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Home My WebLink About11-22-05 .. REV-1500 EX + (8-00) *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 ~ Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Rae Jr. Geor e W DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 5/23/2005 6/14/1931 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) w .... lil:~1Il (.) a:lil: wQ.(.) :z:li!9 (.)Q.ID ~ [R] 1. Original Retum o 4. Limited Estate [R] 6. Decedent Died Testate (AIlach copy 01 Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (AIlach copy of Trust) o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBER .-L ..L -...9... .L JL...i. .L JL_ COUNTY cooe ' YEAR NUMaER SOCIAL SECURlfYiNUMBER 207-22-0826 THIS RETURN r.jUST BE FILED IN DUPLICATE WITH THE ReGISTER OF WILLS SOCIAL SECURITY !NUMBER o 3. Remajnder Retum (date of death prior to 12-13-82) o 5. Feder!il Estate Tax Retum Required 1... 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AIlach Sch 0) .... z w c z o Q. III W a: a: o (.) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENC NAME David H. Stone Es uire FIRM NAME (If Applicable) Stone LaFaver & Shekletski TELEPHONE NUMBER 717 774-7435 New Cumberland z o ~ ::>> ~ D: <C o w ~ 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. JoinUy Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o t= ~ ::>> Q. :IE o o S 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X _ (15) 182,710.82 X ~ (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) 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 ULD BE DIReCTED TO: PA 17070- OFFICIAL USE ONLY r-.l = <= c:.n Z (~ c; ~ ""- :J..j I'Tl C') c:::> c~~j I-n c::J ,0 "'. ::tJ J~P, -~_. (:~) ~ 9,066.04 ) (;1 0 ,-' )'-....J-1I r'- ':u 21,147.8 J t:-; 3,345.55 (8) 37,374.93 37,534.83 (11) (12) (13) (14) 20. 0 << N N -0 C) ..--;-1 -"1"1 r) rn ) r', '-_0 -",-, Cf? ~ 0" 257,620.58 74,909.76 182,710.82 182,710.82 o d · C I t Add ece ents omple e ress: STREET ADDRESS 510 SDrine House Road CITY I STATE I ZIP Camp Hill PA 17011- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 8,221.99 9.000.00 473.68 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 9,473.68 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) 5. 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 1.251.69 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE 'BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 00 ~ =~:"::~"':~..I:.~.~~.~~.~.~...~;:::::::::::::::::::::::::::::::::::: ~. ~ d. receive the promise for life of either payments, benefits or care? ............................................................. CJ 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 3. ~:~~ec:~~ ~~~:::~~:~d:~a~~;:~;~.~~~ .~~~~.~~~~.~~~~~~.;; ~~~~~.~;.~;~.~;~~;~~~~~.::::: :::::::::::: B 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 00 00 00 o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT ~S PART OF THE RETURN. PA 19067 DATE . \",). or PA 17070 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 ofthe surviving spouse isP% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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)]. 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)]. A sibling is defihed, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. - REV-1502 EX + (6-98) . SCHEDULE A REAL ESTATE COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rae. Jr.. Geon;Je . W 21 05 0479 All real property owned lolely or II a tenant In common mUlt be reported at faIr market value. Fair market value is defined as the price at whic~ property would be exchanged between a willing buyer and a willing seUer, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Reallll'Ooertv which II Jolntlv-owned with rlaht of lurvlvorshlp mUlt be dllclosed on Schedule F. ITEM NUMBER 1 : DESCRIPTION Property located at 510 Spring House Rd. Hampden Twp., Cumberland County, PA sold to Joeffrey W. Smith and Sonya Smith, his wife, on September 29,2005 /" VALUE AT DATE OF DEATH 192,400.00 I TOTAL (Also enter on line 1, Recapnulation~ $ (If more space is needed, insert additional sheets of the same size) 192400.00 REV-1503 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA . INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Rae. Jr.. Geol'ge . W FILE NUMBER 21 05 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0479 ITEM NUMBER 1 VALUE AT DATE OF DEATH 31,661.10 DESCRIPTION 762 shares Allied Irish Banks stock @ $41.55 each TOTAL (Also enter on line 2, Recapitulation); $ (If more space is needed, insert additional sheets of the same size) 31661.10 REV-1508 EX + (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rae. Jr.. Georae . W FILE NUMBER 21 05 Include the proceeds of litigation and the dale the proceeds were received by the estate. All property Jolntly-owned with right of survivorship must be disclosed on Schedule F. 0479 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 650.00 1991 Chevrolet Lumina 2 M&T Bank-Checking Acct. #98381466 wiG William Rae, Associaties DBA, G. William Rae, Sole Pro., and Janice Rae Mitrovich, Signator, Prine. $6547.08, Int. $.160 6,547.68 3 USAA Savings Acct. #000271284 1,868.36 TOTAL (Also enter on line 5, Recapitulation~ $ (If more space is needed, insert additional sheets of the same size) 9 066.04 REV-150!~ EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Rae. Jr.. GeorQe . W FILE NUMBER 21 05 If an asset was made joint within one year of the decedenrs date of death, It must be reported on Schedule G. 0479 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Janice Rae Mitrovich 1365 Brentwood Road Yardley, PA 19067 Daughter B c JOINTLy-oWNED PROPERTY: LETTER 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 DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrSINTERES 1 A 8-18-98 M& T Bank-Checking Acct. #64928284 joint 1043.34 ! 50. 521.67 w/Janice Mae Mitrovich on 8-18-98, Princ. $1043.28, Int. : .06 2 A 7-30-99 M& T Bank-Checking Acct. #950266590 joint 920.71 50. 460.36 w/Janice Rae Mitrovich on 7-30-99, Prine. $920. 70, Int. ~ .01 3 A 8-18-98 M&T Bank-Checking Acct. #98222813 joint 40331.71 50. 20,165.86 w/Janice Rae Mitrovich on 8-18-98, Prine. $40,312.58, Int $19.13 , , TOTAL (Also enter on line 6, Recapitulation) , $ 21 147.89 T (If more space is needed. insert additional sheets of the same size) REV-1510 EX + (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rae. Jr.. GeorQe . W FILE NUMBER 21 05 0479 DESCRIPTION OF PROPERTY ITEM lNCluoe THe NAME CJ' TIE TRANSfEREE, THeIR RELATIONSHIP TO oeCEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THe CATE CJ' TRANSFER. ATTACH A COPY CJ' THe DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APfUCA8lE) VALUE 1. Greater Beneficial of Pittsburgh-Annuity #22070502 3,345.55 100. 3,345.55 I , , , , TOTAL (Also enter on line 7 Recapitulation) $ 3 345.55 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rae. Jr.. Geol"Qe . W SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 05 0479 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Rolling Green Cemetery-services rendered 595.00 Musselman's Funeral Home-funeral expenses 2,985.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) i Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2005-2006 : 2. Attorney Fees David H. Stone, Esquire 12,903.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant i Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 318.00 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 7. Bridge Street Realty-appraisal fee on property 300.00 2 Ehrlich-services rendered at property 34.98 3 Ehrlich-services rendered at property 34.98 4 Duty's-services rendered 76.62 5 Ehrlich-services rendered 34.98 6 Ehrlich-services at property 34.98 7 Gingrich's-services rendered 40.00 8 USAA-homeowners insurance 70.00 9 Adam Williams-lawn service at property 130.00 10 USAA-homeowners insurance I 15.62 11 Hampden Twp-sewer and trash at property 115.00 12 Settlement costs $15792.62 less reimb. $1107.85 I 14,684.77 I TOTAL (Also enter on line 9, Recapitulation) $ 37374.93 I .. (If more space IS needed, Insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Rae, Jr., George, W Decedent's Name Page 1 21 05 0479 File Number Schedule H - Funeral Expenses & Administrative Costs - 87. ITEM NUMBER AMOUNT 40 41 42 43 44 45 46 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 DESCRIPTION i : PP&L-electric services at property AT&T-telephone service at property UGI-gas service