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Home My WebLink About06-03-15 1505614134 EX(03-14)(FI) REV-'1500 OFFICIAL USE ONLY Bureau of Individual TaxesINHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 1 4 0 9 4 2 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMODYYYY 0 9 0 9 2 0 1 4 0 4 1 5 1 9 2 5 Decedent's Last Name Suffix Decedent's First Name MI L A V E R T Y J R C H A R L E S E (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Ml THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(date of death Prior to 12-13-82) 0 4.Agriculture Exemption ❑ 5.Future interest Compromise(date of F-1 6.Federal Estate Tax Return Required (date of death on or after 7-1-2012) death after 12-12-82) Q 7. Decedent Died Testate F-1 8. Decedent Maintained a Living Trust 1 9.Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) ❑ 10. Litigation Proceeds Received ❑ 11.Non-Probate Transferee Return ❑ 12.Deferral/Election of Spousal Trusts (Schedule F and G Assets only) ❑ 13. Business Assets ❑ 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number D A V I D H S T 0 N E E S Q U I R ? 1 ? 7 7 4 7 4 3 5 First Line of Address 4 1 4 B R I D IS E S T R E E Second Line of Address City or Post Office State ZIP Code N E W C U M B E R L A N D P A 1 7 0 7 0 Correspondent's e-mail address: DISTONEEISTONELAW - NET REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY DATE FIR DTAMP X X Cn PLEASE USE ORIGINAL FORM ONLY Side I IIIIIIINIIIiIIIIIIIIIiINllllllllllllllllllllllllllllllllll , rri C) 1505614134 15 o 5 6j'Al 1'3 4 00 1505614234 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: CHARLES E - LAVERTY JR RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . 6 4 0 0 0 . 0 0 2. Stocks and Bonds(Schedule B) 2. 1 1 3 8 4 2 , 1 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 Miscellaneous Personal Property(Schedule E). . . . . . . 5. 2 7 0 3 9 7 . 7 3 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property (Schedule G) �❑ Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 4 4 8 2 3 9 , 8 5 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9• 7 9 7 7 3 • 8 2 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 3 7 8 . 6 5 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 8 0 1 5 2 . 4 7 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 3 6 8 0 8 7 . 3 8 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. 3 6 8 0 8 7 . 3 8 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 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.0_ 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 3 6 8 0 8 7 . 3 8 18. 5 5 2 1 3 . 1 1 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 5 5 2 1 3 • 1 1 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct a d complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATtaf2-�EP SO R SIBLE FO FILING RETURN DATE r -- �-' DDR 1 CA 0 01141 EET NEW CUMBERLAND PA 17070 S NATUR F tPtt`Z R OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN /DATE ADD 4 BRIDG STREET NEW CUMBERLAND PA 17070 111111111111111111111111111111111111111111111111111111111111 Side 2 1505614234 1505614234 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 21 14 0942 DECEDENT'S NAME CHARLES E • LAVERTY JR STREET ADDRESS 824 LISBURN ROAD CITY STATE ZIP CAMP HILL PA 17011— Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 551213 - 11, 2. Credits/Payments A.Prior Payments 56 ,000 - 00 B.Discount 2,7 6 0 . 6 6 (See instructions.) Total Credits(A+B) (2) 5 8,7 6 0 • 6 6 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 oval on Page 2,Line 10 to request a refund. (4) 3,547 - 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 ...................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............................... ❑ 0 c. retain a reversionary interest ..................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ 0 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after 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 step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent(72 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: CHARLES E. LAVERTY JR 21 14 0942 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION Property located at 262 Susquehanna Ave Enola 641000 . 00 East Pennsboro Twp , Cumberland County, PA sold to Charles A Wevodau on February 27, 2015 TOTAL(Also enter on Line 1,Recapitulation.) $ 641000 - 00 If more space is needed,use additional sheets of paper of the same size. REV-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCETAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER CHARLES E . LAVERTY JR 21 14 0942 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ML-GNMA 01-53 PM REMIC MultiClass CMO 276 . 41 2 ML-Lancaster PA NTS G/0 $10000 Bond due 5-1-29 101702 . 60 3 3802 shares ML-Pepco Holdings Inc stock B $27 . 055 ea 1021863 . 11 TOTAL(Also enter on Line 2,Recapitulation) $ 1131842 - 12 If more space is needed, insert additional sheets of the same size REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: CHARLES E . LAVERTY JR 21 14 0942 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 HB McClure-refund check received 99 . 00 2 Members 1st FCU-Cert of Deposit #281995-40 201000 . 00 Princ $20,000, Int $4 . 82 Rollover from 3-21-2009 3 Members 1st FCU-Cert of Deposit #281995-40 - Accr 4 . 82 Int 4 Members 1st FCU-Cert of Deposit #281995-41 151000 . 00 Princ $15,000 . 00, Int $'? • 1? 5 Members 1st FCU-Cert of Deposit #281995-41 - Accr 7 . 1? Int 6 Members 1st FCU-Cert of Deposit #281995-42 26 ,002 . 38 Princ $26,002. 38 , Int $5 . 13 7 Members 1st FCU-Cert of Deposit #281995-42 - Accr 5. 13 Int 8 Members 1st FCU-Cert of Deposit #281995-49 40,000 . 00 Princ $40,000 . 00, Int $13 . 