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HomeMy WebLinkAbout02-05-15 _J 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 20 14 00508 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05132014 11291934 Decedent's Last Name Suffix Decedent's First Name M I s SULLIVAN NANCY C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 0 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 0 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 ❑ 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: F Name Daytime Telephone Number ry CRAIG A . HATCH, ESQ . 717-7311600 :n � rT1 REGISTER,' WILLS USE,ONIL � O Ci rte.; x r r-1 r n First Line of Address , s Ln t 2109 MARKET STREETr, 0 Second Line of Address City or Post Office State ZIP Code '`-'MATE FILED N CAMP HILL PA 17011 Correspondent's e-mail address: C - H A T C H a H H G L L P - C O M 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. SIGNATURE OF P N. ONSIBL OR FILING RETURN DATE ADDRESS r o�) i S 1783 SOUTH MEAD W DRIVE MECHANICSBURG , PA 17055 SIGNATURE OF7PREP �- ` .HAN-REPRESENTATIVE DATE ADDRESS 2109 WARKET STREET CAMP HILL , PA 17011 i PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 1505611185 OM4647 3.000 1505611285 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: SULLIVAN NANCY C RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 104 -1950 - 00 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. 0 . 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. 331296 . 84 6. Jointly Owned Property(Schedule F) F-1 Separate Billing Requested . , , . 6. 0 . 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) 7 Separate Billing Requested . . . . 7. 0 - 00 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8, 138 -,246 - 84 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 291887 - 82 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , . . , , , . 10, 261407 • 01 11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. 56,294 • 83 12, Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12. 81,952 - 01 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13, 0 - 00 14. Net Value Subject to Tax(Line 12 minus Line 13) , , . , , , , . . . 14. 81-1952 - 01 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 . 00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X.05 81 ,952 . 01 16. 3,687 . 84 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. 3-,687 - 84 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT T Side 2 1505611285 1505611285 OM4648 3.000 REV-1540 EX(FI) Page 3 File Number Decedent's Complete Address: 20 14 00508 DECEDENTS NAME SULLIVAN NANCY C STREET ADDRESS 1908 LETCHWORTH DRIVE CUMBERLAND CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 3,68? . 84 2. Credits/Payments A. Prior Payments 61000 - 00 B. Discount 184 - 39 Total Credits A+B (2) 61l84 - 39 3. Interest (3) 0 . 00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund, (4) 2,496 - 55 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0 . 00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . 1:1 y b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . Rx� c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El Qx� 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? FRI 4. Did decedent own an individual retirement account,annuity,or other non-probate property,which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 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 orafter July 1,1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to orfor the use ofthe surviving spouse is percent[72 P.S.§9116(a)(1.1)(1)). 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 172 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. OM4671 2.000 REV-9542 EX+(12-92) SCHEDULE A Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Nancy C Sullivan 20 14 00508 All real property owned solely or as a tenant in common must be reported atfair 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 DESCRIPTION OF DEATH 1. Real Estate located at 1908 Letchworth Drive, Camp Hill, PA 17011 104,950.00 There were 2 appraisals done for the real estate (first appraisal is $120,000 and second appraisal is $89,900) . Balance as of date of death is the average of both appraisals. TOTAL (Also enter on Line 1,Recapitulation.) $ 104,950.00 2W4695 2.444 If more space is needed,use additional sheets of paper of the same size. REV-1508 EX-(08-12) Pennsylvania SCHEDULE E DEPARTMENTOF REVENUE CASH, BANK DEPOSITS&MISC. INHERITANCE TAX RESIDENT DECEDENTRETURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Nancy C. Sullivan 20 14 00508 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. PNC Checking Account Number 5140063057 12,431.33 2 PNC Savings Account Number 5130127539 1,693.98 3 M&T Bank Checking Account Number 82832447 9,999.56 Thomas J. Sullivan was listed as joint owner of account, Thomas J. Sullivan predeceased Nancy Sullivan on April 2, 2014 4 2010 Ford Fusion (SOLD) 8,500.00 5 Travelers Insurance (insurance claim refund) 462.69 6 Highmark (refund) 209.28 TOTAL(Also enter on line 5,Recapitulation) $ 33,296.84 2W46AD 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX-(08-13) pennsylvania SCHEDULE H DEPARTMENTOF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Nancy C. Sullivan 2014 00508 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Giant Food (food for funeral luncheon) 125.08 Total from continuation schedules . . . . . . . . . 907.04 B. ADMINISTRATIVE COSTS: 1 Personal Representative Commissions: 6,000.00 Name(s)of Personal Representative(s)Kenneth L. Kostelac, Sr. Street Address 1783 South Meadow Drive City Mechanicsburg State PA ZIP 17055 Year(s)Commission Paid:2015 2. Attorney Fees: 7,000.00 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: 383.50 5, Accountant Fees: 6. Tax Return Preparer Fees: T 1 Stanley Steamer (carpet cleaning) 104. 94 2 UGI (utility bill) 687.08 Total from continuation schedules . . . . . . . . . 14,680.18 TOTAL(Also enter on Line 9,Recapitulation) $ 29,887.82 3W46AG 2,000 If more space is needed,use additional sheets of paper of the same size. Estate of: Nancy C. Sullivan 20 14 00508 Schedule H Part I (Page 2) Item No. Description Amount 2 L'Koste Villa Restaurant (cake for funeral luncheon) 50.00 3 Stephen Stringer(music for funeral) 200.00 4 Msgr. King (funeral mass) 125.00 5 Zimmerman Auer Funeral Home, Inc. (cremation service) 532.04 Total (Carry forward to main schedule) 907.04 Estate of: Nancy C. Sullivan 20 14 00508 Schedule H Part 7 (Page 2) 3 Sherwin Williams Paint (paint for house) 87.51 4 Haller AC/HVAC (repairs) 74.00 5 PP&L (utility bill) 251.12 6 C&C Plumbing (plumbing repairs) 185.00 7 Pennsylvania American Water (utility bill) 456.48 8 Lower Allen Township (sewer and trash bills) 374.47 9 Lititz Mutual Insurance (umbrella insurance policy) 250.00 10 Ken Kostelac (reimbursement for expenses and bills paid) 7,488.01 11 Appraisal Solutions (appraisal for 1908 Letchworth Drive, Camp Hill, PA) 350.00 12 Kmart (landscaping supplies) 72.32 13 Ed Hoffman (drywall for house) 850.00 14 M.C. Walker Realty (appraisal for 1908 Letchworth Drive, Camp Hill, PA) 200.00 is Republic Waste (dumpster rental) 5.62 16 Bonnie Miller, Tax Collector (real estate tax and per capita tax) 1,513.93 17 Travelers Insurance (homeowners insurance) 961.00 18 Cumberland Law Journal (estate publication notice to creditors) 75.00 19 The Patriot News (estate publication notice to creditors) 246. 