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Home My WebLink About06-24-15 (2) � � 1505610101 RfV-1500 °`��_1°> �' OFFICIAL USE ONLY PA Department of Revenue P��a Courrgr Code Year File Number Bureau of IndividualTaxes INHERITANCE TAX RETURN �"� PO BOX 28o6oi � Harrisburg PA i��z8-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number �Date of Death MMDDYYYY Date of Birth MMDDYYYY � �V`"�T' a � '�'o�o�� 9 DecedenYs tast Name ' Suffix Decedent's First Name MI � (If Applicable)Errter Survrving Spouse's lnfonna4on Below Spouse's Last Name Suffix Spouse's First Name MI ��I Y 1 i 1 I�' � � Spouse's Social Securi4y Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE � � REGiSTER OF WILLS FILL IN APPROPRIATE OVi4t.S BELOW � 1.Original Retum O 2.Supplemental Retum O 3. Remainder Retum(date of death prior to 12-13-82) p 4.Limited Estate Q 4a.Future Irrterest Compromise(date of Q 5. Federal Estate Tax Retum Required death after 12-12-82) Q 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Wiii) (Attach Copy of Trust) p 9.Litigation Proceeds Received O 10.Spousal Poverly Credit(date of death O 11. ElecUon to tax under Sec.9113(A) beiween 12�1-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT— THISSECTION MUSTBf COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORINATION SHOULD BE DIRECTED.TO: Name Daytime Telephone Number G � � 9 REGISTER OF N{�C�'S USE ONIY t7 �_.. i^7. �,:: C", ...1-� -'1 i'il _ C_ � First line of address ;,, ;'~ � <"-� . ___ � -,_ _.. , - „,:� y ._ � �.:� __ _ ('�.� �;i �r� __..i Second line of address ' _. .,,,.W _ i City or Post Office Srdte ZIP COd2 D'•ATE FIL�ED � C�J , , L � 0 7 p f�. � �.� �--, -�� Correspondent's e-mail address: �Cr sl�er� Q C:'C��r` �1/1�• � Under penatties of peYury,I dedare Uiat I have examined this retum;induding accompanying schedules and stater�nts,an to the best of my knowledge and belief, it is true,correct a�complete.Dedaration of prepa other Uian the personal re resenta' is based on alf ir�f�frmation ich preparer has any knowledge. SI T OF ON FILI RETURN S �'.°'L��/J `L� e,/ � �.J � ,��+��i' ,' / Ess Q f �.i� c�.r1 ,4 . / .3 G ts �s'_ SIGNATURE OF PREPARER O R THAN REPRESENTATIVE ATE ADDRESS PLEASE USE ORIGINAL FORM ONI.Y Side 1 � 1505610101 1505610101 � �` � 15056101�5 REV 1500 EX pecederiL's Sociai Security Number ' � � 4( � � DecedenYs IVame: RECAPITULATION �, ry � � /,, � � 1. Rea!Estate(Schedule A). ............................................ 1. � � � � �L �-?�"kQ� � � � �� ;s � 2.� � � �`j�_6'`'�� 2. Stocics and Bonds(Schedule B) ........•••••••........................ � ; . _ � . � 3. Cbse�Y Held Corpora6on,Partrtership or Sole-Proprietorship(Schedule C) ..... 3. = � � ,� ' � � ' �,� : � g � 6� � p 4. Mortgages and Wotes Receivable{Schedule D).........................,. 4. ' � : R6��6 � t 5. Gash,Bank Deposits and Misceilaneous Personat ProPertY(Sc�eduie E)....... 5. x � � t � te Bi7lir�g Requested ....... # � � , Q 6. Jointly Owned Property(Schedule fi� O �P� � � � 6. '' �. �' 7. I�Vivos Transfers 8�Msceilaneous Non-Probate Property � � � �� ' , �� (Schedufe G) O �te BiWing Requested........ 7. ,, � , � ' � �� ` ' � �/� � 8. To�l Gross�4ss�s(totai Lines 1 through 7)............................. 8. �, d- e. � ° ............. 9. a Q , 9. Funeral Expenses arid Administrative Cosis(Sdtedule H)..._.. �� ° �� `� i : 10. Debts of Decedent,Mortga9e Liabilities.and Liens(Schedule I).............. 10. • , : : � 11. Total Deducda�s(total Lines 9 and 10)................................. 11.� � �. •�, . .� 7 (� � �l 3 q; 12. Net Value of Estate(Une 8 minus Line 11).....:........................ 12. g � �.� 3 � � 13. Charitable and Gavemmental Bequests/Sec 9'!13 Tnuts for which , : an election to tax has not been made(Schedule J) ........................ 93.� - ' �� g r ' 1 ' � ............. ,a.� � : � � 5 ,�`�{�3 � , 14. Net Value Subject to Tax(Line 12 rtunus Line 13) ........... TAX CALCULATION-SEE INSTRtlCTIONS FOR APPUCABLE RATES 15. Amount of Line 14 taxable at Uie spousal tax rate,or , trarisfers under Sec.9116 � � �' sfe (ax12)X.0- � �� 15.` ` 16. Amount of Line 14 taxabie �p �/� at Gneal rate X.0�!SJ � ` � , ��' `J ..n "`C {� 18. � `Z • 17. Amount ot l.iae 1 a taxable ;� g at sibling rate X..12 � ��- . 18. Arnourrt aF Line 14 taxabfe . at Collaterai rate X.15 1 � 18. � s cw��P.P.w--+a„� . . 19. TAX DUE......................................................... 19, 20. fILL Ml THE OVAL IF YOU ARE REQtlES71NG A RfFUND OF AN OVERPAYMEN'P , � O Side 2 � 1SQ56}�0105 1505610b05 � REV-1500 EX Page 3 File Number ao j 3-- b 6��/ Decedent's Complete Address: DECEDENTS NAME �.�-;� � ��/e�— STREETADDRESS / L CITY , STATE I ZIP �sl / D�ZS� Tax Payments and Credits: 1. Tax D�e{Page 2,Line 19) ��) 2. CreditslPayments A Prior Paymer�s � B.Discount Total Credits(A+B) (2) 3. Interest (3) 4. if Line 2 is greater than Line 1 +Line 3t errter the di�erence. This is the OVERPAYINENT. Fill in oval on Page 2,Line 20 to request a refund. (4j 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is fhe TAX DUE. (5) Make check payabfe to: REGISTER OF WILLS,AGENT. PLEASE ANSWER THE fOLLOWfNG QUESTIONS BY PLACING AN "X" !N THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the prope�ty transferred:.......................................................................................... ❑ � b. retain the rigM to desigrtate who shail use the property fransferred or its income:............................................ ❑ c. refiain a reversionary interest;or.......................................................................................................................... ❑ � d. receive the promise for life of either paymer�ts,benefits or care?...................................................................... ❑ � 2. If death occurred after Dec.12,1982,did decedent transfer property within or�e year of death without receiving adequate consideraSon?.............................................................................................................. � � 3. Did decedent own an in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent ovm an individual retirement accamt,annu9ty or other non-probate proper�r,which � containsa benefiaary designation? ..........................................................................................................:............. ❑ IF THE ANSWER TO AI�Y OF THf ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEQULE G AND F1�.E tT 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 vaiue of transfers to or for the use of the surviving spouss is 3 pe�cent[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 vafue 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 sta#utory requirements for disdvsure o#assets and filing a tax retum are still applicable even'rf the surviving spouse is the onty benefiaary. For dates of death on or after July 1,2000: • The tax rate imposed on the net walue of transfers from a deceased chi� 21 years of age or younger at death to or for the use of a na#ural parent, an optive parent or a stepparent of the child is D percent(72 P.S.§9116(aK12)]. The tax rate imposed on the net value of transfers to or for the use of the deceden#'s lineal beneficiaries is 4.5 percent, exeept as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. . The tax rate imposed on the net value af transfers to a for the use of the dec�denYs siblings is 12 percer�[72 P.S.§9t16(a)(1.3)].A sibling is defineci,under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adopbon. = REV-1502 EX+(01-10) � �� pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDEM ESTATE OF: � FILE NUMBER: /yQ�/U�� G�' P/��r �,20/.� - po � s�/ Aii real properly owned solely or as a tenant m common must be reported at fa�r market value.fair market value is defined as the pnce at which property would be exchanged between a wiiling buyer and a wiliing seller,neither being compeiled to buy or seil,both having reasonable knowiedge of the relevant facts. Reai 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 soid. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common, VALUE AT DATE � NUMBER OFDEATH DESCRIPTION 1. . �C�I i�,L.i�O �G� �LLI�t f.�l id 1��. �''�1�` �� 4rn o _ l e -�B� - 13 �1,s� , � — .�r s/ D o� - �a�a , Pa �� -� ��,�� / � �� h� �� e , TOTAL(Also enter on Line 1,Recapitulation.) $ l�� . U� If more space is needed,use additional sheets of paper of the same size. Summary � ResidentialAppraisal eport FileNo. 81AR101d The purpose of this appraisal repat is to provide tt�e clierrt wtth a aedible opinion of the defined value of the w'eU properly,given the intended use of Ne appraisal. Ciienc Namenrrtenaed user Joanne M E-maii wam wnsolidated.net � Clierrc Ad�ess 81 Amold Road C' Enola S�ace PA zi 17025 • aocrt�onai ime�wed u s Joanne Mood and her assi ns • Intended use Fair market value for tential future sale. Pro narness 81 Amold Road C Enola Suce PA zi 17025-2148 owner or Pumic Recara Marietta C.Keller cou Cumberland � ai�esai on Deed Book 0034Z Pa e Number 00595 " Assessor s Parce�# 09-12-2992-060 Taz Year 201 R.E.7axes E 2 267.00 Ne hbahood Name Louis Park Ma Referen 09-12-2992-060 Censu Tract 0101.00 Ro Ri A aised X Fee Si le Leasehold OU�er describe research did did not reveal a �a sales or transfers of the sub�eG fa the three 'a to tlie effective date of this a isal. PriorSalelTronsfer: Date Price Sources Analysisofpriorsalea0ansfethistayofthewbjectpropeny(andcomparabiesales,'rfapplicable) A sers ana sis shows no transfers for the sub'ed �O � in the ast three ears.Prior sale of Com arable#2:07/09/12 for$60 000 ri r to substantial rehab/renovation.Prior sale of com arable#4:10/19/2012 for$66 001 and 07/16/2012 for$1 an a arent e transfer.No rior sales for com arables#1 and 3 within the ear rior to the recent sale. OfFerings,opdons and contraUs as of the elFecOve date of the appraisal None Known .. ,„p., � �. s„ , .. . _ ,. .� .. ,�a,r,.. «;�a �. „ ;; � '�., . . �,�,'�.,v. -",.,;�, ,.g... ..�t,a� ,� � , . _._ ....... . ......_.. ..,. � „r, .i�. >wwz_.. . . A,.�....,.. . ...._. e , ,., . .. . . ,,. ., .._..... Lacation Urban Suburban Rural Ro Values Inaeasi X Stable DeUinin PRICE AGE One-Unit 73% Buih•U XOver75% 25-75% Under25% Deman�YS Sharta InBala e OverSu I SODO 2-4Unit 5% Growth Ra id Stabie Slav Mark ' Time Under 3 mths X 36 mth Over 6 mths 31 Low 10 Mulli-fami 5% � Neighborhood Boundaries See Attached Addendum 300 Hi h 100 Commercia� 15% • 140 Pred. 60 Omer VaCant 2% Neighbahood Description This suburban nei hborhood has most ublic utilities avaif ble relativel eas access to em lo ment and services and is com titive with other nei hborhoods in the eneral area. Most have s ilar ameniUes. MaAc�Conditioin(induding wppatfathe above conciusiaa) While housin rices on a natio al basis are said to be deGinin the Central PA market area in eneral has not seen this of de reciation. However the market in this area has slowed in that residential dweilin s are bein marketed for lon er eriods of time ical less than 180 da s. A ra ers have also encountered more sellers concessions/assistance than in recent ears. Dimensions See Plat Ma Area.16 5 e Recxan ulaf View Residential/Ave s circ Zoni Gassiecason R3 Resident Zone 3 zoni Desrri on Allows for current se as a sin le fami detached residential dwellin . Zonin Co liance L al Le I Nomm�(amin Grandfathaed Use No Zoni I al describe Is the highest and best use of the wbject propelty as improved(or as proposed per plans and specifications)th rrc use? X Yes No If No,desaibe. Utfllties Public Other descriDe PuDlic Other(Jesc be) OH-sitelm ovements—T Public Privau E�ectric water X 5veet As halt Gas Sanita SeHu X Alle None sice Commen�s Site has avera e site im rovements avera e landsca in and ical maintenance.The site im rovements and services to the site are ad uate and acce table in this market There are no a arent dverse easements encroachments or other adverse conditions on this site. .,c;'�,.:, �ERA�.D�iP'IfOk��, �' �° �., fQ[JND1.fi�OFt.,. .,�'',�,..`'�. E)C£E#tl0 . .�fi2tFT[ON . mafee�als. '��.,ti�[Et�IOR�:�.._ �a15,�,5, ,b� % t � a uniu X one onew�nccunrt j X Concre�esiab CrawlS ace Foundalior�waus ConcreteSlab/Ave Fio«s C Win I/AbAve #of Stories 1 Full Basement Partial Basement Ene�or Waiis Vin I/AIum/Ave wans D alVAbveAve i X Dec. Att. SDetJEnd Unit Basemern Area n Rwf s�uta Shin IelGood 7rimlFinisn Wood/AbveAve X Exisnn Pro sea UoderConst. BasemenlFinish % Guaersa own ucsAluminumlAve BathFloor Cr UAve Desi n S ie Ranch ou�siaeE i�ca Sum Pum woaowT DoublelnsuVGood eamwa�nscoi Marlite/Ave YearBuilt1953 StormSashllnsulate0 Y2S✓AV2 CarStwa e None Efiective A e rs 20 Screens 1 Yes/Ave X Drive S of Cars 1 Attic None Heatin FWA HW Radiarrt Amenities` WoodStwe s k0 Drivewa SurfaceAS halt Dro Stair Stairs Other FueiGas Fire a s i 0 X FenceChnLflk Gara e #oFCars 0 � Floor Sarttle Coolin X Central Air CondNonin X Patio/Ljeck FfO�t Porch NO�e Ca rt B of Cars 0 Finished Heated InOividual Other Pooi I�one ou,er None Aa Det. Built-in A liances P Refri erator X Ran e/Oven X DisFiwasher X Di osal Microwave P fJashed r Other describe � Finished area above rade contains: 7 Rooms 3 Betlrooms � 1 Bath 5 1,224 re Feet of Gross Livi Area Above Grade � AddiUonal Features See Attached Addendum � i a . � Commentson the Improvemems The im rovements are of avera e uali frame desi and reflect above avera e maintenance.Pro e reflects normai h sical de reciation and no deficiencies are noted.Utili floo lan is ical for a house of this a e and s le and should receive avera e acce tance in the market lace. � ,. � � Aoa�e�:yna�emo,zu.em....,.x�.m� msmmc.�,,,.�yr��mos.zmonaa�,aisocm�s�.K.anaqua a. i a a (qPAR'"1 cene�a vupose ry�paas�REp0n osnoia � GGAR100d_1005162010 .:iN:s:,, , . r,••�..:. �...^.c�v: � Summary Residential Appraisat eport Fi�eNo. 81Amold FEATURE SUBJECT COMPARABLE SALE N0.1 OMPARABLE SALE N0,2 COMPARABLE SALE N0.3 81 Amold Road 85 Amold Road 99 A old Road 822 Arnold Road naaress Enola Enola Enola Enola Roxim to sub� x ;��3�'�''� 0 05 mdes SE 0 19 �les SE 0 18 m�les SE ,,�,,,`q,�'��;`„�,. E 107 000 , , �%''..��,`?t�'S 125 000 �;:�c r��`��4:S 100 000 Sale Price 5 . Sak RiceX'�mss tiv.Nea E 0.00 .R E 107.00 tt ,��`_a�'" ��°�.._f 12 .00 .R:t, �' y ;�S 100.00 .fl ,��`"��`, Data Source s "�.se��a�"��'T�WILS/Tax ReCords ML aX RerArds MLSITax ReCords � verficauon Source s '"� � � ��'=Tax Records Tax rds T2x Records VAIUEADJUSTMENTS DESCRIFlION DESCWPTION .(-)s DE RIPTION .�-)s DESCRIPTION =(�)s saie a Financ�ng � ��` � ;s Conventional Conv ntional FHA Concessior� M �. None Known Closi Costs -1 000 Closin Costs -800 DateotSale/fime � ��' 07/20/2012 11/29 012 04/18/2013 Laation Suburban Suburban Subu an Suburban LeaseholdlFee Sim le Fee Sim le Fee Sim le Fee m le Fee Sim le srte .16 Acre .16 Acre .19 A e .16 Acre view ResidentiaUAve ResidentiaUAve Resid ntiaUAve Residential/Ave Desi n 5 ie Ranch Ranch Ran Ranch - Qual' of Constrixtion Avera e Avera e Avera e Avera e AGual A e 60+/-Y22fS 59+/-Years 60+/-� ears 60+/-Years � Condnion AbOVPAve AbOVPAve GOod -8 000 Above +6 000 Above Grede rmai ea� earts Tomi eam� saurs r� ean� Tomi ad aams � Room Coum 7 3 1 6 3 1 6 1 6 3 1 � Gioulioi Area20.00 1224 .R 1000 .ft. 4,500 1,000 ft 4,500 1000 .R 4500 easemeM a Finisnea None None None None Rooms Below Grade None None None None Funa�oroi uur Avera e Avera e Avere e Avera e - tieaun Cooiin GasFWA C/Air GasFWA G/Air GasF A C/Air GasFWA C/Air E Ei�dern rtems DI Windows None +2 000 None +2 000 None +2 000 Gara dCa rt 1 Car Drivewa 1 Car Ca rt -4 000 1 Car tt Gar -6 000 1 Car Drivewa PorchlPa[idDeck Patio Porch Cov tio -1 000 Patio Other None None None None Other Fence Fence Fen None +1 000 Other Shed None +2 000 None +2 000 None +2 000 NetA'stment otal � '" �'rs?,;.N.' t 8 4 500 + X- E 7 500 X + E 14 700 Adjusted Sale Price �.