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HomeMy WebLinkAbout01-17-06 (2) REV-1737..~ EX (S-OO) '* FILE THIS RETURN WITH: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV.1737.A INHERITANCE TAX RETURN NONRESIDENT DECEDENT I- Z W C W U w c W I- ~ :$lI) l)0::~ wOol) J: 00 " O::.J ~ 00 III 00 < DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Lahar Elton B. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 04/20/2005 12/24/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [X] 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBER -0 5 004 1 0 COuNTY"Co5E ---VEAR- - - NuMaER-- SOCIAL SECURITY NUMBER o 02- 1 4 - 6 1 6 9 SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALLCORRESPONDENCEANDCONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Theresa L. Shade Wix Es uire 4705 Duke Street FIRM NAME (If Applicable) Wix, Wen er & Weidner TELEPHONE NUMBER 717 652-8455 Harrisbur PA 17109 REFER TO METHOD OF COMPUTATION IN THE NONRESIDENT DECEDENT INSTRUCTION BOOKLET (REV-1736) Check One: [R] Flat Rate 0 Proportionate (Complete Worksheet on Reverse Side) METHOO z o I- <( ...J :::> l- e: <( u w a::: I- Z W Cl Z o 00 lI) W 0:: 0:: o l) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) (1) (2) (3) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subjectto Tax (Line 12 minus Line 13) (8) (11) (12) (13) (14) 94,537.02 OFFICIAL USE ONLY .~ ~. c.:.. --~ 13,887.89 \.~:,,') 108,424.91 67,373.45 67,373.45 41,051.46 WHEN PROPORTIONATE METHOD IS ELECTED, REFER TO WORKSHEET ON REVERSE SIDE FOR AMOUNTS TO BE ENTERED ON LINES 15 THRU 18, 41,051.46 W O::z Wo :I:- ~I- u~ w::>> :I:1l. U:! :I: 0 UU ~>< 1-<( <(I- SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X .0_ (15) 39,693.28 X .045 (16) 1 ,358.18 X .12 (17) 0.00 X .15 (18) (19) 0.00 1,786.20 162,98 0.00 1,949.18 QJ- 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > B.ESURE TO ANSWERALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 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. Make check payable to Commonwealth of PA III III Q) I.. " " ~ Q) - Q) Q.. 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CII c :::i CII m nI a.. C o >< o .c ..>0: U CII ..c U ~ '" o '"" c.O ~ '" ..c: m~ ~~c;)x '0 ~ ~ 2 $ C ~ ~ C'O::Jc(ij "Coo Q) ~ E 'E ~ g< 8. m ~~e Q) Q) ..- n... :0 ~ ~x ~ ~";i;?fi ~ ma; ;5 c..j ~~ m u:) r--..: ~ x x c;;- O) c: ~ x i!J e? ~ i!J .!ll o U m Ol :0 '" x '" c: I- 0 ct :::I 0 o 0. E e <0.. 0) Ol ... a.. c: o -e l!! .2! c: 0> Q) .0 g 0> :0 a> :::I ~ CD <n Q) c: :.:i '0 - '3 <n l!! Q) ..c: I- c;;- Ol c: 2. en I REV-1737-1 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 This affidavit must be completed and sworn to by a person having personal knowledge of these facts, preferably by a surviving spouse or member of the decedent's family. Date of Death 04/20/2005 NONRESIDENT DECEDENT AFFIDAVIT OF DOMICILE Name of Decedent Lahar, Elton B. Legal Address at Time of Death: Street Address City/Borough Carlisle State 3761 Spring Road PA Zip Code 17013 The following information is submitted in support of the statement that the above individual was not domiciled in the Commonwealth of Pennsylvania at the date of death. 1. Names and addresses of the decedent's surviving spouse and members of his/her immediate family: Name and relationship to decedent Kimberly L. Lahar Street Address 2601 N. Old Stage Road, #15, Name and relationship to decedent Craig Lahar Street Address 6445 Gallop Road Name and relationship to decedent Jeff Lahar, 488 Quail Ridge Road, Fincaster, VA 24090 Street Address 488 Quail Ridge Road 2. Did the decedent ever live in Pennsylvania? If yes, during what periods? May 2001 to April 2005 City/Borough Mt. Shasta Daughter State Zip Code CA 96097 City/Borough Harrisburg Son State PA Zip Code 17111 City/Borough Fincaster IX Yes Son State VA No Zip Code 24090 3. Did the decedent spend time in Pennsylvania during the five years preceding death? If yes, during what periods and at what address? May 2001 to April 2005 - 3761 Spring Road, Carlisle, PA IX Yes No 4. What was the nature of decedent's places of residence during the five years immediately preceding death? Indicate whether decedent resided in a house or apartment and whether it was rented or owned by the decedent, and/or whether decedent resided in a hotel or the home of relatives or friends. From May to October 2001, decedent rented an apartment. On October 31, 2001 the decedent bought a home at 3671 Spring Road, Carlisle, PA which property he intended to resell and then move back to California. 5. Was the decedent employed during the five years preceding death? C Yes ex No If yes, list the name and address of employer(s). 6. Did the decedent leave a will? iXl Yes No If yes, state the court which admitted the will to probate, the date admitted, and attach a copy, including all codicils, and a certificate of issuance of letters testamentary. On May 3, 2005 the Register for Cumberland County, Carlisle, PA issued Letters Testamentary 7. If the decedent did not leave a will, has an administrator of his estate been appointed? C Yes ~ No If yes, state the court which appointed the administrator, the date of appointment, and attach a certificate of the issuance of letters of administration. Not Applicable 8. At any time during the last five years did the decedent execute a will, a codicil, trust indenturE!, deed, mortgage, lease or any other document in which the decedent was described as a resident of Pennsylvania? -. i Yes [Xl No If yes, describe such document. NONRESIDENT DECEDENT AFFIDAVIT OF DOMICILE (continued) Page 2 9. Had the decedent paid a tax on income or on intangible property to any state, county, or municipality during the last five years? If yes, where and when was it paid? x: Yes i No The decedent filed income taxes as a California resident and mailed his taxes to Franchise Tax Board, P.O. Box 942867, Sacramento, CA 94267 10. To what regional office ofthe Internal Revenue Service did the decedent forward his Federal Income Tax returns during the last five years preceding death? The Austin Service Center 11. At the time of death, did the decedent own, individually or jointly, any interest in real property, including lease.holds or tangible personal property located in Pennsylvania? XI Yes [] No If yes, describe the property in detail. The decedent owned the property located at 3671 Spring Road, Carlisle, PA 17013 12. In what business activities was the decedent engaged during the last five years preceding death? Indicate whether decedent was employed or otherwise engaged in business, and state the names and the addresses of the persons, firms or corporations with which the decedent had such business affiliations. (Except for employer listed in #5) None 13. What is the estimated gross value of the decedent's estate, wheresoever situated, exclusive of real property and tangible property located outside of Pennsylvania? Approximately $780,000.00 14. At the time of death, did the decedent own or operate an automobile? eYes If yes, in which state was it registered? XI No 15. At the time of death, was the decedent a member of a church or any other organization?:::J Yes If yes, provide the name and address of the church or any other organization. Xi No 16. State the purpose or reason the decedent owned real property in Pennsylvania. The decedent owned real property in Pennsylvania for an investment opportunity. 