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Home My WebLink About07-27-15 (3) . . . i ;.i. � ��■ � � 1505610140 REV-1500 EX �°,_,°, PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po aox 2aoso� INHERITANCE TAX RETURN 2 1 1 5 0 2 9 4 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 2 1 � 2 0 1 5 0 6 1 3 1 9 2 6 Decedent's Last Name Su�x DecedenYs First Name MI S � H R I V E R R 0 B E R T W (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1.Original Retum � 2.Supplemental Return � 3.Remainder Return(date of death priorto 12-13-82) � 4.Limited Estate � 4a. Future Interest Compromise(date of � 5.Federal Estate Tax Return Required death after 12-12-82) OX 6.Decedent Died Testate � 7.Decedent Maintained a Living Trust _ 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) � 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(date of death � 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD B�IRECTED T0: Name Daytime Tele�one Number � � �7 -... c,� m` M A R C U S A . M c K N I G H T , I I I 7 1 7 � ..�� 9 �3 �n'� REGIS�fR ^ ,N�S U3E�DNLY�,:�D � - -..7 .> � , r � .:� _::7 _ \,.7 First line of address ::> —n �.> > ... ..,.a � � I R W I N & M c K N I G H T , P • C • : : � �= Second line of address ' r � o tn 6 � W E S T P OM F R E T S T R E E T � City or Post Office State ZIP Code DATE FILED '. C A R L I S L E P A 1 7 0 1 3 - 3 2 2 Correspondent's e-m ' address: Under pen ies of peryu , declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true, ect and ete.Decla tion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN OF S N ESPON IBL ING RETURN DATE ' �1 ADDRES 60 W T POMFR STR T CARLISLE PA 17013 SIGN OF ARER N REPRESENTATIVE DATE ADDRESS 60 WEST OMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY \ Side 7 � � 1505610140 1505610140 J � . ri i � ■�a . � Continuation of REV-1500 Inheritance Tax Return Resident Decedent ROBERT W. SCHRIVER 21 15 0294 DecedenYs Name Page 3 File Number Correspondents Name Daytime Telephone Number D O U G L A S G . M I L L E R 7 1 7 2 4 9 2 3 5 3 First line of address I R W I N & M c K N I G H T , P . C . Second line of address 6 0 W E S T P O M F R E T S T R E E T City or Post Office State ZIP Code C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this retum,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. SIG F PER N RE NSIBL 0 ING RETURN DA E � � ADDRES 60 WEST P FRET STREET CARLISLE PA 17013 . . . . . i .i .� •�• i � 1505610240 REV-1500 EX Decedent's Social Security Number DecedenYsName: ROBERT W• SCHRIVER RECAPITULATION 1. Real Estate(Schedule A) .... .. . ... . .. ... . . . . . .. . .. . .. . . . ... . . .. .. . . � ' 2. Stocks and Bonds(Schedule B) . . .. . ..... . .. . .. . . . . .. . .. . . . . . . . . ... . . 2 ' 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. . . . 3. • 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . .. ... . .. . . .. . . . . 4. • 5. Cash,Bank Deposits and Miscellaneous Personai Property(Schedule E).. . . .. . 5. 8 4 7 4 4 . 3 5 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. .. .. . 6. • 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested .. . . .. . 7. • 8. Total Gross Assets(total Lines 1 through 7) .. . . . ... .. . . . . . . . . . ... .. . . . 8. 8 4 7 4 4 , 3 5 9. Funeral Expenses and Administrative Costs(Schedule H) ... ... . .. . . . . . .. . . 