�� ,�� Net Adj. 4.2% Net Adj. -6.0% Net Adj. 14.7% � otCan arab�es �`�^�s��`;��.ri,Gmss . 11J% E 111 500 Gmss 19.6% E 117500 Gmss . 16.3% E 114700 Summa ot Sa�es Com arison ach See AttaChed Add6ndum � � � �� .�,�4„ � .Jti?PAt6lk£.�TT`(X1Y8'CtfE:;�'�.�:,_.., ':, �,�a ,;;. ...,,.'�:. ,1..v. •�: .,s.:- 3�t.,,,'�-, ., i'�.: , ��,�..'�'�. �� .,�.,�r.=x:.�,�Sw�,�':r....,,: SRe Value CommeMs � ESTIMATED REPRODUCTION OR REPLACEMENT COST NEW OPINION OF SITE VALUE........................................=S Source of cost data Dwellin 1 1 224 .Ft.@ E ........a E 0 � Qual' raan hom cost service Eftective date oF cast data S.Ft.@ 5 ............m 8 • Comments on Cost A roach ross livi area calalaAorts, eciation,etc. in view of the a e of these im rovements the Cost A roach cara r�ca s.Fc.�a ...=s cannot be considered an accurate indicator of value. Trnai Estimac rcost-New =E 0 less Ph ical Funcuonal Extemal De reciaaon -E 0 edated oflm ovemerrcs. .................:............=S 0 "As-is'Value She Im ovemenu................................=E INDICATED V LUE BY COST APPROACH.._.................. =S 0 - ��rrt-.,,v, �,•�, - � ` ��. � ,� � F 1N'C.OI�IE`.'A�pPRf}AGlf"$��`,I4tk1E:„%a'� f�*t.�:��' l,i,. �,;� s"'R,�'�.i. rf, 'a"�'"�,y.. ,., .> . .... .. .. ... .. .�.�.,,. .._. ,. .� �.. _ , ..u... , .� ... ,.,, Estimated Morrth Market Rerrc S X Gross Rern Mulri ier -S Indicated Value b Income A roach • Summary of Income Approacn Gncwdirg suppon f«market rern a�GR� The Income A roach i�ina ro riate because the ical bu er of d ro e similar to the sub ect in s le,condition and a al would be an owner occu t. InAicatetlValueb: SalesCom arisonA oachf115000 Cos[A �roach(ifdevelo d)�0 IncaneA oachCrtdevelo S See Attached Addendum � . k ' This appreisal is made X'as is,' wbject m compie6on per pians and specifiratlons on the basis of a ypotheticai contlition that tne improvemems have been completed, Q wbject ro tbe fdlaving repairs a alterauons on che basis oi a hypaheucal conaition mat the repairs or ahera ons have been completed ❑wbject to the follavirg: • .,.,., Basedonthescopeofw ssumpUons,limitingcotWiUonsandappreiser'scertifieation, (our)opinionofthedefinedvalueoftherealproperty � thatisthesubjectofthi eportis$ 115,000 �asoi 04/25/2013 � ,whichistheeffec[ivedateofthi5appraisaL . '�^• a Foq�.MusvgAGviiwae.BW.2318727ww. '� .mm TNsiamCop„kjla�t1110Rp0iveiond150Qtim55evim.InCAlRkegp�ofnsP e�M. Paqe 2 d 1 (9PAR"')Generd Pupose 1p��t0U1_t005�MIDi0 M.,�:, Mark Heckman Real Estate Ap raisers i� c ._ . .,.w .... . - REV-1503 EX+(E98) scNE�u � s COMMONWEALTH OF PENNSYLVANIA STOCKS & B NDS INHERITANCE TAX RERJRN � RESiDENT DECEDENT ESTATE OF , �. FILE NUMBER l�l.L ri�;//�( �• /�G�� o/ � — o c�a-*�/ All property jointty-owned with rigM of survivorsh�p must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. r �; F'�s f ,��f C�-- � � /� • �� 9 ��c- e.r � � � � TOTA�(Also enter on line 2,Recapitulation) $ �lO��•� � (If more space is needed,insert additiona�sheets of the same size) a CUNA Brol:erage Sei�ices,Inc. Pershing `- , Uffice of Supervisor}�Jarisdiction 2000 Hcrildgc�l'ay Waverlv,lA 511677-9209 AN AFFQ,ih'tE OF THE flAN}:OF NEN YOF}:MELLON� PhOnz:19-�S�-�n0� One Pershing Plaza,Jersey Ciiy,W 07399 Pershing LLC,member FINRA,NYSE,SIPC Page: 1 of 1 ESTATE OF MARIETTA C KELLER 282 0084 Account Number: 3VK-058872-1 HAROLD K KELLER JR & Amount Paid: $7,612.64 JOANN K MOODY CO—ESECUTORS Issuing Bank Acct: 0300956497 1215 HARNEY RD LITTLESTOWN PA 17340-9368 I��ili�il��l�i�lr��i�i�uni�il�lrulli�iiu��i�i��innil�l�l PAYMENT S L�IZ?VIA.F�Y - - _ _ __ _ . _-- __ _ CHEeKNUMBER: 4014039531 CHECK DATE: 04/04/2013 DATE DESCRIPTION AMOUNT 04/Ol/2013 FIRST UNITED CORP CUSIP 33741H107 4,296.59 04/O1/2013 FIRST UNITED CORP CUSIP 33741H107 1 644.63 04/O1/2013 fIRST UNITED CORP CUSIP 33741H107 �843.56 04/O1/2013 FIRST UNITED CORP CUSIP 33741H107 $2�•$6 NET AMOUNT $7,612.64 ............................................................................ ................................... (Detach Herel ......................................................................................................... � ........ :.«,� ��,..�,.s.,.�. , j Symbol: FUNC - + We confirm the below trades, subject to the terms and condifions set forth on�this confirmat�on ;:.: ;: ,::::: •;:::::;;.: :.,;,;.::::::.>::;::::::;::;;:.:::..:::::::;;;.;:;::::;::.. coanmiss�.. s�znc�; > ►a�`�n�' ::�r�>::::::::.. .... ...:.:::.. ;:::.;: .>.;; . ��Y ::::::.:.:.: :.....: E 7�rs�� .....,:.;:>: ��a�r�i�: ;;>::>.::::::::;:r�. rtcta��...............tr�r��?................ .. ,::>::::..: ;...:.........:....... ust�::>::::::<::_..:....:::.;;::.<><;. ;.::...:.:...:;.;;»:.. : '�€I'�;:<:»>::.;;;::�?RtC�:..:::..::.:::::.ftl.:......::::::::::::.:::::::....::.....:.::..:::.:::: tJ111.:..::.::.�HAFtGE.:::::.:::.:::::::::::.::.:::<::::.:::;:<.;>.:.::::::::... �lUat�;:::::::::::.:::::::::.::::.:::::.::..:.:.:::::.:.:;:,.:;::,»::::::::::...::::::.:.:<.;::;>::::,::::._.::±Gi�1�1�VfLR.._:::...:::..::::.:..::::: �IUME�:::>::«::<»;:::>:;;:»::»::::<:>:;:»:::<:»:<::<:»::;;;.::.;>:;.;::::<.;:::::.;::::«:.:.;:::::::::::::::,.:::::::::......................... __._.............. 13H6YC 200 8.30 1,660.00 1�.84 2.50 0.03 1,644.63 1 Unsolicited Order � 13H6YE 100 8.50 850.00 �.42 0.02 843.56 1 Unsolicited Order --- 13H6YF 100 8.343 834.30 �6.42 0.02 827.86 1 Unsolicited Order — 13H6YG 519 8.343 4,330.02 �i.32 0.11 4,296.59 1 Unsolicited Order ' Totals 919 T,674.32 5�.00 2.50T 0.18 7,612.64 Defauft Tax Lot DisposRion Method:FIRST IN FIRST OUT ` Tax lot information will only be displayed for partial dispositions. Fuli disposRions wili use all�the available tax lots. You may change the disposition method or tax lots applied to this trade before the eariier of settlement date or three business days.For;more cost basis information,piease contact your investment Professional. ------- — __—.: __ - -.___ _ _ . ___ —____------- CUN:�Brokerage Sers-ices,Incs Pershing , ��ice of Supernisorp Jnrisdicti�n 1. 2000 Hcrilxgc t1'ay Waverlv,1.4 50677-9209 AN AFFIllATE OF7HE BANK OF NE�U YOF}:MELLON ' Phone 319-;5'J_4040 One Pershing Plaza,lersey Cily,W 07399 I Pershing LIC,member fINRA,NYSE,SIPC � a Page: 1 of 1 ESTATE OF MARIETTA C KELLER 282 0084; Account Number: 3VK-058872-1 HAROLD K RELLER JR & Amount Paid: $7,612.64 JOANN R MOODY CO–E%ECUTORS Issuing Bank Acct: 0300956497 1215 HARNEY RD 'y LITTLESTOWN PA 17340-9368 ; I��ili�il��l�i�li��i�i�nni�il�li�iilli�iiii��i�i��niinl�l�l PAYMENT S ��Y CHECKNUMBER: 4014039531 CHECK DATE: 04/04/2013 DATE DESCRIPTION AMOUNT 04/O1/2013 FIRST UNITED CORP CUSIP 33741H107 �4,296.59 04/O1/2013 FIRST UNITED CORP CUSIP 33741H107 1 644.63 04/O1/2013 FIRST UNITED CORP CUSIP 33741H107 a �843.56 04/O1/2013 FIRST UNITED CORP CUSIP 33741H107 i 827.86 NET AMOUNT $7,612.64 i , i i i � 3 � , i t i s � i i r 1 � � ru � si■ � 1 _ i � REV-1504 EX+(1-97) SC1�IEpVLE C .. CLOSELY HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA pq�tTNERSHIP bR INHERITANCE TAX RETURN RESIDENT DECEDENT SOLE-PROPRIET SHIP ESTATE OF � FILE NUMBER i Schedule C-1 or C-2(including all supporting information)must be attached for each cl�sely-held corporationlpaRnership interest of the decedent,other than a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships. ; VALUE AT DATE ITEM NUMBER NUMBER DESCRIPTION ; OF DEATH V 1. ? ! ,' k i 0 i ! i I Y ! 1 � t $ � Y I j � � � � j i � � t � � t � � I i i � I � � � r i i � j � � � � I ai I � �� Q �� TOT{�L(Also enter on line 3,Recapitulation) $ (if more space is needed,insert additio�l sheets of the same size) z � REV-1505 EX+(6-98) SCNEDULE �`1�1 -� CLOSELY HELD CO�RPORATE COMMONWEALTH OF PENNSYLVANIA STOCK INFORMATION REPORT_ INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF 9 State on Incorporation 1. Name o Corporation '•. Date of Incorporation Address State Zip Cod� Totai Number of Shareholders City � ; Business Reporting Year 2. Federal Employe .D.Number i 3. Type of Business Proc�uct/Service � 4. ' ��- 'NCIINSER Q�'�,' - �A�C1E£� �� °.