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Home My WebLink About11-15-06 (2) REV-1500 EX. (~) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W (,) W C ~ :ll::!!;1I) oO:::ll: w~g ::E:o::..J o !LID ~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) JAMES D. HANSEN DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 6 0 0 8 3 COU;:;TYCOOE ~- - - NOOER- - SOCIAL SECURITY NUMBER 391-30-6570 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (dale of death prior kl12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under See. 9113(A) (Attach Sch 0) z o ~ ~ l- ii: <C (,) w a::: z o ~ I- ~ Q. :IE o (,) ~ 10/26/2005 11/09/1934 (IF APPUCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 1XJ 1. Original Return D 4. Limited Estate !Xl 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (daleofdealh aIler 12-12-82) D 7. Decedent Maintained a Living Trust (AttachcopyofTrusl) D 10. Spousal Poverty Credit (dalll of death between 12-31-91 and 1-1-95) 15,281.35 225,065.53 (8) 466,492.40 ..... z w c z o !L II) l::! 0:: o o NAME David M. Frees III FIRM NAME (If Applicable) Unruh Turner Burke & Frees P.C. TELEPHONE NUMBER 6109338069 COMPLETE MAILING ADDRESS 120 Gay Street Phoenixville 26.043.89 6,132.17 (11) (12) (13) 32,176.06 434,316.34 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) 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 Subject to Tax (Line 12 minus Line 13) 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 _ (15) 434,316.34 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) (14) 434,316.34 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 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete ress: ST~T ADDRESS 814 N. Arch Street CITY I STATE I ZIP Mechanicsburg PA 17055 Add Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 19.544.24 14.500.00 763.14 Total Credits (A + 8 + C) (2) 15,263.14 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 4. Total Interest/Penalty (D + E) 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 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) 0.00 to: REGISTER OF (4) (5) (5A) (58) AGENT 0.00 4,281.10 5. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check 4,281.10 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 [Xl b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [Xl c. retain a reversionary interest; or ...................................................................................................... 0 [Xl d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 [Xl 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 [Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [Xl 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS PA 19143 DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX + (6-98) 'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER JAMES D. HANSEN 21 06 0083 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 DroDertv which Islointlv-owned with rIGht of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION Gross Sale price of real property located at 814 N. Arch Street Mechanicsburg, PA Cumberland County, Pennsylvania - per attached settlement sheet VALUE AT DATE OF DEATH 170,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 170 000.00 REV-1508 EX + (6-98) 'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JAMES D. HANSEN ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 06 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. 0083 DESCRIPTION Members First Certificate of Deposit Account #24929- opened 1/18/00 - titled James D. Hansen - per attached VALUE AT DATE OF DEATH 16,496.71 Members First Regular Savings Account #24929-00 - opened 8/12/1980 - titled James D. Hansen - per attached 2,762.92 Members First Checking Account #24929-11 - opened 1/24/1983 titled James D. Hansen - per attached 1,535.51 Members First Money Management Account #24929-05 - opened 10/10/85 titled James D. Hansen - per attached 19,750.41 Members First Certificate of Deposit Account #24929-49 opened 8/18/99 titled James D. Hansen - per attached 5,429.07 Miscellaneous Personal Property 1,000.00 1997 Rav 4 - sold 2,000.00 1999 Ford Ranger 1,800.00 Citzens Bank Circle Checking Account #610076-997-6 - per attached statement 5,370.90 TOTAL (Also enteron line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 56 145.52 -----:r:.~--- REV-1509 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF JAMES D. HANSEN FILE NUMBER 21 06 If an asset WlS made joint within one year of the decedenfs date of death, it must be reported on Schedule G. 0083 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Bruce J. Hansen 5020 Hazel Avenue Philadelphia, PA 19143 son B c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCiAl INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VAlUE OF ASSET INTEREST DECEDENrSINTERES 1. A. M&I Marshall and Usley Bank 28,639.20 50. 