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HomeMy WebLinkAbout10-13-05 " REV -1500 EX + (6-00) .. I I OFFICIAL USE ONLY I i I i 100198 . ~...... ~ .w lII:::CII) uii!>:: wl>.U :coo uO::..J 1>.01 I>. 0( z o ~ ~ ::l l- ii: .< o W 0:: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER FILE NUMBER II 05 COUNTY CODE YEAR SOCIAL SECURITY NUMBER I- Z W o W o .W o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Speck, Mary A. DATE OF DEATH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN D~PLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 176-26-1712 DATE OF BIRTH (MM:DD,YEARJ: 01-17-2005 07-14-1933 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) [!] 1. Original Return 04. Limited Estate [!] 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o o o o 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 1 o Spousal PovertvCredit (date of death between . 12-31-91 end 1,1.-95) 2. Supplemental Return o 3. Remainder Retum (date of death pri(Jr to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit IBoxes D 11. Election to tax under Sec. 911 a (A) (Attach Sch 0) I- Z W o z 2 II) W 0:: 0::. o U NAME Jan M. Wiley FIRM NAME (If applicable) Wiley, Lenox, Colgan, & MarzzaccQ,P.C. TELEPHONE NUMBER 717 -432-9666 i'~' 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 0 Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) OFFICIA~ USEOfft. Y , ) ".1 t I _J .,..'~' ~ '-1- -. u' 432,876.48 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11) 83,649.63 349,226.85 345,618.81 3,608.04 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been m~de (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SiDE FOR APPLICABLE RATES (13) (14) 15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) or transfers under Sec. 9116(a)(1.2) z 0 (16) ~ 16.Amount of Line 14 taxable at lineal rate 0.00 x .045 ~ ::l l1. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :E 0 0 18. Amount of Line 14 taxable at collateral rate 3,608.04 .15 (18) >< x ~ 19. Tax Due (19) 0.00 0.00 0.00 541.21 541.21 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00; . ~. . 3. Did decedent own an "in trust for" or payable upon deaih bank account or security at his or her death?........ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?... ................................................................... ................... ..................... ....... [!] 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RaTURN. Under penalties of peryury, I dedare that I have examined this retum. Induding accompanYIng schedules and statements, and to the best of my knowledge and belief, ~ is true, correct and ~Iete Dedaralion of preparer other than the personal representative IS based on all information of whIch preparer has any knowledge \ SI~"'ATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE \ J n Hey 130 W. Church St. '^^-..-~ . DiIIsburg, PA 17019 - ,/-(/.:;,- TURE OF PERSON RESPONSIBLE FORFI G RETURN ADMESS DATE 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 valueoftra [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exempt.a transfertb aSlJrviving spouse of assets and filing a tax return are still applicable eilenifthe sOniilfing spouse is the only I 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 yean natural parent, an adoptive parent, or a stepparent ofthe child is 0% [72 P.S. ~9116 (a) (1 lhe tax rate imposed on the net value oftransfers to or for the use of the decedent's linea 99116 1.2) [72 P.S. 99116 (a) (1)]. . . Decedent's Complete Address: STREET ADDRESS 10 Ridgeway Drive CITY Carlisle STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 0.0-0 Total Credits (A + 8 + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the differenCE!. This is the OVERPAYMENT. (4) Check box on Page 1 line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (S) A. Enter the interest on the tax due. (SA) . . B. Enter the total of Line 5 + SA. This jstbe BALANC.EDUE. (S8) . Make CheckPayabletb:R'E:GISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUE5TIONS BY PLACING AN lOX" IN THE APPROPRIATE BLOCJS 1. Did decedent make a transfer and: 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;.................................... c. retain a reversionary interest; or...... .... .............;...................................... ................................................ .... d. receive the promise for life of either payments,b~nefitsor care?............................................................. 2. If death occurred after December 12, .1982, did decedent transfer property within one year of death without receiving adequate consideration?........ .c......;;........ ;.'; ....;...;; .... ...~.... ............;...... .... ................ ......................... .... Yes 8 8 ~ .-;" : ,- w ADDRESS 130 W. Church St DiIIsburg, PA 17019 N~-PD -.J '. Ausr 541.21 0.00 541.21 54 L 21 o o No ~ ~ [!] [!] [!J [!J DATE /0 -II-():s~ :JGuse is 0% for disclosure use of a , 72 P.S. The tax rate imposed on the net value of transfers to or for the use ofthe decedent's siblil bling is defined under Section 9102, as an individual who has at least one p.arent in common with the decedent, wnetner DY 01000 or acoption. . SCHEDULE A REAL. ESTATE 1~ I I I I I , . Rev,1502 EX+ (6:98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAA RETURN RESIDENT DECEDENT FILE NUMBER 21-05-00198 ESTATE OF Speck, Mary A. All real property owned solely or es . tenant In common must be reported et fair market value. Fair market value is defined es the prtce et which property would be exchanged between e willing buyer and a willing seller, ne~her being compelled to buy or sell, both having reasonable knowledge of the relevant faels. Real property which Is Jolnlly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION Sale ofreal estate situate at10 RU:lgewayDri~ejCarIiSle, PA, and tax proration due estate: VALUE AT DATE OF DEATH 160,085.51 TOTAL (Also enter on Line 1, Recapitulation) 160,085.51 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) I" Rev-1508 EX+ (6-98) *' SC"i:DULE E CASH,BANKPEPOSITS, & MISC. PERSONAL PROPERTY. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Speck, Mary A. FILE NUMBER 21-05-00198 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolnUy-ovined with the.rlght of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Adams County National Bank CO##149051: VALUE AT DATE OF DEATH 10,015.31 2 Capital Blue Cross (refund): 371.98 3 Capital Blue Cross (refund): 371.98 4 Cash found in decedent's home: 44.00 5 Central PA Conference United MethodistChufch: 20,235.78 . 6 Citizens Bank Checking #6100747271: 8,415.45 7 Citizens Bank Checking #6101199065: 11,937.82 8 Citizens Bank Savings #6140744883: 30,090.30 9 Citizens Bank Savings#614078020~: 10,025.26 10 Comcast (refund): 3.36 11 Haar's Auction (sale of personal property): 43,709.00 12 Income Tax Refund Check: 349.06 13 Kemper Insurance (refund): . 330.00 14 Legg Mason Individual Retail Account#363~04055-16: 59,361.07 15 PNC Bank Account #5003965353: 15,203.47 16 Prudential Financial Account #00047604048: 3,687.22 17 Second Hand Boutique (sale of clothing): 31.20 18 Sprint (refund): 20.80 Total of Continuation Schedule(s) See attached page TOTAL (Also enter on Line 5, Recapitulation) 214,426.89 (II more space is needed, additionill'pag:es 01 the same size) Copyright (c) 2002 form software only The Lackner Group; Inc. Form PA-1500 Schedule E (Rev. 6-98) r I I Rev-1508 EJ(+ (6.98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued COt.t.tONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT FILE NUMBER 21-05-00198 ESTATE OF Speck, Mary A. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 19 Sprint (refund): 20.81 20 The Bon Ton (paychecks): 203.02 TOTAL (Also enter on Line 5, Recapitulation) 214.426.89. Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) y ~ev-1/j10 EX+ (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC.NON~PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERlTANCETAX RETURN RESIDENT DECEDENT ESTATE OF Speck, Mary A. FILE NUMBER 21-05-00198 This schedule must be completed end filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERlY . . INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 .,' -",- .. ","\.; :-. . Legg Mason IRA (Beneficiary: YorkSpririg'sJJM Church): . . 2 PNC In.vestments/MetLife Investors Annuity- Account #78694181 (Beneficiaries: 88% to York Springs UM Church, 4% to Patrick Lee Williams, 4% to Adam B. Williams, 4% to Alicia J. Williams): 3 Western Southern Life AssuranceCompariy' Annuity (Beneficiary: York Springs UM Church): TOTAL (Also enter on Line 7, Recapitulation) DATE OF DEATH % OF DECO'S EXCLUSION VALUE OF ASSET INTEREST (IF APPLICABLE) 13,297.04 30,067.04 15,000.00 (If more space is needel;!, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. TAXABLE VALUE 13,297.04 30,067.04 15,000.00 58,364.08 Form PA-1500 Schedule G (Rev. 6-98) Rev-1502EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Speck, Mary A. ITEM NUMBER SCHEDULE H-A FUNERAl EXPENSES continued FILE NUMBER 21-05-00198 1 Cocklin F'uneral Home: DESC~IPTION . Copyright (c) 2002 form software only The Lackner Group, Inc. Subtotal 11 AMOUNT 12.012.18 12.012.18 Form PA-1500 Schedule H-A (Rev. 6-98) REV-1151 EX+(12-99) ESTATE OF . r I \ I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT . . . . . "' . . SCHi;DULI! H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Speck, Mary A. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-05-00198 ITEM NUMBER A. . FUNERAL EXPENSES: B. DESCRIPTION AMQUNT See continuation schedule(s) attach.ed 12,012.18 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Rer)fl!sentative(s): Street Address City State Year(s) Commission paid See continuation schedule(s) attached Zip 21,625.00 Attorney's Fees See continuation schedule($)attach~d 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 21,625.00 2. City Relationship of Claimant to Decedent State Zip 4. 427.00 Probate Fees See continuation schedule(s) a.ttached' 5. Accountant's Fees 6. Tax Return Preparer's Fees See continuation schedule(s) attached Other Administrative Costs See continuation schedule(s) attached 500.00 7. 25,219.61 TOTAL (Also enter on line 9, Recapitulation) 81,408.79 Copyright(c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule.H (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-B1 PERSONAL REPRESENTATIVE'S COMMISSIONS continued . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Speck, Mary A. ITEM NUMBER 1 Jan M. Wiley (Administrator): Copyright (c) 2002 form software only The Lackner Group, Inc. DESCRIPTION FILE NUMBER 21-05-00198 Subtotal AMOUNT 21.625.00 21.625.00 Form PA-1500 Schedule H-B1 (Rev. 6-98) .. 11 I I Rev-1502 EX+ (6.98) . SCHEDULE H-82 ATTORNEY'S FEES c<:)('t~it1ued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Speck, MaryA. FILE NUMBER 21-05-00198 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 The Wiley Group: 21.625.00 Subtotal 21.625.00 Copyright (c) 2002 form software only The Lackn.er Group, Inc. . Form PA~1500 Schedule H.B2 (Rev. 6-98) Rev,15D2 EX+ (6-98) . SCHEDULEH-B4 PROBA'fEFEES continued COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Speck, Mary A. FILE NUMBER , 21-05-00198 ITEM NUMBER 1 DESCRIPTION Register of Wills (probate and shortcerts~): AMOUNT 427.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Subtotal 427.00 Form PA-1500 Schedule H.B4 (Rev. 6-98) ReY.1502 EX+ (6.98) ESTATE OF ITEM NUMBER 1 2 3 4 5 6 7 . SCHE,QI.fLEH-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Speck, Mary A. DESCRIPTION Commissions, Fees, etc., from sale of real estate: Cumberland Law Journal (advertise estate): Department of Revenue (Form 1040 - tax.du~): . , . . Haar's Auction (commission.. sale of pe..sonalproperty): PA Dept. of Revenue (PA Income Tax): Paul & Betty Herr (sale help): Register of Wills (filing fee): 8 The Sentinel (advertise estate): . Copyright (c) 2002 form software only The Lackner Group, Inc. . FILE NUMBER 21-05-00198 Subtotal 11 i \ AMOUNT 13.790.78 75.00 578.00 9.742.25 164.00 648.10 30.00 191,48 25,219.61 Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) *' SCHEDULE I Di:BTSOFDECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Speck, Mary A. Include unrelmb\lrsed medical expenses. ITEM NUMBER DESCRIPTION 1 Andora Radiology: 2 Bronstein Jeffries: 3 Capital Tax Collection: 4 Eckerd DrugStore: 5 Kemper Auto & Home (insurance): . 