17. Include any other information you wish to submit in support ofthe contention that the individual was not domiciled in Pennsylvania at the time of death. If more space is needed, insert additional sheets of same size. The decedent did not vote in Pennsylvania nor did the decedent have a Pennsylvania driver's license. It was the intent of the decedent to return to California but various health and medical problems delayed his return to California. Continued on a Separate Page Name of person completing affidavit Relationship to decedent Kimberl L. Lahar Street Address Dau hter 2601 N. Old Stage Road, #15 City Mt. Shasta State Zip Code CA 96097 Under penalties of perjury, I declare that based on my personal knowledge of the decedent, the information provided on this form is true, correct and complete. Signature of peJson completing aff' avit Date ~. /2. -"1.,,J" ~C)~ Continuation of REV-1737-A Inheritance Tax Return Nonresident Decedent Lahar. Elton B. 05 00410 Page 1 17. Information Supporting that the Decedent Was Not Domiciled in Pennsylvania at the Time of Death On April 20, 2005, the date of the decedent's death, Kimberly Lahar, the decedent's daughter, was coming to Pennsylvania from California in order to pick up her father and take him home to California. Due to the decedent's deteriorating health condition he was unable to travel alone. Kimberly Lahar had already left her home and was on her way to Pennsylvania when the decedent's death occurred. The majority of the decedent's finances and financial matters were managed in California by his daughter, Kimberly Lahar INVENTORY Estate of Elton B. Lahar No. 05 00410 , Deceased Date of Death 4/20/2005 Social Security No. 002-14-6169 also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside 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 inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Theresa L. Shade Wix, Esquire P7:;ep9:~ / 8w'*'>< I.D. No.: 43089 Address: 4705 Duke Street Harrisburg Telephone: (717) 652-8455 Dated J;J- - ;2fr - 0") PA 17109 Description 3761 Spring Road, Carlisle, Pennsylvania Value 50,000.00 Allstate Insurance payment for dwelling coverage for fire at 3761 Spring Road, Carlisle, Pennsylvania on April 15, 2005 44,537.02 Personal Property of Decedent 13,887.89 Total (Attach Additional Sheets if necessary) 108,424.91 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 REV-1737-2 EX + (9-0(* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF SCHEDULE A, PART 1 REAL ESTATE IN PENNSYLVANIA FILE NUMBER Lahar, Elton B. 05 00410 Part 1 must include all real property owned by the decedent individually or as a tenant in common with another party(ies), having its situs in Pennsylvania. Property which is jointly-owned with right of survivorship should be disclosed on Schedule F. All real estate must be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 3761 Spring Road, Carlisle, Cumberland County, Pennsylvania 50,000.00 (Owned by Elton B. Lahar, now deceased. The Estate of Elton B. Lahar by its Executrix, Kimberly Lahar, conveyed said property unto Matthew J. Rutkowski and Martin P. Rutkowski on July 26,2005.) (See Schedule A, Exhibit 1) 2. Payment from Allstate Insurance Company for dwelling coverage for fire 44,537.02 loss to property located at 3761 Spring Road, Carlisle, Pennsylvania on April 15, 2005 (See Schedule A, Exhibit 2) PART 1 TOTAL $ 94,537.02 PART 2 TOTAL Proportionate Method Only from reverse side $ TOTAL (Also enter on line 1, Recapitulation) $ 94,537.02 (If more space is needed, insert additional sheets of the same size) ) i1- ,1:j'? 3" fif1 ,,~'-~ TAX PARCEL NO.: 21-04-0373-026 -, r,::) S- -, -.-!' 7; ~ G L [(1, : \ ~...' --: ...~ I' .' - - '" - " - - - -,'~;-, ::: E D S f" .- :.J ',);. -' ,_... ... i ~! It.- .' '.J" -, ') r- '''\ I · I ~" CO U Ii T Y - ~ ;1 ;,.~I':':\~}\;;'. 51-- MADE THE ~q I DAY OF THOUSAND ONE (2001) THIS DEED ctC.C 'OlNOU 2 Arl8~~ , IN THE YEAR TWO BETWEEN: James S. Hostetter and Margaret L. Hostetter, His Wife, GRANTORS AND Elton B. Lahar GkANTEE WITNESSETH, that in consideration of the sum of Eighty-nine Thousand five hundred ($89,500.00) Dollars, in hand paid, the receipt whereof is hereby acknowledged, the said grantors do hereby grant and convey to the said grantees, their heirs and assigns: ALL THAT CERTAIN parcel of ground situate in the Township of Middlesex, Cumberland County, Pennsylvania, bounded and described pursuant to the Deed Plot as parepared by John S. Shambaugh, P.E. ofFPE Consulting Engineers, Dillsburg, Pennsylvania, dated May 5, 1994, as follows: BEGINNING at an iron pin found along the boundary line between said property and the Church of the Brethren, South 52 degrees, 43 minutes, 14 seconds East along lands now or formerly of said Church of the Brethren and along lands now or formerly of Daniel Roebuck, 370.98 feet to an iron pin; thence North five degrees, 19 minutes, 28 seconds West along lands now or formerly of Lester Wetzel 73.09 feet to an iron pin; thence North 42 degrees, 28 minutes, 44 seconds West along lands now of formerly ofJames S. and Margaret L. Hostetter, a distance of 419.39 feet to a point along Pennsylvania Legislative Route 34; thence South 42 degrees 31 minutes 54 seconds West along said Pennsylvania Legislative Route 34, a distance of 128.91 feet to a point along Pennsylvania Legislative Route 34 at the property of the Church of the Brethren; thence 52 degrees 43 minutes 14 seconds East along lands of said Church of the Brethren, a distance of 103 feet to an iron pin, the Place of Beginning, Containing 39,678.92 square feet or .911acres, more or less. IT BEING the same premises which Hazel B. Miller, formerly Hazel B. Hostetter and Jane Humer by their deed of June 30t\ 1994, and recorded in Cumberland County Records in Deed Book 107 at page 809, granted and conveyed unto James S. Hostetter and Margaret L. Hostetter, his wife, Grantors herein. AND the said Grantor(s) do hereby WARRANT SPECIALLYthe property hereby conveyed. 