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HomeMy WebLinkAbout02-18-15 J1505618411 REV-1500 EX Decedents Social Security Number DecadenrsName_ Yocum,Dana S. RECAPITULATION 1. Real Estate(Schedule A)...................................................................................... 1. 122,716-0 0 2. Stocks and Bonds(Schedule B)............................................................................. 2- 3- Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4_ Mortgages and Notes Receivable(Schedule D).................................................__ 4. 5. Cash,Bank Deposits and Miscefdaneous Personal Property(Schedule E).......... 5. 210,1=08.713 6. Jointly Owned Property(Schedule F) FI Separate Bl6ng Requested............ 6. 7. Inter-Vroos Transfers&Miscellaneous Non-Probate Property (Schedule G) Separate BoiRng Requested............ 7. 6,377-89 8. Total Gross Assets(total lines 1 through 7)........................................................ 8- 339,702.65 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 32,926-15 10. Debts of Decedent,Mortgage Liabilities and liens(Schedule q............................ 10- 3,748-75 11. Total Deductions(total lines 9 and 10).........................._.....___.._......_.._.._........... 11. 36,674-90 12. Net Value of Estate(Line 8 minus line 11).......................................................... 12. 3 0 3,0 2 7-7 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13_ 14. Net Value Subject to Tax(Line 12 minus line 13)............................................... 14. 303,027-75 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.00 15_ 16. Amount of line 14 taxable at lineal rate X .045 303,027-75 16. 13,636.25 17. Amount of lime 14 taxable at sibling rate X.12 0-0 0 17- 0-GO 18. Amount of line 14 taxable at collateral rate X.15 11-1111 18_ 0.00 19. TAX DUE...............................................................-............................................... 19. 13-,636-25 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Under pares of perjury.I declare I have examined this return,including accompanying schedules and statement,and to the best of my knowledge and belief d-s true,corm and coplate.Declaration of preparer other than the person responsible forLaing the return is based on an inform mon of which preparer has anykmWedge_ t SIGNATURE OF PERAM,RESPONSI FILING REru�r�J,`� Donna R. Hartman °ATE ADDRESS 210 North High Street,t4t,-wbuiL P A 17240 SIGNATU F THER ATIVE Jerry A.Weigle Esquire DATE / ADDRE 126 East Kling Streret,Shippens un�g,{PA ii17257 Side 2 �, 1505618411 1505618411 REV-1500 EX Page 3 File Number 21-14-0602 Decedent's Complete Address: DECEDENTS NAME Yocum,Dana S. STREETADDRESS 1 S. High Street CITY STATE ZIP Newburg PA 17240 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 13,636.25 2. Credits/Payments A. Prior Payments 15,855.44 B. Discount 681.81 Total Credits(A +B) (2) 16,537.25 3. Interest (3) 4_ If Line 2 is greaferthan Line 1+Line 3,enterthe difference. This is the OVERPAYMENT. (4) 2,901.00 Check box on Page 2,Line 20 to request a refund 5. If Lime 1+Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) Make Check Payable t0: 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;................ p....................................._......................... �I n b. retain the right to designate who shall use the property transferred or its income;.................................. n W st c. retain a reversionary intereor.....•........................................................................................................ El W d. receive the promise for fife of either payments,benefits or care?............................................................ 2 If death occurred after Der. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................................................................................................................... F] Ifxx 3. Did decent own an-intrust for" or payable upon death bank account or security at his or her death?....... 4. Did decent own an individual retirement account,annuity,or other non-probate property which containsa beneficiary designation?................................................................................................................ El n IF THE ANSWER TO ANY OF THE ABOVE:QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN!. For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P-S-§9116(a)(1.1)(Q). For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P-S_§9116(a)(1-1)(ii)). The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000. •The tax rate imposed on the net value of transfers from a deceased chid 21 years of age or younger at death to or for the use of a natural parent;an adoptive parent,ora step-parentof the child is 0 percent[72 P.S.§9116(a)(12)1 •The tax rate imposed on the net value of transfers to or for the use of the decedents 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 decedents siblings is 12 percent[72 P.S_§9116(a)(1.3)1 Ass-bung is defined, under Section 9102,as an individual Kfro has at least one parent in common with the decedent,whether by blood or adoption. Rev-15M EX+(12-12) SCHEDULE A Pennsylvania REAL ESTATE DEPARTME!,tTOF REVENUE M ERIrANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Yocum,Dana S. 2144-0602 All real property owned solely or as a tenant in common mull be reported at fair market value.Fir corket vakre is defined as the price atVA-Ach popertyvrrudd be exchanged babNeen awfing buyer and a wiling seller.neer being welled to buy or sA bNh Having reasonable krnaadedge of the rete-rarrtfacts_ Real property that is joudly<rwned with right of survivorship rmrst be disclosed on schedule F Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest Downed as tenant hr common ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Mountain Ground in Hopewell Township,Cumberland County-20.58 acres;Assessed value 2,716.00 of$2809.00 x the common level ratio of.97 2 Real estate wfimprovements located in the Borough of Newburg with address of 1 South 120,000-00 High Street,Newburg,PA 17240-Assessed value TOTAL(Also enter on Line 1,Recapitulation) 122,716.00 (tf more spare is needed.addrfonal pages of the same size) Copyright(c)2012 form solf vare only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.12-12) Rev-ISM IX+(05-92) SCHEDULE E pennsy{vania CASH, BANK DEPOSITS, &MISC. DEPART ABff OF Rt-vaCr INFERITANCETAX RETURN PERSONAL PROPERTY RES0FNTDECEDENT ESTATE OF FILE NUMBER Yocum,Dana S. 21440602 kdude the pnxeeds otG tim and the date the prods were received by the eaats A®pmperty ioirdlY udih the right of survivorship.zP-m be dfscrosed an sche&de F. I'T'EM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Coins -(5 Silver Dollars$5.00(2)of which are valued at$25.00 each) (4.50 pieces$2.00) 70.50 2 Erie Insurance-Home Insurance refund 546.00 3 Erie Insurance-Car insurance refund 340.00 4 Orrstown Bank CD#44000016052-27 Month CD 10.000.00 Accrued interest on Item 4 through date of death 0.27 5 Orrstown Bank CD#4000038024-24 MonthCD 40,000.00 Accrued interest on Item 5 through date of death 0.27 6 Orrstown Bank Checking Account##693995 27,228.48 7 Orrstown Bank Checking Account#1693995-Credits to account from date of death to closing 576.24 Accrued interest on Item 7 through date of death 0.45 8 Orrstown Bank Money Market Account##814334 - 127,630.68 Accrued interest on Item 8 through date of death 0.87 9 1996 Classic Chevy Caprice 4 Door-Sedan-Proceeds of sale 10-21-2014 Check#757 2,000.00 (Cramer) 10 Misc household items-at appraised values 2,215.00 TOTAL(Also enter on Line 5,Recapitulation) 210,608.76 (If move space is needed,additional pages of the same size) Copyright(c)2012 form software only The Ladmer Group,Inc. Form PA 