�. -��tt�€��n!"t�. �� r�i�a�r-r��c� �`��_ , � ._... � ,, : ,.. . , ,...:..r.� � : $ Common � -- � $ � Preferred Prow all rights and restricfions pretair�ing to each class of stock. 5. Was the decedent empioyed by the Corpor ion? ... .... . . .. ... . .' ❑Yes ❑ No Annual Salary $ } Time Devoted to Business If yes,Position j 6. Was the Corporation indebted to the decedent? .. .. .. .. .. . ..... .. .� . . . ... .. . . . . . . ❑Yes ❑ No If yes, provide amount of indebtedness$ � 7. Was there life insurance payable to the corporation upon e death of the�decedent? .. . . . 0 Yes ❑ No If yes,Cash Surrender Value$ Net proceeds payable$ i . Owner of the policy j 8. Did the decedent sell or transfer an stock in this company within on ea�prior to death or within two years if the date of death was prior to 12-31-82? ; ❑Yes ❑No If yes, ❑Transfer ❑ Sale ber of Shares Transferee or Purchaser Conside#ati $ Date Attach a separate sheet for additional transfers and/or sales. 1 g. Was there a written shareholder's agreemerrt in effect at the time of the decedenYs dea ? ....C7 Yes ❑ No If yes,provide a copy of the agreement. ? 10.Was the decederrt's stock soid? ....................... ..............i.............. . ❑Yes ❑ No If yes,provide a copy of the agreemerrt of sale,etc. ( 11. Was the corporation dissoived or iiquidated after the decedenYs death? .•. •••• .......... .. Yes ❑ No If yes,provide a breakdown of distributions received by the estate,inciuding �ates and amour�ts rece . 12.Did the corporation have an interest in other corporations or partnerships? . .... . . . . . • ❑Yes ❑No If yes, report the necessary information on a separate sheet,including a Schedule C-1 or C-2 for each interest. ♦ • •- + � � ! A. Detailed ca�culations used in the valuation of the decedenYs stock � B. Complete copies of financial statements or Federal Corporate Income Tax r�ms(Form 1120)for the year of death and 4 preceding years. C. If the corporation owned real estate,submit a list showing the complete address/es and estimated fair market value/s.If real estate appraisa�s have been secured,attach copies. D. List of principal stockholders at the date of death,number of shares held an jtheir refationship to the decedent. E. List of officers,their salaries,bonuses and any other benefits received from t�ie corporation. F. Statement of d'nridends paid each year.List those declared and unpaid. � G. Any other information relating to the valuation of the decedenYs stock. � (If more space is needed,insert addfional sheets of the samo size) E 3 REV-1506 EX+(9-00) SCI�IEDt�LE �C-Z PARTNERSHIP COMMONWEALTH OF PENNSYLVANIA �NF��.�ON REPORT INHERITANCE TAX RETURN RESIDENT DECEDENT + ' FILE NUMBER ESTATE Of � � 1. Na of Partnership � Date Business Commenced e I Business Repor6ng Year Addr ; � State Zip Code City 2. Federal Employe .D.Number ; 3. Type of Business ProducUSenrice 4. Decedent was a ❑Gen I �Limited partner. If decedent was a limi�ed partner,provide initial irnestrnerrt$ � 5. i A. ' ; B. ' C. i D. ' — � ; 6. Value of the decedenYs interest$ 'i 7. Was the Partnership indebted to the decedent? . . .. . . . . . . . . . . . . . .I. . . . .. . . . . . . . . ❑Yes ❑ No If yes,provide amount of indebtedness$ � 8. Was there life insurance payable to the partnership upon the dea of the�decedertt? ....• ❑Yes ❑No If yes,Cash Surrender Value$ N�t proceeds payable$ Owner of the policy � 9. Did the decedent sell or transfer an interest in this partnership within one ar prior to death or within iwo years'rf the date of death was prior to 12-31-82? { ❑Yes �No if yes, ❑Transfer ❑Sale Perce e transferred/sold Transferee or Purchaser Conside�ation$ Date ! Attach a separate sheet for additionai transfers and/or sales. � 10.Was there a written partnership agreemerrt in effect at the time of the decedeirt's death? . . .. . ❑Yes ❑No ff yes,provide a copy of the agreement. �; 4 11.Was the decederrt's parmership interest sold? ........................j..-••.......... ❑ ❑ No If yes,provide a copy of the agreemern of sale,etc. � 12.Was the partriership dissolved or liquidated after the decedeM's death? ...!............... ❑Yes No If yes,provide a breakdown of distributions received by the eshate,induding c�ates and amourits received. � 13.Was the decederrt related to any of the partners? .....................�........... .... ❑Yes ❑No if yes,explain � 14.Did the partnership have an interest in other corporations or.partnerships4 ......... ..... 0 Yes ❑ No If yes, r•eport the necessary information on a separate sheet,including a 3chedule C-1 or G2 for each interest. 3 • . � �� . � . A. Detailed calculations used in the valuation of the decederrt's partnership irrterest B. Complete copies of financial statemerits or Federal Partnership Income Tax retums{Form 1065)for the year of death and 4 pr�eding years• C. If the partnership owned real estate,submit a list showing the complete addr�es and esfimated fair market value/s.ff real estate appraisa�s have been sec:ured,attach copies. i D. My other information relating to the valuation of the decedenYs partnership ir�terest. ; 1 I REV-1507 EX+(1-97) a SCNEpULE D ` MORTGAGES &INOTES COMMONWEALTH OF PENNSYLVANIA RECEIVABL� INHERITANCE TAX RETURN RESIDENT DECEDENT , ESTATE OF FILE NUMBER i All property jointly-owned with right of survivorst�p must be disclosed on Schedule F. VALUE AT DATE ITEM '' OF DEATH NUMBER DESCRIPTION � i �. + i i I i i 1 i , i i i i 3 i : 1 i � a ; { : i � I i i 1 , � � ` TOTAL(Also enter on line 4,Recapitulation) $ (If more space is needed,insert additior�i sheets of the same size) � _ RE�f-s�E�c+tsr�o) .- �r: #��s�;rlva�ria / 5��•E E UEPhBTftENT OF REVENUE Wi.7H� S�VGr��S � 1'II.T.. ��T�� Pf R�tAt PROPERTY �oEc�eKr ; ��.�.��: �Y FILE NUMBER: /y�r��a � l��Y c�o%�-- Dd.�4�/ Include the proceeds of litigation and the date the`proceeds were received by the estate. AH property jointly owned with rigfit of surviv�ip must be disclosed on Schedule F. � . VALUE AT DATE �R DESCRIPTION i . OF DEATH Gl ' � C��` l �s' �� ; ��i`: ' '' • � .�`io. � 9 � C�� . . � � r , , � ` � '� �4�% �� • ��.�-w , ; � a �; 7,5"� - d a �� • % � s� � �- . ; Tl aI S:'s'..3 �- /� ��.-�-� �� Ga� � � ; � � ; � � ; � TOTAL(Also enter on Line 5, Recapitulation) � �o �J'`�3• � if mae space is needed,use addidonal shee�ts of paper of the same size. j � n i r�. � BELCO COMMUNITY CREDIT UNION'P.O.Box 82'Harrisburg,PA 17108 CHECK NO:OOOOO��I�I� 3 1-800-642-4482 www.belco.org Acct: 0000425730 Teller: *** Date: 03/19/13 Time : 9 : 53am ------------------------------------------------------------------ ------------------------------------------------------------------ Check Number: 00 0000019913 Purpose C1os�e�Share 0001 Amount ��",.�'� aM.fi,�-��° �,,, Pay to : MARIETTA C KELLER 81 ARNOLD ROAD ENOLA PA 17025-2148 � BELCO COMMUNITY CREDIT UNION'P.O.Box 82*Harrisburg,PA 17108 CHECK NO:OOOOO�99� 1 1-800-642-4482 www.belco.org ACCt: 0000425730 Teller: 1278 Date: 03/19/13 Time: _ 9_53am________ ------------------------------- See receipt for reference ------------------------------- Check Number: 00 0000019911 Purpose ��g�T , ��. Amount �'��:�:41 '"� Pay to : ESTATE OF MARIETTA C. KELLER '� BELCU ' COMMUNITY CREDIT UN10N �'�.� BELCO CONII�l[JNITY CREDIT UNION , CAMP HILL BRANCH ' 3500 TRINDLE RD ' Inquiries Ca11:800-642-4482 CAMP HILL PA 17011-4439 ' Account XX�O��U�X730 KELLER,I�iRIETTA Effect: I�03/19/13 Post: 03/19/13 Tlr: 1278 ID DUE DATE PRINCIPAL INTEREST E'EES ', BALANCE TRAN AMOUNT SEQ , Withdraw from CHECRING 0040 Prev Balj: 1,255 .17 0040 1,255.17- 0.00 0 .00 ' 0 .00 1,255.17 #169933 Deposit to SAVINGS 0001 Prev Bal': 505.29 0001 1,255.17 0. 