrix,this day of 1--WA of 2 COMMONWEALTH OF PENNSYLVANIA- KR�Y jV.�N"ENTZ-ER(ignauire) NOTARIALSEAL DARCIE A.NEIL,Notary Publie Boro of Carlisle,Curnbarlanci County My Commission Expires Nov.24,2013 (Signature of Notary Public) (Seal of Notary Public) AFFIDAVIT COMMONWEN-TH OF PENN$YLVA m h. NJA 'it COUNTY OF -�a We, boitv.�- e_ _2 JAW, ohe witnesses whose names are signed to the attar ted. or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrumentas her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and und9r no constraint or undue influence. Zorn, to/Pr affirmed and subscribed to before,1 rne by L C� i,77t.�/&-)and witnesses,this day of 24 ? 0 qVt'4- Witness ignalure)V N0TAF,3JA1L6fP.t,AL DARCIE A.NEIL,Notary Pubho nj C r",'(11'119,GUMbOrlp 70 ,,no C,70Unty Nty NOV,24,2013 -WoclNoTary Public) (Signaru (Seal of Notary Public) Page 5 of 5 . • A. Settlement Statement (HUD-1) OMB Approval No.2502-0265 1.©FHA 2.❑RHS 3.❑Comr.Unins. •File Number. 7.Loan Number. 8.Mortgage Insurance Case Number. 14447 27018558 446-2250970-703 4.F1VA 5.❑Comv.Ens. C.Note:This forth is furnished to give you a statement of actual settlement costa Amounts pail to and by the settlement agents are shown.hems marked "(p.o.c)"were paid outside the dosing;they are shown here for informational purposes and we not included In the totals. D.Name&Address of Borrower. E.Name&Address of Seller: F.Name&Address of Lender. Shannon E Underwood Estate of Kmberly A Mentzer GMH Mortgage Services,LLC 671 Bamberger Road,Ettem,PA 17319 132 North Pitt Stiff,Carlisle,PA 17013 625 W.Rhtgs pike,Building C.Suits 100, Conshohocken,PA 19428 G.Property Location: H.Settlement Agent t.Settlement Dater 12M 20114 132 North Pitt Street 1st Advantage Settlement Services Inc. Disbursement Date:12/12=14 Carlisle,PA 17013 6375 Mercury Drive,Suite 102,Mechanicsburg,PA 17050 Carlisle Borough 717.691-7765 dleExp place375 Drive,Suite 102,Mechanicsburg,PA 170.50 Printed 12/1212014 at 1 t23 am byVW. J.Summary of Borrovter's Transaction mm� K.Summary of Seller's Transaction ,..., .. f00: Gross Amount Due from Barter ow400.�tiipas`AmountDue.td SeSer�: 1ft contract sales price 89, .00 401. Caftet sales price $9,000.00 102. Personal 402. Personal 103, Settlement Charges to borrower(line 1400) 7,430.89 403. 104. 404, 105. 405. Adjustments for items paid by seller in advance Adjustments for Items pWd by seller in advance 106. CityAown taxes to 406. Cityka taxes to 107. Courhy taxes 12/1212014 to 12131/2014 35.69 407. County texas 12M2014 to 12/3112014 15.69 f 108. School Taxes 12/122014 to 06/30/2015 754.72 408. School Taxes 12/12/2014 to 06130@015 "754.72 109. 409. 110. 410. 111. 411. 112. 41Z 120, Gross Amount Due fmm Borrower 87,221.30 420. Gross Amount Due to Seller 89,700.41 200. Amounts Paid byor to Behalf of Borrower 5w.- in Amount Due to Seger 201. Deposit or earnest money 1, see ons # n j, 202. Principal amount of new loan(s) 87,387.00 502. Settlement charges to Wier Pine 1400) 14,297.54 q 5�� 1•S'7 203. &jsft o s taken subject to SM. EME o s taken sutiiect to• -�- 204. Borrwans Lenders Deposit 495.00 504. Payoff offirst mortgage loan to PSECU 23,914.11 206. 505. Payoff of second mortgage loan 206. 2nd Mortgage 3,384.00 506. 2nd Mortgage t �����. 207. 507. 208. 508. 209. SellerAsmst 2,670.00 509. Seller Assist 2,670.00 Adjustments for hems unpald§y seller Adjustments for items unpaid by seller 210, Cdy n taxes to 510. Cityhown taxes to, 211. County taxes to 511. County taxes to 212. School Taxes to 512 School Taxes to 213. 513. 214. 514. 