9 1 1 1 2 2 . 4 3 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) .. . . .. . . . . . . . 10. 3 3 2 � . 5 1 11. Total Deductions(total Lines 9 and 10) .. . . . . . . .. . . . . . . .... . .. . . ... . . . 11. 1 4 4 4 2 . 9 4 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . ... .. .. . . . .. . . . . .. . . 12. 7 � 3 0 1 . 4 1 13. Charitable and Govemmental 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. 7 0 3 0 1 . 4 1 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 _ 0 . 0 0 15. � . � 0 16. Amount of Line 14 taxable at lineal rate X•0_ � • � � 16. 0 • � � 17. Amount of Line 14 taxable at sibling rate X.12 � • � � �� 0 • � � 18. Amount of Line 14 taxabie 7 0 3 0 1 . 4 1 �e. 1 0 5 4 5 . 2 1 at collateral rate X.15 19. TAX DUE �s. 1 0 5 4 5 • 2 1 . . . . . .. . .. . ... . .. . . .. . ... . . . . . . . . .. ... . .. . .. . . . . . . . . . . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 L 1505610240 1505610240 � . . . . . i... i_ � •.�• � REV-1500 EX Page 3 File Number Decedent's Complete Address: 2� 15 0294 DECEDENTS NAME ROBERT W. SCHRIVER ___ STREET ADDRESS 1000 W. SOUTH STREET ___ CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tau Due(Page 2,Line 19) (1) 10,545.21 2. Credits/Payments A.Prior Payments 9,500.00 B.Discount 475.00 Total Credits(A+B) (2) 9,975.00 3. Interest (3) 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 570.21 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: ...................................................................... ❑ � b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ X c. retain a reversionary interest;or .....................................�......................................................... ❑ � d. receive the promise for life of either payments,benefits or care. ....................................................... 2. If death occurred after December 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?.................................................................................................. ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a suNiving 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 chiid 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. . . . .. . .. . . . . . .. ... i i.0 .� �r■ � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ROBERT W. SCHRIVER 21 15 0294 Inciude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK-CHECKING ACCOUNT#9840523311 1,513.14 2. M&T BANK-CERTIFICATE OF DEPOSIT#31003916165268 60,795.91 3. PNC BANK-CHECKING ACCOUNT#5140190769 21,341.50 4. MT. HOLLY CHURCH OF GOD-CERTIFICATE OF LOAN 1,093.80 TOTAL(Also enter on Line 5,Recapitulation) $ 84 744.35 If more space is needed,use additional sheets of paper of the same size. ri i i �i■ . i REV-1571 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIOENT DECEDENT ESTATE OF FILE NUMBER ROBERT W. SCHRIVER 21 15 0294 Decedent's debts must be repoRed on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOLLINGER FUNERAL HOME&CREMATORY, INC. 385.77 2. PASTOR 100.00 3. MT. HOLLY CHURCH OF GOD 250.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)ofPersorfal Rep�esentative(s) MARCUS A. McKNIGHT, III 2,250.00 StreetAddress 60 WEST POMFRET STREET ��y CARLISLE State PA z�P 17013 Year(s)Commission Paid: 2, Attomey Fees: IRWIN &MCKNIGHT, P.C. 5,000.00 3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address ��y State ZIP Relationship of Claimant to Decedent 4. ProbateFees: REGISTER OF WILLS 235.