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HomeMy WebLinkAbout01-0232 PETITION FOR PROBATE and GRANT OF LETTERS Es if Joseph F. Arnold tate 0 also known as Joseph F. Arnold, Sr. No. To: Register of Wills for the , Deceased. County of in the Social Security No. Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of ag~ol oldfi an the execut ors in the last will of the above decedent, dated u y and codicil(s) dated N . A. C-7~/ijd(,)u::_7 H AYkcl,j- c/~'&-?:l /J~f ~ / 9~t 21-01-232 n~wed , 19_ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) p~cendent was domiciled at death in Cumberland County~ PennsY.1vania, with h last family or principal residence at Ij.J C Street, tlorough 01.: Carlls1e (list street, number and muncipality) Decendent then 81 years of age died February 5 at Cariisle Hospital, Carlisle, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in f'.eonSYlv..ania . situated as follows: j) C ~treet, Carllsle ,~ 2001 , SeGu.OD $ $ $ $ {D, t~O{), DO WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.La.; administration d.b.n.c.La.) theron. Joseph F. Arnold, Jr. 68 Leho Road Carlisle, PA 17013 Jack L. Arnold 250 Mountain View Road Shippensburg. PA 17257 '" a:r u c v :g3 v... iXv c -00 c'':: ~.;: __v ~Q.. v,- 50 ~ c 00 rn 4-~ t~9 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA l ..,.. r s~ COUNTY OF' Cumberland J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the kilOwledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed 'l-wd ~ before me this 28th day of ~. ~;~;~Y~;L<<'~~~;:;P/ j~~, ~ / / Register ~ / /,- (] I~-/ ~o. 21-232-2001 Estate of Joseph F. Arnold , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW FEBRUARY 28 ~ 200~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated July 11, 1996 described therein be admitted to probate and filed of record as the last will of Joseph F. Arnold, a.k.a. Joseph F. Arnold, Sr. and Letters Testamentary Joseph F. Arnold, Jr. and Jack L. Arnold are hereby granted to , ()'1.'. ~ 7J)/)Ui/ . ,:;' ///L<'~t7t/(N'-),,~y . R . lster of Wil s (; FEES Probate, Letters, Etc. ......... $ Short Certificates( ).......... $ x-pag~s. RenuncIatIOn ................ $ $ 5.00 TOTAL _ $ 141.00 Filed... .~~~:. .~~!. .~q~~................ 115.00 12.00 ~.uO Stephen B. Lipson 19453 ATTORNEY (Sup. Ct. J.D. No.) 5 Hilltop Drive, Mount Holly Springs, ADDRESS PA 17065 (717) 486-8981 JCP PHONE 21-01-232 REGISTER OF WILLS OF C C),,,/gj;;U/1J/j) COUNTY OATH OF SUBSCRIBING WITNESS ,S-f 2~,j;7jel/ B, L/';?f"c~ fl - ;- - - ~ I~'- (......., a subscribing witness to the will presented herewith, ~ being duly qualified according to law, depose(s) and say(s) that A p present and saw ~" ( 0:/, the testat 0 j~ , 'sign the same and that A e request of testati2L- in h fj" presence and (in d~o p"^M ~ other subscribing witness(es)). signed as a witness at the II ! lh H) (in the presence of the ~~-g~, ,S- -fe--T/C',6~ (Name) LJ.- /_y"JrC /7 ,S 1// / /-7-:-: ~ J.J/'A~ A f -f ~ J Ie:' /1/ (~ddress )l/~F~,d~,f ~ /;1 ) 7 C /-~;- Sworn to or affirmed and subscribed before me this day of 19_ Register (Name) (Address) REGISTER OF WILLS OF C'G,i/!5fi-:/!-,LAi-j) COUNTY OA'IH OF NON-SUBSCRIBING WITNESS ,~7;;__<;-'L~' ;:~i F A /7t C h/~ ~ ~ a subscriber hereto, ( {) being duly qualified according to law, depose(s) and say(s} tha~ ) e /~ familiar with the signature of :JO S ';1'/ ~ A /-h (' / '" ~ .ft1j 'I testat c y of (OR If' fro R'l~..;h;ng "'itIU!lJ l!l 181 the will presented herewith and ~ that /\ ~. believes the signature on the will is in the handwriting of J;; -> <2-/,/ to the best 0; <A /7;- I~' A // , ' /I r /1 c t cf/" ~ knowledge and belief. ) /Jt?(7 /i/!/L4~---Ci/ ~ Of~/''< (Name) F A r '" Ie{ {- P' c<. e t!' c ;(7 < ~-ct , (Address) .--7" , " Cc< //It'vA=) j7,'/1 ) /C/J (Name) ~.A// Sworn to or affirmed and subscribed before me this day of 19_ Register (Address) h 1~ IS to certify that the information here given is correctly copied from an original certificate of death duly filed with me as ,)(;;] Registrar. The original certificate will be forwarded to the State Vital Records OffIce for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. &-~.~~~~ Local Registrar Fee for this certificate, S2.00 P I 6948235 FEB 7 2001 Date 21-01-232 105. ;43 Rev 2/87 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH 81 UNDER 1 D~ -.os ! Minut.. SEX STR E FILE NUMBER SOCIAL SECURITY NU"BER NAME Of DECEDENT I~"" "oddle. l"" \==. I. ..:JO"::>.e h Ar(\old 5R. 2. M 3. 162 - 12 .. 2/5/2001 Vrs BIRTHPLACE !Co/'; arod PlACE ~ DEATH IC_' Of'Iy 0I'e - __ ,,,,"ueloOOO on _ _I Stale Of Fcrewgn Coontrv) HOSPITAL..; Mt. Union, PA Inpa,;....lZl ERIOuIpo...nt 0 7. ... FACILITY NAME (II nrn ,n"'M""'. gIve st'eelan<l nomee" ="",0 AGE (la.. Bw1noay) 5. COUNTY ~ OE)JH '" FATHER'S NAME (F.... M_.. La..) ". Frank W. Arnold INFOAMAHT'S NAME (T ypelPrinl) 200. Jose h F. Arnold, Jr. METHOO Of DISPOSITION O IIuri8l tzl C,_ion 0 ~ OI'-~\ . 21" SIGI'UlTURE Of FU 17b. Cou Did -- Mina Cumberland .......,,;p? 17d.~ ::;;"'~~OI MOTHER'S NAME IF..t MoO<lIe. MalClen Sufnamel ". Lila Ber INFORMANT'S MAIlING ADDRESS t$IJeeI. CtyITown, SWte, rill Codel 2Gb. 68 Lebo Rd., Carlisle, PA PLACE Of DISPOSITION. N..... 01 Cemet.ry. C,emaoory 0< Ol/Ie< Place MARITAL STATUS. M_ N~ "'.(fied. Widowed. ~ced (Speclly) 1.:Widowed 17C.0 _.__in RACE . A~ Indian. 8teck.. Whit.. MC (Speclyl 10. White SURVIVING SPOuSE (" 'MI.. grve maiden namel ;\. . .... Cumber land DECEDENT'S USUAL OCCUPIJION I~_~ ~.';.,"=':::':l,:'i' llL Diesel Electrician lib. ilr DECEDENT'S MAllING ADORESS (51,.... C...,/1Own. SlaM. Zop Code\ 135 "e" Street Carlisle, PA 17013 Ie, 118. Slate PA lWp. Carlisle c:ily/bon). Carlisle, PA 17013 Hane, PA 17013 0/ No~ c...o P"D DUE 10 (OA AS /l, CONSEOUENCE Of): 21. I Approximate : interval bet'wMn I...-anddealll ! ~'" kr... PART II: 0I1ler .ignillcant _ conItt>ullng to de.th. but noI .....ftineJ in .... underlying 08_ given in PmT I. 2., M. 25. 21. PART I: Enter rhe diuaus, inlur," ot comohCafions which caused the death. 00 netent., the mode 01 dying, such as cardillC Of respiratory anes'- st1c)a or neart lailure List 0ftIy one cause on each tine l : c.~TN..'