6 Med-Ed: 7 SMTMA (municipal authority): 8 Spring Road Family Practice: 9 Sprint: 10 UGI Utilities: FILE NUMBER 21-05-00198 TOTAL (Also enter on Line 10, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. VA UE AT DATE OF DEATH 309.65 122.11 13.37 47;66 780.50 145.81 99.00 47.75 49.67 625.32 2,240.84 Form PA-1500 Schedule I (Rev. 6-98) 11 1 REV"1513 EX+ (9.00) *' SCHEDULE .J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Speck, Mary A. NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers' under Sec. 9116{a){1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee s FILE NUMBER 21-05-00198 SHARE OF ESTATE AMOUNt OF ESTATE (Words) 1$$$) EST A TEOF I. See attached schedule II. Total 3,608.04 Enter dQllar amounts for distributions shown above on lines. 5 through 18, as appropnate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS:' A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See continuation schedule(s) attached 345,618.81 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 45,618.81 Copyright (c) 2002 form software. only The Lackner Group, Inc. Form PA.1500 Schedule J (Rev. 6-98) ESTATE OF: Mary A. Speck 176-26-171201/17/2005. .. Item Name and Address of Person(s) Number Receiving Property 1 Adam Bradley Williams PA 2 AI.icia Joelle Williams PA 3 Patrick Lee Williams PA SCHEDULE .J BENEFICIARIES (Part I, Taxable Distributions) Relationship Nephew Share of Estate (Words) Nephew Total 1 r Amolilnt of Estate ($$$) 1,202.68 1,202.68 1,202.68 3,608.04 ~ev-15D2 EX+ (6.98) SCHEDULE ~-IIB CHARIT ABLE. AND GOVERNMENT AL . DISTRIBUTIONS continued * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF . Speck, Mary A. ITEM NUMBER DESCRIPTION 1 The Crippled Childrens Hospital- Penn Statef'ersheyMedical Center: 2 The United Methodist Home For Children.: 3 York Springs United Methodist Church: Copyright (c) 2002 form software only The Lackner Group, Inc. FILE NUMBER 21-05-00198 Subtotal AMOUNT 96.954.27 96.954.27 151.710.27 345.618.81 Form PA-1500 Schedule J-IIB(Rev. 6-98) l' fLittsllfill crn.a {I[eslcrm:eut OF MARY A. SPECK BE IT REMEMBERED, that I, MARY A. SPECK, of 10 Ridgeway Drive, Carlisle, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publi$h and declare this as and for my Last will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath as follows: (A) Thirty-three and one-third (33 1/3%) Percent thereof to THE CRIPPLED CHILDRENS HOSEITAL, Elizabethtown, Pennsylvania, absolutely; (B) Thirty-three and one-third (33 1/3%) Percent thereof to THE UNITED METHODIST CHILDlRENr S HOME, Mechanicsburg, Pennsylvania, absolutely. WITNESS: .....-.... ~ dc~hIL {SEAL I MARY. C -1- 11 \ ! (e) The remaining Thirty-three and one-third (33 1/3%) Percent thereof to THE YORK S~RINGS UNITED METHODIST CHURCH, to be used for their general purposes, absolutely. ITEM 3: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the ~ transfer of r , any property pass1.ng hereunder or otherwise passing by reason of my demise,.may be subject and to dharge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross esrtate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the pe~sons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 4: I appoint CITIZENS BANK, as Executor of this my Last Will and Testament. ITEM 5: I direct that my Executor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ 7 f-h day of Aut} tis-+- , 2002. WITNESS: ~a'~EALI MARY SPECK~ -2- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK We, MARY A. SPECK, JAN M. WILEY, ESQUIRE and SH$RRY A. FITZKEE, the Testatrix and the witnesses respectively, whose names are signed to the attached or foreg~ing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testa~ent and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last Will and Testament as witness and that to the best of their knowledge the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this ~7~~ day of A";i "rf ~1i;;'002. ~~ NOTARY PUBLIC MY COMMISSION EXPIRES: Notarial Seal s. DDallwo Gladfelter, Notary Public Isburfj Boro, York County My CommissIon Expires May 11, 2005 Member, PennsylVania Association of Notaries '-' w.." i-..,J i-.UW~ .ll...' -;, r ',WI I. UWI ',--HI'! hHK II'IHI'J rlrc:''-!':::Jrbl/Jl<'J I U:(1 (4~~c::'i/}4c'b 11 \ P.2/5 A. SETTLEMENT STATEMENT U.S. OEPARTMENT OF HOUSING AND URBAN DEVELOPMENT OMB No. 2502-026 B. Tvoe of Loan 1. gFHA 2.. DFml1A 3. 0 Cony. Unlns. ..1 6. File Number: 17. Loan Number: I B. Moltgage InsL~nce Csse Number: 4. OVA 5. 0 CorlV. Ins. RE05.131 014$225082 C. NOTE: This form i,l furnlshea to give you a statement of actualllettJement costs. Amounls paid 10 and by tho soltlement agent are shown. /lemll marl<ed "(p.o.e.)" were paid outside \ha closing; they lire shown hate for informatIonal plJr~<!la and are not Includod in the totllls 0, Name and Addre" or Elorrowor{s): E. Name 11M Address of Seller{e): ! Michael K. Gener Estate 01 Mary A. Speck Julie E. GOIlOr Jan Wiley, Administrator 3240 R Street NW 10 Ridgoway Drive Washin!lton DC 2000.,. Carlisle. PA 17013 F Name and Address of lender: G. proposty Location: WeUs Fargo Bank, N.A 10 RidgewIIY Drlve. Cartilile, Penn3ylvanla 17013 SOuth Middleloll Township. Cumberland Counly 7485 New Horizon Way 40.24-0748-008 Fredl)tick, MD 21703 Place of SelUomont H. Name of Settlement Agent 1 Irvine Row, CarliSle. PA 17013 Dun~n & l1artrnan. P.C. I. Settlement Date. Funding Dale' 13-24.20Q5 6.24.2005 J. SummarY of eorrowor"s Tranaactron ~~:':~'. ,-f t'- K. Summllrv of SeUer's Tramu.ctlon f .' . \: . ; '. : \!foo) Gross Arl10uiit'Due',f'rom\BorTowor ! ..;~-'" f '.~ ~ .~~ "',,< 400~ Gross Arnau'ii.; Duetro'.sollei :'i,'1i :'. '..!:.;r~i .' ,.." ,:. f.!<1 .'. " ! : ~... :."..