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 375.00 FINAL FIDUCIARY TAX RETURN 7. CUMBERLAND LAW JOURNAL- ESTATE NOTICE 75.00 8. THE SENTINEL-ESTATE NOTICE 201.16 TOTAL(Also enter on Line 9,Recapitulation) $ 11 122.43 �e�"____""___a_a ........da:r.....,1..6..eM nf n�nnr nf thc e�mn ci�e �ontinuation ot KtV-�5oo Inheritance Tax Return Resident Decedent ROBERT W.SCHRIVER 21 15 0294 DecedenYs Name Page 1 File Number Schedule H -Funeral Expenses 8 Administrative Costs-B1 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 2• Name(s)ofPe�sonalRepresentative(s) DOUGLAS G. MILLER 2,250.00 StreetAddress 60 WEST POMFRET STREET City CARLISLE State PA zip 17013 Year(s)Commission Paid: SUBTOTAL SCHEDULE H-B1 2,250.00 . . i...i. � ■ra � . pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT� INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT W. SCHRIVER 21 15 0294 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VAOF EADHTE 1. MILLENNIUM PHARMACY SYSTEMS, INC.-MEDICAL 18.09 2. CENTURYLINK-TELEPHONE 23.93 3. THREE SPRINGS FAMILY PRACTICE-MEDICAL 8 72 4. SARAH A. TODD MEMORIAL HOME- NURSING 2,831.37 5. CARLISLE REGIONAL MEDICAL CENTER - MEDICAL 130.65 6. CARLISLE BRAKE& FRICTION, INC. - REIMBURSEMENT OF RETIREMENT 307.75 TOTAL(Also enter on Line 10,Recapitulation) $ 3 320.51 If more space is needed,insert additional sheets of the same size. . . . . . I 1L.11..II ■I.• � REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ROBERT W. SCHRIVER 21 15 0294 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. WAHNETTA HARVEY Collateral 104 IAN DRIVE 20% REMAINDER MT. HOLLY SPRINGS, PA 17065 2. EVELYN BERGEY Collateral 1017 KENT GARDENS LITITZ, PA 17543 3. HOWARD VINES Collateral 855 YELLOW HILL ROAD BIGLERVILLE, PA 17307 4. ROBERT VINES Collateral PO BOX 46 ARENDTSVILLE, PA 17307 5. JOAN AUGHINBAUGH Collateral 1635 EAST MAYBERRY ROAD 50% REMAINDER WESTMINSTER, MD 21158 6. SUZANNE GRIEST Collateral 1170 UPPER BERMUDIAN ROAD GARDNERS, PA 17324 7. PETER SCHRIVER Coilateral 5 LATIMORE ROAD GARDNERS, PA 17324 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. Ij. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 6.CHARITABIE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. . . . . .. i . i � ■i■ � . Continuation of REV-1500 Inheritance Tax Return Resident Decedent ROBERT W. SCHRIVER 21 15 0294 DecedenYs Name Page 2 File Number Schedule J -Beneficiaries -1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 8. REGINA MILLER Collateral 45 SUNSET AVENUE CHAMBERSBURG, PA 17201 9. WILLIAM SCHRIVER Collateral 725 MIDDLE ROAD ASPERS, PA 17304 10. REBECCA FLINCHBAUGH Collateral 1550 ANGEL DRIVE YORK, PA 17404 11. CHRISTINE COOL Collateral 17335 MOUNTAIN VIEW ROAD EMMITSBURG, MD 21727 12. DANIEL SCHRIVER Collateral PO BOX 26 BENDERSVILLE, PA 17306 13. JOHN SCHRIVER Collateral 279 PEACH-GLEN IDAVILLE ROAD GARDNERS, PA 17324 14. KELLY SCHRIVER Collateral 279 PEACH-GLEN IDAVILLE ROAD GARDNERS, PA 17324 15. DONNA M. BREWER Collateral 125 CONFEDERATE DRIVE 25% REMAINDER GETTYSBURG, PA 17325 16. PATRICIA J. BREIGHNER Collateral 345 GOLDENVILLE ROAD GETTYSBURG, PA 