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Home My WebLink About09-11-15 � C�� penosyl�an�a 1505618403 ""�x Im.ie� REV-1500 OFFlLINL USE ONLY CounryCWe Year Filervumber BureauonndlvitlualTaxes INHERITANCETAXRETURN POBOX280601 2], 15 0097 Harrisour PA 1]12B-o601 RESIDENTDECEDENT ENTEft OEGEDENT INFORMATION BELOW Social Sewrily Number Da�e of Death MMDDVYYY Da�e of Bitlh MM��YYYV OY 18 20L5 ❑3 19 1932 DecetlenYs Last Name Suffx Decedenfs First Name MI MCCOY PAl1LINE E (If Applicable)En[er Survivin9 Spouse's Intormation Below MI Spouse's Last Name Suffix Spouse's First Name THIS RETURN MUST BE FILEO IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ❑ O L OriginalReWm � 25upDlemen�alReWrn 3. RemalntlerFeWm(tlaleoftleath prior�o 12-13-82) � Q Ag�icul�ural Exemp6on(tlale of � 5. FUWre Inleres�Compmml5e(tla�e ol � 6. Fetleral Es�a�e Tax ReNm Required tlea�hOnorafier]-1-2012) dea�M1efler�242-82) O 1. Decetlent Dietl Tesla�e � 8. �eceaen�Malnlainetl a Living Tmsl _ . 9 To�al Numbet of Safe�eposil Boxes (At�ach copY olwill) IA�tach mpy o�tms�.) � ID. liliga�ion PmceeEs Receivetl � 1t Non-Pmba�e Transferee ReWm � 12. De�erraVElection oi Spousal Tms�s (SCM1edule F entl G Asse�s Only) � 19. Bu5lness H55P�5 � id. SpouS¢Is Sol2 Bene(iGiary (No wst Imoroea) CORRESPONDENT-TNIS SECTON MOST BE COMPLETE�.ALL CORRESPONDENCE AN�CONFI�ENl1AL TAX MFOftMATION SHOULD BE DIREQE�TO' Name Daytime Telephone Number ROBERT C SAIDIS (7177 243 6222 First Line ot Atltlress 26 W HIGH STREET Second Line of ACtlress CilyorPoSlOHice SGte ZIPCotle CARLISLE PA 17oy3 CorresponCenl'semailatltlress: 5aitlis ssr-allorne s.com REGISTEIZpF LSUSEf1�LY �.,� CJ O r—p GJ PEGISTEROFWILLSVSEONLY . . Z) OATEFlLEOMMUDYYYT � � � � '�� Fa J � . � '� J �ATEFILEDSTAMFV � ' ��.-� �� O Q) �1 Side 1 I I��I�I II��I�IIII I�I�I IIIII IIIII II�II IIIII�I�II��I��IIII I��I L1505618403 1505618403 � � � � isos6aavlz REV-150�E% DaradenYnSOGalSacutlryNumba� � neceaenrer+ame�. McCoy, Pauline E. _ _ �� RECAPITULATION 1. ReelEs�ala(Sc�etluleA),..._......._................._...........,........................................ t 2. SlackeantlBands(SchetluleB)......................._........,........_.....__...,....._...,....._ 2 1�8.66 , 3. posalyHeMCorpora�lon,PetlnershiporSole-Pmprie�orship(ScheOulaC)._..,... 3. , - 4. Mort9egesaritlNotesReceNebb(ScheCulaD)..............._....,..,..................,,....,.. 4. � e. Cesh,Bank Deposils antl Miscellaneous Parsonal Propetly(Schetlule E)....,..... 5. 119,146•55 6. Jointy Owned PropatlY(Sc�adule F) ❑ Saperete Bllling Requesletl_.,........ 6. 17�919•00 � ]. InlerNivosTfanslers&MlscallaneousNo�-Pmbe�ePmperty (Sc�etlule G) LJ Separele 6illing Raquestetl.....,..,... L B .863•07 B. TotslG�ossAssaln(totalLinaelPmugh�)........_......,._....__.......,...._.._,,........ 8, L46.057.28 � 8, FunerelFi�pansesaMAdminiatretiveCosls(Sc�edulaH}.................................. � 9, 8.854 -63 10. Deb�sofDecadanl,MORgagaLlabllttleseMLiens(Schedulel)...._.._.,....._........ 10. 1.934 •70 � it. Total�eauctionsltotalLineaBarMlol__....................................._........_.......... iL 10�769.33 . 12. NelValueofEstate(LineBminuaLinell)............._.........,......,....................,,.,.. 12 135,287.95 � 13. Chetl�ableandGovemmentalBequesislSece113Tmstsbrwhlch en eleclion to t�Aas noC been mede(Schetlole J)................._....,.,....._._._...,_. 13, 14. NetVelueSublattoTez(Linel2minusLinetll.._.,....,...._.............................. 14. 13$i2B7.95 TAX CALCULAIION-SEE INSTRUCTIONS FOR APPIJCABLE RATES � 15. AmounlofLi�ldtauEle �, at I�e spousal taz reta,o� ' Irensfereun0er5oc.8116 (e)(12)X.00 �5. 