14,319.60 Checking Account #22751652 - titled James D. Hansen and Bruce J. Hansen - see attached 2. A 102883 PNC Bank Checking Account #5070038402 1 ,923.50 50. 961.75 titled James D. Hansen and Bruce Jay Hansen per attached TOTAL (Also enter on line 6, Recapitulation) $ 15281.35 T (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) '. SCHEDULE G INTER-VIVOS TRANSFERS & MISC, NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JAMES D. HANSEN FILE NUMBER 21 06 0083 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 OECEOENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COf7'( OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST OF APf'UCASLE) VALUE 1. PNC Bank Certificate of Deposit 29,398.98 100. 3,000.00 26,398.98 Account #31300253127 titled James D. Hansen and Bruce Jay Hansen - est. 12/22/04 2. Members First IRA Certificate of Deposit 37,890.54 100. 37,890.54 #24929-20 - opened 5/18/04 - per attached 3. CUNA Brokerage Services 6CR-265578 IRA FBO 21,728.44 100. 21,728.44 James D. Hansen - per attached 4. T. Rowe Price Investment Services, Inc. 52,307.87 100. 52,307.87 IRA titled in decedent's deceased wife's name per attached 5. PNC Bank Certificate of Deposit Account 51,461.72 100. 51,461.72 #31300253129 titled James D. Hansen and Bruce Jay Hansen - est. 12/22/04 6. PNC Bank Certificate of Deposit Account 25,719.68 100. 25,719.68 #31100253035 titled James D. Hansen and Bruce Jay Hansen - est. 12/22/04 7. Citizens Bank 12-14 month IRA CD #6140-696100 9,558.30 100. 9,558.30 per attached statement TOTAL (Also enter on line 7 Recapitulation) $ 225 065.53 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JAMES D. HANSEN ITEM NUMBER A. B. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 06 Debts of decedent must be reported on Schedule I. DESCRIPTION 1, FUNERAL EXPENSES: Robinette Butts - organist 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s)IEIN Number of Personal Representative(s) Street Address City State Zip 2. 3. Yea~s) Commission Paid: Attorney Fees Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees Cumberland County Register of Wills 5. 6. Accountants Fees Carl LaMastra - estimated Tax Return Preparer's Fees Carl LaMastra - final lifetime returns 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Settlement Charges per attached settlement sheet Cumberland County Mechanicsburg Sewer and Water Chapman Oil Service Pp Electric Bill United Water Verizon - telephone Verizon - telephone Pp Electric Bill United Water Barry Heckard - taxes Barry Heckard - taxes TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheels of the same size) 0083 AMOUNT 100.00 380.00 500.00 300.00 19,104.30 46.00 531.56 414.07 71.64 11.08 43.82 14.32 47.60 11.08 672.20 11.00 26 043.89 Continuation of REV-1500 Inheritance Tax Return Resident Decedent JAMES D. HANSEN Decedent's Name Page 1 21 06 0083 File Number Schedule H - Funeral Expenses & Administrative Costs - B7. ITEM NUMBER AMOUNT 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. DESCRIPTION United Water Verizon - telephone Verizon - telephone Pp Electric Bill Verizon - telephone bill Verizon - telephone bill Pp Electric Bill United Water Verizon Verizon Pp Elecric bill United Water Verizon Verizon Pp Electric United Water Verizon Verizon Pp Electric Verizon Verizon Aero Energy - propane tank Chapman Oil Service United Water AOL internet service United Water Pp Electric Bill Reimbursement to Executor for travel to and from decedent's home tolls and gas Reimbursement to Executor for food while staying in Mechanicsburg Trash removal and clean up of decedent's home - getting ready for sale Lawn Maintenance at decedent's home Reimbursement to Executor for packing supplies Van rental to revomve items from decedent's home 11.08 41.78 14.31 64.27 42.92 14.31 43.83 6.76 41.79 14.31 48.58 6.76 42.84 14.91 45.85 6.76 43.17 14.74 39.72 42.86 14.72 66.00 1,271.02 17.84 101.60 8.56 73.93 550.00 360.00 400.00 150.00 70.00 100.00 SUBTOTAL SCHEDULE H.B7 3,785.22 REV-1512 EX +.<6-98) 'w SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JAMES D. HANSEN FILE NUMBER 21 06 0083 Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1. MBNA - Credit Card VALUE AT DATE OF DEATH 1,400.55 2. East Pennsboro Ambulance 3. Bank Card Services - credit card 4. Members First - credit card 5. Musical Heritage Society - dues 6. PNC Bank - credit card 7. Members 1 st - credit card 8. PNC Bank - credit card 9. PNC Bank - credit card 182.24 300.00 239.68 58.73 2,292.45 61.71 82.95 1,513.86 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheels of the same size) 6132.17 eEV-"~""'* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER A......... r 21 06 0083 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude OU~ht s~usal distributions, and transfers under Sec. 9116 (a (1. )) 