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HomeMy WebLinkAbout01-30-15 1505610101 REV-1500 Ex(ol-lo) enns lvania OFFICIAL USE ONLY PA Department of Revenue p Y County Code Year File Number ERI.RTMENT Oi REVENUE Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 �V� Harrisburg,PA 1128-0601 RESIDENT DECEDENT � ENTER DECEDENT INFORMATION BELOW &L ]I yi, k_ - — Decedent's Last Name Suffix Decedent's First Name MI od, (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1.Original Return Q 2.Supplemental Return Q 3. Remainder Return(date of death prior to 12-13-82) Q 4. Limited Estate Q 4a. Future Interest Compromise(date of Q 5. Federal Estate Tax Return Required ' death after 12-12-82) Go 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9.Litigation Proceeds Received Q 10.Spousal Poverty Credit(date of death Q 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nulff 1j!�'J j_-_! �61LJLEj,Ll s'1L)q]I!lAiA'4111L_/1 1 � JJ �q4'*Jof J !�; RE T!P jM WILfSrR USE ORLt rrI c First line of address L0 71 C.) C:) Jlcl�-4jL '��J-1 � bjl��� 'k'�J�J_J; '-� Second line of address _ M - Ji---U-!- --J-i-_- J JJ City or Post Office State ZIP Code DATE FILED rn �Lk14 Correspondent's e-mail address: Cesh"Vats3CR?Comeasf,ne, ' 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 PERSON RESPONSIBLE FOR FILING RETURN DATE �I s ADDRE -SExICA S. WEN6ER, q4I-XhNN,4 DR., 64 RL/SLE P.4/7o/&- SIGNAT OF P EPAR ;=,,;EP!VTATIVE DATE ADDRESS Cha►-Ics �h�eb�s Es�., (Q Clnwse-r fld., !l'lechan;�sbter�, PA /7o 5s PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 .J 1505610105 REV-1500 EX ♦ � RECAPITULATION 1. Real Estate Schedule A). ........... Ou 2. FIR Stocks and Bonds(Schedule B) .. ...... ...... . ..... ........... ......... 2. 10MID •L�i } r 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. • 4. Mortgages and Notes Receivable(Schedule D)....... ..... ..... .......... 4. DEMOnn D•LVJ 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. � �l DC7 s 6909 6. Jointly Owned Property(Schedule F) p Separate Billing Requested ....... 6. � � . 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested........ 7. � N1 .4•D7 8. Total Gross Assets(total Lines 1 through 7)........ ..................... 8. p ( � edule H)......:............ 9. [TIF" `J S •�E 9. Funeral Expenses and Administrative Costs S.h 10. Debts of Decedent, Lien {Mortgage Liabilities,and ) ?� s Schedule# ....:......... 14. 11. Total Deductions(total Lines 9 and 10)... ...:. . ..... ...... ..... ......... 11. 00I A ! I !0 6 ,NE e 12..'Net Value of Estat (Line 8 minus Line 11) .:.....:..... ...... .......... 12. ✓�-� 3 . � 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ` Fin an election to tax'has not been made(Schedule J) ..... ....::..f .. :. 13. � rail 14. Net Value Subject to Tax(Line 12 minus Line 13) .............. .......... 14. ? 3 • "� TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 • 15. 16, Amount of Line 14 taxable Q at linea!rate X.0' x,616. D , 17. Amount of Line 14 taxable at sibling rate X 12 �J • 17. • O 18. Amount of Line 14 taxable w at collateral rate X.15 : d O' 18 •.�l 19. TAX DUE . .... ........ ......... .. ,.....`��, > .,.*..r`....:rq....... .. 19 S"2 '� ! 7 *..V. .SFS TAY C Leal. 7ip4 sff,9,cr i477ACW00 AJ 1711 Fk/°1�fit/�ToV 20: ;FILL 1N THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT • t Side 2 1505610105 1505610105 ................ f 74�70* of ol --wu4jv� Ir Jv! i 714 .41 f IVAWIVIP Al�,yrol" ?"f al Loawmw i(M 10/ 1p, -Fly/ y O-W7 Vold W21W 'may 17 r)Q W02H -- COMMONWEALTH OF PENNSYLVANIA REV-1162 EX0 1-96) DEPARTMENT OF REVENUE ` BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 { ((•• PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 019017 WENGER JESSICA S 44 FOXANNA DRIVE CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ------ /old --------- 14106957 $289.03 ESTATE INFORMATION: 14106958 $141 .26 FILE NUMBER: 2114-0057 DECEDENT NAME: HARRY EDWARD F DATE OF PAYMENT: 04/14/2014 POSTMARK DATE: 04/11/2014 COUNTY: CUMBERLAND DATE OF DEATH: 01/02/2014 TOTAL AMOUNT PAID: $430.29 REMARKS: RECEIPT TO ATTY CHECK# 183 INITIALS: CJ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS TAXPAYER REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME �d�Qrd � �Qrr STREET ADDRESS CITY CQ _5 le STATE A4 ZIP 1�7olS r�, Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) q rmu 2. Credits/Payments 1� A.Prior Payments B.Discount < p�a, 6 s Total Credits(A+B) (2) y$ , g y 3. Interest (3) 0 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. D Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 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;.......................................................................................... 0 X b. retain the right to designate who shall use the property transferred or its income;............................................ El X c. retain a reversionary interest;or.......................................................................................................................... ElX.. d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ X 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 11 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. X ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)].The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[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. REVAM EX-(19ri . Ok SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MSC. . INHEPJTANCERESIDENT EC RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF fidtvard F. Harr FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointty-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH: 1. e� � 1�c+.Ot', No-,5P8033(f99f ANC Qaolk fi�ZJ. T� aQ �. d.0,q/ Bal ,Z/ra, Na, / or D./.Z. <se� valua/�"Oa l A 4//amid) /Jl*nd on �Cur�f� De/,osif oCv--x 2 �ar/y/� Gs» rte: j1�od:/a floe a Le�6f%s T4./er ��rrk 02o.4el_ Csee &bleat ?Atccl) 3. 