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Home My WebLink About07-22-15 (2) I r pennsylvania 1505618403 DEPARTMENT OF REVEN X(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 15 0481 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 04 13 2015 08 09 1912 Decedent's Last Name Suffix Decedent's First Name MI GEORGE DOROTHY M (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return 3. Remainder Return(date of death prior to 12-13-82) n4. Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) 7. Decedent Died Testate 8. Decedent Maintained a Living Trust 1 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) ❑ 10. Litigation Proceeds Received 11. Non-Probate Transferee Return 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) ❑ 13. Business Assets E] 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROGER B IRWIN ESQ 717 249 6333 First Line of Address 354 ALEXANDER SPRING RO Second Line of Address ry rrl City or Post Office State ZIP Code CD �_ 6-.) rte. CO CARLISLE PA 17015 r --r- t— r Correspondent's email address: rogerbirwingsalzmannhughes.com REGISTER OF WI-ELS-USE ON Y + CJ 'moi REGISTER OF WILLS USE ONLY rr r_ DATE FILED MMDDYYYY —i 1710f"— "� C,J C!) co DATE FILED STAMP Side 1 r -1 (-1 A /1 rl 1505618403 1505618403 \ 1505618411 REV-1500 EX Decedent's Social Security Number Decedent's Name: George, Dorothy M RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 15 ,757 - 50 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages and Notes Receivable(Schedule D).................................................... 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 147 ,376 - 62 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 163 ,134 - 12 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 19 ,90? - 61 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 108 - 55 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 20,016 - 16 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 143 -,117 - 96 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 14�1,117 . 96 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 143,117 - 96 16. 6,440 - 31 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 110 18. Amount of Line 14 taxable at collateral rate X.15 0 . 011 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 6,440 - 31 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. o SIGNATURE OF PER,�i/i ADDRESS r ON E PON BLE FOR FILING RETURN John T Weber �.E ^^ 7 2156 Douglas Drive, Carlisle, PA 17013 SIGNATURE PREPARER OTHE THAN R,EPRESENTATIVE Roger B. Irwin Esq. DTE v 1S ADDRESS 354 Alexander pring Road, Suite 1, Carlisle, PA Side 2 �I r /-% r /`k -1 fl A -1 1 1505618411 1505618411 PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER George, Dorothy M 21-15-0481 Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Signature#2 Name ane E Brown Address1 950 W.South Street Address2 City, State,Zip Carlisle,PA 17013 Date REV-1500 EX Page 3 File Number 21-15-0481 Decedent's Complete Address: DECEDENT'S NAME George, Dorothy M STREETADDRESS 770 S. Hanover Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 6,440.31 2. Credits/Payments A. Prior Payments 6,000.00 B. Discount 315.79 Total Credits(A +B) (2) 6,315.79 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 124.52 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................... ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ ❑x d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. ❑ FxI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-485 EX(05-04) 48500041046 - SAFE DEPOSIT . BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number 04/13/2015 21 15 0 4 81 i i Decedent's Last Name Suffix First Name MI - --..._..----..-------...—.._...._.._.. _............__......._.. ..-_..__...._....-_._....-- . ; George ` ---------------.._.._........_ ' Dorothy._...__.......__._....-----................_..........__.._........_......