17325 17. GLORIA M. SHANK Collateral PO BOX 29 McKNIGHTSTOWN, PA 17343-0029 18. DAVID D. SCHRIVER Collateral 5 COUNTRY DRIVE GETTYSBURG, PA 17325 19. JoANN A. WILLIAMS Collateral 310 CARLISLE AVENUE YORK, PA 17404 20. JOHN AND KELLY SCHRIVER Collateral 279 PEACH-GLEN IDAVILLE ROAD 5% REMAINDER GARDNERS, PA 17324 i i i �i■ � ` , • , , . , LAST WILL AND TESTAMENT of Robert W. Schriver I, ROBERT W. SCHRIVER, of the South Middleton Township, Cumberland Counry, Pennsylvania, being of sound mind, disposir�g memory and full legal age, do hereny make, publish and declaze this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my 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 properly composing of m}�gross estate for death tax purposes,whether or not such property passes under this Will, shall be paid by the 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. 2. My Ex�cu�ors may, at their discreti�n, compromise claims, borrow money, retain 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 lega.l investments unless otherwise provided hereunder. 3. I authorize and empower my Executors to sell any realty andlor personalty owned by me at my dea.th 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 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 Executors. 4. I devise and bequeath all of my estate of every nature and wherever situate as follows: a. My personal items including clothing, etc. are to be disposed of by WAHNETTAH HARVEY; and b. All the rest,residue and remainder as follows: (1) Twenty Percent (20%) to the children of MARGARET VINES, share and share alike; (2) Fifly Percent(50%)to the children of HOWARD SCHRNER; (3) Twenty-five Percent (25%) to the children of DONALD SCHRIVER, share and share alike, and (4) Five Percent (5%) to JOHN and KELLY SCHRIVER, share and share alike, and if they are not living at the time of my death, to their children, share and shaze alike; 5. I nominate and appoint ROGER B. IRWIN, MARCUS A. McKNIGHT, III and DOUGLAS G. MILLER to be the Executors of this my Last Will and Testament. . . . . .. i.a.i. � .ai.■ i 6. No person(s) sha11 benefit hereunder unless such beneficiary sha11 survive me by sixty (60)days. 7. No 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 pled.ge 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. I hereby suggest that my personal representatives retain the services of Irwin & McKnight as attomeys in the settlement of my estate. n IN WITNESS WHEREOF, I have hereunto set my hand and seal this /y � day of February, 2008. �Y. -� �SEAL) ROBERT W. SCHRIVER Signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in our presence, who, at his request, in his presence and in the presence of each other have hereunto set our names as subscribing witnesses. i , , . ,, , �; ��r . �• � . . . . . . . i . i �.