HomeMy WebLinkAbout01-23-15 (2) 1505610105
REV-1500 EX(w-ii)(FI)1'.`r
enns lvania OFFICIAL USE ONLY
PA Department of Revenue P y County Code Year File Number
Bureau of Individual Taxes ` ``nVe
PO BOX 28o6o> INHERITANCE TAX RETURN 14 �(S
Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
06/10/2014 03/09/1945
Decedent's Last Name Suffix Decedent's First Name MI
Barnhart _ Jr. Kenneth S
i.
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
I N/A
Spouse's Social Security Number
r ---- -- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
' REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
QD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust U 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death Q 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Robert R. Black, Esquire (717)243-3727
REGISTY�OF WILLS USRNLY
crt M
C O M
First Line of Address t73
36 South Hanover Street n r r o
rrl m
Second Line of Address CIS
J O
C 7 c7 -Y1 .ter "ri
City or Post Office State ZIP Code DATE FILED
A F ' M
Carlisle PA 17013 ''� -� I—► c i o
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.
SIGNAT RE OF PERR P SIBLE F=TURN DATE
A RESS
914 S Ablemarle St York PA 1740 822 E Louther St Carlisle PA 17013 700 Long Gaps Rd Carlisle F4 17013
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
36 South Hanover Street, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
1505610205
REV-1500 EX(FI) Decedent's Social Security Number
Decedent's Name: Kenneth S. Barnhart, Jr. ;
RECAPITULATION
1. Real Estate(Schedule A). . ... .... .. .. . .. ..... ... . ............ .... . ... 1. 55,054.87
2. Stocks and Bonds(Schedule B) . ..... ........ .... ..... ......... .. ..... 2. 109.00 !
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. ... 3. 0.00
4. Mortgages and Notes Receivable Schedule D 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 19,487.22
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00 {
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. . . . .. . 7. , 246,096.39 i
8. Total Gross Assets total Lines 1 through 7 8. 320,747.48
9. Funeral Expenses and Administrative Costs(Schedule H).......... . ...... .. 9. 19,941.08
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 1,634.93
11. Total Deductions(total Lines 9 and 10). ... ............... ............ .. 11. 21,576.01
12. Net Value of Estate(Line 8 minus Line 11) ... . .... . .. ................ . . . 12. 299,171.47
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .... . .......... ......... 13. 0.00 l
14. Net Value Subject to Tax(Line 12 minus Line 13) ...... ... .......... . . . . . 14. 299,171.47
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 t
(a)(1.2)X.0_ i 15.
16. Amount of Line 14 taxable
at lineal rate X.0_ I 16.
17. Amount of Line 14 taxable
at sibling rate x.12 224,378.87 17, 26,925.46 1
18. Amount of Line 14 taxable -- _-! 11,218.931
74,792.87
at collateral rate X.15 - 18
'
19. TAX DUE . . ........ ... .. . .. .... ..... ........... ............. .... .. 19. 38,144.39
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J r
REV-1 500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS AME
Kenneth S. Barnhart,Jr.
STREETADDRESS
145 Porter Avenue
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1, Tax Due(Page 2,Line 19) (1) 38,144.39
2. Credits/Payments
A.Prior Payments 27,978.00
B.Discount 1,472.48
Total Credits(A+8) (2) 29,450.48
3. Interest
(3)
4. If Line 2 is greater than Line I +Line 3,enter the difference. This is the OVERPAYMENT.
Fill In oval on Page 2,Line 20 to request a refund. (4)
5. If Line I+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 8,693.91
Make check payable to: REGISTER OF WILLS, AGENT.
777
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................................. ....................__......... 11 N
b. retain the right to designate who shall use the property transferred or its income ............................................ El 0
c. retain a reversionary interest....... ...........................................................................................___....... El 0
d. receive the promise for life of either payments,benefits or care?...................................................................._ El 0
2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................__.......................................................... El 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ 0 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.
