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HomeMy WebLinkAbout02-14-06 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INVENTORY Estate of HURLEY, Bobby E. No. 21 05 0285 , Deceased Date of Death 3/7/2005 Social Security No. 426829034 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: Jill M. Wineka, Esquire I.D. No.: 58802 Address: 1719 North Front Street Personal Representative: ~. ;~~iI;4 ~ J1~ a 0111- Constance C. Webb Dated .;J..-' / -;{ C)O~ . HarrisburQ, Telephone: (717) 234-4178 PA 17102 Description 20.87 acres of vacant ground located on Rt. 44/144 in Potter County, owned as tenants in common by the Decedent and Virginia R. Adams Value 7,500.00 Prudential Value Portfolio, 2,001.71197 units @ $2.265560/unit 4,535.00 Prudential Jennison Portfolio, 2,215.77950 unites @ $1.715250/unit 3,800.62 AIM V.1. Premier Equity Fund, 3,020.53803 units @ $1.398100/unit 4,223.01 Janus Aspen Series International Growth, 1,504.52667 units @ $1.948740/unit 2,931.93 Premier VIT Op Cap Small Cap, 3.783.24043 units ~:$,{998780/unit 7,561.81 (Attach Additional Sheets if necessary) s ; ~ : l \ t.'.~; Total l' ..... -~.- 205,784.05 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 shduld not be. extended into the total of the Inventory. RW-4 pJ. Continuation of Inventory HURLEY, Bobby E. 21 05 0285 Paqe 1 Description of Inventory Description 181 Shares of Prudential Common Stock @ $58.595/share Value 10,605.70 Members 1 st Federal Credit Union, Savings Acct. No. 20563-00 5,169.28 Members 1 st Federal Credit Union, Money Management Acct. No. 20563-05 25,447.80 Members 1 st Federal Credit Union, Certificate of Deposit Acct. No. 20563-40 15,629.12 Citizens Bank, Checking Acct. No. 6100707202 115,035.61 1997 Dodge Truck, VIN No. 1B7GG23Y1V5307955, Title No. 51354026301 HU 3,075.00 Highmark Blue Shield refund 251.37 The Prudential Insurance Co. of America - dividend check 10.54 The Prudential Insurance Co. of America - death benefit 7.26 Subtotal $ 175,231.68 205,784.05 Grand Total $ LAW OFFICES HOWARDB. KRUG LEON P. HALLER JOHN W. PURCELL JR. JILL M. WINEKA BRIAN J. TYLER NICHOLE M. STALEY O'GORMAN LISA A RYNARD LATOYA C WINFIELD Purcell, Krug & Haller 1719 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17102-2392 TELEPHONE (717) 234-4178 FAX (717) 783-4939 HERSHEY (717) 533-3836 JOSEPH NISSLEY (1910-1982) JOHN W. PURCELL VALERIE A GUNN OJ Counsel February 13, 2006 Register of Wills Cumberland County Court House Carlisle, PA 17013 Re: Estate of Bobby E. Hurley No. 2005-00285 Dear Register of Wills: Enclosed for filing, please find the following documents in the above-captioned Estate: 1. An original and three copies of the Pennsylvania Inheritance Tax Return; 2. An original and two copies of the Inventory; and 4. A check made payable to the Register of Wills in the amount of $30.00 in payment of the filing fees of $15.00 each to file the Pennsylvania Inheritance Tax Return and the Inventory. Please return two date-stamped copies of each document to me in the enclosed stamped, self- addressed envelope. Thank you. Sincerely, ~::; ~ JMW/bas Enclosures cc: Constance C. Webb, Exec. wlo enc. Bureau of Collections & Taypayer Services wlo enc. (estates\hurley\02-13-06 Itr to Register) . REV-1500 EX + (6-00) '- '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICiAl USE ONLY FILE NUMBER 2 1 -0 5 0 2 8 5 "'ColiNTY"CoiiE ---VEAR- - - NUMBER- - DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ Z W C W U W C HURLEY Bobb E. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 4 26- 8 2 - 9 034 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ~ :$ en ua::~ w~u :1:00 " a::..J ""~ClI ~ c( 03/07/2005 07/12/1940 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) o 3. Remainder Retum (dale of death prior to 12-13-82) o 5. Federal Estate Tax Retum Required ~ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 01 Webb Constance C. IX] 1. Original Return o 4. Limited Estate IX] 6. 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 ofTru.t) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) I- Z W C Z o ~ en w a:: a:: o u THIS SECTION MUST BE COMPLETED. ALLCORRESPONDENCEAND CONFIDENTIAL TAX INFORMATIO NSHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Jill M. Wineka Es uire FIRM NAME (If Applicable) Purcell Kru & Haller 1719 North Front Street TELEPHONE NUMBER 717 234-4178 Harrisbur PA 17102 z o i= <( ...J ::> !:: a.. <( u w 0:::: 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o 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) OFFICIAL USE ONLY 7,500.00 33,658.07 L.."'''' .