06 Rollover from 9-21-2011 9 Members 1st FCU-Cert of Deposit #281995-49 - Accr 13 . 06 Int 10 Members 1-st FCU-Savings Acct #281995-00 36 . 69 11 Miscellaneous deposit 28 . 97 12 ML-Cash Account 4 ,650 . 16 13 Nationwide Insurance-refund on- homeowners ins 5 . 50 14 Net proceeds on personal property sold at auction 1,523. 75 by Cordier Auctions on March 7, 2015 15 PA American Water-refund 4 . 42 16 PNC Bank-Cert of Deposit #11020047481 61588. 39 Princ $6 ,588 . 39, Int $ • 21 TOTAL(Also enter on Line:5,Recapilulation) $ 270,397- 73 If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent CHARLES E. LAVERTY JR 21 14 0942 Decedent's Name Page 1 File Number Schedule E -Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1? PNC Bank-Cert of Deposit #1102004?481 - Accr Int 0 . 21 18 PNC Bank-Checking Acct #5140301561 39 ,229 . 19 Princ $39 ,229 .19, Int $ •31 19 PNC Bank-Checking Acct #5140301561 - Accr Int 0 . 31 20 PPL Electric-refund received 21 . 28 21 SecurChoice-Annuity held for preneed funeral exp ?1883 . 00 22 Susquehanna Conference UMC-Acct #2-11584 82 ,541 . 60 8 Cert of Deposits totalling $82,541 . 60 with int of $342 . 60 for all cdrs (see attached copies) 23 Susquehanna Conference UMC-Acct #2-11584 - Accrued 342 . 60 . 24 The Woods-refund on living exp at nursing home 3,396 . 59 25 US Treasury-CSA checks received 12 ,58? • 19 26 US Treasury-refund from dec 2014 1040 tax return 210 . 00 2? VA proceeds received 101216 . 32 28 Numerous miscellaneous items given to the Historical 0 . 00 Society Note : Edwin F Harne Jr predeceased the decedent as he was to receive personal prop mentioned in Item II of will SUBTOTAL SCHEDULE E 1561428 - 29 GRAND TOTAL SCHEDULE E (Also enter on Line 5,Recapitulation) $ 270,397.73 REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER CHARLES E . LAVERTY JR 21 14 0942 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Richardson Funeral Home—funeral expenses ?,883 . 00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Jon F L a F a v e r 20,929 - 00 Street Address 120 Carol Street City New Cumberland State PA ZIP 1?0?0 Year(s)Commission Paid: 2015 2. AttomeyFees: David H Stone, Esquire 20,929 - 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: See 422 below plus copies 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. Wells Fargo-annual fee charge 100 . 00 2 Wells Fargo-commission and fees on sale of stock 59 . 29 3 Wells Fargo-commission and fee on sale of bond ? • 00 4 Wells Fargo-commission on sale of bond ? • 00 5 HB McClure Co-service at residence 134 . 00 6 Checks written prior to death but not cleared 4 ,430 . 55 ? PA American Water-service at property. 95 • ?5 8 John Cohick-POA services to date 5,424 . 58 9 PA American Water-service at property 43 • ?3 10 PNC Bank-charge for lost safe deposit key 15 . 00 11 East Pennsboro Twp-sewer and trash for prop 91 . 50 12 PA American Water-service at property 31 . 00 TOTAL(Also enter on Line 9,Recapitulation) $ ?9,??3 • 8 2 If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent CHARLES E. LAVERTY JR 21 14 0942 Decedent's Name Page 2 File Number Schedule H - Funeral Expenses &Administrative Costs-67. ITEM NUMBER DESCRIPTION AMOUNT 13 East Pennsboro Twp-sewer and trash at prop 91 . 50 14 HB McClure-service at property 3 . 26 15 HB McClure-service at property 99 . 00 16 PA American Water-service at property 30 . 99 17 Mark Heckman-appraisal fee on property 450 . 00 18 HB McClure-service at property 116 . 19 19 PA American Water-service at property 32 . 01 20 The Sentinel-advertising grant of letters 190 . 54 21 John Cohick-lawn maintenance and repairs to Feb 489 . 20 22 Stone LaFaver & Shekletski-Reimb for probate, 478 . 00 23 filing inh tax return and Inventory, and copies 24 Selling costs ($4 ,788 . 57) less reimb ($643 . 27) 4 ,145 . 30 25 PPL Electric-service at property 59 . 72 26 PPL Electric-service at property '15.76 27 PPL Electric-service at property 15. 91 28 PPL Electric-service at property 19 . 29 29 PPL Electric-service at property 21 . 28 30 PPL Electric-service at property 28 .75 31 Stone LaFaver & Shekletski-Reimb for adv letters 75 . 00 32 (75) and mailings (26 . 48) 101 . 48 33 Register of Wills-addrl probate costs 50 . 00 34 US Treasury-Reimb for funds received from OPM 12,580 . 24 35 Reserve for closing expenses 500 .00 SUBTOTAL SCHEDULE H-137 19,593 - 42 REV-1512 EX+ (12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER CHARLES E. LAVERTY JR 21 14 0942 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 Spartan Pharmacy-perscriptions 1 . 99 2 Griswold Home Care-services rendered 11 . 50 3 Yin N Moe-home care services 250 . 00 4 West Shore EMS-ambulance service 115 . 16 TOTAL(Also enter on Line 10,Recapitulation) $ 378 - 65 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: CHARLES E. LAVERTY JR 21 14 0942 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions and transfers under Sec.9116(a)(1.2).) 1. BARBARA LODE Niece 100% residue Collateral 368,087 . 38 1060 BORGNESE LANE, UNIT 1405 NAPLES FL 34114- Collateral Note : Glenn S Laverty and Edwin F Harne Jr have predeceased the decedent leaving 100% to the above person ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE, I1. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. ep\wi11s\1sverty.ce\6-97 ♦S 1+' LAST WILL AND TESTAMENT OF CHARLES E. LAVERTY, JR. I, CHARLES E. LAVERTY, JR. , of East Pennsboro Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executors hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I heraby give and bequeath all of my household furni- ture and equipment and other tangible personal property unto my nephew, EDWIN F. HARNE, JR. ITEM III: All the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath as follows: A. Ten ( 10%) per cent unto my brother, GLENN S. LAVERTY, if living. B. Twenty (20%) per cent unto my niece, BARBARA LOWE, if living. C. Seventy (70%) per cent unto my nephew, EDWIN F. HARNE, JR. , if living. Should any of the above named persons fail to survive me, the share of said person shall lapse and shall be added to the other Page 1 of 4 shares created in this Item III in the same proportion as they now bear to each other. ITEM IV: I appoint my nephew, EDWIN F. HARNE, JR. , and JON F. LaFAVER, as Co-Executors of this my last will. If either the said Edwin F. Harne, Jr. , or Jon F. LaFaver should predecease me, fail to qualify or cease to act as such, then the other shall serve alone. ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, CHARLES E. LAVERTY, JR. , have hereunto set my hand and seal this / day of SUNS' , 1997 . CHARLES E. LAVEAV, JR. SIGNED, . SEALED, PUBLISHED and DECLARED by CHARLES E. LAVERTY, JR. , the Testator above named, as and for his Last Will and Testament, and in the presence of us, who at his request, in his presence and in re re ence :oTh other, have subscribed our names as witnesses. s i Hess ' Address Witness Address Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND It CHARLES E. LAVERTY, JR. , the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein con- tained. CHARLES E. LAVER'±Y, _JR. Sworn to or affirmed to and acknowledged before me by CHARLES E. LAVERTY,, JR. , the Testator, this day of 1997. Notary Pukilic CLfit-?rlaid Co. my CGMM'.-s!On E*,as April 13,1999 COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND We, Ot......... and the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as Page 3 of 4 CI r his last will; that Testator signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. tness Witness Sworn to or affirmed to and acknowledged before me by and �� il. Z;� witnesses, this day of � 1997 . Notary Public NO TA"AL SEAL C0^'1 a ,lfr I i I �.;i �� ;r11L1 Hol-ay Public l c'�l'u'� CumbarlandCo. My Ccmmissio I J�xp)res Apr1J 13, 1999 Page 4 of 4 REV-485 EX(05-04) 48500041046 SAFE DEPOSIT * BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number 09/09/2014 21 14 0942 Decedent's Last Name Suffix First Name MI Laverty Jr. Charles E ADDRESS OF DECEDENT STREET CITY: STATE: ZIP CODE: 824 Lisburn Road Camp Hill PA 17011 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME: David H. Stone, Esquire STREETADDRESS: CITY. STATE: ZIP CODE: 414 Bridae Street New Cumberland PA 17070 NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING a. NAME: RELATIONSHIP: Jon F. LaFaver executor of estate STREET ADDRESS: CITY: STATE: zip CODE: -- 120-Carol Street---- New C-amb6dand' 'PA- --17070— b. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: c. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: PNC Bank STREETADORES& CITY: STATE: ZIP CODE: 235 N. Enola Road Enola PA 17025 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY John E. Cohick, POA 9/4/14 0:00 am DATE OF CONTRACT TO RENT BOX " NUMBER OF BOX i TITLE UNDER WHICH BOX IS REQUESTED 05/13/1975 138 Charles E. Laverty, Jr. M NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX a. NAME: b. NAME: Charles E. Laverty, Jr. John E. Cohick, POA STREET ADDRESS: STREET ADDRESS: 824 Lisburn Road 260 Susquehanna Avenue CITY: STATE: ZIP CODE: CITY: STATE: ZIP CODE: Camp Hill PA 17011 Enola PA 17025 NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY Jennifer Carr Wj WAS A WILL IN THE BOX? El YES R1 NO If yes, a. Date of will; b. Name and address of personal representative,if named In the will NAME: STREET ADDRESS; CITY: STATE: ZIP CODE: c. Name and address of attorney,if any NAME: STREETADDRESS: CITY: STATE: ZIP CODE: L. 48500041046 48500041046 REQ/-485 EX SAFE DEPOSIT BOX INVENTORY Page Df INSTRUCTIONS (1) Cash:Report total only. (2) Stocks:List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S,Government:Number of items,date of issue,face value,names in which registered and type of ownership, i.e.,jointly held,payable on death,etc. (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (5) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing in book,name of bank and branch,and balance. (6) Jewelry,Coins,Stamps,Manuscripts,etc:List and describe as fully as possible. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of indebtedness:List and describe as fully as possible. (8) All other contents, (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.260601 HARRISBURG,PA 17126-0601 ITEM ITEM DESCRIPTION NO. EMPTY I CERTIFY UNDER P J R THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORREC TH OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: SIGNA RE } SIGNATURE PRINT NA --- PRINT NAME AND CHECK APPROPRIATE BOX BELOW: David H. tone, Esquire PRINT TITLE DATE CHECK APPROPRIATE BOX: Attorney for Estate ❑Executor(trix) ❑Administrator(trix) Estate Representative Q Joint owner of safe deposit box NOTE:Attach additional 8'l:rr x 11"sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law,42 U.S.C.