1. Bruce J. Hansen Lineal 434,316.34 5020 Hazel Avenue Philadelphia, PA 19143 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 TAXIS 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) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 14.500.00 Discount: 763.14 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 1985 1986 1987 1988 throuah 1991 1992 1993 throuah 1994 1995 throuah 1998 1999 2000 2001 2002 2003 2004 2005 2006 13 3 466.63 0.00 TOTALS 13 0.00 Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17,1996: Penalty: 01/23/2006 12:10 2153512536 SHM PAGE 03/03 Hln.un5 REV IJOS' . . . This is to certify that the infonnati01.'l here given is correctly copied from an original certificate of death duly filed with me as Local Registrar, The original certificate will be forwarded to the State Vital Records Office for permanent filing. . WARNING: It is Illegal to duplicate this copy by photostat or photograph. No. Date ?-e~ Local Regl.-Strar Fee for this cc~cate. $6.00 P 12059904 OCT 2 8 2005' ~."3 """,.'" COMMONWEALTH OF PI!NNSYLVANIA . DEPARlMI!NT OF HEALTH . V1T~ AICORDS CERT1FICATE OF DEATH ""'. dI\>'bclIo. {Ii. 2ot. \\.:. M. rt~"MI.'1z ..........................................t6JlMlllfha~". .......'.......-..411 , . W.1Ifll,.,........4Wl4Mlth. _.....ft CAIlII! 1- ........ .,.-.... -",In_l_ ~........... :.-:.=:.~ '^....c-..."'Io'7 ttIt........ ...". _......._1......, ~ =-..~~_ N_~TH COMI'LEnDH 0' CoWl. No.... "'1::1 tit' a....T"" _... [J No"e 0._ 0 .. b.d 0Ull E' .... DIll! ro tan MAceJf,llI!OUD/!CI. )l OF_ . . III.IUIlV"T_Kl .0000001'ItN9I/1JU11Yo~'a. ..- -..- ~.... bo-.....,t -0 ....0 . -. ~DCATIQN (~...~~. ....j ,,\~ ~ OCT 2 8 2005 X' .>:';1; ~ ~=~.:.= ..';'T""~'~----- JAMES M. BACH ATTORNEY AND COUNSELOR AT LAW 352 SOUTH SPORTING HILL ROAD MECHANICSBURG, PA 17055 TELEPHONE (717) 737.2033 "'~ I, JAMES D. HANSEN of the BOROUGH of MECHANICSBURG, COUNTY of CUMBERLAND, COMMONWEALTH of PENNSYLVANIA, being in good bodily health and of sound and disposing mind and memory, and not acting under duress, menace, fraud, or undue influence of any person whomsoever, merely calling to mind the frailty of human life, and being desirous of disposing my worldly goods while I have the strength and capacity so to do, I do make , publish and declare this my LAST WILL AND TESTAMENT. I hereby revoke, cancel and annul all my former Wills and Testaments, including codicils thereto, by me at any time made, and declare this alone to be my LAST WILL AND TESTAMENT. AS TO SUCH ESTATE AS IT HAS PLEASED GOD TO ENTRUST ME WITH IN THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ: ITEM 1. I direct that my Executors hereinafter named, pay and discharge all of my just debts, funeral and testamentary expenses. ITEM 2. I order and direct that my bodily remains be cremated. Further, I order that my remains be placed for permanent burial at the Fort Indiantown Gap Military Cemetery. ITEM 3. All the rest, residue and remainder of my entire estate, wheresoever situate, and whatsoever it may consist of, I give, devise, and bequeath, absolutely, and in fee, to my dearly beloved wife, ARUS Y. HANSEN. In the event my dearly beloved wife dies with me in a simultaneous disaster, or fails to survive my death by thirty (30) days, then I give, devise, and bequeath my entire estate, wheresoever situate, and whatsoever it may consist of, to BRUCE J. HANSEN, provided BRUCE J. HANSEN survives by thirty (30) days. In the event that BRUCE J. HANSEN does not survive my death by thirty (30) days, then I give, devise, and bequeath my entire estate, wheresoever situate, and whatsoever it may consist of, to ALFRED T. DENNY, per stirpes. ~.~~ Page 1 of 3 ~. ITEM 5. I nominate and appoint ARLIS Y. HANSEN as Executrix or tms my LAST WILL and TESTAMENT. Should the Executrix named fail to qualify or cease to act as Executrix then I appoint BRUCE J. HANSEN as Executor in her stead. In the event that BRUCE J. HANSEN, cannot serve, then I nominate and appoint ALFRED T. DENNY, in his stead. ITEM 6. I hereby direct that all my personal representatives, as well as their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM 7. I order and direct that my Personal Representative(s) named herein use the legal services of JAMES M. BACH, as Attorney for my Estate. ITEM 8. I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for tax purposes, whether or not such property passes under this LAST WILL, shall be paid by my Executrix out of my residuary estate. ITEM 9. I grant to my personal representatives herein named, in addition to, but not in limitation of those powers vested by law, to be exercised without prior application to or approval of any court, the power and authority to retain indefinitely any property, to invest and reinvest any assets or the proceeds derived from the sale of assets, although said investments may not be of the character prescribed by law, to sell, convey, assign, transfer and encumber any property, to pay, settle or compromise all claims, to make distribution or divisions in cash or in kind, and in general to exercise all powers in the management of any property hereunder which any individual could exercise in the management of similar property owned in his own right, and to execute and deliver any and all instruments and to do all acts which may be deemed necessary and proper. j~D.