~ ';-"1 to. --' 164,625.98 ~==.'; 0.00 '.' (8) 205,784.05 12,341.41 973.63 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= <( ~ ::> a.. :! o U >< <( ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 19. Tax Due 192,469.01 X 0.00 (15) 0.00 X _(16) 0.00 X .12 (17) 0.00 X .15 (18) (19) (11) (12) (13) 13,315.04 192,469.01 16. Amount of Line 14 taxable at lineal rate (14) 192,469.01 17. Amount of Line 14 taxable at sibling rate 0.00 0.00 0.00 0.00 0.00 ~ 18. Amount of Line 14 taxable at collateral rate 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < , Decedent's Complete Address: STREET ADDRESS 1191 Letchworth Road CITY Camp Hill, STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 Total Interest/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. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 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 IKI b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IKI c. retain a reversionary interest; or ...................................................................................................... 0 IKI d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IKI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 IKI 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 IKI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 IKI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE - / / -cJ {itJ SIG Jill M. Wineka, Esq., 1719 North Front Street, HarrisburQ, PA 17102 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. S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. s9116(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. S9116(1.2) [72 P.S. s9116(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. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. > . : -- ~:~~ LAST WILL AND TESTAMENT OF BOBBY E. HURLEY I, BOBBY E. HURLEY, of Camp Hill, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ITEM I: I direct that all my just debts and funeral expenses, including my grave marker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease, as a part of the expense of the administration of my estate. ITEM II: All federal, state and other death taxes payable because of my death with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such tax, shall be considered as a part of the expense of the administration of my estate, and shall be paid out of the principal of my estate without apportionment or right of reimbursement. ITEM III: I give, devise and bequeath my World War II swords and myfather's World War I rifle to my nephew, BRIAN HURLEY of Carlisle, Pennsylvania. ITEM IV: I give, devise and bequeath all of the rest, residue and remainder of my estate of every nature and wheresoever situate to my wife, CONSTANCE C. WEBB, provided that she shall survive me by thirty (30) days. ITEM V: Should my wife, CONSTANCE C. WEBB, predecease me or die on or before the thirtieth day following my death, then I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wheresoever situate to my brother, FRANKLIN HURLEY of Carlisle, Pennsylvania ITEM VI: I appoint my wife, CONSTANCE C. WEBB, as Executrix of this my Last Will and Testament. Should my wife, CONSTANCE C. WEBB, predecease me or fail to qualify or cease to act as Executrix, I appoint my brother, FRANKLIN HURLEY as Executor of this my Last Will and Testament. . . ITEM VI: I direct that my Executrix or Executor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this j) (3t..G m 0E fL , 2004. ow, t day of (SEAL) The preceding instrument, consisting of this and one other typewritten page, was, on the date thereof signed, published and declared by BOBBY E. HURLEY, the Testator therein named, as and for his Last Will, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. 1k'~/ . i:;:;L:.. /" W..t .'" / ~ J '. 1 -ru Yh l~lcJa0 residing at /) . . ( ~1/c.il51 e. ~- '?4 residing at frJuAcvlucoJ fM-C, #' P4 2 COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF DAUPHIN J . VYE, BO~BY E.. HURLEY, and '<:;.._ ,II 1V1. lt/j n cJ:.c/\..,. , the Testator and the witnesses, re pectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will, and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. .