§405(c)(2)(C)(1),to require disclosure of Social Security numbers in connection with administering state tax laws.The Department uses the Social Security number to identify the decedent and personal representatives of the estate.The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities.The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. Z:\RlADED1Laverty.Char1es to Wevadau.Charles—262 Susquehanna Ave Tax Parcel#: Address:262 Susquehanna Ave. Enola,Pa 17025 DEED THIS INDENTURE made the' , day of I in the year 2015, between JON F. LaFAVER, Executor of the Last Will and Testament of CHARLES E. LAVERTY, JR, late of the Township of East Pennsboro, County of Cumberland, and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantor, - AND- CHARLES A. WEVODAU, of the second part,hereinafter called the Grantee; WHEREAS, the said CHARLES E. LAVERTY, JR became in his lifetime seised, as of fee, of and in a certain tract of land, together with the improvements thereon erected, situate in 262 Susquehanna Ave., East Pennsboro Township County of Cumberland, and Commonwealth of Pennsylvania, and more particularly described hereinafter; and being so thereof seised, died on September 9, 2014, having first made his Last Will and Testament in writing dated June 18, 1997, duly probated and registered in the Office of the Register of Wills of Cumberland County on October 1, 2015, wherein and whereby he appointed as Executor, the said JON F. LaFAVER, to whom Letters Testamentary were duly issued by said Register of Wills on October 1, 2014, wherein and whereby said premises hereinafter described were not specifically devised, all as in and by said Will and the records of said Register of Wills, recourse thereunto being had, appears: NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of the sum of SIXTY FOUR THOUSAND and 00/100---($64,000.00) Dollars, which has been paid to they by the said Grantee at or before the sealing and delivery hereof, receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by these presents does giant, bargain, sell, alien, release and confirm unto the said Grantee, ALL THAT CERTAIN lot or piece of land situate in East Pennsboro Township, Cumberland County, Pennsylvania,bounded and described as follows, to wit: BEGINNING at a point in the northerly line of Susquehanna Avenue at the distance of one hundred ninety (190) feet measured eastwardly along said line of Avenue from the southeasterly extremity of the arc or curve having a radius of ten (10) feet connecting the easterly line of Wyoming Avenue with the said line of Susquehanna Avenue; extending thence North ten (10) degrees twenty (20) minutes West one hundred forty (140) feet; thence North seventy nine (79) degrees forty (40) minutes East fifty (50) feet; thence passing through the middle of the party wall between the house on this lot and the house on the lot adjoining on the east, South ten (10) degrees twenty(20) minutes East one hundred forty (140) feet to a point in the said northerly line of Susquehanna Avenue, and thence along the same South seventy nine (79) degrees forty(40)minutes West fifty(50) feet to the place of BEGINNING. HAVING thereon erected a two story frame dwelling house known as 262 Susquehanna Avenue, Enola, Pennsylvania. BEING the same premises which Guy H. Shambaugh and Elsie M. Shambaugh, his wife, by Deed dated July 20, 1943 and recorded October 1, 1943, in the Office of the Recorder of Deeds of Cumberland County in Deed Book S, Volume 12 ,Page 337, granted and conveyed unto Charles E. Laverty and Esther B. Laverty, his wife. The said Charles E. Laverty died on August 6, 1951, vesting title in Esther B. Laverty. Esther B. Laverty died August 13, 1978, having made her Last Will and Testament in writing dated October 3, 1975, duly probated in the Office of the Register of Wills of Cumberland County to File No. 21-78-576, whereby she devised and bequeathed her entire estate including the within described property to Charles E. Laverty,Jr.,the deceased, all as in and by said will and the records of said Register of Wills. TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever, thereunto belonging or in any wise appertaining and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of him, the said CHARLES E. LAVERTY, JR., at and immediately before the time of his decease, in law, equity, or otherwise howsoever, of, in,to or out of the same. TO HAVE AND TO HOLD the said lot or piece of ground above described, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances unto the said Grantee, to and for the only proper use and behoof of the said Grantee, forever. AND the said Grantor, for himself and his respective heirs, executors and administrators, does covenant, promise and agree to and with the said Grantee, his heirs and assigns, that he, the said Grantor, has not heretofore done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered in title, charge, estate or otherwise howsoever. IN WITNESS WHEREOF, the said Grantor has hereunto set his hand and seal the day and year first abo tten. n'year 'rt abo Signed, d elivered I e e Kco f 1� �! SEAL) ---Wih4ss Ir �—JON F. LaFAVER, Executor of the Last Will and Testament of CHARLES E. LAVERTY, JR. 2- COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the rcS* day 2015, before me a Notary Public, the undersigned officer, personally appeared JON F. LaFAVER, Executor of the Last Will and Testament of CHARLES E. LAVERTY, JR., known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL CAROL L.TROXELL, Notary Public Notary Public New Cumberland Boro.Cumberland Co. My Commission Expires Dec. 27, 2017 I hereby certify that the precise address of the Grantee is DATE: Attorney for 3- Charles Laverty Date of Death Value Page 1 of 1 tburkey@stonelaw.net 0 Authenticated by wellsfargo.com Valid Signature From: amanda.j.barnett@wellsfargoadvisors.com To: tburkey@stonelaw.net Sent: May 20, 2015 1:44:40 PM CDT Subject: Charles Laverty Date of Death Value Attached: Charles Laverty Estate.docx (14 kb) Hello Per our conversation today,attached is the date of death values for Charles Laverty. Should you have any further questions or concerns, please feel welcome to contact me. Thank you Amanda Amanda J Barnett ISr. Client Associate Wells Fargo Advisors, LLC I Harrisburg PF Office 700 S 28th Street I Harrisburg, PA 117103 Tel: 717-232-6974 1 Toll-Free 888-529-29731 Fax:717-232-6979 amanda.j.bariiett@wellsfargoadvisors.com Email Encryption Provided by Wells Fargo Advisors. Copyright 2013 Wells Fargo. All rights reserved https:Hvoltage-pp-OOOO.wellsfargo.com/reader/br/WFA/5e8O92792d5ee854331 df7959556... 