0•00 i6. AmountofLlne141�able ' auroeaireiexoas 135 ,287-95 �s. 6,OB7•96 I 17. Amoun�ofLine1dtaxeble at sibling rete X.12 � •00 »� 0•D O 18. Amounl af Llne 141e�taEle 1e 0•0❑ �'� a�collelaral rale X A5 0 •0 0 is. rnxouE ............._. _.,......_.. _..__...,...... .........._.. ts. 6,087.96 20. FILL IN THE OVAL IF YOU ARE REDUESTINO A REFUN�OF AN OVERPAYMENT � I u�m�w�e�uasoiwn�n.meuarein��miroam�srewm,��.wme�cem�re.cn�aw�sa�c�mm��a,a�a�omaees�amrx�Wnmaeanooenei, � nkWe.corteclenawmplele.DeclamiwnolpepererolM1arNaniM1eperwnresponalblerorAlbgtliarelumiseasetlonelllMormal'molwlibnpreparorNc , enyknowletlga. � SIGNANftEOFPER50NR PONSIBLEFORFILINGNETIIRN fBfl@1YA.MCCOy p � C' � qUORESS � 531 D arman Road. rllsle,PA 170 SIGNATUREOiPftEPAFEROTHE PPESEMPTNF ftobertC.Saidis � E ADURESS � 26 W High S reek C sl — � �� II II��I�IIIIII�IIII�II�I�III��II�IN�III�IIIIII�III��II��II��I Sltle2 � �I � 1505618411 1505618411 � ��, REV-1500 E%Page 3 File Number 21-15-0097 Decedent's Complete Atldress: DECEDENT'SNAME McCoy, Pauline E. .. . --- - — STREETAD�RESS � � � 341 Meadowbrook Roatl . _ .. _— _ —�� - CITV _— _ . —. __— .. _— ._— . IaTATE .__.iLP —_ Carlisle PA 17015 Tax Payments and Credits: 1. Tax Dua(Page 2, Line 19) (1) _ 6,087.96 2 CretlitslPayments A. PriarPaymen�s 5,500.00 B. Discount � Z89.4� To�ei Creaits(A t B) (Z) 5,789.47 (3) 3. In�erest — q, If Line 2 is greater�han Line 1 *Line 3,enter�he tliHerence. This is lhe OVERPAYMENT. (4) _ _ . Check boz on Page Y,Line YU lo requw/a retuntl 5, If Line 1 +Line 3 is grea�er t�an Line 2,enter Ihe difference. This is t�e TAX DUE. (S) . 29$-49 Make Check Payable to: REGISTER OF WILLS, AGENT. � PLEASE ANSWER THE FOLLOWING �UESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did tlecetlent make a Vansfer and' Ves No ri a. re[alnt�euseorincomeofthepropertytrensferretl:_ ._ �- - x� b. re�ain the rigM to tlesignate who shall use��e property trans�erretl or Its mcome ... � r '• c. retainareversionaryinleres[or._.. .._._.. .... .._ ._ I I � d. receive IM1e promise for li(e of ei�her paymenis benef[s or care� ._ ...... ._... L � 2. I( tlea�h occurretl atler Dec 12 1982, ditl deceden� �rensfe� property wit�m one year of tlea�M1 withoW � � receivingadequa�econsitlerehon� ._.__ ......._ ,,,,,_ ._..._. ---, .x� 3. Did decetlent awn an"in�ms�for" or payable upon death bank account or security a�his ar her tlea�h?.._._ I ..� �� 4. Did tlecetlent own an intlividual retirement accoun�,annui�y,or other non-probate pmperty wM1ich � —� cmtainsaEenefciarytles9na�on�._ _.. ...._._. .....__. ..___. __..._ � _. IF THE ANSWER TO ANY OF THE ABOVE OUESTIONS IS YES YOU MUST COMPLETE SCHEDULE G PND FILE IT AS PART OF THE RETURN. Fordeteso(tlea�honorefleNuty119B4andbeforeJan11985 �hetaxreteimposetlonNene�valueoiVens�ers�oorfortheuseoi�M1esurvivingspouse �� I5 3 Percent�]2 P.S§9116 fa)(1.1)(i¶. Por da�es of tleath on or afler January 1.1995,ihe tax rale imposed on�he net value o�trans(ers�o or(ar��e use oflhe surviving spouse is 0 percenl �I2P.5-§911fi(e)(1.1)Qi)�. Thes�al�tetloesnotexemplelronsfertoasurvivingspousefmm�ax.and�hesteWtoryrequiremenls(ortllsclosureofassetsand filing a�ax reWrn are still appliwble even if the surviving spouse is ihe only benefmiary. Por dates ot dealh on or after July 1,20�0- • The lax rate imposed on the net value oi Iransfers irom a tleceasetl chi10 21 years oi age or younger at deat�10 ar for the use of a naWral parent an edoptive parent,or a stapparent ot Ihe ch➢d Is�percent p2 P.S-§9116(e)(t2y. • The tax rele imposetl on @a ne�velue oi Vensiers la or tor the use ot ihe dece0enl's llneal benabciaries is 4.5 percent,except as notatl�m�]2 PS.§9116(e)(1)�. . T�e tax�a�e imposed on�he nel value o�Vanslers�o or(or��e use o��he tlecetlenfs si011ngs is 12 percen��]2 P.S.