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Home My WebLink About01-12-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 006198 BROWN DONNA FOX- 96 SHADY LANE ANNVILLE, PA 17003 ACN ASSESSMENT AMOUNT CONTROL NUMBER _____n_ fold ---------- -------- 101 I $8,538.07 ESTATE INFORMATION: SSN: 169-10-0201 I FILE NUMBER: 2105-0932 I DECEDENT NAME: SIMPSON DAVID C I DATE OF PAYMENT: 01/12/2006 I POSTMARK DATE: 01/12/2006 I COUNTY: CUMBERLAND I DATE OF DEATH: 10/13/2005 I I TOTAL AMOUNT PAID: $8,538.07 REMARKS: CHECK# 0420 INITIALS: MW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-'SOO EX 16-01]) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 W f- lI::$en ulrll:: wn.u J:oo ulr...J n.1Il n. <C FILE NUMBER -;> /. "! C;' /- - C ,_) -- -- COUNTY CODE YEAR INHERITANCE TAX RETURN RESIDENT DECEDENT 0932-- NUMBER I- Z W C W () W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 511"!) c ')"on ( DO-III d C. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) /0--/3 -oS 8 -19-- /91'1 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER (tr>9 - Ie - {)ZO/ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W'Original Return o 4. Limited Estate [B1': Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required -8 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) f- Z W C Z o n. en w lr lr o U L4'/?~ 1/'003 COMPLETE MAILING ADDRESS qu Shculc/ linn VI/Ie PA NAME broUJY7 FIRM NAME (If Applicable) TELEPHONE NUMBER 7/7 - 832 - CG80 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) n OrlL /6:>/, / Ie'}, :3 5 none- II one- ,3~, CjQB,OC) ~--~i t .-, 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o ~ ..J :J t: D.. <( () w ~ 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) 8. Total Gross Assets (total Lines 1-7) (8) (J 7-').'"7 c: o I ...J h,--, ,:.)0 Y1cn-f2-- 19P~ 1/7,Y-tJ (6) non e-. . .1 --I (7) rJ t.J 1/ €- I..C 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) 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) (11) (12) (13) b, 3b2. 60 / B'~ 7 3'--/-,90 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) /8?- 73'-/, 9() SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ :J D.. :E o () ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O _ (15) x .0 45 (16) (0 c"30. 07 DJ""---)' C-J, /09 73Lj. qO , 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate x12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 8,5:36, 07 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT The: ri~\;t chlllee tiJr the long term" -@- f~~~~,~~~.can Funds' NOliolk VA 23501-2280 I~_ccount Statelnent November 7,2005 , , Your fln:Ulcial adviser KELLEY DAVID C SIMPSON PO BOX 471 SUMMERDALE PA 17093-0471 CAMBRIDGE INVESTMENT RESEARCH, INC. 120 FERREE ST HARRISBURG PA 17109-2805 l. "111'1,111",1,1,,,,11,11,",1. ,11",1",111",1",1111",1 Transactions Washington Mutual Investors Fund - Class A Fund number 01 Account number 941353546 Trade date Desc Tlptlon Dollar amount Share pric e Shares this transaction 03/18/05 03/18/05 06/17/05 06/17/05 09/16/05 09/16/05 11/07/05 Beginning Share Balance Income Dividend 0.14 $108.60 $30.32 3.582 Dividend Withholding $42.24 Income Dividend 0.15 $116.75 $31 .10 3.754 Dividend Withholding $45 .40 Income Dividend 0.15 $117.15 $31 . 