5a/e of /jy5/ ''Z.mmer 1*k1k //ogle /W 4ei 6ys xm SDD• ma ale 4446), / /y an Am is F-y• dred, l/{»)01?, Kt ar ii19S /�Cc1. -* 1Il ?3 -00 .Znt a ecrme,d -16 d.o.d. ort Zlem Ny o. D. 02 &'&e valaa6*wl /e1tor aoAcAed) ck 111a1111cld L104 etch n: Q.rit� � g o5dAs paeeiS 2A dw-a°) 3.1000.oa F TOTAL(Also enter on line 5,Recapitulation) $ �Q� ysQ, [J (If more space is needed,insert additional sheets of the same size) May. d. 1U14 J: 14YM VNU bank No. 110) r. in e� AUl ��t9 May 8,2014 Charles E Shields III,Esq 6 Clouser Rd Mechanicsburg,PA 17055 RE: Name: Edward F Harry SSN: 172-24-8363 DOD: 01/02/2014 Dear Mr. Shields: In response to your request for Date of Death(DOD)balances for the customer noted above,our records show the following: Certircate of Deposit Account#31400220195 Established:09/18/2001 EDWARD F HARRY ITF JESSICA S WENGER DOD balance: $ 13,521.94+0.45 accrued interest Interest paid 01/01/2014 thru 01/02/2014$0.00 YTD Account#31500219307 Established: 09/18/2001 EDWARD F HARRY ITF JESSICA S WENGER DOD balance: $-6,608.21 +0.17 accrued interest Interest paid 01/01/2014 thru 01/02/2014$ 0.00 YTD Checking Account Account#5080338994 Established: 11/04/1994 EDWARD F HARRY DOD balance: $22,724.20+0.12 accrued interest Interest paid 01/01/2014 thru 01/02/2014$ 0.00 YTD Page 1 of 2 � lay. 8. 2014 3. 14PM PNC Bank No. 2285 P. 212 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 Phis message is intended for the use of the individual or enrity to which it is addressed and may contain information that is privilegeq' confidential and exempt from disclosure under.applicable law. Xf 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 ofthis communications is strictly prohibited. 1f you have received this communication in error,please not me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. F Page 2 of 2 Fe u Real Estate Investments Estate of Edward Harry C/O Mary Swinn 7192 Wertzville Road Carlisle,PA 17015 July 24,2014 Enclosed please find the security deposit refund for your former residence at Leiby's MHC.The amount of your refund is summarized below: Description Char es Payments Balance May 2014 Balance Forward $ 51.27 June Rent Billing $ 358.00 $ - $ 409.27 Proration of June Rent Billing $ (363.00) $ .46.27 Final Water Billing $ 20.38 $ 66.65 Final Sewer Billing $ 12.88 $ 79.53 Security Deposit $ (100.00) $ (20.47) Amount to be refunded $ (20.47) Should you have any questions or concerns,please do not hesitate to contact our office. Thank You, The Carlyle Group,Inc. P 9073 Nerno Street o West Hollywood_ California 90069 • (310) 550-8656 • Fax(310) 275-8556 THE FACE OF THIS DOCUMENT HAS'ACOLORED BACKGROUND ON WHITE PAPER " :t. r.7'he P ....,... •... t. _ . . __.. . _:,...... . ...,�'� Sfreet'-Suite :11U- ) .�. 523 •1.: >s'. Y-A (.,. u u'rsl AGeo= F. n , et 073 01 tSd -H - West , t f < ✓'::.y.V,:r.,?'i. c5i 1 "Z ' '":r•.;,• .., :w: '::.. :• :,ti ^' 'i:J'.r: - -.`�;1,. .,(b}4�,`!:il<�•.�:wl. , :'":' :_ ..,.::.,. .-.).t.:-_•:,,,-::_y:•,:• i , ,. t}�t�+?,'�...:iii::'`�:�'�. l D. - { N ' 1.0 > .i ,RDE R f.. ` r .. .,..... a-�,,,,n'::5o_,�:J., .::..;!..,:.::'i '':1:!�' •J +1..: ....... c,. ) k.: •, • , v.:.!n ....;+r.5 rte.. ,:�,'::f"'�t' lam: f W ar� _ ta � a k !' 1 ''\ v S U.0; - ::.,.•�.. ........ ..( ;:'�.:�,.....rte.•�..'v ' rtzvt a ��f' pA.a ;Q,,, �_ THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK—HOLD AT AN ANGLE TO vo 1 5 3 5 711■ - 1: L 2 204 280 0 3- 109D 3811' DATE:07/23/2014 CK#:15357 TOTAL:$20.47**—** BANK:TCG-ABB Fund Dis6ursement(7000op) PAYEE:Estate of Edward Harry(IM218) Job(Prop) Categ(Acct) Invoice-Date Description Amount (0130) (2006-0999) :Refund-06/05/2014 Move out refund 20.47 20.47, F 1 BILL OF SALE Date: June 5, 2014 KNOW ALL MEN BY THESE PRESENTS, that Jessica Wenger, Executor for the Estate of Edward Harry (seller) have, for the sum of $10,500.00 bargained, sold, granted and conveyed and by these presents does bargain, sell, grant and convey unto Leiby's MHC, LLC (Buyers), buyer's heirs, executors, administrators and assigns,the mobile home located on Space 60, Leiby's Mobile Home Community, 7075 Carlisle Pike, Carlisle, PA 17013 described as follows: YEARIMAKE: 1984 ZIMMER 3BED11BA. SIZE: 14 X 70 VIN: ZZP20078 Items: "As is"with new water heater, oil furnace, stove, refrigerator and shed. TO HAVE AND TO HOLD the same unto Buyer and Buyer's heirs, executors, administrators and assigns forever. Seller specifically disclaims any warranties as to the physical and mechanical condition of the mobile home. Buyer acknowledges that they have inspected the mobile home and appliances and are purchasing them "as is." Seller covenants and agrees to warrant and defend title to the mobile homes sold against any person, firm, corporation or association. , IN WITNESS WHEREOF, Seller has caused these presents to be signed this 5�h day of June 2014. Acknowledged and Agreed to: Sellers: Buyer: Leiby's MHC, LLC A Maryland limited liability company v ; i— `rte By: r` Je * Wenger, Date Joseph R.Weber, Chief Operating Officer E er or for the Estate of Edward Harr For.The Carlyle Group, Inc. It's General Partner r r j DEPARTMENT OF TR*NSPORTATION C.ERTIFJICATE OF TITLE FOR A VEHICLE 1933 950060013001464-001 is t. ZZP20078 1841 ZIMMER 35718.797403 HA VEHICLE IDENTIFICATIONNUMBER YEAR MAKE OF VEHICLE TITLE NUMBER ' L , MH BODY TYPE I' DUP I SEAT CAP I UNLADEN WEIGHT I GVWR I GCWR. . TITLE BRANDS, '. 11/29/83 1/13/95 1/13/95 EXt - 4 DATE PA TITLED DATE Of ISSUE :� PRIOR TITLE STATE .'i ODOM.PROCD.DATE I ODOM.MILES: .� ODOM.STATUS ' �$„)'i I ODDMETEfj gT.TUS D ACTIIAI MILEAGE..i . XC IMILEACEEEEDItTHE MECHANICAL . :�'tniaa x,.. ,L. r.^will„-.tA•r.ta,i i%w- + � '✓G-'' _ V:fiF'•W','FB,.'Vw>;iRn. ��' LEnGE ' _ D�:iXJF:TME. EAGE-0DOMETER sAsr+, ODO E. DT GL6tujkE "E' 1540 '$Y 1 ti Al LAW + � XEMI�T FROM b00f/$}ER DSCLOSURE REGISTE OWNERIS) ,. T1TlE 8RA S A ANiIOUE yE CIE A . EO.WR }. Fr BARRY L� �1 t�. —--•..;.-w-....- ..---- 13 OPoGNALLY MFf�o IPPR _ LOT D L' - '\ - -H AGFj�(AILTURAL'VEMJJK:I� GAR -I S:LE>;PA ::17013 r. p.-FDRuv:xratl�E {acLE ...g'. - R='fiECONSTRUCTED • 5-STREET ROD ,T-RECOVERED T EFT HK:LE . %swoVEreGt:E p61y7�E ISSUED vN Vf�1flCt.E . FIRST U AFAQ OF: SECOND UEN FAWR OF: rr • - .. I it e World Gennormi is listen RE upCn sailSfectibh,of the first Klin ma �ief� • 1leWIder must:forward this TiW to the Bureau of Motor Vehlples FIRST U&M ED .• ' apjVopiiate tam end tee. '� BY ` .•.. .StDL1EN ryElEA$ED, a r '...a'``t `� .. - AUTHORIZED REPREBENTATNE ' l�d'aA?451:.:6ik�![T?7X'�RWihc`A::,""r2C-1'if�•1••_•••rF•'=5?:'9aKc99+fF.se:.uRa�*;d•c'�Ki1�'�+z....-a!�u�?1RrS5lNR'A�sii,:xs.rsr.,pl@ MAIUNG ADDRESS . BY • AUTHORIAL)REPRESENTATIVE EDWARD F HARRY 7073 CARLISLE PIKE • LOT 60 CARLISLE PA 17013 HOWARD!-*I5AUSA1L'IM I certify as of the date of issue,the official records or the Pennsylvania Department : a'petSD,Tsr6Com,7"aryf�f�e'S��[FFuYawFWowneT.