00 0.00 ' 1,760 .46 1,255.17 #169934 Withdraw from HOLIDAY CLUB 0020 Prev Bal!: 105. 95 0020 105. 95- 0. 00 0 .00 ' 0 . 00 105. 95 #169935 Deposit to SAVINGS 0001 Prev Bal';: 1,760 .46 0001 105. 95 0.00 0.00 ', 1,866. 41 105.95 #169936 Account X��CXX730 Available Balance: S0040 ' 0.00 Available Balance: S0001 1,861.41 Available Balance: S0020 ', 0 .00 Authorized by Play ball! Join us for Spring Training at the 2013 Belco Annual Meeting and Membership Gala on Sat. , Apr. 13. Tickets are $25 and on sale now at all branches, or by phone at 800-642-4482 . Join us for a grand slam evening of dinner, door prizes, and music. Hope to see y,'ou there! �, a li I ; i l Household Inven;tory Estate of Marietta C Keiler 1998 Honda Civic, DX,4 door,good condition $1,441 Household Furniture: $ 1,050 Household Decor: ' $ 200 Appliances: Window A/C $ 50 , Microwave $ 25 Refrigerator $ 100 Dryer $ 75 , Freezer $ 75 $ 325 Electronics , $ 430 2 Flat Screen Ns $400 Blue Ray Player $ 30 Kitchen Equipment/Supplies $ 320 Yard Equipment/Tools $ 500 Mantis Roto Tiller $ 100 , Lawn Mower $ 50 Snow Blower $ 100 j Misc Tools $ 200 Leaf Blower $ 25 ', Hedge Trimmer $ 25 Jewelry ' $ 450* Diamond Ring $200 ' Diamond Heart Neck. $ 100 Misc Sterling Silver $ 100 ' Misc Rings/Earrings $ 50 ', Baseball Charm Brclt �*- �� ' Total Household ' $4,716 ', ,c�p .�—�-"� , � �7�"'�0 'i 'kEY-t50B IX�(t9� . SCHEDULE F . COMMONWEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER if an asset was made joird within one y�r of the decedenYs date of death,it must be reported on Scfiedule G. SURVNING J01 TENAM'(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. JOINTLY-0WNED PROPERTY: LETTER pp7E DE ON OF PROPERTY %OF DATE OF DEATH ffEM FOR dpINT MADE Indude narne of fir�ciai instihrtion and b� M nurt�ber or similar ide�tiying numb�.Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOIM deed for joiMly-held teal estale• VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. � i i i � � i � i i T�TAL(Also enter on line 6,Recapitulation) $ � � � (If more space is needed,insert additiona�sheets of the same size) REV-1510 EX+(OS-09) �� pennsylvania SCHEDULE G DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCETAXRENRN 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 page three of the REV-1500 is yes. DESCRIPIION OF PROPERIY DATE OF DEATFi %OF DECD'S IXCLUSION TAXABIE �M INQUDE iHE NAME OF THE iRANSFEREE,iHE[R RELATIONSHIP 70 OECmBQT AND NUMBER THE DAtE Of TRANSFBt. ATfACH A COPY OF THE D�FOR RFAL ESfATE. VALUE OF ASSET INTEREST (t��cas�) VALUE 1. TOTAL(Also enter on Line 7, Recapitulation) $ `� C9 �' If more space is needed,use additional sheets of paper of the same size. ' REV-f511 DC+(.10-06) SCi�IED��.E N . COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8� INHERITANCE TAX RE7URN ��f N��rn� CQ� RESIDENT DECEDENT ESTATE OF FlLE NUMBER . /v��, ��--� C . J� �� a� ��- oa � �� Debts of decedeni must be reported on Schedule L ITENI NUMBER DESCRIPTION AMOUNT A FUNERAL IXPEN ES: 1 �. �tG' �r��2/��0 �- :C2L mAT�wv �' l�E�/�7 t� �i,=�rrFr �l�r� '�Er �l� �d C7 ��rcr 2��s �'f��v� ��K i'}7a, ��r�2�sl3ulz �� f�.� SS,�.35 � CM 6R1/�'L S�nv�c� -T�.v�<r� �.�s r�+y �-.� C'��ur��.+ � �r 8'(,.� �J -��vr�rLm�.Ur � Y� vt�[. - n. � c� ,,� p �rn � 1 /�-�s - /�L-�n —Q r/`� �07� O� B. ADMINISTRATIVE COSTS: 1. Personal Represenhative's Commissions Name of Personal Repr�rtative(s) Sh�eet Address . City State Zip Year(s)Commission Paid: 2. Attomey Fees 3. Family Exemption:(If decederrt's address is not the same as daimanYs,aGach explanation) ClaimaM ' Street Address City State Zp Relationship of Cfaimarrt to Decedent 4. Pro te Fees - ��'Gr J S T G 2 0 � w l�- L- Jc ,.�!j�; s� 5.. AccountaM's Fees 6. Tax Retum PreparePs Fees � �3-a�v � �G s � �s r r� �N1%Gl� � C �cc o u ti? i �3. l S � � C�os�,�1c� �srs S�.�t-- a �� 2 a�n ��, a�i � s 3� C '7�.0 �, aus� P 2/-�-t SYJ-� �`'�`[> � D�G r�. ' C=!'Lf?CG =�' L-/ DLC-GCI'V1 `j`a S�GL ��oGG S� ' � �c O(� .. O O �c, c�M,�� ,,�� Qus�� GLc=/�N�NG� -o sc�� r��u s� �s� o 0 P �� c-' 2 /�-L t�Arr,2s- �-�Qu s�� s t� o�✓ To S z�-c„ /�o u S� 3 O , ,�o t�- TI Ft -- G �NSLS �SL=Lc- Z o� � � l3J 6z . TOTAL(Aiso enter on fine 9,Recapi#ulation) $ � �� . 7� (if more space is needed,ir�sert additional sheets of the same size} HARRISBURG�STOWNLROAD UNT SERVICES OF PENNSYL�ANIA' �NC• 41�0 �o� UER CREMATION HARRISBURG, PA 1i109 PHONE u17171 545-4001 • 1-800-�Z�-g221 • Fak�1�-541-��43 • Shawn E.Carper,Supervisor )Jonestown Road• Harrisburg,PA 17109 1lzrchant ID: b00019197677 Ref �1: 60b1 Phone Order �XY,Xx�XXXXXX�I6Z VISa Entrv Method; Manual lotal: � 1��15�44 130082 SVP5 �1�28�13 10,3�:�8 Inv �; 4��401 R�pr Code; 002i4C paarud; Online Batch#: 000�94 aVS Code: EXRC1 MRTCN Y CVV2 Code, MRTCH M J an 1 s , 2 013 c�5to�»2�� copY TNANk YOU HAVE A IJICE DAY! Mr . Harold Keller , Jr . 81 Arnold Road Enola, PA 17025 � Marietta McKee Keller - Deceased SPECIAL CHARGES $1 , 695 .00 X Direct Cremation Nationwide Guarantee Program Worldwide Travel Protection Program $1 ,695 . 00 TOTAL SPECIRL CHARGES PROFESSIONAL SERVICES Included X Services of Funeral Director & Staff Bathing and Disinfection of Deceased Facilities & Staff for Memorial Service Staff & Equipment for Memorial Service Private ID Family Viewing Witnessing the Cremation Packaging/Forwarding of Cremated Remains Personal Delivery of Cremated Remains Scattering of Cremated Remains $0 .00 TOTAL PROFESSIONAL SERVICES AUTOMOTIVE EQUIPMENT Included X Removal Vehicle Lead Car/Clerqy Car Family Car Service Vehicle $0 .00 TOTAL AUTOMOTIVE EQUIPMENT _.«..� ni{..0 nr�.. , �� MERCHANDISE Register Book Memorial Cards Thank You Cards Remembrance Package Alternative Container X Cardboard Container Urn Burial Vault Container Veterans Flag Case Grave/Memorial Marker TOTAL MERCHANDISE 50 .00 CASH ADVANCED ITEMS Grave Opening Cemetery Equipment Newspaper Notice Newspaper Notice Newspaper Notice Clergy Church/Sexton/Organist/Soloist Flowers X Crematory Charge Included X Dauphin County Coroner Fee $30.00 X 15 Certified Copies of Death Certificate $90.00 TOTAL CASH ADVANCED ITEMS $120.00 SUMMARY OF CHP,RGES Special Charges $1 ,695 .00 Professional Services $0.00 Automotive Equipment $0.00 Merchandise $0.00 Cash Advanced Items 5120.00 SUB TOTAL $1 ,815 .00 CREDITS S@��0 AMOUNT PREPAID Date $0.00 TOTAL $1 ,815.00 AMOUNT PAID Date Jan 28, 2013 -$1 ,815 .00 BALANCE DUE $0.00 THIS STATEMENT MAY NOT REELECT ALL NEWSPAPER GHARGES �... „�,-.�, .,�.�� A N N � � � ^ � � N N Z a/> � Q --, O � O O O 0 O �A I� N . � � �M V? M � Q t/} t/) Q \ a � � � o 'n m � o O1 ,,..i � ,ri m 0p Ln N � z i/1� i/} i/? � Z � Q � � Ln O O O � � m o �n o � �o �ri o0 0 °i �. N r-I l0 tf1 � � J N 00 M i/� �' Q � � � � _ � � d' O O O O N u'f O O O N M �O O O O O I� M O � O u? � I� �Pf O i.r1 I� 1� t0 �n o0 O M � � � N O N N 01 N r-I l0 � r Q � � i%?, i/1� N t/� � V? � � O � � � �' F�- p� T � _ �� U � � o�S � _ w Z Q W O � Y ~ � Q 1— = p Z U Z V Z O � � a a p a >- � c~i� a � Y � � O � Y O Q Q cn � W N � N � � O w a W � w ~ � � � F— m � Y W z � � O m � Z LL p = � � � � p u. 0 cn O v cn � oc � Z p 1= Z m J Q Z � Q v O � � w m � � � } Y N � W a v�i H w Q � Z V °C � � w � Z � � � Q = Q � cC w O c/) a0 Z U = � � U � U ...,. �� .,� e Electrical Bill for 81 Arnold Lane, Enola, PA 1702526� t h � 3[ R� � t� � � C Reconfigured living room recepts so that a gfci recept.will protect all recepts in living room -$125 3 GFCI Receptacles in kitchen on countertop and 1 GFCI in kitchen at low desk -$150 Box added to attic and extension cord removed and replaced with romex to fix open spliced conductors-$70 Diagnose faulty branch circuits and fix dead receptacles—one in the bedroom and one in the living room-$85 Total cost: $430 Please make checks payable to Jason Baney, my mailing address is 141 N. 33rd st. Camp Hill, Pa. 17011 Sept 2014 Samantha Coons worked 11 hours @10.00 per hour painting at 81 Arnold Road preparing Marietta Keller's house ready to put on the market. -� �11 X 10.00=$110.00 Check No. � �s Date: `� � � S^ David Moody worked 11 hours @ 10.00 per hour painting the interior and exterior of 81 Arnold Road preparing Marietta Keller's house ready to put on the market. 