at property PA Water-water service at property Verizon-telephone service at property PPL Electric Utilities-electric serv. at property UGI-gas service at property PA Water-water service at property AT&T-telephone service at property PPL Electric Utilities-electric servo at property PA Water-service at property UGI-gas service at property AT&T-telephone service at property Verizon-telephone service at property PPL-electric service at property Verizon-telephone service at property PA Water-service at property AT&T-telephone service at property UGI-gas service at property Verizon-telephone service at property UGI-gas service at property PPL-electric service at property PA Water-services at property UGI-gas service at property Cumberland Law Journal-advertising grant of letters The Patriot News-advertising grant of letters Janice Mitrovich-Reimb. for 6 hotel stays ($1616.93), repairs $184.86, and turnpike fees ($101.25) Linda Rae-Reimb. for 2 rentals of car/truck and gas for hauling Kathryn Wiegand-services rendered Accurate Doc Destruction-destroying old docs Checks written but not cleared by bank until after death in two accounts BC Mechanical Services-services rendered Register of Wills-filing Inh. Tax Return and Inventory Reserve for closing expenses 57.79 16.04 31.11 21.38 24.82 62.51 17.83 19.62 5.98 43.78 54.00 88.94 29.67 25.23 58.13 4.51 30.11 25.70 36.06 51.39 24.34 13.99 22.75 9.97 75.00 113.61 1,903.04 550.95 250.00 80.00 683.75 40.00 30.00 500.00 i SUBTOTAL SCHEDULE H-B7 5,002.00 REV-1512 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rae Jr.. Georoe . W FILE NUMBER 21 05 0479 Include un reimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION USAA Credit Card Services-debt of decedent : VALUE AT DATE OF DEATH 1,434.74 2 USAA Credit Card Services-debt of decedent 92.17 3 Mortgage Service Center-Mortgage payoff 13,863.77 4 Gevalia-debt of decedent 58.30 5 USAA Federal Savings Bank-home equity payoff 17,312.62 6 USSA Credit Card Serv.-debt of decedent 3,602.24 7 USSA Fed. Savings Bank-3 mortgage payments @ $102.33 each 306.99 8 Visiting Angels-nursing services 864.00 TOTAL (Also enter on line 10, RecapitulatiO~) $ (If more space is needed, insert additional sheets of the same size) 37 534.83 . <<EV-"" "'... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER R;lA Jr W ?1 Ofi 047Q RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Janice Rae Mitrovich Lineal 60,903.60 1365 Brentwood Road Yardley, PA 19067 2. Linda Marie Rae Lineal I 60,903.61 101 Jones Crossing Hartwick, NY 13348 3. David William Rae Lineal 60,903.61 4585 White Angel Drive Perry, OH 44081 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, <l>N REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I I TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ I .. (If more space IS needed, Insert additional sheets of the same size) -"..,.-::.~,.,.<..__.-._-~ '/' .......- '*' ... C~~~~n_~ / DEPARTMENT OF REVENUE . INHERITANCE TAX DMSION . DEPT. 280601 HARRISBURG, PA 17128-0lI01 SAFE DEPOSIT BOX INVENTORY MUST BE COMPlETED BY REPRESENTATIVE OF FINANCIAL INSTlruTlON WHERE SAFE DEPOSIT BOX IS LOCATED AND RETlIJRNED TO ABove ADDRESS COUNTY CODE FILE NUMBER SOCIAL 8ECURJ1Y IRecMr.cQ OR DeATH CERTIFICA ~'onIy If SSM Is ~I 21 2005-00479 207-22-0826 i DECEDENT'S NAME (LAST, FIRST, MIDDLE) DATE OF DEATH RAE, JR., GEORGE WILLIAM OS/2312005 ADDREsS OF DECEDENT (STREET) (CITY) ("TE) (ZIP CODE) 510 SPRING HOUSE ROAD CAMP HILL PA 17011 Please Print or Type NAME AND ADDRESs OF PERSON REQUE8nNG THE OPENING OF ,THE SAFE DEPOSIT BOX (NAME) DAVID H. STONE, ESQUIRE (STREET NAME) 414 BRIDGE STREET (CITY) NEW CUMBERLAND (Sl'ATE) PA (ZIP CODE) 17011 NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) b. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STAfrE) (ZIP CODE) c. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) I (STAte) (ZIP CODE) · NAME AND ADDRESS OF FINANCIAL INSTITUTIoN WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) M&T BANK (STREET NAME) (CITY) (STAre) (ZIP CODE) 5528 CARLISLE PIKE MECHANICSBURG P , 17050 I NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY JANICE RAE MITROVICH 5/16/2005 11 :03 am DATE OF CONTRAcT TO RENT BOX NUMBER OF BOX TITLE UNDER WHICH BOX IS REQUESTED 09/22/1998 341 GEORGE W. RAE NAME AND ADDREss OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) b. (NAME) JANICE RAE MITROVICH (STREET ADDRESS) (STREET ADDRESS) 1365 BRENTWOOD ROAD (CITY) (STATE) (ZIP CODE) (CITY) (STA1fe) (tip CODE) YARDLEY PA 19067 · NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY DAVID H. STONE, ATTORNEY FOR THE ESTATE WAS A WILL IN THE BOX? 0 YES it NO b. NlIIIIe and addrwu of personal Nprenntatlve. If named In the will (NAME) If yes, a. Date of will: (STREET NAME) (CITY) (STATE) (ZIP CODE) c. Name and addN.. of attorney, If any (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE) i" <.'......... / ./ / SAFE DEPOSIT BOX INVENTORY Page 1 of INSTRUCTIONS The Department is authorized under federal law , 42 U.S.C. S 405(c), to use the decedent's Social S,curity number in administering this state tax law. The Department uses Social Security numbers to establish a decedent's identity and ensure proper credit for tax payments. (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. I Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is rQglstered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, Le., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date $ppearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of Indebtedness: List an~ describe as fully as possible. (8) All other contents. i ITEM ITEM DESCRIPTION NO. , NONE : i i : i I I I ICER )~ F PERJURY THAT THE ABOVE RECORD IS PERSON RECEMNG COPY OF CORRE [HE BEST OF MY KNOWlEDGE AND BEUEF. SAFE DE~SIT BOX INVENTORY: SlGNATUf 1 SIGNATURE "- PRINT NAME ~ "' PRINT NAME AND CHECK APPROPRIATE BOX BELOW: DAVID H. STONE, ESQUIRE PRINT TITLE DATE CHECK APPROPRIATE BOX: I ATTORNEY FOR THE ESTATE o Execulor(lrtx) o Admlnla1r8tor(lrtx) ItI Esl8te R....-.. [J Joint - of IlIfe depaeIt ix>x . t " " : j' / / / NOTE. Attach additional 8/. x 11 shaet(s) If necessary or use duplicates of this page of form. Last Will and Testament I, George William Ra~ Jr.~ 510 Springhouse Road, Camp Hill, ClUllQerland County~ Pennsylvania, being of sound mind, memory and understanding, do make, publish I and declare this my Last Will and Testament, hereby revoking and making void all wills or declafations by me at any time previous to this writing. Item I: I devise and bequeath all of my estate of every nature and wherever sittjulte as follows: A One-third to my daughter, Janice Rae Mitrovich B. One-third to my daughter~ Linda Rae Grant C. One third to my son, David William Rae Item ll: I appoint my rlslHghter, Janice Rae Mitrovich, Executrix of this ~ Last Will and Testament. Item ill: No fiduciary acting hereunder shall be required to post bond or enter !security for the filithful performance ofher duties in any jurisdiction. ' , In witness whereot: I, George William Rae, Jr., have to this my Last Will andl Testament, so I documented and signed below. /0 ~,uy4Jy kef Date Signed, sealed~ published and declared by George William Rae~ Jr., Testator~ as aind for his Last Will and Testament, and in the presence of us, who at his request, in his p~ and in the presence of each other~ have subscribed our names as witnesses. ~~ ,...--" ... .-.-.-...,.- NOTARIAL SEAL CHARLES A. HARBOLD. NoIary PlbIlc Camp Hili Boro. Ctnlbertand County My Commlnlon ExpIrII Dec. 30. 2006 /0 rAJV'IJ~ ;Jeo'-( Date Witness Notary Public . ~ .../ r) . ~ . / ~-:. ,J ,-...../ III :..,.'7'i , " ( _/,. .".....c. .. _ -...._ ~ Witn~s /0 - t\i~~,~ilO Y Date rJ I re\ded\RAEESTATEsmith-executdeed PARCEL #10-19-1598-231 DEED THIS DlDEII'rllRE made the dCi~ day of ~~ ,in the year 2005, between JANICE RAE MITROVICH, Executrix of the Last Will and Testament of George William Rae, Jr., late of Hampden township, County of Cumberland, and Commonwealth of Pennsylvania, of th$ first part, hereinafter called the Grantor, - AIm - JEFFREY W. SMITH and SONYA SMITH, husband and wife, of the second part, hereinafter called the Grantees; WHEREAS, the said George William Rae, Jr., became in his lifetime seised, as of fee, of and in to a certain tract of land, together with the improvements thereon erected, situate in Hampden Tqwnship, County of Cumberland, and Commonwealth of Pennsylvania, and mOire particularly