1 .7 _71
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 Jan. 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 F2 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+(6-98)
�b SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kenneth S Barnhart, Jr. 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 which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t Lotof ground and residence sold at public sale being known $55,054.87
as 145 Porter Avenue, Carlisle, PA. See attached HOD-1
TOTAL(Also enter online 1, Recapitulation) $ 55,054.87
(if more space is needed,insert additional sheets of the same size)
REV-1503 Ex+{8-1z}
101 pennsytvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kenneth S. Barnhart, Jr. 21-14-0615
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. United State Savings Bond Series EE-Face Value$100.00 N00516652110EE. 109.00
Value date June 10,2014.Copy attached
TOTAL(Also enter on Line 2, Recapitulation) $ 109.00
If more space is needed,insert additional sheets of the same size
REV-15o8 EX+(o8-i2)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Kenneth S. Barnhart, Jr. 21-14-0615
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. M&T Bank-checking acct 2676050418-see attached letter 5,594.14
2. M&T Bank-savings acct 15004201159371-see attached letter 5,593.58
3. 2003 Dodge Dakota 02 Sport Truck. Total loss-see attached check copy 6,490.00
4. Goodville Mutual Casualty Co. Further truck proceeds-see No.3 above 1,622.50
.5. Refund of truck insurance 187.00
-T
TOTAL(Also enter on Line 5, Recapitulation) $ 19,487.22
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
ry pennsytvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kenneth S. Barnhart, Jr. 21-14-0615
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL.ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE
1. Pacific Life Ins.Co.Annunity Contact No.FA09020911-see attached letter 58,368.09 100 0.00 58,368.09
designated receipients:
Terry L.Barnhart-brother-50%822 E Louther Street,Carlisle,PA 17013
SSN:197-40-8514
Ann L.Owings-sister-50%700 Longs Gap Road,Carlisle,PA 17015
SSN:187-44-9406
2 M&T Securities,Inc.No.AZ427446-IRA-see attached letter 187,728.30 100 0.00 187,728.30
same beneficiaries as set forth in 1.
TOTAL(Also enter on Line 7, Recapitulation) $ 246,096.39
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
Kenneth S. Barnhart, Jr. 21-14-0615
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
Ewing Brothers Funeral Home-funeral services 5,107.88,
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 0.00
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 9,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 0.00
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 614.04
S. Accountant Fees: 0.00
6. Tax Return Preparer Fees: 75.00
7. Social Security Administration-return social security payment June 2014 2,050.00
8. PPL-utility service 38.381.
9. CenturyLink-telephone service 39.21
10. Comcast-TV/cable 21.85
i. Borough of Carlisle-water/sewer 74.82
12. UGI-utility service 73.00
TOTAL(Also enter on Line 9, Recapitulation) $ 19,941.08
If more space is needed,use additional sheets of paper of the same size.
Schedule H - continued
13. Charles Holtry - real estate taxes (school) $1,092.94
14. Steve Barrett Agency -real estate appraisal $375.00
15. PPL - utility service $35.17
16. UGI - utility service $70.45
17. Lititz Mutual Ins. Co. - homeowners insurance $153.00
18. PPL- utility service $22.75
19. UGI - utility service $12.49
20. Borough of Carlisle - water/sewer $74.82
21. Boiling Spfings Animal Hospital -account $184.40
22. Boiling Springs Animal Hospital -account $96.00
23. PPL-utility service $21.34
24. UGI- utility service $12.49
25. PPL-utility service $18.86
26. UGI-utility service $47.22
27. PPL-utility service $29.97
28. Reserve for closing&releases $600.00
Total: 19,941.08
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kenneth S. Barnhart, Jr. 21-14-0615
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. PPL-utility invoice 40.36
2. UGI-utility service 73.00
3. Cumberland Goodwill Ambulance Services-services 1,113.05
4. Carlisle Physicians Service-emergancy room 408.52
TOTAL(Also enter on Line 10, Recapitulation) $ 1,634.93
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Kenneth S. Barnhart, Jr. 21-14-0615
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. Edward L. Barnhart,Sr.,914 S.Albemarle Street,York,PA 17403 brother 25%
2. Terry L.Barnhart,822 E.Louther Street,Carlisle,PA 17013 brother 25%
3. Ann L.Owings,700 Longs Gap Road,Carlisle,PA 17013 sister 25%
4. Aron E.Bobb, 111 Petersburg Road,Carlisle,PA 17013 nephew 12.5%
5. Adriane E.Reeves,909 Cavalry Road,Carlisle,PA 17013 niece 12.5%
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 n—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.