90 20 Susan L. Kostelac (reimbursement for home improvement expenses for 1908 Letchworth Drive) 1,138.82 21 Lenker's Tree Service (removal of broken branch over house) 100.00 Total (Carry forward to main schedule) 14,680.18 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 Nancy C. Sullivan 20 14 00508 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• M&T Bank Installment Loan Number 12044446798194998 Installment Loan has two portions, a variable rate portion and a term portion. Balance on date of death is variable loan portion which had a 0 balance. Current Balance is the term portion of the loan which had a balance of $26,005.44 as of date of death. 26,005.44 2 Verizon (phone and cable) 164.91 3 AT&T (cell phone bill) 49.20 4 Association of Kidney Disease (medical bill) 38.33 5 PP&L (electric bill) 149.13 TOTAL(Also enter on Line 10,Recapitulation) $ 26,407.01 2W46AH 2.000 If more space is needed,insert additional sheets of the same size. PHOTOCOPY OF THE CERTIFIED DEATH CERTIFICATE H105.805 REV(9111) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 - This is to certify that the information here given �SNOfp"' correctly copied from an original Certificate of Dea duly filed with me as Local Registrar. The origin w- za certificate will be forwarded to the State Vit Records Office for permanent filing. P 20734644 ��99T�1ENT OF��P�;( l 0- Certification Number '../"jJIII'/I)Il Local egistrar Date Issued Type/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH VITAL RECORDS Permanent CERTIFICATE OF DEATH Bl.ek Ink State Fila Number: 1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Date of Death(Mo/Day/Yr)(Spell Mo) NancyCar 11 Sullivan Female 200-26-8154 May 13, 2014 Sa.Age-Last Birthday(Yrs) 15b.under 1 Year Sc.Under 1 Day S.Oeste of Birth(Mo/Day/Year)(Spell Month) 7a.Birthplace(Glty and States or Foreign Country) Months Days Hours Minutes Mount Jo Panna lvania 79 November 29, 1934 7b.Blrthplace(county) Lancaster Be.Residence(State or Foreign Country) ab.Residence(Street and Number-Include Apt No.) 8c.Did Decedent Live In a Townshlp? Pennsylvania 1908 Letchworth Drive 93 Yes,decedent lived l n Lower Allen twp. 8d.Residence(County) I .. ma Cuberind - Be.Residence(Zip Code) 17011 0 No,decedent lived within limits ofcity/born. 9.Ever in US ArmedForces? 10.Marital Status at Time of Death 0 Marled ® Wltlowed il.Surviving Spouse's Name(H-if.,give name Prior to first marriage) 0 Yes IM No Unknown I__3 Divorced 0 Never Married 0 Unknow 12.Father's Name(First,Middle,Last,Suffix) 1 13.Mother's Name Prior to First Marriage(First,Middle,Last) Charles . Ashen£elter, Sr. Clara B. Aston 14a.Informant's Nome 14b.Relationship to Decedent 14c.Informant's Malting Address(Sheat and Number,City,State,21p Code) Susan ICostelac Daughter 3.783 S. Meadow Drive, Mechanicsburg, PA 17055 C - _ __ -- ____ _ Ise- ace o eat ee IW Yone _ _-__ - __ - _ If Death Occurred Ina Hospital: Cl inpatient Ili desth Occurred Somewhere Other Than a Hospital ❑Hospice FaUllty �Decedent's Home O Emariancy Room/Outp.tient C3 O.sd on Arrival 1-3 Nursing Home/Long-Term Care Facility O Other(Specify) 1Sb.Facility Nam.(If not instltu<lon,give sheet and number) 11 Se.CIN or Town,State,and ZIP Code 15d.County of Death 1908 Letchworth Drive Camp Hill, Pennsylvania 17013. Cumberland 16a.Method of Disposition 0 Burial ® Cremation 16b.Date of Disposition i6c.Place of Disposition(Name of cemetery,crematory,or other place) 0 Pe,;oval from State 0 Donation ocher(specify) 05/16/2014 Cremation Society of Pennsylvania 16d.Location of Disposition(City or Town,State,and Zip) 170.Si nature of a Service n on'In Char of Interment 17b.License Number Harrisburg, Pennsylvania 17109 FD 138940 E 17e.Name and Complete Address of Funeral Facility 8 Auer Cremation Services of Pennsylvania Inc. 100 Jonestown Road, Harrisb g, A 17109 18.Decedent's Education-Check the box that best describes the 19.Decedent of Hispanic Origin-Check the 20.Dac Race-C eekONE OR MORE res es to indicate what highest degree or level of school completed at the time of death. box that best describes whether the decadent the decedent considerehimself or herself to be. 0 8th grade or less Is Spanish/Hilpanlc/Latlnc. Check the"No" P9White 0 Korean 0r./No diploma,9th-12th grade box If decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese f",High school graduate or GED Completed 0 No.not Spanish/Hisp.nic/Latino 0 American Indian or Alaska Native 0 Ocher Aslan 0 Some college credit,but no degree 0 Yes,Mexican.Mexican American,Chicano 0 Aslan Intllan 0 Native Hawaiian 0 Associate degree(e.g.AA,AS) 0 Yes,Puerto Rican 0 Chinese 0 Guamanian or Chamorro 0 Bachelor's degree(e.g.BA,AB.BS) 0 Yes,Cuban 0 Filipino 0 Samoan 0 Master's degree(e.g.MA,MS,MEng,MEd,MSW,MBA) 0 Yes,other Spontzh/Hlspanlc/Latino 0 Japanese 0 Other Pacific Islander 0 Doctorate(e.g.PhD,EdD)or Professional degree (Specify) 1-3 Other(Specify) .MD DDS DVM LL..,.) 21.�,Dfecedent's Single Race Self-Designation-Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 228.Decedent's Usual Occupation-Indicate type of work P White D_Jap ...so 0S. done during most of working life. DO NOT USE RETIRED. 0 Blackor African American 0 Korean 0 Other Pacific Islander Director Of Operations & Educatio 0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure 0 Aslan Indian 0 Other Aslan 0 Refused 22b.Kind of Business/Intlustry 0 Chinese 0 Native Ha II.n 0 Other(Specify) 2$ 0 Filipino O Guamanian or Chamorro PA Podiatric Medical Assn. ITEMS 238-23d MUST SE COMPLETED 230.Data P onounced Dea Mo Day 23b. nature of Person Pronouncing Oeath Only w en applicable 23c.License Number BY PERSON WHO PRONOUNCES OR �- vv CERTIFIES DEATH J 23d. ate SI netl M /O y/Vr) 24.TI o Death 25.Was Medical Examiner or Coron ntacted? Yes 0 No CAUSE OF DEATH : Approximate 26.Part 1. Enter the chain of ev s--diseases,Injuries,or complications--that directly caused the death. DO NOT enter terminal events such ascardiac arrest, I Interval: resplratory arrest,or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line.Add additional lines if necessary. I Onset to Death end s-rocx v-e_y c'i� IMMEDIATE CAUSE -----------> a. 1 (Final disease or condition Oue to(or as a consequence of): 1 resulting In death) - b. Sequentially list conditions, Due to(or as a consequence of): I if any,leading to the cause I listed on line a. Enter the [ UNDERLYING CAUSE Due to(or as s consequence of): (disease or Injury that ' W in iti.eed the events resulting d. In death)LAST. Due to(or as Is consequence of): )g 26.Part 11. Enter other ontributinR to death but not resulting in the underlying cause given in Part 1. 