described hereinafter; and being so thereof seised, die~ on May 23, 2005, having first made his Last Will and Testament in ~riting dated January 10, 2004, duly probated and registered in the Office of the Register of Wills of Cumberland County on May 27, 2005,: wherein and whereby he appointed as Executrix, the said Janice Rae ~itrovich, to whom Letters Testamentary were duly issued by said Register of Wills on May 27, 2005, wherein and whereby said premises herefnafter de- scribed were not specifically devised, all as in and by said Will and the records of said Register of Wills more fully appears; -1- NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of the sum of One Hundred Ninety-Two Tho~sand Four Hundred and NO/100 ($192,400.00) Dollars, which has be~n paid to her by the said Grantees at or before the sealing and delivery hereof, receipt whereof is hereby aCknowledged, has granted, b~rgained, sold, aliened, released and confirmed, and by these presents! does grant, bargain, sell, alien, release and confirm unto the said Grantees, ALL THAT CERTAIN lot of land and the improvements ther~on erected, situate in Hampden Township, Cumberland County, Pennsy~vania, more particularly described in a survey by William B. Whittqck, P.E., on April 3, 1975, as follows: BEGINNING at a pin at the corner of Lot 29 and the edg~ of a walkway 25 feet from the centerline of Springhouse Road, said point also being 516 feet North of the right-of-way of Lantern Drive; t~ence along aforesaid walkway, North 11 degrees 10 minutes, 00 secqnds West, 90 feet to a pin on line of Lot 27; thence along Lot 27, ~orth 78 degrees 60 minutes 00 seconds East, 155.52 feet to a pin on li~e of Lot 39; thence along Lot 39, South 09 degrees 45 minutes 20 seqonds East, 90.03 feet to a pin on line of Lot 29; thence along Lo~ 29, South 78 degrees 50 minutes 00 seconds West, 153.30 feet to a po~nt and place of BEGINNING. . BEING all of Lot No. 28, Block "P", Plan 13, Pinebrook, which Plan is recorded in the Cumberland County Recorder's Office in ~lan Book 22, I Page 198. HAVING thereon erected a single brick and aluminum rancp-type dwelling with 2 car garage, known and numbered as 510 Springhous~ Road, Camp Hill, Pennsylvania. BEING THE SAME P~SES WHICH Joseph Mcginley, a singleiman, by his deed dated July 31, 1998, and recorded August 5, 1998, ~n the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Record Book 182, Page 1023, granted and conveyed unto George William Rae, Jr., Deceased. -2- TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoeverl, thereunto , belonging or in any wise appertaining and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of him, the said George William Rae, Jr., at and immediately b$fore the time of his decease, in law, equity, or otherwise howsoever, of, in, to or out of the same. TO RAVE AND TO BOLD the said lot or piece of grou~d above de- scribed, with the buildings and improvements thereon e~ected, hereditaments and premises hereby granted or mentioned,1 and intended s6 to be, with the appurtenances unto the said Grantee~, to and for I the only proper use and behoof of the said Grantees, fqrever. And the said Grantor, for herself and her respecti~e heirs, I executors and administrators, does covenant, promise an~ agree to and I I with the said Grantees, their heirs and assigns, that s~e, the said Grantor, has not heretofore done or committed any act, ~atter or thing whatsoever whereby the premises hereby granted, or any ~art thereof, is, are, shall or may be impeached, charged, or encumbered in title, charge, estate or otherwise howsoever. -3- IN WITNESS WHEREOF, the said Grantor has hereunto set her hand and seal the day and year first above written. Witness tAL) E MITROVIC , Executrix of t Will and T~stament of William Rae, iJr. COMMONWEALTH OF PENNSYLVANIA: COUNTY OF C~W\.k \c-..~ On this, the ~~ day of ~~~~, 2005, be~ore me a Notary ! Public, the undersigned officer,personally appeared J~NICE RAE SS: MITROVICH, Executrix of the Last Will and Testament of iGeorge William I Rae, Jr., known to me or satisfactorily proven to be tHe person whose name is subscribed to the wi thin instrument, and acknowiledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. ~ I I hereby certify that the precise address of the Grantee is Attorney for -4- .MSN Money - AIB - Stock chart, Index chart Page 1 of2 MSN Home My MSN Hotmail Shopping Money People & Chat Sign In Web Search: msn". 