11 X 10.00=$110.00 Check No.j �� Date: s/z I � s � �� ` ' 'p�yCMq.F OMB Approval No.2502-0265 - -� � A. Settlement Statement (HUD-1) �. • ' 6.File Number: 7.Loan Number. 8.Mortgage Insurance Case Number: 1.QX FHA 2 Q RHS 3.Q Conv.Unins. CH15-01490 000096387 446-2409040.703 4.Q VA 5.Q Conv.Ins. C.Note:This form is fumished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown.Items marked "(p.o.c)"were paid outside the ciosing;they are shown here for informational purposes and are not inciuded in the totals. D.Name&Address of Borrower: E.Name 8�Address of Selier. F.Name&Address of Lender: CARYN L HANKS THE ESTATE OF MARIETTA C.KELLER,ALSO HomeSale Mor�qage,LLC 17 Hardy Court,Lancaster,PA 17602 IQVOWN AS MARIETTA MCKEE KELLER 215 S.Centerville Road,Lancaster,PA 1215 Hamey Road,Littlestown,PA 17340 17603 G.Property Locallon: H.Settlement Agent I.SetUement Date:04/24/2015 81 ARNOLD ROAD,EAST PENNSBORO Homesale Settlement Services Disbursement Date:04J24/2015 TOWNSHIP 4000 Crums Mill Road,Suite 101,Hartisburg,PA 17112 ENOLA,PA 17025 Hampden Township phone:717-671-9876 Fax:717-671-9676 Place of Settlemen� Ti�eExpress BHHS HomeSale Services,3435 Market Street,Camp Hill, Printed 04/24/2015 at 2:41 pm PA 17011 by SH . . . • 100. Gross Amount Due froro Borrower 400: Gross Amount Due to Seller 101, Contract sales price 116,500.00 401. Contr�t sales price 116,500.00 102. Personal 402. Personal ro 103. Settlement charges to borrower pine 1400) 7,439.07 403. 104. 404. 105, 405. Ad'ustmenfs for items 'd b seller in advance Ad ustrner�ts for items aid b seller in advance 106. Cityrtown ta�ces to 406. Ciryftown taxes to 107. County taxes 04I24I2015 to 12131/2015 326.89 407. County taxes 04f24/2015 to 1213112015 326.89 108, School taxes 04J24/2015 to 06/3D/2015 269.58 408. School taxes 04l2412015 to 06/30/2015 269.58 109. Sewer 04/24I2015 to 06/3012015 68.37 409. Sewe� 04124/2015 to O6i30l2015 68.37 110. 410. 111. 411. 112. 412 120. Gross Amou�Due irom Borrower 124,603.91 420. Gross Amount Due M Seller 117,164.84 200. AmouMs Paid or in Betiaif of Bomou�r 500. Reductions In Amount Due to Selier 201. Deposit or eamest money �,000.00 �o�. Excess de�osic�see�nstruc�ons) 202. Prinapal amount of new foan(s) 112,611.00 502. Settlement charges to seller(line 1400) 14,579.31 203. Existin s taken su 'ect to 503. 6dsti loa s taken sub'ect to 204. Cumberiand County Grant Funds 3,000.00 504. payoff of first mortgage loan#827468083 to Green ��•78 Tree �, 505. Pa off of second mort a e loan 206. 506. 207. 507. 208. SellerAssist 2,330.00 508. Se1lerAssist 2,330.00 209. �. Ad ustrnems for items un 'd b seller Ad"ushnents for items unpaid b seller " 210. CityRa�un taxes to 510. Cityftown taxes to 211. Countytaxes to 511. Countytaxes to 212. School taxes w 512. School taxes to 213. 513. 214. 514. 215. 515. 216. 516. y�7. 517. 218. 518. 219. 519. 220. Total Paid b Ifor Borrovuer 118,941.00 520. Tohdl Reduction Amaunt Due Selier 40,244.09 300. Cash at Settlement frortJto Bortower 600. Cash at$ettlement tolfrom Seller 301, Gross ameunt due from borrower(line 120) 124,603.91 gp�, Gross amount due to seller(line 420) 117,164.84 3p2, Less amountS paid byifor borrower(line 7L0) 118,941.00 602. ��ons in amount due seller(line 520) 40,244.09 303. Cash OX From ❑ To Borroxrer 5,66291 603. Cash ❑X To ❑ From Seller 76,920.75 ro va�sv� .��•�o. � �r�r m � . ais mm . ws ram.wessn d4purs a amen�N wia oMe mrma nunex.No amm�nmiMk assuea:mkds�a is mendetoy.reis bd�qneE m v�0 ma v�es a a RFsrn cwaea umsedbnwdn wamauon cuMu We xn�emem v�s. .- �oo. Tohaf Rea1 Eshate BrokecFees $7,o75.2o Paid From Paid From Division of commission Iine700 as folbws: BOrrOW2r'S Sellel''S �Q�, �6�� ta Howard Hanna Real Estate Services Fu nds at Funds dt 702. $3,425.10 to Berkshire Hathaway HomeServices Settlement Settlement 703. Commission paid at settlement 6,07520 704. Eamest Money Deposit to Howard Hanna Real Estate Services $1,000.00 P.O.C.B' 1,000.00 705. Buyer Broker Flat Fee to ��hir�Hathaway HomeSe�ces 225.00 800. kems P le in Connection with Loan 801. Our origination charge (Indudes Originatlon Point 0.000°h or$0.00) $845.00 (from GFE#1) 802. Your aedit or charge(points)for the speafic interest rate chosen $ (from GFE#2) 803. Your adJusted origination charges (from GFE A) 845.00 804. Appraisal fee to HSM fbo Burkholder 'sal Services (from GFE#3) 40�.00 805. Credft report to HSM fbo E u'rfax (from GFE#3) 11.10 gpg. Tax Service to from GFE#3 807. Flaod certiflcatlon to HSM fbo Cwe ic (from GFE#3) 12.50 808. to 900. i�ms Required b Lender to be Paid in Advance 901. Daily interest charges from from 04/24/2015 to 05/01/2015 @$11.7300/day (from GFE#10) 82.17 902. Mortgage insurance premium fw months to De rUnent of HUD (from GFE#3) 1,936.81 903. Homeowner's insurance for 1 �rs fo Farmers Insurance $367.47 P.O.C.B'(�m GFE#11) gp4, months to from GFE#11 1000.Reserves De sited wit�Lender 1001. Ini�al deposit for your escrow account (from GFE#9) 1,088.70 1002.Homeownei'sinsurance 4��s $ 30.62/month $1�.� 1003.Mortgage insurance maiths $ 73.17/month S 1004. Pro taxes months $ /rtwnth 1005.County ta�cces 4�nths $ 40.26Imonth $161.04 1006.School Taxes 11 morrths $ 123.05/month $��•55 1007.Aggregate Adjustrr�ent $-548.37 1100.Title Ch es. 1101.Title services and lender's title insurance $ from GFE#4 1,358.00 1102.Settlement or dosing fee to $ 1103.Owner's title insurance-Old Republic Title Insurance Company $ from GFE�5 20.00 1104.Laider's tide ir�surance-Old RepuMic Title Insurance Company $1,240.00 1105.lenders title policy limit$112,611.00 Lenders Policy 9106. Owners title policy limit$116,500.00 Owners Policy 1107.AgenYs portion of the total title fnsurance premium $1,010.15 to Homesale Settlement Servioes 1108. UndenNriter's portion of the total title insurance premium $249.85 to Oid R ublic Title insurance Com 1109. 1200:Govemment Recordin and Transfer Ch es 1201.Govemment recording charges $ (from 6FE#� 260.00 1202. p�$g3,pp Mo $113.00 Release$ 1203.Transfertaxes $ (from GFE#8) 1,165.00 1204.City/Counry taxlstamps Deed$1,165,00 Mo e$ 1205.State Tax/stamps Deed$1,165.00 Mo e$ 1,165.00 1206. Deed$ Mort e$ 1207. 6rant $32.00 1208. Grant Release $32.00 1300.Addidonal SeClement Ch es 1301.Required servioes that you cart shop for (fran GFE�6) 1302. to $ 1303.2015 County/Twp Taxes to Debbie Lu ,Tax Collecto 473.47 1304.Tax Certification to Homesale Setllement Services �• 1305. Notary Fee ro Pubfic 12.00 306.Wire Fees(2) to Hom�sale Settlement Services 40. 1307. Inherit�ce Tax Esaow to CPSS Escrow Account 5��. 1308.Dced PreP to Homesale Settlerr�nt Services 1 t5. 1309. Sew�4/1115 to 6130h5 to East Pennsboro Townshi A ��• 1310.Trash 4/2 15 to 6/30/15 to East Penr�sbaro Townshi Atrth ` �•� 1311.Ublity Cert to East Pennsboro Townshi Auth ' 10, 11 • . - . ►r_ - - 1 • . • 1 • 7,439.07 14,579.31 'Paid outside of dosing by(B�rmwer,(S)eller,(L�nder,(I)nvestor,Bro(K}er."Cred'd by lender shown on page 1."'Cred'�t by seHe�shown on page 1. Com rison:or'=Good Faifh.Esfimatc�GF and:HUD-1;Gha es : : . Good Faith"Esdmate -` ' HUD�1 C :" es Tfiat Cannot,lnciease HUD�1 Une�Number : Ou�.ongmaUon;charge, ; - ;# �801 845.00 845.00 Your:aed'd�or etiarge(poi.n.ts),forthe speafic intenast rate chpsen �.# � . 0.00 0.00 Your.adjusted:originatiai.charges ;: #, 803�; 845.00 -845.00 Trdnsfer-tazes;' . ,=- # 1203; 1�165.00 1,165.00 ;Ctia: es Ttiat;in Total:Cannot-lnc�ase.More:Than 10%:' , Good FaiU�`Estimate ; HU61 ; ' •Govemment recoMing:diaiges-,; ,; # 1�11;' , : 250.00 260.00 Appiaisal fee ,' # 804" 400.00 400.00 Cred�trepori ; #.805..' 