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Home My WebLink About12-14-06 (2) -.J 15056041147 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes .~ PO BOX.280601 ~ Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN 21 06 RESIDENT DECEDENT File Number 00851 Date of Birth 162098039 09152006 12311916 Decedent's Last Name BELTZHOOVER Suffix Decedent's First Name DOROTHY MI I (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW [!] 1. Original Return o 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) O 7 Decedent Maintained a Living Trust . (Attach Copy of Trust) o ~ o 9. Litigation Proceeds Received 0 1 O. ~=:~ ~3~~l%f~dt 1(~1~~5)f death 11. ~~:~n ~~nder SeC!13(A) f~. CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR . . OUL E DIR!;CT 0: Name Daytime Teleptl . mbe.L- ;~:; \ r'11 IVO V. OTTO I I I 71724 33~U ,f:'".'; C:J ~U)/, r'") ..--:; ~l --n C'''5 :-1'1 ,--) o 4. Limited Estate o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required [KJ 6. Decedent Died Testate (Attach Copy of Will) o 8. Total Number of Safe Deposit Boxes Firm Name (If Applicable) MARTSON DEARDORFF WILLIAMS &: REGISTER 0,; GILLS USE ONLY -,- ~ -:-: u -..=r..... First line of address 10 EAST HIGH STREET W N Second line of address City or Post Office CARLISLE State PA ZIP Code 17013 DATE FILED Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT\!RE OF PERSON ~PONSIBLE FO . ILlNG :;{RN OAT /7A~.-1..J :,~.-"I"/-_. \/./r.1..) Mary Lea Shenk IL '()G ADDRESS / Ivo V Otto III OAT} ).:2,1/ ,J I'; &.'~? 10 East High Street, Carlisle, PA 17013 L Side 1 15056041147 15[]56[]41147 -.J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Beltzhoover, Dorothy I 21-06-00851 Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Signature #2 D'. ! \ ~ ----. .;~ \;, ,~ Nancy V. Tritt 33 Silver Maple Drive Name Address1 Address2 City, State, Zip Boiling Springs, PA 17007 /d.-/;3 /()~ Date -.J 1S0S6[]42148 REV-1500 EX Decedent's Name: DOROTHY I BELTZHOOVER Decedent's Social Security Number 162098039 RECAPITULATION 1. Real Estate (Schedule A).......................................................................................... 1. 2. Stocks and Bonds (Schedule B)............................................................................... 2. 102,907.30 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D).......................................................... 4. 341,213.46 218,657.89 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested............. 7. 8. Total Gross Assets (total Lines 1-7)....................................................................... 8. 662,778.65 48,830.75 9,103.23 57,933.98 604,844.67 5,000.00 599,844.67 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)...................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11)............................................................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J)................................................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. of transfers under Sec. 9116 (a)(1.2) X ~ 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 o . 0 0 15. o . 0 0 16. 0.00 0.00 17. 18. 89,976.70 19. 89,976.70 0.00 0.00 599,844.67 19. Tax Due..................................................................................................................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. D Side 2 L 15[]56[]42148 15[]56[]42148 -.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Dorothy I Beltzhoover STREET ADDRESS 210 Big Spring Road File Number 21-06-00851 CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 89,976.70 4,498.84 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 4,498.84 TotallnteresUPenalty (D + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) (4) (5) (SA) (5B) 85,477.86 85,477.86 Make Check Payable to: REGISTER OF WILLS, AGENT 'l, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No ~ ~ o ~ o ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?...................................................................................................................... 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. ft .. 