~~ WITNESS~~ - --'"' wmms ^ ~^ It ~ ~ ~~WADGE --------=-----------END-------------------- Page 2 00 1 i' ~, AC:KNOWLEDGMENT ~! :.1 ? COMMONWEALTII OF PENNSYLVANIA ) ) ss COUNTY OF CUMBERLAND ) ~.i k II ~ , ; I 1 I, JAMES D. HANSEN, the TESTATOR, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. Sworn to or affirmed and. acknowledged before me, by: JAMES D. HANSEN, the TESTATOR this 301H day of October ,1997. f}~~}J~ NOTARIAi. SEAL ATI'ORNEY JAMES M. BACH. Notary Public CUmbeltand County MyCommtI8ion ExpIres May 13. 1999 SM. BACH, ESQUIRE NOTARY PUBLIC Mechanicsburg, P A 17055 My Commission Expires: 05/13/99 AFFIDA VIT COMMONWEALTII OF PENNSYLVANIA ) ) ss COUNTY OF CUMBERLAND ) We, JOHN NUGENT and LISA WADGE, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw TESTATOR sign and execute the instrument as his LAST WILL; that the TESTATOR signed willingly and that he executed it as his free and voluntary act for the purpose therein expressed; that each witness in the hearing and sight of the TESTATOR signed the WILL as witnesses; and that, to the best of our knowledge, the TESTATOR was, at the time, 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and acknowledged before me, by: JOHN NUGENT and ::ADG~}i;;da:::~" 7ll oliN NT SM. BACH, ESQUIRE NOTARY PUBLIC Mechanicsburg, P A 17055 My Commission Expires: 05/13/99 Page 3 of 3 June 13, 2006 ft. CUNA Brokerage Services, Inc. A broker dealer of the CUNA Mutual Group UNRUH, TURNER, BURKE & FREES MR. DAVID M. FREES, III BOX 289 120 GAY STREET PHOENISVILLE PA 19460-0289 Re: 6CR - 265578 IRA FBO James D. Hansen Dear Mr. Frees III: Enclosed is the requested infonnation for the account of James D. Hansen, which is held at CUNA Brokerage Services, Inc. The account was established on October 27, 1997. The Account of James D. Hansen, 6CR-265578, had the following market prices as of the close of business on October 26,2005: · $11.69 per share for 1,858.720 shares of AIM Basic Balanced Fund Class A (BBLAX) Pershing LLC carries this account as clearing broker pursuant to a clearing agreement with CUNA Brokerage Services, Inc. Both Pershing LLC and CUNA Brokerage Services, Inc., do not provide tax, investment, or legal advisory services. The market prices have been obtained from various quotation services which we believe to be reliable; however, we cannot guarantee their accuracy. Our customers are encouraged to consult their tax advisors for verification. Please know that we are always here to assist you with any transactions or answer any questions you may have regarding the brokerage accounts. If you need any assistance, please be sure to contact your MEMBERS Financial Service Representative at your local credit union, or our Customer Service area at 1-800-369-2862 between the hours of 8:00 a.m and 9:00 p.m., Central time. Sincerely, J-Jer.,. ~rwr Brokerage Cashier Office of Supervisory Jurisdiction . 2000 Heritage Way . Waverly, IA 50677- 9202 Business: 319/352-4090 . Fax: 319/352-1441 Member NASD/SIPC MAR-27-2006 21:35 PNCBANK 412 768 3458 P.01 G PNCBAN< March 28, 2006 Unruh, Turner, Burke and Frees PC AtIn: Tara M Walters POBox. 289 120 Gay St. Phoenixville, PA 19460-0289 RE: Estate of James D Hansen (Deceased) SSN: 391-30-6570 DOD: 10-26-2005 scp Dear Ms. Walters: In response to your request fOr Date of Death balances fOt" the customer noted above, our reoords show the following: Certificate of Deposit Account #31300253127 Established 12-22-2004 JAMES D HANSEN BRUCE JAY HANSEN DOD balance: $28,789.7.3 + $609.26 accrued interest Interest paid 01-01-05 thru 10-26-2005 $0.00 YTD Account #31300253129 Established 12-22-2004 JAMES D HANSEN BRUCE JAY HANSEN DOD balance: $50,395.24 + $1,066.48 accnaed interest Intercstpaid 01-01-05 thru 10-26-2005 SO.oo YTD Account #31100253035 Established 12-22-2004 JAMES D HANSEN BRUCE JAY HANSEN DOD balance: $25,186.67 + $533.01 accrued interest Interest paid 01-01-05 thru 10-26-2005 SO.OO YTD Page 1 of2 MAR-27-2006 21:35 PNCBANK 412 768 3458 P.02 Cbedcing Account Account #5070038402 Established 10.28-1983 JAMES D HANSEN BRUCE JAY HANSEN DOD balance: $1,923.50 + $0.00 accrued interest Interest paid 01-01.05 thru 10-26-2005 $4.09 Y1D Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any ftnancial traJ1SactioDS or provide statements. If you need assistance with any of these items, please call1.S88-PNC-BANK (1-888-762-2265) or stOp by your local PNe Bank branch office. Sincerely. ~ ::/.~ Erica. L Schlegel 1-800-762-1775 P7-PFSC-04-F SOD First Ave. Pittsburgh PA 15219 Member FDIC Page 2 of 2 TOTAL P.02 OMS NO. 2502.0265 ~ A. B. TYPE. OF LOAN: U.S. DEPAR'TWIENT Of HOUSING & URBAN DEVELOPMENT 1-DFHA 2-DFmHA 3. [!ICONV. UNINS. 4-DVA 5.0CONV. INS. Ill. : 17. v~..'v,~w_,. : SETTLEMENT STATEMENT TAGHI.AM 17002110 8. MORTGAGE INS CASE NUMBER: C. NOTE: 'ThIs form Is furnished to give you a stalement of actual settlement costs. Amounts paid to and by the settlement agent ere shown. Items fTIBJ1ced "[POCr _ paid outside the cJosIng; they are shown here for Informational putpOSSs and are not Included in the totals. 1.0 3198 (TAGHI.AM.PFD/TAGHI.AMI34) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDREss OF SELLER: F. NAME AND ADORES::> OF LENDER: ABDERRAHIM TAGHI and BANK OF WHITTIER MELlSSAJ. TAGH I BRUCE J. HANSEN, Executor 15141 EAST WHmlER BLVD THE ESTATE OF JAMES D. HANSEN WHITTIER, CA 90603 G. PROPERTY LOCATION: H. SEmEMENT AGENT: 23-2402316 I. SETTLEMENT DATE: 814 N.ARCH STREET PURITY ABSTRACT COMPANY MECHANICSBURG, PA +Mtt 17~ July 14, 2006 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT 3329 Mar1<.et Street Camp Hill, PA 17011 J. K. 100. GROSS AMOUNT DUE FROM BORROWER: O. GROSS AMOUN DUE TO SELLER: , 101. l,;Ontract ::;ales Price . vantract Sales Price 170,000.0 102. t'ersonal t'fOPBrty . t'ersonal Property ,lU;S. ::;emement \jnarges to Borrower (LIne 1400Y 104. lAX to ,Ie 1, f105. Adjustments For Items Paid By Seller In advance Adjustments For Items Paid Bv Seller In advance 10t!. l,;Ounty/!loro raxes 071'14106 to 01101107 ..,,<>,<> , . \jOuntylBoro Taxes 07/14/Ut! to ulIu1/u7 298.6' 107. City Tax \0 . CltyTax to 11U . ::;00001 1 ax to . School Tax to 109. [1 O. 41U. 11 . 411. 111 . 1 41z. 120. GROSS AMOUNT DUE FROM BORROWER 176,377.52 420. GROSS AMOUNT DUE TO SELLER 170,298.6 200. AMOUNTS PAlO BY OR IN BEHAJLF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 20 . Depositor earnest money 5,000.00 )1. Excess Instructions IZO . t'nnapal AmOUnt of New Loan sl lo;"UUU.UU 102. Settlement Charges to Seller (Line 4001 18,769.1' 20 . Existing Ioan(S) taken subject to 103. EJdsung Ioan(sl taken sub/ect to 20 . 104. Payoff of first MOngage 2C5. . t'ayOll 01 secona MOflDage 206. 207. . (Deposit dlSl>. as proceedS) . 208. 09. Adjustments For ltams Unpaid By Seller Adlustments For Items -Unpaid By l:ie/Ier 210. l,;OUntyllloro axes \0 1 . CountylBoro Taxes to 211. City Tax to . \,;Ity ax to 212. Schoo Tax 07101106 to 07114/06 63.23 . School Tax U1101106 to UH141utl 63.2< 213. 214. 215. ~16. 1211. 1 1218. .1::;T&2 to lU1'1II Z1,.Yt 1219. 220. TOTAL PAID BYIFOR BORROWER 158,063.23- 520. TOTAL REDUCTION AMOUNT DUE SELLER 19,104.3C 13uu. : 600. CASH" I "c I : 1301. urossAmOUntDueFrom ne 120\ 116,377 .52 I 601. Gross Amount Due o-sillei'lLlne 4Z01 170,298.6; 1302. Less AmOunt t"alo !lY/l'or BOrrower (Line 220) 10ll,U03.,", ' ll\I'. Less Reductions Due Sellerl[fne 520) 19,104.31 303. CASH ( X FROM) ( TO) BORROWER 18,314.29 603. CASH ( X TO)( FROM) SELLER 151,194.3i The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. Borrower ..,- tl;;;~ SUBSTITUTE FORM 1099-5 PROCEEDS FROM REAL ESTATE TRANSACTIONS FOR THE TAX YEAR: 2006 OMB No. 1545-0997 SETTLEMENT AGENT/FILER'S NAME AND ADDRESS PURITY ABSTRACT COMPANY 3329 Market Street Camp Hill, PA 17011 (717)737-8359 SELLERlTRANSFEROR'S NAME AND ADDRESS BRUCE J. HANSEN, Executor Filer's Federal Tax 10 Number: File Number: 23-2402316 T AGHI.AM J Transferor's Federal Tax 10 Number: 2CJ(J' .L 000 tr3 1) Date of Closing: 2) Gross Proceeds: 4) X here If property or services received: 5) Buyer's part of real estate tax: July 14, 2006 170000.00 298.67 3) Address or Legal Description: 814 N. ARCH STREET/MECHANICSBURG PA THIS IS IMPORTANT TAX INFORMATION AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE. IF YOU ARE REQUIRED TO FILE A RETURN, A NEGLIGENCE PENALTY OR OTHER SANCTION MAY BE IMPOSED ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE IRS DETERMINES THAT IT HAS NOT BEEN REPORTED. YOU ARE REQUIRED BY LAW TO PROVIDE PURITY ABSTRACT COMPANY WITH YOUR CORRECT FEDERAL TAX IDENTIFICATION NUMBER. IF YOU DO NOT PROVIDE PURITY ABSTRACT COMPANY WITH YOUR CORRECT FEDERAL TAX IDENTIFICATION NUMBER, YOU MAY BE SUBJECT TO CIVIL OR CRIMINAL PENALTIES IMPOSED BY LAW. UNDER PENALTIES OF PERJURY, I CERTIFY THAT THE NUMBER SHOWN ABOVE ON THIS STATEMENT IS MY CORRECT FEDERAL T ENTIFICATION NUMBER. I ACKNOWLEDGE RECEIPT OF A COPY OF THIS STATEMENT. _ ...... If /(.:? OOb ~e Instructions for Transferor You MUST enter your Federal Tax Identification Number above. Sign and return a copy of this form immediately to PURITY ABSTRACT COMPANY. For sales or exchanges of certain real estate, the person responsible for closing a real estate transaction must report the real estate proceeds to the Internal Revenue Service and must furnish this statement to you. To determine if you have to report the sale or exchange of your main home on your tax return, see the 2006 Schedule D (Form 1040) instructions. If the real estate was not your main home, report the transaction on Form 4797, Sales of Business Property, Form 6252, Installment Sale Income, and/or Schedule D (Form 1040), Capital Gains and Losses. You may have to recapture (pay back) all or part of a Federal mortgage subsidy if all the following apply: · You received a loan provided from the proceeds of a qualified mortgage bond or you received a mortgage credit certificate. · Your original mortgage loan was provided after 1990, and · You sold or disposed of your home at a gain during the first 9 years after you received the Federal mortgage subsidy. This will increase your tax. See Form 8828, Recapture of Federal Mortgage Subsidy, and Pub. 523, Selling Your Home. If you have already.paid the real estate tax for the period that includes the sale date. subtract the amount in box 5 from the amount already paid to determine your deductible real estate tax. But If you have already deducted the real estate tax in a prior year, generally report this amount as income on the "Other income" line of Form 1040. For more Information, see Pub. 523. For Paperworl< Reduction Act Notice. see the 2006 Instructions for Forms 1099, 1098, 5498, and W-G2. Department of the Treasury - Internal Revenue Service (T AGHI.AM.PFDITAGHI.AM/32) OWNERS AFFIDAVIT FTPA-7 (REVIS~D 2/~) First American Title Insurance Company COMMITMENT NO: P.06-129 PREMISES: 814 N. ARCH ST, MECHANICSBURG, PA COMMON,L TH OF PENNSYLVANIA COUNTY UMBERLAND, . ON THE DAY OF JULY, 2006 before me, the undersigned Officer, personally appeared BRUCE J. HANSEN, Executor of the Estate of James D. Hansen, widower, who being duly sworn according to law and intending to be legally bound, depose(s) and say(s) that the following statements are true and correct to the best of my/our knowledge and belief: That the Grantor(s)/Mortgagor(s) herein is/are the owner(s) of premises being insured hereunder and the same Grantee(s) as narned in the Deed Book recitals set forth in the above captioned commitment, and that the facts of identity relating to any other person(s) named in the Deed Book recital(s) are true and correct. That there are no mortgages, judgments, encumbrances, easements, bankruptcies, or pending suits adversely affecting the owner(s) and the premises which are known to the undersigned and not being properly provided for in this transaction. That there have been no repairs, additions or improvements made, ordered or contracted to be made on or to the premises, within four (4) months from the date hereof, nor are there any improvements or fixtures attached to the premises which have not been paid for in full; and that there are no outstanding or disputed claims for any such work or items. That there has been no work done, or notice received that work is to be done, by the Municipality (City, Borough or Township), or at its direction, in connection with the installation of sewer or water or for improvements such as paving or re-paving of streets or alleys, or the installation or repair of curbs or sidewalks. That no notice has been served by any governmental authority for the removal or abatement of any nuisance, for the violation of any zoning regulations or concerning the condemnation of any portion of said premises. That there has been no violation of any restrictions affecting the premises. That there are no purchase money obligations being created in this transfer. That the Grantor(s)/Mortgagor(s) in this transaction is/are in actual possession of the entire premises, and there are no leases or agreements affecting the premises or any part thereof outstanding, other than those that are presently being assigned. That the present transaction is not made for the purpose of hindering, delaying or defrauding any creditors of said owner(s) and does not come within the provisions of any Bankruptcy or Insolvency Acts. That the Grantor(s)/Mortgagor(s) in this transaction are over 18 years of age and in every respect competent to conveyor encumber the title to the premises in question. That the Grantor(s)/Lessor(s) has/have not received a notice of claim from any Real Estate Broker claiming a right to a lien in accordance with Act 34 of 1998. That all homeowner's association fees, if applicable, taxes, sewer and water rents, or other lienable municipal services assessed, levied or filed against the said premises as of the date of this settlement are fully paid. That as to each Grantor/Mortgagor who is an individual: A. That the Grantees in the last Deed of record, if identified therein as husband and wife (tenants by the entirety), have not been divorced from each other at any time since their acquisition of title. B. If presently married, that he/she is neither separated from his/her spouse nor a party to any pending divorce proceeding in any jurisdiction. C. That any interest in the premises has never been awarded or distributed to or Iiened in favor of any current or former spouse nor is his/her interest in the premises subject to the continuing jurisdiction of any court for support obligations or possible future awards or distributions to any current or former spouse. D. That there are no Overdue Support Obligations of record with the Domestic Relations Section of any Court through the date of recording the instrument(s) to be insured. . I further certify that any and all outstanding inheritance taxes due for the above referenced Estate shall be paid in full and agree to indemnify Purity Abstract Co and/or First Americ?!,~itle Insurance Co against any losses resulting from non-payment of said inheritance taxes. ~ initials W ade for the purpose of inducing First American Title Insurance Company or its duly t to hold settlement on the above premises, and to issue its title insurance policy, insuring the o make dis rsement of funds arising out of said transaction. , B SWORN TO AND SUBSCRIBED before me, the day and year aforesaid. My Commission Expires: 2 , . ~~ Citizens Bank 1-888-910-4100 Call Citizens' PhoneBank anytime for account information. current rates and answers to your questions. US002 BR290 JAMES D HANSEN 5020 HAZEL AVE PHILADELPHIA PA 19143 Circle Account Statement e Of 2 Beginning April 14, 2006 through May 11, 2006 Contents Summary Checking Retirement Page 1 Page 2 Page 2 Circle Summary ~ Bal_ Last Statement Ballnee This Stetement Account Number DEPOS IT BALANCE Checking Circle Checking Retirement 12-14 month IRA CD 610076-997-6 5,423.51 6140-696100 9,528.44 Monthly combined balance to waive monthly fee is Your monthly combined balance this statement period is 5,000.00 14,945.17 :~1;:>f:1i',~;' FD!:; @ t~!:)j Hou;m~n Li"r.-dcr 5,370.90 9,558.30 JAMES D HANSEN BRUCE J HANSEN Circle Checking 610076-997-6 e e Totel DeposIt Balence 14,929.20 Totel Reletionship. BaIIllC8 14,929.20 ~~ Citizens Bank 1-888-910-4100 Call Citizens' PhoneBank anytime for account information. current rates and answers to your questions. Account Statement e OF 2 Beginning April 14. 2006 through May 11. 2006 Checking SUMMARY Balance Calculation Previous Balance Checks Withdrawals Deposits & Additions Current Balance 5.423.51 .00 - 52.61 - .00 + 5.370.90 = JAMES 0 HANSEN BRUCE J HANSEN Circle Checking 610076-997-6 Previous Balance TRANSACTION DETAilS Withdrawals Other Withdrawals Date Amount 04/24 45.85 04/27 6.76 Description Pp Elec Bill 060424 9543083002ws United Water Pen Water Bill 060425 999551405 Daily Balance Date 04/24 Balance 5.377.66 Date 04/27 Retirement Balance 5.370.90 Date Balance 5.423.51 e e Total Withdrawals 52.61 Current Balance 5.370.90 SUMMARY Balance Calculation Previous Balance Withdrawals Deposits & Additions Interest Paid Current Balance 9.528.44 .00 - .00 + 29.86 + 9.558.30 = Maturity Opening/Renewal Date Opening/Renewal Amount Maturity Date 09/17/05 9.355.93 09/17/06 JAMES 0 HANSEN 12-14 month IRA CD 6140-696100 Previous Balance TRANSACTION DETAilS 9.528.44 Date 04/17 Amount Description 29 .86 Interest M(>f1~.'ef Fiji:; g f:qUJi h;;:;;!;l!1fJ L(.milJ; Interest Interest Rate Annual Percentage Yield Interest Paid this Year 3.691 3.751 116.04 o o Total Tr..sections 29.86 Current Balance 9.558.30 iJli:; \'volj<;iwet l)t(::~..}E be sure Account Bali;lflc€' '!Norksheet C",W'!l('" C,oNLc __--"-'_'~''^',.~^~W''~=~A~'..W.~~.,-.,~W~,~.~.~^.,,_'"~,,~ """~~""^"'"~''"~'''~'-^_~''~~.'~'~''''^~''',,,,,'~'~_w.' c.h0.ckt)r)ok rcqi:;L'::1" ba1JlnCi:\ DV ;,,,',. nn "i~ -Ah~(t'l do ncd appf ~~, on tl.'T:G=l:,!' ;'i ~d .{ 4 d<:( !.-'. t.r~~n".;;'(:;':';., dD (:q>peal on !l);~: 5 h',::; '1 hi:~ s; ,(';tltd ", :!';Clie : ',' ,~: ~ t i'~ ~ bdL:'1no.:' I" ~f i>H~,'S ~H ;)uflst.kl;1S ~tfH:t yrn:f Puso1~~llh;:j)o<;i!. lh.~tn,)ll~( Tr~n~Yns .>, L)-d,l 5(,-rt~mwns :..':;,J:<:( Hn~f:rt: ChrKW (atrdath)(,s hi" tht~:'<.'h4L tiri~ ~,f L:'!c11t ,:},,_(:')t:I1't<; aC!~;bl 'In A-Vi)r;)g(': GaitV Bal,w(f) Co:n?ljL~nj)n M.:t!l.,j Ch?nqe .M i~,ddres:; ~~l(',);:( ,';:; V" t', ",.,<,.. V<}:: fr):-- L,.';fh ,/;~ ^-">'c:~;.) e(J.::~:. Page: 1 Document Name: untitled IMI2 07/31/06 IM ACCOUNt HISTORY 12.11.45 PAGE 001 KEY 060-000-0000-6100769976 CNTL2 060 CNTL3 000 CNTL4 0000 ACCT# 6100769976 SERIAL POST PAR#/SPRAY TRAN RET NUMBER DATE NUMBER CODE AMOUNT DESCRIPTION/SOURCE DAYS 06/01 1502729407 0170 580.00 BUR OF PUB DEBT H/HH INTST 48 *** (060106/2391306570/060106 ) *** 06/13 1633007468 0119 42.86 VERIZON PaymentREC 48 *** (061306/7176972338/URRING ) *** 06/13 1633006755 0119 14.72 VERIZON PaymentREC 48 *** (061306/7176972985/URRING ) *** 06/26 1772212719 0119 49.18 PP ELEC BILL 15 *** (062606/9543083002/060626 ) *** 07/14 1940535966 0119 47.60 VERIZON PaymentREC 15 *** (071406/7176972338/URRING ) *** 07/14 1940534316 0119 14.72 VERIZON PaymentREC 15 *** (071406/7176972985/URRING ) *** Date: 7/31/2006 Time: 12:11:52 PM of T. ROWE PRICE INVESTMENT SERVICES, INC. A1 BROKERAGE WWW.TROWEPRICE.COM P.O. Box 17435 Baltimore, Maryland 21297-1435 4515 Painters Mill Road Owings Mills, Maryland 21117-4903 Toll-free 800-225-7720 Fax 410-345-6244 June 25, 2006 Law Offices of Unruh Turner Burke & Frees Attn: David M Frees III PO Box 289 Phoenixville P A 19460-0289 Subject: Estate of Arlis Y. Hansen Brokerage Advantage Rollover IRA 30A192456 Dear Mr. Frees: Thank you for contacting us about the Brokerage Advantage Rollover IRA shown above registered to the late Arlis Y. Hansen. B I . th I inti d fO b 26 2005 e ow IS e account va uation ormation vou reQueste as 0 cto er , Fund Name Number of Shares Share Price Balance Accrued Dividends* Prime Reserve 15,069.26 $1.00 $15,069.26 $32.18 GNMA 1,896.37 $9.41 $17,844.85 $6.15 Blue Chip Growth 35.95 $30.82 $1,108.04 N/A EQuity Income 435.37 $25.85 $11,254.28 N/A New America Growth 217.29 $32.36 $7,031.44 N/A *Accrued dividends shown are not included in the balance shown. Accrued dividends were reinvested on October 31, 2005. If you have any questions, please call a Brokerage representative at 1-800-225-7720. Representatives are available Monday through Friday from 8 a.m. to 8 p.m. ET. Sincerely, /p:/~&f ~/ ?--' Jared Hague Senior Account Services Representative Correspondence Number: 01010265 T.~1\ice t.. INVEST WITH CON FI DENCE ..... \ INVENTORY Estate of JAMES D. HANSEN No. 21 06 0083 Date of Death 10/26/2005 Social Security No. 391306570 also known as ,. Deceased 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. IN/e 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 unswom falsification to authorities. Name of Attorney: David M. Frees, III 1.0. No.: 43962 ~_alq E-=- ....--?"" / / Dated /j?;P'b Address: 120 Gay Street Phoenixville Telephone: 6109338069 PA 19460 Description Value Stocks & Bonds Closely-Held Corporation, Partnership or Sole-Proprietorship o ~O Ci3 ;g U.1:cO ,.J-.,J):..'-- :-'2rn :;'=u3~ '~JOO (::-)0., r.::J C : ::0 :0-1 P Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property Members First Certificate of Deposit Account #24929- opened 1/18/00 - titled James D. Hansen - per attached Members First Regular Savings Account #24929-00 - opened 8/12/1980 - titled James D. Hansen - per attached Total (Attach Additional Sheets if necessary) ......., <= = 0'" Z o -< CJ1 -0 ::l: ~ +" N 16,496.71 2,762.92 226,145.52 ~D ;:,;~ :::'.q Cl C) en =0 ......:,0 ..-r'"] 1" ::;:'JO C) C) - ~'; -"fl -n o n" s.;~ 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 ~ .. ...., '\ Continuation of Inventory JAMES D. HANSEN 21 06 0083 Paae 1 Description of Inventory Description Members First Checking Account #24929-11 - opened 1/24/1983 titled James D. Hansen - per attached Value 1,535.51 Members First Money Management Account #24929-05 - opened 10/10/85 titled James D. Hansen - per attached 19,750.41 Members First Certificate of Deposit Account #24929-49 opened 8/18/99 titled James D. Hansen - per attached 5,429.07 Miscellaneous Personal Property 1,000.00 1997 Rav 4 - sold 2,000.00 1999 Ford Ranger 1,800.00 Citzens Bank Circle Checking Account #610076-997-6 - per attached state nent 5,370.90 Real Estate Gross Sale price of real property located at 814 N. Arch Street Mechanicsburg, PA Cumberland County, Pennsylvania - per attached settlement sheet 170,000.00 Subtotal $ Grand Total $ 206,885.89 226,145.52 c..:) lJ..I c) Cl: Li. ' C)C:5 C.:J n- LW;' , (~ ;:::= Cr;:: (.,) C~r3 C)IU 8:-1 '): " STATUS REPORT UNDER RULE 6.12 Name of Decedent: JAMES D. HANSEN Date of Death: 10/26/2005 Will No. 2106-0083 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I . State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasona~ believes that the administration will be complete: ""of {.l.Ls 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No b . The separate Orphans' Court No. (if any) for the personal representative's account is : c . Did the personal representative state an account informally to the parties in interest ? Yes No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. -,-D~fr1 14/rCf&v SIgnature Date: 10/9/2006 David M. Frees. III Name (Please type or print) 120 Gay Street Phoenixville PA 19460 Address M ..::t' ~ :It: Cl... I.r) (610 ) 9338069 Tel. No . I-Cl: ~d :sac> uc" ~ C/) . ";,; EE> :::< -1~-; u:crr 0... Leo. c:r:: c: O~ ~ U Capacity : Personal Representative x Counsel for personal representative ;::.... 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