30 3.743 Dividend Withholding $45.56 Shares Redeemed -$33,405.54 $30.69 -1,088.483 Ending Share Balance 3D-day purchase/exchange hold. You have redeemed or exchanged $5,000 or more from this fund. As a result, and as described in the fund's prospectus, you cannot purchase or excha nge $5,000 or more into this fund and account for 30 calendar days. You will again be able to purchase shares in this fund and account after 12/07/05. We regret any inconvenience this may cause. For more account information /oj;3/CS- '1 ;)9. 7/ . Call yourfinancial adviser . Automated information and services American FundsLine ,. 800/325-3590 Website - amencanfunds.com . Personal assistance - 8 a.m. to 8 p.m. Eastern time M-F Sha reholder Services 800/421-0180 To add to your investment Make check payable to American Funds Service Company. Please write your account number on your check. Do not send cash. Share balancf 1 ,077 .404 1,080.98E 1,080.98E 1,084.74C 1 ,084. 74C 1,088.483 1,088.483 o.ooe 0.000 DAVID C SIMPSON If investing in a new fund, please obtain a prospectus from your financial adVIser or our webslte. American Funds Service Company :00 Box 2280 Norfolk VA 23501-2280 Fund Fund Account number /lumber investment amount 3412535'46 $ $ .'JdshtnOlOn fVluluallllvestors FlInri.,~ 01 1.,1 ,1,.11"1,1,11,","11,,1,1..1,11"1,11,"11,,,11'111".11 Check total $ :177 44 7962 1]05 0000000 \ lillI' '\\\1 \1\11 \\1111111111111111 0000 93933010 009413535464 0000001 .\FS -69102" 15898690 l':l 006]4 I~093COlAFSO I SHR IAfl0073J0463 r:l~~ ri':..~ht d10ic:: ((II' the' lun~ t::rnl" @ ~R~,~}:~can Funds' NOli,:,lk VA 23501-2230 Account Statenlcnt November 7,2005 DAVID C SIMPSON PO BOX 471 SUMMEROALE PA 17093-0471 Your t1nandal adviser KELLEY I. " III " ,III. " 1,1 " .,11.11. " , I. ,II " .1, " III " ,I. ,,1111. " I CAMBRIDGE INVESTMENT RESEARCH, INC. 120 FERREE 5T HARRISBURG PA 17109-2805 Transactions The Growth Fund of America - Class A Fund number 05 Account number 941353546 Trade date Descnption Dollar amount Share pric e Shares this transaction Share balanc 11/07/05 Beginning Share Balance Shares Redeemed Ending Share Balance -$34,380.15 $29.86 -1,151,378 1,151,37~ o .aO( o ,OOC 30-day purchase/exchange hold. You have redeemed or exchanged $5,000 or more from this fund. As a result, and as described in the fund's prospectus, you cannot purchase or exchange $5,000 or more into this fund and accountfor30 calendar days. You will again be able to purchase shares in this fund and account after 12/07/05. We regret any inconvenience this may cause, For more account information jJ'1t-~' (Z' I OJI 3 Ju ~- Q' ZB, ~f.-., . Call your financial adviser . Automated information and services American FundsLine ' 800/325-3590 Website - americanfunds.com . Personal assistance - 8 a.m. to 8 p.m. Eastern time M-F Shareholder Services 800/421-0180 To add to your investment Maku chuck pavable to American Funds Service Company. Please wnte your account l1umber all your check. Do nof send cash, DAVID C SIMPSON If II1vesting in a new fund please obtall1 a prospectus from your financial adViser or our webslte. American Funds Service Company PO Box 2280 Norfolk VA 23501-2280 Fund Account Fund number fIumber Investment amount file [,roWlll cund III 11merlca.A OS :J413535J6 S $ I. .1.1. .11. .111.11. \l1"III.l,I"I,II..I.lll \111111 11111/., .11 Check total S J7H47962 805 0000000 \ \1111' 'Ill' \l\\II\'l\ 1111111111111 0000 39987410 009413535464 0000005 .l.F'!' ."'3100. 