OMB Approval No.2502-0265
A. Settlement Statement HllD-1)
of ..
1.❑FHA 2.❑RHS 3.❑Conv.Unins. 5.File Number: 7,Loan Number: 8.Mortgage Insurance Case Number:
JONESG12-14
4,❑VA 5.❑Conv.Ins.
C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown Items marked
"(p.o.cY were paid outside the closing;they are shown here for informationat purposes and are not included in the totals.
D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender:
GERALD P.JONES,MARJORIE L.JONES KENNETH S.BARNHART,SR,ESTATE
75 GOODYEAR ROAD,CARLISLE,PA 17015
G.Property Location: H.Settlement Agent: t.Settlement Date:12115!2014
145 PORTER AVENUE I&M Real Estate Services,LLC Disbursement Date:12/15f2014
Carlisle,PA 17013 West Pomfret Professional Bldg,60 West Pomfret Street,
Carlisle Borough Carlisle,PA 17013
Place of Settlement: TitleExpress
West Pomfret Professional Bldg,60 West Pomfret Street, Printed 12115/2014 at 8:38 am
Carlisle PA 17013 by JMR
I Summary of Borrower's Transaction k.Sumirigy of Sillees Transaction
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seiler
101. Contract sales price 57,000.00 401. Contract sales price 57,000.00
102. Personal property 402. Personal property
103. Settlement charges to borrower(line 1400) 1,256.00 403,
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. Cityllown taxes 1211512014 to 1213112014 24.72 406. Cityilown taxes 1211512014 to 1213112014 24.72
107. County taxes to 407. County taxes to
108. School Taxes 1211512014 to 06/3012015 592.88 408. School Taxes 1211512014 to 06130/2015 592.88
109. 409.
110. 410,
111, 411.
112. 412.
120. Gross Amount Due from Borrower 58,873.60 420. Gross Amount Due to Seller 57,617.60
200. Amounts Paid by or In Behalf of Borrower 500. Reductions In Amount Due to Seller
201. Deposit or earnest money 5,000.00 501. Excess deposit(see instructions)
202. Principal amount of new loan(s) 502. Settlement charges to seller(line 1400) 2,562.73
203. Existing loos taken subject to 503. Existing loa s taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second moil a e loan
206. 506.
207. 507,
208, 508.
209. 509.
Ad ustments for Items unpaid by seller Adjustments for items unpaid by seller
210. City/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216, 516.
217. 517.
218. 518.
219. 519.