§9116(a)(1 3)�. A sibling is de0ned untler Section 9102.as an'mCivitlual who�as at least one parenl in common wit�Ne deceden�,whelher by blood or aCop�ion. a=..�soo ex.loe.ix� SCNEDULE B pennsylvania STOCKS & BONDS oevnarMErvr oF REvervuE ie�HERi.aucE rnx xEruan aesioer�r oeceoeNr ESTATE OF FILE NUMBER McCoy Pauline E 21-15-0097 ui o�oa�nyioimiye.�.a mm,�ym o�s�rvmor:nir m�.�o.a�.�io..a o�s<n.aw.v. VALUE AT�ATE ITEM CUSIP DESCRIPTION UNITVAWE OFDEATH NUMBER NUMBER 7 $50.00 U.S.Savin9s Bond tlated 03 1986-See attachetl 108.66 Valuation TOTAL�Also enter on Line 2,Recapitulation) 708.66 Qf more space is neetletl,atlEilional pages oI1M1e same slze) Copyrigh�(c)2012 form so(iware only The Lackner Group,Inn Pomi PA-05U0 Sc�edule B(Rev.0842) CaIcW etcd Value oC Youc Pzper Sevings Bond(s) Page I of 1 Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date OS/2015 Total Price Total Value Total Interest YTD Interest 25.00 108.66 83.66 0.00 Bonds: 1-1 of 1 Serial # Series Denom Issue Next Final Issue Interest Interest Value Note Date Accrual Maturity Price Rate 258566595EE EE $50 03/1986 03/2015 03/2016 $25.00 $83.66 4.00% 5108.66 Totals for 1 Bonds $25 00 $83.66 $108.66 Notes NI Notlssued NE Not eligible for payment PS Indudes 3 month interest penalty MA Matured and not earnin interest h¢p://www.tceesurydicectgovBGSBCP�ice 4/7/2015 qe.-isoe ex.�aenn SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. °E`"R'""E"`°`a`�`"�E pERSONAL PROPERTY iNrvEairnuce*�RETURr+ kEsio�nr oeceoerv. ESTATE OF FILE NUMBER McCo , Pauline E. 21-15-0097 mowae ina oro�e.m o�nnaa�io�em me ae�a ina pro-�as.ere re��ae ov�na�+a�a. ui c�oa=nyio�miv4w�w.am me nsn�oi.��.mor:nia m�.�e.m.=io.<e o�.meaw.r. ITEM VA W E AT DATE NUMBER DESCRIPTION OF DEATH 7 1946 Willys Jeep CJ2A-not in running condition 2,000.00 2 2002 Subaru Forester-See attachetl NADA valuation 2,825.00 3 American Funds Account#0068343995-See attached letterfrom Edwartl Jones dated March 1,767.72 3,2015 4 MST Bank Certificate of Deposit#37003913463607-See attached letter from M6T Bank tlated 4.098.4fi February 17,20'15 5 M8T Bank Checking Account tl869104 -See attached letter From M8T Bank tlated February 12.473.04 17,2075 6 M8T Bank Savings Account#25006920098397-See attachetl letter from M&T Bank datetl 120.07 February'17, 2075 7 Members ist FCU Certificate of Deposit#179432-00-See attachetl letter From Members'Ist 17.656.87 FCU datetl February 27,2015 8 Members 7st FCU Certifieate of Deposit#t79432-0'I -See attached letter from Members ist 3.04fi.05 FCU dated February 27,2015 9 Members 1st FCU Certificate of Deposit N179432�2-See ariached letter from Members ist 2,831.77 FCU tlated February 27, 2075 10 Members 1st FCU Certificate of Deposit#779432-03-See attached letter from Membere ist 16,394.36 FCU tlated February 27,2075 71 Members'Ist FCU Certificate of Deposit#179432-04-See attached letterfrom Members 1st 5,789.24 FCU dated February 27, 2075 ip Members'IstFCUlnvestmentSavingsAceounl#779432-05-Seeattachedletterfrom 35.'120.72 Members ist FW tlated February 27, 2075 Total of Continuation Schetlule See attachetl page TOTAL(Also enter on Line 5, Recapitulation) 179,146.55 Qf more spaw is nretletl,a0eltional pages of�he same size7 Copyright(c)2012 form sofiware onty The Lackner Gmup.Inn Fortn PA-0500 Schetlule E(Rev.0842) Re�1508 E%��OBA3� BCHEDULE E pennsylvania CASH, BANK DEPOSITS, 8 MISC. oEraRrmEu�oFaEVENue PERSONAL PROPERTY inneair�wce*u ae.�Ru aesmeHr oeceoevr conti nued ESTATE OF FILE NUMBER MCCo , Pauline E. 21-15-0097 ITEM VALUE AT�ATE DESCRIPTION OFDEATH NUMBER 13 MemberslstFCURegular5avingsAccounti{779432-�0-SeeattachedletterfromMembers 74.940.63 isl FCU tlated February 27.2015 14 Orretown Bank Certificate of Deposil#SU80059131 -See attached letterfrom Orrstown Bank 2.b79.1U tlated March 20,2015 15 Orrstown Bank Certificate of Deposit#5080062823-See attachetl letter from Orrstown Bank 2.877.96 datetl March 20,2015 76 Refuntl from AAA ZZ.