27.Was aautopsy pTr-.d? On Yes No 28.Were autopsy findings available to complete the cause f death? m O Yes it.3 29.If Female: 30.Old Tobacco Use Contribute to Death? 31.Manner of Death o Not pregnant within past Ye.r Yes 0 Probably Natural 0 Homicide Pregnant at time of death 0 No 0 Unknown -W. Ac. 0 Pending Investigation 1_3 Not pregnant,but pregnant within 42 days of death Suieitle 0 Could not he determined 0 Not pregnant,but pregnant 43 days to 1 year before death 32.Data of Injury(Mo/Day/Yr)(Spell Month) 0 Unknown if pregnant within the past year 33.Time of Injury 34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of Injury(Street and Number,City,County,State,Zip Code) 36.Injury at Work 137.If Transportation Injury,Specify: 38.Describe How Injury Occurred: 0Yes 0 Driver/Operator 0 Pedestrian 0 No 0 Passenger 0 Other(Specify) 39a.Certifier-physician,certified nurse practitloner,medical a miner/co er(Check only In.): ga-<rtifying only-To the best of my knowledge,death occurred due to the uuse(s)and manner.-ted. 0 Pro nouncing&Certifying-To the best of my knowledge,death occurred at the time.date,and place,and due to the cause(s)and manner stated. 0 Modlcal Examiner/Caro e -On the basis nation antl/or investig.tlon,In my opinion,death occurred at The time,date,and plate,and due to the cfa�usrre-(��s)and manner stoted. Signature of c<'If, Title of certifier License Number: 6 1/(7g V�to L_ t 39 .Name,Address antl mp Cotle of Person seting Cause of Death('iqm 26) !� 39c.Date S�ed( o/ y r) u7 a Intl 40.Registrar's District Number 4 egistrar's Slgnaturo 1 ash l/ { 43.Amendments 2 ]�� /^ � EV 07/20 Disposition Permit No. C-JrJ(!J REV 07/2012 LAST WILL AND TESTAMENT LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN I, NANCY C. SULLIVAN,now of 1908 Letchworth Drive, Camp Hill, Cumberland County, Pennsylvania, 17011, do publish and declare this to be my Last Will and Testament, hereby revoking all other prior wills and codicils made by me. FIRST: Family Background and Appointment of Executor. (A) Family andBackground Information. I am married to THOMAS J. SULLIVAN. Our children are NANCIE C. MENAPACE,SUSAN L.KOSTELAC and JENINE A.BRINTON. Throughout this will, THOMAS J. SULLIVAN will be referred to as "my husband" or "my spouse" and NANCIE C.MENAPACE,SUSAN L.KOSTELAC and JENINE A.BRINTON will be referred to as "my children." The word "issue" will include my children as well as my other descendants. I decline to make distribution or provision for my daughter,JENINE A.BRINTON. (B) Appointment of Executor. I appoint as my Executor and successor Executors (all hereinafter referred to as Executor)under this Will,the following named persons to serve without bond and without being required to account to any Court: Executor: My son-in-law, KENNETH L. KOSTELAC,SR. Successor Executors: My daughter, NANCIE C. MENAPACE, and my daughter, SUSAN L.KOSTELAC,to act jointly or individually.. SECOND: Funeral and Last Illness Expenses; Taxes. (A) Expenses of Funeral and Last Illness. Notwithstanding that my husband, THOMAS J. SULLIVAN, survives me, I direct my Executor to pay my funeral expenses and the expenses of my last illness from my estate. (B) Taxes. I direct my Executor to pay any and all estate, inheritance, succession, legacy, transfer and other death taxes or duties, by whatever name called, including any and all interest and penalties thereon, imposed under the laws of any jurisdiction by reason of my death upon or with respect to any and all property included in my gross estate for the purpose of such LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN PAGE 2 taxes, whether such property passes under or outside of this Will. Without any apportionment otherwise required by law and without being prorated or apportioned among or charged against the respective devises, legatees, beneficiaries, transferees, or other recipients of any such property or charged against any property passing or which may have passed to any of them, I direct that any taxes so paid shall be charged against my residuary estate. My Executor shall not be entitled to reimbursement for any portion of any such taxes from any such person. THIRD: Tangible Personal Property. Except for those items enumerated in the Letter of Instruction, I bequeath all my tangible personal property, including but not limited to clothing, jewelry, heirlooms, furniture, household furnishings,personal effects, motor vehicles, and all other similar articles,which I own, and the insurance thereon,to my daughter, NANCIE C. MENAPACE and my daughter, SUSAN L.KOSTELAC,per stirpes, to be divided among them as they shall select in as nearly equal shares as is practical. Tangible personal property shall not include: (1) any and all property used by me in any business, (2)cash on hand or on deposit in banks, (3) stock or securities, (4) any type of evidence of indebtedness, and (5) any life,health or accident insurance policies. If there is any disagreement as to distribution, I direct my Executor to make such distribution. The decision of my Executor shall be final and binding. Any items not selected or any items which my Executor considers unsuitable for my children may be distributed or sold in the sole discretion of my Executor and, if sold,the net proceeds therefrom shall be added to the residue of my estate. Any such article allocated to a minor may, as my Executor deems advisable, either be delivered to the minor or to any person to safeguard on behalf of the minor. Notwithstanding any other provisions in this Article THIRD, I may leave a separate, dated and unsigned Letter of Instruction,which I shall place with my Will, containing directions as to the ultimate disposition of certain of the property bequeathed under this Article THIRD, and such Letter of Instruction shall determine the distribution of such items. FOURTH: Residuary Estate. I devise and bequeath all of the rest, residue and remainder of my estate,real, personal and mixed, of whatever nature and wherever situated to which I am legally or equitably entitled,to my daughter, NANCIE C. MENAPACE and my daughter, SUSAN L.KOSTELAC, in equal shares,per stirpes. If and in the event that either of my daughters,NANCIE C.MENAPACE and SUSAN L. KOSTELAC,predecease me with9ut LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN PAGE 3 leaving surviving issue,then I leave the rest, residue and remainder of my estate to the survivor of NANCIE C.MENAPACE and SUSAN L. KOSTELAC,per stipes. By this Will, I have made the decision to exclude my husband, THOMAS