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 three (3) percent [72 P.S. 99116 (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 zero (0) percent [72 P.S. 99116 (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 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 zero (0) percent [72 P.S. 99116 (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 four and one-half (4.5) percent, except as noted in 72 P.S. 99116 1.2) [72 P.S. 99116 (a) (1)]. 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, benefits or care?.............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................. .................................................................................................... ,,~g~{rWA:~~'I:~~:~~ ~~~~~te.~,..~I"tf;'~~:t~~J~1fl'::37i~~l~ l;>~v' ~~~.~.~,~~'~(ftff1tji~~1?;il~~:}3~~~~~~l~1~..~Nl~,f;l>K~~~1~;~{:t *:,.~,!~t'.F~~~, ~:J, ~': :':,~~ ~;." ~~ if! , ,~;~~ The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116 (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-1503 EX+ (6-98) . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 55261F104 770 shares of M & T Bank Corp - Com 120.53 92.808.10 Accrued dividend on Item 1 through date of death 462.00 2 U.S. Savings Bonds 9.637.20 TOTAL (Also enter on Line 2, Recapitulation) 102.907.30 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule 8 (Rev. 6-98) Rev-1507 EX+ (6-98) . SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEOENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 Rudolph Mortgage/Note Receivable - dated June 15, 2005, face $336,000, see attached Note VALUE AT DATE OF DEATH 323.917.99 2 Agway Liquidating Trust - Unpaid balance of allowed claim in bankruptcy 17.295.47 TOTAL (Also enter on Line 4, Recapitulation) 341.213.46 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule D (Rev. 6-98) Rev-1508 EX+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the rtght of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 AARP health insurance refund VALUE AT DATE OF DEATH 143.75 2 Advanta Bank Corp C.D. - $10000; 5/3%; matures 06/28/07 9.984.00 Accrued income on Item 2 through date of death 114.71 3 Capital Crossing Bank C.D. - $10,000 face; 4.85%; matures 03/29/07 9.960.50 Accrued interest on Item 3 through date of death 225.93 4 Countrywide Bank C.D. - $15000; 4%; matures 9/29/06 14.987.10 Accrued interest on Item 4 through date of death 27.95 5 Discover Bank Greenwood Del C.D. - $10000; 4.45%; matures 11/16/06 9.977 .60 Accrued interest on Item 5 through date of death 369.36 6 Great Southern Bank C.D. - $15000; 4.1%; matures 10/19/06 14.973.30 Accrued interest on Item 6 through date of death 242.64 7 Imperial Capital Bank C.D. - $10000; 4.55%; matures 01/18/07 9.963.20 Accrued interest on Item 7 through date of death 299.28 8 International City Bank N.A. C.D. - $10000; 5.1%; matures 5/18/07 9.971.20 Accrued interest on Item 8 through date of death 166.24 9 Lehman Brothers Bank FSB DE, C.D. - $10000; 4.35%; matures 05/02107 9.929.90 Total of Continuation Schedule(s) See attached pagels) 218.657.89 TOTAL (Also enter on Line 5, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1508 EX+ (5-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued COMMONWEAl. TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH Accrued interest on Item 9 through date of death 162.11 10 Lehman Brothers Bank FSB DE, C.D. - $10000; 4.5%; matures 11/02/07 9.894.70 Accrued interest on Item 10 through date of death 167.69 11 Lehman Brothers Commercial Bank C.D. - $10000; 4.6%; matures 7/19/07 9.928.50 Accrued interest on Item 11 through date of death 73.08 12 Lehman Brothers Commercial Bank C.D. - $10000; 4.6%; matures 6/14/07 9.936.80 Accrued interest on Item 12 through date of death 117.18 13 M&T Tr NY C.D. - $10000; 4.65%; matures 2/15/07 9.959.70 Accrued interest on Item 13 through date of death 270.09 14 Mercantile Bk Mich Grand C.D. - $10000; 4.65%; matures 12/12/07 9.902.70 Accrued interest on Item 14 through date of death 121.03 15 Metro Bank of Dade Cty FL C.D. - $10000; 4.5%; matures 12/28/06 9.967.00 Accrued interest on Item 15 through date of death 321.81 16 Presbyterian Homes Inc. - Refund 3.865.77 17 SmithBarney Acct #73H-01573-18 5 - Bank deposit program 21.411.63 Accrued interest on Item 17 through date of death 36.35 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev.1508 