�e 77 Refund from Comcast Cable 33.96 18 Refund from Coventry Health Care, Ina -Overpayment(or prescription �3.�2 79 Refuntl from Inlernal Revenue Service 51.00 20 Retuntl from State Farm Insurance-Insurance on Subaru 253.28 21 Refuntl from State Farm Insurance-Renters Insurance ��'� 22 Refund from State Farm Insuance-Insurence on Jeep �4'46 TOTAL IAlso enter on Line 5, Recapitulaeionl 1'19.746.55 Copyright(c)2012 form software only The Lackner Gmup, Ina Portn PA-0500 Schedule E(Rev.08-12) 2002 Subaru Forester Wagon SU 5 AWD Prices,Values & Specs -VADAguides Page 1 ot 1 �a> , .� The Powor of Whicb��formWion � Close W ndaw . . � NADAqvid.+.com 2/2/2015 2002 Subaru Forester-4 Cyl.-AWD Wagon 5D S AWD - NprdA�uid�s�corrrPrice Repor� . — - __ __ _- Rough Average Clean Clean Trada-In Tratle-In Trade-In Retail BdSO PfICE Sl,]25 $3,975 $3,0]5 $4,975 Mfleage: ;�e,000) mnes ;i,ioo 3i,aoo ;i,ioo Sl,loo TOSaI Base V�ica S2,B35 $3,515 54�1]5 $6,OJ5 Options: Plum��num/AI'�.oy Wheels Std. Sid. Std. Sttl. PRICE with Options $2,825 $3,575 $4,175 $6,075 The history of a vehicie° � � impacts 'rts value Get the Mstay at AutoCheck.can/NADAguddes O , `� � ' '— � . �� F�. "^ '^ ,^`ir .'.t�. ' � _ , Search across any device ° � ' - . -- ---- - _ -- _ ---- _ _ - S�COPYriQ�I2015 NNOP9uidW.PII NigM16 Raservep. (p COPyIIgM1!$035 NAOASC RII Rlgh[S N¢SCrved. - - http://www.nadaguides.com/Cars/2002/Subana/Forester-4Cyl-A W D/W ago�rSD-S-A W ll/V... 2/3/?O15 Mpit l u tuta ��' ;I�1 �� o� EdwardJones '""" 'p�_—_— io D?� 02 /5 � � : of.r � � ' ' _ � � I P ',G�� — .Pr�i,t�— — �r 3+.3 �,_ _ s�s,ER � �� '� �/ G��/' ` ,) 2 ;'� `/ L 1� `J `� � . u.Cc�.�: �� oocc4�i 501�2 , i��,�,i,v,� oo�9343�5 i Ckl - (� -'�Je� �� ..�,-u.d,�.u7�.�.�s2 3. a� � �� , , �� SS�3.�7 .�n�.d�.��d� � i7�i �z 4. (i e� aa� vi�i��oi5 : � °J• C,�Z�� • , .,C.I.Li�A-Q-o � �J G�I � ' �"e C.O� ' `-^"'"`��C�� c�• �L�,4 I;�uP J :1 ��Z,i�I(��✓�_�„P�_/ r �e a 3 za�s p�s�x ManufaaWrereentlTretlersTmslCompa�y.OneWes�Hlgh3veel,Cedlsk,PAP013, ^'/02404535a11]2404518 �I , Saidis, Sullivan & Rogers . 26 West High Street ' Carlisle, PA 17013 February 17, 2015 �i � RE: Estate of Pauline E. McCoy , Date of Death: January 18, 2015 , SocialSewriTytt: 168-26-3937 Dear Saidis, Sullivan & Rogers: Please find the information you requested on February 5, 2015 listed below. L The account numbers are 869104, 25004920098397 and I 31003913463607. �� 2. The dates the accounts were established are 03/24/1988, 10/28/1993, � and 09/23/2005. '��.. 3. The registered owner of these accounts is Pauline E. McCoy, as an individual owner. There was a POA listed; Jeffery A McCoy. � � 4. The date of death balance is enclosed. �. � Please contact me with any questions or concerns. �, Sincerely, � �� '� �a�L � Ivonne C. Clark � Relationship Banker III �� '' i , I � a �� 499 Mit�ell Roed,Millsbwo,DE 199bb Reco�ds Monab mcnt v�one888-5024J49 e ex (JO1)934�3955 Fcbmaryl],2015 Ivonne C]ark . High Street-01 i1 I I Re: Eslate of Pauli ie E.McCov � S ' 1 Sec 'ri' 1 6 8-2 63 93 7 � Date ofDeeth� lanuarv �8.2015 — 4 � Dear Sir or Medam: � �I Per your inquiry on February 10,2015,plcase be advised Ihat ffi the 6mc of death,the above-named decedent i had on deposit wilh[his bank the following: I. TypeofAccount Chuking�ccowt � ' AccaurtfNumber 869104 �` ! Owners/up(Namec on Je,(lery A.McCtry(POA) � Pavfine&McCoy . V OpemngDafe 03/24//988 '� Bulnnce or�Daie ojDeath 5 12.4I3.04 � . Acc�ruedlmues( $ �� ', . ....._...___""____'_____—_..._.