220. Total Paid by/for Borrower 5,000.00 520. Total Reduction Amount Due Seller 2,562.73
300. Cash at Settlement fromlto Borrower 600. Cash at Settlement to/from Seiler
301. Gross amount due from borrower(line 120) 58,873.60 601, Gress amount due to seller(line 420) 57,617.60
302, Less amounts paid by/for borrower(line 220) 5,000.00 602. Less reductions in amount due seller(line 520) 2,562.73
303. Cash ❑X From ❑ To Borrower 53,873.60 603, Cash 0 To ❑ From Seller 55,054.87
Y m.Y
Nb loan,ynl,}.Y Nfpltyf.turt,nty v.ld OMB owMM o{mfpef.Np cMIgCM4111Y N i13MiMd;lois OispOSVrc Is maM,ipy.TAB b OHgn,tl Io yovb,thU polo o,Rl9PA COv,r,tl U,nuCllpf,Mn Inlorm,lip�W,inp Ido �
Yt11om,M{XOC,ll
Previous editions are obsolete Page 1 of 4 HUD-1
L.Settlement Charges
L----
700, Total Real Estate Bmker Fees Paid From Paid From
Division of commission line 700 as follows: Borrower's Seller's
701, $400 to Funds at Funds at
742. $0.00 to Settlement Settlement
743. Commission paid at settlement
840. Gems P able In Connection with Loan
801. Our origination charge (Includes Origination Point 0.0001/o or$0.00) $ (from GFE#1)
802. Your credit or charge(points}for the specific interest rate chosen S {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
846. Tax service to from GFE#3
807. Flood certification to from GFE#3
808, to
900. items Required by Lender to be Paid in Advance
941. Daily interest charges from from 1211512014 to 0110112015 @$0.001day (from GFE#10)
902. MoNage insurance premium months to from GFE#3
903. Homeowners insurance months to from GFE#11
904, months to from GFE#11
i000.Reurves Deposited rider
1001. Initial deposit for your escrow account (from GFE#9)
1002. Homeowner's insurance months @$ /month
1003. Mortgage insurance months @$ /month
1004.Property taxes months @$ 44.24/month $
1005, months @$ /month
1006.School Taxes months @$ 91.08/month $
1007.Aggregate Adjustment $
1100.Title Charges
1101. Title services and lender's title insurance $ from GFE#4
1102. Settlement or closing fee to $
1103.Owner's title insurance $ from GFE#5
1104.Lender's Otte insurance $
1105. Lender's title policy limit$0.00
1106. Ownefs title policy limit$57,000.00
1107.Agent's portion of the total title insurance premium $
to
1108. Underwriter's portion of the total title insurance premium $
to
1109.Atiomey Fee to IRWIN&MCKNiGHT, 600.00
F.C.
1110. notary to 7.04 14.00
1200.Government Recording and Transfer Charges
1201.Government recording charges $ (from GFE#7) 79.00
1242.Deed$79.00 Mort a $ Release$
1203.Transfer taxes $ (from GFE#8) 574.00
1204. City/County tax/stamps Deed$570.00 Mort $
1205. State Tax/stamps Deed$570.00 Mortgage$ 570.00
1206. Deed$ Mortgage$
1300.Additional Settlement Charges
1301.Required services that you can shop for (from GFE#6)
1302. to
1343. to
1304. Auction Services to JONES&MARTIN AUCTIONS,LLC 1,907.47
1305. Final Wtr1Swr#009036 to CARLISLE BOROUGH 75.66
ME111111111111FIFIM11r r 1,256.00 2,562.73
'Paid outside of dosing by(B)onower,(S)eller,(L)ender,(I)nvestor,Bro(K)er."Credit by lender shown on page 1.-Credit by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
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 transactiort.I further certify that i have received a copy of the HUD-1 Settlement Statement,
GERALD P.JONES
MARJO L. NES
KENNETH S.BARNHART,SR.ESTATE
EDWARD L.BARNHART SR.,ADMINISTRATOR TERRY L.BARNHART,ADMINISTRATOR,
1 ]AA)RIM-
�
T
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.I have caused or will cause the funds to be
disbursed in accordance with this statement.