4500 Schedule E(Rev.0842) Rev-1510 IX+(0&09) SCHEDULE G pennsyivania INTER VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RErUM MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF iFILE NUMBERR' Yocum,Dana S. I 2744-0602 ThTs sche&ft mstnemmplefedand rifedifthe womar to mW of qms5am1araigfc4«opageUweeaftheREV-15Wisyes_ tTEI♦R DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECU8 TRANSFER. �ION TAXABLE NUMBER � FER � TIOoOD���DINTEREST ^Pwn R ESTATE VALUEOFASSET E 1 Ohio[National Financial Services#E1238257 6.377.89 6,377.89 TOTAL(Also enter on Line 7,Recapitulation) 6,377.89 (ff more spate is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Im Foam PA-1500 Schedule G(Rev_0&-09) Ric"V--1511 S(+(08-13) pennsylvranla SCHEDULE H DEPAWNE crOFPEVIMUE FUNERAL EXPENSES AND TAX RrMRN RESiDFNTDEECEDe" ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Yocum, Dana S. 21-14-0602 Decedent's debts must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 113,279.40 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) SheetAddress City State Zio Year(s)Commission Paid Waived 2_ Attorney's Fees Weigle&Associates,P.C. 15,470.00 3_ Family Exemption_ (If decedent's address is not the same as dlaknant's,attach explanation) 3,500.00 Claimant Sheet Address City State Zm Relationshin of Claimant to Decedent 4. Probate Fees 443.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. OtherAdminishaSive Costs 233.25 See continuation schedule(s)attached TOTAL(Also enter on line 9,Recapitulation) 32,926.15 Copyright(c)2013 form software only The Lamer Group,Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Yocum,Dana S. 2144-0602 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Fogetsanger Bricker Funeral Home-Less$100.00 VA donation 11.830.40 2 Kathy's Deli,LLC-Funeral meal 1,249.00 3 Middle Spring Presbyterian Church-Donation 100.00 4 Newburg Hopewell Fire Company-Donation 100.00 H-A 13,279.40 Other Administrative Costs 5 Cumberland Law Journal-Advertising 75.00 6 News Chronicle-Advertising 88.25 7 Reserve for Release to be filed to complete estate administration with Register of Wills 20.00 Cumberland County 8 Weigle&Associates,P.C.-Postage,miscellaneous phone calls,copy costs 50.00 H-137 233.25 Copyright(c)2002 form softmare only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev_6-98) Rev-1512 EX+(1242) SCHEDULE I pennsylvanla DEBTS OF DECEDENT, i aMRTWRaff OF REVBMfBE MRSIfrAMCETAX PMRM MORTGAGE LIABILITIES AND LIENS RESKEW DECMaff ESTATE OF FILE NUMBER Yocum,Dana S. 21-14-0602 Report debts inured by the decederd priorto death that nunained unpaid at the date of dead;including urueimbutsed medical ewes VALUE AT ELATE WNBER DESCRIPTION OF DEATH 1 Certified Mailing-Pa.Dept.of Revenue-for Lockbox Inventory 6.49 2 Cramer Insurance-Renter's insurance on property 646.00 3 Erie Insurance-Auto Insurance 385.00 4 Harry Killian,Tax Collector-School Tax 2014-2015 29.31 5 Newburg-Hopewell Joint Authority-Sewer bill 64.00 6 Ohio National Financial Services 69.42 7 Penelec-Electric Bill for May 42.51 8 Penelec-Electric Bill for June 31.72 9 Penelec-Electric Bill for July 48.43 10 Penelec-Electric Bill for August 30.14 11 Richard Hockenberry,Tax Collector-Real Estate Taxes 1,241.56 12 South Central Home Settlements,Inc.-Recording Deed 85.00 13 State Employees'Retirement System-May check to be returned as account was overpaid 249.08 14 Terry L.Shetter,LLC-Dumpster 375.00 15 Terry L Shetter,LLC-Appraisal-personal items 100-00 16 Weigand's-Lawn Service 33.03 17 Weigand's-Lawn Service June-July 33.03 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 10,Recapitulation) 3,748.75 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev.12-12) Rev-1512 EXf(1212] SCHEDULE I pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVUE WSWANCETAX RETURN (MORTGAGE LIABILITIES AND LIENS RESIDENT DECMOU continued ESTATE OF FILE NUMBER Yocum,Dana S. 2144-0502 (TEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 18 Weigand's-Lawn Service Aug-Sept. 33.03 19 Zachary McMullen-Lawn mowing-May June July 245.00 TOTAL(Also enter on Line 10.Recapitulation) 3,748.75 Copyright(c)2012 form software only The Lackner Group,Inc. Farm PA-1500 Schedule I(Rev.12-12) REV-1513 EX+(Ot-10) pennsylvania SCHEDULE J DEPAffnWO rOFREVENUE MI-tERITANCETAX RETURN BENEEICUUUES RESIDENT DECEDENr ESTATE OF FILE NUMBER Yocum,Dada S. 12144-0602 NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) Do Not List Trusteeftl TAXABLE DISTRIBUTIONS ['include outright spousal dastributions,and transfers under Sec.9116(a)(12)) Donna R.Hartrnan Daughter One Hundred 301,865.27 210 North High Street Percent Newburg,PA 17240 Total 301,865.27 Enter dollar amounts for diistnbutions shown above on fines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TARN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV--1500 COVER SH Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-15500 Schedule J(Rev.01-10) LAST WILt_, AND TESTAMENT (f i j 1, DANA S. YOCUM, of the Borough of Neiburg, Cumberland 9 County, Pennsylvania, being of sound mind, memory and understandin , do wake and publish this my Last Will and Testament, hereby revs g making 6 ( c� voice.. any and all former wills by me at any time. hereto-1 -fore made. n + ° k ? ' t. 1tZST 2 d3re.ct.my,..hereinater_named Executrix to pay all my ek t t deb Es..-and funeral expenses as soon as conveniently may be rafter my decease_ SECOND. I give, devise and bequeath all my property, real, Personal and mixed, whatsoever and wheresoever situate, to my beloved wife, BERTHA V_ YOCUM,., absolutely: F THIRD_ 1 hereby nominate,:. constitute and appoint-my said wife, BERTHA V. YOCUM, as the. sole Executrix of this my Last Will and Testament. FOURTH. Provided, however, .that if any said wife., BERTHA V. YOC Mr should predecease me or if we should die in a common., disaster, then in either of said events, -I give, devise and bequeath all my property, real, personal and maxed, whatsoever and wheresoever situate, to,my daughter_, DONNA RHES, HARTMM; provided E, further, Haat in the event my said daughter should predecease me, then in that event, 1-give the share-of the said deceased daughter to her children, equally, share and share alike; provided further haat in the.event any of my aforenamed legatees are not of full legal age at the time of any decease, then in that event, I hereby nominate, constitute and appoint THE -FIRST NATIONAL BANK OF SHIPPENSBURE G, Shippensburg, Pennsylvania, as the Guardian of the salol-minor's estate, the said Guardian to take and receive the `share.o€-_the; said minor child, and- invest and reinvest the same in legal or non-legal investments, whichever in its discretion it -" deems proper, and the said Guardian to have full power and au h6�i in its discretion to pay such amounts of income and j , - :;.. �. (SEAT.) -- t }f- GK�v.KJa 4' principal as are necessary for the support, maintenance and educe tion'of the said minor child, and upon the said minor child r: reaching full legal age, to pay the said share to the said child. FIFTH. Provided further, that in the event my said wife, BEIRTRA v_ YOCUM, should predecease ne or if we should die in a common disaster, then in either of said events, I hereby nominate, ' constitute and appoint my said daughter, DONNA RHEA HARTefAN, as � 'he Executrix of this my Last Will and Testament, my said Execu- trix to have full power and authority to do any and all things °'.r,_ ''y.• necessary for the complete administration of my estate, including the power to sell any and all real and personal property of which I may die seized, at public or private sales, in her discretion, and without any Order of any Court; and I further direct that my said Executrix not be required to file a.ny'Band in connection with r the settlement of my said estate; provided further, that in the event my said wife, BERTHA V. YOCUM, and ijiy said daughter,.