__. ��, �. TotaJ 5 11,413.04 �.i �' 2, 7ypeofAccoun7 Swir�ya'Accaunt �� i AccmmtNumber 25004920098J97 �, I Ownershlp(Names on Je$rry A.MeCoy(/'OA) ', Ppu7ine F,.McC% I I ' OpenfngOnte lQ28/]9Y3 ' ' Balaxe on Dale ofDeulh S 110.0/ I Accnredfntererf $ .00 � � _ ._—__.._"'..._.'__'__'___'_'_—.___ '', Tom! $ 110.0/ � I � I i I i i � 3. Ty/moJAceount CerlrficWeafDepwir . AccmmlNumber 3/003913463607 Owttership(Nqmu aJJ JeJfreyA. Mc('oy(POA) PwlineE.McCoy (�eningUa�e 09/23R005 Ba(onceonDafeafUeafh 5 4.095,74 � � � I AccruedfnferesT 3 Z�2 'I .__'_ ..._____ ...... 7bm( 5 4,09846 Far�oy�dJifionalleforme�louonlheaboveaceouv0.ineluJingorvirtrshipm��nyc4vngn,clmuresAnd/orrelmbnrunm�offuoJ> � pkaepllthe5foaheJgeaf]1RN0��534. � . Wa w¢re��Gk�o loe�k�ny wR Jepwil baa for IGe�bovnmenHonea deceJmc ' Thu Ietta.�W�+nal iv<lode eoy�c�0iiub N rvLu6 ihe�InewN m+Y�+�T��IIs1eU u Powe of Anw�y,CiutoJmn of llnifarm l'rn�n. � �. ReprexndHvePnyee.mTrvskeuixlereWrltknAgrtement � � � � Sincertly, � �� VelarieMemer ' � 2ecords Management . � . . . . . . . . � _ __ _ _ . ; . :; . , ,_. , _: , _ I � ; . _ __ _ _ � i , � � I i i NAR 0 3 2015 �� MEMBERSI" p�tlMLCRFDITVNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 179432-00 Date Account Established 10119/1998 Principal Balance at Date of Death $14,939.80 - Accrued Interest ro Date of�eath $0.63 � Total Principal and Accrued Interesl $14,840.63 Name of Joinl Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 179452-05 Data Account Established OB/23/2005 Principal Balanceat Date of Death S35,119.08 Accrued Interesl ta Date of Death $�� . Total Principal and Accrued Interest $35,12072 Name of Joint Qwner None � CERTIFICATE OF DEPOSIT: � Account Number/Suffix 778432�0 179432-01 �. Date Account Established OV2312007 10/17/2D04 � Principal Balance at Dale of Death 511,654.64 $3,045.70 �. � Accrued Interest to Date of�eath $2.17 $0,35 , Total Principal and Accrued Interest $11,65fi.81 $3,046A5 '�I Name of Joint Owner None None CERTIFICATE OF UEPOSIT: �I � AccounWumbeUSuffx 179452�12 17943243 i, Da[e Accou n[Est2blished 04/26/2004 11/74/2002 I Principal Balance at Date of Death $2,831.38 $16,39207 Accrued Interest to Date of Death $0.33 3z,z9 . � Total Principal and Accrued Interest $2,631.71 $16,394.36 ��. �� NameofJoin[Owner None None �� CER7IFICA7E OF DEPOSIT: �� , Accoun[NumbedSuffix 179432-44 Date Account Established 01/23/2007 ', � Pnncipal Balance at Date of DeaN $5,788,43 '� Accruetl Interest to Date of Dee[h $0.81 �� To�al Principal antl Accrued Interest $5,789 24 i �� Name of Joint Owner None i M�E�M/BER51�FEDERAL CREDIT UNION ! � Tessa L Klug-�� i Lending Insurance Support Specialist . February 27, 2�15 Estale of: PAULINE E MCCOY j Date of DeaM: 07l18I2015 Socfal Security Number: 168-28-3837 � 5000 Loiilse Urivc � EO. liox�0 • Mechanicsburg Pennsylvania 17055 • (800)283-2328 • www.memberv1st.ucg STO � ATradilion ofExcellence March 20,2015 Law Offices of Saidis, Sullivan,&Rogers 26 W High St Cazlisle PA 17013 Fax Numba 717-243-6486 Re: Estate of PaWine E McCoy Social SecuriTy Number 168-26-3937 Uate ofDeath O1/18/15 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEllENT HAD THE FOLLOWING ACCOUNT WITH ORRSTOWN BANIC TIME DEPOSII' AccountNo- 508005913] AccountType- 24MonthCrowth Account Title- Pauline E McCoy DatcOpened- 11/03/00 Joint Account(narne/date) No Balance- $2,SL8.77 Accmed Interest $033 17ME DEPOSIT Awom[No- 5080062623 Account Type- 18 Month Growah Account Title- Pauline E McCoy Date Opened- 09/10/99 Joint Accoun[(name/date) No Balance- $2,871.80 Accrued Interest $0.16 Best Regerds, �.��-�...