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(h.5r~ Allied Irish Banks PIc ADR Date High Low Close Volume 5/31/2005 42.0400 41.6100 41.7400 81,800 5/27/2005 42.nOO 42.2500 42.6300 106,300 5/26/2005 42.1800 41.8100 42.0500 63,700 5/25/2005 42.2500 41. 9600 42.0800 101,100 5/24/2005 41.8100 41.4500 41. 7700 43,100 5/23/2005 41.6100 41.1800 41.5500 61,300 7,,~ $As X 41.S's- - 5/20/2005 41.3900 40.9000 41.2100 38,300 ~ 5/19/2005 42.0500 41.6100 41.8100 38,900 J(~"f./O 5/18/2005 42.2500 41. noo 42.0200 56,200 5/17/2005 41.nOO 41.3700 41.6600 50,100 5/16/2005 41.0400 40.5000 41.0200 59,900 5/13/2005 40.8900 40.4500 40.5500 47,000 5/12/2005 41.5000 41.2200 41.4000 42,000 5/11/2005 42.0200 41.5400 41.8200 39,100 5/10/2005 42.3900 41.8600 41. 9000 176,400 5/9/2005 42.5700 42.1300 42.5200 56,900 5/6/2005 42.4000 42.1500 42.1800 45,100 5/5/2005 42.7800 42.3500 42.5600 67,300 5/4/2005 42.8800 42.2400 42.5600 50,400 5/3/2005 41.5500 41.1500 41.3000 84,000 5/212005 41.0000 40.6300 40.8800 36,500 I Trade Now I http://moneycentra1.msn.com/investor/charts/chartd1.asp?Symbol= AIB&DateRangeF orrh= I... 6/3/2005 I I I II M&fBank 499 Mitchell Road, MiIIsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302) 934-2955 June 9, 2005 Stone LaFaver & Shekletski Attorneys At Law 414 Bridge Street - POBox E New Cumberland, Pennsylvania 17070 Re: Estate of: G William Rae Social Securitv: 207-22-0826 Date of Death: May 23. 2005 Dear Sir or Madam: . Per your inquiry dated JWle 02, 2005, please be advised that at the time of death, the above-named ~t had on deposit with this bank the following: I 1. Type of Account Account Number Chec/cing Account 64928284 Ownership (Names of) Janice Rae Mitrovich * G William Rae · Opening Date Balance on Date of Death 08/18/98 $1,043.28 $ 0.06 Accrued Interest Total .-.------.-----------------..--------..-..---------..---..-.----------..+-------------. $1,043.34 2. Type of Account Checking Account 98222813 Account Number Ownership (Names of) Janice Rae Mitrovich · G William Rae * Opening Date Balance on Date of Death 08/18/98 Accrued Interest $40,312.58 $ 19.13 Total -------------------------------------------------------------------------!'"------------. $40,331.71 .Kelley Blue Book - Private Party Pricing Report - Chevrolet, Lumina Page 1 of2 _~ Ketley lue Book .. . THE TRUSTED RESOURCE . ...... ._;; _"~~',:,,,:'~:'.~__'n~~,,:?,_, "'~"IIII'''' USED CARS BLUE BOOK.' PRIVATE PARTY REPORT Pennsylvania · November 2, 2005 1991 Chevrolet Lumina Sedan 40 BLUE BOOK )l:UrJ, Li,,-,c! C --f-~'ii '-_~li Seg[ch Listings for this Cg[ I"j~ Y.our Qqr FQLSgttOn1ine QuickJ'~J~I,f{~~r Pti~Qvote FJ"eenC_ARFAXRecQrt_Cb~c!s Auto Loans from.5.1b_AP~ Insuranc~ Quote Print "EQLSale" Sjgn f'<:!;iment C~J.gl!l~tOI Q t 6 VE find exact you want. Engine: V6 3.1 Liter Trans: Automatic Drive: FWD Mileage: 130,000 adv Air Conditioning Power Steering AM/FM Stereo Equipment Consumer Rated Condition: ~air "Fair" condition means that the vehicle has some mechanical or cosmetic defects land I needs servicing but is still in reasonable running condition. This vehicle has a c1ecjn title history, the paint, body and/or interior need work performed by a professional. ~he tires may need to be replaced. There may be some repairable rust damage. Private Party Value SeflrchJ,..QcaLListL~ I 1d.$1 Ibj~.C~r forSflle $1650 Private Party Value is what a buyer can expect to pay when buying a used car frqm a private party. The Private Party Value assumes the vehicle is sold "As Is" and carr;es no warranty (other than the continuing factory warranty). The final sale price ma~ vary depending on the vehicle's actual condition and local market conditions. Thi~ value may also be used to derive Fair Market Value for insurance and vehicle don~tion purposes. G~t~UsedCar Trflde:lo.Value Get Invoice & MSRP on New Cars Get a l,5.MiDl"teJ~_eSQ9ns~ W.l1en YoU,4.pply for a Blank Cb.ec:k@.Auto I."oan http://www.kbb.comlkb/ki.dll/kw.kc.ur?kbb.PA;042886;PA041&17011;+p&723;Chevrp1e...l1/2/2005 I I I GBU 4254 Clairton Boulevard · Pillsburgh, Pennsylvania 15227.3394 . 