-DONNA V RHEA HART-MAN, should both predecease me, then in that event, I hereby nominate, constitute and appoint such of the children of my said daughter, DOAK RHEA_YOCUM, as are of full legal age at > the time of my decease, to be the Executors of this my Last Will and Testament, and in the event none of them are of full legal age at the time of my decease, I then nominate, constitute and s' appoint THE FIRST NATIONAL BAN OF SHIPPENSBURG, Shippensburg, Pennsylvania, as the Executor of this my Last Will and Testament. IN WITNESS WHEREOF, I, .DANA S. YOCUM, have hereto set my hand and seal to this my Last Will and Testament, written on two (2) sheets of paper, this llth day of June, 1975. (SEAL) Signed, 'published and declared by �}{ F S. Ftp, the Testator, as and for his {' last Will and Testament, written on two (2) shee' of paper, in the presence of us who hav/e t his request, sided our names as ses hereto in tt pres�-toe of the said oC` lk eac' 1 her - -2- ti r i x }^ 48500041046 REV�185 IX 485,13a04111146 SAFE DEPOSIT BOX INVENTORY PA Depadittenl of Fa mue PLEASE MI ORIGIAll.FORM O ILY Socia!Security or Death Certificate Number Date of Death County Coda Year Fie Number Sudor First Name 1 ( ©ADDRESSOF � /� W-• /��GC��LC�[ - - 9�TE 3P OOHL NAME ANDkDDRESS OF P€ ON�RgOU-ESTTMG THE OPENING OF THE SAFE DEPOSIT BOX i STREETADDii�$P Al / w/C�f}y� �� St 23 ! NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE OPENING a. NAME: REIATIONSHIP. E I STREETADDRESS: CIM STA ZIP CO t b.NAME: RELATIONSHIP: E E STREETADDRESS: CITY: STAT: ZIP 001e i a ISAME RELJITIONSHtP: STREETADDRESS: STAI 1- ZIP CO E NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX is LOCATED i i ADD Cmr: ZIP CO a �r ake-e Sal r OFPERSON �LAST ENTRY DATE AN E OF LAST ENdWRY $ DIWO`ONTO CTTO ENT[[BOX ^ NUMBERt r TM.E11 QER�Q D EQ N i NAME AND ADDRESS OF PERS N(S)HAVING ACCESS TO BOX 1b[ a. E: L_- � l b. NAME S / RESS STREETADDRESS: i I TATE/7ZIP CITY TE. ZIP DE ! f NAME AND'ITILE OF OYEE TAKING THE INVENTORY i WAS A WILL.IN THE BOX?\R YES ❑ NO If yes, a.Data of vft b.Name and address of personal repmsentaUve.If named in the innTl j NAN.E: STREETADDRESS: CITY: STAGE ZIP CO E �B e c. Name and address of attorney,if any NAME: +� f t .-.—STREETADDRESS.— ----- --•-- CITY'. _.r_---STA�• ZIP CO 48500041046 485011041016 t i d REV-485 EX SAFE DEPOSIT BOX INVENTOR 9e INSTRUCTIONS (1) Cash:Report total only. j (2) Stocks:List in detail every common or preferred certificate,warrant or other rights found in box Stacks are designated name of company,certificate number,date of certificate,carne in which stock is registered,and number of stiar'es;nd ciass of st (3) Obligations of U.S.Government:Number of items,data of issue,face value,names in which regfsteredilar I of owne k. i.e.,jointly held,payable on death,etc. f (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (5) Bank and Savings and Loan Passbooks:Slats name of depositor,number of book,last date appearing in� name of b k and branch,and balance. (6) Jewelry,Coins,Stamps,Manuscripts,etc:list and describe as fully as possiible. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of indebtedness:List and desaibe a Illy as possibl (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.280601 i HARRISBURG.PA 17128-0601 NO. ITEM A DESCRIPTION I NO. � D/,rJe,G t�d 4 iJ7 I cL�.1011 I p 61 t � I ail � I i9 I a IC FY UNDER PENALTY OF P RY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF Co CT AND COMP BEST OF FAY OVILEDGE AND BEl IEF, SAFE DEPOSIT BOX INVENTORY. SIG TU SIGNATURE PR f�ME PRINT RAM AND CHECKAPPROPRIATE BOX aELOW: �U� FLG PRINT THLE DATE CHECKAPPROPRIATE BOX ll Fsfade ReFwenta}im o jant�dsafe . 6 4- NOTE:Attach additional MO x 11'sheet(s)if necessary or use duplicates of Oft page of form The Depaitinm is aWwized by law.42 U.S.C.