� ��,_ Susan R Eyer Deposit Processing Representa5ve II 2695 Philadelphia Avenue� Chambecsburg,PA 17201 Rer-0509 E%�101-10) pennsylvania SCNEDULE F o�Pna.MeHroFAeveHue JOINTLY-OWNED PROPERTY INHERITANCE TM RETURN RESI�ENTDECEOENT ESTATE OF FILE NUMBER McCoy Pauline E 21-15A097 n.�....i w..m.na io�m wnnm o�.ya.,mme ee�eae�r.mm or a..in,�n m�.<te repon.a o�.m.a,n.e. SURVIVINGJOMTTENANT(S)NAME ADDRE55 RELATIONSHIPTODECEDENT A. Jeffery A. MCCoy 531 Dyarman Road Son Carlisle, PA 17015 B. C. JOINTLV OWNED PROPERTV: pESCRIPTIONOFPROPERTV �pF oareoFoenrH ITEM LETTER DATE iHc�uoErvnM[oFrixnrvcw�ir�s*i�uriorvarvoen�uxncco�Hr DATEOFDEATH DECD'S oECEoiNrsiNrEaEs� NUMBER FORJOIN MADE uumaeaoasimunaioervnvvwcuuMeea.nnACHoeeoroa VAWEOFASSE MTEREST TENANT JOINT ioirvnv�NE�oaEn�Es*n1E. 1 A 07/2fi12009 Real Estate situate at 537 Dyarman Roatl- 35.838.00 50.000% 17.919.00 See attachetl fax assessment of$36,200.00 x common level ratio of.99 gives a tair market value ot SJ5,838.00 TOTAL IAlso enter on Line 6,Recapitulationl 77.979.00 (It more space is neetletl,atltlitional pages of iM1e same siee) CopyrigM(c)2010 form soflware only The Lackner Group, Ina Portn PA-150�ScM1edule F(Rev.0140) Property Mapper Cumberland County, PA coov�s��mv e:ri.au nsnv:re:erv=a rn�:�v zavs a�.acwe am. N�. 35-19.IJfi<-Ce]F L4B aMCCOv.9caVIINE F&lEF4RFV P e CoOe � reaSm 0 - 93eao e�sams .s. 3zzao cnng5As5e55e0 Value S�.G000 al AssesSed Vdlue f� ]610a Sa��e Pnce 5�. t Sa'�e Da[e�. Mon)an 361009 0]'40'00 vm t9C� '.�CRTtl MIDJLETCN TW? nl�5mne5�. 1 Nei�M1��i Ibpeal�wel'lig�.DEfPOI BeGmomS^c`�Z O PwA5�0 E%��08�09) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS AND oEPA�+.reHrorREVEN�E MISC. NON-PROBATE PROPERTY INHEPITPNGETA%RETpRN PESIDENT OFLFIIFNT ESTATE OF FILE NUMBER McCoy Pauline E. 21-15-0097 .n�,�moa�ie��ee�moie�ea am mea ume e�i,+-e.e a�y m a�ae�o,�i mro�qn a o�oeee mree or m:aev-isoo�.y�. ITEM DESCRIPTIONOFPROPERTV DATEOFDEATH °�oFoeco's ExcwsioH TAXABLE NUMBER }HE�on°rEOM*a�nusaEasniincHTacoavoF?�EOE�Eo�oaaeAi srni[ VALUEOFASSET ��'EaEST ��^Pv�icna�E� VALUE 1 American Funds IRA#00648750fi2-See attached 8.883.07 8.883.07 letter from Edward Jones tlated March 3,2015. Beneficiaries are Dakota MCCoy antl Cotly McCoy TOTAL IAlso enter on Line 7,Recapitulation) 8.883.07 Qt more s0ace is neeOeQ atltlitional pages of the same size) Copyright(c)2009 form soflware only The Lackner Gmup,Inn Portn PA-0500 ScheEule G(Rev.08-09) nsv-isn ex.�oeni pennsylvania BCHEDULE H ocPnR.reN.oFaeveH�e FUNERALEXPENSESAND a sioEH�oECEOE«rTua� pDMINISTRATIVE COSTS ESTATE OF FILE NUMBER McCoy Pauline E. 21-15-0097 Decedenl'S tlebts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT R q, FUNERALEXPENSES: See continuation schedule�s) attached 2,572.15 B. ADMINISTRATIVECOSTS: 1. PersonalRepresenta[ive'sCommissions Name of Personal Represen�ative�s) SVeetAtldress Clry State _ Zio Vear(s)Commission Paid z. nnomey's Fees Saidis, Sullivan & Rogere 5,500.00 3. Family Exemptio¢ Qf tlecedenPs atltlress is mt the same as daiman�'s,aLLach explana�ion) Clalmant SUeetAtltlress Cily State Zio Relationshio af Glaimant to Decetlent a. ProbateFees 380.50 5. AccountanfsFees 6. Tax Relurn Preoarer's Fees ]. O�her AdminisVa�ive Cosls 401'98 See continua[ion schetlule�s)attached TOTAL(Also enter on line 9, Recapitulation) 8.854.63 Copyright(c)2013 form software only The Lackner G�oup, Inn Porm GA-0500 Schetlule H(Rev.08-13) SCNEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER McCoy Pauline E T1-15-0097 ITEM AMOUNT NUMBER DESCRIPTION F��neral Exoenses 7 HoHman 8 Roth Funeral Home 751.45 2 WestminsrerCemetery-Openingandclosingof9rave 7.82070 H-A 2.572.15 Other Adm'nis[rative Goste 1 CumberlandLawJournal-AdvertiseLetters 75.00 4 Melanie A.Strickland,Taz Collector-Decetlent's share of real esGte tax 55.08 5 Members ist Federal Lredit Union-Checks 9.25 6 PPBL Eleciric 87.36 7 PPBLEIectric-FinalBill 40.70 8 StateFartnlnsurance-InsuranceforJeep 13.94 9 Valley-TimesStar-AdvertiseLetters �2�'ZS H-B7 40'1.98 Copyright(c)20W fortn software only The Lackner Group,Ina Form PA-0500 Schetlule H(Rev.6-98) Rrv1A3E%��II-II) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, oevnR�MeNroraeveHue MORTGAGE LIABILITIES AND LIENS iuHEairnNce,u aE.uAn aEsioervr oecEOEHr ESTATE OF FILE NUMBER McCov Pauline E 21-75-0097 a.aon a<e�:m��rr.e ey�n.m�.a.m ano,maanum.