5/20/2015 Charles Laverty Estate DOD Values 9/9/2014 Cash $4,650.16 Stocks PEPCO Holdings Inc (POM) $102,863.11 (3802 shrs x $27.055) Government Asset Backed/CMO Securities GNMA 01-53PM Remic Multiclass CMO $276.41 CPN 5.500% Due 10/20/31 (38373TAP0) (0.02764101 x 10,000) Municipal Bonds Lancaster PA NTS G/O (514282QP0) $10,702.60 Cpn 4.750% Due 05/01/29 (107.026 x 10,000) TOTAL DATE OF DEATH VALUE $118,492.28 .~~. `"B~.~=^ I FEDERAL Ca000UNION REGULAR SAVINGS ACCOUNT: AccourkNumnUer/Suffix 201995-00 Date Account Established 03/22C2008 Principal Balance atDate of Death $36.38 Accrued Interest to Date ofDeath $0.00 Total Principal and Accrued Interest $36,39 Name ofJoint Owner None CERTIFICATE OF DEPOSIT: AunountNumbor/Suf5x 281995~40~ 201995-41 Date Account Established 03/20/2014 02/14/2011 Principal Balance atDate ofDeath s20.000.00 $15.000.00 Accrued Interest to Date ofDeath $4.82 $7.17 Total Principal and Accrued |nbenoot $20.004.02 $15.007.17 Name ofJoint Owner None None *Rollover from CID 281Q95-43opened O3/21/2DO9. CERTIFICATE OF DEPOSIT: AcoountNumnbar/SuOir 281995~42 281996-49^ Date Account Established 08/20/2013 12/21/2012 Principal Balance atDate ofDeath $28.002.38 *40.000.00 Accrued Interest to Date ofDeath $6.13 $13.06 Total Principal and Accrued Interest $28.007.51 $40.013.08 Name ofJoint Owner None Nona *Rollover from CD281S95-48opened OS/21/2O11. MEMBERS 1 IT FEDERAL CREDIT UNION Lending Insurance Support Specialist October 1O. 2O14 Estate of: CHARLES E LAVERlY,JR. Date mfDeath: 09A29/2014 Social Security Number: 192-14-5260 5000 Louise Drive . PO. Box 40 * Mechanicsburg, Pennsylvania 17055 - (800) 283-2328 - wwwrnemberslsto rg Oct. 21, 2014 1 :55PM PNC Bank No. 5644 P. i rM PN C October 21, 2014 David H Stone Esq. Stone Lafaver& Shekletski 414 Bridge St P0Box E New Cumberland,PA 17070 RE: Charles E Laverty Jr. SSN: DOD: 09-09-2014 Dear Mr. Stone: In response to your request for Date of Death(DOD)balances for the customer noted above, our records show the following: Certificate of Deposit Account# 11020047481 Established: 05-05-2005 CHARLES E LAVERTY JR DOD balance: $ 6,588.39 +0.21 accrued interest Interest paid 01-01-2014 thru 09-09-2014 $ 14.82 YTD Checking Account Account# 5140301561 Established: 09-01-1978 CHARLES E LAVERTY JR DOD balance: S 39,229.19+0.31 accrued interest Interest paid 01-01-2014 thru 09-09-2014 $ 1.19 YTD Safe Deposit Box The decedent maintained safe deposit box# 00138 CHARLES E LAVERTY JR Located at: Enola Branch 235 N Enola Rd Enola, PA 17025 (717) 732-5388 Page 1 of 2 Oct. 21. 2014 155P PNC Bank No. 5644 P. 2 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 This message is intended for the use of the individual or entity to which it is addressed and may contain 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 notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page 2 of 2 FORM 1 iChoice TM yoo (a pre-arranged funeral program administered and ��ECEIVEG by the Pennsylvania Funeral Directors Associ ND DEPOSITED PART( SEP 0 9 2014 Pre-Need and Individual Trust Agreement ("The Agreement') This Agreement is made this ! 2duT�by and between DATE Funeral Home ��r %��l�r��t�uY� mow& NAME Address �� Sy nth r[-°�i,..�14/ A-,'11/✓ �,i}.��r .4 J�V BUSINESS ADDRESS and the Purchaser a B�G� ?C-A L'!_ •/�—/��! �(O'J �r (� (hereinafter"You") 1"n NAME D/O B SOCIAL SECURITY t ADDRESS d S for the Benefit of —Ja�_ 0 I-^/'--/74-r V_/,Z`� (M) (F) (If Beneficiary's NAME WOM SOCIAL SECURITY it is different from a-11 €ajnc2D S 0Q&R RUAf the Purchaser) ,rZ,q AIS SURN 04D ADDRESS C [ANNUAL FINANCE Amount Financed Total of Payments Total Sale Price ERCENTAGE CHARGE The amount ofcedrt The amount You wit have The total cost of Your ATE The dollar amount the prWded'a You or on paid after You have made purchase on Credit, credit will cost You. Your behalf. Nr payments as scheduled Including Your towne met d Ycur Credit Payment ofa yearly rate. 0.00% 0.00% $ $ $ If not paid in full,Your Payment Schedule will be: Itemization of Amount nced No.of Amount of I When Payments Are DueCash Price payments payments $ p $ Monthly beginning Total Downpaymeni Y9 (a)Cash - (b)Death Benefit of Paid Up Lite I S See reverse side for any additional informatiPal' Assigned!Unpaid Balance of Cash Pride a about Nonpayment and default. Amaum Financed S You hereby agree to buy and Funeral Home hereby agrees to sell the funeral goods("Merchandise"),funeral services("Services')and cash advance items for 3rd party charges(Cash Advances)which are described in itemized list attached as Exhibit A for a Total Sale Price of . (see paragraph 5 on the reverse side for price details) After payment of the Total Sale Price and all other payments required to be made, the Funeral Home will render, upon the death of the Beneficiary,all the Merchandise,Services and Cash Advances described on attached Exhibit A.This Agreement is subject to the terms and con- ditions shown above and on the reverse side of this page,which you have read and accepted. You reby elect that this Agreement shall be: Irrevocable upon payment In full of the Total Sale Price Revocable by You at Your option at all times You nd the Funeral Home agree that the Professional Services,Facilities and Automotive Equipment shown on Exhibit A are: _ Guaranteed by the Funeral Home upon timely paymem of the Total Sale Price Not Guaranteed by the Funeral Home You and the Funeral Home agree that the Funeral Merchandise shown on Exhibit A are: Guaranteed by the Funeral Home upon timely payment of the Total Sale Price Not Guaranteed by the Funeral Home VYou d the Funeral Home