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HomeMy WebLinkAbout07-26-05 20"r "'I ^ UJ vi, / r:; P" I ~~ ,-" II : 03 ,'" I -~.. ,-",.-,. ,i' ~ ~ ;.;) <,.~ .- " '_\.. ~ ~ ~ C\,- l~ (\r1 ,8 ~ .':/. ~ \J '1-~ ~ ~ J ~, ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 'J.;_ ~ ~ ~ t 'I- '\) ~' ( ~ ~ f( '-.. .: ;; r~ g,..~' , tr. ( S-~:.. , ._ r' ~~ ~,,'r' ~. rJ Edward M. Brown, Esq., P.c. _ Reply to: He 60, Box 531 Orbisonia, PA 17243 Phone: (814)447-3455 Fax: (814) 643-4616 _ Reply to: 225 Washington Street Huntingdon, P A 16652 Phone: (814) 643-9787 Fax: (814) 643-4616 July 24, 2005 Cumberland County Register of Wills Courthouse I Courthouse Square Carlisle, P A 17013-3387 Re: Estate of Harold E. Benson Dear Sir or Madam: Enclosed is an original death certificate, one original and one copy ofthe Pennsylvania Inheritance Tax Return, check #2475 in the amount of$15.00 for the filing fee, check #2474 in the amount of $2,314.20 for the inheritance tax due and a return envelope for a receipt. Please feel free to contact me if you have any questions or need any additional information. Sincerely, ~~-~~- Edward M. Brown r...;, <::::J = =-1 <.- c:: 1- i"'0 en ~ c::> N C.'-) I--r! REV-1 SOO EX + (~) '* I- Z W C W o W C COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Benson Harold E. DATE OF DEATH (MM-D[)'Year) OfFICiAl USE' ONlY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~ ')1--0 _Q1L~.L_ ~1Y CODE YEAR NUMBER SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-D[)'Year) 1 77- 3 2 - 8 567 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 01/07/2005 01/04/1942 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) w ... :.::$(1) olt:~ wlLO :%:00 ofi lL <( z o ~ < ..... ::) I- ~ < o w a: z o ~ ~ ::) Q. :i o o >< <( I- 00 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (AttllchcopyofWi~ o 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER o 2. Supplemental Return D 4a. Future Interest Compromise (date of death * 12-12-a2) D 7. OecedentMaintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Cred" (daIoof_be_n 12-31-91'"""-1-95) o 3. Remainder Return (daleof_p<iorto12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Depos" Boxes o 11. Election to tax under Sec. 9113(AltAttllchSchO) ... z w o z o lL <I) w It: It: o o 'I"IU'iU NAME Edward M. Brown FIRM NAME (If Applicable) Edward M. Brown Es . P.C. TELEPHONE NUMBER 814-643-9787 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, PartJ1ership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule 0) 5. Cash, Bank Depostts & Miscellaneous PelSOnal Pmperty (Schedule E) 6. JoinUy Owned Property (Schedule F) o Separate BOling Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. T etal Gross Assets (lotal Lines 1-7) 9. Funeral Expenses & Administrative Cos1s (Schedule H) - :news Huntin don PA 16652 (1) (2) (3) (4) (5) OFFICIAL USE ONLY :-..;) c::::J C::l en L. (:::: ,- N 0'\ l -.-n I iT1 (") C) =':"J C..) r~r 1 C:J c~) -0 'h ::~ .. ~~~'] -, C) c~., r-TI <:::) ,-j '=?, , w \ _____ _..J (6) 20,250.00 (7) (8) 20,250.00 (9) 965.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (Iota I Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (11) (12) (13) 965.00 19,285.00 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES (14) 19,285.00 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due X _(15) X _(16) 19,285.00 X .12 (17) 2,314.20 X .15 (18) (19) 2,314.20 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o d . C I t Add ece enfs om pIe e ress: STREET ADDRESS 19 Half Mile Drive CITY I STATE pp Gardners PA 17324 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C 1 (2) 3. Interest/Penalty if applicable D. Interest E. Penalty T otallnterest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) S. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check 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 olthe property transferred; ........................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 00 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pe~ury, I declare lI1at I have exanined lI1is retum, includi~ accompanying schedules and statements, and to the best of my knowlecge and belief, it is !rue, correct ood ccmplete. Declaration of prepamr other than lI1e pernonal representative is based on a11ln!olmation of which preparer has allY knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETU N DATE / - 06- PRESENTATIVE PA 19468 DATE 07 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [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% [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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, 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% [72 P.S. ~9116(a)(1.3)J. 