1<;8996901'300flJS 14094 COlAFSD I SHRIAF 1001330463 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF c-' :)! n\ PSDI'l REV';503 EX' (1.97) f SCHEDULE B STOCKS & BONDS D(lll I'd C FILE NUMBER 2/-- C5-- 0932. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. .3. J-/. VALUE AT DATE OF DEATH DESCRIPTION (~\\,-eY";((\~, l=Lt.v\OIS ~ LDQS\'\\1-7f:Jl-ol) ~/lILl:+u_()LJ1 T\\\.,{'s'hv..$ Fu_nol - C lc'lSs, A I, Obl2. q z.>';~ S~)()...(e<:, cd 1> 2C-1 -l liS/to. ;/z- ~ 32i3'~'Q. ~~_\.~ An\-{?,'kr,-', Furd<.:,", ',h-e 0:rOU,"'-"V-1 ~u.JxJ (I (\ ~\"ey\cc,- - C"-oS~s ,A \ , I 15 I . 3") 't':; GLuArt" S. CLJ <1, LS. tf(o l; I~ ve- f... 7 t;;) -) :)'2/ (, CJ, 2. ~ flo.}tY/ C Ctl? F L/ ncl5> . 0) c f:J J ny; r /< Cl - Ck.i S .r1 /:::-U JlC/ c -f J-;/) ~ 0 rn -f' 1/82D.rS3 6IlLA,"rS a+ ~ /7, 8 9/sha /'''L- 1> 32, 57:3 2... '7 /! rn~ l/("Ct r' F LultfS- IV t LV I!e rs/ e c Ir u e.... Fu FlQl .. C 10 c" 5 .A I. 22'S. 532. Sl.arrs ELi "128.5/ IShCtY,€- <:] . 3L/, 939 92- C;-' .J" ';1711 C' r {(" c, YJ /:;'0 uls - ;h-e 11 {J/r:::n'Cil - [lacs ,;4 2, 15 () _ E3 7~ .-S/iarr"S I!l..;d Ho.d 0 t C"LI- 7$ /3,2.S-/f;ll~il-e- </2B, '-199, /1 TOTAL (Also enter on line 2, Recapitulation) $ 1&1- 1/9- 3s- (If more space is needed, insert additional sheets of the same size) The eight choice for the IO\1I~ (elTl1" @ 1\r~,~~~ean Funds' NOlf,:,lk VA 235012280 L-\.ccount Statement November 7,2005 Your fin:ulCial adviser KELLEY DAVID C SIMPSON PO BOX 471 SUMMERDALE PA 17093-0471 CAMBRIDGE INVESTMENT RESEARCH, I NC. 120 FERREE ST HARRISBURG PA 17109-2805 I. 1111111,111. "1,1",,11,11,,,,1. ,11",1, "111",1,,,1111. "I Transactions . .. . ... ...... . ...... ....... .............. .... . ... ... . ....... .... ..... .. ., . .... ..... . ...... .. ., . ......... . ...... .... . ......... .. ... ... . ...... .,. . .., ... . .. ......... ..... . . ...... ... . .. . .., .............~....... ... .. ....... The Income Fund of America - Class A Fund number 06 Account number 941353546 Trade date 03/24/05 03/24/05 06/24/05 06/24/05 09/23/05 09/23/05 11/07/05 11/07/05 11/07/05 Description Dollar amount Share pric e Shares this transactloll Share balanc, .................... ............................................................................................................................................................................. Beginning Share Balance Income Dividend Dividend Withholding Income Dividend Dividend Withholding Income Dividend Dividend Withholding Shares Redeemed Dividend Withholding Income Dividend Ending Share Balance 1 ,786 .46C $199.49 $18.07 11 . 040 1 ,797 . SOC $77 . 58 1,797.50C $213.41 $18.34 11 .636 1 ,809. 13E $82.99 1 ,809. 13E $214.91 $18.50 11.617 1,820.75:: $83.57 1,820.75:: -$33,083.08 $18.17 -1,820.753 O.OOC $44. 10 O.OOC $113.40 O.OOC 0.000 3D-daV purchase/exchange hold. You have redeemed or exchanged $5,000 or more from this fund. As a result, and as described in the fund's prospectus, you cannot purchase or exchange $5,000 or more into this fund and account for 30 calendar days. You will again be able to purchase shares in thiS fund and account aher 12/07/05. We regret any inconvenience this may cause. For more account information '~"""" 0.0............00..... 