§405(c)(2)(C)(1),to te#,e d5dwine of Socel S=Wx numbers in cr Bdm writ ft state x The;De t utas Ste Social sem*number tD ideitTy the decedent aW pmsvd representatins of the estate.The Canmw eat8t may also use the bifoNneff n in ex of tax' .rds WM Fedual aid brat taft auftilles.Tho stat LIN proh'bls filo Cm—aaWs personnel fiom disdowig con(ida-dal tax hlfarma5m excret for o6a i June 30,2014 PA Dept of Revenue-Safe Deposit Box Unit PO Box 280601 Harrisburg, PA 17128-0601 To whom it may concern: Please be advised that Donna R. Hartman, Executor,will be entering the safe deposit box for the Estate of Dana S.Yocum,at 10AM on Friday July 11,2014. The safe deposit box is held at Orrstown Bank,77 E.King Street,Shippensburg, PA 17257. Respectfully, Donna R.Hartman Executor,Dana S.Yocum Estate i ORRsrowN BANK ATia&Wo ,o'Ek Z=e Date �... r . t Under penalties of perjury I swear that I gave the notice required un Section 2193 of the Inheritance and Estate Tax Act,72 P.S. 9193,to Pennsylvania Department of Revenue,via United States Postal Servi e, of my intention to enter this safe deposit box on today's date. = X �L 4, Lai _ Estate Representative b 1.81 LORRSTOWN r r ORRSTOWN BANK A Tradition o f Excellence July 15,2014 Weigle&Associates,P.C. Attorneys-At-Law 126 E Ring St Shippensburg,Pa 17257-1397 Fax:717-532-5289 Re: Estate of Dana S Yocum Social Security Number Date of Death 05/17/2014 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE FOLLOWING ACCOUNT WITH ORRSTOWN BAND: SAFE DEPOSIT BOX Account No- 335003 Account Type- Lock Box Account Title- Dana S Yocum Date Opened- 10/01/1998 Joint Account(name/date) No Balance- $0.00 Accrued Interest $0.00 CBECKWG ACCOUNT Account No- 693995 Account Type- Relation Interest Checking Account Title- Dana S Yocum/Donna a Hartman(POA) Date Opened 10/01/1996 Joint Account(nameldate) No Balance- $27,228.48 Accrued Interest $0.45 2695 Philadelphia Avenue Chambersburg,PA 17201 CIIECKINGACCOUNT Account No- 814334 Account Type- Money Market Account Account Title- Dana S Yocum/Donna a Hartman(POA) Date Opened- 08/15/1986 Joint Account(name/date) No Balance- $127,630.68 Accrued Interest $0.87 TIME DEPOSITACCOUNT Account No- 4000016052 Account Type- 27 Month CD Account Title- Dana S Yocum/Donna a Hartman(POA) Date Opened- 04/13/2007 Joint Account(name/date) No Balance- $10000.00 Accrued Interest $0.27 TILIEDEPOSPTACCOUNT Account No- 4000038024 Account Type- 24 Month CD Account Title- Dana S Yocum Date Opened- 06/18/2010 Joint Account(name/date) No Balance- $40,000.00 Accrued Interest $0.27 Best Regards, 41t�- k Lisa.R.Kline Deposit Processing Representative III _ t vp oS )44 y f {{ { i . ,.. 1 1-71 ` 4 1`j 6 b t q.-Ls t E 4, ys:b tS t s`t -3 t cam" . �.a- .. x'M 'r F � Y a � n .. �' • ' � tae rx y ru ' LU � E �� � UJ Q a � � 03 ru 1 t ru i k. zhS ► ru 0 f . f Ln _ Cn i MMY3.WEIGI.E WEIGLE & ASSOCIATES, P.C. Attorneys-at-Law Associates 126 EAST'ICING SrREEr JOSEPH P.RUAA'E SIHPPEIN?SBVRG,PU4NSY1.VAINTIA 17'x-7-1397 RICHARID I..WEBBER,JM rELEPHONIE(717)532-7388 or(717)776-4295 Of Counsel FAX(717)532-5289 rHO1VI_AS I..BRIGHT February 17,2015 Cumberland.County Register of Fills 1 Courthouse Square Carlisle,PA 17013 RE: Estate of Dana S.Yocum Dear Ladies and Gentlemen: I have enclosed the following items: 1. Inheritance tax return,in duplicate original; = ' r.a r i > 2. Copy of the return;and C/) 3. Self-addressed stamped envelope. 00 co Please time stamp the copy and return it to me in the envelope. Thank you for your assistance. CA) �7 Very truly yours, WEIGLE&ASSOCIATES,P.C. Jerry A.Weide, quire JAW/paf Cc: Donna Hartman,Executrix(w/enclosure) P.C. ire .. PIT. 'Y Covic RD L i r• ✓I v {� X57 — r n , _ { 02 IP 2OVO CS REGt ' ; . 0003986150 FEB 17 2015 tr}'�_,'+-•�� 4WLEU F20;t ZIP CODE 17257 MS FEB 18 FM 12 23 CL i OF O�tP�i,-.r,s' G.''' 1 Cumberland County Register of Wills 1 Courthouse Square Carlisle, PA 17013