-_..........._...._ ,..M. , ---------------...__........- .._..__....- - .... - - .... -.._...--..i i_..__.._.__.._.....---. __........._..____...---....----.._.............._...._.._........ ...._..-......._._...._....__...._...._.� i__...._ i ADDRESS OF DECEDENT STREET: CITY: T STATE: ZIP CODE: 770 S. Hanover Street Carlisle PA 17013 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME. John T. Weber, Co-Executor I STREET ADDRESS: CITY: STATE: ZIP CODE: I 2156 Douglas Drive Carlisle PA 17013 NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING a. NAME: RELATIONSHIP: John T. Weber Co-Executor STREETADDRESS: CITY: STATE: ZIP CODE: { 2156 Douglas Drive Carlisle PA 17013 b. NAME: RELATIONSHIP: Jane E. Brown Co-Executor t STREETADDRESS: CITY: STATE: ZIP CODE: I 950 W. South Street Carlisle PA 17013 c. NAME: RELATIONSHIP: Roger B. Irwin Attorney for the Estate STREET ADDRESS: CITY: STATE: ZIP CODE: j 354 Alexander Spring Road Suite 1 Carlisle PA 17015 NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: M&T Bank STREET ADDRESS: CITY: STATE: ZIP CODE: 1 West High Street Carlisle PA 17013 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY i 4/15/15 at 2: 54 p.m. DATE OF CONTRACT TO RENT BOX NUMBER OF BOX 1 TITLE UNDER WHICH BOX IS REQUESTED i 1 /27/1965 2767 NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX a. NAME: b. NAME: Dorothy M. GeorgeTohn W -her I STREET ADDRESS: STREET ADDRESS: i 770 S. Hanover Street 2156 Douglas Drive CITY: STATE: ZIP CODE: CITY: STATE: ZIP CODE: I Carlisle PA 17013 Carlisle PA 17013 NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY i Caren Brosius, Relationship Banker I WAS A WILL IN THE BOX? ❑ YES ❑ NO If yes, a. Date of will: b. Name and address of personal representative,if named in the will NAME: John T. Weber and Jane E. Brown Co-Executors STREET ADDRESS: CITY: STATE: ZIP CODE: 2156 Douglas Drive Chambersburg PA 17013 c. Name and address of attorney,if any NAME: i Roger B. Irwin, Esquire STREET ADDRESS: CITY: STATE: ZIP CODE: - 354 Alexander Spring Road, Suite 1_._.-..__.__.-_..___.__.___-..-._..........__...._.._._......_...._Carlisle .-__.........._......___.._...._._._..__PA_.__...._.__.._........---......701.5__.._; 48500041046 48500041046 REV-485 EX SAFE DEPOSIT BOX INVENTORY Rage 2 of 2 INSTRUCTIONS (1) Cash:Report total only. (2) Stocks:List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government: Number of items,date of issue,face value,names in which registered and type of ownership, i.e.,jointly held,payable on death,etc. (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor,number Of book,last date appearing in book,name of bank and branch,and balance. (6) Jewelry,Coins,Stamps,Manuscripts,etc: List and describe as fully as possible. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of Indebtedness:List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.280601 HARRISBURG,PA 17128-0601 ITEM ITEM DESCRIPTION NO. 1 U I or Or i n_. ock sir f i f i Ca to numhPr P4 R 2 UGI Corporation. - stock certificate number PU4840 cell I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX VENTORY: SIGNATURE � C 51GNAT PRINT NAME— P T NAME AND CHECK APPROPRIATE BOX BELOW: Roger B. Irwin John T. Weber PRINTTITLE DATE CHECK APPROPRIATE BOX: Attorney 04/29/2015 R]Executor(trix) ❑Administrator(trix) EJ Estate Representative ❑Joint owner of safe deposit box NOTE:Attach additional 81h"x 11"sheet(s)if necessary or use duplicates of this page of form. The Department is authorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disclosure of Social Security numbers in connection with administering state tax laws.The Department uses the Social Security number to identify the decedent and personal representatives of the estate.The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities.The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. Rev-1503 EX+(08-12) SCHEDULE B