f"
/�fls/ly
SETTLE NT 4tENT DATE
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 1a:U.S.CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete Page 4 of 4 HUD-1
Calculated Value of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 12/2014
Total Price Total Value Total Interest YTD Interest
50.00 $109.00 $59.00 $4.24
Bonds: 1-1 of 1
Issue Next Final Issue Interest
Serial # Series Denom Date Accrual Maturity Price Interest Rate Value Note
C516652110EE___EE $100 04/1995,01/2015 04/20.25.:-'$5.Q.00 r $59_.00T__4.00%,009.00T
Totals for 1 Bonds;$50.00, $59.00, 109.00
Notes
NI Not Issued
NE ,Not eligible_for payment
P5 Includes 3 month interest penalty
MA'Matured and not earning interest
http://www.treasurydirect.gov/BC/SBCPrice 12/24/2014
p M&TBank
499 Mitchell Road,Millsboro.DE 19966 Records Management
Phone 888-502.4349
F ax (302)934-2955
July 25,2014
Landis & Black
36 S. Hanover Street
Carlisle,PA 17013
Re: Estate of Kenneth S. BarnhartJr.
Social Security:
Date of Death: June 16 2014
Dear Sir or Madam:
Per your inquiry on July 22,2014,please be advised that at the time of death,the above-named decedent had on
deposit with this bank the following:
1. Tvpe ofAccount Checking Account
Account Number 2676050418
Ownership(Names ofi Kenneth S. Barnhart,Jr.
Opening Date 0310111978
Balance on Date of Death S 5,594.74
Accrued lnterest $ .00
Total 5,594.14
2. Type of Account Savings Account
Account Number 15004201159371
Ownership(Names of) Kenneth S Barnhart,Jr.
Opening Date 0311011998
Balance on Date of Death S 5,593.56
Accrued Interest $ .02
Total S 5,593.58
Gorodville Mutual Casualty Company 0000584913
DESCRIPTION CHECK AMOUNT
KENNETH S BARNHART JR POLICY NUMBER: PA 745078 $ 6,490 . 00
POLICY DATES: 3/20/14 TO 9/20/14
!LAIM NUMBER: R 438043 JPC LOSS DATE: 6/10/14
!LAIMANT: KENNETH BARNHART
'YPE OF PAYMENT: PARTIAL PAYMENT
IN PAYMENT OF
Partial settlement of total loss of 6/10/14 .
Balance of $1622.50 due upon our receipt of
title, death cert, ltr of executor & POA.
CHECK TOTAL $ 6,490.00
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Goodville Mutual Casualty Company Check Date heck NO.
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625 West Main Street,PO BOX 489 0194114 rl000qAq9q—
New Holland,PA 17557-0489 60-912
Susquehanna Bank 313
Lancaster PA 17604 Check Amount
$******6,490.00
PAY SIX THOUSAND FOUR HUNDRED NINETY DOLLARS &00/100
TO THE ORDER OF
ESTATE OF KENNETH S BARNHART JR DAU4T E S AT RE
_---------2MTH0RT7ED SIGNATURE
11.00005849 & 311• 1:03 1309 L 231: 1 2 3 4 LL. S tie
07oodville Mutual Casualty Company 0000584913
DESCRIPTION CHECK AMOUNT
INSURED: KENNETH S BARNHART JR POLICY NUMBER: PA 745078 $ 6,490.00
POLICY DATES: 3/20/14 TO 9/20/14
CLAIM NUMBER: R 438043 JPC LOSS DATE: 6/10/14
CLAIMANT: KENNETH BARNHART
TYPE OF PAYMENT: PARTIAL PAYMENT
IN PAYMENT OF
Partial settlement of total loss of 6/10/14.
Balance of $1622.50 due upon our receipt of
title, death cert, ltr of executor & POA.
CHECK TOTAL $ 6,490.00
PACIMLIFE
July 8,2014
Kimberly Heavner
M&T Secuft es;Inc
Fax:717-240-4526
Contract(s): FA09020911
Annuitant(s): Kenneth 8 Barnhart Jr
Cwner(s): Kenneth Barnhart Jr
Designated Reciplents(s): Terry l-Barnhart, Ann Owings
Dear Ms.Heavner:
We are writing in response to information requested on the above-referenced contract,
The Accumulated Cash Value as of 6/1012014 was$58,368,09,
If you have any questions, you may contact an Annuity Information Specialist at(600)722-2333,Monday
through Friday from 6 a.m.to 5 p.m., Pacific Time. You may also contact your registered representative
with questions. Neither Pacific Life nor its representatives give tax or legal advice.