■ra � . o- . . • . ' ACKNOWLEDGMENT AND AFFIDAVIT WE, ROBERT W. SCHRIVER, CHERYL L. CLELAND and TRACI D. SMITH, the Testator and witnesses respectively, whose names aze signed to the foregoing instrument, being first duly swom, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Twst�tor, signed the Will as a witness and that to the best of their lrnowledge the Testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. l�� , ROBERT W. SC R � C RYL L.CL ,/ ' ' e TRACI D. H COMMONWEALTH OF PENNSYLVANIA : � : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and a�knowledged befo:e me by ROBERT W. SCHRIVER, the Testator herein, and subscribed and swom to before me by CHERYL L. CLELAND and TRACI D. SMITH,witnesses,this �s� day of February, 2008. � . �' N ary Public CO ONW ALThi QF PENNSYLVANIA Notarial Seal Rager B.Irvuin,Nohdry Public Cadisle Boro,Cumberland Counry My Commissi�Erpires Oct 3,2008 Mamber,PQnnsyivPNa<.ssa:iation Of Notaries . . . i . i i �i■ � Q ��vt,�T��:;��ank � .�.� _� �� 499 Mitchell Road,Millsboro,DE 19966 Records Management Yt�•A;� A� , 1 l ; , Pno��$��q.�i��FiT aP i 9��ds'� Irwin & McKnight,P.C. West Pomfret Professional Building 60 West Pomfret Street Carlisle,PA 17013-3222 Re: Estate of Robert W. Schriver Social Secur�: 179-20-7672 Date of Death: Februarv 10,2015 Dear Sir or Madam: Per your inquiry on Apri102,2015,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type ofAccount CheckingAccou»t Account Number 9840523311 Ownership(Names o� Wahnettah A.Harvey(POA) Robert W.Schriver Howard E. Yines(POA) Opening Date 12/12/2005 Balance on Date ofDeath $ 1,513.13 Accrued Interest $ •�l ----------------------------------------------- ------- Total $ 1,513.14 2. Type of Account Certificate of Deposit Account Number 31003916165268 Ownership(Names o� Robert W.Schriver Howard E. Vines(POA) Opening Date 10/09/2008 Balance on Date of Death $ 60,793.33 Accraed Interest $ 2•S8 --------------.._..------------__-- _.--- -�--�_�-- Total $ 60,795.91 . . . . .. . . i. ..i.. � .��.■ � . For any addidonal information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the Mount Holly Springs at 7171186-3038. We were unable to locate any safe deposit box for the above-menHoned decedent This letter does not include any accounts in which the deceased may have been tisted as Power of Attorney,Custodian of Uniform Transfers, Represen�tive Payee,or Trustee under a Written Agreement. Sincerely, Valarie Mercer Records Management . . . .. . . . . i .i.. � .■.i■. i Ap r, 9. 2015 3:33AM PNC BANK 412-705-0057 No. 1665 P. 1 � ��. . April 9,2015 � bouglas Miller 60 W Pomfret St Carlisle,PA 17013-3222 �: Robert�V Schriver SSN�: 179-20-7672 DOb:02-10-2015 Dear Mx.Miller: Ia.response to your request for Date of Death(DOD)balances for the customer noted abo�re,our records show the following: , � � r Checl�ang Accoant Account#5140190769 Established: 04-01-1963 ROBERT W SCHRIVER AOD balazxce: $21,341.40+0.10 accrued interest Interest paid O 1-O l-2015 thru 02-10-2015 �0.29 Y'TD Plcase note that this office pro�rides date of death balances for deposit accounts{T�As,Cbs,Checldng and Savings). We do not proceas any financ�al transacYrons or pro�de statements. If�ou need assistance with an�'of these items,please call 1-888-p1�C-BANT�(1-888-762-2265)or sto�hy your local PN'C Bank branch office_ � Sincerely, National F�naxxcial Se�v'ices Center PNC Bank,N.A. Member FDIC This message is Y�ter�ded for the zrse of the inc�'ividuaC or entity to which id is addressed and may co�ntain informcrtion that is privzlege� con,fiderattal and exempt from dasclosacre under applicable larv. If t�re reader of r'his message is not the intended recipient or the emplayee or agent respori.sible for delavering this message to the intended recipient,yau are hereby noti�ed that any disserninatior� distribution or copying of this commu�nicatio�s is strictly prohibited. .1'f yozc have received this communication in error,please notify rrte irrlmedfately by reply or by telephone a�800�762-1775 and immediately dest�oy this fmred doczsment. � Page 1 of 1 . . . . . . I..1LIl,.II..