pennsylvania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER George, Dorothy M 21-15-0481 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 902681105 UGI Corporation-proceeds from sale of 350 book entry 12;302.50 stocks(sale price=$12,302.50 minus$67.00 trading fee) 2 902681105 UGI Corporation-proceeds from sale of 100 certificated 3,455.00 stocks(sale price=$3,455.00 minus$37.00 trading fee) TOTAL(Also enter on Line 2, Recapitulation) 15,757.50 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev. 08-12) rdyU t m t Computershare Computershare Trust Company,N.A.G1 PO Box 30170 College Station,TX 77842-3170 CORPORATION Within USA,US territories&Canada 800 850 1774 Outside USA,US territories&Canada 312 360 5100 www.computershare.com/investor 002594 __ II'IIIIIeIIunIIIr1111eItllnlllellllrlll1111rlllllrleleJellrlel DOROTHY M GEORGE 770 S HANOVER ST CARLISLE PA 17013-4105 Holder Account Number C0000041858 IND Ticker Symbol UGI CUSIP 902681105 UGI Corporation - Sales Advice Trade Date: 15 Apr 2015 15:03(Time) Settlement Date: 20 Apr 2015 Cost Basis Method: FIFO Shares/Units Price per Gross Amount Trading BankingMire Backup Otherl Net Amount Sold I Share/Unit(USD)I of Sale(USD)I Fees(USD)I Fees(USD)I itholding(USD) Fees(USD) of Sale(USD) 350.000000 35.150000 12,302.50 67.00 0.00 0.00 0.00 12,235.50 Covered Transaction Total: 0.000000 Noncovered Transaction Total: 350.000000 Covered Shares/Units Covered Cost Covered Short Term Covered Long Term Overall Covered Sold I Basis(USD) Gain/Loss(USD)I Gain/Loss(USD) Gain/Loss(USD) 0.000000 NIA N/A N/A N/A PLEASE SEE REVERSE SIDE FOR IMPORTANT DISCLOSURES AND DEFINITIONS 1 L T R UG I + 001 C070003 us.I trx.4dy.sal.i I_5750/002594I002594/i WARNING:MULTIPLE SAFETY FEATURES.THE FACE OF THIS CHECK HAS A BLUE BACKGROUND AND FLUORESCENT INK(HOLD UNDER BLACKLIGHT TO VIEW).REFER TO SECURITY ENDORSEMENT BACKER FOR TRUE WATERMARK AND ADDITIONAL FEATURES. UGIHarris Central N.A. 70.1659 CORPORATION Roselle,Illinois 719 PLEASE DEPOSIT THIS CHECK PROMPTLY. UGI Check Number:0042408700 Pay to' DOROTHY M GEORGE 770 S HANOVER ST CARLISLE PA 17013-4105 20 Apr 2015 $""l 2,235.50**** k The sum of $""TWELVE THOUSAND TWO HUNDRED THIRTY-FIVE DOLLARS AND FIFTY CENTS US Computershare Inc, FUNDS ONLY"'" Authorized Paying A nt _ 6 Computershare Inc. 250 Royall St,Canton,MA 02021 8j Security Features Details on Beck. Authorized Signature(s) II'004240870011' 1:07 19L551B01: 0411122P, S36oil Lill Page 1 of 2 tomputershare + Computershare Trust Company,N.A.G1 PO Box 30170 CORPORATION College Station,TX 77842-3170 Within USA,US territories&Canada 800 850 1774 Outside USA,US territories&Canada 312 360 5100 www.computersha re.comfinvestor 002523 _= Ill�lrnll�r�l,lnl�lllnllll�llr�llll�l�ll�rlllll�lrllllllull JOHN T WEBER &JANE E BROWN EX EST DOROTHY M BROWN 2156 DOUGLAS DRIVE CARLISLE PA 17013 _ Holder Account Number C0000285471 FID Ticker Symbol UGI CUSIP 902681105 UGI Corporation - Sales Advice Trade Date: 01 Jul 2015 09:30(Time) Settlement Date: 07 Jul,2015 Cost Basis Method: FIFO Shares/Units Price per Gross Amount Trading BankingMire Backup Other Net Amount Sold Share/Unit(USD)I of Sale(USD)I Fees(USD) Fees(USD)Oitholding(USD)I Fees(USD) of Sale(USD) 100.000000 34.550000 3,455.00 37.00 0.00 0.00 0.00 3,418.00 Covered Transaction Total: 0.000000 Noncovered Transaction Total: 100.000000 Covered ShareslUnitsCovered Cost Covered Short Term Covered Long Term Overall Covered Sold I Basis(USD)I Gain/Loss(USD)I Gain/Loss(USD) Gain/Loss(USD) 0.000000 N/A N/A N/A N/A PLEASE SEE REVERSE SIDE FOR IMPORTANT DISCLOSURES AND DEFINITIONS 1 LTR UG I + 001CD70003 us.Itr.c.4dy.sal.il_5919/002523/002523/i _ _ _WARNING,MUL7IPLE SAFETY FEATURES.THE FACE OF THIS CHECK HASABLUE BACKGROUND AND FLUORESCENT INK tHOLD UNDER BLACKLIGHT TO VIEW.REFER TO SECURITY ENDORSEMENT BA F6 ii WATERMARK AND ADDITIONAL FEATURES. UGIHarris Central N.A. 70-1558 CORPORATION Roselle,Illinois 719 --,.,_— _ __ _—,PLEASE.DEP—OSIT,-THIS CHECKP.t30MPJL� UGI Pay to JOHN T WEBER Check Number:0042408806 &JANE E BROWN EX EST DOROTHY M BROWN 2156 DOUGLAS DRIVE CARLISLE PA 17013 07 Jul 2015 I $****3,418.00**** The sum of $""THREE THOUSAND FOUR HUNDRED EIGHTEEN DOLLARS ONLY US FUNDS Computershare I . ONLY"" Authorized Paying A nt Computershare Inc. 250 Royall St,Canton,MA 02021 8 Security Features,Details on Back. Authorized Signature(s) ii,004 2408B0GIIo 1:07 j9 L 55801: 0111,--1 2 26-1 536-1 LII' Rev-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OFPERSONAL PROPERTY INHERITANCE TAXAXRETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER George, Dorothy M 21-15-0481 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash on Hand-cash in purse 8.00 2 Penn Treaty-long term care payment for February 2015 1,120.00 3 UGI Corporation-replacement check for two uncashed dividend checks from 2008 and 2012 133.50 4 M&T Bank Certificate of Deposit#31003913025788-date of death value 25,000.00 Accrued interest on Item 4 through date of death 1.24 5 M&T Bank Certificate of Deposit#31003917742049-date of death value 55,000.00 Accrued interest on Item 5 through date of death 12.21 6 M&T Bank Checking Account#2670010202-date of death balance 54,962.34 Accrued interest on Item 6 through date of death 0.41 7 Jewelry specifically bequeathed in Paragraph 4a of decedent's Will-it should be noted that 1,562.65 one of the diamond rings was made into a necklace prior to decedent's death-appraised value 8 Chapel Pointe-refund from nursing home 5,670.00 9 Penn Treaty-long term care payment for March 2015 1,240.00 10 Penn Treaty-long term care payment for partial month April 2015 480.00 11 State Farm -refund of Medicare Plan C cancellation 2,186.27 TOTAL(Also enter on Line 5, Recapitulation) 147,376.62 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.08-12) M MsTBank 499 Mitchell Road,Millsboro,DE 19966 Records Management Phone 888-502-4349 F ax (302)934-2955 May 11,2015 Salzmann Hughes,P.C. 354 Alexander Spring Road, Suite 1 Carlisle, PA 17015 Re: Estate of: Dorothy M George Social Security: Date of Death: March 28, 2015 Dear Sir or Madam: Per your inquiry on April 30, 2015, please be advised that at the time of death,the above-named decedent had on deposit this bank the following: I. Type of Account Checking Account Number 2670010202 Ownership(Names of) Dorothy M George John T Weber(POA) Opening Date 09/01/1967 Balance on Date of Death $54,962.34 Accrued Interest $ .41 Total $54,962.75 2. Type of Account Certificate of Deposit Account Number 31003917742049 Ownership(Names of) Dorothy M George John T Weber(POA) Opening Date 09/17/2008 Balance on Date of Death $55,000.00 Accrued Interest $ 12.21 Total $55,012.21 3. Type of Account Certificate of Deposit Account Number 31003913025788 Ownership(Names of) Dorothy M George John T Weber(POA) Opening Date 10/26/2005 Balance on Date of Death $25,000.00 Accrued Interest $ 1.24 Total $25,001.24 For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds,please call High Street Carlisle at 717-240-4536. We were unable to locate any safe deposit box for the above mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers,Representative Payee,or Trustee under a Written Agreement. Sincerely, Tomara Williams Records Management ParkerJewelers 300 E Street, Carlisle, PA 17013-1326 717-249-3531 June 18, 2015 To Whom it may concern: We certify that we have carefully examined the following listed and described articles, the estate of: Dorothy George Executrix: Jane Brown 950 W South St Carlisle, PA 17013 In our professional opinion we have listed the value for estate or other purposes at the current resale value, excluding any and all taxes. In establishing these values, we make no agreement to purchase or replace the articles. 1. 14 karat white gold diamond pendant with 16.5" curb chain. The necklace consists of one 1/2 carat round brilliant cut diamond and three .05 carat full cut round diamonds. The half carat diamond is of VS clarity and G-H color. $1450.00 2. 