1(412)884.5100 or 1(800)765.4GBU Fax: 1(412)884.9815 . E.mail; info@gbu.org ANNUITANT: George W Rae, Jr ANNUITY STATEMENT AS OF 6-30-2005 ANNUITY #: 22070502 DISTRICT #: 0791 ISSUE DATE: 11-01-1977 HR-I0 DATE ACTIVITY FROM 1-01-2005 TO 6-30-2005 1-01-2005 Beginning of 2005 value 1-31-2005 Fixed Amount Stl Check 2-28-2005 Fixed Amount Stl Check 3-31-2005 Fixed Amount Stl Check 4-30-2005 Fixed Amount Stl Check 5-31-2005 Fixed Amount Stl Check 6-30-2005 Fixed Amount Stl Check AMOUNT INTEREST BALANCE $200.00- $200.00- $200.00- $200.00- $200.00- $200.00- $15.,66 $13.,50 $14.~4 $13.09 $12.81 $11.70 $4,089.06 $3,904.72 $3,718.22 $3,532.46 $3,345.55 $3,158.36 $2,970.06 Cash Surrender Value as of 6-30-2005 = $2,970.06 2005 Taxable portion of withdrawals made from 1-01-2005 to 6-30-2005 = $1,200.00 Interest Rate Daily Rate Effective Annual Yield Current Rates: 1-01-2005 to 6-30-2005 4.500\ .000123288 ..603\ Put your money to work in one of GBU's Preferred Annuities. Call for det~ils. Interest is compounded daily. Current rates are subject to change. ~PF~2~______________________________:________ 68U 4254 Clairton Boulevard Pillsburgh, Pennsylvania 15227.3394 America's Fr.t.....' UIe lnaurance Society Promoting German CutlUN ANNUITY: 22070502 ANNUITANT: George W Rae, Jr ELECTED PREMIUM: $.00 GEORGE W RAE, JR 13 65 BRENTWOOD RD YARDLEY PA 19067-3925 Please in~icate any change of address. I I 2050703T2~FLPRS40010B0160B I U. S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMB No. 2502-0265 . . SETTLEMENT STATEMENT nlepro for Windows no ,,"we , RIVERSIDE LAND TRANSFERS, L.L.C. 301 Market Street, Suite 100 B. TYPE OF LOAN Lemoyne, PA 17043-0109 01.FHA 02. FMHA 03. CONV.UNINS. (717) 441-1555 04.VA 05. CONV. INS. 6. FILE NUMBER: r LOAN NUMBER: 143320 0004328359 MORT. INS. CASE NO.: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o. c.)" were paid outside the closing; they are shown here for Information purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER Jeffrey W. Smith, Sonya D. Smith George William Rae Jr. National City Bank of Indiana 3232 Newmark Drive Miamisburg OH 45342 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: Riverside Land Transfer I. SETTLEMENT DATE: 510 Springhouse Road Sep 29 2005 28.Plnebrook Thursday Hampden Township PLACE OF SETTLEMENT: 301 Market Street, Lemoyne, PA 03:00 PM Cumberland County. PA J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. Gran Amount Due From Borrower 400. Gran Amount Due to Seller 101. Conbact sales price 192,400.00 401. Contract sales price 192,4OO.OC 102. Personal Property 402. Personal Property 103. Setllement Charges (line 14oo) 4,807.88 403. 104. 404. 105. 405. Adjustments for items paid In advance by seller(s} Adjustments for Items paid In advance by seller(s) 106. CltylTown tax 406. CltylTown tax 107. CountylCly tax 09129105 to 12/31105 85.80 407. CounlylClty tax 09129105 to 12/31105 85.8C 108.~ 408. Assessments 109. School Tax 09129105 to 06130106 1,020.80 409. School Tex 09129105 to 06130I06 1.020.S( 110. Sewer-JullAuglSep 09129105 to 09130/05 1.25 410., Sewer-JullAuglSep 09129/05 to 09130105 1.2~ 111. 411. 112. 412. 120. Gross Amount Due from Borrower 198,315.73 420. Gross Amount Due to Seller 193,607.8! 00. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller 01. Deposit or earnest money 5,000.00 501. Excess deposit (see Instructions) 02. Principal Amount of new Ioan(s} 153,900.00 502. Settlement charges to seller (line 14oo) 15,792.62 03. ExIsting Ioan(s} taken subject to 503. ExIsting loan(s} taken subject to 04. 504. Payoff of First Mortgage Loan Mortgage Service Center 13,863.77 205. 505. Payoff' of Second Mortgage Loan 206. Seller to Buyer Credit' 2,499.00 506. Seller to Buyer 2,499.00 207. Proceeds from 2nd Mortgage 28,766.50 507. 208. 508. 209. 509. Adjustments for Items unpaid by seier Adjustments for Items unpaid by seller 210. CltylTown tax 510. CltylTown tax 211. CounlylClty tax 511. County/City tax 212. Assessments 512. Assesaments 213. School Tex 513. School Tax 114; 514. !15. 515. !16. 516. '17. 517. i18. 518. !19. 519. 