J. SULLIVAN, from a share in my estate. FIFTH: Powers of Executor. In addition to the powers and duties as may have been granted elsewhere in this Will, but subject to any limitations stated elsewhere in this Will, the Executor shall have and exercise exclusive management and control of the Estate and shall be vested with the following specific powers and discretion, in addition to the powers as may be generally conferred from time to time upon the Executor by law: (A) In the management, care and disposition of the Estate, the Executor shall have the power to do all things and to execute such instruments, deeds, or other documents as may be deemed necessary or proper, including the following powers, all of which may be exercised without order of or report to any Court: (1) To sell, exchange or otherwise dispose of any property at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Estate, and to grant options, including any option for a period beyond the duration of the Estate. (2) To invest all monies in such stocks, bonds, securities, mortgages, notes, choses in action, real estate or improvements thereon, and any other property as the Executor may deem best, without regard to any law now or hereafter enforced limiting investments of fiduciaries. (3) To retain for investment any property deposited with the Executor hereunder. (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security. LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN PAGE 4 (5) To use attorneys, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand by or against the Estate and to agree to any rescission or modification of any contract or agreement affecting the Estate. (7) To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Estate. (8) To retain and carry on any business in which the Estate may acquire an interest, to acquire additional interest in any such business, to agree to the liquidation in kind of any corporation in which the Estate may have an interest and to carry on the business thereof, to join with other owners in adopting any form of management for any business or property in which the Estate may have an interest,to become or remain a partner, general or limited, in regard to any such business or property and to hold the stock or other securities as an investment, and to employ agents and confer on them authority to manage and operate the business,property or corporation, without liability for the acts of such agent or for any loss, liability or indebtedness of such business if the management is selected or retained with reasonable care. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that such security is a Estate asset and the Executor shall be responsible for the acts of such nominee. (B) Whenever the Executor is directed to distribute any Estate assets in fee simple to a person who is then under twenty-one (2 1) years of age,the Executor shall be authorized to hold such property in Trust for such person until he/she becomes twenty-one (2 1)years of age, and in the meantime shall use such part of the income and the principal of the Estate as the Executor may deem necessary to provide for the proper support and education of such person. If such person should die before becoming twenty-one (2 1)years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN PAGE 5 (C) In making distributions from the Estate to or for the benefit of any minor or other person under a legal disability, the Executor need not require the appointment of a guardian, but shall be authorized to pay or deliver the same to the custodian of such person, to pay or deliver the same to such person without the intervention of a guardian, to pay or deliver the same to a legal guardian of such person if one has already been appointed, or to use the same for the benefit of such person. (D) In the disbursement of the Estate and any division into separate trusts or shares, the Executor shall be authorized to make the distribution and division in money or in kind, or both,regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Executor shall be binding and conclusive on all persons taking hereunder. The Executor may in making such distribution or division allot undivided interests in the same property to several trusts or shares. (E) The Executor shall be authorized to lend or borrow, including the right to lend to or borrow from any trusts which I or my husband may have established during life or by will at an adequate rate of interest and with adequate security, and upon such terms and conditions as the Executor shall deem fair and equitable. (F) The Executor shall be authorized to sell or purchase at the fair market value as determined by the Executor, any property to or from any trust created by me or my husband during life or by Will, even though the same person or corporation may be acting as Executor of my estate or as Trustee of any of my other trusts. (G) The Executor shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal as the Executor may deem equitable and fair under all the circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal,to treat any dividend or other distribution of any investment as income or principal, or apportion the same between income and principal,to charge any expense against income or principal or apportion the same, and to provide or fail to LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN PAGE 6 provide a reasonable reserve against depreciation or obsolescence on any assets subject to depreciation or obsolescence, all as the Executor may reasonably deem equitable and just under all the circumstances. If the Executor does not exercise the above discretionary power, the cash or accrual allocation shall be in accordance with Chapter 81 of Title 20 of the Pennsylvania Consolidated Statutes, or the corresponding provisions of subsequent state law. (H) If at any time the total fair market value of the assets of any trust established or to be established hereunder is so small that the corporate Trustee's annual fee for administering the trust would be the minimum annual fee set forth in the Trustee's regularly published fee schedule then, in effect,the Trustee in its discretion shall be authorized to terminate such trust or to decide not to establish such trust, and in such event the property then held in or to be distributed to such trust shall be distributed to the persons who are then or would be entitled to the income of such trust. If the amount of income to be received by such persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee in its discretion shall determine. (11) Except as otherwise provided in this Will, when the authority and power under this Will is vested in two (2) or more Executors or Trustees,the authority and powers are to be held jointly by the Executors or Trustees, respectively. A majority of the Executors or