18 karat white gold engagement ring setting containing no stones. $67.59 3. 18 karat white gold wedding band setting with two diamonds. $45.06 The above values are made with the understanding that the appraiser assumes no liability with respect to any action that may be taken on the basis of this appraisal. C. Thomas Parker Date f - _ = M&T Bank -Manufacturers&Traders Trust Company - _ Altoona, PA 1660) Cha el Pointe --- . _ - _ - _ 00000�89�4 ,l' al Carlisle Fn_9aq 313 TM 770 South Hanover Street, Carlisle,PA 17013-410.5 May 14, 2015 Five thousand six hundred seventy and 00/100 dollars. *****5,670.00 Pay to the order of Estate of Dorothy George C/o John'Weber Carlisle, PA 17013 _ - - AUTHO IGNATURE 11400000 Lag 1411' 1:03 130 295 5I: 20 70 7 111' REV-1511 EX+(08-13) -,1 pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER George, Dorothy M 21-15-0481 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 2,125.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) John T.Weber Jane E Brown Street Address 2156 Douglas Drive city Carlisle State PA zio 17013 Year(s)Commission Paid 2015 7,525.36 2. Attorney's Fees Salzmann Hughes, P.C. 8,275.36 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 355.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,626.39 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 19,907.61 Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER George, Dorothy M 21-15-0481 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Ewing Brothers Funeral Home, Inc.-funeral service 1,500.00 2 John T.Weber-reimbursement of funeral expenses: organist-$150; minister-$150;funeral 625.00 reception food-$325 H-A 2,125.00 Other Administrative Costs 3 Computershare-trading fees for sale of 350 shares of book entry stock 67.00 4 Cumberland Law Journal -legal advertising 75.00 5 Jane E. Brown-reimburse for jewelry appraisal fee 39.75 6 Reserve-to be held for preparation of decedent's final life income tax returns,fiduciary 1,200.00 income tax returns,closing costs and miscellaneous contingencies required to administer the estate 7 The Sentinel-legal advertising 201.16 8 UGI Corporation-trading fee for sale of 100 certificated stocks 37.00 9 US Postal Service-certified mailing fee for safe deposit box inventory 6.48 H-137 1,626.39 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-12) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OFMORTGAGE LIABILITIES AND LIENS RET INHERITANCE TAXAXRETURRNN RESIDENT DECEDENT ESTATE OF FILE NUMBER George, Dorothy M 21-15-0481 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cumberland Goodwill Fire Rescue EMS Inc-ambulance service rendered prior to death 84.03 2 Millenium Pharmacy Systems, Inc.-prescription services rendered prior to death 24.52 TOTAL(Also enter on Line 10, Recapitulation) 108.55 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER George, Dorothy M 21-15-0481 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Eric Alspaugh Stepgrandchild 1/8th of 46 Farmington Lane $50,000.00 Elizabethtown, PA 17022-9346 2 Jane E. Brown Granddaughter 1/4th of Residue 950 W. South Street +2 diamond Carlisle, PA 17013 rings as per specific bequest 3 Stephanie G. Douglas Stepgrandchild 1/8th of 1000 Forbes Road $50,000.00 Carlisle, PA 17013 4 Jonathan Geiman Great-grandson 1/4th of Residue 103 Earl Street Boiling Springs, PA 17007 5 Mary Beth Heller Great- 1/4th of Residue 306 Amherst Drive granddaughter Carlisle, PA 17013 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Dorothy M George 04/13/2015 201-16-0198 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Anthony Hess Stepgrandchild 1/8th of$50,000.00 4 Rosewood Court Easton, PA 18042 7 Christine Hess Stepgrandchild 1/8th of$50,000.00 878 Weir Lake Road Apt 201 Kunkletown, PA 18058 8 Angela A. Lane Stepgrandchild 1/8th of$50,000.00 1138 Shannon Lane Carlisle, PA 17013 9 Tracy(Hill)Orndorff Stepgrandchild 1/8th of$50,000.00 264 S. Hanover Street Apt 5 Carlisle, PA 17013 10 John T.Weber Grandson 1/4th of Residue 2156 Douglas Drive Carlisle, PA 17013 11 Amy(Zinn)Welch Stepgrandchild 1/8th of$50,000.00 4549 Duke Drive Prescott Valley,AZ 86314 12 Scott Zinn Stepgrandchild 1/8th of$50,000.00 115 Shady Road Newburg, PA 17240 1 LAST WILL AND TESTAMENT 1, DOROTHY M. GEORGE, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. 