~/:'~~14 Witness ..1/ . t rn. t~'nf-~~ Subscribed, sworn to and acknowledged before me by BOBBY E. HURLEY, the Testator, and subscribed and sworn to before me by 7>12-fAIU I( HUI?ULf and ~JI LL Ivt. tu IIV t?Jt~ , witnesses, this <lY-J.. day of /)€CtI116~1l 2004. /~AJJ-fUtA- 0 . ~~ I Notary Public . (wills\hurtey\ will) r~-'-"""i'~OTAR!AL SEAL -, I BAP,8..!\F{;:.. .lJ... SHADEL, No1:ai-y pubnc. Oit<J of Harrisburg, DauphIn County ~~lf~9:?!!~~~~s!?n ~~ M<.:~~ 19:~OO7 : '. : REV-1502 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HURLEY Bobby E. 21 05 0285 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value 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. Real property which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION 20.87 acres of vacant ground located on Rt. 44/144 in Potter County, owned as tenants in common by the Decedent and Virginia R. Adams. See attached Deed dated 2/9/1999 from Richard B. Moyer, Jr. to the Decedent and Virginia R. Adams. The Deed was recorded on 2/23/1999 in Potter County Book 272, Page 931. The total value of the real estate is $15,000.00. VALUE AT DATE OF DEATH 7,500.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7 500.00 "','"'''' ( .... iL,. ,).31 Warranty Deed POTTER CO. Th is /11 de 1''1 tureGISTER [,. RECORDERS /i j9'FEB 23 Prl 3 05 .\f:iiJ[ IIII' (: f day of Fe~ruary, in IlIe YCilr n.follr I.orel nnc IlIoIlSC/lH/11I1!,> III11:drer! illld ni;lcly-nine (A.D. 1999), ilETWF.EN Richard 13. I\toyrr. Jr.. ofR.D, 3. Box 7SK. \V~'lIsboro, PA 16901, hereinafter called GRA~TOF.. .ANO- Bohhy E. lIurlry and Virginia R. Adams, of 145C Ncwville Ro l\1, Carlisle, P A 17013, hereinafter caned GJ1d;\TEES" lI'ITNfSSfTlI, Thill 110 cnllsit!emtinn o( FlI:TEEN THOUSAND DOLL...\RS AND 00/100-,,"'----,--00--- u' _....u_uu.__...___.n..u__..n nun__u ...-( S 15.000.00 )_'00" _.._u....n_ __..n ___nn..___.' ..-..n -.--...Dollo'lrs, lilll.fIlIIl/OIlCI' o/the Unitc'! States tf.lmcrit'il, ii, hant! paid, t/IC receipt whereofis herchy ackllO\\'ledgcd. the said Grantor docs herehy gram (uld COIII'C." to the said Grantees, their heirs and assigns, 111 fcc, as tenants in c{.mmon. ALL that certain piece. parcel or tract of land silllale, lying and ceing. in the TOWNSHIP of ABBOTT, COUNTY of POTTER and CO\IMONWEALTH ofPE~SYL\'ANIA, bounde': ~.Id described as follows: BEGINNING al an iron pipe tLt the sCllIlhwesl comer of The,)dore Sykora lands hy Deed Book Volume 198. at page 587; t'.lenec along the: west hne ofThedore Sy~:vra lands, North 09 degrees 33 minutes 17 seconds East ~QS.5~ fect to an iron pipe; thence alon~ lands o!'Clay:on Fl"CY. South 8 I degrees 37 mir:t::cs 59 seconds Ea.it 1.4$2.05 feel to ,'In iron rod; thence along lands of Bob Hines, Soulh 48 degrecs 22 minutcs 25 seconds East 113.1':1 feel r.O a.n iron rod; thence still along lands of Bob Hines, North 31 degrees 40 minutes 51 seconds Easl 306.17 feel t.) an iron rod; thence along lands of Clay10n Frey, North 30 degrees II m:nutes 12 seconds Easl 374.75 feel to an iron pipe; thence along lands of Tcleford Parks, South 43 degl'e':s :17 minuf<:s 50 seconds East 252.00 feet to a point in the cenlerline of a joint.use driveway; thc!,'{ along the ec:nterlinc of said joint.use driveway C:;outh 42 dr:grees 3] minutes 25 seconds West 199.94 f',:c:t to a poinl in Ihe cenler of a mountain steam; thence along Ihe center of said Mountain Slream, South 1)3 rlcgrees 40 minutes 07 seconds East 130.00 feet to a point in the centerline of Lillie KClllc Creek; IlK nee along Ihe cenledin,: of Little KCllle Creek, South IS degrees 48 minutes 07 seconds \Vest IOI.S4 kct 1.0 a poinl. Ihence along lands of Fred Reynolds, North 60 degrees 26 minutes 03 seconds West 175.00 kc: 10 an iron pipe; thence along the east side of the of the aforementioned joinl.use driveway. SouIII 34 degrees 43 minutes 44 seco'lds West 113.05 feet 10 an iron pipe; lhence along lands of Leslie Adam~. South 29 dl:grees 20 minutes] 2 r;econds West 110.55 feet to all iron pipe; thence slill along Leslie Adl1ms, South 01 degree 3:; minutcs 37 seconds East 118.10 fect to an iron pipe; thence still along lands of Leslie: Adams. South 63 degrees 35 minutes 41 seconds East 10/.59 feet to an iron pipe on the \\'L_. bank of Little Kettle Creek; thence South 52 degrees J I minutes 57 ~e('onds East 22.51 [tet to a point on Ihe easl bank of Lillle Kelllc: Creek; thence along lands of John Tlipak. South 79 degrees 20 minutes 00 seconds East 266,50 feet to a point in the centerline of Pennsylvania Roule 44; thence along the centcrline of Pennsyh'ania ROllte ~. South 14 degrees 48 minules 40 sc.:onds West 164.43 feet to a point; thence along lands of Edmund Suzenski. North 79 degrees 54 minutes 35 sccor.ds West 2. 