EX+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued COMMONWEALTH OF'PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 ITEM NUMBER 18 DESCRIPTION Southwest Bank of St Louis, MO C.D. - $10000; 5%; matures 4/24/07 VALUE AT DATE OF DEATH 9.965.90 Accrued interest on Item 18 through date of death 197.28 19 Trustmark National Bank-MS C.D. - $10000; 5.45%; matures 7/19/07 9.996.60 Accrued interest on Item 19 through date of death 86.59 20 Wachovia Bank C.D. - Principal 10.000.00 21 Wachovia Bank, checking #1000324143545 925.02 Accrued interest on Item 21 through date of death 0.13 22 Washington Mutual Bank, NV, C.D. - $10000; 5.25%; matures 8/23/07 9.980.50 Accrued interest on Item 22 through date of death 33.07 TOTAL (Also enter on Line 5, Recapitulation) 218.657.89 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV.1151 EX+ (12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I Debts of decedent must be reported on Schedule I. FILE NUMBER 21-06-00851 ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT See continuation schedule(s) attached 1,668.75 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Mary Lea Shenk Nancy V. Tritt Social Security Number(s) I EIN Number of Personal Representative(s): 206-32-4446 186-34-2176 Street Address City State Year(s) Commission paid 2006-2007 See continuation schedule(s) attached Zip 22,900.00 2. Attorney's Fees Martson Deardorff Williams & Otto 23,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 366.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 896.00 TOTAL (Also enter on line 9, Recapitulation) 48,830.75 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H.A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 ITEM NUMBER DESCRIPTION AMOUNT 1 Hollinger Funeral Home - Gravemarker 819.00 2 Wenger Meats - Funeral reception food 849.75 Subtotal 1.668.75 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H-B1 PERSONAL REPRESENTATIVE'S COMMISSIONS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 ITEM NUMBER DESCRIPTION AMOUNT 1 Mary Lea Shenk - Fiduciary fee 11.450.00 2 Nancy R. Tritt - Fiduciary fee 11.450.00 Subtotal 22.900.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B1 (Rev. 6-98) Rev-1502 EX+ (6-98) '. SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 ITEM NUMBER DESCRIPTION AMOUNT 1 PA Vital Records - Certified copies, death certificates 129.00 2 Register of Wills - Short Certificates 52.00 3 Register of Wills - Filing fee 15.00 4 Register of Wills - Additional probate fee 200.00 5 Reserved for misc. filing fees and administration expenses 500.00 Subtotal 896.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COf0.9.40NWEAl TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 Includ. unrelmburs.d m.dlcl' exp.n.... ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Continuing Care RX - prescription account 316.11 2 PA Dept. of Revenue - 2006 estimated payment, check cleared after death 280.00 3 Presbyterian Homes Inc. - Nursing home, check cleared after death 8.072.50 4 U.S. Treasury - 2006 estimated payment, check cleared after death 400.00 5 Wachovia Bank, checking #1000324143545 - check cleared after death 34.62 TOTAL (Also enter on Line 10, Recapitulation) 9,103.23 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) ESTATE OF NUMBER I. 1 2 3 4 5 * SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Beltzhoover, Dorothy I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal aistributions, and transfers under Sec. 9116(a)(1.2)] Brenda Wise Appicciafuoco 612 Nantucket Circle King Of Prussia, PA 19406 FILE NUMBER 21-06-00851 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) RELATIONSHIP TO DECEDENT Do Not Llet Trueteelel Grand Niece 10,000.00 Melissa A. Bennett 21 Ladnor Lane Carlisle, PA 17015 Foster Granddaughter 134,940.68 Samantha L Bennett 21 Ladnor Lane Carlisle, PA 17015 Foster Greatgranddaug hter 5,000.00 Diane Wise Cox 108 West Beidler Road King Of Prussia, PA 19406 Linda Jacoby 52 Strawberry Drive Carlisle, PA 17013 Grand Niece 10,000.00 Niece 10,000.00 See continuation schedule attached Continuation 432,322.03 Total 602,262.71 Enter dollar amounts for distributions shown above on lines 5 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See continuation schedule(s) attached 5,000.