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-1509 EX + (6-96) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Benson Harold E FILE NUMBER If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Merrill G. Benson 129 South 9th Ave. Royersford, PA 19468 sibling B c JOINTL Y-OWNED PROPERTY: LEnER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. An ACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 072375 Real estate in Cromwell Township, Huntingdon County, 40,500.00 50. 20,250.00 Pennsylvania, described in Deed Book 127, Page 620, and having Tax Parcel No. 11-16-22. Deed copy attached. Appraisal attached. Surviving joint owner to pay the tax due. TOTAL (Also enter on line 6, Recapitulation) $ 20250.00 (If more space is needed, insert additional sheets of the same size) I. REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Benson Harold E. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s)IEIN Number of Personal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attorney Fees Edward M. Brown, Esq., P.C. 750.00 3. Family Exemption: (If decedenfs address Is not the same as c1aimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills, filing fee for Inheritance Tax Return 15.00 5. Accountanfs Fees 6. Tax Return Prepare(s Fees 7. Integrity Appraisals, appraisal of Huntingdon County real estate 200.00 TOTAL (Also enter on line 9, Recapitulation) $ 965.00 (If more space is needed, insert additional sheets of the same size) L. ;'";\(, .- --. ~. -- ..':...u':~!.o.'~'~'" .~!" ,: I. \~,l Ii 1:1 111 [;! Ii,.\ r !~} ',,< ,_....c-.......,~_-.,;-'--',.-..........JJo......_.....:-.-...'_~~~., ~ 12'7 !'rICE 620 THIS INDENTURB hOOK '""~ day of July in the year of our Lord one lIADE the thousand nine hundred and seventy-five (1975). FRED L. BENSON, Administrator of the Estate of BETWEEN lIABEL GRACE BElISON;',deeeased; FRED L. BENSON and MARLENE, his wife, both of the Borough 01 Phoen1xville, County:of Chester, I4ERRILL G. BENSON and DONNA BENSON, his wife, both of the Borough of Royer.- :i ~ I , , f I r: ford, County of Montgomery, BERLYN W. BENSON , unmarried, of the Township of Cromwell, County of Huntingdon, VIOLA R. GLUNT and WENDELL E. GLUNT,her huebandboth of the Borough of Shade Gap, , ! ) ; ! ; . , I i; i I ! " , \ (\ County of Huntingdon, HAROLD E. BENSON and BONNIE BENSON, his wife, both of the Borough of Mount Holly Springs, Cumberland County, all of the Commonwealth of Pennsylvania; and ETHELDA G. STYDINGER and ~, her husband, both of the Borough of Cartsre , County of Middlesex, State of New Jersey, GRA NTORS AND ~ I , .J I " , ~ i ~ :! )\ .< ji . \' :) '( HAROLD E. BENSON, of the Borough of Mount Holly Springs, Cumberland County, and MERRILL G. BENSON, Of the Borough 01 Royersford, County of Montgomery, Commonwealth of Pennsylvania; as Joint Tenants with right of survivorBbip and not as Tenants in Common. GRANTEE I I: WHEREAS, the said MABEL GRACE BENSON died SeptelRber 4, 1974 I: Ii iI Ii I! ,. il Ii II ) . \ . l I .1 I . I I i I I .'. . intestate and letters of administration on her Estate were grant- ed to FRED L. BENSON, by the Register of Wills of Huntingdon County on September 21, 1971; and, REALTY TRA;~SFER TAX DISII.3~T fJ:::'~=:;ff.l.~ TAX PAID ~~.,,_ ./ . DATE II -f"" 7) ~ C?9tJ"dJ... CoU.clo< ~b~';~~'~;"'I,iilr ~ 0\,>'" \?;~tr; ,~ . ";'~'~,S r -' ... '." '_- .-~~:ni~lq r '1/."';"" n'H~I'.I\I-,;1j. . .... ...\ 11 ~ ~ " :/ { I \1 -' , , ~_. -.'.~. ,~.. .' ..'~. ._.~._,.....----.--,-,.~_.... . I 1 ,~ \ '.