agree that the Cash Advances shown on Exhibit A are: Guaranteed by the Funeral Home upon timely payment of the Total Sale Price Not Guaranteed by the Funeral Home EXCLUSION WARRANTIES: THE FUNERAL HOME IS NOT PROVIDING TO YOU ANY WARRANTY OF MERCHANTABILITY OR WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE FOR THE MERCHANDISE.The only warranties You are receiving for the Merchandise are the express written warranties,H any,which are provided by the manufacturers of the Merchandise sold to You under this Agreement.Only the manufacturer shall have any liability to You under such warranties. You and the Funeral Home have signed this Agreement on the day and year written above and intend to be legally bound. By signing this Agreement,the Funeral Home,as agent for the Purchaser,hereby agrees establish an individual trust with the Trustee under the Master Pre-Need Trust Agreement(the"Master Trust')between the Funeral H an the Trustee(the'Trust). &ILA -- -Signatarsel-Eicens neral-Birector- ' Signature o Pu License Number of Funeral Director SUBJECT TO TERMS AND CONDITIONS ON REVERSE SIDE:You acknowledge receipt of a completed copy hereof.You,the buyer, may cancel this transaction at any time prior to midnight cf the third business day atter the day of this transaction.See the attached Notice of Cancellation form for an explanation of this right. PART II FOR OFFICE USE ONLY The Trustee hereby accepts the Trust herein created for the Beneficiary under the Master Pre-Need Trust Agreement with the Funeral Home. L-NC Bank. National Association By 0 1 1' _ BANK A THORITED PERSON DATE White Copy- PFDA Yellow Copy-Funeral Home Pink Copy-Purchaser PFT 5D1-10.13 SUSQUEHANNA CONFERENCE A PENNSYLVANIA CONFERENCE OF THE UNITED METHODIST CHURCH COUNCIL ON FINANCE AND ADMINISTRATION 303 MULBERRY DRIVE • P.O.BOX 2053 • MECHANICSBURG, PA 17055-2053 TELEPHONE(717)766-5275 • TOLL FREE 866-227-6529 • FAX(717)766-7696 December 9, 2014 Stone Laver & Shekletski Attn: Jon F LaFaver, Executor PO Box E New Cumberland, PA 17070 RE: Estate of Charles E Laverty, Jr. Dear Mr. LaFaver: In response to your letter dated December 8, 2014, the principal balance was $82,541.60 on account 2-11584.for the Estate of Charles E Laverty, Jr. as of September 9, 2014. The interest earned from June 1, 2014 to September 9, 2014 was $342.60 and was disbursed on December 1, 2014 for the period of June 1, 2014 to November 30, 2014. To close the investment account, please provide the original Certificates of Deposit. If the Certificates are not available please let me know and I will send you a withdraw form. If you should have further questions, please contact our office at 717-766-5275 extension 5. Sincerely, j-t� Sue Ellen Adams Administrative Accounting Assistant g 1..MON MAW. 4041;� §1 t 303 Mulberry Drive,P.O.Box 2053,Mechanicsburg,PA 17055-2053 16539 August 22, 2002 No. Date On demand we promise to, m t8 the order of CHARLES E. LAVERTY, JR. 00.00 **FOUR THOUSAND AND NO/100--------------------------------------------- Dotlars Without defalcation or stay of execution, for value received,with interest at 5*50 %,per annum,waiving inquisition and exemption laws, and confess judgment for above sum without offset, with interest and costs of suit,and with five percent for collection fees.There is a 1%penalty on all monies not left in the fund for a period of one year. THE CENTRAL PENNSYLVANIA CONFERENCE COMMITTEE ON DANS THE UNITED METHODIST CffiU#CH A test: -r TREASURER CHAIRPERSON OF THYCOMMITTEE ON LOANS. III W- I A 01994Goes 4420 All Rights Reserved ---------- -111, Ilk XXIMMY-112 Z 303 Mulberry Drive,P.O. Box 2053,Mechanics9urg,PA 17055-2053 iti No. 15909 Date DECEMAER 28, 2001 On demand we promise to ,mar t0e rder CHARLES E. LAVERTY, JR. .80 f $ **** -----N ------ Dollars THOUSAND AND-------------------- 50./ Without defalcation or stay of execution, for value received,with interest at 6. per annum,waiving inquisition and exemption laws, and confess judgment for above sum without offset,with interest and costs of suit,and with rive percent for collection fees.There is a 1%penalty on all monies not left in the fund for a period of one year. THE CENTRAL PENNSYLVANIA CONFERENCE COMMITTEE OAN THE UNITED METHODIST MCH Attest: ?A,.,, tv- - ----- TREASURER '-�TRSGN OF OMMITTEE ON LOANS 01994 G—4420 All Rights Reserved *rz�M— ct" 303 Mulberry Drive,P.O.Box 2053,Mechanicsburg,PA 17055-2053 No. Date 19434 November 13, 2006 On demand we promise topay to the order of CHARLES E. LAVERTY, JR. **10,000.00 **TEN THOUSAND AND N01100--------------------------------------------------Dollars Without defalcation or stay of execution, for value received,with interest at r,1 0/46, per annum,waiving inquisition 7 and exemption laws, and confess judgment for above sum without offset,with i�terest and costs of suit, and with five percent for collection fees.There is a 1% penalty on all monies not left in the fund for a period of one year. THE CENTRAL PENNSYLVANIA CONFERENCE COMMITTEE ON LOANS THE UNITED METHODIST RCH 17 DcAttest: �4IIIIIIIIIIIIIIIIIIIII�1I TREASURER0MAIR—P 4w rr" 1✓ q'` ✓" 't_yyeJ i' 303 Mulberry Drive,P.O.Box 2053,Mechanicsburg,PA 17055-2053 No. 29884 Date MARCH 23, 2009 y On demand we promise to pay to the order t~ of CHARLES E. LAVERTY JR. $ *10,000.00 ` ****TEN THOUSAND AND 00/100-----------------------------------------------------------------------------------------Dollars P Without defalcation or stay of execution,for value received,with interest at 5.50%.per annum,waiving inquisition and exemption laws,and confess judgment for above sum without offset,with interest and costs of suit,and with five percent for collection fees.There is a 1%penalty on all monies not left in the fund