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 5,000.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Dorothy I Beltzhoover 162-09-8039 09/15/2006 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Lee and Lucy McNair Friend 2,500.00 1005 Petersburg Road Boiling Springs, PA 17007 7 Michael L. Shenk, custodian for Foster Greatgrandson 5,000.00 Kiefer Shenk 313 Prospector Trail Harker Heights, TX 76548 8 Brandi Jo Peffer Foster 5,000.00 570 Zion Road Greatgranddaughter Carlisle, PA 17015 9 Carl and Mary Lea Shenk Foster daughter and 269,881.35 580 Zion Road son-in-law Carlisle, PA 17015 10 Michaell.L. Shenk Foster Greatgrandson 5,000.00 313 Prospector Trail Harker Heights, TX 76548 11 LTC Michael L. Shenk Foster Grandson 134,940.68 313 Prospector Trail Harker Heights, TX 76548 12 Nancy V. Tritt Niece 10,000.00 33 Silver Maple Drive Boiling Springs, PA 17007 Total 432,322.03 1 ReY.1502 EX+ (6.98) . SCHEDULE J.IIB CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS continued COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Beltzhoover, Dorothy I FILE NUMBER 21-06-00851 ITEM NUMBER DESCRIPTION AMOUNT 1 First Presbyterian Church 2A North Hanover Street Carlisle, PA 17013 2.500.00 2 First United Presbyterian Church 111 Big Spring Avenue Newville, PA 17241 2.500.00 Subtotal 5.000.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J-IIB (Rev. 6-98) ~~----. NOTE Date: June 15, 2005 Carlisle, Pennsylvania 533 & 516 Lerew Road, Carlisle, Cumberland County, Pennsylvania 1. BORROWER'S PROMISE TO PAY In return for a loan that I have received, I promise to pay U.S. $336,000.00 (this amount is called "principal"), plus interest, to the order of the Lender. The Lender is DOROTHY I. BEL TZHOOVER. I understand that the Lender may transfer this Note. The Lender or anyone who takes this Note by transfer and who is entitled to receive payments under this Note is called "Note Holder. " 2. INTEREST Interest will be charged on unpaid principal until the full amount of principal has been paid. I will pay interest at a yearly rate of 6% per annum fixed for the first year, thereafter the rate will float at prime plus .25% to be adjusted annually. The interest rate required by this Section 2 is the rate I will pay both before and after any default described in Section 6(B) of this Note. 3. PAYMENTS - Time and Place of Payments (A) Time and Place of Payments I will pay principal and interest by making payments every month. I will make my monthly payments on the 15th day of each month beginning on July, 2005. I will make these payments every month until I have paid all of the principal and interest and any other charges described below that I may owe under this Note. My monthly payments will be applied to interest before principal. If, on June 15, 2025, I still owe amounts under this Note, I will pay those amounts in full on that date, which is called the "maturity date". I will make my payments at 87 Zion Road, Carlisle, Pennsylvania 17013 or at a different place if required by the Note Holder. (B) Amount of Monthly Payments My initial monthly payment will be in the amount ofU. S. $2,407.21. The monthly payment will be subject to change after the initial first year term. As additional changes in the interest rate are made the monthly payment will be similarly adjusted. ..J{~ H . 'b) ~ -k~/\ I C,)~) 4. BORROWER'S RIGHT TO PREPAY I have the right to make payments of principal at any time prior to the maturity date. Such a payment of principal is known as a "prepayment." When I make a prepayment, I will tell the Note Holder in writing that I am doing so. I may make a full prepayment or partial prepayments without paying any prepayment charge. The Note Holder will use all of may prepayments to reduce the amount of principal that I owe under this Note. If! make a partial prepayment, there will be no changes in the due date unless the Note Holder agrees in writing to those changes. 