-.;F _�.....___ .. of the paid Vehicle. s - Sccretary[of Tr•nsportaaon m APPLICATION 1• AND INFORAPPROPRIATE SECTIONS ON THE REVERSE SIDE OF ThiMATION i r ,. III RE SUBSCRIBED AND SWORN s When ll"ing for lille.ADAa w o«ner,Wier than your ilRe,apOMeck one oa TO BEFORE ME: : _ e these blocks It no block is cixcked,tioe'will be issued as'Tenants Iri,'Comhvi:- s 'MO. t DAY YEAR 'A O Joint Tenents with Right of Sarvrvwship(on daidi of one owner;title Roes T, -the wtviong owner). . `.B ❑ Tenants in Common(on deem of one owner,Interest of deceased owner goes to his or her heirs or estafC) - S*NATURE OF PERSON A NISIERNG OATH UEN IF NOUEN DATE: CHECK BOX FIL)ST LIENHOLDER:. = Q trE.. ,)y) STREET . _ . .. C .1 p.. 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Account Number/Suffix 11183-00 Date Account Established 1010111974 Principal Balance at Date of.beath $706.18 Accrued Interest to Date of Death $0.02 Total Principal and Accrued interest $706.20 Name of Joint Owner None SAFE DEPOSIT BOX: NONE MEM RS 1sT FEDERAL CREDIT UNION Zterson Lending Insurance Support Specialist July 25, 2014 r Estate of: EDWARD HARRY Date of Death:01/02/2014 Social Security Number 172-24-8363 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 (800)283-2328 www.memberslstorg • r t r � � /��.PGG' (t' � 1, DEPARTMHNT OF TRAFI�Fst��'t��d71�P �:�� rv�l k d IA E EK ER + - VEHICLE IDFlCATION NUMBER YEAR MA VEIt.IDL.E :'Elft. ��r1Me� s ,� '. 'k..-xa "E•zk< _ .'""�¢.r, .n. S CAP MN., l>.,, i A trr'rrrrrr111 ED X fir^ `DATE OF I$^{!E" v titNLAD�NWVE1�3�f[ ,,,�'.: '+ � f r'<4'° n.� ! k x }40Y z s77 SlRY ++ Fm) .5 FAVOR OF SECONDUSNFAVOROF 7S 1 AtAkf >5 road k 7 �' �' U�t��+ns`td�9aA!'7dd 'rro4U�a AV,. + r r <A -'(ryE" SEObt`ID,"1� "?TL a. MR •-4,W' •t ;n'•`r" . MAILING ADDRESS ". ' EDWARD IF HARRY j <r Q T � s 71373 CARSLiSLE PIXE � x(y LOT 613 CARLISLE P A 17UI.3Ai � '� "th•y .A 'de tti•dHkial ecords of:tn Farti+syivar++a Doparfi119�tT {,a ^+.'ea<Ff� r ; '.: r to F t3iY ..S �... tTtiaR[tie p§Tson(s)or+brnpHny Rame6 Herein is the Iaw�ul o»ivver > W R j :h? '�, I, Ar:s +, 1 BE COMPLETED BY PURCHASEA WHEN VEHICLE IS SOLD AND THE APFROPRIATE SECIMNS ON THE REVERSE SIDE OF THiS DOCUMENT AnE APPLICATION FOR TITLE AND LIEN INFORMATION- CONVLETM CD -K F�iq" AKI DAY Y Y "� +� ''�'��� �� �. .. � a6 ft t3��aSAchit�ly�• Fiw'YsM �`"'` r��`+ � �A�. �:. y � � � � ;�•- z�. � {,��- �f (5f UF�hI�TI: �N, <� L� � �. o �"' s� �� -',.�`<� y _-s{ � ,,` y< INA,.'T""�' YK F`- �� w 7�Ns%.. ..�.`• "ivy` KY e CD N eat�r}ed= rot y tee!ee yp tion Ler Cerotote of nt�e to rr i vet•c a geneea y k. .. �' to mb+@ncana other Ie9aI dalm§JFaI ft y h� o/ _ z: STREET r i a•e § t OF APP3I ANTAR AUTHORIZED SIGNER - Nloll { b 9 sib 1OfCie a pEPARTMENT OF TRANSPEaRTATtgN a �f �= ry ER`i"IFI ATE OF T`ITL.E�'C?R A1 E-Irl, W4 p _,,;,,_•,�'*c a VEHICLE)pFNTIFICATKN!NU,Nl zx.". YEAR MAR4aFtn'VEHlC(E s .y� TiR'"tM r }, I. EiObV IE .�\ s 101 TKSA#.,'3�PRIOA7lTtrE STAYED ODQM.$AOCQ DATE x �. �"-•~_ q. „ pATE'PA Tf?`N1EDATE, issuE :x UNLADE'i`P Grrr `} ( i_ fs'' si: F� UDOMF$sT' . j t ►u �LScp T*IEMEaaNscAF t '�£' a�` �`� ,, s � �1dvi�' •na'�r 7�ft���'�s,, ,`! s".:y @a�'+r'�'Tg�n'`'" '"�1r4'si�r 3�k} yr�e�. � .:� �!" �Er� '#: R �r � • f,AR L. {.j'+�� # i. YY♦yam R\ l9 P V61yJl,{,'bC�NM<GNS SSf1L`„D VIN I W' FLOOG VEHIir(.E k�lRSY,LlEN FAVOR OF .S ( sEtkNN4llENfAVDR DF X ERLY ATAXi { � Y Ve. J. r G 2 r K'" , r ff¢I s@gogd 9e1RIxjMeT'b fia':4ed tsaLsfactfo4. t�p� ' .s ]f�MYblder=Ni4s1„t fg this TMAtl10 6taeSu:�Mo16! 4: 0.tAiLJN4 ADDRESS ED D -AUfHllRln REPRES'EjJTATf,)iE.+ i/ Rfl 1=HARRY r n ' 71173 CARLISLE-PIKE LOT 60 CARLISLE PA 1ic 7I13r3 M{. k r,. ka €ry sqa 4 } t carkiyribr the d9ta ar' -e tide otfiar{i records atf'#*elirtsYWaaF;Dapartme#-` " � + tY o{TIAnv.,A, ..refiact that he Pere,on(s)w company mined herein hs�ha;lewlui owner ` - i - da Crt Ihe.eaKf vahide ` "/ ! ?'!•e9$.P�t on \ Srcrtr pt I t ttnoblo�ilb clreGd TO BE COIAPLETED BY PURCHASER WHEN VEHICL SOLD AND THE APPLICATION FOR TITLE AND LIEN INFORMATION- APPROPRIATE SECTIONS ON THE nEVeRSt SIDE OFETIliSis DOCUMENT ARE A r3,.:.��aMs wqh �SN 5 S❑ enardts in C doFr-'a#E� l ( death oi� dace t 'ib rVWeIg,M�1 �-� ..h v orrnfen orl owner; �se¢x�dwrder r-_" -: ..-' r to hl4 w Pse helre d ealetdir <,a Vit:SKi TURN OT*PERSON AONINISTERINCi OATH DAT DATE: . .. FIRST f-rERl ER: . f \ NAME < rYffEET< kt x. • - p s:> a t - t > ., y CRY h r�, .,�c. qr r, OCD LIEN 6 £ T4' 1EJ'1 z b:QAT Ttda undehalgnAd eby'adakes apPlkWim for Cerlffo a Tate to Ddb v hide cl xrlbed, I SFCQND t:IENHOLDEA: , aboY6 eNb 4}t N M@BecV re{r�9s'end other legal xre 4 twill bete. wF 1:^' - t-r Nm iNfiEOF AP T AUTHOR ILL STREET 1 V J AUTHORIZED SIGNER 00 F .y `< NANiSEAF QOAF, ANTJTTk EOF`AurkdAIzED.SIGNE'\i STATE CD SIG 5. No.. 003977.0 PA TITLE NUMBER(AS SHOWN ON ATTACHED TITLE) MAKE OF VEHICLE MODEL YEAR PURCHASE o PRICE ZOO(sea Hwa 0.Revaso.) ,_.1"if L \ VEHICLE IDENTIFICATION NUMBER CONOTTIOH i�•J-�/ N �Z M L �/C (-1 p(�?z0 O GOOD AIR O POOR LESS TRA VUR B. LAST NAME(ORFU.L BUSINESS NAME) /� Fl NAME M NAME ,-�(�'`C C..-�L•�1C.f TAXABLE AMOUNT �i COSELLER 1,SALES TAX E . X 6%(. X (AT)OR C.. LL.LAST NAME(OR FUBUSINESS NAME) FIRST NAME MIDDLE NAME PA DUPHOTO OX DATE t`4 X 6%ja T% 1 Q OR BUS IDK C7 6�j *( Nato an Rsvaaa.) Gvnfik� hCl� (n'�Gi 'h2uJ 2 X 1 6682 a,"AX£MPTION.;'. FIRST AME MIDDLEBIRTH §O z PAOUPHOTOIDA BI !.(lo: - -',.z•;rc.< ,�:: >+.° STREET-COUNTY CODE p8BlGNMEHTw:• ASSIGNM( T; ir: - <:E y �Z mcun CZ tx�� CZE r+ 2 1 rcy�l STATE ZIP CODE DATE ACQUIRED/ 2 TITLE FEE[�rREFER TO COUNTY CODES L�jt•Q.• �`A I' ':i* 1 7 LIST No ON REVERSE SIDE' OF YELLOW COPY. ALIEN FEE D LAST NAME(OR FULL BUSINESS NAME) FIRST NAME ' MIDDLE NAME PA DUPHOTO IDA DATE OF BIRTH OR BUS.IDD I.REGISTRATION OR O O . . .. PROCESSING FEE PURC, LAST NAME FIRST NAME MIDDLE PA 6UPHOTO IDA DATE 017 BIRTH ' FEE EXEMPT NUMBER AS ASSIGNED BY THE DEPARTMENT - STREET I COUNTY CODE 6 DUPLICATE REG, :r 4 FEE NO.OF CARDS_,_ CITY STATE LP CODE GATE ACQUIRED/ •'>: PURCHASED REFER TO COUNTY CODES S.TRANSFER FEE - LISTING ON REVERSE SIDE,. OF YELLOW COPY E MAKE OF VEHICLE VEHICLE IDENTIFICATION NUMBER T.INCREASE FEE I • MODEL YEAR BODY TYPE(CP,M ETC.) CONDITION 6.REPLACEMENT FEE O GOOD O FAIR O POOR TOTAL PAID I• 70. F, O PLATE TO BE ISSUED BY O TRANSFER OF mvio JSLY ISSUED PLATE (ADD 1 THRU 6) DEPARTMENT(PROOF OF O TRANSFER&RENEWAL OF PLATE INSURANCE MUST BE O TRANSFER 6 REPLACEMENT OF PLATE 11.GRAND TOTAL SEND ONE CHECK III r) EXCHANGEATTACHED. O TRANSFER OF PLATE 6 REPLACEMENT OF STICKER (ADD 9 6 1t1) THIS AMOUNT,� O EXCHANGE PLATE ro e£ SUED 8Y0£PARTMEM ELATE :";.;;. ....: -.:' w;,:;:.',.'