for a period of one year. THE CENTRAL PENNSYLVANIA CONFERENCE COMMITTEE ON LOANS THE UNITED METHODIST RCH � Attest: Q- � �# TREASURER CILAIUERSON OFMCOMMITTEE ON LOANS 01994 Goes 4420 All Rights Reserved Ks f �� ^ '� ':F' .N—_ S• p', N.''J _fir r P.O.Box 2053,Mechanicsburg,PA 17055-2053 303 Mulberry Drive, g ( `> No. 29886 Date MARCH 19, 2009 `I On demand we promise to pay to the order of CHARLES E. LAVERTY JR. $ *5,000.00 t-F -k V ****FIVE THOU SAND AND 00/100------------------------------—-------------------------------------------------—-----Dollars J Irl . Without defalcation or stay of execution,for value received,with interest at 5.50%,per annum,waiving inquisition and exemption laws,and confess judgment for above sum without offset;with interest and costs of suit,and with five rpercent for collection fees.There is a 1%penalty on all monies not left in the fund for a period of one year. \ THE CENTRAL PENNSYLVANIA CONFERENCE COMMITTEE O OAN �. THE UNITED METHODIST CH � � r Attest• i. 4111 /-,1- TREASURER CRAIRPERSON O OMMITTEE ON L AgoMLr { 01994 Goes 4420 All Rights Reserved ., ;. <, 303 Mulberry Drive,P.O.Box 2053,Mechanicsburg,PA 17055-2053 No. 29960 Date MAY 4,2009 On demand we promise to pay to the order of CHARLES E. LAVERTY,JR.. $ *12,038.76 ****TWELVE THOUSAND,THIRTY-EIGHT AND 76/100-------------------------------------------------------------- lr Dollars Without defalcation or stay of execution, for value received, with interest at 5_5%, per annum, waiving inquisition J and exemption laws, and confess judgement for above sum without offset,with interest and costs of suit,and with five "' percent for collection fees.There is a 1% penalty.on all monies not left in the fund for a period of one year. THE CENTRAL PENNSYLVANIA CONFERENCE COMMITTEE ON L ANS N THE UNITED METHODIST RCH f'I' Attest: TREASURER C Al ERSON OF TH MITTEE ON LOANS I�;`> `7� �'` tib, 7 - �` ai• 01994 Goea 4420 All Rights Reserved �^�--_•Vt�/---'"..,U��`" �kyr '11tV-�y�`�✓M�,. Y��"'�...,..�.,�"� ,,,; ,�.+`. ,,� �.;�-•":�It✓' ; �:'.-';�•W ,.�. 303 Mulberry Drive,P.O.Box 2053,Mechanicsburg,PA 17055-2053 ; � No. -n051 Date MAY 22,2009 �tlx On demand we promise to pay to the order of CHARLES E. LAVERTY,IR. $ *$,500.00 a **** EIGHT THOUSAND, FIVE HUNDRED AND 00/100---------:------------------------------------------------------Dollars Without defalcation or stay of execution, for value received, with interest at_ Iyo, per annum, waiving inquisition and exemption laws,and confess judgement for above sum without offset,with interest and costs of suit,and with five percent for collection fees.There is a 1%penalty on all monies not left in the fund for a period of one year. ., THE CENTRAL PENNSYLVANIA CONFERENCE COMMITTEE ON LOANS THE UNITED METHODIST URCH Attest: If TREASURER ERSON II MITTEE ON LOANS 01994 Goes 4420 All Rights Reserved 303 Mulberry Drive,P.O.Box 2053,Mechanicsburg,PA 17055-2053 No. 15610 Date October 19, 2001 On demand we promise totot er " of CHARLES E. LAVERTY, JR. $�� '72 3 AI.09 j `} **Twenty—Two Thousand, Two Dollars and 84 Cents--------- ---------------------Dollars Without defalcation or stayof execution, for value received,with interest at 6.50% , per annum,waiving inquisition Fx and exemption laws,and confess judgment for above sum without offset,with interest and costs of suit,and with five percent for collection fees.There is a I%penalty on all monies not left in the fund for a period of one year. �4. THE CENTRAL PENNSYLVANIA CONFEREN COMMITTEE ON ANS ' HE UNITED METHODI C URCH ' CAttest: WE TREASURER IRl'ERSO O COMMITTEE ON LOANS ws. 01994 Goes 4420 All Rights Reserved Statement A. Settlement Statement U.S.Department of Housing and Urban Development B.Type of Loan OMB Approval No.2502-0265 1. ❑FHA 2. OFmHA 3. ❑Cony,Unins. 6,File Number 7,Loan Number 8.Mortgage Insurance Case Number 4, VA 5, Conv.ins. 32875WEVODAU s mnl is um:s o qwe yw a s omen a cos p an y e s em agen are own. C.Note: Items marked•(p.o.c•1'weirs lied outside IM do xv;they aro shown here for Informauan purposes and errs nal Inctdad n the totals. TitleEXpress Settlement System WARNING:a ls a Crime to knowingty make false Stleamenta to the United States an dt3 er an Oats nrt+ar tans.Ponafdes upon conoction can ktoluds a fine and aonmern.For details sell:rib iS u.s.Code Seaton t�o+ens Secaon to1o. Printed 02/2712015 at 14:43 CLT D.NAME OF BORROWER: Charles A.Wevodau ADDRESS: E.NAME OF SELLER: Estate of Charles E.Laverty,Jr. ADDRESS: 414 Bridge St. New Cumberland Pa 17070 F.NAME OF LENDER: ADDRESS: G.PROPERTY ADDRESS: 262 Susquehanna Ave,Enola,PA 17025 East Pennsboro Township H.SETTLEMENT AGENT: Cedar Cliff Abstract Agency,Inc.,Telephone:717.774.7435 Fax:717.774.3869 PLACE OF SETTLEMENT: 414 Bridge Street New Cumberland PA 17070 1.SETTLEMENT DATE: 02/2712015 J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION: 100.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER 101. Contract sales price 64 000.00 401. Contract sales once 64 000.00 102. Personal Pro402. Personal Property 103. Settlement charges to borrower One 14001 1,Z6.50 403. 104. 404, 105. 405. Adjustments for Items paid by seller!n advance Ad'ustments for items oaid bv seller in advance 106. Cit(town taxes 406, Cit(town taxes 107. Counlit taxes 02/27115to12131115 280.10 407. county taxes 02127115to12131115 280.10 106. School taxes 0212711 5 to 06130115 330.64 408. School taxes 02127115 006130115 330.64 109, 409. 110. 410. 111. 1st atr sewer Orin 02127115to03131115 32.53 411. 1st qtrsewer 02127115!003131115 32.53 112, 412, 120.GROSS AMOUNT DUE FROM BORROWER 66i09.77 420.GROSS AMOUNT DUE TO SELLER 64 643.27 200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 5.000.00 501. Ex see insinuctionsl 202. Principal amount of new loans 502. Settlement charges to seller line 1400 4,788.57 203. Existing loans taken sulbiect to 503. Exist!ng loans taken sub' to 204. 