60.00 11.10 Floodcertific�atlon . ':. �.':.: `: , : #.80T 12.50 1250 Mortgage insurance premium•. ; .# 902: . 1,936.81 1,936.81 Ttle s�rvlces-and lentler!s;tltle insuranc:e . �110t 1,464.00 1,358.00 Owner's 6tle insurance,-:QId Repub_fi,c Title.Insurance CompanY # 11�: - 100.00 20.00 - . . ; ' _��:.. '. 0,00 0.00 - - - - — - - "_.. . 4�223.31 3,998.41 . . � � . . $ -224.90 r -5.3252% Ch es�That:Can Chan e � Good.FaitH Estlmate. .. ; : HU41. Initial deposit;foryou��escrow acxounf. # 1001" � 1,726.50 1,088,70 Dailymterest:chargesfroin ` ' #:�1 $11.73001da 164.7L 82.11 Homeowner's insurance : , ': .# 903 600.00 367.47 :# # - ,; # Loan Terms Your.inlUal loari amountis= $112,611.00 Your loan tertn;is 30.years Yai�mfial.inte�est rate is:: s 3.7500% Your initial morithty amount qwed fw pnncipal,interest;arid any rtiatgage, $594.69 indudes insGrance is - ' QX Prinapal ;� QX Interest ,_: XQ Mortgage Insurance Cari;your irrterest rate rise?. [�X No. ❑Yes,it can rise to a maximum of %. The first change will be on / 1 and can change again every years after / ! . Every change date,your interest rate can increase or decrease by %. Over the life of ' ' the loan,your iMerest rate is guaranteed to never be lovwu than °h or higher ' than %. Eyen ff you make.payments on time,can.your loan balance;iise? QX No. ❑Yes,it can rise to a maximum of$ . Even'rf ydu make payments on time,can youc monthly amount owed fo� ;. QX No. ❑Yes,ihe first increase can be on / / and the monthty prinapal,interest,and mortgage insurance rise?' amount owed can rise to$ . The maximum ft can ever rise to is$ . Does your loairhave a prepayment penaltyt„ �, ; XQ No. ❑Yes,your ma�dmum prepayment penalry is$ . Do`es your toan'have�balloon payment? X�No. ❑Yes,you have a balloon payment of$ due in years on 1 1 . Total monthlyamount owed including escrow accour�payments ❑You do not have a monthly esanw payment for items,such as property taxes and homeowners insurancz. You must pay ihese items directly yourself. X�You have an adddional monthly escrow payment of$193.93 that results in a total initlal monthly amount owed of$788.62. This includes prindp�,interest,any mortgage insurance and any items chedced below: ; X�Property taxes 0 Homeowners insurance , �Flood insurance XQ Schoot taxes `, ❑ ❑ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. � . • •.�- " HUD CERTIFICaTION OF BUYER AND SELLER I have carefuliy reviewed the HUD�1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction I further�rtify that I have received a copy of the HUQ1 Setdement Statement CARYN L HANKS THE ESTATE OF MARIETTA C.KELLER,ALSO KNOWN AS MARIETTA MCKEE KELLER The HUD-1 Settlement Statement which I have prepared is a true and axurate axount of this fransadion.I have caused or wiB cause the funds to be disbursed in accordance with this statem � SETTLEMENT AG DATE � WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON REV-1512 IX+(12-08) ��> pennsylvania SCHEDULE� I DEPARTMENT OF REVENUE DEBTS OF DECEDfNT, . INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS RESIDENT DECEDENT ESTATE 0 FILE NUMBER ��l P�a C. ��P� ao/3 -�liO � Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. �M VALUE AT DATE NUMBER DESCRIPTlON OF DEATH 1 TOTAL(Also enter on Line 10, Rec.�pitulation) $ ^ � � If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) j�pennsylvania SCHEDULE � ry� OEPARTMENT OFREVENUE INHERITANCE TAX RETURN BENEFICIARIES �RESIDENT DECEDENT ' ESTATE OF• FILE NUMBER: �/"l,P�.�� . �Gf pi/� ��^ ��02�� RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF RERSON(S)RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRfBUfIONS[Include outright spousai distributions and transfers under Sec.9116(a)(1.2),] 1. �,a,r..c�(� K. . /��,r� -J^i�2 . Sor) �� z�s µavrx��Rd. t.,�ffl�stav�� PA �7�0 � 1��,� �. ��,�o � Z�-,� �� '��eaz( � Ft�ri S �c�-z (fk /7 6 J �� . � V � a.�;cE a �C. a-►�art - (� Pa sb�� ,-bs r"�c�9r l�c�, l�or.ka�n,c� ,��o � J� K , Coo�s � �a� q.� A! . I�A.in St � �"��svil�e� 1'4, �7�s.� ENTER DOLIAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF RfV-1500 COVER SHEEf,AS APPROPRIATE. II NON TAXABLE DISTRIBUTIONS- A. SPOUSAL DISTRIBlfTIONS UNDER SECTION 9113 FOR WHICH AN ELECiTON TO TAX IS NOT TAKEN: 1. B, CHARTfABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. � �� :;.� ,._._ TOTAL OF PART II—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. � REV-1514 EX+(12-03) SCf�IEDULE K LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA & TERM CERTAIN INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4 on REV-1500 Cover Sheet ESTATE OF FILE NUMBER ' schedule is to be used for all single Iffe,joint or successive I'rfe estate and term certain caiculations. For dates of death prior ta 5-1-89, actuarial factors for single I'rfe calculations can be obtained from the Department of Revenue,Specialty Tax Unit. A rial factors can be found in IRS Pubiication 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 430-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax retum. ❑ �II ❑ Intervivos Deed of Trust ❑ Other . , . � ,,� �,�"�.vf.,.�a,. , � - '�' � 7".c -� �, � n�r s by �w �n,�r ,��-ro.. �� :. D 4+:�,,,q�',In,�.�� t � t ro�._�� :C� � e �' „K, .i... �ys�f �n .A � y� v � � Sr' :�-`,E�'z+��'P- Y4w,r '�'r� . `'�� 'rr ;:✓ �-�ft�� .,.��, y .,�r�+Mh�tz+nr�`�' :�f' z,�3,�&.� ...r., .:t.. ,.F'e, s d, ,...�' ❑ L"rfe or ❑Term of Years ❑Life or ❑Term of Years ❑ Life or �Term of Years ❑Life or ❑Term of Years 0 Life or ❑Term of Years 1. Value of fund from which Iffe estate is payable . .. . . .... .. . ...... .. . ...... . .. . . ... . .. .. .$ 2. Actuarial factor per appropriate table .... .. .... . . .. ..... .. . . . .. .... . ... .. . . . .. .. .. . . . Interest table rate—❑3 1/2% ❑6% ❑ 10% ❑V 'able Rate % 3. Value of life estate(Line 1 multiplied by Line 2) ... ... ...... . . . .. .. .. ... . .. . . .. . .. . ..$ � , , � �`�� r�x �W'�ax'�"�''s��. t-�` � ; �`"��`° �`��"�i�F �, s;�� '� ; '" ^� ' k � � �� c , �n �� m �:,� .�3. _ , :.. -. ��'�p�a ,Tn:Mr�xf �� W1+��,'+'- !� � '.d'..2 _ S- �� _ �u.Jz ocmast"✓„Nre+._'.�i(,t ❑Life or ❑Term of Years ❑ L'rfe or ❑Term of Years ❑L'rfe or ❑Term of Years ❑ Life or ❑Term of Years 1. Value of fund from which annuity is payable . ....... ... .... .. .. . .. .. .. . ... . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding(number) ... .. ..... ... . .. . ... . . .. . Frequency of payout—❑ Weekly(52) 0 Bi-weekly(26) O Monthly(12) ❑ Quarterly(4) � Semi-annually(2) ❑ Annually(1) ❑Other( ) 3. Amountofpayoutperperiod .... ........... .. ... .. . .. . . . . ... . . ... .. ... . . . . . . .. . ... . .$ 4. Aggregate annual payment,Line 2 multiplied by Line 3 ... . ... ... .. ... .. .. ... .. . . . . . .... . . 5. Annuiry Factor(see instructions) Interest table rate—0 31/2% ❑6% � 10% ❑Variable Rate % 6. Adjustment Factor(see instructions) ..... .......... ...... ......... . .. .... . . . .. .. ...... 7. Value of annult�r— If using 31/2%, 6%, 10%,or if variable rate and period payout is at end of period,calculation is:Line 4 x Line 5 x Line 6 ........ .... . . . . . . . . . .....$ If using variable rate and period payout is at beginning of period,calculation is: (Line 4 x Line 5 x Line 6)+Line 3 .... ..... ....... .. .... ..... .. ...... . . . . . . ... ..... .$ NOTE:The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax retum.The resulting I'rfe or annuity interest(s)should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed,insert addRional sheets of the same size) �"644D`��04� INHFRITANCE TAX sct�Eau�E � COMM WEALTH OF PENNSYLVANIA ��pfNDER PREPAYMENT 'N RES)ANCED EDENTRN OR iNVASfON OF TRUST PIttNC1PAt FILE NUMBfR I. ESTATE OF t Name) {First Name) (A6ddie�o'dia� This schedu is appropriate only for estates of decedents dyi�g on or before December 12, 1982. This schedule is to be u for a11 remainder retums when an election to prepay has been filed under the provisions of Section 714 of the nMeritance and Estate Tax Act of 1961 or to report the invasion of trust principal. n, REMAINDER PREPaYMENT: A. Election to prepay filed with the R ister of Wilts on (Date) B. Name(s)of Life Tenant(s) Date of Birth Age on date Term of years income orAnnuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .$ 2. Stocks and Bonds . . . . .. . ... . . . . . . . . . . .. . . . .$ 3. Closely Held Stock/Partnership . . . . . . . . . . . . . . .$ 4. Mortgages and Notes . . . . . . . . . . . . . . .. . . . . .. .$ 5. Cash/Misc. Personal Property . .. . . . . .. . . . . . . .$ 6. Total from Schedule L-1 . . .. ... . . . . ... . . . ... . . . .. ... . . .. . . . . . . . . . . . ... . . . . . ..$ D. Credits: Compiete Schedule L-2 1. Unpaid Liabilities . . .. . . . . . . . . . . . . . . .. . .. . . . .$ 2. Unpaid Bequests. . . . . . . . .. . . ... . . .. . . . . . .. .$ 3. Vaiue of Unindudable Assets . . . . . . . ... . . . . . . .$ 4. Total from Schedu{e L-2. . . . . . . .. . . . . .. . . . .. . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . ..$ E. Tatal Value of trust assets(Line C-6 minus Line D-4) . ... . .. . . . . . . . . . . . . . . . . . .. . . . . . . $ F. Remainder fador(see Tabfe i or Table Ii in Instruction Booklet) . . . .. . . . . . . . . . . .. . . . . . . .. G. Taxable Remainder value(Line E x Line� . . . . . . . . . ... . .. . .. . . . . . . . . . . . . . . .. . . . . . ..$ (Aiso errter on Line 7, Recapitula#ion) jII, INVASION OF CORPtiS: A. Invasion of corpus (Mor�th, Day,Year) B. Name(s)of Life Tenant(s) Date of Birth Age on da#e Term of years in rne or Annuitant(s) corpus or annuity is paya e consumed C. Corpus consumed . . . . . . . . ... .. . . . . .. . . . . . . . ... •-- . . . . . . . . . . . . . . . . . . .._ .. . . . . .$ D. Remainder factor(see Table I or Table 11 in Instruction Bookiet) .. . . . . . . . . . . . . . . .. . . . . . . . E. Ta�cable value of corpus consumed(Line C x Line D) . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) ��;P� INHERiTANCE TAX SGHEDULE L-1 COMMOI�WEALTH OF PENNSYWANIA REMAINDER PREPAYMENT ELECTION INNERI7ANGE TAX RETURN StDENT DECEDEN7 -ASSETS- FILE NUMBER I.. Esf e of (Last Name) (Frst NameJ (Middle(nitian 11. Iten� N Description Value A. Rea) Estate (please describej Total value of rea) estate S (indude on Section I1, Line C-1 on Schedule L) B. Stocks and Bonds (p ose listj Total value of sto and bonds S (indude on Section t, Line C-2 an.Schedule L) C. Gosely Held Stock/Partnership (attach Sched C•1 andlor C-2) (please list) Tota!value of qosely Held/Partnershi S (indude on Section 11, Line C-3 on S le lJ ' D. Mortgages and Notes (ptease tist) 7ota)vaiue of Mortgages and Notes (indude on Sedion il, Eirte C-4 on Schedule L� E. Cash and Miscellaneous Personol Property (please list) Total value of Cash/Misc. Pers. property $ (indude on Sedion I I, Line C-5,on Schedule L) ��• TOTAL(Also enter on Section 11, Une C-6 on Schedule lj $ (If more spoce is needed, ottach additionol 8'h x 11 sheets.l REV-1646 EX+ �a.ea� INH�RITA�WCE TAX � SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN FILE NUMBER RESIDENT DECEDENT —CREDITS— I. Est of (Last Name) (First Name) (Middle Inkial) II. Item No. Description Amount . Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) To I unpaid (iabilities $ �a _ (inc de on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable fr assets reported on Schedule L-1 (please list) Totol unpaid bequests S � _ (include on Section II, Line D-2 on chedule L) ` C. Value of assets reported on Schedule L-1 (other than unpaid b uests listed under "B" above) that are not included for tax purposes or that do ot form a part of the trust. Computation as follows: Total unincludable assets S � ` (include on Section II, Line D-3 on Schedule L) 111. TOTAL (Also enter on Section II, Line D-4 on Schedule L) S — G I (If more space is needed, attach additional 8'/s x 11 sheets.) � ui � n■ � REV-1647 EX+(02-10) � pennsylvania SCHEDULE M � DEPAHTMENT OF HEVENUE FUTURE INTEREST COMPROMISE INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on REV-t5oo) ESTATE � FILE NUMBER This sched is appropriate oniy for estates of decedents who died after Dec. 12, 1982. This schedule i to be used for all future interests where the rate of tax that will be applicable when the future interest vests in possession and e 'oyment cannot be established with certainty. Indic e below the type of instrument that created the future interest and attach a copy to the tax return. ❑ Wi11 ❑ Trust ❑ Other I. Beneficiaries NAME BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5: II. For decedents who died on or afterJuly 1, 19 4, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check th. ppropriate box below and attach a copy of the document in which the surviving spouse exercises such withdrawai right. ❑ Uniimited right of wit rawal ❑ Limited right of withdrawal III. Explanation of Compromise Offer: _ IV. Surnmary of Compromise Offer: 1. Amount of future interest . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. �Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as part of total shown on Line 13 of REV-1500.) . . . . . . . . $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check one. ❑ 6%, ❑ 3%, ❑ 0% . . . . . . . . . . . . . . . . . . . . $ (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one. ❑ 6%, � 4.5% . . . . . . . . . . . . . . . . . . . . . . . . . . $ {Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate(12%) (Also include as part of total shown on Line 17 of REV-1500.) . . . . . . . . $ 6. Value of Line 1 taxable at collateral rate(15%) (Also include as part of total shown on Line 18 of REV-1500.) . , . . , , , . � 7. Total value of future interest(sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . . . $ �� If more space is needed, use additional sheets of paper of the same size. REV 1649 EX+(08-09) j i�pennsylvania SCHEpYLE O �y DEPARTMENT OF REVENUE INNERITANCETAXES RETURN ELECTION UNDER SEC.2113(A) RESIDENT DECEDENT (SPOUSAL DISTRIBUTiONS) ESTATE OF FILE NUMBER Do not compiete ' schedule uniess the estate is making the election to tax asse#s under Sedion 2113(A) of the Inheritance and F.state Tax Act. If the election to more tha one trust or similar arrangement,a separate form must be filed for each trust. This election applies to the Trust(marital,residual A,B,by-pass,Unified Credit,etc.). If a trust or similar arrangemen eets the requirements of Section 2113(A)and: a.The trust or similar a ngement is listed on Schedule 0 and b.The value of the trust or ' ilar arrangement is entered in whole or in part as an asset on Schedule 0,then the transFeror's personal representa- tive may specifically identi e trust(ail or a fractional portion or percentage)to be included in the election to have such trust or similar proper- ty treated as a taxable transfe in this estate.If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0,the personal rep tative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fiacdon is eq I to the amount of the trust or simi�ar arrangement included as a taxable asset on Schedule 0.The denomi- nator is equal to the totai value of the st or similar arrangement. PART A:Enter the description and value of all ' terests, both taxable and non-taxabie, regardless of location, which pass to the decedent's surviving spouse under a S ion 2113(A) trust or similar arrangement. Description Value Part Total $ r � _ PART B: Enter the description and value of all interests included in Part A for which e Section 2113(A) election to tax is being made. Desaiption Value Part B Total $ ✓ � � If more space is needed,use additional sheets of paper of the same size.