�1■. 1 l l 1' { • �� r "� , � � � � o � � . � 8 y - � 1 U y "'l " r� � z � � r ol � � � � � � � � � a - � � �� h �� t O � �� ' � n � A � W � � r� � � � N \ � � � '� � � � � a � ` � � � '� � � � y � �. � n � � � �``1 � '`� � O � � � � � � � p o � � � � � � �, t�'' �� ' �, � � �Q� �3 A � co, � � �.�� .� � ,��r � A h � ��0, e� ",��o � � ry.. p � Q � z�, � e-`�1 � � � � a�or.,4 p d t0 d-•> � 1� ��$''a � '`'' W Cs1 � .� -� � O � � � � A � � � � � g � � � � � �� . � Q � � � � � o � - � � � �v � � co � � � � � n ,� � � ; � � �' '� l $ � � � : a � . N ( �----- ; , . . . . . . . . . . e...i... � •.�r � 02-19-'15 11 :58 FROM- Hollinger FH 717-486-3433 1�-95� P4002/0002 F-8G0 � u� .. ■■ r��e� � . .. . Hollinger Funeral Home&Cremat�)ry, Inc. �ric L.Hollinger,Supervisor February 19,2015 , Wahnetta Harvey 1041an Drive Mt.Holly Springs, PA 17065 The Fune�al Seivice for Robert W.Schriver: We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can.Please feet free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED S7A7EMENT OF THE SERVtCES, FACILI7�E5,AUTOM071V�EqUIPMENT, AND M�RCHANDISE THAT YpU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Professional Service Traditional Package Prepaid • Merchandise Casket Prepaid Vault Prepaid Memoria) Package—Ange I . Register Book,Memorial Folders, Acknowiedgement Cards,Bookmarks N/C AT THE TIME FUNERAL ARRANGEhfIENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR 7k�It�5E CHARG�S. Cash Advances Grave�pening Prepaid Cemetery Equipment Prepaid Certified Copies of Death Certificate(6@�61 P�epaid Cler�y Prepaid Flowers-Family Spray-Red&White Prepaid Honor Guard N/C Newspaper Notices Sentinel 255.77 . Gettysburg 7imes 130.00 Total Charges �385.77 50� NORTH ISALTIMORE A"O�NUE • M011NT HOLLY SP121NGS.P�NN�YL'�ANIA t'toss - h 1'r;486-34�� • FAX(7 i 7)a86-32 t 5 .�yww.hOIli ngE�rkuneralhorrie.com . _... . . i �.i. i.,a�c■ . i . . R IPT FOR PAYMENT _�____________ LISA M. GRAYSON, ESQ. Rece.ipt Date: 3/19/2015 Cumberland County - Register Of Wills Receipt Time: 12 :55 :43 One Courthouse Square Receipt No. : 1080811 Carlisle, PA 17613 SCHRIVER ROBERT W Estate File No. : 2015-00294 Paid By Remarks : IRWIN & MCKNIGHT PC CJ ------------------------ Receipt Distribution ------------------------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 135 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERI�AND COUNTY GENER.AL FUN RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 36776 $235 . 50 Total Received. . . . . . . . . $235 . 50 . . . . �.. i . � �i■ � � � � ' �� o y, � � f� o, � F�� :; � � � � � � p ::�. I �� ,1 ' .'��? 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Y if1 L N VTl.- �•- �N 01 O O O 'b' i .�s,,t�: O O N O N O O ��O �.- � G1 i Q �`L;:: 'C. G^ �m C� O C C ;._C�, � �'# .ON ON y0 QW D� fnN !AO :IL: yg O . � �M �O �O 0(V T� •�� Nn h� 1 . '� c� C� Nf7 LOD (7 > >� � N � .�-O .