~ t (~) r ,d' ; oll-,!: , l:\( I SOOK 127 rAGEG21 WHEREAS the grantors berein being the administrator of her Estate and the surviving beirs of the said MABEL GRACE BENSON. NOW THIS INDENTURE WITNESSETH, that the said grantors, for and in consideration of the sum of ONE ($1.00) DOLLAR lawful money of the United States, to it in hand paid by the said granteee at and before the sealing and delivery hereof, the receipt whereof is hereby acknowledged have gn nted, barga ined, sold, aliened, released and confirmed, and by these presents, do grant, bargain, sell, alten, release and ,confirm unto the said I HAROLD E. BENSON, of the Borough of Mount Holly Springs, II I , ! I II il II II II Cumberland County, and MERRILL G. BENSON, of the Borough of Royersford, County of Montgomery, Commonwealth of Pennsylvania; ALL THAT CERTAIN piece, parcel, or plot of ground situate in the Township of Cromwell, County of Huntingdon, more fully described a8 follows: BEGINNING at a stone at land of Joseph Newman: thence North six degrees West twenty feet to a pine (gone); thence North twenty-four degrees and thirty minutes West one hunred ninety- eight feet to a black oak; thence North eleven degrees and thirty minutes West one hundred ten feet to a pine stump: thence North thirteen degrees and thirty minutes West two hundred forty- II "., ",' ,. · ,,,, ".." 'I I I I thence South six degrees and thence North twenty-one degrees and thirty minutes West one hundred eighteen feet to a stone at other land of EdSel Hamman; thence South seventy-six feet to a stone; thence South eleven degrees and forty-five minutes East two hun- , .i " dred f Uteen feet to a black oak; I 'f fifteen minutes East three hundred ninety-two feet to a white oak: thence North eighty degrees and thirty minutes East five hundred seventy-seven feet to a stone, the place of beginning. Containing seven and nine-tenths (1.9) acres. -2- I, " i ~ \ I .}. l J !, " \ , t. I ':1 \ I i I ,I \i .I ;'1 1- ~ , I", '1\ < J..... ,,, ~-': rri ~~i'-1-1:',1';-;;;:~.;-iJ:4 ::i.,~t')l1' 1,1.\'. J !;",'.',\ ",. 'IJ(,--"I" f'- ':~ Jll l-"'l"':. ""1;1 liqi'rr.'1..:tLloJ"IJ. (l~ fli.." ,< 1\' 1 '-'f:\~ f .,-. 1 . .: c.\. ~ ,.) t LJ ~'J : I , \ :'.\ L; "I ~, <~ ~. I , ".1 ~;" ~;t 1'_, ," ~ '.: " ~~ i , . \' BOOK 127 PACE622 having thereon a two story fra. house aud.o~tbuildlngs. BEING the same property title to which became vested in MELV1H \ ~ and MABEL BENSON, his wife, by deed dated JanUarY~943 and recorded in the Office of the Recorder of Deeds of Huntingdon I County on January 18, 1943 in Deed Book A; Volume 8, Page ~23. i'l I MELVIN J. BENSON died October 24, 1973 thue vesting full and Com. i I I plete title to the same 1'n his surviving wHe, MABEL GRACE BENSOH, the said MABEL GRACE BENSON died September 4, 1974 intestate and letters of administration on her Estate were granted to Fred L. Benson by the Register of Wills of 'Huntingdon County on September i " I: I' 21, 1971; the grantors herein being the administrators of her Estate and the surviving heirs of the said MABEL GRACE BENSON. EXCE1>l'ING AND RESERVING, HOWEVER, to BERLYN',W. BENSON the right ~ ,! ~~ t to use and occupy and enjoy the eaid premises for and during the term of his naturdl life at such time as BERLYN W. BENSON dies or removes fmm the property voluntarily or involuntarily, then all hiS right title and interest in the said premises shall ceaSe and terminate. TOGETHER with all and singular ways, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenancos whatsoever thereunto belonging or in anywise appertaining, and the reversions and remainders, rents, issues and profits thereof; and alos, all the estate, right title, interest, uBe, trust. p~?perty. possession, claim and demand whatsoever, in law, equity or otherwise howsoever, Gf. in, to or out of the same: 11 \1 -3- -~-----.-_..." _.'.,-.~,_._~ J . 'I., I ,\ .;,{ .fl .. .\: ,'.<'t , q " ;~ iH ., ,,' '! ;;l :~ , 'q II ,I I \ 1 ,/ :, I 'l J " )0 J f I I _...._-~,.._---.....................~>->,......-;......-..---~...... Il, IF .',,> '~'~ / '.":""1 , , I '---: :. t 1'11::\. J! ~ III ~ 'j \~, ....:,. t ~.~~>~ bOOK 12'7 PAGE 623 TO HAVE AND TO HOLD,' the .aid real estate heredita.ents and premlses hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto the said. HAROLD E. BENSON and MERRILL G. BENSON, as Joint Tenants with right of survivor- , " I ship and not as Tenants in Common, their heirs and assigns, to and for the only proper use and behoof of ,the said HAROLD E. ~ and MERRILL G. BENSON, thelr heirs or asslgns, forever. And the sald Fred L. Benson and Marlens Benson, hls wlfe' and Merrll1 G. Benson and Donna Benson, hls wife; Berlyn W. Benson, unmarrled; Viola R. Glunt and Wendell E. Glunt, her husband; and Harold E. Benson and Bonnie Benson, his wlfe and Ethelda G. I -f I; \ Stydlnger and Vernon, her husband, covonants, promlses and agrees \1 1\ \1 II I I \ I I I' ,\ \1 II 1\ I to and with the said HAROLD E. BENSON and MERRILL G. BENSON, their helrs and assigns, by these presents, that the said Fred L. Benson and Marlene Benson, his wife; and Merrill G. Benson and Donna Benson, his Wife; and Berlyn W. Benson, unmarried, and Viola R. Glunt and Wendell E. Glunt, her husband; and Harold E. Benson and Bonnie Benson, his wife and Ethelda G. Stydinger and Vernon Stydinger, her husband, hove not done, committed, or knowingly or willlngly suffered to be done or commltted, any act. motter or thing whatsoever Whereby the premises hereby granted, or any part thereof; ls, are, shall or III-y be impeached, charged or incumbered, in title, charge, estate, or otherwise howsoever, WITNESS the due executlon hereof the day, month and year flrst above written. (SEA L) ) (ilEA L) -4- .!._-- 1 0, J \ \ " .J ~ \ . I "\ I 'J j ~~ . \ , , ~ ~,~.... "~..,....._....--.... ~....4.-_. ._--'.-.....-----... c r i I I : I ~ ~ \~'t' , " ~,: ~ .;11 t? " ~ ;.\.i.1 ':' :."I"~ i.l>'" i.'J, 1;_ldlr~I,II"t ~",,) jl'\,' .hl'>I; .I,U h " .','-~' '1 'l) , ~ - I ; t, ~! l, ! (j ....t,i'.\ I, '..:.t :: p.> \! i.: !.'; ., r tJ \':".> '. ~ . U I i I ! T~:: \ !.,/'Ij: 1.);'::"1 bOtK 127 rAcEG24 ~t:~.d ~~r-rUSBAL err ." neon i. ': " :'. ,. , . I , I 1 ! , I" (SEA ) .) (SEAt \ I ",... ~.I 1- '. '~~," Vernon Styd1ng r (SEA ) t~ 'I ESTATE OF MABEL GRACE BENSON, deceased By:_i,AJ} t 11" .d'~ Fre L. Benson, Admin trator I I' I " I ~ hereby certify the precise res1dence of the w1th1n grantees is: lIarold E. Beneon, 224 Chester St., Mount Holly Spr1ngs, PennBylv8n18 17065 \ \ \,\ ~' Merr11l G. BenBon, 9th Ave., Royersford, pennsylvan1a 19468 ~~ ' ~ v: / :: 0 ney O~ee9 - I I :i " I \ i -5- ..-.-------_._-"~ . '.._ ._'.. ~.'J 1 ,( ;1 "j ,I J ., .1 '\ ~ " 'J :\ '\ I ~ I ~ , I , , \ I 1 \ \ \'- It:..' ~ - t .~'; 'J ." I"J...:/l') I bCK 127 rAcEG25 COMMONllEA LTH OF PENNSYLVA N IA COUNTY OF HUNTINGDON ss On tbis 3\~~ day of .:J ...J't , 1975, before me a Notary Public in and for said County, came the abo~e named FRED L. BENSON. Administrator of tbe Estate of Mabel Grace Benson, deceased; FRED L. BENSON and M^RLENE BENSON, his wife; MERRILL G. BENSON and DONNA BENSON, bis wife, BERLYN 'If. BENSON .; VIOLA R. GLUNT and WENDELL E. GLUNT, her busband, wbo in due form of law acknowledged the foregoing Deed to be their act and deed, and desired the same to be recorded as such. WITNESS my hand and official seal the day and year atol18said. >,~ It ,1/, '. ". " '~~;d\:'", ~~ ~~~ [L- ~~- ,,(si;:AiiL FlVA JA~If: POttIC1NO;':N~,',~"1I h. Huntln9dQn, ~!II"ljnOJJo" co 'p.: ~",\. '4 C ",. ~' . ,y olYtmlulo'l E.~irlll' Me"." '2'~ 1m . :"./ , 1\ COMMONWEALTH OF PENNSYLVANIA II COUNTY OF CUMBERLAND Ii II d " abofe named BENSON and BONNIE BENSON, his wife, who in 'I'i due form of law acknowletlged tbe foregoing Deed to be their act ! I: and deed, and desired the same to be recorded as such. I: " Ii I, i! " ! SS /?I. On tbiso?d' day of tf/07l11!,! IZ)Lr L. HAROLD E. :NL'1 , 1975, before me a in and for said County, came the WITNESS my band and OffiC~~' ~.:. ", "';; '~~:'~{;::~f. ft- ~'-:: (SEA)..), 111'-" " NUIArl't [1U3\1C ".; ':-,' '.~ My COfmnlnl"" [~"ho. ~"Y 1 To J?7. . . Ml "O;JIl1' 51""\&1 UUf(l. Cu,,,!,,,,I..,,d Co. 0 CJ' \ ~~! ~\ "'" -6- u .,~ I 'I ! \ !, \ , ,.~ " :1 ~ I " ~ r', I' I I I 'I I I Hof APPRAISAL OF THE PROPERTY LOCATED AT RD Three Springs. PA 17264 01/07/05 for: Merrill Benson 129 S. 9th Ave. Royereford. PA 19468 by: Date Signed: 0610312005 James Barlow HeR 71, Box 550 Orbisonla, PA 17243-9506 (814) 448-3349 APPRAISAL PARAMETEI&'CERTIFICATION STATEMENT PARAMETERS . Type of Appn.....: This is a Limited Appraisal (i.e., Departure is herein invoked, as below). . Type .fReport: This is a Summary Appraisal Report. (This report is... to be OOIlSlrued as a home inspectioo repon.) . Iwteaded 11M or lids AppraiSlll: This appraisal report is intended solely for the determination of market value of subject property for pwposes of estate SClIlement as ofD.O.D. ofd<<:edent. . Disdos.re ofCIie.t ud lattllded Vser(s): This report is intended fur use only by the Client(s) identified in the a=mpsnying report and any other User(s) specified by Client(s) at the time of acceptance of this assignment by this Appraiser. . Sc<Ipe aflllis Appn.....: Subject property has been personally inspected by this appraiser. External building dimensions of