800K 249 fAGE 236 Schedule A, Exhibit ~ IN WITNESS WHEREOF, said Grantor(s) havelhas hereunto set their hands and seals the day and year first above written. ~ 7)"'PJ00--1 LJm;v.r u .' /90,m,;J--JqU~EAL) () James S. Hostetter I./h -.0 ,,,) 1. .-h-rt4: // n2l}'. p /. t .--;;f ,,- '/<v~Eii~L-' argaret L. Hostetter / Ct~~~befl.~r":d CDUftty Recarde( -::f ,}:-~'i~ Instrument . 1",.-' ~:ecei::.tF. 351555 In";.tr# 2001...03SB49 : .t/\~2/2t:;~j 1 i~e!l3rk5: TF~I -COUNTY LAHAF~ DEED DEED - ~RIT DEED - xTr STATE Cfj~BEF~LAND tJi~LLEY i',IDDLESEX TWP ;j'/J:I . &":;'7 J':" U'-~':' ,.: [,E~D - ~/H CO IMF:EOVEMfNT FND PEel! Ii'~PRt)HT FUND CheckH .3254 Check# 3248 Check# 3249 "TJtal !~2(eiYed~s::~I: ;~ . .r::'; ; - -. .~.". ;."l ~ l_,. I 800K 249 PACE 237 COMMONWEAL TH OF PENNSYLVANIA: /1 '.' Cf": ss COUNTY OF U/y10L~L.?';L t- On this the a I ) day of QC!.~-r-- ,2001, before me, a Notary Public, the undersigned officer, personally appeared: JAMES S. HOSTETTER and MARGARET L. HOSTETTER, his wife known to me, or satisfactorily proven to be the person(s) whose Name(s) is/are subscribed to the within instrur.lent, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. 1 I . \ 'Ct~A- eL:l..- );,1 rilLi . .- .,NOTARY PUBLIC MY COMMISSION EXPIRES; Not:lrial Seal ;J Glenda M. vVethingtorJ, Notary PUb. lie Camp Hill Bora, Cumberland County My Commission Expires Dee. 27, 2002 ...--- ~1erllb9r, fJennsyivanLJ As:;ccia'uGn c: No~ari8S CERTIFICATE OF RESIDENCE I he. reby certify~h~ pr~cise residenge of t~ Grantee( s) herein ~/~ follows: ~=J 1 (y I ~,.1Jl)vvv\.l I~ c\ I L CCA__Li .~ k-( I .., c\._ 176 {_~ ~ / / t _/( VI' '- 0 / , Ct, C--J 'fcc;-e - f Attorney/ 'gent fi' r Gra~e(s) , ~ Office of the Recording of Deeds in and for CUMBERLAND County,. Pennsylvania, Recorders' Certificate: C '{' ,. , I 0'-;""1 "1e 1(\ ;-, ~'," \,...1 i...J. t f .., ..., l"J .. -' I C-' ",..1 .: 'o- n ,lill::.k,I.,;,; /-.-:-, C:;"""'" .,"\ ;'. '." t,. ,'.' .....: ...'....', " ...... .1 '"" "\ ,", , ,..-.',' ", l ., , .' .- ".. ,.- ,/ 1;.._" BOO~ 249 PAGE 238 DEED Tax Parcel No. 21-04-0373-026 Made the;). r ~ay of j u.-l '( , in the year of our Lord Two Thousand Five (2005) Between Kimberly L. Lahar, Executrix of the Estate of Flton B. Lahar. party of the first part ("Grantor") ~ .k.~ ~ tJ..4 {7 '/~ . .. ~tJ ..~ Idp :>~ ~" ~/~-U(~ AND Matthew J. Rutkowski and Martin P. Rutkowski, parties of the second part ("Grantees") WHEREAS, the said Elton B. Lahar became in his lifetime ~vl.;;JV"'; ... .~~, _.~_.._. . certain lots or pieces of ground, situate in the Township of Middlesex, County of Cumberland and State of Pennsylvania, and more particularly described hereinafter; and WHEREAS, the said Elton B. Lahar departed this life on April 20, 2005 after having first made his Last Will and Testament in writing, dated November 21, 1997; WHEREAS, the said Last Will and Testament was duly probated and filed in the Office of the Register of Wills of Cumberland County on May 3, 2005; and WHEREAS, Elton B. Lahar by said Last Will and Testament appointed as Executrix Kimberly J. Lahar. Kimberly J. Lahar was granted Letters Testamentary which were duly issued by the said Register of Wills on May 3, 2005 as in and by said Will and ~ecords of sai9.Re,9ister of Wills, recourse thereunto being had, appears; ~ ;. . w,!~, fit.(~~ ~J1IM.4tIJf~ ~. 11t ITNESSETH; Tnat the said Grantor for and in consideration of the sum of FIFTY '. <:, uJ THOUSAND and 00/100 ($50,000.00) DOLLARS, lawful money of the United States, ~ unto Grantor well and truly paid by the said Grantees at and before the sealing and delivery hereof, the receipt of which is hereby acknowledged, by virtue of the power granted by law, Grantor granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, baraain, sell, alien, release and confirm unto the said Grantees, Grantees' heirs and assigns, ALL THAT CERTAIN parcel of ground situate in the Township of Middlesex, Cumberland County, Pennsylvania, bounded and described pursuant to the Deed Plot as prepared by John S. Shambaugh, P.E. of FPE Consulting Engineers, Dillsburg, Pennsylvania, dated May 5, 1995 as follows, to wit: BEGINNING at an iron pin found along the boundary line between said property and the Church of the Brethern, south fifty-two degrees (520) forty-three minutes (43"), fourteen seconds (14') east along lands now or formerly of said Church of the Brethren and along lands now or formerly of Daniel Roebuck, three hundred seventy and ninety- eight hundreds feet (370.98') to an iron pin; thence north five degrees (50), nineteen minutes (19") twenty eight seconds (28') west along lands now or formerly of Lester Wetzel seventy-three and nine hundredths feet (73.09") to an iron pin; thence north forty-two degrees (420) twenty-eight minutes (28") forty-four seconds (44') west along lands now or formerly of James S. and Margaret L. Hostetter, a distance of four hundred nineteen and thirty-nine hundredths feet (419.39") to a point along Pennsylvania Legislative Route 34; thence south forty-two degrees (420) thirty-one minutes (31 ") fifty-four seconds (54') west along said Pennsylvania Legislative Route 34, a distance of one hundred twenty-eight and ninety-one hundredths feet (128.91 ") to a point along Pennsylvania Legislative Route 34 at the property of the Church of the Brethren; thence fifty-two degrees (520) forty-three minutes (43") fourteen seconds (14'), east along lands of said Church of the Brethren, a distance of one hundred three feet (103") to an iron pin, the place of BEGINNING, containing thirty-nine thousand six hundred seventy-eight and ninety-two hundredths (39,678.92) square feet or .911 acres, more or less. BEING THE SAME premises which James S. Hostetter and Margaret L. Hostetter, his wife by their Deed dated October 31, 2001, and recorded in the Cumberland County Recorder of Deed's Office in Deed Book 249, Page 236, granted and conveyed to Elton B. Lahar. TOGETHER with all and singular ways, waters, water courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in anywise appertaining and the reversions and remainders, rents, issues and profits thereof; and also all the estate, right, title, interest, use, trust, property, possession, claim and demand whatsoever of Grantor, in law, equity or otherwise, of, in, to, or out of the same. TO HAVE AND TO HOLD the said hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances unto Grantees, Grantees' heirs and assigns, to and for the only proper use and behoof of the said Grantees, Grantees' heirs and assigns, forever. AND the Grantor, for Grantor, and Grantor's heirs, executors