1 direct my Co-Executors to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Co-Executors from my estate, and that none of the aforesaid taxes shall be prorated among those persons or entities named herein or otherwise beneficiaries hereunder. I M k, -Execuiors may, at their discretion, compromise claims, borrow money, retain 2- y Co A property for such length of time as they may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as they may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. 3. 1 authorize and empower my Co-Executors to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My Co-Executors are authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Co-Executors. 4. 1 give, devise and bequeath all of my estate of every nature and wherever situate as follows: a. My two (2) diamond rings to my granddaughter,JANE E. BROWN; b. Fifty Thousand and no/100 ($50,000.00)to be divided between my step-grandchildren, ANTHONY HESS, CHRISTINE HESS, STEPHANIE G. DOUGLAS,ANGELA A. LANE,SCOTT ZINN, AMY J. ZINN, TRACY HILL and ERIC C. ALSPAUGH, share and share alike; and c. All the rest residue and remainder of my estate to be divided between my grandchildren, JOHN T.WEBER and JANE E. BROWN, and my great-grandchildren, MARY BETH HELLER and JONATHAN GEIMAN, share and share alike. 2 5. I nominate and appoint JANE E. BROWN and JOHN T. WEBER to be the Co- Executors of this my Last Will and Testament. 6. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. 7. No Co-Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 8. No beneficiary may assign, anticipate or pledge his or her interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 9. If any person entitled to share in any distribution under the terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest the probate of this Last Will and Testament, such person shall forfeit his or her entire interest inherited hereunder and all provisions in favor of such person shall be declared void and of no effect. The share of such person so forfeited shall be distributed as part of the residue pursuant to Paragraph No. 4 hereof, as the case may be, except that if such person is entitled to share in the said residue, that interest shall be distributed proportionately to the other residuary beneficiaries. 10. I hereby suggest that my personal representatives retain the services of Irwin & McKnight, P.C. as attorneys in the settlement of my estate. 3 IN WITNESS WHEREOF, I have hereunto set my hand and seal this Zs day of February 2010. LL !i'62 7 (SEAL) DORO HY M. GEORGIt Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in our presence, who, at her request, in her presence and in the presence of each other have hereunto set our names as subscribing witnesses. 4 ACKNOWLEDGMENT AND AFFIDAVIT WE, DOROTHY M. GEORGE, MARTHA L. NOEL and SHARON L. SCHWALM, the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. DO THY M. GEOIfGE MA7R'r1WL NOEL SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMDERL AND Subscribed, sworn to and acknowledged before me by DOROTHY M. GEORGE, the Testatrix herein, and subscribed and sworn to before me by MARTHA L. NOEL and SHARON L. SCHWALM,witnesses, this Z-5' day of February 2010. Not ry Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Roger f!.Irwin;Notary Public Carlisle Boro,Cumberland County My Commission Expires Oct.3,2012 Member,Pennsyiv,,nia F.s^ociation of Notaries 5