�nm.m.a�ow�e.un.e.�eme.:iq m�me��v��r<imo�n.a�mr.sie:n.�.... ITEM VAW E AT DATE NUMBER DESCRIPTION OF OEATH 1 Carlisle Regional Medical Center 65.00 2 Century Link 85.83 3 Kough's Oil Service,Inc. 467.40 4 MS Hershey Metlical Center 42Z'45 5 MS He�shey Medical Center 98.83 6 MSHMC Physicians Group 133.00 7 Pinnacle Health Hospitals 200.00 8 PPBL Electric 6'1.87 9 Publishers Clearing House ��'95 70 Tax qaim Bureau-2014 Real Estate Wxes 362.43 TOTAL(Also enter on Line 70, Recapitulation) 1,914.70 (0 more space Is neetlea,atltlitional pages ot tne same sixe) Copyrigh�(c)2�12 form soflware anly The Lackner Group, Ina Form PA-05W Schetlule I(Rev. 1242) P W-15ll E%�IOtAY� pennsylvania SCHEDULE J �EPARiMENTOFREVENUt ��„Ea��A��E.�aE.�a� BENEFIqARIES aesiuEHr oECEOEHr ESTATE OF FILE NUMBER McCo , Pauline E. 27-15-0097 NAMEANDHDDRESSOF RELATIONSHIPTO SHAREOFESTATE AMOUNTOFESTATE NUMBER pERSONfS1RECEIVINGPROPERTY �ECEDENT (yyords) ($$8) N Ia1T TAXABLEDISTRIBUTIONS �'mcludeou�rightspousal �• tlislribNions,antl irensfers under Sec. 9116 a 12 CotlyMcCoy Grantlson 50%ofAmeriwn 531 Dyarman Road Funtl IRA Carlisle, PA 77075 p0066875062 Oakota McCoy Granddaughter 50%American 531 Dyamlan Roatl Funtl IRA Carlisle, PA 17075 #U064815062 JeHeryA. MCCoy Son 100%ofresidue 531 Dyarman Road Carlisle, PA 17075 Total Enter dollar amoun�s for disVibulions sM1own above on lines 151hmu h 19 on Rev 1500 cover sheet,as a m ria�e. NON-TAXABLE�ISTRIBUTIONS�. II. q.SPOUSALDISTRIBUTI0N5UN0ER5ECTION9113FORWHICHANELECTIONTOTAXISNOTTAKEN B.CHARITABLE ANp GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TPW�BLE DISTRIBUTIONS ON LWE 13 OF REV4500 GOVER SHEET Copyright(c)20f 0 form sofiware only The Lackner Gmup,Inc. Form PA-0500 Schetlule J(Rev.0140) LAST WILL AND TESTAMENT OF � PAULINE E. MeCOY I, Pauline E. McCoy, of North Middleton, Cumberland County, � Pennsylvania, �eing of sound ard dieposing mind, m=mory and � underatanding, do hereby make, pu�lish and declare this as ar.d for my Last Will and Testament, hereby revoking all other wills and Codicils here�ofore nade by ne. , FIRST � I direct the payment of my just debts and expenses of my last illness and funeral fxom my e=taCe as soon after my death ,' as conveniently may be dor.e. L` there be no cemeCery lot ' available for my iatermer_t owned by me at the time of my deaCh, , I authorize my perse�al representative to purchaee such cemetery �, l.ot with a mntract for perpetual care, using therefore funds �. �=rom rzry estace in �uch amount as they ehall consider necessary . and desirable, and I authorize my personal representative to cause title to or ownership of such loC so purchased to bc veyted in such perso� as my pereonal representative eha':1 ��. designate. SAIDIS, F10WER Si Further, I authorize my personal representative to expend , I.INDSAY '�:W"`��"��rt`� funde from m estate, in scch amount as m ersonal c,d�i�,vn Y Y P � representative s�all consider necessar.y ard desirable for the � purchase, erection aad inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all the rest, residue and remainder of my eatate to my beloved son, Jeffrey A. MCCoy, per atirpea . THIRD In addition to the powera co�ferred by law, I authorize any