�:.�.'i.';::.. REASON FOR REPLACEMENT -TEMPORARY PLATE ISSUED •....:�;::... .. ,� ' BY FULLAGENT(Hole:This _..•..•. ...........:.......`....:. O LOST O DEFACED O STOLEN O NEVER RECEIVED(Lost iJA-ND pats will expire 90 days eom EXPIRES Month Yew NOTE:I'NEVERRECEIVED"block id oh a eQ appAcam muH comPl Form MV-O date of Issuance.). TRANSFERRED FROM TIRE NO. VM F /J '..':�;,:'"-""•�:"": -.,�.�'� R SIGN HERE RELATIONSHIPOAPPLI T ;TEKAP:;PIATE IVO;';; PLATE IS BEING TRANSFERRED(IF OTHER THAN APPLICANT) �g N. M1RC)AW£tGHT UNLADEN.WEIGHT I{JCWDI&LOAD . (IF APPLICABLE) IN E CC 4i� NAME TrOL1CY N0.OR POLICY,EFFIECdJVl3 (2 DATE 71 ` t✓ ATT AT£1 lJ t `J I J I CERTIFYTHAT ON MONTH DAY YEAR 1 NA (1 ISSUING I HAVE CHECKED TO DETERMINE THAT THE VEHICLE IS INSURED jJ AGENT ISSUED TEMPORARY REGISTRATION TO THE ABOVE APPLICANT.NINFORMATION COMPLIANCE WITH ALLAPPUCASLE PROVISIONS OF THE VEHIC(.E'- U O iCODE AND DEPARTMENT REGULATIONS. w ) '7%cb-(�`, WJE CERTIFY THAT WYE HAVE EWtMMEDANO SIGNFA THIS APPLICATION AFTER TION.HANE T 3 EfREM ARE TRUE AND CORRECMAKE APPLICATION FOR CERTIFICATE OF TITLE FOR THE VEFpCLE DESCRIBED I AIF ANY TION IS THE HASER FF��RiRTFIER CERTIFIESAUTHORREO TO CLAIM TF11S EXEMPTION.WVE ACICNOWLEOGE 1liAT VIfYE MAY /QVR OPERATING8) R VEH REGISTRATION FORFAWFtERESPONSIBILITY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD GISTRATION.HAVE ACKNOWLEDGE MAY BE SU83ECT TO A FIRE NOT EXCEEDNG 45.0 IMPRISONMENT OF NOT MORE THAN TWO YEARS FOR ANY FALSE STATEMEN T UWE MACE ON THIS APPLICATION. 1ST MEW Siprwyurs of C04hvdmsedTge off Audwn ( ) .2ND ftneture of SeeoM Purchaser or A~zed Signer Telephone No. ASSIGN MEDT Signature ( ) H. ZO NOTE:IF A CO PURCHASER OTHER THAN YOUR SPOUSE IS LISTED AND YOU WANT THE TITLE TO BE LISTED AS-JOINT TENANTS WITH RIGHT OF SURVIVORSHIP(ON DEATH OF ONE OWNER•TITLE GOES TO SURVIVING OWNER.)CHECK HERE O.OTHERWISE. N THE TITLE WILL BE ISSUED AS COMMOK(ON DEATH OF ONE OWNEK INTEREST OF DECEASED ;: OWNER GOES TO HI ESMER HEM OR ESTATE.) NOTE:IF THE VEHKXF IS TO BE USED AS A DAILY RENTAL OR LEASED VEHICLE,CHECK THIS BLOCK O. IF BLOCK IS CHECKED.COMPLETE AND ATTACH FORM W IL. MEW MESSENGER 140. 2.DEALERASSUING AGENT SA-20:(10-of wsD: 14049 3400 011936-001 title: 41710292/24-FE13-14 DealerTrack on-Line Registration system Pennsylvania Department of Transportation Applicant summary Statement Transaction: Reassign Title/New Reg Processor: TEAM RAMAL OF SILVER SPRINGS INC/008SSS34 Processed By: 3ESSICA APGAR Purchase Data.' Feb 18, 2014 Process Date: Feb 18. 2014/ Temp Reg Date: Feb 18, 2014 Prev Title No: 51710292 Prev pup Title count: None State of origin: PA Stock No: 195917 vIN: 1GW IDWVC40D220 condition: G000 unladen weight: chassis Mftr: YR/Naka: 1997/aura Body: CP GVwR: Body Make: Odom Reading: 9967 Fuel; G GOAR: Seat cap: Odom Qual:-ACTUAL MILEAGE Purchase Price: $2,500.00 NO of Axles: Brands• MATTHF1w LEE CUNNINGNAM/S [ j Tenant in ERIE INSURANCE EXCHANGE 627 MOUNT ROCK RD Survivorship? Q101507260 CARLTSLE/PA/21 ( j Tenant in 17015 COmmen Oct 15, I013 -Apr 1S, 2014 ( ] Retired ( ] oDTF [ ] Daily Rental Nail code: Disabled veteran: 0 PlnhDOT Fees v2N: None None - Tax exempt season: Sales/use Tax: .250OD YR: Tax exempt N0: Motor Veh. Fees: $8.50 Make: Taxable Sale Price: $2,500.00 other Fees: Am Condition: sales Tax credit: Total: $208.50 Allowance: () ELT [) Local sales Tax override? Trade In d2• None Allowance: LienNtdre2: None Assigned Tag Type: PASSENGER/01 class: Assigned Exp Sticker Ho: 0046969 - Assigned Tag No: 3LK3443 Reg. Sm. Class sticker No: Assi wed Date: 3an/2015 Rea. GCw: Transferred Title No: gnu re or Person froo tam Tag is Being mos crr Transferred Tag No: [ ]w/Renewal Relation to Applicant: (]w/Tag Replacement No Pf OW R Cards• 0 w/Te Exchange IT- Reque5t or Optlona Registration At A we g t�Excee ng a GVWR (MV-1005) amRAM.TM operation of a truck loaded beyond the mamrfacturer's erose vehicle weight acting(0101t)my create unsafe conditions and also void the amufactvmr's warranty if damage should result frog such overloading.deck with your dealer or factory representative.Yoe should also consult your insurer concerning possible adverse sFfocts to your lnsurence coverage with respect to such overloading.I/wa redift t that the above described vehicle be registered at etre gross vehicle-weight(Rm or aaco0 listed above under - eM provisions of Section 1916(6)of the vehicle code as attended by Act no, approved 2-IS-90.1/ftacknowledge that z have been warned by the Departeeot of Transportation that loading my truck beyond the Manufacturer's gross weight wring Bay daMlg♦the truck and endanger its occupants,as well as other vehicles and their occ�ants and pedestrians;and%Am assume all risks connected with any such overloading of the truck. zwwe Kar1olY Hagge that z/we nay lose my/our operating-p pa es or c e s n ons r Tat sure.ta mintain financial responsibi lity on thegkrran y rep ice Vehicle for the Period of registration. I/ee further acknowledge that IAn may be subject to a fine not exceeding$5,000 and toprisom"t of not more than two(2)years for false statement that I/we mke on this form,and the certify that I/tre have exaNnrd and signed this forts after its coepletion; and that if an etc tion from pay sunt of sales tax is claimed, 9 an/we are authorized to clj.this anmp'I., I/we further certify that all stataants herein are true and correct and make application for certificate of title for the vehicle described above. Date Subscribed sworn L0: gnatmre O —Ap-pTicant or AutheriZed Signer: - Signature of Notary Administering oath: Signature of Co-Owner it e of Authorized Signer: VIN GVWR Certification or Trac n9 S Required ...................................................................... S lace Signature of Person verifying viN/GVwR or the Tracing Here: E I hereby certify that I have verified the VIN/GVWR of A this vehicle and the vni/GvwR listed above is correct. L SIGN: DIN• - - -ore -- — — — — —— — ———— — — —— ---- -^- -- -- - -- - -- -- —— —— — — COMMONWEALTH OF PENNSYLVANIA REGI0 v' '4 13. j "i-f 0r r r Ts -0 EXPIRY:.JAN 31, 2016 1 rot, PLATE: 7Lk3443 C3 TITLE:' "493 ' —T—— ,SIGNATURE ——CO iN� t cal. SYR/MAKE: Z .M n'. tj . TYPE: e. tou ?