5. LOAN CHARGES If a law, which applies to this loan and which sets maximum loan charges, is finally interpreted so that the interest or other loan charges collected or to be collected in connection with this loan exceed the permitted limits, then: (i) any such loan charge shall be reduced by the amount necessary to reduce the charge to the permitted limit; and (ii) any sums already collected from me which exceeded permitted limits will be refunded to me. The Note Holder may choose to make this refund by reducing the principal I owe under this Note or by making a direct payment to me. If a refund reduces principal, the reduction will be treated as a partial prepayment. 6. BORROWER'S FAILURE TO PAY AS REQUIRED (A) Late Charge for Overdue Payments Ifthe Note Holder has not received the full amount of any payment by the end often (10) calendar days after the date it is due, I will pay a late charge to the Note Holder. The amount of the charge will be 5% of my overdue payment. I will pay this late charge promptly but only one on each late payment. (B) Default If I do not pay the full amount of each payment on the date it is due, I will be in default. (C) Notice of Default If I am in default, the Note Holder may send me a written notice telling me that if I do not pay the overdue amount by a certain date, the Note Holder may require me to pay immediately the full amount of principal which has not been paid and all the interest that I owe on that amount. That date must be at least 30 days after the date on which the notice is delivered or mailed to me. D -I L-Z./4) (D) No Waiver By Note Holder Even if, at a time when I am in default, the Note Holder does not require me to pay immediately in full as described above, the Note Holder will still have the right to do so if! am in default at a later time. (E) Payment of Note Holder's Costs and Expenses Ifthe Note Holder has required me to pay immediately in full as described above, the Note Holder will have the right to be paid back by me for all of its costs and expenses in enforcing this Note to the extent not prohibited by applicable law. Those expenses include, for example, reasonable attorney's fees. 7. GIVING OF NOTICES Unless applicable law requires a different method, any notice that must be given to me under this Note will be given by delivering it or by mailing it by first class mail to me at the Property Address above or at a different address if! give the Note Holder a notice of my different address. Any notice that must be given to the Note Holder under this Note will be given by mailing it by first class mail to the Note Holder at the address stated in Section 3(A) above or at a different address if I am given a notice of that different address. 8. OBLIGATIONS OF PERSONS UNDER THIS NOTE If more than one person signs this Note, each person is fully and personally obligated to keep all of the promises made in this Note, including the promise to pay the full amount owed. Any person who is a guarantor, surety or endorser of this Note is also obligated to do these things. Any person who takes over these obligations, including the obligations of a guarantor, surety or endorser of this Note, is also obligated to keep all ofthe promises made in this Note. The Note Holder may enforce its rights under this Note against each person individually or against all of us together. This means that anyone of us may be required to pay all ofthe amounts owed under this Note. 9. WAIVERS I and any other person who has obligations under this Note waive the rights of presentment and notice of dishonor. "Presentment" means the right to require the Note Holder to demand payment of amounts due. "Notice of dishonor" means the right to require the Note Holder to give notice to other persons that amounts due have not been paid. b-/ (?,Jy) 10. UNIFORM SECURED NOTE This Note is a uniform instrument with limited variations in some jurisdictions. In addition to the protections given to the Note Holder under this Note, a Mortgage, Deed of Trust or Security Deed (the "Security Instrument"), dated the same date as this Note, protects the Note Holder from possible losses which might result if I do not keep the promises which I make in this Note. That Security Instrument describes how and under what conditions I may be required to make immediate payment in full of all amounts I owe under this Note. Some of those conditions are described as follows: Transfer of the Property or a Beneficial Interest in Borrower. If all or any party of the Property or any interest in it is sold