- ~, ,,<:'\l'\\~(,. ~~ ~""'~ DUE 10 (OR "S /l, CONSEQUENCE OF): DUE 10 (OA AS A CONSEOUENCE OF)' WERE AUlOI'SV FINDINGS """"lABlE PRIOR 10 COLlPLETlON OF CAUSE OF DEnH7 MANNER QF DEATH DATE OF INJURV IMonlt\. Day. Year) TIME Of INJURV INJURV J(f WORK? OIESCRIBE HOW INJURV OCCURRED. Aceldent Pending Invesligation o o o ~~CE OF INJURV - .\1 hom.. ...~~;..... factory, ollie. bu;tdino. .tc. IS_Ov\ 30.. _ 0 NoD Suiclde ~ o o HomOClCM Natural REGISTRAR'S SIGNATURE AND N B ~. ~tu.-~U-t>J ~l,~\ {J! ""''U e ..~~~ ()1.. No 1}(- VIIS 0 NoD Could not be determIned 210. 2.b. aRT IFIEA IC~eck ani., one) .CEJIITlfYING PHYSICIA" (PT'I'fSlClroln cP.r,1fytng cause ~ ~aln 'Nr"" anOll'er OhVSK:lan has pronovnc::ed death ano completed lIem ZJ) To"'- best of my knowle<fge, death oeeurred due 10 the c.u.e(s~ and manner a. stated. . . . . .PftONOUNCIHG AND CERTIFYING PHYStClAN (PhySIC~n tJQft: iJlOnOUf'IC11"lg tleath and C~"Ylnq 10 cause 01 deatt'\l To the best of my knowl.d';)l"I, dell I'" occurred at the Um., date, ~nd place. .nd due to the clluse(s) IInd manner n slaled .MEDICAL EXAMINER/CORONER On the b..il of examination andlor Investigation, in my opinion, death occurred 1'1 the time, dale, and place, and due to the cause(l) and m.nne, a. .t.tl'd.. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . 31._ d-,\S1) \ ~ ~ 0l ~ LAST WILL AND TESTAMENT OF JOSEPH F. ARNOLD I, JOSEPH F. ARNOLD, of 135 C street, Carlisle, Cumberland county, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make and declare this as my Last will and Testament and revoke all wills and codicils heretofore made by me. FIRST I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there is no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from my estate in such amount as my personal representative shall "'- ~consider necessary and desirable. r Further, in this connection, I authorize my personal representative to expend reasonable funds from my estate, in such / amount as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all of my property, both real, personal and otherwise, wherever located, to my beloved Wife, GERALDINE H. ARNOLD, should she survive me by thirty (30) days. THIRD Should my Wife, GERALDINE H. ARNOLD, predecease me or fail to survive me by thirty (30) days, then I give, devise and bequeath my entire estate in four equal shares, per stirpes, one share to each of my beloved children, JOLENE N. BARRICK of Carlisle, Pennsylvania; JOSEPH F. ARNOLD, JR. of Carlisle, Pennsylvania; JACK L. ARNOLD of Shippensburg, Pennsylvania; and LINDA L. STONE of North Middleton Township, Pennsylvania. Any share which passes to my grandchildren under this Paragraph shall be subject to the provisions of Paragraph Fourth, infra. FOURTH ~ ~ ~ ~ . ~ Any share of my estate passing to a beneficiary under the age of twenty-one years shall be in trust, with the trustee to be designated by my Co-executors. The income and/or principal of said trust may be accumulated or expended for the maintenance, education and support, including college education, of such ~ beneficiary as my trustee in its sole discretion may determine; ~and my trustee, in the expenditure of income and/or principal for ~ such purposes, may, at its discretion, apply the same directly ~ithout the intervention of a guardian or pay the same to any ~,~ person having the care or control of said beneficiary or with whom the beneficiary resides, without duty on the part of the trustee to supervise or inquire into the application of the funds by any person to whom any payment is so made. The balance of such income and/or principal shall be paid to such beneficiary upon reaching the age of twenty-one years, or to such beneficiary's estate in the event of death prior thereto. FIFTH I nominate and appoint my Wife, GERALDINE H. ARNOLD, as Executrix of this my Last will and Testament. Should my Wife fail to survive me or be unable to serve in this capacity, then I nominate, constitute and appoint JOSEPH F. ARNOLD, JR. AND JACK L. ARNOLD as Substitute Co-executors of this my Last will and Testament. I hereby relieve my Executrix or Substitute Co- executors from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification, this / I/!-;' /"i/ ~,. ~ day of ~J' I , ~/ L / i../ , 1996. / / ~~#?'~lf2t~~d > (SEAL) Signed, sealed, published and declared by the above-named Testator, JOSEPH F. ARNOLD, as and for his Last will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. / b rz (1/ ~ Jtfd, (" J..d- - ? If. <; fL- ! / ,/ / ///;; ( ,.)p--~-~-:i': / C~~~>~ ./~'/ ~~-~/ I 71 /,;/~?,0~ ../ ,/ ...... . " 4 ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: JOSEPH F. ARNOLD, a.k.a., JOSEPH F. ARNOLD, SR. Date of Death: February 5, 2001 Will No: Admin. No. 21-01-0232 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ;u'0YC/t/ 15- ,20fL: Name Address Joseph F. Arnold. Jr.. 68 Lebo Road. Carlisle. PA 17013 Jack L. Arnold. 250 Mountain View Rd.. Shippensburg. P A 17257 Jolene N. Barrick. Box 970. RR # 2. Landisburg. P A 17040 Linda L. Stone. 18 Heather Dr.. Carlisle. PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No exceptions. Date: (:3)/5)6/ ~/ b-->-- Stephen B. Lipson, Esq. 5 Hilltop Drive Mt. Holly Springs, P A 17065 Phone: 717-486-8981 /' Capacity: Counsel for personal representatives E: .-- \ .-" , IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA IN RE: Estate of JOSEPH F. ARNOLD, a.k.a. JOSEPH F. ARNOLD, SR., deceased, Estate No.21-01-0232 TO: Joseph F. Arnold, Jr. 68 Lebo Rd. Carlisle, PAl 7013 Jack L. Arnold 250 Mountain View Rd. Shippensburg, PA 17257 Jolene N. Barrick Box 970, RR # 2 Landisburg, PA 17040 Linda L. Stone 18 Heather Dr. Carlisle, P A 17013 Please take notice of the death of decedent and the grant of letters to the personal representative( s) named below. Joseph F. Arnold, Jr. and Jack L. Arnold The Decedent Joseph F. Arnold, Sr., died on the 5th day of February, 2001, at Cumberland County, Pennsylvania The Decedent died testate (with a Will); The personal representatives of the decedent are (name and address): Joseph F. Arnold. Jr.. 68 Lebo Road. Carlisle. PA 17013 Jack L. Arnold. 