�� I hereby gds day Bort 1 have received WID:' 9 -001 a9€:.Ei- ►.. '. •' notice Ofthe Provisions ofSection 37MdDoVehicle TITLE BRANDS: Code EMISSION INSPECTION REQUIRED/DIESEL EXEMPT COUNTY CUMBERLAND MATTHEW LEE CUNNINGHAM 627 MOUNT ROCK RD CARLISLE PA 17015 ' ;. Ic•t•., A�PdRTMENT OFTRANS�p { ATIO R<, .tr R•`�ke . 7 1EC :O T' TL.Ery(� • � ,.�'-• .:' '�� (�, .�`.•i'� „ ,A'#' ?.t: �':' �, :,, ti e PSS ty. `. �`• " v1:: ftp Y, rel.,••, ,R;li A' -• t�` SS t? Y. r' 7- ry� �. it, Kh , ` .} 'f• .N..r`.,:Lt>\ p.: '(, }• yi •0.p F. 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'.;}_.' ,••t.���c,: .:� *� lyr 1....+'�Aid,••+S:Gt'•,��„V11+c.;.-�:.`. `'J:�;.r. -mss ..�:•���•-,• ii a:.Y, e::•.;'°, b �...s.. .. �^•'�4'G?5 4''tf O: .e'••'.`~., ':�'�.�?,: ,5>;, >:. -41*9 obco td ll�: b Ma As v� f•Nan d*o eras- ol. '- �k c7 - •�`h ;,,�v" ,'•• 's:``•:', =-�r',7kn71abor mlpq:ke■md UiY Tlei..lo= 9umud Mh MUM ADDRESS 6a;'?'�'x f?•ue"C�v' :�'Y.}t:r:�..::���'':,:;._.�;�.�. tri:.,. %'; -�.�;.aFFlo!tietam?g0��'*�`:r-'r5;,;:•`=s•:'.i:•. �°•` ;?tit R�wb}'`,�v'+: TE.`,- ,.+r;.a ..u;�•! i,%' 'a�'`-•y:::..,,.� - •'* `l'.n.�=•�y'�•';:�a:;��s',''^:','�,Y fi" is +`� `; +�, x-:...•z�::�.,,;� •:7 -z-r' ,,:: •<�t 4 .�_'fi,d+ ':�:iYz•t' � si7,6FORIR1JFJt ,�'-�'�.,•:..<:5'.t. � _ ,.�rj,T, ... ,.i_�1R•.}!i ''S�:n.4 :R's."Kir,a�-:.�-,-'+'T�y r���z w`�..t• p EDWARD F HARRYk$ � E �!'i : :., , ^r�,; 7073 CARSLISLC PIKE LOT 60 CARLISLE PA 17013 • � ;�.. .s yy r�% tom, � '. -� Klo a®!'al.>�•:e>,dkW r•oola•:d fi,. ,>< ' �.'E'Ii L'" ORY. ..•plFal l°Ft me wWSIt4 or Welgty MIIN6°Ot•bt 4 91B Idtr�4 ONRIIf t- Sevefr&y of'U=Wwbtkb' Von t. r Ir 'Ski - '< a ::.•'r=•�.. �... � ; A T t or LMN ' ; x` .-!GL:/.t'<T'r u _ ,1t K•:! STREET 'J ~•�"�' � AL Sl�:� - �'*.:,, 's1'� �A"`'• �}r STATE � '.:zw ; 53TIL 4 ° Vid .•f bt Oa0$aiu at iib ben d•ac1ID•0 •t:. ,r .: t,.•, '• ,• b OII,Ot bpY tla11,�RNr1Wef 11•If. :;A,-t`,�'`+ ',Y�IJ',1Av'�.`�,�': V STREET OF .V j,�'i. `Fid. Y '' .•',1 GtYLo "4•£'1' ..+. tk"�•B?AT0' .. ., '�=�. d W ,+��:•µr '•; ::.I '�`r,.'. � �R p:t:at�:a. 3 1 '� 1 IN • • o — s RECEIPT FOR PURCHASE OF: 1997 GMC SONOMA VIN: 1GTDT19X6VK506796 TITLE NUMBER: 51.005801601 SELLER: JESSICA WENGER, EXECUTOR 44 FOXANNA DR CARLISLE PA 17015 BUYER: NAME: It " it ADDRESS: AMZC D: $ aCDC BY: ASHCHECK #: SELLER DATE: BUYER: DATE: p TRUCK IS BEING SOLD AS IS NO WARRANTY OR GUARANTEE IS EXPRESSED OR IMPLIED RE'V451a EX-JI-97) ab SCHEDULE G INTER-VIVOS TRANSFERS& COMNHEWTANCELTH DTAX NRETURN�� MISC.NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OFTHE TRANSFEREE,THEIR RELATIONSHIP TODECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER w t r� ATTACH A coof THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST FAPPL=&E 1. C,.1,%j res Bt L�oos,'t 401--AAC d"k f�. # 3/f(o0 2AP / S' ,� 13� S 2/.9 rf /oo q„ --o - /3, SZ/.I4< IQ. '&t Q cc.r. to d-o•q! an A. "'0.V'r L'. 4� 31S oo t/9 3o 7 �`6,608:2/ •r " 4de.,z 17.-Tr Cl6U : d.aw. on C. < D.17 sr " s'p,/7 80�! CvS Are "A X_wsl ���' 7tss;rw s WPsl9@F� �//IQI./��4d1��7�Cr --6,,/@-- --L//t�lCc'��2/�: CSCE va4Kll4eh `M&_ 1i6Cs1Pl) TOTAL(Also enteron line 7,Recapitulation) $ �,O /3 O. 77 (If more space is needed,insert additional sheets of the same size) F INDIVIDUAL TAXES Pennsylvania Inheritance Tax pennsylvania 2806D1 SBURG PA 17128-D601 Information Notice Iff DEPARTMENT OF REVENUE And Taxpayer Response REV-154 3 Ei D.EZEc cos-121 FILE NO.2114-0057 ACN 14106957 DATE 02-10-2014 Type of Account Estate of EDWARD F HARRY Savings Checking Date of Death 01-02-2014 Trust JESSICA S WENGER County CUMBERLAND X Certificate 224 KEY WEST BLVD CARLISLE PA 17015-8546 PNC BANK NA provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.31400220195 Remit Payment and Forms to: Date Established 09-18-2001 REGISTER OF WILLS Account Balance $13,522.39 1 COURTHOUSE SQUARE CARLISLE PA.17013 Percent Taxable X 50 Amount Subject to Tax $6,761.20 Tax Rate X 0.045 Potential Tax Due $ 0.04 5 NOTE': If tax payments are made within three months of the decedent's date of death,.deduct'a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE-) due. Any inheritance tax due will become delinquent nine months after the date of death. PA1 RT Step 1 : Please check the appropriate boxes below. A [:]No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B The information is The above.information is correct,no deductions are'being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C ❑The tax rate is incorrect. n 4.5% 1 am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased. (Select correct tax rate at right,and complete Part F—] 12% 1 am a sibling of the deceased. 3 on reverse.) 150% All other relationships(including none). DO Changes or deductions The information above is incorrect and/or debts and deductions,were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E F]Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required,you may attach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date Line 1 account balance Line 2 or percent taxable Line 3 Y 9 ( ) ( ). Pe ( ), please obtaina.w.ritten correction from the financial institution and attach it to this form: 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the.account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"intrust for"another or others were 100%owned by the decedent. ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the total number of owners including the decedent. (For example:2 owners=50%,3 owners=33.33%,4 owners =25%,etc.) b. Next,divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate,please state your relationship to the decedent: 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. . Amount Subject to Tax 4 $ 5. Debts and Deductions 5 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ 9. With 5%Discount(Tax x .95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not send payment directly to the Department of Revenue. Under penalty of.perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work �,. Home- T ayer Signature Telephone Number Date 3101(l IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR° TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 OF INDIVIDUAL TAXES pennSyLvarnd � Pennsylvania Inheritance Tax 280601 1,RISBURG PA 17128-0601 Information Notice T—aDEPARTMENT OF