173.65 feet to the point of beginning. I 1 ;; { ~ .. ~ :t " ~ I"~ :\-: \ 1 .: l' ~ , .r " ....._" r ..: ( ..: ,J :"L? CO:\"TAIi\ING 20.87 acres of lJnd, including ro III rights-of-way. SUBJECT TO po:;siblc;pring rights and right-cf-way for access in common with the Grantee hercln (prior), his ~:cirs or .lssigns. C i\D E R .\ ND SUB.! ECT TO an casement of a printe roads 16 feet in width. which roadway :.hall be used in common with the heirs and assigns of Frank K:lrhan. EXCEPTING .\i'lD RESERVING all oil, gas and Inineral nghts as resc!ved in a deed from Charles Scheibner and \lary G. Scheibner to Wenzel A. Karhan and Frank Karhan, dated April 27.1920. and reco:'ded :-'lay 19, 1920 in Deed Book Volume 92, at p.lge 300, records of Potter County. EXCEPTI;-.1G A1\'D RE.5ER\'Ii'lG a parcel of land conveyed to Cla)10n Frey, et ux. by Jeed datl:d October '27, 1988, recorded thl: sanlC day in Deed Book Volumc 229, at page 1036. records of Potter County. EXCEPTI1\G AND RESEI1\'ING a p.lrcel of land conveyed to William :VI otter, et al. by deed dated FebrJary S, 19~9, rl'C,)rded Febmar)' 13, 19S:Y in Deed B,)ok Volume 229, at page 1036, records of Potter COL:n\)'. BEING th~ same p;'emises conveyed to Richard B. Moyer, Jr. by deed of RicharJ B. Moyer, said deed being dated the 30th day of March, 1995 and recorded the 3 I" day of March, 1995 in Deed Book Volume 254, at page 628, records of Potter County. ALSO BEING the same premises which \\'as subject to a certain Article of Agreement b'7twcen Richa-j B. r-,'10)'er. Jr. and Lcslie Adams and Bobby Hurley, said Article of Agreement being dated the n'J d.l}' of September, 1996 and r~eorded the 1 st day of Octo her. 1996 in Miscellaneous Book Volume H-9, :It page 584, rcconls of Potter County. The parti.cs bereto acknowledge that the temlS of said Article of Agreer'I.:nt have be~n satisfied. MOi\;.'Over, it is 3cknow\cdged that Leslie Adams passed this life testate on Febmai)' 24, 1998. survived by his widow and sole beneficiary Virginia R. Adams, who has satisfied the tCilTlS and conditions of the Arlicle of Agrecmt:nt, and thus. is taking title to the subject property as a tenant i:1 common with Bobby E. Hurley. Grantor has no~ di~posed of hazardolls wa.~te nor docs he have actual knowledge of hazardolls waste disposal on the above-described real property. THIS DOCU1\IENT l\IA Y NOT SELL, CONVEY, TRANSFER, INCLUDE OR INSURE THE: TITLE TO THE COAL AND RIGHT OF SUPPORT UNDERNEATH THE SURFACE LAND DESCRIBED OR REFERRED TO HEREIN, AND THE OWNER OR OWNERS OF SUCH COAL J\LA Y I1A VE THE COMPLETE LEGAL RIGHT TO REl\IOVE ALL OF SUCH COAL AND. IN THAT CONNECTION, DAMAGE MAY RESULT TO THE SURFACE OF THE LAND A,'\'D Ai,\,Y HOUSE, BUILDING OR OTHER STRUCTURE ON OR IN SUCH LAND. THE INCLUSION OF THIS NOTICE DOES NOT ENLARGE, RESTRICT OR MODIFY ANY LEGAL RIGHTS OR ESTATES OTHERWISE CREATED, TRANSFERRED, EXCEPTED OR RESERVED BY THIS INSTRUMENT. ~@.~~.@;...~. ..). .r ~: r. ....... . "4l.. ~ .~ l'- . . \, , ",,~\\t~. ~U:;::V. r' '1iC'C:~,yfllhon '.ith'tH....*,'IJ'i.h-,;1!',(jFmJ>;tf'Jlit -. '1'ffiiI'1t!:M;\'1~""'lh . 'de '~:'. d'LaIYcl:COI1scrv tion I~.i ~.!':A:tI.'t~~.tSo~t.""PQ:,...Ul'l:,T:i~~~._ ~",.!mP~lt~'~=-~~!.S _qs_i!Il_'_~""'_A.' ~,1t.~. A - ;t 'bf.t 96~'f\tbe;:'ind<~'F'tm)o.lf!.'1:'_. 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"Hi ',n~~j;,;d;fl;..t;!jth'.. ..Y~~~..~l'r.t~I~l.J::Ii!.llI1_.,,'''l~.<<:.~..~:;:liJ;.~S~~.ra.'t...:m_.Jt.~~~P.l~.t'.m~9r:::..:m..~~j.'t . ti""'hfi.,i"liInf'.-M~li1~bt!"'i&""'t~l"ltlia :fM'rtf!n';rifjf'm'~'hyjli'f~~1~\!'dPnCiof;n~Tffi1ifiO- cO'IitnlCf; f1h'e B.f~~r::J..""-~_4::J.lt~~~tt.:,,"~~.-.t.~"1...~::~~t:f'iIoo~~~~I"" , ~....=W"d'~;t'..::r..~~u_-....~~~..,.. ~~eono . .--;i.tit~ii11Iplj'I"^,,,tn;~Vi ',IF;I'r'fl.foTo'ceHl f'<rl. t"iif";f""O~~eH'ihs!y~r;'i",&",,.^l';,"~cxtif1"ri'''';.1ii-UIitt)~ ,........_.IDlC?l~;n~"':':'.:.:.~tt..-T:l_~~;l..~~~~~I~:a.~\lrl~ ~.....~.. ~~~ 2-~...!t,,~~g~~~l"f....-.J m.tl.....tJilJarl...-. . . -.. .c1.m~;tint~fi'jirt':lJoOOd~h.~~nlt'tvn.