subject property at ground level and where otherwise read1able have been measured by this appraiser and are rounded up or down to the nearest foot fur plllpOseS of g.1... (gross living area) calculations and graphic depictions thereof, property sketches are bused upon deed maps or recent surveys where available, and where not are mostly bused upon county assessors' maps. Data have been collected from appropriate souroes and verified insofar as possible. However, configuration, dimensions and other details of comparable properties have in some cases not: been verified; Depanure on this point is. tberefure, invoked, as below. In tbese cases data are derived from county assessors' records., MLS records or other sources. Data from puhlic sources are assumed to be accurate; however, the IlCCW'IlCY of these data cannot he guaranteed. These data have been analyzed using accepted appraisal principles and practices. and the bestll11<lOt reliable data have been used to oomplete this assignment. In the Cost Approoch replacement-cost estimates are primarily bused upon data supplied by local oontractors; site valuation, as-if-vacant. in most cases is bused upon statistical analysis of recent vacant-land sales. On the URAR form where an entry for Condition is required, a nwnerical rating scale from 1-5 is utilized, 5 being the best and I the poorest. All three approecheo to value have been considered, and the values derived from the approoches herein utilized have been reoonciled to yield the best estimate of value. . Depa........I.voIoed: Specific DepartUres invoked in this assi@lU1lent include: a) Some data from comparable properties have not been verified; Departure from Standards Rule 1-4 . Hypodoetlcal C..ditiwslExtnonlillAry AH.....I'li-: Nt A . Type ofVelaeAppnised: Market Value (Source: 2005 USPAP, AO-22. p. 210): DdlnItJon: The most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller each. acting pnulenlly. legally and knowledgeably, and assuming the price is not affected by undue slimulus. Implicit in this definition is consu/'I'UfIGtion ofa sale as of a specified date, and the pa33ing oftirlefrom seller to buyer under conditions whereby: t. buY" and ",II... are typi<aIly _ivatod; 2. both pmties are well infunned or- well advised and lire &<:ring in what they 00bSidc:r their DWD be9t ~ 3. a reasonable amount of time is allowed for exposure in the open rnat'kd; 4. JllI)'ment is made in terms of cash in U.S. doIJars or in terms offinanciaJ arranpnents QOO1puab1e thcrc:m: S. tbe price n::pn:sents die normal COIISidemioo fix the property sold., unaffected by special 01" creative fiaancing or sales conccsstons granted by any puty llSSOCiakd with the sale APPRAlSER'S CERTIFICATION STATEMENT I cmi1Y ,1ttIt, lD 1M _ of"'" _..IIIUI b6Uf: (A) The statements of fact contained in this report are true and oorrect. (B) The reponed analyses. opinions and conclusions are limited only by the reponed assumptions and limiting tonditions and are my personal. impartial and unbiased professional analyses. opinions and conclusions. (C) I have no (or the specified) present or prospective interest in the propeny that is the subject of this report, and that I have no (or the specified) personal interest or bi.. with respect to the parties involved. Any exceptions to point (C) are as follows: I8lNt A Osee attached (D) I ha'Vc no bias with respect to the property that is the subject of this report or to the parties involved with this as!(ignment. (E) My engagement in this assignntent was not contingent upon the development or reporting of any predetermined results. (F) My compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value that favors the: cause of my Client. the amount of the opinion of value. the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended us of this appraisal. (G) My analyses. opinions and conclusions were developed, and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice, (H) No one provided significant real property appraisal ..sistance to the person signing this Cenification, except as may be noted. Any exceptions to point (H) are herein identified: NI A (I) I havel8llhave notOmade a personal inspection of the property that is the subject of this report, identified herein .. tax ~1l-16:2~:~nty: fum~ Slpetare:~~~ Date signed: 0610312005 James A. Barlow: PA Certified General Real Estate