REVENUE REV-155 E%DocE%EE(00-12) And Taxpayer Response FILE-NO.2114-0057 ACN 14106958 DATE 02-10-2014 Type of Account Estate of EDWARD F HARRY Savings Checking Date of Death 01-02-2014 Trust JESSICA S WENGER County CUMBERLAND X Certificate 224 KEY WEST BLVD CARLISLE PA 17015-8546 PNC BANK NA provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No.31500219307 Remit Payment and Forms to: Date Established 09-18-2001 REGISTER OF WILLS Account Balance $6,608.38 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $3,304.19 Tax Rate X 0.045 Potential Tax Due $148.69 NOTE': If tax payments are made within three months of the decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) •$(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ,0 No tax is due. I am the.spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death_ Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B MIThe information is The above intoimaf6n i§correct;no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C The tax rate is incorrect. �4.5% I am a lineal beneficiary(parent,child,grandchild etc.)of the deceased. (Select correct tax rate at right,and complete Part 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships(including none). DF]Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E F]Asset will be reported on The.above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART Debts and Deductions 2 Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required,you may attach 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date Line 1 account balance Line 2 or y g ( ) ( ), percent taxable(Line 3), please obtain a written correction from-the financial institution and attach it to this-form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"in trust for"another or others were 100%owned by the decedent. ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the total number of owners including the decedent. (For example:2 owners=50%,3 owners=33.33%,4 owners =25%,etc.) b. Next,divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate,please state your relationship to the decedent: 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $. 9. With 5 Discount(Tax x.95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of As listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work Home ayer Signature Telephone Number Date 211011� IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 REV-1511 EX+(10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL. EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF y1 � FILE NUMBER ,p Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ' My, /.Jujrl )Zm,-x,/ o�lehre t /1?et mn;c s6u� /�, 33/, oe (See 6;//;n9 !l �tc�J�i✓) B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions t d Name of Personal`Representative(s) _TG SStCsr S. CiJPAtAP�' X 2, /73, 8G Street Address ' q OOxan na Dr• city NA'.slG state—Af-_zip /1015 Year(s)Commission Paid: 2. AttomeyFees (!hA4ge5 je. Sh►!✓IdS ff, , ESb- -?/RIO.37 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) Claimant NQ. O/VF 4`46//3LE NDN'E Street Address City State Zip Relationship of Claimant to Decedent /p __II ` 4. Probate Fees Awd 0t ij►hal )3sme- W �]014� CF.)�7 C,W,,hwL. 7b NrSE;54,eAlS A/5t3,577 5. Accountant's Feeslopy��f �neshn k, 4d4-" 4'. Ass—:�-Gs,AM- 6. Tax Return Preparer's Fees P" T't 'n C• GS ��3 C�J/�� /�i��; /4v/ �. 0 O, D D 7. Re nb. t Chat_ r. Sh•tslels fp,- &dd,� sho4 ceF�fi�afcs X20.00 t. li r. �a a. tt grSQO 9. Adw,-/7 a� �Or-a 6eLke- /o. 4?ei,b. * C&J C--. J,6,e/e/c d9rr r1aSka, cer�Iy. 0?A;m1r, luxe S, PAA>eep.a 5, t✓yc. (a -.A'^,) S« Con Ain S`/iee TOTAL(Also enter online 9,Recapitulation) $ m ys i-0 (If more space is needed,insert additional sheets of the same size) par ESI. 0-1' F/G No. ,Z/ i1 e l /YZ 96 i _ RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date: 1/16/2014 Cumberland County - Register Of Wills Receipt Time: 15 :02 :42 One Courthouse Square Receipt No. : 1076744 Carlisle, PA 17g13- HARRY EDWARD F Estate File No. : 2014-00057 Paid By Remarks : ATTY CHARLES E SIELDS III WZ ------------------------ Receipt Distribution ------------------------ Fe e/Tax Description Payment Amount Payee Name PETITION LTRS TEST 45.00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 20 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 .50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 3441 $143 .50 Total Received. . . . . . . . . $143 .50 MARJORIE A.WEVODAU LISA M.GRAYSON,ESQ. a s FIRST DEPUTY REGISTER OF WILLS a AND 'WAYNE M.PECHT,ESQ CLERK OF ORPHANS'COURT - . SOLICITOR REGISTER OF WILLS CLERK OF THE ORPHANS' COURT COUNTY OF CUMBERLAND ONE COURTHOUSE SQUARE,SUITE 102 CARLISLE, PA 17013 (717)2406345 . FAX(717)2407797 I INVOICE Bit!To: InvoiceNo: 4591 Invoice Date: 1123/2014 CHARLES E SHIELDS III Estate of: EDWARD F HARRY 6 CLOUSER RD Estate No: 21-2014-0057 wz MECHANICSBURG,PA 17055 Qty Fee Description Fee Total 4 Short Certificate 5.00 $20.00 Total: $20.00 r' 3-76551364 ATW CHARLES E;SHIELCIS Ili J 4 5 6 CLOUSER RD MECHANICSPURG PA 17455 -4 PAY TO THE ORDER OF ttFF��.�� �.� T ID'77 DOLLARS o+sae.� XX Citizens Bank& MEMO a�-�'�r�g� �Zllav +1:0360761S01: 621SS.S12480 345S Checks should be made payable to the Register of Wills.Terms: Net 30.. Please return one copy of this invoice with your payment. Thank you. I MARJORIE A.WEVODAU LISA M.GRAYSON,ESQ. ' FIRST DEPUTY REGISTER OF WILLS _ "Q AND = .3 _. WAYNE M.PECHT,ESQ CLERK OF ORPHANS'COURT - '. ; ` ! SOLICITOR REGISTER OF WILLS CLERK OF THE ORPHANS' COURT COUNTY OF CUMBERLAND ONE COURTHOUSE SQUARE,SUITE 102 CARLISLE, PA 17013 (717)2406345 FAX(717240-7797 INVOICE BillTo: InvoiceNo: 4767 Invoice Date: 6/20/2014 CHARLES E SHIELDS III Estate of: EDWARD F. — (Q y 6 CLOUSER RD Estate No: 21-14-0057 wz MECHANICSBURG,PA 17055 Qty Fee Description Fee Total 3 Short Certificates 5.00 $15.00 Total: $15.00 FS E SHIELDS IIC �0 7 6 LfEE#IiA QNICSBU�tG Pio 47055- ;0.90 i t >� + ' -TgTH4-4 E k . F ; S + i1.I, "�Itizens BankO : ME1�0 ,•. k +t: 13f�0?'6 SOI: 62LSSSL24811• Checks should be made payable to the Register of Wills.Terms:Net 30. jir•3.' ti7�u• 3i ij:_;::n:. "'-`.5,.^�Yi�? ,,�- .._ '.`y_1`�nJ.y;2.,�:Xa'w•?�.L-"�,��."qr,� l'' '�. �?K",yE?''v�n�'�f�}yt�"s+�:"'':',�9,' :� ,}'S,'.`��..Y'k`:F.,u<;. ...<F't4��zr.; `G f=iyv'..Y,L��Qa`.*'•:r gr,',.'',K:< f.':,. r:JF.. ....-ti•:k^i a�.'d+�" t'�Y:= h.