or transferred (or if a beneficial interest in Borrower is sold or transferred and Borrower is not a natural person) without Lender's prior written consent, Lender may, at its option, require immediate payment in full of all sums secured by this Security Instrument. However, this option shall not be exercised by Lender if exercise is prohibited by federal law as ofthe date of this Security Instrument. If Lender exercises this option, Lender shall give Borrower notice of acceleration. The notice shall provide a period of not less than 30 days from the date the notice is delivered or mailed within which Borrower must pay all sums secured by this Security Instrument. If Borrower fails to pay these sums prior to the expiration of this period, Lender may invoke any remedies permitted by this Security Instrument without further notice of demand on Borrower. WITNESS THE HANDS AND SEALS OF THE UNDERSIGNED. WITNESS: ~'-r r~&- If ',\ .,") '. . Isaa~~~~~Ru~of~h:~ower (SEAL) ~. / / (,/' ./..' ....11, Ami Rudolph, Borrower (SEAL) -D-I (L/-}'-J) F .F ILES DA T AFILEIE'131e PIJnn.Clg 4245,2. W WIlL2004 LAST 'VILL AND TESTAMENT I, DOROTHY I. BEL TZHOOVER, of South Middleton Township, Cumberland COllnty, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils made by me. 1. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all inheritance taxes (whether sllch taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part ofthe administration of my estate. My personal representatives shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. Ifmyhusband shall survive me by thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, unto my husband, CREEDON M. BEL TZHOOVER, absolutely. 3. In the event my said husband shall predecease or fail to survive me by more than thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, as follows; (a) I give and bequeath the following cash legacies, however, I direct that the total of said cash legacies shall not exceed forty percent (40%) of my net taxable estate. In the event the total shall so exceed said forty percent (40%), the legacies shall be reduced proportionately so that the total shall represent forty percent (40%) of the net taxable estate. Said cash legacies are as follows; FIRST lJNITED PRESBYTERIAN CHURCH, NEWVILLE, PA 52,500.00; FIRST PRESBYTERIAN CHURCH, CARLISLE, P A 52,500.00; BRENDA WISE APPICCIAFL'OCO S 1 0,000.00; DIA:\E WISE COX S 10,000.00; Page I of 4 Pages /.1..J. 8. D.LB. BRA~TII JO LANIOUS PEFFER 55,000.00; SAMA0rTHA LEE BE~ETT 55,000.00; KEEFER ADA.\1 JOHN SHENK 55,000.00; MICHAEL IAN L YNN SHE~'K $5,000.00; NANCY VIRGINIA TRITT $10,000.00; LINDA JACOBY $10,000.00; LEE R. McNAIR and LUCY McNAIR, or the survivor $2,500.00. I direct that the legacies to the children ofMe1issa Ann Shenk Bennett and Michael L. Shenk, shall be held by Melissa and Michael for the use and benefit of their respective children. (b) All the rest, residue and remainder of my estate, both real and personal property, I direct shall be sold by my Executor or Executors and the proceeds arising therefrom shall be divided into four parts: I give two parts thereof unto CARL and MARY LEA SHENK, or the survivor; I give one part thereof unto MELISSA ANN SHENK BENNETT; and I give one part thereof unto MICHAEL L. SHENK. 4. I nominate, constitute and appoint my husband, CREEDON M. BEL TZHOOVER, as Executor of my estate. In the event he shall be unable or unwilling to serve in such capacity, then I appoint CARL L. SHENK and MARY LEA SHENK, as co-Executors with NANCY VIRGINIA TRITT and RICHARD LAWRENCE TRITT. I direct that in serving as Executors Carl and Mary Lea shall act as one-half and Nancy and Richard shall comprise one-half, of the ultimate authority. Any survivor shall continue to act with the one-half oftheir respective authority 5. I authorize and empower my personal representatives, in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of \vhich I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind fanning a part of my estate for such tC1l11S and such prices as they may deem advisable; to bOlTOW money for any purposes connected with the Page 2 of 4 Pages II) 'J~ I~ "DJR . protection and preservation of my estate; to mortgage or pledge any real or personal property fonning a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representatives consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representatives shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this ,;2.jl.J.... day of . )1Lf'J ,2004. (SEAL) SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. /(' .' /"... I , .I Page 3 of 4 Pages COMMONWEALTH OF PE~'NSYL VANIA ) : SS. COl.JNTY OF CUMBERLAND ) We,DorothY1.Beltzhoover"'!