Trustees may exercise any authority or power granted under this Will or granted by law, and may act under this Will. Any attempt by one such Executor or Trustee to act under this Will on other than ministerial acts shall be void. The action of one such Executor or Trustee under this Will may be validated by a subsequent ratification of the act by a majority of the Executors or Trustees. SIXTH: Rights and Liabilities of Executor. (A) No bond or other security shall be required of any Executor. (B) This instrument always shall be construed in favor of the validity of any act or omission by any Executor, and any Executor shall not be liable for any act or omission except in the case of gross negligence, bad faith or fraud. Specifically, in assessing the propriety of any investment,the overall performance of the entire Estate shall be taken into account. �' LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN PAGE 7 (C) Each Executor shall be entitled to receive reasonable compensation for services actually rendered to my estate, in an amount the Executor normally and customarily charges for performing similar services during the time which he/she performs the services. SEVENTH: Spendthrift Provision. No beneficiary shall have the power to anticipate, encumber or transfer his or her interest in the estate in any manner other than by the valid exercise of a power of appointment. No part of the estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. EIGHTH: Tax Elections. (A) In determining the estate, inheritance and income tax liability relating to my Estate, the Executor's decision as to all available tax elections shall be conclusive on all concerned. If the Executor joins with my husband in filing income tax returns, or consenting for gift tax purposes to having gifts made by either of us during my life considered as having been made one-half by each of us, any resulting liability shall be borne by my Estate and my husband in such proportions as they may agree. In accordance with IRC Section 2632(a) and without regard to whether a Federal estate tax return is actually filed, my Executor shall allocate so much of the Federal Generation Skipping Transfer(GST) exemption amount as will fully exempt any generation skipping transfer which may occur under this Will. (B) The Executor may, in its discretion, determine the date as of which my gross estate shall be valued for the purpose of determining the applicable tax payable by reason of my death. (C) The Executor may, in its discretion, decide whether all or any part of certain deductions shall be taken as income tax deductions (even though they may equal or exceed the taxable income of my estate and whether or not claimed or of benefit on my estate's income tax return) or as estate tax deductions when a choice is available; and in the event that all or any part of such deductions are taken as income tax deductions, no adjustment of income and principal accounts in my estate shall be made as a result of such decisions. NINTH: Defmitions and General Provisions. ��,� LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN PAGE 8 (A) Survival. Any beneficiary who dies within sixty (60) days after my death shall be considered not to have survived me. (B) Captions. The captions set forth in this Will at the beginning of the various articles hereof are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. (C) Children. As used in this Will, the words "child" and "children" shall include persons who are legally adopted and the issue of said persons, whether born in or out of wedlock, so long as any person born out of wedlock is acknowledged in a written instrument executed by the one of their natural parents who is a descendant of mine to be the child of said descendant. The word "issue" shall include descendants of all generations including adopted persons. A posthumous child shall be considered as living at the death of his parent. The birth to me or the adoption by me of a child or children subsequent to the execution of this Will shall not operate to revoke this Will. Except for discretionary distributions which may be made unequally among a group of persons and distributions pursuant to a valid exercise of a power of appointment, in making a distribution to the children of any person, the property to be distributed shall be divided into as many shares as there are living children of the person and deceased children of the person who left children who are then living. Each living child shall take one share and the share of each deceased child shall be divided among his then-living descendants in the same manner. (D) Code. Unless otherwise stated, all references in my Will to section and chapter numbers are to those of the Internal Revenue Code of 1986, as amended, or the corresponding provisions of any subsequent federal tax laws applicable to my estate. (E) Other terms. The use of any gender includes the other genders, and the use of either the singular or the plural includes the other. (F) Powers of Appointment are Exercised. By this Will I exercise any and all Powers of Appointment which I possess at the time of my death. LAST WILL AND TESTAMENT OF NANCY C. SULLIVAN PAGE 9 IN WITNESS WHEREOF,I, NANCY C. SULLIVAN, the Testatrix, have to this my Last Will and Testament, typewritten on ten (10)pages, including the Acknowledgment and Affidavit, set my hand and seal this"�_L-�.,,4ay of April, 2010. NANCY C. SULL Signed, sealed,published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, in the presence of the said Testatrix, and in the presence of each other. Each of us further declares that he or she believes the Testatrix to be of sound mind and memory. The preceding instrument consists of this and nine (9) other consecutively numbered typewritten pages including the Acknowledgment and Affidavit. ,y residing at (print name) residing at a t?f (print name) ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF The Testatrix and the witnesses whose names are signed and subscribed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge, depose and say to the undersigned authority, that the Testatrix signed and executed the instrument as her Last Will in the presence of the witnesses; that she signed it willingly or willingly directed another to sign it for her;that she executed it as her free and voluntary act for the purposes therein expressed; that each of the witnesses were present and saw the Testatrix sign and execute the instrument as her Last Will; that each subscribing witness in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. `~• TesTwix Witness Witness Sworn to or affirmed, subscribed to, and acknowledged, before me by the above-named Testatrix and witnesses, this day of April, 2010. __..,.. COMMONWEALTH OF PENNSYLVANIA Notarial Seal , Teri L Walker,Notary Public r ' Notary Pub Lemoyne Soro,Cumberland County i' My Cgrilmission Expires: my commission Expires Jan.20,209 9 f ✓. ; Member.Pennsyivania Association of Notaries CERTIFICATE of GRANT of LETTERS COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND rt 11 LISA M. GRAYSON, ESQ. Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 23rd day of May, Two Thousand and Fourteen, Letters TESTAMENTARY 0 in common form were granted by the Register of said County, on the estate of NANCY C SULLIVAN late of LOWER ALLEN TOWNSHIP (First,Middle,Last) in said county, deceased, to KENNETH L KOSTELAC (First,Middle,test) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 23rd day of May Two Thousand and Fourteen. File No. 2014- 00508 PA Fi 1 e No. 21- 14- 0508 Date of Death 511312014 S. S. # Register OfWiz, /D/"t� Deputy " 7 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL PA REV-1500 SCHEDULE A REAL ESTATE OFFICIAL NOTICE PAGE ONE (1) COMPARATIVE MARKET ANALYSIS FOR THE PROPERTY LOCATED AT: 1908 Letchworth Drive,Cama Hill,PA 17011 STREET MAILING ADDRESS, CITY, STATE, ZIP CODE Lower Allen Township—West Shore MUNICIPALITY-------SCHOOL DISTRICT Act 112, effective November 25, 1999, is the only legislation in Pennsylvania that describes/defines `comparative market analysis'. As such, a comparative market analysis must contain the following statement printed conspicuously and without change on the first page: "THIS ANALYSIS HAS NOT BEEN PERFORMED IN ACCORDANCE WITH THE UNIFORM STANDARDS OF PROFESSIONAL APPRAISAL PRACTICE WHICH REQUIRES VALUERS TO ACT AS UNBIASED, DISINTERESTED THIRD PARTIES WITH IMPARTIALITY, OBJECTIVITY, INDEPENDENCE AND WITHOUT ACCOMMODATION OF PERSONAL INTEREST. IT IS NOT TO BE CONSTRUED AS AN APPRAISAL AND MAY NOT BE USED AS SUCH FOR ANY PURPOSE." CMA PREPARED BY: Christine Walker Skozilas, Salesperson M. C. WALKER REALTY 14 NORTH WALNUT STREET, MECHANICSBURG, PA 17055 m-c. WALKER REALTY 14 North Walnut Street Mechanicsburg, Pennsylvania 17055 Phone: (71,7) 697-9487 Fax: (717)'697-9480 www.mcwaiker.com walkerrealty@pa.net A SYMBOL OF REALTY EXCELLENCE -Page 2 7/17/2014 Mr. and Mrs. Kenneth Kostelac 1783 South Meadow Drive Mechanicsburg, PA 17055 Dear Mr. and Mrs. Kostelac, I, Christine Walker Skozilas, do hereby state that upon your request, I have made an investigation and analysis of the following described property: 1908 Letchworth Drive, Camp Hill,PA 17011 Parcel#: 13-23-054-7201 And that I am of the opinion that the market value of the land and improvements thereon is: $89,900.00 I further state that,to the best of my knowledge and belief,the evaluation contained in this comparative market analysis report is correct. The physical condition of the improvements described herein was based on visual inspection. Respectfully submitted, Christine W. Skozilas, Broker MEMBER-CENTRAL PENN MULTI-LIST, INC. 9 Main Fie No.14-Kostelac P e#1 APPRAISAL OF REAL PROPERTY LOCATED AT: 1908 Letchworth Dr Documem:201320643 Camp Hill,PA 17011 FOR: Nancy C Sullivan Estate 1908 Letchworth Dr,Camp Hill,PA 17011 AS OF: 05/13!2014-Retrospective BX: Appraisal Sobrtions Brett Lechthaler,PA Certified General Appraiser 16 San Juan Drive Wchanicsburg,PA 17055 Ferm GM—WnTOTAV appraisal sothvane by a la mode,inc.—1-MALAMODE IMaln Fie No.14-Kastelacl Page#3 SUMMARY OF SALIENT FEATURES Sutject Address 1909 Letchworth Dr Leo Dextipfon Document:201320643 City Camp Hill County Cumberland State PA bp Cade 17011 Celsus Tract 0110.02 Map Reference Metro:2848/13-4 Sale Nce $NA Date of Sale NA Bonower/Clent NA Lender Narxy C Sullivan Estate Sim(Square Feel) 1,590 Price per Square Foot $ Location Average Age 59 Condition Average To1N Roans 6 Be morns 4 Baft 2.0 Appraiser Brett Lechtl aler,PA State Cert Gen Appr Date of Appraised Value 05/13/2014 Final Estimate of Value $120,000 Form SSD—WnTOTAI'appraisal software by a 12 mode,inc.—1-800-ALAMODE WA Fie W 14-Kostekclfte#21 He No.14-Ymstelac August 03, 2014 Appraisal Solutions 16 San Juan Drive Mechanicsburg, PA 17055 717-697-1828 The accompanying Appraisal Report is based on a site inspection of improvements, investigation of the subject neighborhood area of influence, and review of sales, cost, and income data for similar properties. I have performed no services, as an appraiser or in any other capacity, regarding the property that is the subject of this report within the three-year period immediately preceding acceptance of this assignment. This appraisal has been made with particular attention paid to applicable value-influencing economic conditions and has been processed in accordance with nationally recognized appraisal guidelines. The value conclusions stated herein are as of the effective date as stated in the body of the appraisal, and contingent upon the certification and limiting conditions attached. Please do not hesitate to contact me if I can be of additional service to you. Respectfully, Brett Lechthaler, PA State Certified General Appraiser Fam MIR--I.WiTO IAL'aooraism software by a f mods in.—1-WD-ALAMODE PA REV-1500 SCHEDULE E CASH, BANK DEPOSITS & MISCELLANEOUS PERSONAL PROPERTY -Jul. 18. 2014 7: 15AM PNC Bank No, 7998 P. 1 PN C LEAb1.NG THE'W,kY July 18;2014 Traci L Hilferding Halbruner Hatch& Guise LLP 2109 Market St Camp Hill, PA 17011 RE: Nancy C Sullivan SSN: 200-26-8154 DOD: 05-13-2014 Dear Sir/1\4adam: In response to your request for Date of Death (DOD)balances for the customer nosed above, our records show the following: Checking Account Account# 5140063057 Established: 09-01-1972 NANCY C SULLIVAN DOD balance` S 12,431.33 + 0.00 accrued interest Interesi paid 01-01-2014 thru 05-13-2014 S 0.13 YTD Savings Account Account# 5130127539 Established: 11-01-1982 NANCY C SULLIVAN DOD balance: S 1,693.98 + 0.00 accrued interest Interest paid 01-01-2014 thr .05-13-2014 S 0.07 YTD Please note that This office provides date of death balances for deposit accounts(IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements, If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC Page 1 of 2 Jul, 18. 2014 7: 15AM PNC Bank No, 7998 P. 2 This message is intendedfor the use of the individual or entity to which it is addressed and may containn information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited, .If you have received this communication in error,please note me immediately by reply or by telephone at 800-762-1775 and immediately destroy chis faxed document. Page 2 of 2 M M&TBank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-5024349 F ax (302)934-2955 July 14,2014 Law Offices Of Halbruner,Hatch & Guise, LLP 2109 Market Street Camp Hill,PA 17011 Re: Estate of Nancy C. Sullivan Social Security: 200-26-8154 Date of Death: May 13,2014 Dear Sir or Madam: Per your inquiry on July 03,2014,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 82832447 Ownership(Names qfi Nancy C Sullivan Thomas J.Sullivan Opening Date 08128/1964 Balance on Date of Death $ 9,999.56 Accrued Interest $ .02 ............................................................................................................ Total $9,999.58 2. Type of Account Installment Loan Account Number 12044446798194998 Ownership(Names of) Nancy C.Sullivan(co-borrower) Thomas J.Sullivan(borrower) Opening Date 11/22/2005 Balance on Date of Death $0.00**This amount is not to be used for payoff purposes. For a payoff balance {� please call 1-800-724-2440 ,P� Current Balance $ 26005.44 **This balance is not a payoff balance r c" For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the West Shore Plaza at 717-731-1730. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement Sincerely, Valarie Mercer Adjustment Services CRe�cei Sale eiplt o�fale of 2 'OT6—ra`Fu-sI-6—n --) December 5,2014 This letter serves as a receipt of sale of a 2010 Ford Fusion,VIN 3FAHPOHA6AR169734,by Kenneth L. Kostelac Sr. Exectutor of the estate of Nancy C Sullivan,to Susan L. Kostelac. Condition of Auto: Fair- Mechanically sound but has been in (3 )three accidents. Price:$8500.00 Paid in Full to the Estate of Nancy C.Sullivan. Check#2018 Kenneth L. Kostelac Sr. Extr. CC;file Attorney Hatch z KENNETH L KOSTELAC 60-82242313 2018 SUSAN L KOSTELAC 0045220336 PH.717-691-0347 �� [ 1783 S MEADOW DR. DATE MECHANICSBURG,PA 17055-51190 PAYTO �tdY�Y+.tTlt'L�.k(�SfG�!/T.SQ �jj�Tb,i,ry�y -'V ?7!E ORDER OF DOLLARS 8 } G vLnt.:v. S5. MEMBERS In FEDERALCit£DR WIQV 51ccLaaia6nfE,YA 11615 1. 231382241+: 004122033 2018 _... In CERTIFICATE OF TITLE FOR A VEHICLE } r }7 347 : p~ �5� C392I��i:3�fQl3f31,6781 LIQ1 = 3FAHPEEHA6AR1:6�I?3.4 2D10 . FORD 6741;=5C3H9D1 Sit VEHICLE IDENTIFICATION rdU.taER YEAR MAKE OF VEHICLE I TITLE NUMISSR 'ZDN1 8l'07 D9 IIQ©flit& D BODY TYPE - DUP SEAT CAP PRIOR TITL'c STATE ! ODOfi-PROCD.DATE ODMI.fAiLES. ODOi 1 STATUS l 8/071119 8/137/39 DATE PA TITLED DATE OF ISSUE UNLADEN WEIGHT Gl^'vJR � R GCWR TITLE BRANDS f F' ODOMETER STATUS '• f} - 0=ACTUAL Ir1LEACE • I MILEAGE EYCEEDS THE IACCHANICAL • - LIMITS .• 2=NOT THE ACTUAL MILEAGE �t 3;NGT THE ACTUAL LIILEAGE•OOCIASTER TAh1PERIUG VERs,m { d=EXEYBT FR.IA.I1.TER DISCLOSURE OWNERSHIP WITH RZG.HT�:�.�{?.F, SURVIVOR qq ,. L REGISTERED OWNER(S) TITLE BRANDS .�. .,L .. ,• A=ANTIQUE VEHICLE /��{ q - C=CLASSIC VEHICLE ' NANCY C & THOMAS sf !t l': '.;,;•;..t'; D=COLLECTIBLE VEHICLE F=OUT OF • s ttCt�T Y AN = COUNTRY v=DN LT-ryiU . DISTRIBUTION H=AGRICULTURALVEHICLE 19I38 LETCHWORTH OR L -LOGGING VEHICLE aOLYEtICLE • :-� CAMP HILL PA 17011 C� i} S=STREET ROD RECOVERED THEFT VEliiCLE V=VEHICLE CONTAINS REISSUED VIN -<- '+ t Yf=FLOOD VEHICLE FIRST LIEN FAVOR OF: SECOND LIEN FAVOR OF: •=ISAVPS A DL:1 sr • �C D ,F It a second Iienholder is listed upon satisfaction of the fitcl lion, the fust 11enho111. must loneard this Tile to the Bureau of 11ator Vehicles tlith the nE FIRST LEN RELEASED appropriate form and tea DATE a._ �z SECOND LIEN RELEASED "r AUTHORIZED REPRESENTATIVE DATE MAILING ADDRESS AUTHORIZED REPRESENTATIVE NANCY C & THOMAS J ;- _ rULLIVAN 1908 LETCHWORTH DR =_ r_= CAMP HILL PA 17011 ff G iir a Eir'�FL '�V•' l• Y B' S I Certify 3s of the date of Li U2,the Orl remris Cf the Fe:wS;lvania Oeparis^cnt ALLEN D B I E H L E R cf.T---__ _ uran is Ou _ �._,._.n..:,a_- tea!a>a�rs.:n(e)or ut...p.^.�r•n.tl hlin tk o e} of the said vehide. Sccretart•of Transportatioa - i r i IDv I It a co-purchaser other than your spouse is listed and you tvant the title to - :(_ :SUBSCRIBED AND SWORN I be listed as'Joint Tenants Rtith Right of Survivorship" TO BEFORE t.1E: g p"(On death of one f" to. DAY YEAR owner,title goes to surviving owner.)CHECK HERE 0.Otherwise,the title '`t will be issued as'Tenants in Common`(On death of one Owner,interest of deceased owner goes to his/her heirs or estate). I�54� GIGlJATURe OF PERSC Ao!UNaTc-R!I:f.OA t:-1�vti�t� IF k0 LEN,CHECK❑ IS THIS Atd ELT?(IF YES,Fl.fl REQUIRED) YES Ct NO yWy -`{�Fr I3 IST LIENHOI DER FINA14 1AL IN ' CINSTITUTION NUiiBER: [• -"'h i IST LIENHOLDER,NAME '+ a P ; STREET Q i CITY STATE ZIP y � i IF NO 2ND LIEN.CHECK Cj IS THIS AN ELT?(IF YES.FIN REQUIRED)YES❑NO❑ �. T- c 7r..-0 I C abb r.Jx ap;�.-:Sa: to- Csfkaoto G T.eo to tto v hM_''..' dS=Jed i 'Y:':3,.:COY t>Yz Mo.RA'r...�„5 31"1^•n.,t 1?i:-1 tL¢a,E tuRt t�C. 2ND LIENHOLDF.R FINANCIAL INSTITtPON NUhdBER: i 2N0 LlENHOLDER NAh1E S:GtI T•JRE FAP U=T OR AUTH.�5:C1:ER 3- 3 STREET rrA'3 • -'1.r,.'c OF CO..PFLICAI I.OF AVfH Ar"D SGFMR 1 C r ITY STATE ZIP ..-�• ... x.• :.+ >u w Vii: • "/*"j/✓� AD-Automatic Deposit•AP-Automatic Payment•ATM-Cash Withdrawal•DC-Debit Card•FT-Funds Transfer-SC-Service Charge•TD-Tax Deductible NUMBER E OR PAYMENT,FEE, / DEPOSIT, BALANCE DATE TRANSACTION DESCRIPTION WITHDRAWAL(-} V CREDIT(+) L7 pi/v Jtri N� /c cS ✓ 12 4 7 7"/11,14 ST"tNI-.e S .s e h ix Y c�✓' -�/ ,vs 77:-* f >'ti iv� ✓ . r M r u A It 1 6 e ( :11010 �l(.t U Cf a ]4 b 13 C'I' w R .a .M �!i AD-Automatic Deposit•AP.Automatic Payment•ATM-Cash Withdrawal•OC-Debft Card•FT-Funds Transfer•SC-Service Charge•TD-Tax Deductible NUMBER ORPAYMENT,FEE, / CREDIT , �` BALANCE CODE DATE TRANSACTION DESCRIPTION WITHD WAL H V ✓c. Ala l 2 7 r 1h4.c'ry;Grr J.1 4,J 1.4.2- d I Z zhil { 711 ,41) UC�EJ �:U 11 :1 6 C r J 0 1 nuU bC2 :3 4 to t3 Ctl' t..1 6 5 a f PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COSTS RECEIPT FOR PAYMENT J LISA M. GRAYSON, ESQ. Receipt Date : 5/23/2014 Cumberland County - Register Of Wills Receipt Time : 14 :47 :43 One courthouse Square Receipt No. : 1078117 Carlisle, PA 17913 SULLIVAN NANCY C Estate File No. : 2014-00508 Paid By Remarks : KENNETH L KOSTELAC HW ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 50 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 364383 . 50 Total Received. . . . . . . . . B83 . 50 ��f � r '•"�� AD-Automatic Deposit•AP-Automatic Payment•ATM•Cash Withdrawal•DC-Debit Card•FT-Funds Transfer•SC-Service Charge•TO-Tax Deductible t NUMBERREOR PAYMENT,FEE, DEPOSIT, BALANCE D..AT�E TRANSACTION DESCRIPTION W(THORAWAL(•) CREDIT{+) p$� "/Vc� �f�/ S/'• � r i G?t �� dC "l!f vl�+t> 'ltJ�r jL. -' r /1Z.1 r Cil !vS f�� �. 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L.1784 COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: July 11, and July 18, 2014 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. 