Appraiser, Certificate # GA-OOJ51 J-L ~"-~1AlI. _,\ ~Address_RE___ City_Three Springs ~_I'A ~~l 7264 LeqaI~ DeedR"f: ~b()ol</page or other): 127/620 County Huntingdon := ~9fi-la~plr:~!s2al-- --Merril;;::S-on -=-____ R.E T~=-~ -H-:~:"-I~:$jF PlqJertyr\lhtsappraised X FooSimple I.eosel1oId ~.!ype ~'PuD__----,C~(HlJOl'IAOIIttl___ ~ Neigh~NlIIl. Cromwell Twpo____ __ __ _Maplleleren,"___ COOsusTrect Sale Price $- -- - Date OiSaiO - Oesaql\ion and $ 8IMUIII ofioall ~Conces.i<Ins to be paid by ..... Lendertclient Me r-rTII-Ben son --AddresS ---i29" --'s _ -g-Ul---A ve ., -RO-yer-sf 0 rd ~- PA 1 94 6 8 Appraiser James A~ Barlow Address HeR 71, Box 550, Orbisonia, PA 17243-9506 LoceIion Urban _: Suburban ,X Rural _omInant Single ,"""Iy houIing _ _ ... % LIIld ... chango Bull up o..r 15% XC 25-15% i Under 25% occu_ PRICE AGE , One family 4 0 X' NoIli<eIy Growth role Rapid X ' ~ Slaw X . 0wf1er $(000) Low (yrs) 2-4 family In_ . PlqJerty v_ lnaeasing X'SllilIo DecIming Tenant High: Mulli-family DomlWldlSupply Shortage 'Y! In _ o..r '"PP~ Vaca>t (0-5%) P!OCkxnil1Mi II'!~ Commen:ioI Merketingtine Under3mosY::l-6mos Qver6mos. r--Vac.(over5%j Vacant .....: RiCllncliho~~ ofti.t.nlit~...not__tOc:iC... Neighborilood boundaries and dul'acteristics: _~~_~_~l C_~?~~_!~ Tw~ ~, _~.c:?9~_~_~~:un i t__~__._~._I!l~_~_~!)' _~~,c~t wooded/ CU~?V~:t:'_ ~~d ~G ~and _ ",-__r _~__~?~~~__,~_8_8:t:lmbl_~ge __Cl__~re~ide:nce~ _9fva:ried _~tyles/ii_(l~S' FIdOfs u.a.' aiii.Ci the maril8i8biity of Il18 ~ in the neighborilOOd (prox.nity to Sinptoj!ner1i.';,ianenllies. employment .tdY:-3iJpOOI- to market. e1c,): ~~_er~9~ __.for ,rur_~l m~~d:___~!l___':!_~~_t--.:__ ~~n._'__ ,_u ____ ,_,_ _n____u__ _______n_n__________ ____ ______ '__n___ __ MarkOt condilionsin the 5;;bj..:i n<iighborilOOd (InCluding 5lIppOft frx the 3Iiove conclusions _to tile treOd of property ._, dem-...pply. and marketing time.. such as data on compelilivo properties for sale in the n8gh_. overage ___ing ptico ratio. doocripIion of the pI8Y8Ierloe of _ and Iinencing _, e1c,J- R~_!~_!:~__~lOW' m!:.~. activi ~X for county. Values conclu~ed ~~\:)e lo~_=-a_~~~___~~)l:: ru~~l__ mxts. in Hunt. Co. PiqoOtTntOnnollon for PIlot . (W ~1..1l18 ~~inOOOirolQi"", Hon..o.--AmC~, IHOAji- Yes f<ppnlximol8 _ number 01 units in the subject projocI Appr1lxinlale _ number of units frx saIo in Ihe .ubjecl projocI _ common _enls and rllCIOlfu1allacililios: Dimension. . T 0ll0lIf3llhY SiteiW88 1.9 ae. No Size Specific zoning c:IaeificeIi<xl and doocripIion , SlIapo Zoning Complilolce ,__ LeqaI Legol nonconIonning (Gra1dfaIherod use) No zoning , Olainege H. _&~tuse_@3_~~_~__~~~____ '--_:Q!:h<<1M1~_L____ _~VIf1W U_ PuIiIic 0Ih0r Off-silo improvements Type Public PrlvIllO LandscapIng Eloaricil"j :~:: ~ Strool Gravel -j{ nn-ey Surface Gal Curtllguller :1\pperont8llSefllOl11> W.. Dev - s~9o:-.2 ~alk FEMA ~ F100d Hezanl Anla SoniIiwys.<< ___. Septic ,S_ighls ~o FEMAZone ~_____2____ ,_~ _ ____ .FEM~JAap!lJ!. Comments I_I -.. _enls, encroachments. .peciaI........ents. slido _, illegal.. ingaI 00IIt<llIi0Imin zoning, use, etc.): private R/W--maintenance liability. GENERAl-IlESCRIPTION--- -EXTERIOR DESCRiPTioli- No. of Units UnlivableFoundatioo Unlivable No,ofStorios ExtericxW. Type (tlelIAlt.) RooISurface Design (Styio) . G<rtt8s & DwnsplS, Existing/Proposed Window Type /\go firs.) Storm/Screens E_1Ige firs.) Menufoctured House ROOMS-Foyer living Din"i Kicherl Besernont L_1 L_2 o Bedroom(s); BaIh(.); 0 HEATING KITCHEN EOUIP. ATTIC AMENITIES Type _jRefrigorat.. None !FifopIece(.), None 'Fuel RalgtVOvon I,S1aiIs Polio Glrege Condition - - Disposal 'Drop Stair DocI< AIIacherl COOUNG--- llisIIw_ScuttlePutil IletacIled . Central FanlHood !FIoor Fence Buit-in 0Ih0r Microwave HooIod 'Pool _ Carport Condition WastwlOryef Finished ,--- - I Driveway Mition8t4e8tures{spedalenetgyefficientems, etc.) Ne~_~~_x_~--=~~_re___tra~~__ _~n u.se_<?luded __setting._ _",{ fun?t~onal septic B ys t_~_~~~(i ___~~.?_~~_~._ sP.r:_i_f!_g:3__~(_~_C:?c:1__.!a t~!X _~e~en t- old 1_9~~ ~ _ g_~r~q-e/~h-~d -~( r~~gh_--bo-ard exterior). (Residence is unlivable--see below.) -- --- - --.-- -- -- - -- --- Ilen -, FOUNDATION ~ Unlivable Crawl Space Basonront , Sump Pump OlIIlpness SetItomont Infestltion , FaroNy Rm, : R.c,Rm. --t .