((rl..dLt,(~. QC1:.k,-<- ,and \ \,h.-. ;-r': the Testatrix and the witnesses, respectiV'ely, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will and that the Testatrix has signed willingly, and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of hislher knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. (...-- ; . ) : 'f"'" '. l I. '. .,~. .-,'- ,~(.-~-( '", ./~ .~.( . Witness / - ;~~/./ ;~, of / t'". i . " " Witness Subscribed, sworn to and acknowledged before me by Dorothy 1. Beltzhoover, the Testatrix, d b b d d t b c: b t I . I I' r t . " d an su scri e an sworn 0 elore me y '; ;Vtt,. -.1 L (, ~_ ,-T' _J.. f( -f an i C k ,<,~ '. ,r He , the witnesses, this'-'s1ayof -JI'[,r ,2004. /' . ") ( / ,1 , ' ,:""..).) I (..-I It" J./v/ ,tL,,"(J NOtary Public / j ~. ~-'-" ~.. ~ ....... -~ -.... --.. ^~--- , "II,""-\:-,I.,\L ~.: ~~,"L ,', " L" .:c.: '..YT.';1' r' 11 :\. . .~ ,', \-,,~. i.. "', '~ \"/\'1 ' ,. ~:~.>,-. Page 4 of 4 Pages COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES --.~ -- DEPT,280601 HARRISBURG, PA 17128,0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHENK MARY LEA 580 ZION ROAD CARLISLE, PA 17015 ___u___ fold ESTATE INFORMATION: SSN: 162-09-8039 FILE NUMBER: 2106-0851 DECEDENT NAME: BEL TZHOOVER DOROTHY I DA TE OF PAYMENT: 1 2/1 4/2006 POSTMARK DATE: 12/14/2006 COUNTY: CUMBERLAND DATE OF DEATH: 09/15/2006 NO. CD 007562 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $85,477.86 I I I I I I I I TOTAL AMOUNT PAID: $85,477.86 REMARKS: MARY LEA SHENK NANCY V TRITT CHECK#1004 SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS .. r In the Court of Common Pleas of IN RE: Estate of Dorothv I Beltzhoover Cumberland County, Pennsylvania ORPHANS' COURT DIVISION NO. 21-06-00851 Date Letters Granted: 10/02/2006 (") Co S::o "i"l--"(1 (,"i =r: (") ;:q 2? hj '"" Z '::0 .';; uS 7' ;:5 c") 0 -, 0 --n "".--',) ".-- :--) '::0 . =---1 "0 ~-p r...,) c;::3 c:;::) t::::J" <==' ~ ~)\}l G ::;J(J ~:~ ~~ ::0 CJ C)o -f\~' ?:.::> fr1 Certification of Notice Under Rule 5.6(!l Name of Decedent: Dorothv I Beltzhoover Date of Death: 09/15/2006 To the Register: - s:- -0 :x - .. rv co I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on , 2 -/4 - 2 DOc::' Name Appicciafuoco, Brenda Wise Bennett, Melissa A. Bennett, Samantha L Cox, Diane Wise First Presbyterian Church First United Presbyterian Church Jacoby, Linda McNair, Lee and Lucy Michael L. Shenk, custodian for Kiefer Shenk Peffer, Brandi Jo Shenk, Carl and Mary Lea Shenk, Michaell.L. Shenk, Michael L. See continuation schedule attached Address 612 Nantucket Circle, King Of Prussia, PA 19406 21 Ladnor Lane, Carlisle, PA 17015 21 Ladnor Lane, Carlisle, PA 17015 108 West Beidler Road, King Of Prussia, PA 19406 2A North Hanover Street, Carlisle, PA 17013 111 Big Spring Avenue, Newville, PA 17241 52 Strawberry Drive, Carlisle, PA 17013 1005 Petersburg Road, Boiling Springs, PA 17007 313 Prospector Trail, Harker Heights, TX 76548 570 Zion Road, Carlisle, PA 17015 580 Zion Road, Carlisle, PA 17015 313 Prospector Trail, Harker Heights, TX 76548 313 Prospector Trail, Harker Heights, TX 76548 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except. Date: 12 -I ~- 2-oo~ ~~ Signature Name: Address: Telephone: Capacity: }. Ivo V. Otto III 10 East High Street Carlisle. PA 17013 717 -243-3341 Personal Representative X Counsel for Personal Representative 'y ~. .. Estate of Dorothy I Beltzhoover Cumberland County, Pennsylvania ORPHANS' COURT DIVISION NO. 21-06-00851 In the Court of Common Pleas of IN RE: Certification of Notice Under Rule 5.6(!l (Continued) Name of Decedent: Date of Death: Dorothy I Beltzhoover 09/15/2006 I certify that notice of beneficial Interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 12 - ) 4- - '2- DO b ~ Mdress Tritt, Nancy V. 33 Silver Maple Drive Boiling Springs, PA 17007