-'.nWOi'~li<A~li."jthe~...a..~!i rc ~c' :i1rtl:'.Hn ~.J.:t'-M~ ~F..~-..__ t~.r:rt:'~ft,_U~_~.u""d.~y~P~n:..r.r.~~~"'l':'=..:.::.1l:--:t~ ~.. ~Ilt:,.... ..t :P1_........."=........ ar'..."l.'t'J\Vi>....w.:f'"w -of.t,;'Uri;or , ~.:.A.~I"'\l\J" t!"t~.1...i,;U:".,.""..'~..M.. P...'\O.1..~-..r i I I I . I I \ ,/ " . .')~{) '--fA.- 0J3 TOGETHER with all and singular. the ways. watcrs. water-COUT!'es. rights. lib(,",1ics. buihiir,gs ;.nd improvcments. privileges, hereditan'ents and appurtenan-::$ whatsoevcr thereunto belonging. or in anywise appertaining. and the re,,(."r.;ions and remainders. rents. iSSllt.::i :1no profits thereof; and all the est3te. rifht, title. iilterest. propeny, claim and demand whatsoever of the Grant0r. as well:!s Jaw as in equity. of. in and to the same. TO !{A VE Ai'\D TO HOLD the said lot or piece of ground above described. with the messuage or t<:llement thereon erected. hereditaments and premises hereby granted. or mentioned and intended so to lx:... with the appurtenances. unto the Grantees. their heirs and assigns. to and for the only proper use and b-:hoofofthe Grantees. their heirs and assigns. fore"er. UNDER AND SUBJECT. nevertheless. to certain conditions and restrictions ofnxoru. as aforesaid. AND the said Grantor. for himself and his heirs. executors, and administrator.; docs by these presents Co\'el"'l\t. promise and agrl:e. to and with the said Grantees. their heirs and assigns. that he. the said Grantor and his heirs and assigns. all and singular the hereditaments and premises here:,y granted or mentioned and intended so to be. with the appurtenances. unto the said Grantees. their heir!> and assigns. against him. the said Grantor and his heirs and against all and every other person or PCrsOIl$ whomsoever lawfully claiming or to claim the same or any part thercofby. from or under them or any "fthem. shall and will. subject as aforesaid. GENERALLY WARFANT AND FOREVER DEFEND. IN WITNESS WHEREOF. said Crolllor has hercunto set his hand llnd seal, tire dllY mldycar first ahm'c-Il'ritrcn. 7~c: and delil'e::cd in the presence of r I.' " '1-, I 1. 1 LLL- (,..h..,,~. ./ l'i~-./ ,I n _. '-::l / ~_2-(g~.:=i.~_ISEAL) Richard B. Moyer, Jrtl ,;Y ) I J CER71F1C4TE OF RESIDf:..WCH I hcrchy certify that the precise n'sidcnce oflhe Gm''''!l~r herein is a.~ )!JllolI's: 1450 Newville RO:ld 1\i\{1 l(N}J~.-'-~ Carlisle. PA ] 1.QJ...:L Atromey or Agent for Granfr('s ConllllOlill'C(dlh 0/ Pcnllsyl\'a/lia } County of ~ Ti" '1 ~ ) 011 this, the ---.!:!.1 day of February. 1999. before me, i) I') I('((~M?. '- (.; I, Ii') ~ ~ t/:. I J'-"; f- the undersigned o.lfreer. personally app:?l1red Richard B. Moyer, Jr., knoll'll 10 me (or snti~fQctorily prol'en) to be the person whose name is siibscribed to the with ill instnunent, alld ar.knowledged that he execl/ted the samefor thc purpose therein cOl/l7ined. IN WITNESS WHEREOF. I have herel/nto set my hand and officJal seal. ~!t ....[; . I (!i - / . t..rf-.{ {._ ~.. 'LL<' it. Notary PW1/ic ^~v CommiSSIon f.xpires:- ) . ./ 11":, t!. {.<'.<.(:::: ., .., ..0 ,~. '~ .. . -..,. ...... .r._.,ol "j,it..'~'t ""- _.- &. I \ ~ ,\ ~ ;? ,~ ~ :~ jll ':j; ;~ ';;II ',"" ~:~~ !~ i . ;~~ , I') ..... ro, n ") 1 I- I t::.. '-ItJ · Indentul4e Warranty Deed _~.U"'_ ----~,....-- ,- _t~~- Richard B. Moyer, Jr. --AND-- Bobby Eo Hurley and Virginia R. Adams Dated Febnrnry .1999 For --2Q...8.L.;.crllQUillld... more or less. located ill Abbott lmYn.ship. Potter CQY.ll1.y. Pennsylvania Co !IS i d l' ra t io n ~li...Q.QQ...00 Entered for RccOl d in Recorder's OJ}lce ~l.--ru~ COII"ty, the Er;lcrcdfor Record in Recordl'1"'s Office of--..eQ11~______ COllnt)', rhe __ d,7\' of-E(j'2rn..ao~/9-2.2 __ da.v of i'LDeed BQf>k VO/llme ~ at paJ:e Ta.:r, $ Fees, S Recorder ACKER AND LARSEN ATTORNEYS AT LA IV 215 NORTH AlAIN STREET P.O. BO.\' III COUDERSPORT. PA 16915 814-274-7913 \ ~. ~~ ;\; :1 t ( REV-1503 EX + (6-98) '* SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HURLEY Bobby E. FILE NUMBER 21 05 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0285 ITEM NUMBER 1. DESCRIPTION Prudential Value Portfolio, 2,001.71197 units @ $2.265560/unit 2. Prudential Jennison Portfolio, 2,215.77950 unites @ $1.715250/unit 3. AIM V.1. Premier Equity Fund, 3,020.53803 units @ $1.398100/unit 4. Janus Aspen Series International Growth, 1,504.52667 units @ $1.948740/unit 5. PremierVIT Op Cap Small Cap, 3.783.24043 units @$1.998780/unit (See attached Statement from Prudential Financial) 6. 