00.... '0' 0 0 00' 0" 0 0...0.000..0.. o' 0.... o' 0.000..000...0.0.0..0. o. 0 ;C/13/c)- <j) 71 <;?J . Call yourfinancial adviser . Automated information and services American Fundsline ,', 800/325-3590 Website - americanfunds.com . Personal assistance - 8 a.m. to 8 p.m. Eastern time M-F Shareholder Services 800/421-0180 \ \\\\\11\\\1 \\\11 \1\\\ 11\\\ 1Illllll ':'FS .69300' 158986901900636 14095 CDLAI'SO L$HR IAF 1007130463 The right choice for the long term"' .h1. American Funds@ ~ PO Box 2280 NOlfolk VA 23501-2280 Account Statement November 7, 2005 DAVID C SIMPSON PO BOX 471 SUMMERDALE PA 17093-0471 1...11111.111'111.111..11.11'11.1..1111.1'11111...1'111111'111 Your financial adviser KEllEY CAMBRIDGE INVESTMENT RESEARCH, INC. 120 FERREE ST HARRISBURG PA 17109-2805 Transactions ........................................................................................................................................................................................................................-0. New Perspective Fund - Class A Fund number 07 Account number 941353546 Trade date Description Dollar amount Share pric e Shares this transaction Share balance ...................................................................................................................................................................................................................................................................................... 11/07/05 Beginning Share Balance Shares Redeemed Ending Share Balance -$35,846.81 $29.25 -1,225.532 1,225.532 0.000 0.000 30-day purchase/exchange hold. You have redeemed or exchanged $5,000 or more from this fund. As a result, and as described in the fund's prospectus, you cannot purchase or exchange $5,000 or more into this fund and account for 30 calendar days. You will again be able to purchase shares in this fund and account after 12/07/05, We regret any inconvenience this may cause. For more account information .................................................................................................. .;:Nt(!/ Ci''. lel/3Ic:; 'J;}E;.SI . Call your financial adviser . Automated information and services American FundsLine' 800/325-3590 Website - americanfunds.com . Personal assistance - 8 a.m. to 8 p.m. Eastern time M-F Shareholder Services 800/421-0180 ---------------------------------------------------------------- To add to your investment ......................................................................................................................................................................................................................... Make check payable to American Funds SelVice Company. Please write your account number on your check. Do not send cash. DAVID C SIMPSON If investing in a new fund, please obtain a prospectus from your financial adviser or our website. American Funds Service Company PO Box 2280 Norfolk VA 23501-2280 Fund Fund Account number number Investment amount .................................................................................................................................................................................... New Perspective Fund-A 07 941353546 $ 1"1.1,.11..1.1.11,,,.,.11,.1.1,,1.11,.1.11...11.,.11,..1...11 $ ........................................................................ .................. ........................... .................... ................................. Check total $ 077447962 005 0000000 11111111111111111111111111111111111 0000 64801810 009413535464 0000007 AFS.. .69500- 1589869019_00638.14091 CDLAFSO I_SHR.IAF 1001330463 The right choice for the long tcrm" '.1;1' American Funds@ L.:::f-I PO Box 2280 Norfolk VA 23501-2280 Account Statetnent November 7,2005 DAVID C SIMPSON PO BOX 471 SUMMERDALE PA 17093-0471 Your financial adviser KELLEY 1,"111",111."1,1""11,11,,,.1,,11,,,1,"111".1,"1111,"1 CAMBRIDGE INVESTMENT RESEARCH, INC. 120 FERREE ST HARRISBURG PA 17109-2805 Transactions ........................................................................................................................................................................................................................... The Bond Fund of America - Class A Fund number 08 Account number 941353546 Trade date Description Dollar amount Share pric e Shares this transaction Share balance ...................................................................................................................................................................................................................................................................................... Beginning Share Balance 2,090.626 01/25/05 Income Dividend $88.85 $13.59 6.538 2,097.164 02/25/05 Income Dividend $79.27 $13.59 5.833 2, 102 .997 02/25/05 Dividend Withholding $30.83 2, 102 .997 03/24/05 Income Dividend $79.51 $13.35 5.956 2, 108 .953 03/24/05 Dividend Withholding $30.92 2, 108 .953 04/25/05 Income Dividend $79.70 $13.43 5.934 2, 114.887 04/25/05 Dividend Withholding $30.99 2,114.887 OS/25/05 Income Dividend $79.92 $13.43 5.951 2; 120 .838 OS/25/05 Dividend Withholding $31 .08 2,120.838 06/24/05 Income Dividend $80 . 18 $13.52 5.930 2,126.768 06/24/05 Dividend Withholding $31 .18 2,126.768 07/25/05 Income Dividend $80.39 $13.42 5.990 2,132.758 07/25/05 Dividend Withholding $31.26 2,132.758 08/25/05 Income Dividend $80.59 $13.48 5.978 2,138.736 08/25/05 Dividend Withholding $31.34 2,138.736 09/23/05 Income Dividend $80.84 $13.41 6.028 2,144.764 09/23/05 Dividend Withholding $31.44 2,144.764 10/25/05 Income Dividend $81 .10 $13.27 6.112 2,150.876 10/25/05 Dividend Withholding $31.54 2, 150 . 876 11/07/05 Shares Redeemed -$28,348.55 $13.18 - 2,150.876 0.000 11/07/05 Dividend Withholding $12.64 0.000 11/07/05 Income Dividend $32.50 0.000 Ending Share Balance 0.000 3D-day purchase/exchange hold. You have redeemed or exchanged $5,000 or more from thiS fund. As a result, and as described in the fund's prospectus, you cannot purchase or exchange $5,000 or more Into this fund and account for 30 calendar days. You will again be able to purchase shares in this fund and account after 12/07/05. We regret any inconvenience this may cause. ?L"---/~CJ'.' J ~) ~- t- Ie j.-:, (I" f.,. (--- /1.(;)j 1111111111111111111111111111111 III/ AFS K69600. 158986901900639 14098,COlAFSOl SHR,lAF1007J3046J REV-15GB EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 5>/nfJ5ol)) bCl.Lnd C FILE NUMBER 2/-05- 0932- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Co/nl'1'7~r('C t3n/1K - rY't" 1'17';'- ,)'4. i/ I'if S '# CXo/f;;2t;;/92C ~ 8/ 57,31 2, CD)yJ /7Jr'r{!. e f3qnk- c /?~ck /11 '#. 65 3 "" I <:::>-G SS-o 'j, 5--01 S. <1:::,- ('CI/'1I?1rrct:- bonA.- Ceyh'f;cct<). cj" bc/JDs{'f ~Y-{)02-t.f5- <:/. IS ~t)/ s-y. 3, F :;, J'pnpJsy/UQI1'~ ,Jkh &1111<chet/01J -.L !o5caI1<f /191 IVrd' L()':r.'c:< ~[7kf~ C mCilo/hci/#e 29 ( Ii; ,'r COhcY" fro/? 