✓. .fin' 2»sM^f++'�; %4i%".ai.i`gs�...%T;�f?�Y .',y`F,. s;:;;<:t Fk�"���F:..-, w 3},.�'�?.i:-•�.7 a'iat""�:. �' ..i'�c,•,� ..�._�'r{::.,.�..,� r{��<.- ':4k.N�&vi;•ti,$'?`•,?%:fir�ti�„•f _`' . `•��nix;:.u':? .<��,'<�i•<'r.:>=';,' t`�sryy"_1;,.q;.:d5_;%'g.�,�y�",�'f.+c,.,G':ts.i,<�:_ 11 INVa" I"kE Jessica Wenger 44 Foxanna Drive Carlisle,PA 17015 Invoice Number: 11032 Invoice Date: Jan 2,2014 Page: 1 rig . Edward F.Harry January 2,2014 Net 30 DaysWi1gam 4>Christopher PS Professional Services $ 5,840.00 FSE Facilities, Staff and Equipment $ 1,150.0 V Vehicles $ ' 984.00 M Merchandise $ 21525.00 CA Cash Advances $ 1,857.00 CA Cash Advances Adjustments Terms Discount of$808.00 has been applied. i' InkYQU for allowing us and our famfl . Subtotal $ 12,331.00 We gladly accept the following farms of payment: Shipping $ 0.00 Cash, Check,Visa,MasterCard,Discover,American Express Sales Tax $ .0.00 Kindly make your check payable to: Total Invoice Amount $ 12,331.00 Myers-Buhrig Funeral Home and Crematory Payment/Creditpled. $ 12,331.00 Past due accounts are subject to interest charges of 1.5%per month. Walking with Those in Grief Robert"Bob"L.Buhrig,Jr.,r•D,supervitm-William"Bill"L.Christopher,Fo Phone: tn>)766.3421 - Fax: (m)795.7291 - 37 East Main Street • Mechanicsburg,PA 17055 • www.Myers-Buhrig.com • DirectorsQMyers-Buhrig.com REV-1512 EX+(12-03) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE UABILMES, & UENS RESIDENT DECEDENT ESTATE OF FILE NUMBER r/j✓ar �: Harry 4/-/V- S,- Report debts incurred by the decedent prior to death which remained unpaid as of the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. �ron4issory Note-- d Jitn_ 9, Mal ;n 'fie 44& a�n©rtinf �� X13, le+6 2../10 p� C �. 8o�letm,e-,~ e t d. o.a!. X22., 5Y?. 53 See e-416,SAeel 1K �72. 53 „ aged) oslate' " Cred;4- Ci,wd . ► CAsR ?-aM J< 3. ►�Pl X, ;P,'/- IPZW"/ C"-V 33.oo F, Ka4;Tor 1 Kaficl, Assncs . ?7Dd 1. CAP 62dd o kos ve . 9. /-10l t�v%r,f 40y; Q/ t 77 Zz /o, Holy +PW Physic;arI Sery CN �3 9•�&` TOTAL(Also enter on line 10,Recapitulation) (if more space is needed,insert additional sheets of the same size) PROMISSORY NOTE $13,662.10 January 9, 1998 I,EDWARD F.HARRY,currently of 7073 Carlisle Pike,Lot 60,Carlisle,Cumberland County,Pennsylvania 17013,promise to pay to the order of MARY E.SWINN,THRTEEN THOUSAND SIX HUNDRED SIXTY-TWO AND 10/100($13,662.10)DOLLARS without defalcation,value received,with simple interest at the rate of FIVE(5%)per cent,per annum, within five(5)years of the above mentioned borrowing date. This Note is renewable upon mutual consent. And further I do hereby authorize and empower any Attorney of any Court of Records of Pennsylvania,or elsewhere,to appear for and to enter Judgment against me for the above sum, with or without declaration,with costs of suit,release of errors,without stay of execution,and with five per cent added for collecting fees;and I also waive the right of inquisition on any real estate that may be levied upon to collect this note,and db hereby voluntarily condemn the same and authorize the Prothonotary to enter,upon the FL FA.said voluntary condemnation,and I further agree said estate may be sold on a FI.FA.and I hereby waive and release all relief from any and all appraisement,stay or exemption laws of any State,now in force,or hereafter to be passed. Witnesses: F (SEAL) EDWARD F.HARRY I hereby certify that the precise residence of the Judgment Creditor in this JutIgment is 7073 Carlisle Pike,Lot 60,Carlisle,Cumberland County,Pennsylvania 17013. s Attorney Rfrvl-o 413. -3 coo -/v Zoo/ = 6 83. '30e)x .2p-tv '0&S3, ----------- --—-------- --------......... .......... ................. .......... .......... .............. ..................................... ................ ------------- ---------- ---------- -----------------................. ................- ----------- .............. -------------------- ...... servie � g 7601 PENN AVE S,SUITE A600 MINNEAPOLIS, MINNESOTA 55423-5004 TELEPHONE 612-243-8620 Hours(Cr): 7:00 am- 7:00 pm M-TH FAx 877-326-8784 7:00 am- 5:00 pm F TOLL-FREE 877-326-6766 November 7, 2014 The Estate of EDWARD HARRY Attn: CHARLES EDWARD SHIELDS 6 CLOUSER RD MECHANICSBURG PA 17055 Re: Our Client: Chase Bank USA N.A. Account No: ************2730 Unpaid Balance: $343.04 Reference No: 10254676 Dear Sir or Madam: Per your request, enclosed is-0e documentation for the above-mentioned account. Thank you for your attention on this account. Please contact us at 1-877-326-6766 to discuss this matter. Cordially, DCM Services, LLC Enclosure This company is a debt collector. We are attempting to collect a balance-due from the assets of the Estate ano any information obtained will be used for that purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE:SEE NEXT PAGE FOR IMPORTANT INFORMATION - Page 1 of 2 - F 7203 *IMPORTANT INFORMATION* Under the law we are required to notify you of the following information. This list does not include a complete list of rights consumers have under State and Federal Laws. NOTICE ABOUT ELECTRONIC CHECK CONVERSION When you provide a check as payment, you authorize us to either use the information from the check to make a one-time electronic funds transfer from that bank account, or to process the payment as a check transaction. When we use information from the check to make an electronic funds transfer, funds may be withdrawn from that bank account as soon as the same day we receive payment, and you will not receive the check back. FOR COLORADO RESIDENTS Colorado Office Information: George E. Meziere, Esq., 3025 South Parker Road, Suite 705, Aurora, CO 80014, (303) 614-9999. FOR MASSACHUSETTS RESIDENTS NOTICE OF IMPORTANT RIGHTS You have the right to make a written or oral request that telephone calls regarding your debt not be made to you at your place of employment. Any such oral request will be valid for only ten days unless you provide written confirmation of the request postmarked or delivered within seven days of such request. You may terminate this request by writing to the debt collector. FOR NEW YORK CITY RESIDENTS New York City Department of Consumer Affairs License Number: 1239504 To discuss this account, please call our toll free number to speak with JoAnn Palo. A representative will be able to assist you during our normal business hours. FOR NORTH CAROLINA RESIDENTS North Carolina Permit Number: 4440 FOR TENNESSEE RESIDENTS This Collection Agency is licensed by the Collection Service Board of the Department of Commerce and Insurance. MINNESOTA LICENSING INFORMATION This Collection Agency is licensed by MN Commerce Dept., 85 7th Pi. E., #500, St. Paul, MN 55101, License No. 20598440 _. ... _._.... . . . ._ ....._... _ __ ..... . ........... .............. slate 426684126634273000021600000343D4000000003 from CHASED P.O.BOX 15123 WILMINGTON,DE The Past Due t Ji 198505123 amount of$191.0015 Included In your Minimum Payment Account number-4256 8412 6634 2730 $ Amount Enclosed 002W BEx 9 19214 0 Make yow check payable to:Chase Card Servlc s EDWARDFH44 OXANNA DR CARLISLE PA 17015-9088 Jill lnjjl11Prj11111111jrjrr)PIhP9br)jllj111111111111jJill CARDMEMBER SERVICE PO BOX 15153 - WILMINGTONDE 19886.5153 500016028 20312663427309 SI ate =-racoount onfirw. ® ca your a brcwwseerr from CHASE O ', . Account Number.4266 8412 6634.2730. New Balance .. ..