�-O x0 >f0 �Of `� C�O U W ��e N �-, O.O a0 �O JO IL� lLp {L1^ tn 0 Q � � '�� N N gl,�j � Q O O O O O '�� M Y � � *�'� l� � � � � � � �,.'f�0': � Q i � N 'J i 0 '� � �y � ' u i o �..; : � Gl �� c �' N N �n N �V (�O (�p � M a ' ,�. . � r��` . rn OOi a�D GrD � � C�D � �.':"y,0.'+' X ��'� O O OD O � �O tp i %i._; p 'iM; � � 'p�� r� � n n � n n ;�: � ' � I �� n � �n u� �n �n �n = �o � �, o � �I' N N N N N N N �� >:. n�� N N N N O � \ ,�?! � � � �?� O O O O O O O i � i .u. u �.r■ i f�� Centt�ryLink� �, Account Number: 313437990 Page: 1 of 4 / , Bill Date: Feb.25,2015 ,•. Hello, RC�BERT SCHRIVER Monthiy Account Summary Previous Balance 34.06 Payments Received .00 Adjustments(details on page 3) -10.43 Balance Forward 23.63 � � � e o • Current Charg�s(see below) ,gp e � � � Total Amc�unt Due $23.93 � : � � Payment Due By Mar.24,2015 � / . � . The Due Date On This Bill Applies To Current Charges Only Current Ch�rges Summary o 0 0 Late P�yment Charge ,30 0 0 � � Total Currer�t Charges $.30 o 0 � � N O � � n � 11] U� � N Details on next page. .1�- .,��CenturyLink• Need Anythin�g? Call us: Pra'duct,Services and Billing 1-800-201-4099 ' ReRair 5ervice 1-800-788-3600 Visit us: cer}turylink.com **'PLEASE FQLD,TEAR HERE AND RETURN TH1S PORTION WITH YOUR PAYMENT'** This Is Your F�nal Bi1L FOR CHAI�GE OF ADDRESS OR PAYMENT AUTHORIZATION: F D o21215 �Please checkhere and complete reverse.ThankYou. Account Number: 313437990 Amount Due By Mar. 24, 2015 $23.93 >01291� 5047918 0�02 �08243 14Z CenturyLink ROBERT SCHRIVER P.O.Box 1319 1000 W SQUTH ST UNIT 60 Charlotte,NC 28201-1319 CARLISLE;PA 17013-2722 �I��u�h��l�y��lll�'��11�1��1�1�1�1�61��1�'��IIII��I�� i�IIrl��ilh�Ilillilnh�u��I�P��i�li��l��rhl�ili�nl� ODOD31343799030000D00023630000000�000225150000QD239377000000 .. . . .. . . i ..u.d � .�,i.■ � STATEMENT Sarah A Todd Memoriai Home Statement Date: 02/11/2015 1000 West South Street Carlisle, PA 17013-2798 Due Date: 02/25/2015 Telephone: (717)245-218,7 Amount Enclosed $ Amount Due: $ 2,801.37 Account#: 101944 RE: Robert W Schriver Howard Vines 855 Yellow Hiii Road Biglervilie, PA 17307 z �.�+N ��: �°�i �33 ''1� �� a{ :- �: ��: r : :�. "� �;, a. �- ��`` �`' 4,2 a s �.: ��'a �a'i y��y'ic�P � �� 3�.� "C�sl'.k��: � ?y`^.�c,2s i� s �c+�"k �� -� �\ :v �'a �.� wc��, �a�a..i '��/�i��'44,��., � i�L` ��"a7�`.�,'�' '� �"��'�v :..kY...r s�fl��;::..._ ...,w,e��.:a._�\�a,..,..;Y..�i,3�i`�,:..�ca ..�......._. . _� ,.....��.��..�:; ��.._�.:z.'�<�-�. a,*.,a��.5��'?: . .IRRi�. .t�aws; ��..,,\rN ....'Jf�'G a.�� F7a`�� .�....�' Balance B/F 2,801.37 2,801.37 2/09/15 PersonalLaundry Services 1 30.00 30.00 2,831.37 � CuRent 31-60 Days 61-90 Days Over 90 Days Amount Due �� . �� , . 30.00 2 801.37 .00 .00 � � ��' � � , > �. * r3 �■��.,`._,�� NOTE: *****PAYMENT IS DUE UPON RECEIPT*****BUT NO 111TER THE 25TH OF THE MONTH***** Please remit the AMOUNT DUE your statement.Include the ACCT# from the statement on the MEMO Statement Date: 03/11/2015 of your**eck.Payments after 3/6/15 do not reflect on statement. � Due Date: 03/25/2015 NOTE: LATE PAYMENTS ARE SUB]ECl"TO A 1.25/o LATE CHARGE PER MONTH **A$20.00 FEE WILL BE CHARGED for RETURNED CHECKS** Robert W Schriver-Account#: 101944 Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717)245-2187 . . . . . .. . . . i uu..i..:a..u�.