5'f 3 5ftJ<J.. 7'5 1-/. $tIP OOD, 0 0 TOTAL (Also enteron lineS, Recapitulation) $30/ 99Q res (If more space is needed, insert additional sheets of the same size) C0l11111erCe "IIBanl< Commerce Bank/Harrisburg N.A. 100 Senate Avenue Camp Hill, PA 17011 888-937-0004 STATEMENT DATE DAVID C SIMPSON POBOX 471 SUMMERDALE, PA 17093 10/30/05 0616261920 ACCOUNT NO. CLOSED *** SAVINGS *** PREMIER SAVINGS BEGINNING RATE ACCOUNT NUMBER 0616261920 PREVIOUS STATEMENT BALANCE AS OF 04/30/05 ........................ PLUS 6 DEPOSITS AND OTHER CREDITS ................... LESS 1 WITHDRAWALS AND OTHER DEBITS ................ CURRENT STATEMENT BALANCE AS OF 10/30/05 ......................... NUMBER OF DAYS IN THIS STATEMENT PERIOD 183 0.99500 8,117.91 39.40 8,157.31 .00 ---~------------------------------------------------------------------------------- *** SAVINGS ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 05/31 INTEREST PAYMENT 06/30 INTEREST PAYMENT 07/31 INTEREST PAYMENT 08/31 INTEREST PAYMENT 09/30 INTEREST PAYMENT 10/27 INTEREST PAYMENT 10/27 CLOSING WITHDRAWAL DEBITS CREDITS 6.86 6.57 6.87 6.88 6.66 5.56 8,157.31 ----------------------------------------------------------------------------------- *** BALANCE BY DATE *** 04/30 8,117.91 05/31 08/31 8,145.09 09/30 8,124.77 06/30 8,151.75 10/27 8,131.34 07/31 .00 23-2324730 65.90 8,138.21 PAYER FEDERAL 10 NUMBER INTEREST PAID YEAR TO DATE ---------------------------------------------------- *** INTEREST EARNED THIS STATEMENT PERIOD DAYS IN PERIOD ......................... INTEREST EARNED ........................ ANNUAL PERCENTAGE YIELD EARNED (APY).... *** 179 39.40 0.99% ---------------------------------------------------- COllJllJerce .Bank Commerce Bank/Harrisburg N.A 100 Senate Avenue Camp Hill Pa 17011 888-937 -0004 DAVID C SIMPSON 607 MOUNTAIN ST SUMMERDALE, PA 17093 1 *** CHECKING *** ~O PLUS CLUB ACCOUNT NUMBER 0536150550 PREVIOUS STATEMENT BALANCE AS OF 10/21/05 ........................ PLUS 1 DEPOSITS AND OTHER CREDITS ................... LESS 1 CHECKS AND OTHER DEBITS ...................... CURRENT STATEMENT BALANCE AS OF 11/21/05 ......................... NUMBER OF DAYS IN THIS STATEMENT PERIOD 31 *** CHECKING ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 10/27 INTEREST PAYMENT 10/27 CLOSING WITHDRAWAL DEBITS CREDITS .08 5,015.45 *** BALANCE BY DATE *** 10/21 5,015.37 10/27 .00 PAYER FEDERAL ID NUMBER INTEREST PAID YEAR TO DATE 23-2324730 6.87 *** INTEREST EARNED THIS STATEMENT PERIOD DAYS IN PERIOD ......................... INTEREST EARNED........................ ANNUAL PERCENTAGE YIELD EARNED (APY).... *** 5 .08 0.12% Page 1 of 2 STATEMENT DATE 053 50550 ACCOUNT NO. CLOSED 5,015.37 .08 5,015.45 .00 NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC REV-1511 El<+ (12-99) . _9;.I~~ ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF C nJ) 0 I .J I Y. -I Sorl \ ,-!-Jo U I 'c c~ FILE NUMBER '7' . ..- On /7 r-/-O':)-- -j JC- Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: QD\\\'r(~ E;(e-ev1 Cem-e~Vtt - ~VJ+e~m-ev,-'\ -4-L":i J- '')''')01' t-\.L~-t'~8\t. r--\..t.y)~v-t\_J \-\om'f ,:t'Vlt- fcll1-t'VGJ Se(\).(rS ''7 eel')" vn -t' v 0..0.. \ 'C.. \J 1'\ l W vnN-~cdIS 1- Cb0 a I., - C \'f'fc' U YYlC-l n ). ) (I J \ -' C V\'v,<,c--'v'\ r~ ~~ , ~url 1. 1; q q<::--.; .CO <~f..t/2. ~7 . So ~ bee" OQ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Dcr)\"C-L Social Security Number(s)/EIN Number of Personal Representative(s) Street Address C\.(.p ql~ L-i LA VI-<2_ I City V::'\YW\\)\' t\-C- Year(s) Commission Paid: 2L:OlO FO'f--~(Q\..Dn J-DO-- LB - t.vlv ., ~ State YA- Zip II 007) 1>'-3oc::) 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees i Sc) 7. TOTAL (Also enter on line 9, Recapitulation) $ t\ I.~ 732 . s 0 (If more space is needed, insert additional sheets of the same size) ,REV-1513.EX+ (9-00:" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF C -") \ (V, pSCJ n J 8(1\) I C'\ L FILE NUMBER 2/-oS-0932. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. UOI'lI'lC\. Fof-- - ~(O~..., 4 _ r>i J".O \'.^ \ "Q" . \ - r 0. '6~ 0 . ; 11; Lf 3 ~./3 c\ [p s~ 1 OL>--~, u.--'o1 "'--" 'Lt '-~r\. 'tf' '"1 AVllf)U" l\ -e YA 17 OD~ 2 ?J{-t>Id.c<. R-k't:' L~_ loCi\. mDv\~...uY\ 'SUrI"ilty\trd.ct l-e ~A s+- IICq'~ b CL~h.--\-eV <\. acs elv - Lf I ,t:t j 3 .7 3 ~ . Lor-€ ++CL l:::x:t n v., e. r .,,' L r i_ l.D--",€- \ ,?- , _\ t\.(~ {VI -e cJLLAYl l C s b LJ r,S-- -p f\- 1--\ . ~ let ; ne C~yyy) he tI LO'-\ t)vYO Cd-em.!.v.) r<c-J \)Q~h.kv;} S'}['- $'f7//33,7,J -po ~D'{... 2-02- CO(Y,u.Jl~U ~A It Dt~, ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 1/0'50 bO-D1k -W r 73 J 5'70 ~ ~'-f7, Lf33. 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. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) iEctst 3lUIill ,lttO WJ?/,tctttt~nt OF DAVID C. SIMPSON I, DAVID C. SIMPSON, of West Hanover Township, Dauphin County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills by me at any time heretofore made. ARTICLE I I direct my Executrix hereinafter named to pay my just debts and funeral expenses as soon after my decease as conveniently may be. ARTICLE II I give and bequeath unto my wife, S. LOUISE SIMPSON, if she survives me my household goods, motor vehicles, sporting equipment and other tangible personal property. If my wife shall fail to survive me I give and bequeath the same unto my four daughters equally as they shall agree, except that I bequeath the fallowing named family heirlooms to the persons named: Necklace of $1 gold piece to Donna Fox Gold watch on chain to Elaine Campbell Silver watch to Loretta Danner Mother's baby shoes to Brenda Simpson Cedar chest to Brenda Simpson Dutch cupboard to Loretta Danner ARTICLE III All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath unto my wife, S. LOUISE SIMPSON, if she survives me. Should my wife i fail to survive me I give, devise and bequeath the same unto my four daughters equally, the issue of any who may predecease me to take the share of the parent by representation. ARTICLE IV I appoint my wife, S. LOUISE SIMPSON, to be the Executrix of this my Will. Should my wife fail to survive me or fail for any reason to complete the administration of my estate I appoint my daughter Donna Fox to be the Executrix, and should she predecease me or fail to complete the administration of my estate, I appoint my daughter Elaine Campbell to be the Executrix in her stead. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ?:"yl\ day of October, 1981. I '1 t -....,: ~.7\ ,I !(.',. 'f I ...r \--"-~'-'l ........ \ ), , ....~ . ;""/'.... ( SEAL) David C. Simpson Signed, sealed, published and declared by the above-narned Testator, as and for his Last will and Testament, in the presence of us, who at his request and in his presence and ln the presence of each other, have hereunto subscribed our names as witnesses. r"--~-' /' '-;.1.(' '... .- i ,:' ji> 'I" - 2 -