and administrators, does covenant, promise and agree, to and with the said Grantees, and assigns, by these presents, that it, the said Grantor, has not done, committed, or knowingly, or willingly suffered to be done or committed, any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered, in title, charge, estate or otherwise howsoever. In Witness Whereof, the Grantor has hereunto set her hand and seal the day and year first above written. it- State of California SS.: County of On this, the _ day of , 2005, before me, a Notary Public, the undersigned officer, personally appeared Kimberly J. Lahar, Executrix of the Estate of Elton B. Lahar, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within deed and acknowledged that she executed the same for the purposes therein contained. In Witness Whereof, I hereunto set my hand and official seal. Notary Public My Commission Expires: I Hereby Certify that the precise residence of the Grantees herein is as follows: Attorney for Grantees o o MB N .2502-0265 ,r A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.oFmHA 3. DCONv. UNINS. 4.oVA 5.0CONV INS. 6. FILE NUMBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT RUT236-05 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual selt/ement costs. Amounts paid to and by the selt/ement agent are shown. lIems marked -{POer were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3mB (R\ J T 230-05, P FaiR U T216 -05!.1) D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: MATTHEW J. RUTKOWSKI and ESTATE OF ELTON B. LAHAR CASH MARTIN P. RUTKOWSKI 3761 SPRING ROAD 44 DEVONSHIRE SQ. CARLISLE, PA 17013 MECHANICSBURG, PA 17050 G. PROPERTY LOCATION: H. SETTLEMENT AGENT I. SETTLEMENT DATE: 3761 SPRING ROAD CHARLES E. SHIELDS. III, ESQ. CARLISLE. PA 17013 July 26. 2005 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT 3414 CHESTNUT STREET CAMP HILL, PA 17011 J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price I 50,000.00 401. Contract Sales Price I 50,000.00 102. Personal Propertv I 402. Personal Prooerty ! 103. Settlement Charaes to Buyer (Line 1400) I 1,105.25 403. 104. I 404. 105. I 405. I Ad'ustments For Items Paid Bv Seller in advance Adiustments For lIems Paid Bv Seller in advance 106. City/Town Taxes 07/26/05 to 01/01/06 I 128.42 406. Citv/Town Taxes 07/26/05 to 01/01/06 128.42 107. County Taxes to 407. Countv Taxes to 108. SCHOOL TAX 07/26/05 to 07101106 841.37 408. SCHOOL TAX 07/26/05 to 07/01/06 I 841.37 109. 409. I 110. 410. I 111. I 411. ! 112. I 412. 120. GROSS AMOUNT DUE FROM BUYER I 52,075.04 420. GROSS AMOUNT DUE TO SELLER 50,969.79 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest monev 2,500.00 501. Excess Deoosit See Instructions) I 202. Principal Amount of New Loan(s) 502. Settlement Charges to SelleilLine 140m I 9,508.24 203. Existino loanls1 taken subiect to 503. Existina loan(s) taken sub'ect to 204. ! 504. Payoff of first Mortgage 205. ! 505. Pavoff of second Mortaaae 206. I 506. Deoosit retained bv seller 2,500.00 207. 507. 208. I 508. 209. I 509. Adjustments For lIems Unoaid Bv Seller Adiustments For lIems Unoaid Bv Seller 210. City/Town Taxes to 510. Citv/Town Taxes to 211. CountvTaxes to I 511. Countv Taxes to ! 212. SCHOOL TAX to 512. SCHOOL TAX 10 ! 213. I 513. 214. I 514. I 215. I 515. I 216. I 516. 217. 517. I 218. I 518. I 219. I 519. I 220. TOTAL PAID BY/FOR BUYER I 2,500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER I 12,00824 300. CASH AT SETTLEMENT FROM/TO BUYER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Buver Line 120) 52,075.04 601. Gross Amount Due To Seller Line 420 I 50,969.79 302. Less Amount Paid By/For Buyer (Line 220) I( 2,50000) 602. Less Reductions Due Seller (Line 520) I( 12,008.24 303. CASH ( X FROM) ( TO) BUYER I 49,575,04 603. CASH ( X TO) ( FROM) SELLER I 38,961.55 I The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS A TRUE AND ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE RECEIVED A COPY OF STATEMENT. (\\,'\ 0 (j) 0 17 () i I / ' ~ Seller ,__~~ 0'" ....>J.J4J.)}.Ju f.,UvL)t' ESTATEOFJfi~l(W,BI1LAH-t.1il Co /I l"7/ J'u,v CI~((&. ~uU.-Lv L.)(EL MARTIN P. RUT OW SKI IF U /. TO THE BEST OF MY KNOWLEDGE, THE HUD-1 SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS WHICH WERE~ Ap H~E DISBURSED BY THE UNDERSIGNED AS PART OF THE SETTLEMENT OF THIS TRANSACTION. SETTLEMENT OFFICER Settlement Agent WARNiNG: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 1001 & SECTION 1010. ..-:.... L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ @ % PAID FROM PAID FROM Division of Commissionl/ine 700! as Follows: BUYER'S SllLurs 701. $ to FUNDS AT FUNDS AT 702. $ to SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. TRANSACTION FEE to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Oriainatian Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lende~s Inspection Fee to 806. Mortaaae Ins. ADD. Fee to 807. Assumption Fee to 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days %j 902. MIP Totlns. for LifeOfLoan for months to . 903. Hazard Insurance Premium for 1.0 years to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months $ ner month 1002. Mortaaae Insurance months $ ner month 1003. CitvfTown Taxes months ~ $ per month 1004. County Taxes months ~ $ per month 1005. SCHOOL TAX months @ $ per month 1006. months (cj) $ oer month 1007. months @ $ per month 1008. AGGREGATE ESCROW ADJUSTMEI months Ii'il $ ner month 1100. TITLE CHARGES 1101. Settlement or Closina Fee to 1102. CLOSING PROTECTION LETTER to FIRST AMERICAN TITLE INSURANCE COMPANY 1103. 60 YEAR SEARCH & HUD PREP to TRI-COUNTY ABSTRACT SERViCE POC: $150.00 1104. Title Insurance Binder to 1105. Document Preparation to WI X, WENGER & WEIDNER DEED 100.00 1106. Notarv Fees to CASH 6.00 1107. Attorney's Fees to CHARLES E. SHIELDS, III, ESQ. 368.75 {includes above item numbers: 1108. Title Insurance to TRI-COUNTY ABSTRACT SERVICE AGENT 190.00 (includes above item numbers: ) 1109. Lende~s Coverage $ 1110. Owner's Coverage $ 50,000.00 190.00 1111. ENDORSEMENTS 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 40.50; Mortgage $ Releases $ 40.50 1202. City/County Tax/Stamos: Deed 500.00' Mort ane 500.00 1203. State Tax/Stamps: Revenue Stamps 500.00; Mortaaae 500.00 1204. 1205. OVERNIGHT/COURIER FEES 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest Inspection to 1303. 2005 SCHOOL TAXES to PENNY DAVIS, TAX COLLECTOR 21-04-0373-026 903.24 1304. TAX CERTIFICATION FEE to TRI-COUNTY ABSTRACT SERVICE 5.00 1305. ESCROW FOR PA INHERITANCE TAX to WIX, WENGER & WEIDNER. ESCROW AGENT 8,000.00 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K\ 1.105.25 9,508.24 1'11(1"" By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page slatement. t ~~~~ SETTLEMENT OFFICER Settlement Agent Certified to be a true copy. ( RUT236-05 I RUT236-oS I 3 ) :.....:~........I... ~- ;tCD .....