$343.04 Previous Balance $343.04 Payment Due Date 08/08/14 Payment,Credits $000 Minimum Payment Due $216.00 Purchases $0.00 Late Payment Wanting:If we do not receive your minimum payment Cash Advances $000 by the date fisted above,you may have to pay a late fee of up to$35.00 and your APR's will be subject to increase to a maximum Penalty APR Balance Transfers $0.00 Of 29.99%. Fees Charged $0.00 Minimum Payment Warning:If you make only the minimum payment Interest Charged $0.00 each period,you will pay more in interest and it will take you longer to New Balance $343.04 Pay off your balance. For example: Opening/Closing Date 06/12/14-07/11/14 Credit Limn $6,000 it you make no You will pay off the And you w81 end up about credit counse additional charges using balance shown on paying an estimated Available Credit $0 this card and each this statement in total of... Cash Access Line $7200 month you Pay... about... Available for Cash $0 Only the minimum 7 months $351 Past Due Amount $191.00 payment Balance over the Credit Limit $0-DO It you would like Informationling services,call 1.866.797-2685. This account is dosed and no longer available for use. Total fees charged in 2014 $120.00 Total Interest charged in 2014 $11.13 Year-to-date totals do not reflect any fee or interest refunds you may have received. !,i Your Annual Percentage Rate(APR)is the annual interest rate on your account Annual Balance Balance Type Percentage Subject To Interest Rate(APR) Interest Rate Charges PURCHASES Purchases 12.99%(v) -0 -0- CASH ADVANCES Cash Advances .- 19.24%(v) -0 -0 BALANCETRANSFERS Balance Transfer 12.99%(v) •0- -0- (v) 0(v)=Variable Rate 30 Days In Billing Period Please see Information About Your Account section for the Calculation of Balance Subject to Interest Rate,Annual Renewal Notice,How to Avoid Interest on Purchases,and other important information,as applicable. REV-1513 EX+(9-00) SCHEDULE J. COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not ListTrustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)) 1. #74,-y E. Swinn ,$hanyu' /r� rnv le home + -l92 dUeffZvr%/e RW d/000l�/�'�. Contents. /70Is Res:c/ue wnd/�ima:nder ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE,ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE i. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS t. TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed,insert additional sheets of the same size) LAST WILL AND TESTAMENT OF EDWARD F.HARRY I,EDWARD F.HARRY,currently of 7073 Carlisle Pike,Lot 60,Carlisle,Cumberland County,Pennsylvania,being of sound and disposing mind,memory and understanding,do make, publish and declare this my Last Will and Testament,hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I hereby give,devise and bequeath my mobile home currently situate at the above address and all the furnishings and household appliances and wares therein to my companion,MARY E. SWINN. In the event she predeceases me or dies at about the same time as a result of a common disaster or accident,then this gift shall go to my granddaughter,JESSICA S.WENGER. The death taxes hereon shall be borne by the residue of my estate. 3. All the rest,residue and remainder of my Estate,real,personal and mixed,whatsoever and wheresoever situate,I give,devise and bequeath to my companion,MARY E.SWINN,to her own use and benefit absolutely. 4. In the event my said companion,MARY E.SWINN,should predecease me or die at about the same tines I do,such as in an accident or disaster common to both of us,I hereby direct all the rest,residue and remainder of my Estate to be distributed to my granddaughter,JESSICA S. WENGER. 5. I nominate,constitute and appoint my companion,MARY E.SWINN,to be the Executrix of this my Last Will and Testament In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix,I nominate,constitute and appoint my granddaughter,JESSICA S.WENGER,to be Executrix in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WrINESS WHEREOF,I have hereunto set my hand and seal this /49day of &V:�14t , A.D. 1999. T &::4 (SEAL) EDWARD F.HARRY Signed,sealed,published and declared by the above-named EDWARD F.HARRY as and for his Last Will and Testament,in the presence of us,who at his request and in his presence,and in the presence of each other,have hereunto subscribed our names as witnesses.' -2- 1, J i i j US POSTAGE AND FEES PAID j PRIORITY MAIL Jan 29 2015 • a Mailed from ZIP 17055 Priority Mail Fiat Rate Envelope CommercialBasePrice 071M00625744 E PRIORITY MAIL 1-DAY CHARLES SHIELDS 6 CLOUSER RDQQ -0005 MECHANICSBURG PA 17055-9751 i -our r f i RETURN RECEIPT REQUESTED t SHIP TO:- i REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURT HOUSE SO RM 102 V CARLISLE PA 17013-3322 I USPS CERTIFIED MAIL I y of th Ounl, '?Jy for ents. %der P14F- 9402 7.102 0083 0588 3478 21 i rynt S.Po ht I CHARLES E. SHIELDS,III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG,PA 17055 GEORGE M.HOUCK TELEPHONE (717) 766-0209 (1912-1991) FAX (717) 795-7473 January 28, 2015 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle,PA 17013 Re: Estate of Edward F.Harry No.21-14-0057 Dear Register of Wills: Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Edward F. Harry Estate as Well as Check No.0997 in the amount of$45.00 for additional probate. Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, III Attorney-At-Law CES/mj j Enclosures 00 rf, C CD ` CZ) :Q 6=+ C