Sincerely,
Lorene C Gordon
Vice President,Operations
Retirement Solutions Division
Pacific Life Insurance Company
Retirement Solutions Division
P.O. BOX 2376,Omaha,NE 68103-2378 WWW-Paoilicl-ife,00rn
Securities Distributed by Pacific Select Distributors, Inc.,Member,FINRA&SIPC
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M&—T- Securities,Inc.
288 Delaware Avenue,Suite 2000,Buffalo,NY 14202-1885
July 22,2014
Re:Date of Death"Valuation-Kenneth S.Barnhart,Jr.
To Whom It May Concern,
Enclosed you.will find the date of death valuation for account AZR427446, registered as, IRA FBO
Kenneth S.Barnhart Jr.
This information is obtained from sources believed to be reliable, but no independent verification has
been mads and M&T Securities does not guarantee the accuracy.,
The prices per share on the valuation date differ for each security. Stocks are priced per share based on
the low,high and close. Mutual funds are priced per share at NAV.Fixed income is priced at the bid.
Previous business day price is used if DOD falls on a weekend or holiday.
Please note if the client held an annuity position at the time of death-then the valuation should be obtained
by the carrier.
If you have additional questions regarding this information, please.contact the Client Solutions desk at
(800)724.7788,option C.
Since ,
Dani Oyer
o era Investment Specialist
M&T Securities Inc.
investment and insurance Products: Are NOT Deposita Are NOT FDIC-Insured
F_ Are NOT Insured By Any Faderai Government Agency Have No Bank Guarantee•May Go Down 1n Witte
8roRdmp services and insurance products are offered by M&T 8ecuritlse,Inc.(mrnber FtNFW$IPC),not by M&T Bank,
M&T Saourhies,Inc.Is'Aosnaed as an tnavramo agent and sats as tLitent for Insurer3,insurance poRctas aro oblipatbns or the tnaurgre that issua the-poildes,
Insurenca products may not bo avaftble In Ell states.
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M&T Securities,Inc.
285 Delaware Avenue,Suite 2000,Buffalo,IVY 14202-1885
Date of Death.Holdin s.as'of 0611012014
Account : AZR427446
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Soeurlty Name Quant Historical Price Market Vaiuq
Cash and Equivalents
MA t WILMINGTON-PRIME MMKT SERV SHS I 80.73
Mutual Funds
ABALX AMERICAN BALANCED FUND CLASS A 1,851.390 2$.46 142.298.99
ABNDX THE BOND FUND OF AMERICA CLASS A 2,976.930 $12.71 $37 838.78
WASHINGTON MUTUAL INVESTORS FUND
AWSHX CLASS A 778.530 $41.77 $32,519,071
CWBFX CAPITAL WORLD BOND FUND CLASS A 1,458,250 $20.98 $30,594.06
AGTHX THE GROWTH FUND OF AMERICA CLASS A 492.930 •x48.23 $22,295.00
CAPITAL WORLD GROWTH&INCOME FUND
CWGIX CLASS A, 445.540 $48.04 $21443.69
TOTAL $181,728.3
investment and Insurance Products;,Are NOT Doposlta;•Are NOT FDIC-insured
Are NOT Insured By Any Federal Governmo»t Agency*Have NO Bank Guarantee-May Go Down in value
emkyrage services and insurance products are offered by MAT Socurldes,Inc.(mamber FINRA/SIPQ),not by M&7 Sank.
M&T Securities,Inc,is licensed a&an insuranca agent and acta as agent for insurers.Insurance policies aro atAlffations of the Inmate,that lesus the polioles,
insurance product&may not be aVallable In all states.
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