-.:;:::t CJ)i. "o::Ii <.J:) "0\ oi:::::t \0 ...~......:. . 'o:t'N . .....:....~~l. 6.' ... >S~> - ~ - ,:.:.c'N"Q 'fEJ.if2A'~..:I' .<( Iii ~g~ ~.e: '. '0 g 'Os oft tg H CD-O m cC_ cU. .+-~. ....el. cn~ . _2 -< C;:J .:~..... ~:;~: .: ~:, '" ~ << ;: '" o :z. I- .. ffi '" Iii o :11., ",' 0\ ~ .... r-- ~ en t 0'1 ~. ~ ~ .... ; 0 5 0'1 .. an .' . O. o N ...... (X) N,p . ..........~.... "'H 0... iin ..:I o P. ii 0\. N~ ..-I . oZ ~O ME-! "'..:1 1O'1'z1 CD Q' Id k CD '.' > .0 ...t) ~ HIO ..:10 ..:10 ~..~ Qan . ....-1 k...... O"=fl 4-10 ~lW J::O CD ELaI .>, aI Id 0 P...:I '0 CD k rg :E Q CD 00 >~ -ri lZfo o '0'" J::........ 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IX] IX] ~ ru .... .... .... c..IJ o .. ~ lJ'" c..IJ ..J' ~ o ru c..IJ ~ ~ REV-1737-4 EX + (9-0,* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE E, PART 1 MISCELLANEOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Lahar, Elton B. 05 00410 Part 1 must include all tangible personal property having its situs in Pennsylvania. Examples of tangible personal property are jewelry, furniture, paintings, etc. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Personal Property of Decedent 13,887.89 Allstate Insurance Co., 10815 David Taylor Drive, Charlotte, NC 28262 Payment under personal property coverage due to fire loss on 4/15/2005 (See Schedule E, Exhibit 1) PART 1 TOTAL $ 13,887.89 PART 2 TOTAL Proportionate Method Only from reverse side $ TOTAL (Also enter on line 5, Recapitulation) $ 13,887.89 (If more space is needed, insert additional sheets of the same size) '!' ~ <: :< . I F I I I n~ I. III ''-J.'' 110\ I-'J-l .... it:~. 60111 1'i1'" .~. I~~(Q..... [;l1 .'. !:d ,m.... 0 I~-.J III ,-iO ~ l~"" I~w I:i! [z I:i! ;l1 m m :J: C Z o ;l1 m o I!!! i~ I~ 1m '0 la~ ,Ul 10 I~ I~ E-l m o ." CD (/) c !T' tot . . .'. III ...p" III 11 0 -c ",,- () z () " ?< O>z ;D~ ): (j) ~ ~ c m :0 ;:: ?i m z ~ Cl P -,J IJ'1 ~ ru ru r -,J ru .. .tr:.t Ul .('t III .rt .CD O. 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ItS tot-.J 0\ ~'.'~ tote.;) tot Iloo. ..-.J; ;;;.W.. ....~ tsJU1 ........ rtW OW ::SO .... tott.> l>>\D lJ'\D 1lIU1 11 I'd 0 tot ~ ,. ~ \D ,: 0 ~ m ~ .... ~ .... \D ., \D '.; \D ,. -.J ~ \D '" ~. ~ 0 ~ z 0 ~ ;; " '" ,. z ?' ~i i::t:. ~ -- Q"- ~cn a-+ .11) it-+ .~ o .0\ .......... .W o ....... w o o . ~ ~'g ~.~ . .. ~a ~ a --J ..~..~. ~ ~ O}:ff ~._,- g , ~ . o~ a:!il :CAl:'~:; g -<' :J 1"0;;, 1"\.)8 . ...a .~...- ~.. .KY w a> I~. ":':'-"'~~ . ~- ~ .. CD Cll) ....:J Cll) \0 "c', ..c.....:.,.-..;., . ...".,...,-;'.:....::;;.'.'...:. '-". .-,:",--:.' :.-'."-" -'C"'-:::::-,"--""---', _.'--'-'---'--'--:~ Schedule E, Exhibit 1 REV-1737-7 EX + (9-0* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Use Schedule I, Part 2, ONLY for proportionate method of tax computation. ESTATE OF FILE NUMBER Lahar, Elton B. 05 00410 Part 1 must include mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and owing as of the date of decedent's death. Complete Part 2 ONLY when the proportionate method of tax computation is elected. PART 1 - OBLIGATIONS AGAINST PENNSYLVANIA REALTY ITEM NUMBER DESCRIPTION 1. Chase Home Finance, LLC, 3415 Vision Drive, Columbus, OH 43219 Mortgage-Loan #30-1692940450-553, property address: 3761 Spring Road, Carlisle, Pennsylvania, mortgagor: Elton B. Lahar (See Schedule I, Exhibit 1) AMOUNT 67,373.45 PART 2 - ALL OTHER DEBTS OF THE DECEDENT TOTAL PART 1 $ 67,373.45 ITEM NUMBER DESCRIPTION AMOUNT TOTAL PART 2 $ TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 67,373.45 Chase Home Finance LLC June 29, 2005 Loan Number 30-1692940450-553 REQUESTOR: IJO!UWWEIl NAME ANI) I'HOI'EIl'l'Y AI)I)HE~';: ELTON B LAHAR 2601 N OLD STAGE RD SPC 15 MOUNT SHASTA CA 96067-9732 ELTON B LABAR 3761 SPRING RD CARLISLE PA 17013-0000 BREAKDOWN OF AMOUNT OWED PRINCIPAL BALANCH INTEREST FROM 07/01/2005 TO 07/29/2005 66,999.~2 RECORD lUG FEE 27.00 346.93 TOTAL AMOUNT SECURED BY THE MORTGAGE 07/29/2005 . . 67,373.45 TOTAL AMOUNT OWED INCLUDING SERVICE FEES . . . . . . . . . . . . . . . . . . 67,373.45 INTEREST RATE PER DIEM 6.75000% 12.39 Chase Home Finance LLC ("eHF") will issue and mail the annual tax & interest statement (substitute form 1098) record at the end of the calendar year. IF THE PROPERTY IS SOLD, PLEASB PROVIDE THE SELLERS fORWARDIIIG ADDRESS. FORWARDING ADDRESS: The above figures are subject to final verification upon receipt of the payoff remittance by eHF. Except where prohibited, CIIF reserves the right to adjust the above figures and refuse any funds which are insufficient to pay the Total Amount Secured by the Mortgage for any reason including but not limited to error in calculation of the Total Amount Secured by the Mortgage, previously dishonored check or money order, stop payment of checks or ACH payments or additional disbursement made by CHF between the date of this payoff statement and the receipt of funds. The Total Amount Secured by the Hortgage, pursuant to this statement, is further conditioned upon: 1. If the payoff remittance is insufficient to pay the Total Amount Secured by the Mortgage, we will withdraw funds from the borrower(s) escrow account, if available, to complete such payoff. If sufficient funds are not in the escrow to cOll'lplete such payoff, the check will be returned with a new quotation. Insufficient payoff funds remitted via wire transfer will be returned and a new quote will need- to be ordered. -" __ _ 2. All checks which have been tendered to CHF in satisfaction of monthly payments must have cleared the borrower's bank. DO NOT PLACE A .STOP PAYMENT. ON CHECKS previously mailed to CUP or cancel ACH debits by CHF prior to prepayment in full. A late charge fee will be assessed at the close of business on the 16th day of the month if the current payment is not received, and such late charge should be added to the Total AlDount Secured by the Mortgage, if payment is received by CHF after the 16th. You may call 1-800-848-9136 Payoff Wire Account to ascertain the late charge amount. J. Disbursements of all escrowed items (e.g. hazard, flood and PHI insurance, taxes, etc.) WILL BE PAID FROM ESCROW AS NORMALLY SCHEDULED (UP to the date payoff funds are received). It is the responsibility of the borrower(s) and their closing agent (if applicable) to obtain a refund should a double payment of taxes or insurance occur. If you require confirmation of any recent escrow disbursements, please call 1-800-848-9136. Any remaining escrow balance or overpayment will be mailed