181 Shares of Prudential Common Stock @ $58.595/share (See attached date of death value from Yahoo Finance) VALUE AT DATE OF DEATH 4,535.00 3,800.62 4,223.01 2,931.93 7,561.81 10,605.70 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 33658.07 --- Prudential ~ Financial Values Statement PrucoU(e~CoInplIny A I"rudIsial RaadaI CompuIy AaDWly Slnkcs P.O. 8OJI. 7960 PhillldelphlLPA 19176 January 17,2006 BOBBY E. HURLEY 1191 LETCHWORTIiRD CAMP HILL PA 17011 Owner: BOBBY E. HURLEY Annuitant: BOBBY E. HURLEY Contract Nnmber: EOOOI596 Contract Date: 1210611996 Type of Contract: Discovery Select Market: Non-Qualified If you have any questions, please contact your F"uraneiaIJ1iu '" '" "~~:,C"lIlu toUfreut (8Q(J); ~Jk The values provided on this statement are calculated as of 03/07/2005. Any activity after this date is not reflected in this stalement. [f you surrender this contract you will lose the right to future annuity benefits under the contract. In addition, all or part of the distribution may be subject to federal and/or state income tax. You may also be subject to a 10 percent penalty tax for early withdrawal. You may want to consult with your tax adviser if you have any questions concerning the applicable tax treatment, as Prudential cannot offer tax advice. AI though great care has been taken in preparing this statement, we reserve the right to amend the statement as needed. For additional information about the benefits available to you, please refer to your original contract. Account Summary as of 03/07/2005 ~~llf!!l~qir,:q~;;);?J;21~-',':fth?~jB~~~l'i~~iIt.tJ.p~?~~,i,J,ft~ty~*!',;'rUJ>Qf!ll...,~ci9~tUYS~'8Pf"t Prudential Value Portfolio 2,001.71197 2.265560 $4,535.00 Prudential Jennison Portfolio 2,215.77950 1.715250 $3,800.62 Premier VIT OpCap SmaIl Cap 3,783.24043 1.998780 $7.561.87 AIM V.I. Premier Equity Fund 3,020.53803 1.398100 $4,223.01 Janus Aspen Series Int'l Growth 1,504.52667 1.948740 $2,931.93 877018, W SH Discovery Select Variable AMuity is is$ued by Proco Ufe Insurance Company, (in New Vorl<, Proeo Life Insu""",,, Company of New Jersey) aod offered duough Prudential Invcsaoent Management Services LLC. a regWered brokcr-dea1er. Unit values of the variable investment options are determined at the end of the business day on the trade dab:: of Ihc transaction. All are Prudential companies:. Surrender Value as of 3n /2005 Contract Value $23,052.43 Misc. Fees $30.00 Surrender Charge $0.00 Recaprured Bonus $0.00 Cash Surnin(t~r.Ya.iil~l!5 An1ountA~abieto~)Yii~~~-m~Ii~:~u~i:,~~:as'~1:_!J~01~~;'i\$~~Q2~~IY;J,0":;'D!: Beneficiary Information Primary Beneficiaries CONSTANCE C. WEBB Please see the beneficiary designation information in your contract for more details. ,PRU: Historical Prices for PRUDENTIAL FINCL INC - Yahoo! Fi... http://fmance.yahoo.comlq/hp?s=PRU&a=02&b=7&c=2005&d=0... Yahoo! My Yahoo! Mail YAHoot"FINANCE Welcome, jratease [Siqn Out, My Account] Search I. the Web Finance Home - Help Thursday, February 9, 2006, 12:00PM ET - U.S. Markets close in 4 hours. Dow +0.62% Nasdaq +0.53% Home Investing News & Commentary Retirement & Planning Banking & Credit Loans Taxes My Portfolios Market Overview Market Stats Stocks Mutual Funds ETFs Bonds Options Industries Currency Education Get Quotes I ... Symbol Lookup I Finance Search Prudential Financial Inc. (PRU) Trade smarter. Free Trades BrID $7 stock trades At 11:40AM ET: 74.57 ."'1.07 (1.41%) FtaUate $10,9:9 Internet equity tro...l". Now at Ameritrade Historical Prices Get Historical Prices for: I. rq SET DATE RANGE ADVERTISEMENT Start Date: IFlAar .17. ..! 12005 End Date: LFIA.i:lr.1 t?.._......12.99.~. Eg. Jan 1, 2003 €i. Daily C Weekly C Monthly C Dividends Only ;:>r;;,,:',_,':'(':- -- First I Prev I Next I Last EVERYTHING YOU NEED TO BUY YOUR NEW SUV. PRICES Date 7-Mar-05 Open 58.50 High 59.11 Low Close Volume Adj Close" 58.08 58.65 1,145,300 58.05 4111ie. " Close price adjusted for dividends and splits. First I Prev I Next I Last .................................................,'........".... ~j~~jli~~~~474r~;},JGi fJl Download To Spreadsheet YAEOO! AUT05 d: Add to Portfolio 'a Set Alert ":1: Email to a Friend Get Historical Prices for Another Symbol: I .... Svmbol LookuD . Stock Screener . Splits lof2 2/9/2006 12:10 PM PRU: Historical Prices for PRUDENTIAL FINCL INe - Yahoo! 