---. - Bl.SEMENl I Anla Sq Fl .'II.F"1Ilished Coiling Wells -'Floor OUtside EnIiy ________, ___L,u__ F_...._grade_: SURFACES _Condition Floors Wills TrimlFinish BaIh Floor BaIh WeinscoI Ilonrs o Vacenl lMo. likely ~.NO-- Yes ----, xTNo Map Dale Access via shared , INSULATION unl i va~_le_; Roof Coiling Wills : Floor None U"""",", laJncl:Y 0Ih0r AreOSq, FI o .00CIlIS CondIIionoflheim_ts, deprecialion(p/lyslcal. functional, and Ol<lernatl. '"P3irs_.qualityof_, llIC: Residence is unli.vable as ~_~.:._. rO_~_!__~.~~~~L_ fur~~~!:_.__~?~~u_n?_!:_ ~~rk, .p}._~_~i_~_9_m~_oes nOt:_~o~~.~_~a_~__s_fye _ ~V:~~~ll~~-~~-~fe-r-red maintenance in and out-~adjudged to be totally depreciated--N/v. Access via Shared-private il w-=-~~~=~'~~~n-anc-e liabii_~_!:}'-:-------m..--.. ------.. - --- Adv<<seen'lil'mmflntell oonditioM (such as, but not limited to, haurdous wastes, ~OJ;ic substMces, etc.) present in the improvements, on tJMt site, 01 in lhe immediate vicinity of Iht subject property.: !_~~ ap~!~.!:~~-=.__~__ not _ awa re _!?_~_~~l...,-~_~ta~inan t~~~~n_~~~d~Eg lE!_~_~_~~~~~s tOB, toxic mold, etc., on the premises and is not qualified to determine if such do exist. J..... _ (814) 448-3349 Page 1 Frmio Moo Foon 1004 6-93 ESTIMATED SITE VALUE. . ESTIMATED REPROOUCTIOO COST.NEW-Qf IMPROVEMENTS: Dwelling 0 Sq.FI.@$ 0 -$ Sq.FI.@$ ~caport ... sqFt@T ToIlII es_ cOSt NeW.. - $ L.... Pllysical Func:tional Extemal Dopreciation . .. . _ . $ DepociaIed VaIU. of liiiPiMiiienis . - $ 'A$-is' Value of Site inIprowmenIs - $ IHDtCATED VAl.UE BY COST APPROACH. . .. .. .. .. " . . - $ CornmOOtSoo eo8t ~iSUCil.., .oon:eOtcost_lIl8,'Sii. vakJO, iCIi cak"laliOi'Md roitiuo, VA lIld FmHA lI1e_edllVll8ining ecooam~ ifeofll1e pIqB1y). SITE VALUE: $32,000 E_~~.___Of S_~!_~ __Y~l-~~_n~~_~e-dl1po~__,s_t_~~i-~jIca~_~_~~y~__~~__?f 1~_3_~~e_~~~__ land sales (re: data s'heet), w~iCh- ind~~~~~_a_Mean valu~__o~_ $32,000 for 8.2-ac. Mean size. -$ 32; 000 of_~e~_~__~E:!_:':_' sprgs. andq~rage/shed included---un-der Site I_mpr. Springs '$ T OESCRIPTION -OESCRIPTlOO _-="t)$~'-_ OESCRIPTlOO --~._lf~~~t-+- "DESCRIPTION. _~~~}-S~ Fee~__~III:P_l~. 7.9 ac. 1. 5sF IB UNLIVABLE ,(jLD UNLIVABLE '-ToIlII ,. Br IlaItIs 'TOtaI Br IlaItIs , 'TOtal' Ilf B8ttls -" ~"':'Br_.1laItIs o Sq. FI. Sq. FI. Sq. FI. Sq!1. Net A.t(~)_ Adjuote<I SaIeo PTiC8 of~~_ $.._. S Canm...IsOflSaleoCompooison (includingll1e.utIjeclplqB1yCOOlpalil>illtytoll1ene;ghlxlfnooo, etc.): Milt. data "nal'{zed above under Cost ~PP~_,?a_~J:1~_ thi~__~_pf>_~?~~~ to val~~ _~:>_.~ncluded to be i~~pp_li~~t::>ie. ITEM SUBJECT COMPARABLE SALE NO. 1 COMPARABtESALE~ NQ 2 Da8,ririceJl1<lData . Soorce Ie< prior_ __ yrot~eis8I.~m_.n_.__u._..._......_..__.__...... ___. _'.. __....~ AnllIysio of...y CUtTeI1t _ent of sale, option. or listing of Ill. subject _lIld;o18ys~ of any prior _ of SilbiOct Oiid COOl~ .iII>~';;;. yo&' Oia.;p;~ Average INDtCATEIIVALUEBVSAUSi:OiIpARiiiONAPPROACH, , , , . ::. .: . . . , , , .:. . IIIDICATED VALUE BY INCOME APPROACH (If~) Estimated _01 Rent $ N I A This IflIII'IisaI is made X as ~ ,.l'.. subject 10 repairs, _, inSpections or con<itiOfIs Iited bOIow COl1l:ilions of AppraisaI~ N()personal_~__~op~~_~y _ is tt~r~in_aPl?rais~d. Harold Benson); -inspection compleLed 05/19/2005~- - - F~Reconei8bOn;--- - co-st-- App roa-cii nto--';a 1 u-e i g---c>-niy'-apPl--i cab le--appr oa ch, yi eldi-r;g :--$ 4 0, 500 - $ COMPARABlE SALE NO. 3 ,. . ..... " , . ...... .' ".... . .$ N/A IMo.XGIoosRentMulliplier N/A =$ N/A i subject to completion per plans lIld specifications ~pp~~~sed as of 01/07/05 (~.O.D. of F_ Mac Form 70 6-93 J"".. _ (814) <<3-3349 Page 2 F_ Moo Form 1004 6-93 The purpose of Ihis awaisaI is to..Iinai8~ llI8rkol v'*"' of II1e re8i~ ii1atiSlI1e....tijOCtoflhiS~ b8SOdonlli.ablH; COOditions-Md-uMl~, ~t ondliniting condiliono, an<! !l\8ll<lIt__lhaI are._ in Il1e _ F_ Mac From 43!l1F...ie Mae 10048 (Revised N/ A ), I lWEI ESTIMATE THE MARKET VAlUE, AS DEFINED, OF THE REAl PROPERTY THAT IS THE SUllJECT OF THIS REPORT. AS OF 0. 1 /07 /05 {WHICH IS THE DATE OF tN9PEGlIO!l AND THE EFFECTIVE DATE OF THIS REPORT) TD BE S 40., 50.0. ;'SER _ _ --=-~~_ __ ~:::SORYAPPRAlSER(OKLYlfREaUIRED) Nane James A ~ Bar low Name -'-----.'--,.