directly to the borrower(s) within thirty (30) business days after processing of the funds required to pay the Total Amount Secured by the Mortgage. WE WILL HOT ACCEPT OR PROCESS ESCROW ASSIGNMENTS, 4. Payoff funds should be remitted. via wire transfer to: NOTE: FUNDS THAT CANNOT BE IDENTIFIED WILL BE RETURNED. JPMorgan Chase Bank, R.A.. ACCOURT .323553129 lIBA ROO'rIIlG NUIlIlIlR 021000021 ACCOURT RAIlE. Chase HOOle Finance LLC Payoff Wire Account WIRE DESClUPTIOII 1IUS'r INCLUDE CIIASE IIOIII! FIllAJlCE LLC LOAII RIIIIBIlR, CUSTOIIIlR RAIlE, PROP!lIl7Y ADDRESS, AltD llGEIIT'S COHTACT IHF'ORIlArIOR Ai"rlh PAYOFF PROCBSSIIIG If you are not reMitting funds via wire transfer, payoff funds must be in the fonn of a CASHIER' S CHECK or OFFICIAL BANK CHECK payable and forwarded to: CIII\SE IIOIII! FI1Il\1ICB LLC ATTN. DBPARTIIIlH'I' PP-1456 3415 VISIOII DRIVE COLOKBoS, OR 43219 For correct identification and postinq. THE CHASE HOME FINANCE LLC LOAn NUMBER HUST BE PROVIDED ON THE PAYOFF CHECK. 5. If a recording fee is not included in the Total Amount Secured by the Mortgage, the .ortg4qe/release documents .will be returned to the borrower ( s) or borroW'er( s) agent for satisfaction, and any charge~ for record,:ng the release of lien will be the responsibility of the borrower (s) unless othe~1.se requl.red by appll.cable law. Please provide a forwarding address for the borrower(s), when appl1.cable, and the name, address and telephone number of the payer, if different from the borrower(s). 6. You understand and agree that if CHF receives and pr?cesses a payoff and subsequently is requested to return such payoff funds, due to loan rescissl.on or for any other reason unless prohibited by law, CRF will deduct a re-load fee of $1,000 frOlD the payoff funds that are ret~rned to c~pensate Cay for its time and costs incurred in re-loading such loan onto its system. 1. NOTICE TO ACB CUSTOHBRS: CRF requires written notice at least five (5) business days prior to ~~i~~~. if you wish to cancel automatic debit arrangements. Otherwise, the autocharge will rellain in QLTRO Schedule I, Exhibit 1 7-25-2005 8:04AM FROM P.2 ella.limn. I'In.n~ LlC 3415 VialQn Orive Columbus, 01-4 4321~ (llOO) 84a-91~ C\Itlomor c.re (800) 582.0542 TOO I Text T.~ 01 CHAsE . 1 . I I o.te: July 25. 2005 Alto: Mrs. L_ Fax: (530) 926-2387 RIl; Chue Lo.In II: l~ I Property Address: 376 ~ Spring ROll(( PrortrtyCity, SUit. Zip: Carlisle.PA 17013 Mortpp(s); EI<<1ll8.tahar I PaidolfDalc: ~yIO~200S: l'his tenet is to llclcnowlc:4ge thBl ChQse has LeiVed the~' \(l payoff your m~ Ioen mer.w;cd above. a.. HoIne Finance UC will furward the ~nxl dowm to n:lcue i1Illicn; sIK>rtly. If ~ II"" ~ !hat CMs<> reoord the ~lel\. dn<:1II\lent, we will p..ep.rc 1he em and send it to the approprialc county f.:r recording. I Thi$lotW wHl $etVC a~ l"roof thallhc aboTe fetercnccd loan ~ paid in fulL Withm 30 ~ from =eipt of tho payofI flmd:l. Cho:lO will forwud wrJ fiIllib FYIld in ~ of lbc payoff amOllllt and any Imlaining cscrow funds to you. Unlem noti(JCd, a- will MIi4 ~~ cr e.KtOW ntiln4you an: _Wed to ~ a reSlllt of tl)itj paYOfIMayQl.ll' IQSl8 ye3lt end ~ stal=l:I1tiothc lI\ai~lIddn. ~ in ~thi$l~r. !OJ)m'snt <.Iellly$, it is inlpalive thai: youin{ma US of~ ~ to yflrmmlingaddn:1I. lfOlase wascoUcding =ow fund.5 for ~sor~, ~pq.ymemQrtllele ~s i~ flOW YOlA'responSWi1ity. J'leat<! eanlaCt your ~'s insurance agent md)'ow1ljxing authority lO ~ them oethe a4dteS$ fOl' forwatdina f\ltul'e telalQd co.rrespal'ldcnce ana bills. tr your II/ortaasc payment included optiQna) iruunm~e. this ~. Was <:lIllc:eled when ywr lOlln w~ paid off. .Tf yOU rld"lIl8tlCed your loan tI\rousb Chaoc. plca!le conIact automer (".are at (800) 848-9136. if you willh In inquire ~t amtinuing lbi:s ~. , I Olasc's goal j" '" provide the higbo:slloY\lI 0{ 'l\l$lity $Orv\~ If you havc art! queetiOllll or want III change YOOl" mailing addrcsa, plCllllC Ila1laCt Clabncr eara at (SOO) 8-48- 136. You lll({ speik wilh . Custcmtll' ('-3te Profemonal, avaUabl~ Monday througb Fridly from 8:00 . lO 6;00 p.m~ Eastem lime. We appreciate the opp<lI't\mit>, to hIlvo serv~ YQQl' lllort se 10cm 3lld hope that you will Ioolc to CIlasc fir your futw-e (mandaI needs. I I ~~. I triff41lY~ Lit:n Relea.'lO ~ertt o-ltome Finam.-e u..c Thenl;you.4oc REV-1737-7 EX + (9-0r~ REVERSE ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Lahar, Elton B. 05 00410 When flat rate method is elected, list the beneficiaries of the Pennsylvania property. When proportionate method is elected, list all beneficiaries. RELATIONSHIP TO NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE NUMBER Do Not List Trustee(sl OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] 1. Kimberly J. Lahar, 2601 N. Old Stage Road, #15, Daughter 8,210.29 Mt. Shasta, CA 96097 2. Craig Lahar, 6445 Gallop Road, Harrisburg, PA 17111 Son 8,210.29 3. Jeff Lahar, 488 Quail Ridge Road, Fincaster, VA 24090 Son 8,210.29 4. Donald Lahar, 160 Lovejoy Road, Loudon, NH 03307 Brother 8,210.30 5, Chad Lahar, 9613 Constitution Hall Dr., Charlotte, NC 28277 Grandson 8,210.29 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. 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-1737 COVER SHEET $ (If more space IS needed, Insert additional sheets of the same size) LAST WILL and TESTAMENT of Elton B. Lahar I, Elton B. Lahar, a resident of Contra Costa County, State of California, declare that this is my Will. FIRST. I revoke all \Vills and Codicils that I have previously made. SECOND. I direct that my family complete the arrangements for my funeral. THIRD. Except as othenvise provided in this Will, I have intentionally and with full knowledge of the consequences omitted to provide for my heirs. FOURTH. If any beneficiary under this \Vill or any other person claiming to be entitled to a portion of my estate in any manner, directly or indirectly, contests or attacks this \Vill or any of its provisions, any share or interest of that contesting individual granted by this Will is revoked and, along with any other interest claimed (by the laws of succession or othenvise), shall pass instead as if that con testing individual had predeceased me withou tissue. FIFTH. I have not entered into either a contract to make Wills or a contract not to revoke Wills. If any part of this Will is held to be void, invalid, or inoperative, I direct that such voidness, invalidity, or inoperativeness shall not affect any other part of this Will, and that the remainder of this \Vill shall be carried into effect as though such part had not been contained herein. As used in this Will, the masculine, feminine, or neuter gender, and the singular or