~ . ","" '. "'''fi't= 101. Contracr !lBt..!! orlce 159900.00 <l01 Contract sales OI'ice 159900.00 ~02. Per$OO:lllll"o~ 402.P~a'nmnPrtv 103. SRltlement cluIraes 10 borrOWer (line 1400) 5794.36 40S. 104. 404. 105. 405. AdlllstmOnts for itema psld bv sollor In advance ~_. :.\:;r:...;..... . Adjustment.. for Items naid bv seller In advance : "'~.I - . ,. "i".~~ :: -. 's 106. Ci xes to 406 Cltvltown taxes to 107. Counlv taxas 6-24.2005 10 12.31.2005 16262 407. County IllXes 6-24-2005 to 12.31-2005 162.62 f08. A!l!l......M...,'S 10 406ASSO&amenhl 10 1 09 ScnOOl taxes 6.24.200:1 to 6-30-2005 2269 409. School ralles 13-24-2005 10 6.30-200S 22.89 110. 410. 111. 411. 112. 412. 120. Gross Amount ~e From Borrower 165879.87 420. Gross Amount Due To Sellar 16006S.51 !200, . 'PaId B",O~,ln!B' -," WAr' : :'j,',~' !'. :' '.' . . Iii--.' ~'.' _!lOD R - '-:Am'bunt.n "\ , .~~': . ,.;.!,..;! ,loa:" ::..... :- ~. - ~~... ...... .j ... . . 20 1. De~it or ealOMI money fO 00000 501. Excess depOsll (S60 instructions) , 202. Princioal amount of new loants' 127900.00 502. SeltlOment """'rn".. to :leU<< (line 1400\ 13790.78 20S l""i~llna Ioon(5) taken subiect to 503. EYistino loonts) taken !lubiecr to 204. 504. Payoff of first moJ1gage lOi3n , 205. 505. Payoff of second mortgage 101ln 208. 506. 207. 1507. 208. 508. 209. 509. AdJustmonts for items unDald bv 501l0r ! .\'li."Wi ' , Adh./Strnonts for items unoald bv lSeller \ :: " , .-~ 'l.. .:I.\..~1 210. Citvltown taxes to 510. Citvltown taxes 10 :711 County taxes to !l11, County laxeR to 212. Nsessments to 512. Asse"menls 10 213. !l13. , 214 514. 215. 515 216. 516. j 217. 517. 218. 518. 219. 519 220. Total Paid Bv/For Borrower lS7.IHlOOO 520 Total Reduetion Amount Quo Soll.r j 13790.76 ..nn ~"':"'"";At s.>ith.m rrow"'::"!lt!ii,.j ',. ioi:o.:t " ~+, ..1'I......."l(~.,...._; ':.1100. eA;.h 'At.,!';MtI..in" , -. om'Selle'ii....... ~:;.'':' ':"1 .... l 'Nt ...~;. ~ ~:~ .~ ....:-... 301. GrcB811mOunt c10e ftom borft'l\AMr lline 1201 1658)'087 601. GroBII..JlmOUI\I duo to seller /line 420) 160.085.51 302. Less amounla ~id bY/for bol'tOW!lr (line ~O\ 137,000.00 802. I.ess toducliona in llrnounl due seller (line 520J '~,790.78 103. CII,h f2<J From I I '1"0 BOrl'O\('l.er 27 979.87 603. ClUlh IX! To LI FrOm Sel!er 1462~ HUD.. I I .l. I C:-(:oI I b10<0 IU: ( 1 ('f_)cYJ'fc'b 1-'. .~/~ L...-<-'___'-' ~~. . I , \ .."VI I.. UWl '1"-1.\ 'i i irll,li'lHI'i '-''-'l. I -~ -1.:.-59lt';;"ent r;hA';;-OS IJ . .7 SIR rnl".r'a: ..... --' .;; ...:.~,," ,~t~,.. >~: ~:;". "<~>~'~ii:l:. .... <':!r)'"....<ti....~ "''':;.;. '~I..'-J~~t''(;".v.-'" Paid rom Paid From based on once S 15\l 900.00 r!b 7 u,t" - 11193.00 Bom vlters Sellers 0lv1s1on Of CommiMion ClIne 700' "s follows' FlIn ~ at Fund, at 701. ~ 11 193.00 to ERA.NRT Inc. Settl nIlent Seltloment 702,$ to 703. CommiA"iofI nald a\ Settlemp.nt 1119S~O 704 Transaction F",e ERA-NRT In~, "'5.0 1,.'800.'-' "'Orlner.t1on w , ' ",~",":~':J.i'."'.""':. ~...';::" it: .~~~-; , .' .'--.0... .~. ,:...,.:....:\.,~.,.. ::~."!'.CIiIlIii,.mlo', ... . .. '.- ..l:.....1..1 .. 801. Loan Orlnirltllion F.... % 10 802. Loan Di,cD\)ot % to 803 AODfaisal Fe" 804. CrPdit Reoort 805. Underwritina Fee Well~ Faroo Bank N.A. 395.00 806. DOClJl'l'lOn\ p....nl! :-;; 807. Floan r..,rtirlcaUon w--;;iiS Farnn Flood S"1Vi~e 16.00 608 Tax Sorvice Fee Wells Faroo Real Estate Tax Service 100.00 B09, Commllm"nt F'''' 810. AoolicRlion Fee Wells Fa'roo Bank NA. 425.00 1'111. 812. 81'3. 814. t;1 & RBDuir"'" I'Iv' ";'d9r~.B..IP..IO:ln Atlv:an.."r-Ilk. :.,...~..:} ., '. :r.*Xs~,,':":';~ I'r, F\~.. .;~ ~''''''f :~'""J. :~~, .. ".(l'i t:;;.~.- . . . ~ ., ~ :;. ::..:"_.:i'.::.~.::...:.:..t " '--- 901. lnt;;;;:..t!rom 6-24_2005 10 7- 1.2005 r!b S 19.:<'700 Idau 1'"7 '\ 134.89 902. Monnane insuran,.... nremllll'll for m^nthS 10 "- . J 903. HaUlrc;llnsurancG Dnlmium for ve:lrCSl to 904. 905. :' 4nnn.....D6siirv8s [)"nn..191>11 Wjtlj'~/Irii:l"r...~'~ '. ":i- ~ n.......~~.. ' ...-~.:.~ ",.1~ .'J'~ r.... ~il/';P-""~.'....r. '. il<i J.. .' ..::~. .J!... .....,. .........~l.'..~ ; 1001 Hazarl1lnsorance S monlhS !l$ 38.33 DBr momh 114.99 1002. Mortnanp' inaur"nefl monlh~ ll-~- ~r month 100$, City DrOOOrtv taxes 5 monUlS !!$ 26.03 per month 130.15 loo.f.('nlln taxaA mnn1h.. r.1'l. oor month 100$ Annual t111sesament.. months r.ll op.r month 1 OOO.-School t811es 13 '""nths " 111;1.03 nor month 1_608.39 1007 months II: O<!r monlh 1 008. A!1.9r~ate EsCl'OW AdiuGlment -180.81 ., ''':J,.~~J.~ '~.'tk . . i!;~::,... '::'~~,1: '~f .' .~;... ....:.,..~~.': .,. '.':',::s.. ~ II:';:: .- "_7.i$;".3.,.. ".:'~-:l'''.8' ';1 .'11.100'~Ha.C''''m....''. .f' .,~ :i', ....~\"H.':..'. ., . J-. ~,.'...!;. , 1101. SelTl"ment or-;;.(osinn f.... tn '10:>. Abstract or tit'" ~""r,.h to 1 1 03. TrlIe ..xsminatlon to 11 04. TItle lnt;urance binder to 1105. Dnr.umpnt nrenaraiion In 1106.NotaN~PAfoC~Sh 10.00 1107. Attorney's taGs 10 Wilfl!!o/. LellOJ(. Colgan & MarzzllCCO. P.C. POC ~- -.. ,ft..~h_' \ 1108. Title insurance to William A. Dun~". Agent fOr Fidelity Natlonallitle 1.1~8.75 (jncllJrle~ abovo item numb..r~: 1101-1104 \ 1109. LOnder'a coverllap. S"27 900.00 Premium S i:"'"'\:@"L '~~!..' ~: ,. .. . f'.;.a:.~:.,..1 1110. Own""s covcl'tlna -$- 159900.00 f>remlllm s 1 158.75 '. ':.:~.:y ..~. I. j: . ..... ..' :;-.... ':. ~ ). .. .J..'::-:: ~-'i 1111. Endorsem..ot!l100 300 8.1 PUD tn Fldelilv Nationllllitle 2111.00 1112. etos/nn protection Lptter to Fldolilv Nationlll Tlt\p, llS.OO 1113. OvemiohlllNire fee to Duncan & Hartman. P.C. :5.00 :'1200::0oyliinriloht Riicor'dln;'~lIricf'l'i'ihStBr,.cli''''M-t: . . '~'.,~ .'~.-...;: '~i". .. ...;;jj ....., :.' ~'. .. ..>:r:,@::.>;.. '~ '.~~' 'rllk"... :1..) l'd;;;" ..~..'-:~i;.' i_'~ J '" 1701 Rocordina f....... - ;;'-;;;c1 38.50 MOnnMe 74.50 ~R~"O.OO t 13.00 1202 Citv/t'lllln'" Iaxtstam"ll: 1.5! 19_00 1203 State taxI"tamD!<: 1 59~.OO 12004. 1205 1300.'AddI+1n....1 .. . nt ChllraM ''llf.,!.<..: '.':?Iir.. '. (-:\:irb}~.. :. ''':'iIlf..v1 .... .l' '.:.~,ir~ ~. ~. ..~" ."- ,~:'F. ..;'!!!!I'iiiIt . :,,!:!, .;,f..NI' - 1 . .',...... .' ~:..',. '- '.~ :,.,./,,', ~ 1301. Tax Certificl!tion .IUd" Ctlmnbell Tax Collector 10.00 1302. ~OO~ f'.Nmlu&Townsh'o R.e. T(\)(o$ Judu "..mn....;;,1I Tax Collp.mnr 318.78 1303. HomB WRrrAn1V At'lN 4119.00 1304. Finlll Water and Sewer SMTMA #l)1e090 93.50 1305. Loclt Chlln".. Hlllon', Lock S..rvi.... d2.50 t:400. Total SottIGmept Charges ContGr on lines 103. Soetion J snd 602. Seetion 10 5,79.)16 13790,78 CER'\"JFICATION : I have carefUlly reviewed the HUD.1 Settlement Statement and to tile besl of my knOWledgo and belief. It IS a true and acx:ural.ll statement Of all tOeGiplaand dlsl>Ursemenla mllde on my account or by me in this trensaCl1on. I further cel1Jry that I received a copy of the HUe.1 S&ltklment S1alemenl. Signature or Borrower Signature 01 Borrower Signature of Sellef Sillnaluro of SeDer The HUD.1 SeUlemont Statemenl which I have prepared Is a \(ua and BOQUrate account of the tun<ls diSbursed or to be disburlied by me underj;jgnod as Pllrt ot the solUomeni of this transaction. Signature 01 SolUement Agent Date WARNING: It ie a crime 10 knOWingly make faille stal&monta 10 thl;! UnIted Slalos on this or any other similar form. Poolll1iea upon conviction can include a fine and illlpti;;ionment. For de\;lilS soa: Title HIll S. Coda Section 1001 and section 1010. LF..GG MASON Legg Mason Wood Walker, Incorporated 214 Senate Avenue, 7th Floor, P.O. Box 8853, Camp Hill, PA 17001 - 8853 717-737-6500 800-433-8186 Fax: 717-737-0800 Member New York Stock Exchange, Inc./Member SIPC April 7, 2005 The Wiley Group Jan M. Wiley, Esquire 130 W. Church Street, Suite 100 Dillsburg, PA 17019 RE: Mary A Speck Date of Death 01117/05 Dear Ms. Wiley: In response to your letter dated March 22, 2005, following are the date of death values for Ms. Speck. Due to the date of death falling on a holiday, I have indicated values for the date prior to death and the date following death. Individual Retail Account 363-04055-16 Shares 405.635 1200.087 30000 Value 01114/05 $3,691.28 $10,380.75 $30,240.00 15000 Securi Dryden Government Income Fund CIA Scudder US Govt Secs Fd CI A OBA Fed Svgs Bk Gaithersburg CD 4.6% Due 11/09/2006 Fed Home Ln Mtg Corp. 5.5% Due 02/15/2033 Value 01/19/05 $3,695.33 $10,380.75 $30,240.00 Accru~d Inter t NA NAi $30.25i $14,981.25 $14,981.25 $33.49! 'Tot-~: ji Sq ~U\.DTl . Individual Retirement Account 363-71424-19 Shares Securi 1459.609 Dryden Government Income Fund CIA Value Value 01104/05 01119/05 $13,282.44 $13,297.04 The above accounts were established January 2, 1997. The beneficiary listed for the retirement account is the "Estate". If you require additional information, please do not hesitate to contact me. Sincerely, J V. Thomas Associate Vice President - Investments (@1) Western-Southern Lite Assurance Company 11 I I Single Premium Deferred Annui - - - 980 Prepared on 12/09/2004 Owner SPECK MARY 10 Ridgeway Dr Carlisle PA 17013-7614 Page 1 of 1 Western-Southern Ufe appre~iates your business. . - - - - - - - - - Annuitant Contract Number Contract Date Contract Type SPECK MARY W 20603770 12/12/2001 NON-QUALIFIED - - - - - - - - * * * INFORMATION ABOUT YOUR CONTRACT * * * = > Total interest earned during any contract year will be impacted by any withdrawals, including systematic withdrawals, from the contract during that year. For example, if you select the systematic withdrawal plan, the interest you receive will be less than the amount indicated by the effective annual interest rate because interest is being paid out rather than accumulated. SUMMARY OF ACTIVITY 12/1212003 through 12/1112004 Beginning Contract Value plus Interest Credited* less Systematic Withdrawals Partial Withdrawals Surrender Charges Ending Contract Value Surrender Value** $ 15,00moo 678;40 678J40 .00 .00 15,000~00 14,190JOO * The effective annual interest rate for the contract year indicated above was 4.60% and is 4.75% fo~ the current year. The Pacesetter guarantees interest rates each year for two 5-year periods. During the first ~-year guarantee period, the interest rate will increase by .15% each year. The initial rate for the second q-year guarantee period will be set at the current market rate at that time and will not be less than 3.00%. i The interest rate will again increase by .15% each year. The minimum guaranteed interest rate in years 11 and: later is 3.00%. ** Amount available after deducting any applicable charges if you cancel your contract. For further information about your PACESETTER annuity contract, including interest rates, contact your sales representative or call Annuity Operations. ANNUITY OPERATIONS Western-Southern Life Assurance Company PO Box 2918 Cincinnati, Ohio 45201-2918 1-800-926-1702 Customer Service Hours: Monday. Thursday, 8 a.m. to 6 p.m., Eastern Time Friday, B a.m. to 5 p.m., Eastern Time "lDRY0083" ?<I~ ~ Western-Southern Life&l Date: 04/01/2005 THE WILEY GROUP ATTN JAN M. WILEY, ESQUIRE FOR YORK SPRINGS UNITED METHODIST CHURCH 130 W. CHURCH STREET, STE 100 DILLSBURG PA 17019 Re: Contract Number W0020603770 Dear Ms. Wiley: Please accept our condolences on the death of Mary Speck. We are here to serve during this difficult time. As a designated beneficiary, the church is entitled to receive payment on the Western-SoUthern Life annuity referenced above. Payment of benefits under the contract is the obligation of, Find is guaranteed by, Western-Southern Life Assurance Company, Cincinnati, Ohio. The following settlement option is available: · Lump Sum. You can receive your settlement in one installment. Any earnings on this contract may be subject to tax. Western-Southern Life encourages you to seek tax or legal advice before selecting this option. If you choose this option, Western-Southern Life wiill automatically establish a Premier Account in your name. This interest-bearing account provides you immediate, convenient access to your proceeds. See the enclosed brochure for full details. Please sign the enclosed Account Authorization form and return it with the claim form. The enclosed claim form is for the use of the authorized signer(s) for the church in selecting a settlement option. Please return the completed form, along with a certified copy of the de~th certificate and an official notice that confirms who is authorized to sign on behalf of the church, using the postage-paid envelope provided. Our goal is to serve your needs and we will implement your selection as quickly as possible. If you have questions or wish to discuss the option(s), a representative is ready to help yow. Call toll-free at (800) 926-1702 Monday through Thursday, 8:00 a.m. to 6:00 p.m. Eas.ern time and Friday, 8:00 a.m. to 5:00 p.m. Eastern time. F021/FI-42-015-0406 Member Western & Southern Financial Group~ Annuity Operations Group. PO Box 2918 . Cincinnati, Ohio. 45201-2918 Phone (800) 926-1702 . Fax (513) 629-1799 - \1111\'" "721 CO" ..... ~ cD ~ 0 0 <.0 toP (f) 0 ..... 0 0 0 ..... .... ..... 0 <t 8 0 ci to cD cO t3 $ $ $ ...... .... "'" cD 4. c-I. C't~ ..... 0 t- ... ...... c5 c5 ~ ~(/) ~ $ .... (f) ~ .,. $ S ')-1- .0 '" \ 'aJz 0 t- z.... u.l::>..... a:J .a .S :a c5 47- - .... 3"'" '0 .~ l- 0- ~$ ~ c: (/) uJ - E ~ 'Z Glu.l~':1 a ~je. 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E~ ..... 0 <Il <Il III ..., ._ ~ <.0 II) "'a> "'a> %. u-o..... o' I/) () .s:: ~ ro % en ....0 Gl <Il <Il <Il "'6 0 "'coc-l 1/)0 0 () cO :!J. <Il en ~u.lr-: ~cD ~ <). <( l- I- till {) ~Dt: 0':- till l- tJ1 Z ~ Vl ~ ~\t ~ v. 0 ~o-:T .,-- ~r- ~ , \ ~ ~ . -"""'?-:R . S E .- ~ co ~ f'\ 0 'S ~ .0 ~ ~...J -'f.' ~'" .' . #C ~.~ ~~~ ~~ %. o - t- till $ a: o u. %. - a: o t- en III ,.. %. - c: cO .... 0..... '::> o.z 2 <i5.!!l ~ ~ ~ o -00> ~~ ~_<Il enO- .....7; .~ ... .9- E .~ ~ 9).$ en.....- ... c:"" c: '::> oo;5g.. %:5-c"'a> (\):; cO (I) ;;;-::"5E ,~'(j) ~ ~ '*tU:S 0 ..... .s::...<)o.. .~ .g (G (i) .';.:;"*iii'o.s:: -d ... l~: <Il c: 0 c: co cO :::> cO.... 0 "" -0 ..s ,~ a a'> Q.:z . u- o..P =oE~""-o ~:5.~<Il~a ...p~EEQ) '& 7'~ "*iii"*iii en :lIIQ).~(I)Gl(l) c'~~ ~~::g _ ~ ~ _'_ c 'a v "'t . . c. v .. '2 \J. <J~ ~\... fJ\'~ % ~. ...\ ~ ~ E 5 c-I ~ ..... I 0> ..... o ~ 'en ';: ~ ~:I: '" S ~~O- % 0-:::><' ~ (/):I: ~ 47-<) as i >- '3: (/) !e ~oj ~ :E~i5 c;~l3 '~'f ~tJ !~~~t ~WE.~~ -:~u:;a go'fV\; ~ ~ ~~ ~ ~~!~E c: t).- e .e.;~~"5 %.'15 0. .. v e~~~~ _V' t:O~ 1:! . <l) .. r; ~\ ~~ <l) "6: ~ a~ .. e ~0 ~ a ~"'" a'~ ~ .!Oli\ - " .. .. ~ .s~ ~ 0 "" ~';Z~' ~. *- ~. .. -' .~ ~ - .~l\1jfi~~if!~l~X~~;\;~~~f~I!1~~\1~~~t~i~R~~l~I~~~~~~~~~l~i~~~~~'.~~~;.l~W~cr~~\~!!~}I~fw!\t;f; ~~)agr:~e:thiiuh9 a~.ov~mforlllatlon.andst~t~mel1t~)lretruean"l:or!ectto.th.e~.~stofJJ1Y (~ur) knowledgeandbehef an~ arelT1a~e ~Stt~e bas.ls of mv{oul .I,.catlon. .I'(~e). certlfy~un~ei;penaltles ofpe~J~rv ~~at the.abov~s~clalsecunty number(s) IS corre7[ .' '. . . ,J.-:-':, <:;.', ' . , '. '. ..' . ""i., C\', '\ - '~. \ '" (7) ., ,I~ L.. ,::hn. .~:" .....~ t'7 c A'-:-:Q --,'\~ \' \.~ -e::"" ,:yq( . <: ,":;y ','. X;?7:l4;t, ./.~ '. .</..j;;6'0f~ . .' J -: ;:::J -U '--.J nedat{City,State)' ;" '" . OwnerSignat e &Tltle (Annuitah(unless otherwise noted) Date" .. . ....,...' . ......... " ......'..,z,,::::;.../'.'...e.. . .' nt Owile{Signatunl & Tide' '. . ". Ann4itaiitSigri.~ture (if other than Owner) Date.. lht'sSignature< '.' J'Vi!:(..... . ne & Address of Fir '\ te License 10 # (Required for FL) ~4-2'6-2005 . haat~s. cali! tlement 1 et~: 1 It em Hnf.:tR' S ~lUCTION 717--Lf.32-8i:::45 G!ty Page: .-, c:. ESTATE OF MARY SPECK DeSCTiption Pt-. i ce -------------------.----------.--.----.--------------_______.__________._M..________________.________ Total . haa'r~s. co iii Bo x lot Ma t i;) 1'-' i a 1 Box lot BCl>( lot Snm'-Jmen Box lots Staple gun Tub dishE~s T1'~ay lot Box cookbool-<s Tl"ay 1 at Di.she'; 8t at ue Tr'ay lot Pans Pi.llow'; ItE'flls: r.-, CiL:. r=lmount: Commission at 25.12100% -;. 1:'- c:- r ...:,...J. -.JCI Less adjustments: Net due to seller: I-IAAR' 8 AUCTION 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1. 00 0. SIl100 0.7500 2. 121 III 5. 1.~0 3. 0fZ! 1. 00 4. 0lZl Ill. 2500 1. 121 III 2.50 If. 01Z1 7.0121 7.00 3u50 1 . ~.50 142.25 --35. 56 10E,.69 71 7--/1.3;~--8;:::,!j.6 !: 1~_ll.-i~3-o;::~er05 haa'r~s. COlli : I ement . E! t~ ~ 1 ha.3.r"'5. com Item Co m m*l: LI'n Hf-1AH'!:; nUCTION ESTATE OF MARY SPECK CARLISLE PA 17013 DesCt~iption Box lot Bo;{ lot Bo x I at Box lot: Box lot Box lot Box lot Box lot Bc)}( lot Rate Items ;:::5. 0001Z1 10.0000 r.:-f"7,'-', ...J :"'1::, 59.3 (~omITI It Lj. I. '1' I.,. '::'r LI' It L,. Itt~ms: ~593 Total 1 35, 5f;..E,. 75 7,900. OIl) lt3, 55E,. 75 71 -, --.1+3~:::-"8(::L:.E. 8'ag (;! : 11.,. Pl'-'ice Total (~t Y 1 C" 1210 "..0) u Lt. . 1:'-,"11 "] 13. ~3fZI ...)il..i ~J 5~~ I. 1'1-. 00 ...J. ~~ .~ 0e~ .-, 6. 1210 ~. c:. 1 -:.. 00 ..... i. 00 .::' 2. 00 l.- I 1- 00 1 < QK~ J. . 1 1- 00 Amount : I ..~ 566" -'C.. ..,....:, , { ...:J COrlll1l$ 8, 91fj. S':;l 7':30. ';~0 9,706.S9 Less adjustments: -9,705,,69 Net due to seller: 33,880.05 HAi=lR'S AUCTlm.j 717'''432'-8c~46 r vi I CENTRAL PENNSYLVANIA CONFERENC'E THE UNITED METHODIST CHURCH 303 MULBERRY DRIVE / P.O. BOX 2053/ MECHANICSBURG, PA 17055-2053/ TELEPHONE (717) 766-5275 March 29,2005 The Wiley Group Attorneys at Law 130 W. Church Street, Suitel00 Dillsburg P A 17019 Attention: Jan M. Wiley, Esquire Re: Estate of Mary A. Speck Dear Attorney Wiley: This letter is in reference to your request to provide you with the value of the certificates owned by Mary A. Speck at the time of her death, January 17, 2005. The certificates were valued at Twenty ThousandDollars ($20,000.00) and the interest that had accrued on them from November 1,2004 to January 17,2005 was $235.78. The investment account was opened with the first certificate which was dated June 26, 1986. If you care to redeem these certificates you will need to return the original certificates, and we can then process a check for you. . If you need additional information please feel free to contact me. Sincerely, ~~1Av.~ (Mrs.) Zedna M. Haverstock TREASURER-COMP::FR0tI::ER: Enclosure: Check .',. '':_"0 ,,;,__;__,,'~""__'_T._,~",._ '__'. "'.'r, ,_"^,-,"_.~~.s.~~,"~.....-"",_..-;....._..._.",.".,,, _r_..'." -._'. .,._ ," ."