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By accessing the Yahoo! site, you agree not to redistribute the information found therein. 20f2 2/9/200612:10 PM REV-1508 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HURLEY Bobby E. FILE NUMBER 21 05 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0285 ITEM NUMBER 1. DESCRIPTION Members 1 st Federal Credit Union, Savings Acct. No. 20563-00 2. Members 1 st Federal Credit Union, Money Management Acct. No. 20563-05 3. Members 1 st Federal Credit Union, Certificate of Deposit Acct. No. 20563-40 (See attached Statement) 4. Citizens Bank, Checking Acct. No. 6100707202 (See attached Statement) 5. 1997 Dodge Truck, VIN No. 1B7GG23Y1V5307955, Title No. 51354026301 HU (See attached NADA value) Highmark Blue Shield refund 6. 7. The Prudential Insurance Co. of America - dividend check 8. The Prudential Insurance Co. of America - death benefit VALUE AT DATE OF DEATH 5,169.28 25,447.80 15,629.12 115,035.61 3,075.00 251.37 10.54 7.26 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 164625.98 ~.~__c.::. SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner MONEY MANAGEMENT ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Estate of: BOBBY E. HURLEY Date of Death: 03/07/2005 Social Security Number: 426-82-9034 fvlg MEMBERS 1st FEDERAL CREDIT UNION 20563 -00 OS/25/1978 $5,168.43 $.85 $5,169.28 None 20563 -05 OS/23/1995 $25,441.99 $5.81 $25,447.80 None 20563 -40 OS/23/1995 $15,624.91 $4.21 $15,629.12 None ~BERS 1ST FEDE~L CREDIT UNION d"1'''';ac ?l.?a~ D nise A. Wolfe Insurance Services S pervisor April 27, 2005 5000 Louise Drive . Po. Box 40 · Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org /'/ +: CITIZENS BANK 525 William Penn Place Suite 153-2510 Pittsburgh, PA 15219 April 19, 2005 PURCELL, KRUG & HALLER A TIN: TILL WINEKA 1719 NORTH FRONT STREET HARRISBURG, PA 17102-2392 Estate of BOBBY E HURLEY Date of Death: Mar 07,2005 SSN: 426-82-9034 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884. Sincerely, CcGtciL Q~~ Carole Gre~ (J 2J Operations Services .~ CITIZENS BANK Account Number Account Title Date Opened Account Type . Principal Balance as ofDOD Interest from Last Posting to DaD Account Balance as of DaD YTD Interest to DaD 6100707202 BOBBY E HURLEY 1/12/90 Checking $115035.61 $.00 $115035.61 $47.63 .. National Edition .. 1986 THROUGH 1997 PASSENGER CARS LIGHT-DUTY TRUCKS 1 72 Years of Service 1 2005 · JANUARY THROUGH APRIL. 2005 20 DODGE MDdel No. Boar Trad,,-In TYPE 4525 Van 127.6".. .. . . . .. . .821 4950 Maxivan 127.6" . . . . . . . . . . . .821 1997 RAM VAN 3500-1 Ton-V8 6225 Wagon 127.6" .. . . ." 6650 Maxiwagon 127.6". . . 4925 Van 127.6'. . . . . . 5350 Maxivan 127.6" . RAM VAIl omoNS 300 AddSLTTrim ............ 50 Add Aluminum/AUoy Whee~ 75 Add P""er Seal .. .. . 350 Deduct V6 Engine ......... 400 Deduct W/oot "'r Conditioning 75 Deduct W/oot Cruise Control .. . . 75 Deduct Wfoot Power WlI1dows " .835 .. .835 .831 .... .831 1997 DAKOTA PICKUp.l/2 Ton-V6 3400 Sweptline . 4700 Club Cab . 275 Add SL TTrim .. 275 Add Sport Trim .. ... 1500 Add 4 'fi,heei Drive .. 50 Add Cruise Control .. . . 50 Add Power Windows . 300 Add V6 Engine :..... 300 Deduct 4 CyI. Engine. .. .. . .. 300 Deduct W/oot "'r Conditioning . . 1IID Deduct W/"'1 Automatic Trans. . G as the 151 position of the model # denotes 4WQ 1997 RAM 1500 PICKUP-l/2 Too-VII 4225 SweplHne 'WS" (V6). . . . . . . .C16 5100 Sweptline .. ...... C16' 6250 ClubCab................ .C13' 1997 RAM 2500 PICKUP-314 Ton-V8 6200 Sweptline HD .. .. .C26' $18710 7350 Club Cab HD........ ...... ..C23' 20n5 1997 RAM 3500 PICNUP-l Ton-V8-0ual Rear Wheels 1300 Sweptline ... . .. . C36' $20255 8450 Club Cab.. .. .. .. .. C33' 22600 RAM PICKUP QPnOlls 350 Add Laramie SLT Trim (Sid. SS1). . 175 Add Sport Trim. 650 Add SST Pl<g. . . . . 1500 Add 4 Wheei Drive ... .. . .. .. .. . .. .. 3400 Add 5.9L 6 CyI. Turbo Diesel Engine . 300 Add S.OL Vl0 Engine. .. ." 50 Add "'uminum/"'Ioy Wheels 200 Add Leather Seats .. 75 Add Power Seat .............. 350 Deduct V6 Engine (Ex. 'WSj . . . 400 Deduct W/",t Air Conditioning . . . 300 Deduct W/oot Automatic Trans. 