250 Mountain View Rd.. Shippensburg. PA 17257 The Decedent died testate, and thus the will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pennsylvania 17013. Phone No. 717-240-6345. . .. A copy of the Will or petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: 3//5)6} . /---!!? ~ SIgnature: ..-?C::>t::-/ c.~--' ~ Name Stephen B. Lipson. Esq. Address 5 Hilltop Drive Mt. Holly Springs. P A 17065 Telephone (717)486-8981 Capacity: Personal Representative Counsel for personal representative / b -~/-'-/- I * COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280E-1l1 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ReCC.i Re!j REV-1547 EX AFP (12-00> 11-12-2001 ARNOLD 02-05-2001 21 01-0232 CUMBERLAND 101 DATE ESTATE OF DATE OF DEATH FILE NUMBER All =s 1 COUNTY ACN F JOSEPH .01 NOV 16 STEPHEN B LIPSON 61 W LOUTHER ST CARLISLE PA 17g~~berii~;.;.. Amount Remitted PA MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=is4-i-i;f-AFP--ci"2':ocir-NCffici--OF-.rtiHiifiTAifcE-TAi-APPRAisii'-ENT~--ALi-oWAifcE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ARNOLD JOSEPH F FILE NO. 21 01-0232 ACN 101 DATE 11-12-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets 68.000.00 .00 .00 .00 2.395.15 .00 10.500.00 (8) NOTE: To insure proper credit to your accountl submit the upper portion of this form with your tax payment. (1) (2) (3) (4) (S) (6) (7) 801895.15 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 151429.24 337.00 (1U (12) (13) (14) (9) (10) 15.766 24 651128.91 .00 651128.91 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. Amount of Line 14 at Spousal rate (IS) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 651128.91 X 045 = 21930.80 .00 X 12 = .00 .00 X 15 = .00 (19)= 21930.80 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-04-2001 CDOO0350 .00 21930.80 TOTAL TAX CREDIT 21930.80 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)1 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . IF PAID AFTER DATE INDICATED 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. \.. I h -02/~- / COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (12-DD> JOSEPH F ARNOLD JR 68 LEBO RD CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 08-20-2001 ARNOLD 02-05-2001 21 01-0232 CUMBERLAND 162-12-0850 01118021 JOSEPH F Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REfv:is~8-E3f-AFP--(i1f:ool------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-20-2001 ESTATE OF ARNOLD JOSEPH F DATE OF DEATH 02-05-2001 COUNTY CUMBERLAND "- 'I FILE NO. 21 01-0232 TAX RETURN WAS: S.S/D.C. NO. 162-12-0850 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 01118021 FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 49761-11 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS (X> CHECKING ( ) TRUST ( ) TIME CERTIFICATE 04-06-1999 X 1,895.00 0.500 947.50 .00 947.50 .45 42.64 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-03-2001 AA496548 2.13 42.64 TOTAL TAX CREDIT 44.77 BALANCE OF TAX DUE 2.13CR INTEREST AND PEN. .00 TOTAL DUE 2 . 13CR * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) '\. /6-e:l/"t"- I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENTL ALLOMANCE OR DISALLOMANCE OF DEDUCTION~, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (12-00) JOSEPH F ARNOLD JR 68 LEBO RD CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 08-20-2001 ARNOLD 02-05-2001 21 01-0232 CUMBERLAND 162-12-0850 01118022 JOSEPH F Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-v:is~i-E)f-AFP--(i2-:oo1------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 08-20-2001 ESTATE OF ARNOLD JOSEPH F DATE OF DEATH 02-05-2001 COUNTY CUMBERLAND FILE NO. 21 01-0232 TAX RETURN WAS: S.S/D.C. NO. 162-12-0850 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 01118022 FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 49761-00 TYPE OF ACCOUNT: (Xl SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-07-1986 x 542.00 0.500 271.00 .00 271.00 .45 12.20 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due x TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-03-2001 AA496547 .61 12.20 TOTAL TAX CREDIT 12.81 BALANCE OF TAX DUE .61CR INTEREST AND PEN. .00 TOTAL DUE .61CR * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. 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CD C '-.~... ~ -< , '. ..... ~- i : ;1'1 lJ' )> ~ o c Z -i z 0 :::I: m "T1 :IJ "T1 -t - )>"tJ 0 zm - OZ J> mZ r- )>00 Z-< :D c!< m m)> 0 ooZ -t- m )>)> - -t '"'CJ m -I -t )> >< z 9 )> )> .r:::- to 0") Con ~ en JJ m f 0; f\) m x cD ..c:>2 '", ~--~~' ~' -i o -i )> r )> ~ o c Z -i -0 ~ o <:.' )> Z()~ c~m)> ~-i(/)() CDJJ(/)Z mo~ :Or~ -i f "' ,,- - I '.' f~. . c~. ... ." ....>. , ~~>~' ~..,~'';.' "- \'f~, " : .. I ~ o i'ii :JJ m )i c/ Ut.t'I. .:.ouou~ HARRISBURG, PA 17128-0601 I I I ~VQP TAXPAYER RESPONSE DATE ~1 01-0232 Dll18022 04-11-2001 REV-1543 EX AFP (09-00) EST. OF JOSEPH F ARNOLD S.S. NO. 162-12-0850 DATE OF DEATH 02-05-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT [i] SAVINGS D CHECKING D TRUST D CERTIF. JOSEPH F ARNOLD JR 68 LEBO RD CARLISLE PA 1701'3 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Depart.ent with the infor.ation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this infor.ation is incorrect, please obtain written correction fro. the financial institution7 attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co..onwealth of P6nnsylvania. Questions .sy be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 49761-00 Date 05-07-1986 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 542.00 50.000 271.00 .045 12.20 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills7 Agent". x NOTE: If tax pay.ents are .ade within three (3) .onths of the decedent"s date of death, you .ay deduct a 5% discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. Tax PART [!] 1~11i111r"""'i"""':"'''''''''''''''''''''' -...................-.......-.................- ....-...................-...............-..................... ...........-...-...-.-.-.-.-.-.-.-...-.......-.-.-.-.-.-.-.-." [CHECK ] ONE BLOCK ONLY A. ~he above infor.ation and tax due is correct. 1. You .ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue. B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent"s representative. C. c=J The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: OF 1 2 3 4 5 6 7 8 x x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts I ledge and belief. have reported above are true, correct HOME (7/7) 2.S'f- 5'73'> WORK ( ) TELEPHONE NUMBER and -5-- 3/- 0) DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* It' --~/y- - ( '-)' JL c/ INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0232 ACN 01118021 DATE 04-11-2001 REY-l&45 EX AFP (09-00) EST. OF JOSEPH F ARNOLD S.S. NO. 162-12-0850 DATE OF DEATH 02-05-2001 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. JOSEPH F ARNOLD JR 68 lEBO RD CARLISLE PA 17013 REMIT PAYMENT AND FORMS TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Deparbent with the infor.ation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co.monwealth of Pennsyl~ania. Que$tions may be answered by calling (717) 767-.8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 49761 - 11 Date 04- 06 -1999 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 1,895.00 50.000 947.50 .045 42.64 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent"s date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. ~he above information and tax due is correct. - 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart.ent of Revenue. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent"s representative. c=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: OF 1 2 3 4 5 6 7 8 x x PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I e to the best of my knowled and belief. +~~ SIGNATURE have reported above are true, correct HOME (717 ) 2J'f~ 5--75..5-- WORK ( ) TELEPHONE NUMBER and .};:.. 5/-0 I DATE ,. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT LIPSON STEPHEN B 501 S HANOVER ST CARLISLE, PA 17013 ______n fold ESTATE INFORMATION: SSN: 162-12-0850 FILE NUMBER: 21-2001- 0232 DECEDENT NAME: ARNOLD JOSEPH F DA TE OF PAYMENT: 10/04/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/05/2001 NO. CD 000350 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,930.80 I I I I I I I I TOTAL AMOUNT PAID: $2,930.80 REMARKS: JOSEPH F ARNOLD JR C/O STEPHEN B LIPSON CHECK# 098 SEAL INITIALS: PB RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS ~. OKI C/ STATUS REPORT UNDER RULE 6.12 Date of Death: JC) -;- E' fii I' Fe -6 y v ar <.", / F ArA-I~jld~ (~/I) --~ I ;}-()O! ./ Admin. No. ;;Lj-oj- OJ-32- Name of Decedent: Will No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . State w~ther administration of the estate is complete: Yes~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: ----- 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No ~. b. The separate Orphans' Court No. (if any) for the personal representati ve' s account is: --_. c. Did the personal representative sta~an account informally to the parties in interest? Yes ~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: ///~~/O] , ....~~. /?0~- /' ~,. ........-.'. Signat re - ~ / /) / ~ ,5. .--{1AC:?/7 I::> ." c-.- / A1Jc-'k..- Nam . (Please type 9f print) S If /~r A--,/4/-(, Jh:1c '7"'7 Address F4 17~~J (7/7) /.2 C; 9- 3 r ~9 Tel. No. Capacity: Personal Representative ~ L.../"" Counsel for personal representative (MAH:rmf/AM3) Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 (' ..- - Phone: (71 7) 240 - 6345 Date: 1/06/2003 JOSEPH F ARNOLD JR 68 LEBO ROAD CARLISLE, PA 17013 RE: Estate of ARNOLD JOSEPH F File Number: 2001-00232 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 2/05/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: v File Counsel Judge ~V-1!1OOEXIa4l1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 1(" -;;)./4 - I REV-1500 I- Z W C W (.) W C w ... ,,$<1> 0"''' w"O ,,00 0"'-' ..Ill .. .. OFFICIAL USE ONLY , , / (/V INHERITANCE TAX RETURN FILE NUMBER ~/-()I RESIDENT DECEDENT COUNTYCoDE YEAR- SOCIAL SECURITY NUMBER (4.-' /C-O-, Ifn..! /, ..h,j ~ L /6 cL - /;2.- - () J''S 0 F" ... z w Q Z o .. '" w "' "' o o () () ;2.. 3 ;;L HUMBER THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOC~SECUffiTYNUMBER 03. Remainder Retum {dale ofdlllllh priOr 10 lZ-l3-8Zj o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Section to tax under Sec. 9113{A) \P.~SchO) DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL) Ano/J~.r ~ F: DATE OF DEATH (M DO-YEAR) {);L-vS-u/ {)J'-~ft--)'J (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FIRM NAME (II "" COMPLETE MAILING ADDRESS 6 / Wes r Lo u77( er- S7'-: Ca--r/;U/e.- ,tPA 17c/3 ::J OFFICIAL USE ONLY (8) St)(?Y s. / S DATE OF BIRTH (MM-DD-YEAR) ~ 1. Original Return o 4. limited Estate ~ 6. DeceOOn\ Died Testate \kttadl ropy of Will) o 9. li~ga~on Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dale 01 dealh after 1Z-12-821 o 1. Decedent Maintained a living Trust (Anach copy of Trust) o 10. Spousal Poverty Credit (dale of death betWeen 1Z-31-91 and 1-1-95) (11) (12) (13) 15 76b~ ;Lt;- 65 I;;L? '11 NAME :A <2fJ 13- (14) bS /;L'j: 1'/ 5-1 TELEPHONE NUMBER (7/7) :;:L iff - 3 9' ~ '1 d-.-<T30, fo :;:L '73 D. f"LJ 1, Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4, Mortgages & Notes Receivable (Schedule D) (I) (2) (3) (4) (5) {?; voe:. OC ,/ ;2..3 qs: / S z o 5 :J l- ii: < (.) w IX: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6, Join~y Owned Property (Schedule F) o Separate Billing Requested 7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G Of L) 8, Total Gross Assets (total Lines 1-7) g, Funellll Expenses & Admlnistra~ve Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities. & liens (Schedule J) It Total Deductions (total Lines g & 10) 12. Net Value of Estate (Une 8 minus Une 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been mede (Schedule J) (6) (7) /0500, CD (9) /5r;;t.~ ;2-9- 337. GO (10) 14. Net Value Subject to Tax {Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APl'L1CABLE RAttS z o !;;: I-' :J Q. ::::lil o (.) ~ 0.00 t.5 /..2.-!? 