._,.."". .,-.... _~. ",. .""". ..-r_c.,.-" -~...~- ,.".Co ',- .-~.~,' '." ". ., COUNCIL ON FINANCE AND ADMINISTRATION o PNCBAN< ./ March 18, 2005 Jan Wiley 130 W Church St. Suite 100 Dillsburg, PA 17019 scp RE: Estate of Mary A Speck (Deceased) SSN: 176-26-1712 DOD: 01-17-2005 Dear Ms. Wiley: In response to your request for Date of Death balances for the customer noted above, our records show the following: Savings Account Account #5003965353 Established 09-09-2002 MARY A SPECK DOD balance: $15,195.51 + $7.96 accrued interest The decedent maintained Investment Account #78694181, for further information please call 1-800-762-6111. Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank brancp. office. Sincerely, ~~ ;(-~ Erica L Schlegel 1-800-762-1775 P7-PFSC-04-F 500 First Ave. Pittsburgh P A 15219 Member FDIC . . " " . . . ". .' . ...~.....":AD.....".".i.i............~.. .....C......... otJNrr....................... ............... . '.'...' .. ,,' . ..... .-...... "',:. ...c...-'.....'.:.: ,- ....-,.. . .'.:. " .. ',.. .: . NATIONALBANK. March 29,2005 The Wiley Group Attorneys at Law Attention: Jan Wiley 130 W Church Street..Suite 100 Dillsburg, PA 17019 Re: Estate of Mary A.. Speck Dear SirlMadam: The followiJlg information is.qeing provided as per your request: Acct. Type Account Account Accrued Owriership Date Date.J oint No. Principal on InteresJ to Account D.O.D. D.O.D. Opened C.D. 149051 $10,000.00 $15.31 Individual 8-20-99 N/Ai Inquiri~s concerning ACNB Corporation stock information should be directed to the Registrar and rrransfer COIIlP~y at .1-800-3 68..59~~:If you need anyad4N()nal information, please contact me at (717)3l8-2171. Sincerely, ~.~.ri ~. Lois Kime Deposit Services ., -," . '~'-~"- -; ... ~'_-"-. : ~. . :... ~'..'~~ ~v""'-'."i' .,~; '. .' .'". ~,,'. ..-. " - .,,-: ~ ."., .-. ~ i li ,-., :'.,i _s'-.:. \ +: CITIZENS BANK 525 William Penn Place Suite 153 12510 Pittsburgh, PA :5219 / April 18, 2005 THE WILEY GROUP 130 W CHURCH STREET SUITE 100 DILLSBURG, PA 17019 Estate of MARY A SPECK Date of Death: Jan 17, 2005 SSN: 176-26-1712 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884. ~~~ ame1a M Lewis Operations Services I " . . .~ CITIZENS BANK Account Number 6100747271 Account Title MARY A SPECK Date Opened 6/6/1966 Account Type Checking Principal Balance as ofDOD $8415.45 Interest from Last Posting to DOD $.00 Account Balance as of DOD $8415.45 YTD Interest to DOD $.00 I .. . . I .~ CITIZENS BANK Account Number 6101199065 Account Title MARY A SPECK Date Opened 3/1/2002 Account Type Checking Principal Balance as ofDOD $11937.82 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $11937.82 YTD Interest to DOD $ .00 . 11 . . I I i ..... CITIZENS BANK f.. Account Number 6140755883 Account Title MARY A SPECK Date Opened 1/21/2000 Account Type Savings Principal Balance as of DaD $30000.00 Interest from Last Posting to DaD $90.30 Account Balance as of DaD $30090.30 YTD Interest to DaD $.00 l I ., " . .: CITIZENS BANK Account Number 6140780209 Account Title MARY A SPECK Date Opened 10/24/2000 Account Type Savings Principal Balance as ofDOD $10000.00 Interest from Last Posting to DOD $25.26 Account Balance as of DOD $10025.26 YTD Interest to DOD $.00 ~ 4' -.L....A.-'-......ooooooaooo l\,)M-.LOCDCXl~mc.n~(...)I\)-"""" ~--------.....----------------- u.JF\.:)I\:JN lUlU I'\)NNNNI\>I\) 0 O(.oJ~Ol~<.nWmOlW(1'1(Jl(...)"'" 000000'6000'0000 -1>--1>--1>--1>--1>--1>--1>--1>--1>--1>--1>--1>--1>-.1:0 00000000000000 [[[[[[[[[[[[["g OJ OJ cD cD cD cD cD cD cD cD cD cD cD 2. 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(I) :IJ- 0""" 0 )> ..... e: 3.-(I):IJ Q."tJ - CD Jll 0:IJ<> (..""1 -. ...... TI ...en(l)~ D)C: C. 0 3=:::::J0 ::IQ. ...... c Q) Co :::l IlJ _.c 0 c:(1) U) a. ::=. g. (I) 0 ~3. ..... . ...... en o en C ~ iii' CD 0 (1) ::::J- ::::J < _::r~_ C. 0' .0 (I) < ::r :'"~ (1) ... ..... -. 0 0 CIl '< ~o_ I\)l: r (l)e. o- r 0 W_(I) OC: < () C .....-... .I:loe!. CD ... :IJ- IlJ ~ en (I) -11 ~ 0 0.......1lJ Oc: < 0 0"'0 0 O(l)::r 0::1 -. C 5(Q,< (1)Q. CD ::::J -E.(I) (')en :E :-+ 0"1lJ1lJ (1)_ ~ ::=.-... 3D) 0 mO -. 0"- ::::J ::::J ::::J (1)(1) o -(/) IlJ "",,3 -oft (I) =: g w(1) -< ...L::I ~(I)O - 0 ::::J=:... I\) e. e. r::: ::1lJ 0 -::::J 0 ~ 0"(') .I:lo (1)(1) - ::s < CD U> ..... 3 CD ::s ..... U> ""'d ...., O......s:::s::: ~ .;x:. 0 )> Jll :0:0:0= C6-<S' a - ~ G) ;x:. .. """,. mm(J) ~ "~,, ..- ;x:.)>m 4~ -<0 ~o^ 0:0 ...... w t-:fj I --.j """,. m = ...... ~ ~ =' n .... . ~ ..- - '1J I>> co '" 2- .1:0 'CLIENT CONFIRIVIATION Prudential Mutual Fund Services LLC P.O. Box 8310 Philadelphia, PA 19101-8310 Prudential ~ Fi ancial Account Number: 028089687 tJ Page 1 of 2 . JAN M WILEY EXEC EST OF MARY A SPECK 130 W CHURCH STREET SUITE 100 DILLSBURG PA 17019-1232 I.. .111. . .111. ... . .111.1.....11..1.1..11...1.111...11... .1..11 We confirm your Mutual Fund activity on 06/0112005 for the following: len Governmenllncome CI A d #: 0084/ NASDAQ: PGVAX REDEMPTION THRU DEALER Ala OS/27/2005 DIVIDEND CLOSE OUT-CASH .( $3,687.22) $9;09 ( 405.635) 0.000. $2.78 $0.00 0.000 0.000 Ie we make every attempt to ensure that your confirmation Is accurate, errors may Inadvertently occur. Please review your confinltatlon 'oughly and contact us if you find any Information you believe to be inaccurate. If we do not hear from you in 30 days, we will ass~e that all rmatlon Is correct. ,ntial Mutual Fund Services LLC strives for quality processing. Was this transaction executed to your satisfaction? Please call our loll-free Customer ::e number: (800) 778-5970. Please refer to the last page for additional information. Retain this copy for your records. )MAS Dryden Government Income CI A Fund #: 0084/ NASDAQ: tGV AX ........................... ... ~pf~$Wt~tW~NJ&~ ................................ ...................................................................... ............... <>>::ltii:r:jtstNfAtrv)t::f!iii'fdRMAfxbN::::::::::::::::::::::: .. . .. .;.;.::::::::;:::::::::::::::::::::::::\~{<~}<}}<}}jt~ii:~~~~:~N~~t~::::::~:..::~:::~:::~:::::::~:~:::~:~:::::::::..::::~:~<:~<<::::::>:.' unt Owner(s-, .f WILEY EXEC )F MARYA SPECK Additional Investment Form 8 '" ~ .., o o o o .., ~ .., ~ "'ll 2 ~ ~ o ;: .., o .., o <II '" ~ ~ Please use this fonn to make additional invesbnents to your mutual fund accolUlt( s). Please indicat~ the dollar amolUlt you wish to invest on the line below, next to your fund/class. List the total amolUlt of your investment and make your check payable to Prudential Mutual FlUlds. Ir Account Number L'J: 02808968713 1................... ..................................................... ........................ ....... ............... ..................... .............. .... ............... ................. ................. .................... t~:~~r~~~~ij~6~rA#~~~ij~fgg~~f~g~~: .. :~:~:}FUhtt:}~:}>~{/{{{<<:: .. :: :......:... .::;::::::://):::::::::::=:::::::::::::::::::::=::.:.:::.:.'::':':::::::~:@~b.~t:::::::::::::::}}}}:/:'. .. ... ~~~~~~~~T INC CL A ........I~~~~T$. ..... ....... ... ., z ~ z z z Total Investment 1$ 280896871380084000000000000000000003701 jan M. Wiley David j. Lenox Timothy j. Colgan Christopher j. Marzzacco david E. Hershey Bradley A. Winnick T~omas M. Clark Ari D. Weitzman THE WILEY GROUP Attorneys at La~ Wiley, Lenox, Colgan & Marzzacco, P.c. September 12,2005 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 r~.") ~ ' j . " ~ ,II I' --f. c+ -'. -I _. Dear Register: . -;.t Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the ~~atus report with regard to the above captioned estate. Also enclosed is a check in the amount of J $541.21 representing the tax due, and a check in the amount of $30.00 representing the filin, fee. Please return the recording receipts to my attention in the enclosed envelope. In Re: Estate of Mary A. Speck, deceased File Number 21-05-00198 Thank you for your cooperation. Sincerely, ~dfelter! Ass stant Idg encl. 130 W. Church Street, Suite 100 · Dillsburg, PA 17019 · Phone: (717) 432-9666 . (800) 682-4250 . Fax: (7P) 432-0426 Offices in Harrisburg · York · Carbondale www.wileygrouplaw.com I COMMONWEALTH OF PENNSYLVANIA REV-116 EX111-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 00 )893 WILEY JAN M 130 WEST CHURCH STREET DILLSBURG, PA 17019 ACN ASSESSMENT AMOU \IT CONTROL NUMBER __nun fold ---------- -------- 101 I $541. 21 ESTATE INFORMATION: SSN: 176-26-1712 I FILE NUMBER: 2105-0198 I DECEDENT NAME: SPECK MARY A I DA TE OF PAYMENT: 10/13/2005 I POSTMARK DATE: 10/1 2/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/17/2005 I I TOTAL AMOUNT PAID: $541. 21 REMARKS: CHECK#139 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBA JGH REGISTER OF WILLS REGISTER OF WILLS , I 1 County, Pennsy1vanlia i QI i M-05-001'_~__ 01/17/20 5 176-26-1 12 Register of Wills of Cumberland INVENTORY Estate of No. Date of Death Mary A. Speck also known as , Deceased Social Security No. Jan M. Wiley The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following In entory include all of the personal assets wherever situate and all of tl1& real estate located in the Commonwealth of Pen sylvania of said Decedent, that the valuation placed opposite each Item of said Inventory represents its fair value as of th date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this In entory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. . Section 4904 relating to unsworn falsification to authorities. Attorney: Jan M. Wiley / Personal Repre*entative; Signature: l' ~ ""- J, Nf:Wiley Signature: ,/ , Signature: ( j ./ .u~ I.D. No.: 06298 Firm: Wiley, Lenox, Colgan, & Marzzacco, P.C. Address: Address: 130 W. Church St. Dillsburg, PA 17019 T elel?hone: 717-432-5722 Telephone: 130 W. Church St Dillsburg, PA 17019 717 -432-9666 Dated": "'AT'---5 lO -{ I a~ Personal Property Cash..................................................................... .......................... M iscella neous Pro perty ............................. ........ ............................ Stocks/Listed .................................................................................. Stocks/Closely Held.......................................:...~........................... Bonds............... .............................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... 214,426.89 Total Personal Property......................................... 214,426.89 Total Real Property................................................ 160,085.51 Total Personal and Real Property......................... Total Out-of-State Real Property.......................... I ~ ~ I I t I I Ij'~" ~ I: '. 1_-- ,.... -, cr', r I ! <Ie .' ." 1/( ..' o , ...;:r 1.1") ('1,\ I:",'" I::;) ~". I" t;:;) C:, \?... !:'~J t'.,- ,.". Cy C' Ui;' III I'.J ;.,f) '1'..... LX) n.. !I.I ,;., I:) '::) :~!: ',!l~ () !,b (:1 lrt ~;:~ ;:: ~::( I :~) ~) II li:: CI I"" i:J (1;. 1,1.1 ,-i C);!' '. :', ;:') III}: f() () ? ~ C) l'i") 1"\ 1~) 'f.... (:) 'J) '1'- ~' h, Ii""''- 1'.- ,;1- -- ~ ~ :J 0 0 ~ U c.: <ll . 'S ~ d~ X 0 Vl ~ 0 o u . '" c u a;~ ... (j) III ~: ....IN ~ct ~C . ~ Vl >-Ill ...c ~ ~E ~~ U ::J ""..0 ~~ ~; ::J <J1 ..c _ U:= III .0 OJ:) $ ~ 0 0 ~ U M ~ E ~ . ! , . I. "\., !OT .I..0I11 Q) rn ;:j o ..c t:: ;:j o Q) U ~ C;:j ~g~ ~gQ)O ~U~~ ~"'dO~ <O~'€~ ;...., ~::s "- Q) l-<Q) 0 Q) ..... U- rn .0 rn .5h E Q) ~ GJ ;:: :::; C\S c.:::UOU In the Court of Common Pleas of Cumberland County, Pennsylvania INRE: ORPHANS' COURT DIVISION Estate of Mary A. Speck NO. 21-05-00198 Status Report Under Rule 6.12 Name of Decedent: Mary A. Speck Date of Death: 1/17/2005 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete. (-) 3. If the answer to No.1 is Yes, state the following: -, a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account isi c. Did the personal representative state an account informally to the parties in interest: Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: /D -tl-OS ~. U Signature Name: Addres . Jan M. Wiley 130 W. Church St. 1-....' , , .;_~i c.::; c.-., Telephone: Dillsburg, PA 17019 717-432-9666 Capacity: Personal Representative X Counsel for Personal Representative Vi,;