pereonal representative acting under this insCrument, in his absolute discretion: A. To retain in the form received, or to aell eithcr at � nublic or private sale any real or personal propercy; � B. To exercioe any options to subscribe for steeks, bords, cr other imeatnenta; ; C. To join in any plan of lease, mor�.;gage, , consolidaticn, exchange,� reorganization or foreclo�ure of any corporatior in which my estate or any trust may hold scocks, bonds or other securities; �, � � U. To sell, transfer, convey, ciortgage, pledge, lease ', , Y or exchange any property, real or oersonal, which a� a�y � '. time may form part of my estate, for the payment of debts '. SAIDIS, �r Caxes, or for any pnrpose oP administratior. or ' FI.OWER Si �� ' LllVUSAY distribut'_on, for such prices and upon such terms as my �, �� ''�"`"'�`""` ersonal re resentative, in their solc discretion, may deem �. a,�iki�,re P P � j wise, and co execute and deliver deeds of conveyance or �� transfer thereof; � 2 E. To make settlements and comprom:ses on such Le'rms as � my personal representative in their sole discretion may � deem wiee without the r.ecessity of obtaininy any court approval thereof; '. F. To make distribution hereunder either in caah cr kind, as my p=rsonal repreeentative in their diecretion may deem wise. . FOURTH i do hereby nomi�ate, con3ti�ute and appoint my son, Je£frey A. MCCoy, to act as Executor of this my Laet Will and Testament . FIFTH � I direct that no personal representative, guardian, trustee � or othzr fiduciary appocnted under this instrument shall be . requirad to give bond ,for the faithfcl performance oP thei_r duties in any jurisdiction. IN WITNESS WHEREOF, I, Pauline E. MCCoy, have hereu�to seL ��. my hand and seal to thie :ny La3t Will and Tes;:amenC, consisti�g ' of three typewritten pages, the first two o`_ wFich bear my �� SAIDIS� initials in the margin for ider.tificati.on, thi.s 26`n day of �' rl�� January, 2CC9. � ]b Wa'HIAh Rrc<r Grllilq YA P�,�.�.,,� � vne 4�� Pauline E. MCCoy 3 Signed, sealed, oubliehed and dec_ared by the above-named � Pauline E. McCoy, Testator, as and for his Last Will and Testamen� in the prese�ce oT us, who have hereunto subscribed our names at hia request as witnesses chere�o, in the presence of said Testator and oP each other. � ADDRE55 26 West High Street ' Carlisle, PA 17013 (l �� `- c. 2 C� � ADDRESS 26 West High Street Carlisle, PA 17013 CO[MSONWEALTH OF PENNSYLVANIA . � �� CDi7NTY OF CU6ffiERLAND . Ke, Pauline E. McCoy , Robert C. Said:� ard Phyllis McCcy, . the Testator and witnesses, respectiveiy whose names are signed �. to the foregoing or attached instru�nenc, being first duly sworn, �: do hereby declare to the uaderaigned authority that t:�e Testator , eignec and executed the instrument as his Last Will and I Testament and t:�at he signed willingly and that executed as his '. free and voluntary acc for the purposee tnerein expreesed, and �� that each of the witnesses, in the oresence and ?�earinc of the '�, Teatator eigned the Wil7. as witnesses and Chat to the best o`_ � their knowledge the Testator was a� Lhe ti.me eighteen ;18) or . more yeazs of age, of sound mind and under no constraint or undue influence. _�� rnec�_ Pau_ine E MCCoy� % � Rob rC . aidis, Witness `;�° C� h�� SAID1S, Yhy . is I✓.cCOy, Wi ss N7AWER S� I,IVDSAY . � Subscribed, sworn to and acknowledged before me by Pauline . zew<:��i�gns��«� E. NcCo � the Testator, and subscribed to and cworn or affirmed Grlulc,PA Y� � to before me by Robert C. Saidis and Phyllie McCoy, wi[nesses, � thie 26°n day of January, 2009. /_._.. f � � � � � ' otary Public 4 BhRBARAC31'EEI,NoWyPuAllo Cariide Bom,LLm6almd Coopty PA M Commiubn Ex ires hma 7 2�OI1