20. Total Paid BylFor Borrower 190,115.60 520. Total Reduction Amount Due Sellar 32,155.39 ,00. CASH AT SETTLEMENT FromlTo BORROWER 600. CASH AT SETTLEMENT To/From SELLER 01. Gross Aml due from borrower (line 120) 198.315.73 601. Gross Amount due Seller (line 420) 193,507.8~ 02. Less Am!. paid bylfor borrower (line 220) 190,165.50 602. Less reduction in Amt.due Seller (line 520) 32,155.31 03. Cash 181 FROM OTO Borrower 8,160.23 603. Cash 181 TO Oi=ROM Seller 161,352.46 Seller's Signature Buyer or Borrower's Signature ...- L'SETTLEM!NT CHARGES Case f# 143320 Paid From Paid From ' 700. ToIa/Sales Commission based on Price: $ 189,900.00 % Borrower's Seller's Division of Commission at: $ 11,394.00 Tolal Funds At Funds At 701. 5,722.00 The Homestead Group Setllement Settlement 702. 5,672.00 RelMax Realty Professionals 703. Commission paid at Settlement T I 11,394.00 704. BOO. Items Payable In Connection With Loan 801. Loan Origination Fee National City Bank of Indiana 802. Loan Discount 803. Appraisal Fee to 804. Credit Report to 805. Inspection Fee to 806. Flood Certification Fee FDSI 7.50 807. Document Processing Fee 808. Application Fee to Premier Funding ($325 POC) 809. Processing Fee to Premier Funding 150.00 810. Escrow Waiver Fee to Premier Funding 384.75 811. Administration Fee to NCBI 'IF 410.00 900. Items Required By Lender To Be Paid In Advance 901. Interesl from 09129105 to 09130105 @ 23.1900 /Day 46.38 902. Mortgage I.ns. Premium o Months to 903. Hazard Ins. Premium o Vears to 904. o Vears to 905. o Vears to 1000. R_rves Deposited WIth Lender For 1001. Hazard Insurance o Months C!l $ /Month 1002. Mortgage Insurance 0 Months @ $ /Monlh 1003. CitylTown Taxes o Months @ $ /Month 1004. County Taxes o Months @ $ /Month 1005. Assessments o Months @ $ /Month 1006. School Taxes 0 Months G $ /Month 1007. o Months G $ /Month 1008. o Months G $ /Month 1100. TItle Charges 1101. Settlement or dosing fee 1102. Abstract or litJe search 1103. Tille Examination 1104. Title Insurance Binder ,1105. Document preparation 1106. Notary fees Karen L. Turns 1.0.00 1107. AtIomey's fees (includes above items No.:) 1108. TIlle Insurance Riverside Land Transfers ..- (includes above items No.:) 1101-1104,1108 Bask>Endorsamentsl00,3OO.900 1109. Lender's coverage $ 153,900.00 1110. Owner's coverage $ 192,400.00 1111. Closing Service Letter to Riverside Land Transfers 35.00 1112. Ww Transfer Fee to Riverside land Transfers 20.00 I 1113. Electronic Transmission of Documents to Riverside Land Transfers T 25.00 I 1200. Government Recording and Transfer Charges 1201. Recording Fees : Deed $ Mortgage $ 64.50 Release $ 64.50 1202. CitylCounty taxlstemps : Deed $1,924.00 Mortgage $ * 1,924.00 1203. Slate lax/stamps: Deed $1,924.00 Mortgage $ 1,924.00 1204. Recorder of Deeds 1205. 1300. Additional Setllament Charges 1301. Ovemight courier to Riverside Land Transfers 25.00 18.00 1302. Radon Mitigation to Blechler & Tillery * 165.00 500.00 1303. 1304. Tax Service Fee to Land America n.00 1305. Total from Page 3. to 140.00 1,956.62 1400. Total Settlement Charges (enter on lines 103 & 502, Sections J & K) 4,807.88 15,792.62 P-., _1hal no 1iII~ Is assumed by SelIlement Agenllar the IICClIfIICy of Information fUmIahed by olheta as shown on the HUD-l SelIlement Slatement. HUD CERTIFICATION OF BUY t Statement and to the bast of my nsectlon. I further certify iUy8l's Address & Phone: SeIler's New Address & Phone: f/-~"----."7;~::..-"-'._._~" . . Closing Statement Continuation Page Borrower. Smith, Jeffrey, W. Seller. Rae Jr., George, William Property: Springhouse 510. Hampden Township, Cumberland County, PA Form Hud-1 Page 3 Linetl' Detail of Form Hud-1, Line 1305 Borrower Seller 1700. Continued from Page 2. to 1701. Mtg.Broker Fee Pd by NCBI to Premier Funding, 1m;. ($1346.63 POC) 1702. Express maD Fee to Fed Ex $15.00 1703. 2005-06 School RE T_ to Marie Huber $1,359.82 1704. Wood Pest Treatment to Ellrlich 296.80 1705. Debris Removal to Ray Martini 300.00 1706. Transaction Fee to Re/Max Realty Professionals 125.00 1707. to 1708. 10 1709. to 1710. to 1711. to 1712. to 1713. to 1714. to 1715. 10 1716. to 1717. to 1718. to 1719. to 1720. to 1n1. to 1722. to 1723. 10 1724. to Total Amount - transferred 10 Hud-1 Une# 1305 $140.00 $1,958.62 Closing Dale 09l29J05 -