7'1 CJ.OO 0_00 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a){1.2) ,,0_ (15) "Og(18) 16. Amount of Line 14 taxable at lineal rate 17. Amount of line 14 taxable at sibling rate , ,12 (H) , ,15 (18) (19) 18. Amount of line 14 taxable at collateral rate 19. Tax Due 20,0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS /35 C S -/-;,-e L-7 CITY Ca.r l's/e- I STATE I' A I ZIP/7c:13 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) C,(){) Total Credits (A + B + C) (2) u~ {) () (3) C~OO (4) (5) ,;;2-930. ?o (SA) (5B) C?--93C. ?'L? 3. InteresUPenalty ~ applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This Is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund ~ "130. ,f"J 5. If Line 1 t Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT " i . f, ~~" . ~ ~ -' ' . ' , "'" -.,' - "~~.- . -, '" PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Old decedent make a transfer and: Yes 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; or......................."................................................................................................. 0 d. receive the promise for life of either payments, benefits or care? .........."......................................."..."............ 0 2. If death occurred afte' December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .....,...............................................................................,........................ I8r 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 No ~ ~ (;g- Ia o ~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare thai I have examined this return. including accompanying schedules and statemenlS, and to the bast of my knowledge and belief. it is tNe, correct and oomplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN f-/~j /a...d ''eo - ~'<~13/ '-1(DDRESS ~stJ H'Wh :t>..; 1/, 'UN . SI.,I}t?,"'l'/fOJ<,/, ;1. I ]glJ7 SIGNA~4ZR~~R O~ THAN 4~TA~E , ADDRESS ~ / '"" e;: / Lv. /""'" :;?-C_ '.<; 7, , ~ DATE t:j/U/O} 9~ :;.~~ "CO. cx-a~"i.;- ("g Le60 fc! {'t1R./iJU (J tI nOtJ A-/j'~y~ /~.v f2~ :J,~~ / ~:C1/ly(~ , jj,f /7;:;3 / For dates of death on or .fte, July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transters to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)J. DATE r/2fk/ For dates of death on or after January I, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax relum are still applicable even if the surviving spouse is ttle 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the chiid is 0% [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%, exow as noted in 72 P.S. ~911fi(I.2) [72 P.S. ~9~16(a)(I)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REALESTATE ESTATE OF Arnold, Joseph F. FILE NUMBER 21-01-00232 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. All that certain tract of land, together with the $68000.00 dwelling located therein, known and numbered as 135 "c" Street, Borough of Carlisle, Cumberland County, PA. This realty was sold by the decedent's Estate on 5/31/01, and a settlement sheet is attached hereto. TOTAL $68,000.00 COMMONWEALTH OF I'ENNSYLV ANIA INHERITANCE TAX RIITlJRN RESIDENT DECEDENT ESTATE OF Arnold, Joseph F. ITEM NUMBER 1. 2. 3. 4. 5. 6. SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY DESCRIPTION Household goods & furnishings (see attached appraisal). Pro-rated real estate taxes for 135 "C" Street, Carlisle. 1976 Scout (inoperable). 1988 Ford Bronco - sold "as is" with engine problems. One Beacon Insurance - refund Internal Revenue Service - 2001 tax credit FILE NUMBER 21-01-00232 VALUE AT DATE OF DEATH $799.00 $349.70 $100.00 $700.00 $295.00 $151.45 TOTAL $2395.15 COMMONWEALTIl OF PENNSYLVANIA SCHEDULE F INHERITANCE TAX RETURN JOINTLY-OWNED RESIDENT DECEDENT PROPERTY ESTATE OF FILE NUMBER Arnold, Joseph F. 21-01-00232 JOINT TENANT(S): NAME ADDRESS RELATIONSHIP TO DECEDENT A.Joseph F. Arnold, Jr. 68 Lebo Road, Carlisle, P A Son 17013 B. C. JOINTLY-OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY TOTAL VALUE OF DECO'S DOLLAR VALUE OF NO. FOR MADE ASSET % INT. DECEDENT'S INTEREST JOINT JOINT TENANT 1. A 5/7/86 Members 1'1 Savings Tax already acct.#49761-00 paid by A 2. A 4/6/99 Members 1'1 Checking acct. Tax already #49761-11 paid by A TOTAL $ COMMONWEALTH OF I'ENNSYL V ANIA SCHEDULE G INHERITANCE TAX RETIJRN TRANSFERS RESIDENT DECEDENT ESTATE OF FILE NUMBER Arnold, Joseph F. 21-01-00232 ITEM DESCRIPTION EXCLUSION TOTAL DECD.Of. DOLLAR VLAUE NUMBER VALUE OF INT. OF DECEDENT'S ASSET INTEREST A. Bank account at Members l't $3000.00 $27000.00 50% $13500.00 No. 49761-05 that had been jointly owned by decedent and his son, Joseph F. Arnold, Jr. Decedent and co-owner transferred $27,000.00 from this account to Joseph F. Arnold, Jr., alone on January 8, 2001. $10500.00 TOTAL (AFTER EXCLUSION) COMMONWEALTH OF I'ENNSYL VANIA INHERITANCE TAX RETIJRN RESIDENT DECEDENT ESTATE OF Arnold, Joseph F. ITEM NUMBER A. 1. B. 4. C. 1. 2. 3. 4. 5. 6. SCHEDULE H FUNERAL EXPENSES, ADMINISTRATION COSTS AND MISCELLANEOUS EXPENSES FILE NUMBER 21-01-00232 DESCRIPTION Funeral Expenses: Ewing Brothers Funeral Home, 630 South Hanover Street, Carlisle, PA 17013 Administration Costs: Personal Representative Commissions 1. Social Security Number of Personal Representative: Year Commissions paid: Attorney's Fees - Stephen B. Lipson, 61 W. Louther St., Carlisle, PA 2. 17013. (717) 249-3929 3. Family Exemption N.A. Claimant Relationship Address of Claimant at decedent's death Street Address City State _ Zip Code AMOUNT $2553.80 $2337.50 Probate Fees - Register of Wills - opening of estate ($141.00) filing of $278.00 inher. tax return ($15.00), filing ofacct. ($122.00) Miscellaneous Expenses: Patriot - News Co. - Adv. of estate Cumberland Law Journel - Adv. of estate Wayne Myers Auction Service - appraisal of household goods Wolfe & Shearer Realtors - appraisal of realty Group's Taxes and Payroll Service - 2000 income taxes Darlene Moyer, Tax Collector - personal taxes due (continued next page) TOTAL $82.95 $75.00 $50.00 $200.00 $50.00 $9.90 $ 7. 8. 9. 10. 11. 12. 13. 14. IS. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. SCHEDULE H - CONTINUED John Mohler - furnace repair to realty Richard Mowery - trash removal from realty Penna. Power & Light - electric service to realty from Feb. '01 to June '01 Borough of Carlisle - water/sewer to realty from Feb. '01 to June '01 Sprint - phone service to realty for Feb./Mar. '01 Shipley Oil- fuel oil to realty delivered in Mar. '01 CGU - homeowner insurance for realty Comcast Cable - final bill for service to realty I % Realty Transfer Tax for 135 "C" Street, Carlisle Darlene Moyer, Tax Collector - 2001 Municipal taxes for 135 "C" St., Carlisle Borough of Carlisle - final water/sewer bill for realty AHS - home warranty for 135 "C" Street, Carlisle Home Paramount - termite treatment fee for 135 "C" Street, Carlisle Lutria & Rahman Cehajic - credit to buyers at settlement on realty Wolfe & Shearer Realtors - commission for sale of realty Staples - supplies for estate's record keeping US Postal Service - postage Gasoline for lawnmower Comcast Cable - adv. to attempt to sell hospital bed Cindy Arnold - reimbursement for long distance calls Total $20.00 $70.00 $124.09 $68.06 $55.98 $166.84$162.75 $5.30 $680.00 $464.70 $23.49 $182.50 $842.00 $2700.00 $4080.00 $33.84 $21.50 $7.46 $5.00 $78.58 $15429.24 ~~.,.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REI1JRN RESIDENT DECEDENT ESTATE OF Arnold, Joseph F. ITEM NUMBER 1. 2. 3. 4. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS DESCRIPTION West Shore Emergency Services United Church of Christ Home (Sarah Todd) United Church of Christ Home (Sarah Todd) Penn Rehab Associates (deductible FILE NUMBER 21-01-00232 $32.00 $7.00 $198.00 $100.00 TOTAL $337.00 AMOUNT COMMONWEALTH OF I'ENNSYLV ANlA SCHEDULE J INHERITANCE TAX RIITURN BENEFICIARIES RESIDENT DECEDENT EST ATE OF FILE NUMBER Arnold, Joseph F. 21-01-00232 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE 1. Joseph F. Arnold, Jr., 68 Lebo Road, Carlisle, PA SOD One-fourth 17013 2. Jack L. Arnold, 250 Mountain View Road, Son One-fourth Shippensburg, PA 17257 3. Jolene N. Barrick, Box 970, RR2, Landisburg PA Daughter One-fourth 17040 4. Linda L. Stone, 18 Heather Drive, Carlisle, PA Daughter One-fourth 17013 ITEM NAME AND ADDRESS OF BENFICIARY AMOUNT OR NUMBER SHARE OF ESTATE N.A. TOTAL $ ~ ,) ~\ ~ ~ ~-~---- , LAST WILL AND TESTAMENT QE JOSEPH F. ARNOLD (GCQ)[P))f I, JOSEPH F. ARNOLD, of 135 C street, carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make and declare this as my Last Will and Testament and revoke all wills and codicils heretofore made by me. FIRST I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there is no cemetery lot available for my interment, qwned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from my estate in such amount as my personal representative shall ,-. .- ~ consider necessary and desirable. r~ Further, in this connection, I authorize my personal representative to expend reasonable funds from my estate, in such , amount as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all' of my property, both real,' '.' personal and otherwise, wherever located, to my beloved Wife, GERALDINE H. ARNOLD, should she survive me by thirty (30) days. J.. THIRD Should my Wife, GERALDINE H. ARNOLD, predecease me or fail to survive me by thirty (30) days, then I give, devise and bequeath my entire estate in four equal shares, per stirpes, one share to each of my beloved children, JOLENE N. BARRICK of Carlisle, Pennsylvania; JOSEPH F. ARNOLD, JR. of Carlisle, Pennsylvania; JACK L. ARNOLD of Shippensburg, Pennsylvania; and LINDA L. STONE of North Middleton TownShip, Pennsylvania. Any share which passes to my grandchildren under this Paragraph shall be subject to the provisions of Paragraph Fourth, infra. FOURTH c:::::,.,. 'i ,J ~ \j \} Any share of my estate passing to a beneficiary under the age of twenty-one years shall be in trust, with the trustee to be designated by my Co-executors. The income and/or principal of said trust may be accumulated or expended for the maintenance, education and support, including college education, of such ,,,J beneficiary as my trustee in its sole discretion may determine; ~and my trustee, in the expenditure of income and/or principal for '~ ~ such purposes, may, at its discretion, apply the same directly ~ithout the intervention of a guardian or pay the same to any { -' person having the care or control of said beneficiary or with whom the beneficiary resides, without duty on the part of the trustee to supervise or inquire into the application of the funds by any person to whom any payment is so made. The balance of'" such income and/or principal shall be paid to such beneficiary ,.~ upon reaching the age of twenty-one years, or to such beneficiary'S estate in the event of death prior thereto. FIFTH I nominate and appoint my Wife, GERALDINE H. ARNOLD, as Executrix of this my Last will and Testament. Should my Wife fail to survive me or be unable to serve in this capacity, then I nominate, constitute and appoint JOSEPH F. ARNOLD, JR. AND JACK L. ARNOLD as Substitute Co-executors of this my Last will and Testament. I hereby relieve my Executrix or Substitute Co- executors from the necessity of posting security in connection with their duties as such in any juriSdiction in which they may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification, this // day of "J ' ',. , / '/ , 1996. / ~1~)g '-~ Q"t~( ~cJ ose F. Arnold (SEAL) ..:.~ J,_L WAYNE MYERS , SERVICE Office/Residence: R.D. #1, Box 680 Landlsburg, PA 17040-9742 Phone: 789-4264 · AUCTIONEER : · APPRAISER Appraisal Report ~(Q)[pJw Of Personal Property .. Prepared For: Executors: Joseph Arnold Jr. 68 Lebo Road Carlisle, Pa. 17013 Jack L. Arnold 250 Mt. View Road Shippensburg, Pa. 17257 Estate Of: Joseph Arnold Sr. 135 C Street Carlisle, Pa. 17013 As Of: March 3, 2001 " Purpose: Estate Settlement ~ Wayne Myers, Auctioneer/Appraiser #2408 Attorney: Stephen B. Lispson, Attorney Mt. Holly Springs, Pa. 17065 ~ ~ ,,,,\, ~ If'' ~'S ~ '," ,)>~ ("".: ,;.cO '. \'~ ....:~... :.;. ",~Dir" , , ppraijer j Certi icate I, the undersigned, do hereby certify that I have personally inspected the property appraised, that I have no present or contemplated future interest therein, that the fee received for this assignment is in no manner contingent upon the value reported, and that no important factors affecting the value of this property were knowlingly overlooked or withheld. The information contained in this report is not guaranteed; however, it has been gathered from sources we believe to be reliable. The appraiser certifies that to the best of his knowl- edge and belief, the statement, information, and materials contained in the appraisal are correct as set forth. I certify that this report has been completed in conformity with recognized industry standards. The appraisal assignment was not based on a requested minimum valuation or specific valu- ation for approval of a loan. Signed d~ Firm Wayn~ Mypr~ Allf"'t-i nn .c:::~r'1:T; ,...