216, 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid byffor Borrower 94,938.00 520. Total Reduction Amount Due Seller 40,881.88 300. Cash at Settlement:fromNo Borrower' 800 Cash a(Setllementteftm Saner i:' ,., 301. Gross amount due from borrower Pine 120) 97,221.30 601. Gross amount due to Wier pine 420) 89,790.41 302. Less amounts paid bY1W borrower pine 220) 94,936.00 6a ten reductions in amountdue sellerpine 520) 40 881.65 303. Cash QX From Q TOBoRower 2,MJQ 603. Cash ; ❑X To ❑ FromSeher 48,808.70 xA••rom,,w•�x xem•„xyrKd Cl�mMol,•enear.wmxxaeirrrrourau•ax••aun•xx•u�xmiman.ftiisaagnvamp,wtrstde0•�•mxRCBPAavmeda•,,,aahxMm NPortnWaM6glha !•tll•m•/Rpomn Previous editions are 06solete HUD-1 L.Settlement Charges 700. Total Real l tate6mlrerFees 5735.00 :•.Paid;Fromk>..: :PaidFrom Division of commission(One 700 as follows: BOCroWet;S.i. Seilei's- 701. $5,735.00 to Re/Max tat Advantage ;;Funds at.' FUnd's at. 702 $0.00 to °Setttemerit Settlement 703. Commission paidatsettlement 5,735.00 704. Commission to Re/Max 1stAdvantage 595.00 800. Itemsle in.Connwdon vM Loan 801. Our origtnahon charge (includes Origination Pant O.ODO%or$0.00) $750.00 (from GFE#1 802 Your credit or charge(points)far the specific Interest rate chosen $ (finer GFE#2) 803. Your adjusted origination charges (from G 750.00 804. Appraisal fee to Butdrolder Appraisal Servioes FE ) 410.00 805. Credit report to Credit Plus (from G ) 806. Taxservice to GFE#3) 807. Flood certification to from GFE#3 8D8. to 900. Items Reqidred by Wriderto be Paid in Advance 901. Dally interest charges trom from 1ZMz7D14 to 1/01/2015 10.7 day ) 209.49 902 Mortgage Ins.Premium for months to HUD (from GFE#3) 1,50299 903. Homeowners Insurance for 1 years to Philadelphia Constrii utlonsh (from GFE#11) 460.00 904. months to GFE#11 1000.ReservesLender 1001.Initial deposit for your escm account (from GFE R 987.65 10D2 Homeoxmees Insurance 3 months 38.341mmM $115.02 1003.Mortgage Insurance months $ 95.90/rnonth $ 1004.City Property Tax months O.00hnonth $ 1005.County Property Tax 12 months ga$ 54.28rmonOh $651.36 1006.School Taxes 7 months @$ 114.211monih $799.47 1007.Aggregate Adjustment $578.20 1100.Title ch es ; 11011.Title services and lenders tills insurance $ tram GFE#4 1,244.00 1102.Settlement ordosingfee to $ 1103.Owneestitle Insurance-FlrstAmwIcanTitle Insurance Cortyoany $ from GFE 5.50 1104.Lender's title insurance-First American Title Insurance Company $1,109.00 1105.Lenders Me policy limit$87,387.00 Lender's Policy 1106.Owners title policy Nmit$89,000.00 Owners Policy 1107.Agents portion of the total 011e insurance premium $841.07 to Ist Advantage Settlement ServlcesInc. 1108.Underwriters portion of the total title Insurance premium $273.43 to First American Title insurance Company 1109. 1110.Notary to Vidde Welker 10.00 1111. to $ 1112.Overnight Payoff to 1st Advantage Settlement 25.00 Services Inc. 1200.Government Recordig and TransferC es 1201.Government recording charges $ (from GFE#7) 174.00 1202•Deed$79.00 M $95.00 Release$ 1203.Transfer Wm $ (from GFE#8) $90.00 1204.ChylCounty,tax/stamps Deed$890.00 M 1205.State Tax/stamps Deed$890.00 M $ 890.00 1206. Deed$ Mortgage$ 1207. $ 1208.Assignment 67.50 1300.Additional Settlement Cha es 1301.Required services that you can shop for (from GFE#6) 02.TemhfteTm&rwd toTerminex $205.36 P.O.C.M Z240.FO S101111)N S6PL'l 1303.Home Wantonly to American Home Shield 560.00 13D4.2014 County Tax to Charles Holtry 731.04 1305.2014115 School Tax to Charles Hoft 1,538,33 1306.Inspections to Mike Shealy Home Inspections 80.00 1307.Final Sewer and Water to Carfisle Borough 68.117 1308.Escrow for inheritance Tax tolstAdvantage SdgementServ. 2,5WOU• 1400. Total Settlement Charq.mtert + 7,430.89 14,29754 'Paid outside of dosing by(B)onwer,(S)e0er,(L)ender,(I)nvesto,Bro(IQer.-Credit by lender shown on page 1.-Credit by seller shown on page 1. n.5�rT,5 r 1 Previous editions are obsolete HUD-1