504. Payoff of First Mortgatte Loan 205. 505. 206. 506. 207. 507• 208. 508. 209. 509. Adjustments for items unpaid bv seller Ad ustments for Items unpaid by seller 210. Cit own taxes 510. Cft!town taxes 211. County taxes 511. County taxes 212. School taxes 512. School taxes 213. 513. 214, 514. 215. 515. 216, 516. 217. 517. 218. 518. 219, 519. 220.TOTAL PAID 8Y/FOR BORROWER 5,000.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 1 4,788.57 300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower tine 120 66 079.77 601. Gross amount due to seller line 420 64,643.27 302. Less amounts paid b!for borrower fline 2201 5,000.00 602. less reduction amount due seller line 5201 4188.57 303.CASH FROM BORROWER 61,079.771 603.CASH TO SELLER 591854. SUBSTITUTE FORM 1099 SELLER STATEMENT:The mtomaaon contained heron a imixonant W information and Is being furnished to the Internal Revenue Service M you are requued to file a return, a nfpl este penalty or other Benton will be Imataed on you d Into item III required to be raoorW rd the IRS oatennnea mat x nes not been reported.The Contract Sates Price descabaa On xr:dog pb"conswunn the Groh Proceeds d Vis itansaafon. 'rota are required by tow to prowde the ebtdpmera egad(Fed.Tax 10 No: )with your correct taxpayer(demtfitaddn number.d you do not provide your Correct laxaayer idenofflcaation number.you may be sutned to aw or aknmal penrdea impaSed by taw. pd}uty.1 Candy that the member mown Ort this Statemeal M mycomect taxpeyr ktanaetabOn nWIDW- TIN; / _ SELLER(S)SIGNATURE(S): t SELLERS)NEW MAILING ADDRESS: SELLER(S)PHONE NUMBERS: (H) (W) SeA(,^n Itce I �4)000.(rD Ctas4�s �-i,�%F .5 7 4 jg5 .3a t U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number:32875WEVODAU PAGE 2 SETTLEMENT STATEMENT TitleEx ress Settlement System Printed 02/271201 at 14:43 CLT L. SETTLEMENT CHARGES PAID FROM PAID FROM 700.TOTAL SALES/BROKER'S COMMISSION based on price$64,000.00= BORROWER'S SELLER'S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701. to SETTLEMENT SETTLEMENT 702. to 703. Commission paid at Settlement 800.ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Orictinalion Fee /e 802. Loan Discount % 803. A aisal Fee 804. Credit Report 805. Lender's Inspection Fee 806. Mortgage Application Fee 807. Assumption Fee 808. 809. 810, 811. 900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to Ida 902. Mortgage Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905, 1000.RESERVES DEPOSITED WITH LENDER FOR 1001.Hazard Insurance mo. !mo 1002.Mortgage Insurance mo. Imo 1003.City Property Tax mo.A S Imo 1004.County Property Tax mo. 27.75 Imo 1005.School taxes ma. 81.77 Imo 1009.Aggregate Anal sis Ad'ustmeni 1 0.00 0.00 1100.TITLE CHARGES 1101.Settlement or closing fee 1102.Abstrad or title search 1103.Title examination 1104.Title insurance binder 1105.Document Preparation 1106.Notary Fees to Cash 10.00 1107.Attorney's fees t (includes above items No: 1108,Title Insurance to Cedar Cliff Abstract Anency.Inc. 702.00 ndudes above items Na 1109.Lender's Policy 1110.Owner's Policy 64 000.00 -70200 1111. 1112. 1113. 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Recording Fees Deed 79.00 mortgage Release 79.00 1202.City/County taxistam s Deed$640.00 Mortgage 640.00 1201 State Taxlstam s Deed$640.00 mortgage$ 640.00 1204. 1205. 1300.ADDITIONAL SETTLEMENT CHARGES 1301.Survey 1302.Pest Inspection 1303.2015 County taxes to Debbie Lu id' 333.02 1304.2014 School taxes to Debbie Lu Id' P.O.C. 981.18 Seller 1305.Tax w fee io Debbie Lu Id• 10A0 1306.Auctioneer fee to Cordler Auctions$Appraisals 13 7$5.55 1307. 1st qtr sewer,Cert tee 10 to East Pennaboro Township P.O.C. 91.50 Seller 10,00 1308.Trash for March to East Pennsboro Township 15.50 1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section KI 1-436.501 4,788.57 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HLID.1 Settlement Statement and to he beet of my arowle"and Detre,,a is a true ME accurate statement of all receipts atln disbursements made on my account or by me In the transaction.I lusher candy that I have received a copy of the HUD-1 Settlement Statement. Cam A.wevoclau Estate of Chaarlees�E.JLev".Jr. iTy 76"�'L"`aFa ar ecuo J WARNING IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The„UO-i Settlement Sta ant UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION Iraneacaon,I have cauaBd or a CateO av red s a Irua and accurate account ori this CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18; i sa suits in accurate a virtu t this statement. U.S.CODE SECTION 1001 AND SECTION 1610. R SETTLEMENT AGENT: 2 7-�sf _...___._._ qA TE: STONE LAFAVER & SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H.STONE POST OFFICE BOX E OF COUNSEL GERALD J.SHEKLETSKI NEW CUMBERLAND,PA 17070 CHARLES H.STONE www.stonelaw.net JON F.LAFAVER TELEPHONE(717)774-7435 June 2, 2015 FACSIMILE (717)774-3869 Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3887 RE: Estate of Charles E. Laverty, Jr. No. 21-14-0942 Greetings : Enclosed please find an original and one copy of the Inheritance Tax Return and Inventory for the above mentioned estate . IPlease clock in the copy of the Inventory and first page of the inheritance tax return and send them back to my office along with any receipts in the enclosed stamp addressed envelope . Also, enclosed is check #125 in the amount of $50 . 00 representing additional probate costs due . Should you have any questions, please do not hesitate to contact my office . Very truly yours, S LaF R & SHEKLETSKI avid t -e DHS tmb C_- Enclosures �'r •,;;>. 1— r� err -� f V CJ?