0,A,--- LisaM7ar—ie Coy e, Editor S ORN TO AND SUBSCRIBED before me this 18 day of July, 2014 C_' Notary Sullivan,Nancy C., dec'd. Late of the Township of Lower Al- len. Executor: Kenneth L. Kostelac, Sr., 1783 South Meadow Drive, COMMONWEALTH Of PENNSYLVANIA Mechanicsburg, PA 17055. NOTARIAL SEAL Attorneys: Craig A. Hatch, Es- DEBORAH A COLLINS quire,Halbruner,Hatch&Guise, Notary Public LLP, 2109 Market Street, Camp CARLISLE BORO..CUMBERLAND CNTY Hill, PA 17011. My Commission Expires Apr 28,2018 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 July 18, 2014 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Craig A. Hatch, Esquire RE: Nancy C. Sullivan Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. ------------------------------------------------------------------ Advertisement inserted on following dates: July 4, July 11, and July 18, 2014 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 ------------- Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director The Patriot-News Co. • 2020 Technology Pkwy Suite 300 Mechanicsburg, PA 17050 Now you know Inquiries - 717-255-8213 HALBRUNER, HATCH & GUISE, LLP 2109 MARKET STREET CAMP HILL PA 17011 THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin) ss Marianne Miller, being duly sworn according to law, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 2020 Technology Pkwy, Suite 300, in the Township of Hampden, County of Cumberland, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/Community Weekly editions which appeared on the date(s) indicated below. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book"M", Volume 14, Page 317. PUBLICATION COPY This ad# 0002305006 ran on the dates shown below: EETTERS July 01, 2014 Estate of NANCYTC.SULLIVANAMENTARY forihe \ July 08, 2014 deceased,late of the Township of Lower July 15, 2014 Allen,Cumberland County, ` Pennsylvania,having been granted to the undersigned on May 23,2014,all persons Indebted to the Estate are requested to make Immediate payment . . . . . . . . . and those having claims against the Estate arerequested to present them for settlement without delay to: KENNETH L. AC,SR., Executorutor Sworn to and subscribed efore me this 16 day of July, 2014 A.D. 1783 South Meadow Drive Mechanicsburg,PA 17055 or to: CRAIG A.HATCH,ESQ. Holbruner,Hatch&Guise,LLP 2109 Market St. Camp Hill,PA 17011 Notary Pu Ic COMMONWEALTH OF PENNSYLVANIA Notarial Seal Donna M. Maldonado, Notary Public Susquehanna Twp., Dauphin County My Commission Expires NOV.5, 2017 MEMBER,PENNSYLVANIA ASS CIATION OF NOTARIES The Patriot-News Co. 2020 Technology Pkwy z4f atr1*0t'WxeWS Suite 300 Mechanicsburg, PA 17050 NOW you know. Inquiries - 717-255-8213 HALBRUNER, HATCH &GUISE, LLP COP 2109 MARKET STREET CAMP HILL PA 17011 STATEMENT ALL CHARGES ARE NET ACCT# NA E AD ORDER# DATE EDITION ADDTL,INFO, TYPE OF CHARGE AMOUNT 245301 HALBRUNER,HATCH&GUISE,LLP 0002305006 07/01/14 XXX SULLIVAN BOLD TEXT CHARGE $4.00 245301 HALBRUNER,HATCH&GUISE,LLP 0002305006 07/01/14 XXX SULLIVAN BASIC AD CHARGE $79.30 245301 HALBRUNER, HATCH&GUISE,LLP 0002305006 07/08/14 XXX SULLIVAN BASIC AD CHARGE $79.30 245301 HALBRUNER,HATCH&GUISE,LLP 0002305006 07/15/14 XXX SULLIVAN BASIC AD CHARGE $79.30 AFFIDAVIT CHARGE $5.00 TOTAL: $246.90 This is not an invoice. Please do not remit payment from this Statement. An invoice will be generated at the end of the month. --Thank you. NOTE: This Statement replaces the Order Confirmation which we previously sent with Proofs.of Publication + f EST OF NANCY C SULLIVAN DECD 153 KENNETH L KOSTELAC SR EXTR 60-1273/313 1783 S MEADOW DR 106 MECHANICSBURG,PA 17055-5190 / �o� dc�1S }} bate Pay /43e3�+ p..,, Hay to the � 5� Order of /L�.� rC `�. $ 4 [1 rr3� �,,VV--5oifarsPNCB 7n1 PNC Bank.NA, WO For pyoft sD 40 3 13 i 2 7 38r: S0068 3468 2n' O i S 3 PA REV-1500 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES and LIENS M M8T Bank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-5024349 F ax (302)934-2955 July 14,2014 Law Offices Of Halbruner,Hatch & Guise,LLP 2109 Market Street Camp Hill,PA 17011 Re: Estate of Nancy C. Sullivan Social Security: 200-26-8154 Date of Death: May 13,2014 Dear Sir or Madam: Per your inquiry on July 03,2014,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 82832447 Ownership(Names oJ) Nancy C.Sullivan / Thomas J.Sullivan Opening Date 08/28/1964 Balance on Date of Death $ 9,999.56 Accrued Interest $ .02 .......................................................................................................................................... Total $9,999.58 2. Type of Account Installment Loan Account Number 12044446798194998 Ownership(Names of) Nancy C.Sullivan(co-borrower) Thomas J.Sullivan(borrower) Opening Date 11/22/2005 Balance on Date of Death $0.00**This amount is not to be used for 3 V 0j"613-W' payoff purposes. For a payoff balance, r �n,N,I\ please call 1-800-724-2440 Current Balance $ 26005.44 **This balance is not a payoff balance �uUri � For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the West Sbore Plaza at 717-731-1730. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement Sincerely, Valarie Mercer Adjustment Services AD-Automatic Deposit•AP-Automatic Payment-ATM-Cash Withdrawal•DC-Debit Card•FT-Funds Transfer•SC-Service Charge•TD-Tax Deductible NUMBER OR I DATE TRANSACTION DESCRIPTION PAYMENT,FEE, DEPOSIT, BALANCE CODE WITHDRAWAL(-) CREDIT(+) f,�yJ j�r S Pell:*�� It err -lw rt AZ 124A '_ a �iv �. 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Please refer to your available balance since this item may not be credited to or debited from your account at this time. https://www.cct.pncbank.com/IMGPRINT.html 01/30/201.5 * END OF ATTACHMENTS Law Offices of 113 JUAURUMI CH & LLP 2109 MARKET STREET•CAMP HILL, PENNSYLVANIA 17011 MARK E.HALBRUNER (717) 731-9600•FAX:(717)731-9627 BRANCH OFFICE: CRAIG A.HATCH,CELA CORRESPONDENCE ADDRESS: 3 WEST MONUMENT SQUARE,SUITE 304 Certified as an Elder Law Attorney by Camp Hill Office LEWISTOWN,PA 17044 the National Elder Law Foundation (717)248-6909 CLIFTON R.GUISE WEB SITE: STACEY L.NACE Also Admitted to practice before the www.hhgllp.com Paralegal U.S.Patent&Trademark Office - TRACI L.SEPKOVIC JOHN H.MCCULLOUGH Paralegal TRACI L.HILFERDING Of Counsel February 4, 2015 Paralegal VIA U.S. FIRST CLASS MAIL Office of the Register of Wills Q Cumberland County Courthouse U) c r-n wµ imp ? One Courthouse Square - a " . . 0' Carlisle PA 17013 7'" cn f;Z r7 C� RE: Estate of Nancy C. Sullivan Estate No. 21-14-0508 C.0 rn Dear Sir or Madam, Enclosed for filing are the Pennsylvania'inheritance tax return (in duplicate) and Inventory for the Estate of Nancy C. Sullivan. There is no tax liability due on the return. Please time-stamp the photocopy of each document and return them to our office in the enclosed envelope. If you have any questions or need additional information please feel free to contact me or Attorney Craig Hatch. Thank you. Sincerely, Traci L. Hilferding, Paralegal tlh Enclosure cc: Kenneth L. Kostel ac, Sr., Executor r. PRIORITY MAIL 01" I~ t Hasler DIST R OF Ufa-s` 02/0'410015 $05.95° dmnt .. 41 FEB 5 PM 1 32 , ZIP 17011 - - 011D10640858 Law Offices of HALBRUNBR, HATCH & GUISE, LLP 2109 Market Street • Camp Hill, Pennsylvania 17011 � (717)731-9600 •ww'-w.hhgllp.com To: Itttili�t�{ll�ttt��l{���{f�l��lt{ Office of the,'Register of Wills Cumberland County Courthouse One Courthouse:Square Carlisle, PA 17013 r R E 1 t r a t, C ti ' r f