plural number shall each be deemed to include the others whenever tbe context so indicates. SIXTH. I direct that all inheritance, estate, or other death taxes that may by reason of my death be attributable to my probate estate or any portion of it, including any property received by any person as a family allowance or homestead, sball be paid by my Executor out of the residue of my estate disposed of by this Will, without adjustment among the residuary beneficiaries, and shall not be charged against or collected from any beneficiary of my probate estate. SEVENTH. I am married to Mary E. Lahar and any reference in this Will to my "spouse" is to her. I have three children, Jeffrey Lahar, Kimberly Jane Lahar, and Craig Elton Lahar, all of whom are adults. I have no children who died leaving issue surviving. The term "issue" refers to lawful lineal descendants of all degrees; the terms "issue" and "children" include adopted persons. EIGHTH. I nominate Mary E. Lahar as Executor of this Will, to serve without bond. If she fails to qualify or ceases to act, I nominate Kimberly Jane Lahar, to serve as Executor, without bond. If she, too, fails to qualify or ceases to act, I nominate Craig Elton Lahar, to serve as Executor, without bond. I authorize my Executor to sell, with or without notice, at either public or private sale, and to mortgage, lease, and convey all or part of my estate, both real and personal property, at such times and on such terms and conditions as may be deemed best, subject only to such confirmation of court as may be required by law, and within the representative's discretion, to settle, compromise, and adjust any and all claims either in person or by proxy as to all stocks or other securities in my estate, to continue to completion any investment or undertaking of mine pending, but not completed, at the time of my death, and, in that connection, to borrow and pledge assets of the estate to secure any such borrowings. I further authorize my Executor either to continue the operation of any business belonging to me at my death for such time and in such manner as my Executor may deem advisable for the best interests of my estate, or to sell or liquidate the business at such time and on such terms as my Executor may deem advisable for the best interests of my estate. Any such operation, sale, or liquidation by my Executor, in good faith, shall be at the risk of my estate and without liability on the part of my Executor for any resulting losses. My estate shall be administered under the California Independent Administration of Estates Act. NINTH. The following are the facts relating to the Trust into which the residue of this e~.~.e n.~l1 he --"-e..1 -"e- 0- .-~n~~e--e-l .0 ~. .1..e e--l -~ --_h~.e -~ ..1..;s e~.~.e' "lal W111 U }lUU1 U UV 1 1 ua1 "1 11 U L aL LIl lJU V1 t"!UUal VJ. LU1 "lal. a. Name of Trust: ELTON B. LAHAR AND MARY E. LAHAR 1997 TRUST. Name of Trustee of said Trust at the date of signing this \Vill: Elton B. Lahar. I)~.o -~ es.~l...I;~l..._o_. _~ s~;-l 'T_.~.. :"~..~_l.~_ ,,(.sr 100..,. .L.,..IOL\'" VJ.. LOVIJ':'UUJCuL Vi. Otu i 1. U~L. 1 "VT~.Ul.1'Cl ~, i.>',;r,. b. v. As used in this Will, the term "Trust" shall refer to said Trust immediately above described. 'ViII of Elton B. Lahar Page 2 TENTH. I give all of my estate, real and personal, wherever situated, IN TR UST, to the Trustee, or any successor Trustee, appointed in the Trust. Said estate shall be added to, administered, and distributed as a part of that Trust, according to the terms of said Trust and any amendments made thereto prior to my death. This paragraph shall not create, or be construed as creating, a separate or testamentary trust of the assets governed by this paragraph, nor shall this paragraph subject the existing Trust or the property added to it by this Will to the jurisdiction of the probate court or to the laws relating to testamentary trusts. If the disposition in the preceding paragraph is not operative or is invalid for any reason, or if the Trust hereinabove referred to fails or has been revoked, then I hereby incorporate herein by this reference the terms of said Trust on the date of execution of this Will, without giving effect to any amendments made subsequently, and I give all of my estate, IN TRUST, to the Trustee or successor Trustee named in said Trust as Trustee, to be held, administered, and distributed as therein provided. I subscribe my name to this Will this ~t .stf{ day of November, 1997, at Pleasant Hill, California. O:tH:\Br ~ Elton B. Lahar, Testator On the date last above written, Elton B. Lahar, hereinafter called Testator, declared to us, the undersigned that the foregoing instrument, consisting of THREE (3) pages, including this page, was Testator's Will and requested us to act as witnesses to it. Testator thereupon signed this \Vill in our presence, all of us being present at the same time. We now, at Testator's request, in Testator's presence, and in the presence of each other, subscribe our names as witnesses. At the time this \Vill was executed, we believed the Testator was of sound mind and acting voluntarily. \Ve declare under penalty of perjury that the foregoing is true and correct. Executed this cJ!s Hi' day of November, 1997, at Pleasant Hill, California. ~{v\.~ S. ~~ ~~ \Vitness \ C) C \\r\. ,fJ \ \ G D..., ..,:> kl\\ """ \ CI...J \"i iCi\""C\\ \\V....,I"'-'~ \f\ M\\'v\ e'Z... . Cf\ q \.\ S5 3 ,/ h-p/lahar'e[tolt. H:" John MiIgate 4600 Fallow Way, Antioch, CA 94509 Will of Elton B. Lahar Page 3 .;:1": , , ,. Preservation Trust, set forth in Article Nine, Paragraph B, below, as one Trust together with any other property subject to such provisions. ARTICLE NINE Surviving Spouse Holds Power of Appointment Over Survivor's Trust Distribution of Trust A. Survivor's Pmver of Appointment. (1) On the Surviving Spouse's death, the Trustee shall distribute any remaining balance of the Survivor's Trust, including principal and accrued or undistributed income, to one or more of the group consisting of the Settlors' estate, issue, or any charitable organizatiuns, and on any terms and conditions, either outright or in Trust, and in any proportion that the Surviving Spouse shall appoint by Will or Codicil specifically referring to and exercising this Pmver of Appointment. (2) On the Surviving Spouse's death, and subject to any Power of Appointment exercised by the survivor, the Trustee may, in the Trustee's discretion, payout of the principal of the Survivor's Trust the Surviving Spouse's debts outstanding at the time of his or her death and not barred by the statute of limitations, Statute of Frauds, or any other provision of