~ Date March 3 r 200] KAS-660@ 1996 Kiefer Supply Co. Fergus Falls, MN (800) 435-2726 Livinq Room: 3 Pc. upholstered, Matching, Sofa, Chair, Love Seat, Fair Condition $ 75.00 Four (4) Wood End Stands With Matching Coffee Table, Fair Condition Curtis Matis 19" Color TV, Doesn't Work 25.00 8.00 5.00 20.00 No Value 8.00 3.00 Two (2) Wood Stand Lights, Fair Condition upholstered Recliner, Poor Condition RCA 13" Color Portable TV, Fair Condition Wood TV Stand, Fair Condition Electric White Box Fan, Good Condition Total $ 144.00 Dininq Room: Solid Wood Dining Room Table With 2 Captains Chairs And 4 Regular Chairs, Good Condition $ 225.00 Assorted Pots, Pans, Dishes, Silverware, Roasters, Etc. Located On Table 25.00 Kirby Floor Vacuum, Fair Condition 20.00 Total $ 270.00 , Kitchen: Refrigerater Will Be Sold With House Drop-leaf Wood Table With 2 Wood Chairs, Good Condition $ 35.00 Tappan Microwave, Fair Condition, Older Model 20.00 Total $ 55.00 Bedroom #1 - Front Of House 4 Pc. Bedroom Set Consists Of Dresser, Needs Repairs, Chest Of Drawers, Fair Condition, Night Stand, Fair Condition, Bed With Box Spring And Mattress, Fair Condition $ 50.00 Two (2) Room Air Conditioners-110 V And 220 V, Do Not Work - Need Repairs No Value Wood TV Stand, Fair Condition 3.00 Total $ 53.00 Bedroom #2 - Rear Of Home Wood Bedroom Set Consists Of Night Stand, Double Bed With Box Spring And Mattress, Fancy Dresser With Mirror, Chest Of Drawers, Good Condition Humidifier, Fair Condition $ 270.00 5.00 Bath Tub Seat 2.00 Total $ 277.00 , Summary Contents: Living Room $ 144.00 Dining Room 270.00 Kitchen 55.00 Bedroom #1 53.00 Bedroom #2 277.00 Total $ 799.00 ~ ~pprai~al TO: Executors Jn~pph Arnnl~ .TT Jack L. Arnolci Estate Of: RE: Joseph Arnold Sr. 135 C Street Carlisle, Pa. 17013 135 C Street, DATE: March 3, 2001 Pursuant to your request. I have inspected certain personal property located at Carlisle. Pa. 17013 for the purpose of appraising its fair market value as of the 3 rd day of March 1'19 2001 Based upon the information contained in this report in the attachments and schedules attached hereto and hereby made a part hereof and upon my general experience as an appraiser and auctioneer, it is my opinion that said personal property had a estimated fair market value on the above date of Seven Hundred-Ninty Nin~ Doll~r~($ 7qq 00 , The term "Fair Market Value" as used in this report is defined as follows: the highest price estimated in terms of money which the property will bring if exposed for sale in the open market by a seller who is willing but not obligated to sell. allowing a reasonable time to find a buyer who is willing but not obligated to buy, both panies having fuli knowledge of all the uses to which it is adapted and for which it is capable of being used. This appraisal is based upon the following assumptions. limitations and conditions: I. That title to the property appraised is good and merchantable or that is will be prior to the time of sale. 2. That all liens and encumbrances. if any, have been satisfied and the property has been appraised as though free and clear under responsible ownership and competent management. J. That matters of a legal nature have not been considered in this appraisal. 4. That Ihis appraisal report is made for the use of the named recipient oniy and that no part of it maybe used or relied upon by any other person without the previous written consent of client and/or the appraiser. 5. That the fee for this appraisal does not provide for or include compensation for conference or testimony and/or attendance at any court proceeding. This undersigned appraiser hereby cenifies: I. That he has no interest now. heretofore or contemplated in the future in the personal propeny covered by this appraisal. 2. That he has personally inspected the personal property to the extent that it was reasonably necessary and possible to do so. J. That, to the best of his knowledge and belief. all statements and information included in this appraisal are true and are based upon his objective findings and that no peninent information has been knowingly withheld or deleted in this report. 4. That neither his employme~t to make this appraisal nor his compensation for so doing is contingent upon the value of (he property. Even though it is the firm belief of the appraiser that the information furnished in t . appraisal report and the conclusions drawn from this information are true and correct they are not guaranteed. A R.D. Street Address 680 Landisbura. City 17040 KAS.654 K"'erAUCIklnSuppty (800) 43502128 ). ~ ' . ... STATEMENT OF QUALIFICATIONS Wayne L. Myers - Auctioneer .~. Licensed and Bonded Auctioneer - State of Pennsylvania 2. Graduate of HACC Auction School, Harrisburg, Pennsylvania 3. Auctions a weely consignment auction facility. Have been Licensed since 1986. Appraisals are done on a regular basis. 4. College Credits From HACC For Appraising ,A,~ttlement Statement < . 5/31101 B. Type of Loan 1. FHA 2. FmHa 3. Summit Abstract Services, Inc. 3904 Trindle Road Camp Hill, PA 17011 Conv. Unins. Fife Number . Loan Number 8. Mortgage Insurance Case Number 4. VA 5. XXConv. Ins B-1067 2150981 Not Supplied o e: s orm S Uf",!! e 0 9 ve you a 5 a emen 0 ae ua!le emen cos s. moun s pa 0 an y e se ernen agen are shown. Items markerl "(p,o.c.)" were paid outside the closing; they are shown here for Informational purposes and are not Included In the totals -- -.. -- O. Name and Address of Borrower E Name and Address of Seller F. Name and Address of Lender Lutvija Cehajlc I\rnold Estate Countrywide Home Loans, Inc. Rahman Cehajic C/O Stephen B. Lipson, Esq. 500 Park Grenada 537 N. Hanover St Apt 9 501 South Hanover Street Calabasas, CA 91302-1613 Carlisle, PA 17013 Carlisle, PA 17013 G, Property Location CC'@&0jy H. Settlement Agent 135 "C" Street Summit Abstract Services, Inc. Carlisle, PA 17013 lace of Settlement I Settlement Date 3904 Trindle Road Camp Hill, PA 17011 5/31/01 J. Summary of Borrower's Transact!?" 