• � .. _"'_______.. �• • • � � 02/02/15 752 $ Continued THREE SPRINGS FAMILY PRACTICE ' ' ' �' ' ' ' ' 303 NORTH B�ILTIM RE AVE � MT. HOLLY SPRI 5, PA 17065 �� $ CARD NUMBER AUTHORIZATION CODE�❑�� Forwarding Se V10E Requested (last3or4digitsonback of card in signature line) SIGNATURE EXP.DATE 22167 � ROBERT W SCHRIVER THREE SPRINGS FAMILY PRACTICE ' 1 TODD CIRCLE 303 NORTH BALTIMORE AVE APT D MT. HOLLY SPRINGS, PA 17065 CARLISLE PA 17013 �Please check box if above address is incorrect or insurance �Please check box if credit card billing address is different than state- information has changed,and indicate change(s)on reverse side. • ment address and write in address on back ----------------------------_---_ -- _-------------------------------------'------------•----------------------------- ----- ----------•------------ - RETURN TOP PORTION•RETAIN LOWER PORTION �, Please pay upon.receipt. Thank you. Access your medical chart at www.threespringsfp.com Appointment Service Description Charge Payment Adjust Patient 08/28/14 - ROBERT - DELL, DAVID A, M.D. SUB NURSING EVAL/MANAG 2 99307 60.00 0.00 10/28/14 NOVITAS SOLU Payment 34.16 10/28/14 Accept Assign Adj. -16.42 10/28/14 Accept Assign Ad�. -0.70 12/16/14 Copay-Check Payment 8.72 09/06/14 - ROBERT - DELL, DAVID A, M.D. SUB NURSING EVAL/MANAG 2 99307 60.00 0.00 10/27/14 NOVITAS SOLU Payment 34.16 10/27/14 Accept Assign Adj. -16.42 10/27/14 Accept Assign Ad�. -0.70 12/16/14 Copay-Check Payment 8.72 10/13/14 - ROBERT - DELL, DAVID A, M.D. — - - SUB NURSING EVAL/MANAG 2 99307 60.00 0.00 11/13/14 NOVITAS SOLU Payment 34.16 11/13/14 Accept Assign Adj. -16.42 11/13/14 Accept Assign Ad�. -0.70 12/16/14 Copay-Check Payment 8.72 10/28/14 - ROBERT - DELL, DAVID A, M.D. SUB NURSING EVAL/MANAG 2 99307 60.00 0.00 11/20/14 NOVITAS SOLU Payment 34.16 11/20/14 Accept Assign Ad�. -16.42 11/20/14 Accept Assign Ad�. -0.70 12/16/14 Copay-Check Payment 8.72 J LAST PAYMENT RECEIVED 2/16/14 34.88 THREE SPRINGS FAMILY PRACTICE ase 303 NORTH BALTIMORE AVE ,KE CHECK � � rns�eTo: MT. 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I dl.11..Il.L1�, . � . __.— _"_._ .._.. . .. . ....._ _ _.. . . . . . . . . _. . �...ww w_w__ / AOST-RETIREMENT SURVIVOR NOTICE Plan#: 256648 Company: CARLISLE BRAKE & FRICTION, INC. Plan: RETIREMENT PLAN FOR EMPLOYEES OF CARLISLE CORPORATION ESTATE OF ROBERT SCHRIVER May 05, 2015 855 YELLOW HILL RD BIGLERVILLE PA 17307 Please accept our condolences on the loss of Robert Schriver. Any benefits paid sincE Robert's death will need te be returned to the plan.. We have been informed that he died on February 10, 2015 and received 1 payment (3/O1/2015) totaling $305.46 after his death. To account for any trust losses while these funds were not in the Plan's trust accourit, the IRS requires interest be pa'id' on any overpayment. Please submit a check no later than June 05, 2015 payable to RETIREMENT PLAN FOR EMPLOYEES OF CARLISLE CORPORATION in the amount of $307.75 to repay the overpaym.ent and the enclosed Overpayment Tracking form to: Wells Fargo Institutional Retirement and Trust Attn. : Defined Benefit Imaging, MAC D111B-0?_8 1525 W WT Iiarris Blvd Charlotte, NC 28262 If you have any questions, you can contact the Retirement Service Center at 1-800- 728-3123. Representatives are available Monday through Friday, 7:00 a.m. to 11:00 p.m. Eastern Time. You can also access information regarding your benefit online at wellsfargo.com. �