- Dale R8PCrt,SigI1Od-06/o372o() 5 Date~~~ Slal8C~' GA-QQ-1511-L Stale PA StateCertiIicaIion'______ _________ ~ SbD licenH-,--- ----,----. - State or StIie LicenSe' James _ (814) 443-3349 P8IJ'l3 Did ' DidN"" Inspect ~ Stale Stale F_ Mae FOIm 1004 6-93 Tn panel 110 SlIIuIaIe Sale price ACBES HlUIL 4< FaIL C.... about 8.0 aCo 03-02-033 03-02-033C 03-11-009 05-19-007 08-08-060B 09-10-008 10-02-037 10-02-0430 11-07-017H 11-11-09.17 23-02-06.10 23-02-06.6 23-07-04.13 38-05-64.22 45..o3A-14 50-02A..06 50-02A- 55 50-08-10.4 3/03 4/03 5/03 12/03 2/04 6/03 10/03 5/03 4/03 3103 10/03 2103 8/03 10/03 6103 7/03 10/03 5103 $29,000 $29,500 $29,500 $40,000 $30,000 $25,000 $38,000 $33,500 $29,000 $25,000 $39,500 $58,180 $25,000 $30,000 $22,000 $31,000 $28,000 $35,000 6.65 6.71 8.9 10.36 9.87 9 10.39 6.23 8.76 10.39 6.97 9.55 7.18 7.73 6.48 8.25 6.52 7.63 COUNT: 18 AVG: AVG: $32,066 8.198333 MIN: MIN: $22,000 6.23 MAX: MAX: $58,180 10.39 STD: STD: $8,012 1.447194 lender/Client Borrower Property Add..... County Merrill Benson Legal appraisal RD, Three Sprinqs, PA Huntinqdon Front VI_ of Subject Rnr V'- of Subject Street V'- lender/Client Borrower Property AcIcIreh County Merrill Benson Legal appraisal RO, Three Springs, PA Huntingdon Garage III (I~.XI)" r~F\' ')/<;1; This is to certify that the information here given is correctly copicd from an original certificate of death duly filed with me as Local Registrar. The original certificate will he forwardcd to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fcc I'm this certificatc. $].00 ~\I;";I(~{l~'ol:fEl~~ 1.,.~~ ,'4'~"", I~\ ~~ ' ,(.I~\\ }~l ~~\~\ ~.:FjJ. ""~. ',~% (~~'~, ,~l ~ a,'\;... -~ - . ./~/ ~~~,,'-~"- ..-,/~/ ~--_-?!I/ifE/I-T \\\ 't."-;~, ......... 1 11"/ .-,.-":!!!!~ .:.~ Ij 1>""0"7981 J1. 1. . No. ~'''N! (:\.~....~ ~~..~~ Local Registrar JAN 1 () 2005 Date '" = c.~ <:..<1 <- c: ,-- N 0"\ C-) '-i'!1 -11 (') 'r! -TJ r"f1 ;: ..., (:) i~~ "---../ -0 -"'," <::) N H105,144Re",1191 CDMMONWEAlTH~EINNSY~Nf ~~~T~ JEAlTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) TYPE/PRINT 'N PERMANE'NT BLACK INK SEX 2. Male E \JHOE'R1D/IIII Hours Minule! SWE.FILEl'NMBER socrAL SE'CURITY NUMBER 3. 177-32-8567 OATE OF OEATH (Month, Day. 'Mil,) .. January 7, 2005 BIRTHPLACE' (CiI)' end PLACE OF DEArH (Chock only one sell illSll\lC1ions on alher side) Stale Cl( FCl(llIQn eou"lry) HOSPfTAL: untington CO. _"",0 ... and number) ::/Y)D ~ ~ ~ Gunshot to Head DUE 10 (OR AS A CONSEQUENCE OI')' OUEIO (OR ASA CONSEQUENCE OF): DUE. TO (OR AS A CONSEQUENCE ClF't- , WERE AUTOPSY FINDINGS Ml\.A8LE PFlIOR TO COMPLETION OF CAUSE OFOEATH1 MANNER OF OEJUH o o ~ NlllUrlll I-lomlcide ",0 Accident P8ndioglnvesllg.l1tion No 0 SuI<lid8 ... Could nol bodel,rmined 288. Db. CDITIFIER (Chac:k ClI'lly one) 'CEflTIFYJNG PHYSICIAN (PhySiClen C8l1l1ylr1g cause a! death when IInalt1e1 p/1y~ician hes prooounClld d6llth ardcanph,.led Item 23) Toltlebeetolmyk~,d..thOCClUrreclouetothl!lc:euu{!I.ndme",,",r..e~,... ffi @ ~ C ~ ~ ~ 'PRONOUNCING AND CERTIFYING PHYSICIAN (l'hy6lcian 00111 Plllr100nclng ~th and ca<tily;nll to cause 01 dOOIh) To... befi 01 Illy knowledge, dealt! occurred lJt Ih.tlme, oate, and piKe, end du.to tho o:aIi88{l}tnU __uPobrttrd.. .ME'DICAL EXAMINERfCORONE'R On the bM~of 1.lrnl"lIIlon and/or InvellllQlIIlon, ",my Oplnlaa, cItlath occ.UITI!Id.t \h1ttlme, d8te,.rul plBee, and due 10 the cau..(e) and m.IlI~.r.'III.ted,. ...........,.. ............,..... ................. 31e. REGISTRAR'S SIGNAT'UREAND NU ~111d.t 1101 RACE.Amerlcanlndi~.B~,~.1Ic (Speeily) white ". SURVIVING SPOUSE (l'willl.givemaidllOnamCj "" """""" t.Holly Springs,PA17065 21d. NAME AND ADLlRESS OF FACilITY gJlingerF.H.&CrernatoryMt.HollySprings,PA UCE'NSE NUMBER DA1E SIGNED (Month. OaY. Year) 23b, 23c. WASCASE' REFERREDlO MEDICA.L EXAMJNERlCORONER? v..XJ No 0 ". '~\rna\e ;11l\"rvalbelween lOl'1Hlal'lddHlh PlIlRTlI: OIh"fsigll;fl<:DnlcondRlonsconlrlbullnlllodeatlt.blJl not relJuIUnglfllhl!lundflrlylngcau..gty"fll!'l PflRTI TIME: Of INJURY DESCRIBE' HOW INJURY OCCURRED gunshot- PA 2005 ~ ". DAfEI=ILED\Monlh,Day,)'earJ~ I 34. ~\\~ \0, ;;),()05" COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX111-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005615 BROWN EDWARD M 225 WASHINGTON ST HUNTINGDON, PA 16652 ACN ASSESSMENT AMOUNT CONTROL NUMBER _n_~___ fold .--------- ----~--- 101 I $2,314.20 ESTATE INFORMATION: SSN: 177 -32-8567 I FILE NUMBER: 2105-0661 I DECEDENT NAME: BENSON HAROLD E I DATE OF PAYMENT: 07/26/2005 I POSTMARK DATE: 07/25/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/07/2005 I I TOT AL AMOUNT PAID: $2,314.20 REMARKS: CHECK# 2474 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS