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Home My WebLink About11-22-06 AY"v McNees Wallace & Nurick LLC attorneys at law liNDA M. ESHELMAN ESTATE PARALEGAL DIRECT DIAL: (717) 237-5210 E-MAIL ADDRESS:LESHELMAN@MWN.COM November 20, 2006 VIA CERTIFIED MAIL Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: ESTATE OF MILDRED A. ANDRUSCAVAGE PA Department of Revenue 21-06-0261 Cumberland County File No. 2106-0261 Our File No. 24617-0001 Ladies and Gentlemen: Enclosed for filing for the above-referenced Estate are the following documents: · Pennsvlvania Inheritance Tax Return (two oriainals). The return shows a tax due of $75.40 and an estate check is attached in payment thereof. · Inventory (two originals). · Check for the $30 fee to file the return and inventory. Please date stamp the copies enclosed and return to us in the stamped envelope provided. Thank you. LME/mha Enclosures rs truly, /c:)O (l-On '55 ---l :2 -0 =.;: ::D en C) {..~ ~J:) <-.J rTi CJ CO) (:J 11,"'1 -TO, C) rn C) .~1' .., CC: Charles Denison ~ .r:- N P.O. Box 1166.100 PINE STREET" HARRISBURG, PA 17108-1166 . TEL: 717.232.8000. FAX: 717.237.5300 .WWW.MWN.COM COLUMBUS, OH . STATE COLLEGE, PA. LANCASTER, PA. HAZLETON, PA. WASHINGTON, DC " ...1&00 EX (e-OO) . . OI'I'K:W. USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT II ~ II \ II oeceDENTS NAME (LAST, FIRST, AND MIDDLE INIllAL) ANDRt1SCAVAGE MILDRED DAle OF OEAlli (MM-OO-YEAR) DATE OF BIRTH (MM-DD-YEAR) 3/10/2006 9/16/1913 (IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INIllAL) A -1L ....QL 0261 _ __ COUNTY CODE YEAR NUMBER SOCIAl. SECURfTY NUMBER 172-34-4165 1M. RITUM MUIT II PlLID IN DUPUCAft WITH TN. REGISTER OF WILLS SOCIAl. SECURfTY NUMBER " J!! [i] 1. O~i1" Retum D 2. Supplementll Relum D 3. RIIMi1der Retum (dill 01 dtllh prtor to 12-1~) , 0 4. LinKed E.... D 4a. Future Inknlt Compromlle (dltl 01 dtllh tllIr 12-12-12) D 6. Fed... EltIIle TIX Relum Required [i] 8. Decedent DledTIIt.e (Attteh copyolWU) D 7. Decedent Malntailed a Living Trult (Alllchcopy oITIUII) _ 8. Total NumberofSare Depod eo- o 9. Lllg.1on ProceecIl RIOIived D 10. SpOIl'" PovertyCredI (dl" .,dlllll bolwHnl2-31-S11N11-l-l5) D 11. Election to tlXUnd. See. 9113(1.)(_....01 "jl!.EC1ION'MU'8t'.E:dOMPETlb.~L~C().ilEiJC)"bnelE." ... NAME - Debra D. Cantor 1:8 . ]I FIRM NAME (If Appltc8ble) 3 ~.e. Wallace & Nurick LLC PO Box 1166 _~ lELEPHOtE NlMBER 717 -237-5297 1. Real Elllle (Schedule A) (1) (2) Harrisburq, PA 17108 0.00 10,066.35 0.00 7,000.00 189,026.61 0.00 0FFlCW. USE ONLY 2. Stocka and Bonds (Schedule S) 3. Clollly Held Corporwllon, PBrtnll'lhlp or Sole-Proprietorahip (3) 4. M ortgag.. & Not.. Receivable (Schedule D) (4) 5. Cash, Blrlk Deposits & Miscellaneous Personal Property (Schedule E) (5) ., 0.00 ~ co::> g; :~'~:~ ~~ CJ ro: ; In ::J:J N .D CJ ,"'206,092. 96.) C) ~~~? ~~.2 (>r-~ ~ I ! ~~J 0" )' '- ) v:5 N rT\ :B -i .r;:- ') ':~~ 3,~7.93 202,845.03 0.00 J 8. J~ O\'W1ed Property (Schedule F) U Separate SlUng Requllted 7. Inter-Vivos Tr8l1afera & Miscellaneous Non-Probate Property (7) (Schedule G or L) (6) 8. Total Grou ""s.1I (total Lin.. 1-7) (8) 2,650.00 597.93 ~ i. r. 9. Funeral expens.. & Administrative Coats (Schedule H) (9) 10. Debts of Decedent, Mortgage liabilities, & Liens (Sdledule Q (10) 11. T 0111 Deductions (total Linea 9 & 10) (11 ) 12. Net Value of esta.. (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for vdlich 811 election to tax has not been made (Schedule J) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 202,845.03 15. Amount of Line 14 taxable at the spousal tax rate, or transf.rs under See. 9116 (a)(1.2) 0.00 202,845.04 0.00 0.00 x.O L (15) X.o 45 (16) 19. Tax Du. (19) 0.00 9,128.03 0.00 0.00 9,128.03 z o ~ 16. Amount of Line 14 taxable at lineal rate ~ 0. a o u >< ~ 17. Amount of Line 14 taxable at slbUng rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND Of. AN OVERPAYMENT > > SESURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << ~4645 1.000 O!J Decedent's Com lete Address: ~ ADDRESS CHURCH OF GOD NURSING HOME 801 N. HANOVER STREET CllY CARLISLE Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount STAlE PA (1) 0.00 8.600.00 452.63 Total Credits (A + 8 + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 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) ZIP 9,128.03 9.052.63 0.00 0.00 75.40 0.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 75.40 - PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes D D D D without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [2a IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penelliee of perjury. I deciere the! I hew examined this return. induding eccompenying llChedulea end sle!ements, end to the best of my knowledge end belief, K is true, d complete. Decieretlon f preperer other then the personal representetlw Is baed on alllnformllllon of which preperer hu any knowledge. 1/ 7 /)1 L 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefrts or care? . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death Mechanicsburg, PA Harrisburg, PA 17108 No ~ ~ ~ [j ~ og II __ Ii 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 ~ the survilling spouse Is 3% [72 P.S. ~ 9916 (a) (1.1) (I)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value ~transfers to or for the use ~the survilling spouse Is 0% [72 P.S. ~ 9116 (a) (1.1) (il)) The statute does not exempt a transfer to a survilling spouse from tax, and the statutory requirements for disclosure ~ assets and filing a tax ratum are stili applicable ewn if the surviving spouse Is the only benefidary. For dates of death on or after July 1, 2000: The tax rate Imposed on the net value of transfers from a deceased child I'Nenty-one years ~ age or younger at death to or for the use ~ a natural parent, an adoptive parent, or a stepparent ~the child Is 0% [72 P.S.!3 9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use ~the deoedent's lineal benefidaries is 4.5%, except as noted In 72 P.S. 13 9116(1.2) [72 P.S. !39116(a)(1)). The tax rate Imposed on the net value ~ transfers to or for the use ~the deoedenfs siblings Is 12% (72 P.S. 13 9116(a)(1.3)). A sibling Is defined, under Section 9102, as an individual who has at least one parent in common with the deoedent. whether by blood or adoption. 3W4646 1.000 :;EV.l803 EX + (e-II) . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA N-ERJTANCE TAX RETURN RESIENT DECEDENT ESTATE OF FILE NUMBER ~LDUD ~RUSCAVAGB 21 06 0261 All property JoIntly-owned with light ~ aurvlvorlhlp must be dlIcloHd on 8chedule F. .'TEMI tUoeERI ~ 1. U. S. Tr.a.ury 2 Y.ar Note No. 912828000 matur.. 3/31/06, inter..t rate of 1.5' Inter..t accrued to 3/10/2006 VALUE AT Dot. TE OF DEAlM 10,000.00 66.35 ."14&96 1.000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space Is needed. insert additional sheets of the same size) 10,066.35 ;!V.1507El(+ ..) . SCHEDULE 0 MORTGAGES & NOTES RECEIVABLE ~lH OF PENNSYLVANIA MERlTANCE TAX RE'T\JRN F&IOENT' OECEDENT .. ElTATEOF HILDRBD A. FILE~ ANDRUSCAVAQB 21060261 AI.prope"J JoIntIy-- willi light of IUfVlvonhlp mUlt be dllcloMd on Icheclule F. ,,-"'-'.. ITEM ~'lJMBER OESCRIPTlON VALUE AT DATE OF DEATH 1 Loan due decedent fro. William Ancb:'U.cavage; S.. Item Third of decedent'. will. AJ.l other loan. referenced in deoedent'. will were .ati.fied prior to death and had a zero balance at her death. 7,000.00 140AC 1.000 TOTAL (Also enter on line 4, Recapitulation) $ 7,000.00 (If more .p_l. needed, Inaert eddlllonlllheet. d _Ilze) ,V.1l108 EX + (5-88) . ~LTH OF PE~SYLVANIA II'KRITANCE TAX RETURN FaIOENT DECEOENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUr.eER mIDRBD A. ANDRUSCAVAGE 21060261 Includ. the proceeds of 'ltlgetlon IIId tile elM tile proceedI were I'ICIiWcI by the .... All ointlY-owned with the rIaht of IUl'YIYonhID mUlt be cIflIcloHd on kheclul. F. ITEM lUMBER IESCRIP110N VALUE AT DATE OF DfATH 1 Cash 321 .36 2 Cemetery Lots - Proceeds 300.00 THE FOLLOWING ACCOUNTS WERE HELD AT AHERICHOICE FEDERAL CREDIT UNION; COpy OF MARCH 2006 STATEMENT ATTACHED: 3 JUnerichoice Certificate of Deposit Account *27949-60 Interest accrued to 3/10/2006 11 , 801. 22 261.43 4 JUnerichoice Certificate of Deposit Account *27949-66 Interest accrued to 3/10/2006 11 , 772 .42 268.32 5 A%nerichoice Certificate of Deposit Account *27949-69 Interest accrued to 3/10/2006 6,000.00 145.32 6 JUnerichoice Checking Account Interest accrued to 3/10/2006 -- 6,458.98 0.81 7 Aznerichoice Money Market Account Interest accrued to 3/10/2006 151,558.83 107.45 8 A%nerichoice Senior Shares Account 30.47 *These accounts had joint owners on them however the account funds were contributed 100% by the decedent and the joint owners were on for convenience purposes only therefore 100% of the account is being included in the estate. :46AD 1.000 TOTAL (Also enter on line 5 Recaoltulatlonl S (If more space is needed, Insert lIddltionlll sheets ofth. same size) 189,026.61 ;EV-1511 EX. (12-81) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMOtM'EAllli OF PENNSYLVANIA NERlTANCETAX ~ RESlOENTDECEDENT' ~ATE OF NXLDUD A. ANDRUSCAVAGE Debts of decedent mUlt be reportH on Schedule I. ~-r=. FUNEfW.. EXPENSES: DESCRlPTlON 1. ~.r.-Rarner Funeral Ho.., Ino. '. ADMINISTRATIVE COSTS: Personal Representatlve.s Commissions Name of Personal Representatill8(s) Social Security Number(s) I EIN Number of Personal RepresentatlYe(s) 1. Street Address City State Zip 2. Year(s) Commission Paid: Attorney Fees McNees Wallace & Nurick LLC (Estimated) 3. Family Exemption: (If decedent's address Is not the same as daimanrs, attach pPlanatlon) Claimant Street Address City State Zip Relationship of ClaImant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. 1 Cumberland County Register of Wills Filing Fee re PA Inheritance Tax Return and Inventory Total from continuation schedules . FILE NUIlB!R 21 06 0261 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, Insert additional sheats of the same size) /48AQ 1.000 AMOUNT 131.00 2,000.00 364.00 30.00 125.00 2 650.00 . S.tate of: MIIDRBD A. ANDRUSCAVAGE Sohedule H Part 7 (Page 2) 2 HON... Wallao. , Nuriok LLC - a...rve for oo.t. r. duplicating, po.tage, eto. Total (Carry forward to main sohedule) , 172-34-4165 125.00 125.00 !!V.1S12 EX + (12-03) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA N-ERITANCE TAX RETURN RE8lOENT DECEDENT ESTATE OF FILE NUIEER aLOUD A. ANDRUSCAVAGJ: 21 06 0261 R.port d.blt Incurred by the d,ced.nt prior to d..th which rem.lned unplkl It fA the date fA death. Including utnlmbul'Md mecIIcaI....... ITEM IMBER 1. IESCRIPllON VALUE AT DATE Of DEATH Check. out.tandinq Ero. Ameriahoioe Cheokinq Account 209.72 2 Continuing Care RX Balance Due 63.32 3 Final Madical Expen.e 28.64 4 The Church of God Ho.e, Inc. Final Bill 200.91 5 w..t Shore EMS Balance Due 95.34 f4eAH 2.000 TOTAL (Aleo enter on line 10, RecaDitulatlonl $ (If more space is needed. Insert addlllonal sheets of the same size) 597.93 REV-1513 EX+ (9-00) e SCHEDULE J BENEFICIARIES COMMONV\IEAL TH OF PENNSYLVANIA II'\tERlTANCE TAX RElURN RESIDENT DECEDENT ESTATE OF MILDRED A. ANDRUSCAVAGE NUMBER I NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] William Andruscavage 1487 Clover Hill Road Dayton, VA 22821 1 25% of Residue: 50,711.26 2 Andi Carole 20 Sea Street Hyannis, MA 02601 25% of Residue: 50,711.26 3 Geraldine M. Denison 908 Greenbriar Drive Mechanicsburg, PA 17050 25% of Residue: 50,711.26 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Son Daughter Daughter FILE NUMBER 21 06 0261 AMOUNT OR SHARE OF ESTATE 50,711.26 50,711. 26 50,711.26 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN />BOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTlONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS W46AI1.000 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTlONS ON LINE 13 OF REV-1500 COVER SHEET (If more space IS needed, Insert additional sheets of the same Size) $ 0.00 e e Estate of: MILDRED A. ANDRUSCAVAGE 172-34-4165 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 4 Gloria Reidell 604 Erford Road Camp Hill, PA 17011 25% of Residue: 50,711.26 Daughter 50,711. 26 EXHIBIT A -,~.-",",,~~.,.~_... -~~~~.~-"."';"..,..a/j................,--_.. ---..-.- ---- e . ESTATE OF MILDRED A. ANDRUSCAVAGE PENNSYLVANIA INHERITANCE TAX RETURN TABLE OF CONTENTS (EXHIBITS) ... A. Miscellaneous Documents 1. Table of Contents - Exhibits 2. Copy of decedent's will dated June 4, 1998 3. Copy - Pennsylvania Department of Revenue OffIcial Receipt B. Schedule E- Cash, Banks Deposits, & Misc. Personal Property; Copy of Americhoice March 2006 statement and copy of completed joint account assessment notices '... e E:\OFFICE\WPWIN\WPOOCS\WILLS\ANORUSC.WIL June 4.1998 . ~ .!/ LAST WILL AND TESTAMENT OF MILDRED A. ANDRUSCA V AGE I, Mildred A. Andruscavage, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all prior wills and codicils thereto by me at any time heretofore made. I specifically revoke my Will dated August 22, 1994. FIRST I direct that all my just debts and the expenses of my last illness and funeral shall be paid from the assets of my estate as soon as practicable after my decease. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give and bequeath all automobiles, household effects and other tangible personal property, not including cash or securities, owned by me at my death, together with all policies of insurance thereon in equal shares, to my children, Geraldine Denison, William J. Andruscavage, Gloria Reidell and Andi Carole, as are living on the sixtieth (60th) day after the date of my death. In the event any of my children ~~ Mildred A. Andruscavage . . e E:\OFFICE\WPWIN\WPDOCS\WILLS\ANDRUSC.WIL June 4, 1998 e . ~ are not living on the sixtieth (60th) day after the date of my death, I give and bequeath their share to their issue, per stirpes, or in default of said issue, my deceased child's share shall pass to my then living children in equal shares. THIRD I give, devise and bequeath the residue of my estate, of every nature and wherever situate in equal shares, to my children, Geraldine Denison, William J. Andruscavage, Gloria ReideU and Andi Carole, providing that they are living on the sixtieth (60th) day after the date of my death. In the event any of my children are not living on the sixtieth (60th) day after the date of my death, then I give, devise and bequeath their share of the residue of my estate to their issue, per stirpes or in default of said issue then to my then living children in equal shares. Any distribution to my children or their children under this paragraph shall be subject to any amounts owing to me for loans made to them during my lifetime. The balance of said loans is attached hereto as EXIDBIT A and incorporated herein by reference. If my child receives a sum pursuant to this distribution which the full amount is more than sufficient for their needs, it is my express testamentary wish that each of my children gift the sum of up to Five Thousand and 00/100 Dollars ($5,000.00) from their share of my estate to each of their children. FOURTH All principal and income, until actual distribution to the beneficiaries, shall be free of the debts, contracts, assignments, alienations and anticipations of any beneficiary, and the same shall not be subject to any levy, attachment, execution or sequestration. ~,t.~j &..~.~~ Mildred A. Andruscavage " e E:\OFFICE\WPWIN\WPDOCS\WILLS\ANDRUSC.WIL June 4, 1998 e . FIFfH J direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expenses of the administration of the estate. SIXTH My personal representative and trustee shall have the following powers in addition to those vested in them by law and by other provisions of this Will: A. To retain any or all assets of my estate, real or personal, without regard to any principle of diversification, risk or productivity. B. To invest in all forms of property as my fiduciary may deem proper, without regard to any principle of diversification, risk or productivity. C. To purchase investments at a premium or discount. D. To exercise all rights of a security holder or shareholder in any corporation; to give proxies; to join in any merger, consolidation, reorganization, voting trust plan, or other concerted action of security holders; and to delegate discretionary duties with respect thereto. E. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as my fiduciary deems proper. F. To allocate receipts and expenses to principal or income, or partly to each. ~~/AJ /)~~~ ..~..,~...~ Mildred A. Andruscavage e E;\OFFICE\WPWIN\WPDOCS\WILLS\ANDRUSC. WIL June 4, 1998 e ~ G. To borrow money from my corporate fiduciary or others and to mortgage or pledge any real or personal property as security therefore, in their sole discretion. H. To compromise any claim or controversy without order of court or consent of any beneficiary. I. To exercise any option, right or privilege granted in insurance policies or arising from ownership of investments. 1. To make any distribution herein provided for in cash, in kind, or partly in each, at valuations fixed by my personal representative at the time of distribution. K. My fiduciary may, in his or her sole discretion, donate any part or all of my tangible personal property to any charitable organization(s) which would benefit from such donation. My fiduciary is then instructed to use the value of said donationes) as an inheritance tax deduction for any inheritance tax return which may be required to be filed as a consequence of my death. SEVENTH I appoint Charles Denison, Executor, of this, my Last Will and Testament. Should Charles Denison, predecease me or for any reason fail to qualify as such Executor, or having qualified, fail to serve as such Executor, then I nominate, constitute and appoint my daughter, Geraldine Denison, Executrix of this My Last Will and Testament. M~aJwtu4.~ Mildred A. Andruscavage e E:\OFFICE\WPWIN\WPDOCS\WILLS\ANDRUSC. WIL June 4, 1998 e r EIGHTH My Executor shall not be required to post security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of seven (7) typewritten pages, the first four (4) of which bear my signature in the margin for the purpose of identification, this .:;r{ray 0~1998. ~'/~ ~'''4~.. 7~.I- Mildred A. Andruscavage ----------- . e E:\OFFICE\WPWIN\WPDOCS\WILLS\ANDRUSC.WIL June 4, 1998 e .. .' Signed, sealed, published and declared by the above-named Testatrix, Mildred A. Andruscavage, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and pr~sence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~jif!J-r . Address :>>$/ MeUM J+ .. ('fJA-rI/) cJ!c<< p~ I 70 \ I U)O rr/J (tjlJ7_lJ..fA:l Address .;( ~') I Nf'lr 0 ~ ~pJ-\'\\ (,-:pet 110 I I COMMONWEALTH OF PENNSYLVANIA ) : SS: COUNTY OF Wmby-Iord! I, MILDRED A. ANDRUSCA V AGE, THE TESTATRIX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TEST AMENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIRMED TO AND ACKNOWLEpGED BEFORE ME BY MILDRED A. ANDRUSCA V AGE, THE TESTATRIX THISlj4JA Y OFJallZ, 1998. :hu~ ~~~-6."" ~ Testatrjx . ;vA K Norry Public Notartel Seal I MonIca D. Zeroher. Notary Public I Camp HUI 8010, Cumbelland County My CommIssion Elq)l1'8l Jan. 14,2002 Member, Pennsylvania AsSOQial19n III NetarlM n_ ___, ,.,.., ----- - - ----~- e E:\OFFICF:\WPWIN\WPDOCS\WlllS\ANDRUSC. Wll June 4, 1998 . e COMMONWEALTH OF PENNSYLVANIA ) : SS: COUNTY OF Cvmber~ WE,\nfw-bO./'/ AND UXni4 L. Eoisvtr-t THE WITNE!SES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRUMENT, BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SAW THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TEST AMENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTATRIX SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT TIIE TIME EIGHTEEN (18) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. SWORN OR AFFIRMED TO AND SUBSCRIBED TO BEFORE ME, THIS <F- DA Y OFJU ,?<A- , 1998. '" ~~fLb ' ess LliJlfCL3~3hi~ ff J:;,L WItness ~~.~<- Notr Public Notarial Seal MonIca D. lercher. Notary PIilIlc Camp HIU Boro, C\I'Ilberland CounIy My Commlsalon EICpIres Jan. 14, 2002 Member, Ponnsytvanls Astootatton 01 .. ) e E:\OFFICE\WPWIN\WPOOCS\WILLS\ANORUSC. WIL June 4, 1998 . " , William J. Andruscavage Larry and Gloria Reidell Larry and Gloria Reidell Larry and Gloria Reidell ExmBlT A e $7,000.00 1,000.00 1,300.00 700,00 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT COMMONWEAL TH OF PENNSYLVANIA DePARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 e RECEIVED FROM: .: '..... DENISON CHARLES 908 GREENBRIAR DRIVE MECHANICSBURG, PA 17050 _u__._. fold ESTATE INFORMATION: SSN: 172-34-4165 FILE NUMBER: 2106-0261 DECEDENT NAME: ANDRUSCA V AGE MILDRED A DATE OF PAYMENT: 06/09/2006 POSTMARK DATE: 06/09/2006 COUNTY: CUMBERLAND DATE OF DEATH: 03/10/2006 e REV-1162 EX(11-96) NO. CD 006815 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $8,600.00 I I I I I I I I TOTAL AMOUNT PAID: $8,600.00 REMARKS: CHARLES E DENISON CHECK#106 SEAL INITIALS: CM RECEIVED BY: TAXPAYER GLENDA FARNER STRASBAUGH REGISTER OF WILLS EXHIBIT B . _....,""'"..A..;j'''''~;....:........., ._ ~ ___ _..~~>_......-..,. - . ~~~~~ 2175 Bumble Bee Hollow Road. P.O. Box 1429 Mechanlcs~urg._PA :705~. , '-'NCUA- P>,one !71/1 69:.34,4 - \800, 240-436a ."-_"',,=___ Ifottc.. r.".ra. aid. Cor UIport....t. inCo,...UOII r..ardJ.nlJ your right. to d1eput. errore 011 y....r atat_t. - ACCOUNT NtJMBBR. 27949 YTD DIV RECEIVlD. i,090.56 - PAGB NtJMBB1\. 1 of 3 12092 ~ Ti~.d of the wait.ing for your paper etat...nt to ar~iv.? Si n up for eStat..enta' ... .. MILDRED A ANDRUSCAVAGS !!~ 908 GREENBRIAR DR MECHANICSBURG PA 17050-1986 WITH 600 MEMBER REWARD POINTS YOUR NEW LEVEL WILL BE: BLUE RIBBON MEMBERS A~ ASK US HOW MEMBERS GET FREE UNLIMITED ATM TRANSACTIONS_ S~~Y OF YOUR ACCOUNTS I I I S1J1I'FIX 01 SPIOR SHARKS I SUFFIX 13 SKARE DRAFT I SUFFIX 18 MONBY ~BT I JOINT: GERALDINE DENISON I JOINT: CHARLES DENSION 1 JOINT. GERALDINE DENISON I JOINT. CHARLES DENISON I JOINT. GERALDINE DENISON I JOINT: CHARLES DENISON I STATEMENT PERIOD 03/01/06 - 03/31/06 I STATEMENT PERIOD 03/01/06 - 03/31/06 I STATEMENT PERIOD 03/01/06 - 03/31/06 I BEGINNING BALANCE 30.47 I BEGINNING BALANCE 1,237.46 I BEGINNING BALANCE 143,454.25 1 DEPOSITS 1 .03 I DEPOSITS 5 5,293.52 I DEPOSITS 3 22,512.67 I WITHDRAWALS 0 .OO~ WITHDRAWALS 0 .00 I WITHDRAWALS 1 4,000.00 I ENDING BALANCE 30.50 DRAFTS CLEARED 4 279.22 I DRAFTS CLEARED 0 .00 I 1 ENDING BALANCE 6,251.76V'! ENDING BALANCE 161,966.92 I DIVIDEND YEAR-TO-DATE .08 I I I -IDEND THIS PERIOD .03 I DIVIDEND YEAR-TO-DATE 4.33 I DIVIDEND YEAR-TO-DATE 848.80 1 .RAGS DAILY BALANCE 30.47 DIVIDEND THIS PERIOD 2.50 I DIVIDEND THIS PERIOD 333.09 I DAYS DIVIDEND EARNED 31 AVERAGE DAILY BALANCE 5.874.56 I AVERAGE DAILY BALANCE 151,099.52 I ANNUAL PERCENTAGE DAYS DIVIDEND EARNED 31 I DAYS DIVIDEND EARNED 31 I YIELD EARNED 1.17% ANNUAL PERCENTAGE I ANNUAL PERCENTAGE I YIELD EARNED 0.50% 1 YIELD EARNED 2.63%1 I I I I SUPFIX 60 12 MONTH CERT SUP PIX 64 12 MONTH CERT I SUFFIX 66 12 MONTH CERT I JOINT. GERALDINE DENISON JOINT: GERALDINE DENISON I JOINT: GERALDINE DENISON I STATEMENT PERIOD 03/01/06 - 03/31/06 STATEMENT PERIOD 03/01/06 - 03/31/06 I STATEMENT PERIOD 03/01/06 - 03/31/06 I BEGINNING BALANCE 11,801.22 BEGINNING BALANCE 11,867.23 I BEGINNING BALANCE 11,772.42 I DEPOSITS 0 .00 DEPOSITS 1 237.35 I DEPOSITS 0 .00 I WITHDRAWALS 0 .00 WITHDRAWALS 1 12,104.58 I WITHDRAWALS 0 .00 1 ENDING BALANCE 11,801. 22 ENDING BALANCE .00 I ENDING BALANCE 11, 772 .42 I I I DIVIDEND YF.:J>.R.TO-DP.TE (1(\ DIVIDEND YEAR-TO-OATE 237.35 I DIVTm!:Nn YFAR-TO-!1ATE DC i DIVIDEND THIS PERIOD .00 DIVIDEND THIS PERIOD 237.35 i DIVIDEND THIS PERIOD .00 I AVERAGE DAILY BALANCE .00 AVERAGE DAILY BALANCE 11,867.23 I AVERAGE DAILY BALANCE .00 I DAYS DIVIDEND EARNED 0 DAYS DIVIDEND EARNED 365 I DAYS DIVIDEND EARNED 0 I ANNUAL PERCENTAGE I I MATURITY DATE 05/03/06 YIELD EARNED 2.00% I MATURITY DATE 06/01/06 I ANNUAL PERCENTAGE RATE 2.600\ I ANNUAL PERCENTAGE RATE 2.950%1 MATURITY DATE 03/04/07 I I ANNUAL PERCENTAGE RATE 4.200% I I I I - - - ~~~~~ 2175 Bumble Bee Hollow Road. P.O. Box 1429 Mechanicsbu'9. PA 17055 : -'NcUA' Phone (717\ 697-3474 - \800\ 241).4364 -=,,-"'''=''-=:. MOtiC.. ny.ro. lid. for bportut iDforaatioa r.lIar411l1l your rillbt to di.puta error. 011 your .t.t...Dt. ACCOUN'1' NUMBBR: 27949 12093 I surrlx " 12 MONTH CERT I ~o JOINT: GERALDINE DENNISON, POA I ... STATEMENT PERIOD 03/01/06 03/31/06 I =~ BBGIHNING BALANCE 6,000.00 I DBPOSITS 0 .00 I WITHDRAWALS 0 .00 I ENDING BALANCE 6,000.00 I I DIVIDEND YBAR-TO-DATE .00 I DIVIDEND THIS PERIOD .00 I AVERAGE DAlL.Y BALANCE .00 I DAYS DIVIDEND EARNED 0 I I MATURITY DATE 04/04/06 I ANNUAL PERCKNTAGB RATE 2.600\ I I YTD DIV RBCBIVBD. 1,090.56 sur:rx HISTORY DATS 3/31/06 S'OJ'J':IX 1!QBX DATE 3/01/06 3/03/06 3/03/06 3/03/06 3/03/06 3/04/06 3/13/06 3/15/06 3/31/06 DEPCSI'i'S DATE 3/01/06 3/03/06 3/03/06 3/04/06 3/31/06 01 SENIOR SHARES DESCRIPTION DIVIDEND 13 SHARE DRAFT TRANSACTION AMOUNT ACCOUNT BALANCE .03 30.50 DESCRIPTION TRANSACTION AMOUNT UNITE HERE RETIR 41. 02 ./ 3/01/06 UNITE HERE RETIR CMWC TRIAS 303 574.00'"" 3/03/06 CMWC TREAS 303 US TREASURY 303 676.00 ./ 3/03/06 US TREASURY 303 Draft Number 1123 e.r/pttpS 29.50 - t/ Draft Number 1122 ~G-ftIIllto.oo-./ FR 27949-18 4,000.00 '"" Draft Number 1124 OR. 95.36-./ Draft Number 1125 rt1 114.36-./ DIVIDEND 2.50 ,./ DESCRIPTION UNITE HERE RETIR CMWC TRIAS 303 US TREASURY 303 FR 27949-18 DIVIDEND DRAFTS/CHECKS CLEARED DRAFT# AMOUNT DATE 1.122 40.00 3/03 1123 29.50 3/03 SUPPIX 18 MONEY MARKET TRANSACTION AMOUNT 41.02 574.00 676.00 4,000.00 2.50 ACCOUNT BALANCE 1,278.48 PENSION-CK 1,852.48 FEDANNUITY 2,528.48 SOC SEC 2,498.98 2,458.98 6,458.98 6,363.62 6,249.26 6,251. 76 LOCATION UNITE HERE RETIR CMWC TREAS 303 US TREASURY 303 PAGE NUMBBll. 2 of 3 PENSION-CK FEDANNUITY SOC SEC DRAFT# 1124 1125 (* DENOTES AMOUNT DATE 95.36 3/13 114.36 3/15 MISSING DRAFT SEQUENCE NUMBER) DRAFT# AMOUNT DATE DRAFT# 3/01/06 3/03/06 3/03/06 ~ DATE HISTORY DATE 3/04/06 -4/06 .1/06 3/31/06 DESCRIPTION FR 27949-64 TO 27949-13 TREASURY DIRECT 3/31/06 DIVIDEND TRANSACTION AMOUNT 12,104.58 4,000.00-V 10,075.00 ,./ TREASURY DIRECT 333.09 ACCOUNT BALANCE 155,558.83 151,558.83 161,633.83 PAR&INTCDO 161,966.92 . - - - - - 8Ul'I'IX DBPOSITS DATI 3/04/06 3/31/06 3/31/06 v;- Amere10ice ~FlDlRAL CREDIT UNION 2175 Bumble Bee Hollow Road. P.o. Box 1429 Mechanicsburg. PA 17055 =---=-; Phone (717) 697-3474 - (800)240-4364 .""~~::-_ 18 MONBY JIAJUtBT DESCRIPTION FR 27949-64 TREASURY DIRECT DIVIDEND OTHER DEDUCTIONS DATE DESCRIPTION 3/04/06 TO 27949-13 8Ul'I'IX 60 12 MONTH CBRT (NO ACTIVITY) 8Ul'J'IX 64 12 MONTH CERT TRANSACTION AMOUNT 12,104.58 10,075.00 333.09 TRANSACTION AMOUNT 4,000.00 (CONTlNUBD) .. g:; ... LOCATION TREASURY DIRECT LOCATION NOUC.. &'ev.n. d". fo&' iIopo&,tut illfo&'aatico &,.lIU11t.Illl roD&' &'illbt to "i.put. .&'&'O&'I OIl roD&' .tat.....t. ACCOUNT NUMBERI 27949 YTD DIV RECBIVBDI 1,090.56 PAGE NUMBERI 3 of 3 12094 PAR"INTCDO 3/31/06 HISTORY DATE 3/04/06 3/04/06 DESCRIPTION Dividend Payment TO 27949-18 8Ul'J'IX 66 12 MONTH CBRT (NO ACTIVITY) :IX 69 12 MONTH CBRT (NO ACTIVITY) TRANSACTION AMOUNT 237.35 12,104.58- ACCOUNT BALANCE 12,104.58 .00 COIIlOIIlIEAl TH OF PEIIlSYLVAIIIA IIEPARTMENT OF AEVEIlUE IUREAU OF INDIVIIlUAL T AllES IIEPT. 210601 HARRISBURG, PA 17128-0601 e* INFORMATION N~CE AND TAXPAYER RESPONSE FILE NO. 21 06-0261 ACN 06125429 DATE 06-02-2006 TYPE OF ACCOUNT EST. OF MILDRED A ANDRUSCAVAGE 0 SAVIN8S 5.5. NO. 172-34-4165 IilCHECKIN8 DATE OF DEATH 03-10-2006 0 TRUST COUNTY CUMBERLAND 0 CERnf. REHIT PAYMENT AND fORttS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 "V-iii" II II' lit-I" GERALDINE M DENISON 908 GREENBRIAR DR MECHANICSBURG PA 17055 NlERICHOICE fCU has pr-ovided the o.peru.nt with the info,...Uan ll.ud b.ll111 lIhich hII. b.." ulHd In calcul.Ung the potanUel tax duB. Thalr record. Indlnta th.t .t the d8ath Df the .bov. HcedMt, you ...r. . joint _r/b8n8flcl.ry of this .ccount. If you f..l this Info,...Uon Is Incorrect, pl.... obtain lIrltten cDrractlan frDII th8 flnancl.l In.tltuUon, attach a copy to this fo,.. and return it to the abDV. addra... This account Is taxabl. In .ccordanc. lIlth th8 InhlIrltanca T.lC L.... Df the C_lth of P",SYlvanle. Qua.tllll'l. _y bta an....rlld bl/. c.Ulng (717) 787-11327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 27949 Dat. 11-10-1999 Est.U.... ACCOWIt BalMCa Percllnt T8Xllbl. Miount Subject to Tax Tax R.t. Potential Tax Due x 61249.26 16.667 11041.56 .045 46.87 TAXPAYER RESPONSE To Insur. propar cradl t to your account, two (2) cap I.. of this noUc. IIUst accoapany your paya....t to the R8lIlst.r of 11111.. Ilak. chack p.yabl. tD: "R8lIlstar Df 11111., Ag....t". x NOTE: If talC peyaant. er. aada lIlthln thr.. (3) IICInth. Df the dacadant'. data of death, you RY daduct a 5% discount of the talC dull. Any InhlIrltanc. talC due lIUl bec_ dallnquant nine (9) .unth. aftar the det. Df da.th. PART [!] ~.illr:" :C".... '.=".,-:- ....... ,.c...yeo..."-.... --{.t. -'y-''J,...1f-'c-r-,.---_-y-r-'y.'c_r."..~-;e-rc~y e__"C_'.,.-e"_'__' -.- -'--.-" ~_r-r- - -<f'-":S-C :-'-1;:"-1'eC-'_ _"."..e=:-_',%\I"" ":c. , 'T-:!-C""-- ,'::!if.. ""leot:c. .'-'~-{;';::r":-"1ll::m ~~~~~~~~~#iUf~~~:r};L~~~lri~~~:~~~~~*x~~~~_m-~.~1E1it~~ [CHECK ] ONE BLOCK ONLY A. 0 The abov. Infa....tlon and t.lC dull Is corract. 1. You MY chao.. to raalt pay.."t to the Reglst.r Df 11111. lIlth two capl.. af this notice to obtain a discount ar .vaid Int.r.st, Dr yOu AY chack bolC "A" and ratum this notlc. to the R.glst.r Df Wills end an Dfflcl.l .......ant lIlll b. Issued by th. PA DIIP.rta....t af R.venue. B. t7I The .bDve .s..t has b.." ar lIlll blI rllPorted and talC p.ld lIlth the P.nnsYlvanl. Inh.rltanca TalC r.turn j.o.I to ba filed by tha daclldant's rllPra..ntatlv.. C. 0 The above Inforaatlon Is Incorrect endIDr debts and deduction. ...ra paid by yau. You ...t cDllpbt. PART [!J and/ar PART [!] b.lall. PART If you Indlc.t. . dlff.rent t.x ratal pl.... st.t. your [!] rel.tionshlp to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT'TRUST ACCOUNTS LINE 1. Bat. Est.Ushed 1 2. Account B.lanca 2 3. P.rcent Tax.l. 3 X 4. AIIount Subject to Tax it S. Debts and Deductions 5- 6. Mount Taxabl. 6 7. Tax R.t. 7 X 8. Tax Due 8 PART I!l DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I I TOTAL (Ent.r on Lln. 5 of Tax eo.put.tlon) . Under penalti.s of perjury, I declare that the facts I h.y. reported aboy. .re truel correct and co.pl.t. to the best of .y knowl~ and bell.f. HOME ( ) WORK ( ) TELEPHONE NUMBER DATE TAXPAYER SIGNATURE ClIIlIIIINEAL 1M of PENNSYLVANIA IlEPARTIENT 1If REYENUE IlIAEAU 1If INDIVIDUAL TAXES IIEPT. 281601 I HARRISBURG, PA 17128-1601 e.. INFORMATION N~CE AND TAXPAYER RESPONSE FILE NO. 21 06-0261 ACN 06125428 DATE 06-02-2006 IU-U4S EX AF' In-..' CHARLES E DENISON 908 GREENBRIAR DR MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF MILDRED A, ANDRUSCAVAGE D SAVD18S S. S. NO. 172-34-4165 Ii] CHECKINQ DATE OF DEATH 03-10-2006 D TRUST COUNTY CUMBERLAND D CEITIF. R!HIT PA~EHT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 AlERICHOICE FCU hII. pravidlld the QIIp.rtllent lIith the inforntian lI.t_ bIIlaw lIhiah h.s bIIM unci in a1cu1.tlllll the pobnti.l UX dull. TMlr records Indlna th.t .t the a.th of the Hav. dlIcedwlt, you ..~ . joint _r/a.n.flcl.ry of this eccaunt. If YOll '-1 this Inforntion is Incorrect. pl.... abuln IIrlt_ corr.ction frOll the fln_I.1 Institution. .tbch . copy ta this fo... .net r.turn It to thellbov. IIlIdr.... This IICClI\II'It Is tmcIIble In .ccordenc. IIlth the Inherl~ TM L.. of the C_..Uh of PWVlSl/lv.nle. Qu.stlons MY bII M_,..d blt--ca1l1ll11 (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 27949 o.t. 11-10-1999 EstebUshecl x 6~249.26 16.667 1~041.56 .045 46.87 TAXPAYER RESPONSE To Insure pr..r Cr8dl t ta your lICCCJ\II\t. bIG (2) copl.s of this notia ....It eccllllfllll1Y YOU" pBYMII\t to thII Reglsur of W1U.. MlIk. ah8ck pByllb1e tal "Reglsa,. of lUlls, AlIBnt". Account B.lence Percent Tax.bl. AIIou'tt Subject to T.x Tex Rat. Potentl.l T.x Du. x NOTE: If tex pBl/HI1ts .~ .... IIlthln three (3) IIClnths of the d8ced8nt'l deb of d..th, you ..y dllduct . SlC discount of the t8X dull. Any lnh8rltanc. ux due 11111 becCIII. delinquent nine (9) lIOI'Iths efte,. the ate of de.th. PART [!] ~I.r~]-~-=S:~d lfl----1~~~i-;..; + ~~rl t=~---=~_.:-__ ~---~1~~~-T-~'l.~~--~_r~-~~------~-~:~ -~tf;-~: ~'l-t-'f* ~ ~ --; :~~:-~~Jf.r~ ~~~='l,jr~rt;"1i:W1i----!.~f~----:--~-: -~i-~-~;-~~~--~ 1 :: ;----::k~ 1 - -:t~ ~1 ~ [( ;~: -- "'~-~~~;~:~~~:t: ~:Ill'~.;J=j'.~f.ilJ:j>.=Jjfu.it~~'iiiil:'lJh.~'li!il'.iltilliiil!a;:;re*~3:jjfu._'l::ill:.jj::lttf..ri:illll:K;:I:tl,.~:il'.jj:~"i!p.ililll!iH;;jj;1.s:~:*;f~:.a.;;:"1rl~_*jJ:~*~'tiiBW.J:'l:.J:",g.i".ih-':ii:_1 [CHECK ] ONE BLOCK ONLY A. D ThII 8bove infor_Uan end tex dUll Is carract. 1. You ..Y chao.. to r.lt pay_nt to the Register of Il1lls IIlth two copl.s of this noUca to abuln . discount or avoid Interest. or YOU _y aheck box "A" end return this noUce to the Relllster of WUls .nd an offlcl81 .sses_t 11111 be Issued by the PA lItIperuent of Revllf1Ull. B. 1:ti The Have esset hes b.en or IIUl be reported end tex peld IIlth the Pemly1vanla Inherltence T.x return ~ to be filed by the decedent's repre..ntetlve. c. D The Have Infar..Uon Is Incorrect and/or dllbts end deduction. llere paid by YOU. You IlUlt caaplea PART 0 and/or PART I!l bela. If you indlcat. . diff.rent tax rat., pl.... st.t. your rel.tionshlp to decedent: PART I!I TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Dat. EstebUshecl I 2. ACCOW1t B.lanc. 2 3. ParcantTax*bl. 3 X 4. Aaount Subject to T.x 4 5. Debts and Deductions 5- 6. Allount T.xabl. 6 7. Tax R.t. 7 X 8. Tax Due 8 PART (!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Ent.r on Una 5 of Tex COIIPUt.t1on) I . Under penal t1.s of per jury ~ I decl.r. that the fects COIIPl.t. to the best of .y knowledge and b.U.f. I hav. reported above .r. true~ HOME ( ) WORK ( ) TELEPHONE NUMBER correct and TAXPAYER SIGNATURE DATE COIlMOIIIIEAL TH OF PENNSYLVANIA IlEPARTIENT IIF REVENUE BUREAU OF INDIVIDUAL TAXES IIEPT. Z8D6Ul , IlIoRRISIURlil, PA 171Z8-060l e... INFORMATION ~CE AND TAXPAYER RESPONSE FILE NO. 21 06-0261 ACN 06125431 DATE 06-02-2006 .'-1545 EX .FP lit-Ill GERALDINE M DENISON 908 GREENBRIAR DR MECHANICSBUR6 PA 17055 TYPE OF ACCOUNT EST. OF MILDRED A ANDRUSCAVAGE 0 SAVIN8S S. S. NO. 172-34-4165 Iil CHECKING DATE OF DEATH 03-10-2006- 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REflIT PAYltENT AND FORtIS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 AltERICHOICE FCU ha. p...ovlad the o.pe...tllent ..Ith the Info,...tlon listed belDN NhIGh has been used In calcul.tlng the potentl.l tex due. Thel... ...ecor-ds Indicate th.t .t the de.th of the above daced8nt, you ".1"8 . joint o_...lbanaflcl....y of this .ccount. If YOU f..l this Info.....tlon b Inco......ect, pl.... obtain ..r-lttan co.......ctlon f...DS the fll18l1clal Institution, .ttach a copy to this fo,.. and ....turn It to the above add....... This .ccount Is telCllbl. In .ccordanc. ..Ith tha InhlIr-ltanca TIIIC L.... of the C_nw_lth of Pennsylvanl.. Questlons..y be an_MId by calUng (717) 7117-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 27949 Dat. 11-10-1999 Est.a>>11shec1 151,558.83 .16.667 25~260.31 .045 1,136.71 TAXPAYER RESPONSE Account B.l~ Percent T.xMi. AIIount Subject to Tax Tax ht. Pot....U.i Tax Du. x To Insu.... p...op.r cradl t to YDU'" account, tNo (2) copl.s of this notlc. ...t _oap.ny you... paYHllt to the R.glster of NUls. Milk. check payabl. to: "R..lste... of Nllls, Agant". x NOTE: If tax P8l/IIlII1ts al"8 8Bda ..Ithln th...H (3) 80nths of the decadent's d.t. of dsath, YDU _y deduct . s:c discount of the tax due. Any Inhe...ltanc. tax due ..Ill beaDS. delinquent nlns (9) aonths .ft.... the data of de.th. PART ill :"dBf~:~ r~:- -;.n-rf--~-&:~-"'--1,- -:H"~r.'-T.r ---::r.--Cl.:'-~-~-:-i:'J::{'o.r--~"'-M1iir::r.:tr:~f1"'~};'~1..:----T-1-:'1}"'-C-:;h:..r~""'-~~~ a:-:~-":+;lf-1::S~1.-~.n,1"~-rJ-:~11-1-~:f~";;rt~;;~:~-:..:~+~..,...-~ --.rt.:W::+i'ttY~...I::: --_-t..r~~ -J ~::----~-"'";"-"'~1;~ f~~--~k-..r-"'1-'''F 'f--{:"i::l.r---Tr:~-~-~ ~--~-r::~:-fr ~it~~~~~_1ffi:~~~~~ii~~~"~.:\g;:'ir~_~~~~':;j:,;Y.;t:&;:4;J~1 A. 0 The ROV. Info"'Rtlon III'Id tBx due Is co...r.ct. 1. You ..y chaos. to ..._It p.y..nt to the R.gist.... of Ifllls ..Ith tNo copl.s of this notlc. to obtain · discount a... .vold Int.....st, a... yoU _y check box "A" 8I1d ....turn this notlc. to the R.glst.... of NUls 8nd an offlcl.l .ssasssant will b. Issued by the PA Dspa...tasnt of R.venu.. B. ~ The above asset has b..n a... Nlll b. ...spo...t.d and tax p.ld with the P.msylvanla Inh....ltanc. TIIIC ....turn to be filed by the dec.d.nt's "'.PI"8S11f1tatlV.. C. 0 Ths above Info..._tlon Is Inco......sct and/o... debt. and deductions ....... paid by you. You .ust coapl.t. PART 0 and/o... PART ~ b.lo... [CHECK ] ONE BLOCK ONLY PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you lndlcat. . dlff.rent t.x r.t.~ pl..s. st.t. your ...l.tionshlp to decedent: PART I!l TAX RETURN .. COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Det. Estllbl1shed 1 2. Account B.1W\Ce 2 3. P.rcent Taxabl. 3 X 4. AItount Subject to T.x 4 5. Debts end Deductions 5- 6. AIIount T.x.a>>l. 6 7. Tax R.t. 7 X 8. r.x Due 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Ent.r on Line 5 of T.x COIIP\It.Uon) I . Und.r penal'll.. of perjury, I decl.... thet the f.cts coIIP1.t. to the b.st of .y knowl.dge end be11.f. I hev. reported abov. .r. HOME ( ) WORK ( ) TELEPHONE NUMBER trUII~ corr.ct 8I'ld TAXPAYER SIGNATURE DATE CllIIDIliIEAl1M OF PElllSYl VANIA 1EPAR1llENT OF AEVENIE IUIlEAU OF INDIVIDUAL TAXES IEPT. 2a8681 'HARRISBURG, PA 17128-8681 .. INFORMATION N~CE AND TAXPAYER RESPONSE FILE NO. 21 06-0261 ACN 06125430 DATE 06-02-2006 TVPE OF ACCOUNT EST. OF MILDRED A ANDRUSCAVAGE 0 SAVIN8S S. S. NO. 172-34-4165 IiI CHECKIN8 DATE OF DEATH 03-10-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. RBlIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 IIV-1541 EX IF' U'-lIl CHARLES E DENISON 908 9REENBRIAR DR MECHANICSBURG PA 17055 MERICHDICE FCU hII. provlct.d the 1Iepa..~t with the Info....tlan lI.ted b.law .....Ich h.. bMn uHd In Cl81cul.tll1lll the pobntl.l tax duB. ThBI.. "BOard. lndlc.t. that .t the d8.th of th8 .ban dBO...,t, you ...... . joint _../bBMflcl...y of thl. BOcaunt. If you fBBI this lnfa....tlon is Inca"l"8Ct, pl.... obtain wrlttBn cO"l"8Ctlon f..08 th8 flnBncl.1 In.tltutlon, .ttach a CCJPlI to th1s fo... and ...tum It to the llbav. add...... This account Is taxabl. In .cco..danc. with the Inh...lbnca TalC l.... of the C_nw..lth of Pann.lIlvanl.. gu..tlan. MY ba an_...d by c.1l111lll (711) 787-1327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS Account No. 27949 DIIt. 11-10-1999 est_ushed 151,558.83 16.667 25,260.31 .045 1,136.71 TAXPAYER RESPONSE Account 8alW"C. Percent Tax_I. Miount Subject to Tax Tax Rat. Potential Tax Due To Insu..e prope.. credit to lIOU.. BOcount, two (2) copl.. of this notlca BU.t lICC08PBnY you.. P8Y8ent to th8 R8lI1.te.. of 11111.. Milk. check p.yabl. to: '"R8lIiste.. of 11111., AgBnt". x x MOTE: If tBx p.l/8Bnt. .... IRIde within thr.. (3) 8Onth. of the dBC.d8nt'. d.t. of d..th, YOU _y d8duct a 5% discount of the tax duB. Any Inheritanc. tBx due wUl bB008. delinquent nine (9) IIDnth. .fte.. the date of de.th. PART [!] ;-i:1lf~:.r--r---:r- . .,..~-- ""'-Ior. -~ ~-:. :::-;;-----, ,- -- ::,'l-''"'-;-------:'i..'!}--------:.,--;t.-~'':=t----..:---..:---:-'f---~''-~--t:-;;----- --'::-J-:--Hh- - E:-- ----- --ll----"{"-..-... '---~ll .:-~:_'t.~ -~-" c..;,:;.,-; -":"f"":-:-"--':-~-;" -;"-";-"'-':F-~- -i: --;":--";-"-1-1-:--~"-- -_-:~-;..--....~ 1.-.----i~.;::-----"'1';:_-f--(-~-r~"'i:~-.n ~1~.ll:~fr.rilu:~Ik~~'jj:~~~;:,.J~.J.w.~~~~:It;~;;.~~~~:~J.:.:~*~1:1!lh.~:<;:.'iil!n:~_. A. 0 ThB above Infa...Uan .nd talC due is ea.....ct. 1. You.ey chao.. to ...It P8Y88nt to the Registe.. of lUlls with two cap I.. of thls notice to obtdn . discount a.. 1IV0id Int....st, or YOU .y check box ftAft Bnd ..eturn this notlc. to the Registe.. of Wills end .n official asses_ant will b. Issued by the PA Depa..teant of R.venue. II. IVI ThB 8bave asset h.. been a.. wUl be ..eport.d .nd tex p.ld with the PennsYlvanl. Inh.rlhnc. Tax ...turn ~ta be filed by the dec.dent's ..epresent.tlv.. C. 0 The 8bav. infa....Uon ls Incor..ect 8nd/o.. debts and deduction. _re paid by you. You IIUst COIIPl.t. PART I!l BndIo.. PART @] b.law. PART If you Indl_t. . dlff.rent tax rat., pl.ase st.t. your ~ r.latlonshlp to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT'TRUST ACCOUNTS LINE 1. Dat. EstabliShed 1 2. Account Balanc. 2 :5. r.rcent Tax_1. 3 X 4. ~t Subject to T.x 4 5. Debts end Deductions 5- 6. Aaount Taxable 6 7. Tex Ret. 7 X 8. Tax Due 8 [CHECK ] ONE BLOCK ONLY PART I!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAVEE DESCRIPTION AMOUNT PAID I I TOTAL (Ent.r on Una 5 of Tax CoIIputation) . Under PIINlltles of perjury, I declere that the fech I have reported Mov. are true, correct end 001lP1.t. to the bast of IIY knowledge and ba11.f. HOME ( ) WORK ( ) TELEPHONE NUMBER DATE TAXPAVER SIGNATURE