75 Deduct Wfout Cruise Control .. L26' .. L23" . F as Ihe 1st posltion of the model # denotes 4WD ADJUST FOR MILEAGE - ADJUST FOR CONDITION JANUARY THROUGH APRIL 2005 M.S.R.P. 1n10 19360 $23140 24950 20300 20875 Trade.ln sa TY Weight Loan Retail 4032 4075 6225 4234 4475 6700 Mileage Class: III 5047 5625 8125 5343 6000 8515 4414 4450 6675 4633 4825 7125 DODGE 1996 CARAVAN-V6 1700 Caravan . 2350 Caravan SE. 2900 Caravan LE . 3150 Caravan ES. 2200 Grand Caravan 2850 Grand Caravan 3400 Grand Caravan 3650 Grand Caravan 150 Add Sport Trim 175 Deduct 4 CyI. t 1IID Deduct W/out I 1996 RAM VAN 1500-1/ 4200 Wagon 109.6" 3200 Van 109.6".. . 1996 RAM VAN 25oo-3J 4500 Wagen 127.6" 3500 Van 109.6".. 3550 Van 127.6".. . 3850 Maxivan 127.6 1996 RAM VAK 350(\.1 4800 Wagon 127.6" 5150 Maxiwagon 12 3800 Van 127.6".. 4150 Maxivan 127.€ RAil VAN omolls 250 Add SLTTrim 2DO Deduct YO E,.. 300 Deduct W/oot 1996 DAKOTA PICKUP. 2500 Sweptline .' 2450 Sweplline Spc 3500 Club Cab. 3450 Club Cab Spa 225 Add SLT Trim 1300 Add 4 Wheel I 250 Add V8 Engin 175 Deduct 4 CyI. 200 Deduct W/oul 150 Deduct Wfout . G as the 1st posilion of I 1996 RAM 1500 PICKI 3800 Sweptline "^ 450ll Swep\ine . 5500 Club Cab. . . 1996 RAM 2500 PICKI 5250 Sweplline. 5350 HD Sweplllne 6250 Club Cab. . . 1996 RAM 3500 PICKI 6350 Sweplline . 7350 Club Cab. IIDJU $12725 16420 300 350 50 75 75 100 350 350 400 400 75 75 75 75 Mileage Class: II 3273 31175 4950 3762 4250 6425 275 325 275 325 1500 1675 50,75 50 75 300 350 . 300 300 300 300 1IID 200 $14075 15880 18550 Mileage Class: IU 4009 3825 59l1O 4028 4600 6850 4575 5625 8150 Mileage Class: IU 4765 5600 8075 4983 6625 9350 Mileage Class: III 5254 6575 9300 5583 1625 10515 350 400 175 1IID 650 725 1500 1675 3400 3625 300 350 50 75 2lIO 225 75 100 350 350 400 400 300 300 75 75 REV-1510 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF HURLEY. Bobbv E. FILE NUMBER 21 05 0285 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST VALUE (IF APPliCABLE) 1. World War I rifle, 2 World War I swords. 300.00 100. 300.00 0.00 Brian Hurley, nephew of Decedent. Transferred prior to death in December of 2004. TOTAL (Also enter on line 7 Recapitulation) $ 0.00 (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 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF HURLEY Bobby E. FILE NUMBER 21 05 0285 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Musselman's Funeral Home 7,237.60 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Purcell, Krug & Haller 1,000.00 3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) 3,500.00 Claimant Constance C. Webb Street Address 1191 Letchworth Road City Camp Hill, State P A Zip 17011 Relationship of Claimant to Decedent Spouse 4. Probate Fees Register of Wills of Cumberland County 260.00 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. Register of Wills - fee to file Will, Automation fee, JCP fee, Short Certificates 50.00 8. Cumberland Law Journal - advertise Estate 75.00 9. The Sentinel - advertise Estate 158.81 10. Prudential Financial - misc. fee to value fund 30.00 11. Register of Wills - fee to file PA Inheritance Tax Return 15.00 12. Register of Wills - fee to file Inventory 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 12341.41 (If more space is needed, insert additional sheets of the same size) ..... .. . REV-1512 EX + (6-98) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HURLEY. Bobby E. FILE NUMBER 21 05 0285 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Members 1st Federal Credit Union VALUE AT DATE OF DEATH 9.95 2. Metro Med Services 3. Internists of Central PA 4. Holy Spirit Hospital 5. Hershey Kidney Specialists 6. Cingular 7. Moffit Heart & Vascular Group 8. Quantum Imaging 9. PA Gastroenterology Consultants 10. George Shahinian, MD 11. Timothy Clark, MD 12. Lower Allen Township EMS 13. George Shahinian, MD 83.75 155.90 100.00 38.50 26.78 17.00 10.25 14.50 13.00 32.00 465.50 6.50 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 973.63 ,. ""'-""~.". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER HURLEY Bobbv E. 21 Of) 0285 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 (al (1.2)] 1 Constance C. Webb Spousal 1191 Letchworth Road 100% of residuary Camp Hill, PA 17011 2. Brian Hurley - nephew Collateral 150 East Chapel Avenue Personal property Carlisle, PA 17013 referenced in Item III. The rifle and swords were trans- ferred prior to death. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON 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. 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)