100 Gross Amount Due From Borrower K. Summary of Seller's Transaction 400 Gross Amount Due to Seller 101. Contract sales price 68,000.00 01. Contract sales price 68,000.00 102. Personal property 02. Personal property 103. Settlement charges to borrower (line 1400) 3,885.86 03. 104. 04. 105 05. Adjustments for Items paid by sener 1" advance Adjustments for Items paid by seller In advance --'-~'- 06. Citvltown taxes 106. City/town taxes to to 107, County taxes 5/31101 to 12/31101 272.45 07. County taxes 5/31/01 to 12/31/01 272.45 108. School taxes 5/31/01 to 6/30/01 77.25 08. School taxes 5/31/0110 6130101 77.25 109. Assessments to 09. Assessments to 110. Sewer to 10. Sewer to 111. Trash to 11. Trash to 112. 12. 120. Gross Amount Due From Borrower 72,235.56 20. Gmss Amount Due to Sener 68,349 70 200 Amounts Paid By Or In Behalf of Borrower 500 Reductions In Amount Cue To Seller - 201, Deposit or earnest money 1,000.00 50l. Excess deposit (see instructions) 202. Principal amount of new loan(s) 61,200.00 502. Settlement charges to seller (line 1400) 6,272.69 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to '-'-~-- 204. 504. Payoff first mortoage None 205. 505, Payoff second mortgage 206. 506. 207. Credit from Seller for Closing Costs 2,700.00 507. Credtt to Borrower for Closing Costs 2,700.00 208. 508. 209. 509. Adjustments for Items unpaid by selle.r Adjustments for Items unpaid by seller 210 Cityltown texes to 510. Cilvitown taxes to --'--_.---~ --'--'-~-- -_.~_. .211, C~~nty tax~~__~.~~___~_..~__ 511 , County taxes 10 ..---- 212. School taxes to 512. School taxes to 213. Assessments 10 513. Assessments to 214. Sewer to 514. Sewer to 215. Trash 10 515. Trash to 216. .-- 516. 217. 517. 218. 51B. 219. 519. 220. Total Paid By/For Borrower 64,900.00 520. Total Reduction Amount Due Seller 8,972.69 300. Cash At Settlement From/To Borrower 600. Cash At Settlement To/From Seller 301. Gross amount due from borrower (line120) 72.235.56 R01, Gross amount due to seller (line 420) 68,349.70 302. Less amounts paid by/for borrower (line 220) 64,900.00 602. Less reductions in amI. due seller (line 520) 8,972.69 303. Cash From Borrower 7,335.56 603. Cash To Seller 59,377.01 HUD~l (3-86l RESPA, HB 4305.2 :::.h1-ent Charges " ' ;tal~ales/Broker's Comm~sslon based on price $ 66000.00@ 6.00%04080.00 Paid From Paid from ..Jiv~;on of Commission (line 700) as follows: Borrower's Seller's $ 2065.00 10 Wolfe & Shearer Realtors Funds at Funds at - Settlement Settlement J2 $ 2015.00 to Prudential Thompson Wood 103. Commission paid at Settlement 4,080.00 704. Transaction manaaement fee to Prudential Thomoson Wood 125.00 , 800 Items Payable In Connection With loan 801. Loan Origination Fee to 802. loan Discount to 603. Appra\sal Fee 10 Real Estate Valuation Advisors 300.00 804. Credit Report to CHL 25.00 805. lender's Inspection Fee to 806. Mortgage Insurance Application Fee to -~.,-_.._--- 807. Assumption fee to ..~--~-- - 808. Tax Service Fee to CHL 90.00 .._~--~- 809. Courier/Overnight Mail to 810. Document Preparation 10 CHL 350.00 811. Flood Certification to CHL 25.00 812 813. 814. 900 'tema Required By l..ender To Be Paid In Advance 901. Interest From 5/31/01 to 6/1/01 (fjJ 11.95 /dav 11.95 902 Mortgage Insurance Premium for month(s) to 903. Hazard Insurance Premium for year(s) to 904. 1000. Reserves Deposited Wt~h Lender - 1001. Hazard Insurance 3 months @ 10.42 per month 31.26 1002 Mortgage Insurance 1 months @ 27.03 per month 27.03 1003. City property taxes monl~s @ per month 1004. County property taxes 5 months @ 37,95 per month 189.75 1005. Annual assessments months @ per month 1006 School taxes 13 months.@ 78.33 per month 1,018.29 1007. Flood insurance ._.~~~~~-- per month 1008. ._.___~'!i~~@ per month 1009. Mareaale adlustment 1172.67) 1100 Tille Charges 1101. Settlement or cloSing fee ta 1102. Abstract or title search 10 1103. Title examination to 1104 Title insurance binder to 1105. Document preparation to 1106. Notary fees la Diane Jenkins 4.00 1107. Attorney's fees to (Including above items numberS. ) 1108. Title insurance 10 Summlt Abstract Services, Inc. 786.75 (including above items numbers: 1101,1102,1103,1104 ) 1109. lender's coverage $ 1110. Owner's coverage $ 1111 ICS Letter Fee to Security Title Guarantee Corp of Baltimore 35.00 1112 1113. Overniaht mail 10 1200 Government Recording and Transfer Charges 1201. Recording fees: Deed $ 25.50 Mortgage $ 51.50 Rel.lAssign. $ noo 1202. City/county tax/stamps: Deed $680.00 Mortnage $ 680.00 1203. State tax/stamps: Deed $ 680.00 Mortgage $ 680.00 1204. 2001 municipal taxes to Darlene J. Moyer, Tax Collector 464.70 1205. Final sewer bill to Borouah of Carlisle 23.49 1300 Addlllona' Settlement Charges 1301. Survey to 1302. Pest lnsflection to 1303. Radon test to BIS Home Inspection 100.00 1304. PremIum fer home warranty toAHS 182.50 182.50 1305. Termite Treatment Fee to Home Paramount 842.00 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 3,885.86 6,272.69 Certlflcatlon I have carefully reviewed the HUD.1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate s@temen of all receipts and disbursements made on my account or by me In this transaction. I further ce fy u: receive. d a/ copy of the HI/D.l Settlement. State")en!. ._;> _ y ?Mo.t/{....-., c/~j-j?,/t'<:..' _ CC~ -"C-. ,L 'irt~'{f.L t~,kDj(:" ~' Lej Borrowers or( gents I. or A ents The 0.1 Set lem nt Statement which I have prepared is a true and aecurat ceou of this transaction. I shall cause the funds to be disbursed in or~ w his statement. ~ / ) C/0''eJ. 0QIt!1 ent Date Warnfng: ff is a crime .to knowingly make false statements fa the United States on U1is or any of her similar form. Penalties upon conviction can Include a fine Bnd imprisonment. For details see: firle 18 U.S. Code Section 1001 and Section 1010. 5/31/01