law; last-illness and funeral expenses; attorneys' fees; other costs incurred in administering the Surviving Spouse's probate estate; and estate and inheritance taxes, including interest and penalties attributable to the Survivor's Trust or arising on the Surviving Spouse's death. (3) On the Surviving Spouse's death, if and to the extent that the Surviving Spouse shall not have effectively disposed of all property of the Trust Estate through a valid and effective exercise of the Power of Appointment, the Trustee shall distribute the Survivor's Trust as follows: [a] If Elton B. Lahar was the Surviving Spollse, the Survivor's Trust shall be distributed, ou trigh t and free of trust, as follows: [i] All of the Settlors' jewelry, clothing, household furniture and furnishings, personal automobiles, and other tangible articles of a personal nature, or interest in such property not otherwise disposed of herein or in any other manner, together with insurance on the property, to Trustee to distribute in accordance with instructions which each Settlor has left with this Declaration of Trust, and, in the absence of such instructions, or should such instructions fail to dispose of any or all of the Settlors' personal property, said undistributed personal property shall pass in equal shares to Kimberly Jane Lahar and Craig Elton Lahar. Elton B. Lahar and Mary E. Lahar 1997 Trust Page 7 "".,:.0 ;.;.......... . .~ ;,~ . , ..t' I" [ii] The residue and remainder shall be divided by the Trustee into unequal shares, said shares compu ted so that, taking into account the distribution of the Preservation Trtlst, Kimberly Jane Lahar will receive sLxty-five percent (65%) of the combined distributions, Craig Elton Lahar will receive fifteen percent (15%) of the combined distributions, and JelTrey Lahar will receive ten percent (10%) of the combined distributions, Chadwick Lahar will receive five percent (5%) of the cornbined distributions, and Donald Lahar will receive five percent (5%) of the combined distributions. TIle Trustee shall then proceed to distribute said shares, outright and free of trust, to each then-living beneficiary. If a beneficiary does not survive, his or her share shall pass to his or her then-living descendants, by right of representation; provided, if a beneficiary leaves no then- living descendants, his or her share shall be added, pro rata, to the other shares distributed hereunder. (b] If J.lary E. Lahar was the SUll.:iving Spouse, the Survivor's Trust shall be distributed, outright and free of trust, as follows: [i] All of the Settlors' jewelry, clothing, household furniture and furnishings, personal automobiles, and other tangible articles of a personal nature, or interest in such property not otherwise disposed of herein or in any other manner, together with insurance on the property, to Trustee to distribu te in accordance with instructions which each Settlor has left with this Declaration of Trust, and, in the absence of such instructions, or should such instructions fail to dispose of any or all of the Settlors' personal property, said undistributed personal property shall pass to Kimberly Jane Lahar. (ii] The residue and remainder shall be distributed, outright and free of trust, to Kimberly Jane Lahar. If, for any reason, the terms of this subparagraph fail to dispose of all property subject to disposition by Mary E. Lahar, then the property shall be distributed outright and free of trust to her heirs at law determined in accordance with California's laws of intestate succession as they existed on the date this instrument was first signed by Settlor (but subject to Article Eight, Paragraph D, below). Mary E. Lahar deliberately and with full knowledge of the consequences makes no provision for her son, Craig Elton Lahar, except as a contingent beneficiary. Elton B. Lahar and Mary E. Lahar 1997 Trust Page 8 :)/ > ;' B. Distribution of the Preservation Trust. On the Surviving Spouse's death, the Trustee shall treat all assets still held in the Preservation Trust and, after payment of just debts and expenses of the Surviving Spouse, shall distribll te the Preservation Trust as follows: [a] If Elton B. Lahar .vas the deceased spouse, the Preservation Trust shall be distribll ted, outright and free of trust, by the Trustee into unequal shares, said shares computed so that, taking into account the distribution of the Survivor's Trust, Kimberly Jane Lahar will receive sixty-five percent (65%) of the combined distributions, Craig Elton Lahar will receive fifteen percent (15%) of the cornbined distribu tions, and Jeffrey Lahar \vill receive ten percent (10%) of the combined distributions, Chadwick Lahar will receive five percent (5%) of the combined distributions, and Donald Lahar will receive five percent (5%) of the combined distributions. The Trustee shall then proceed to distribu te said shares, outright and free of trust, to each then-living beneficiary. If a beneficiary does not survive, his or her share shall pass to his or her then-living descendants, by right of representation; provided, if a beneficiary leayes no then-living descendants, his or her share shall be added, pro rata, to the other shares distributed hereunder. [a] If Mary E. Lahar was the deceasedspollse, the Preservation Trust shall be distributed, outright and free of trust, to Kimberly Jane Lahar. If, for any reason, the terms of this subparagraph fail to dispose of all property subject to disposition by Mary E. Lahar, then the property shall be distributed outright and free of trust to her heirs at law determined in accordance with California's laws of intestate succession as they existed on the date this instrument was first signed by Settlor (but subject to Article Eight, Paragraph D, below). Mary E. Lahar deliberately and with full knowledge of the consequences makes no provision for her son, Craig Elton Lahar, except as a contingent beneficiary. C. Limitation on Distributions to Persons Under Age Twentv-One (21). If any beneficiary entitled to outright distribution of a Trust or of a portion of a Trust is under age twenty-one (21), the Trustee shall hold and administer the beneficiary's portion of the Trust Estate for his or her benefit. Income of the property retained in Trust shall be added to principal, and the Trustee shall pay to, or apply for the benefit of, the beneficiary as much of the beneficiary's Trust as the Trustee, in the Trustee's discretion, considers necessary for the beneficiary's proper health, education, support, and'maintenance. When the beneficiary attains the age of twenty-one (21), the Trustee Elton B. Lahar and Mary E. Lahar 1997 Trust Page 9