HomeMy WebLinkAbout01-10-07
N 0 LET m~E R S
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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
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~\
61
Dba 9
Date of Birth
183078874
01012005
08122021
Decedent's Last Name
Suffix
Decedent's First Name
MI
LEBO
ANNA
R
(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
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
o
o
o
o
4a. Future Interest Compromise
(date of death after 12-12-82)
o
o
o
6. Decedent Died Testate
(Attach Copy of Will)
7. ~~c~eC~~:~ft~r~~~) a Living Trust
8. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received
10 Spousal Poverty Credit (date of death
. between 12-31-91 and 1-1-95)
o
11.Election to tax under Sec. 9113(A)
(Attach Sch. 0)
~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
EARL RICHARD ETZWEILER 7172345600 r~
Firm Name (If Applicable)
, .
REGISTeR e~ WILLS uSE ONLY
"J -
First line of address
;,:-J
105 NORTH FRONT STREET
Second line of address
City or Post Office
HARRISBURG
DATE FILED
c:)
State
PA
ZIP Code
17101
Correspondent's e-mail address:
Under penalties of perjury, I declare that.1 have examined this return, including accompanying schedules and ~tatements, and to the best of my knowledge and belief,
it is true, correct and complete. Declarat n of preparer other than the personal representative IS based on all information of which preparer has any knowledge.
SIGNA E OF PERSON RESPONSIBLE 0 LING RETURN :<ITE
Dennis E. Lebo
Earl Richard Etzweiler
{
D7
105 North Front Street, H
Side 1
L
15056041147
15056041147
.-J
....J
15056042148
REV-1500 EX
Decedent's Name:
ANNA R. LEBO
RECAPITULATION
1. Real Estate (Schedule A)........................................................................................... 1.
2. Stocks and Bonds (Schedule B)................................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).............. 3.
4. Mortgages & Notes Receivable (Schedule D)............................................................ 4.
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.
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 ~ 0 . 00 15.
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
657,749.70
0.00
16.
17.
0.00
18.
19. Tax Due...
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
Decedent's Social Security Number
183078874
488.01
667,151.25
5,088.32
672,727.58
14,789.18
188.70
14,977.88
657,749.70
657,749.70
0.00
29,598.74
0.00
0.00
29,598.74
o
15056042148
....J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
DECEDENT'S NAME
Anna R. lebo
STREET ADDRESS
CITY I STATE IZIP
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditsJPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
29,598.74
0.00
1,479.94
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A -+- B -+- C)
(2)
1,479.94
Total Interest/Penalty (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)
28,118.80
28,118.80
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;.......................................................................... 0
b. retain the right to designate who shall use the property transferred or its income;......................................... n
cd' retain a trheversionaryfintel'frestf; or.h................. .t.... ..b.......fi..t...............;.................................................................. D
. receive e promise or lea elt er paymen s, ene I s or care. .................................................................. 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?...................................................................................................................... '" 0
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?....................................................................................................................... [J 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.
Yes
No
,---,
~
ix
~
~
o
~
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. 39116 (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 PS. 39116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P .5. 39116 (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. 39116 1.2) [72 P.S. 39116 (a) (1)].
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. 39116 (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.150B EX+ (6-9B)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX. RETURN
RESIDENT DECEDENT
Lebo, Anna R.
IFILE NUMBER
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Comcast - Refund
VALUE AT DATE
OF DEATH
8.84
2 Country Meadows Associates - Refund
372.18
3 Highmark - Refund of Health Insurance Premiums
106.99
TOTAL (Also enter on Line 5, Recapitulation)
488.01
(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.1509 EX+ (6-98) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETLRN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
IFILE NUMBER
Lebo, Anna R. ..
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Dennis E. Lebo
ADDRESS
RELATIONSHIP TO DECEDENT
Son
2951 Central Avenue
Camp Hill, PA 17011
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
LETTER DATE
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTlFYING NUMBER ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENTS INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 11/15/1991 1/2 interest in 1,000 shares of Compass 25,300.00 50.000% 12,650.00
Capital III 7.35% stock @ $25.30 per share
made joint November 15, 1991
2 A 11/15/1991 1/2 interest in 1,000 shares of Entergy La 25,330.00 50.000% 12,665.00
LLC stock at $25.33 per share made joint
November 15, 1991
3 A 11/15/1991 1/2 interest in 1,000 shares of Stillwell 25,530.00 50.000% 12,765.00
Financial stock @ $25.53 per share made
joint November 15, 1991
4 A 11/15/1991 1/2 interest in 1,000 shares of Verizon 25,200.00 50.000% 12,600.00
New England Inc. stock @ $25.20 per
share made joint November 15, 1991
5 A 11/15/1991 1/2 interest in 1,130 shares of ITT Corp. 60,579.30 50.000% 30,289.65
stock @ $53.61 per share made joint
November 15, 1991
6 A 11/15/1991 1/2 interest in 1,200 shares of GMAC LLC 29,028.00 50.000% 14,514.00
stock at $24.19 per share made joint
November 15, 1991
Total of Continuation Schedule(s) See attached
Daqe(s)
TOTAL (Also enter on Line 6, Recapitulation) 667,151.25
<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 F (Rev. 6-98)
Rev-1509 EX+ (6-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
continued
COMMONWEAL 1H OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Lebo, Anna R.
IFILE NUMBER
ESTATE OF
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
JOINTLY OWNED PROPERTY
DESCRIPTION OF PROPERTY %OF
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DATE OF DEATH
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET DECO'S VALUE OF
TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST DECEDENTS INTEREST
7 A 11/15/1991 1/2 interest in 1,334 shares of Calamos 22.597.96 50.000% 11,298.98
Conv. & High Income FD stock @ $16.94
per share made joint November 15, 1991
8 A 11/15/1991 1/2 interest in 1,494 shares of Exelon 89.087.22 50.000% 44.543.61
Corp. stock @ $59.63 per share made
joint November 15, 1991
9 A 11/15/1991 1/2 interest in 1,500 shares of New York 23.790.00 50.000% 11,895.00
Community Bancorp. stock @$15.86 per
share made joint November 15, 1991
10 A 11/15/1991 1/2 interest in 1,684 shares of PPL Corp. 56.632.92 50.000% 28,316.46
stock @ $33.63 per share made joint
November 15, 1991
11 A 11/15/1991 1/2 interest in 2,084 shares of Nuveen Pa. 28.384.08 50.000% 14.192.04
Invt. Quality Mun. Fund @ $13.62 per
share made joint November 15, 1991
12 A 11/15/1991 1/2 interest in 2,410 shares of Eaton 43.741.50 50.000% 21,870.75
Vance Ltd. Duration stock @ $18.15 per
share made joint November 15, 1991
13 A 11/15/1991 1/2 interest in 2,548.83 shares of Franklin 33.924.92 50.000% 16,962.46
Templeton L TO stock at $13.31 per share
made joint November 15, 1991
14 A 11/15/1991 1/2 interest in 244 shares of Host Hotels & 5.646.16 50.000% 2.823.08
Resorts Inc. stock @ $23.14 per share
made joint November 15, 1991
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
Rev-1509 EX+ (6-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX REl1JRN
RESIOENT DECEDENT
Lebo, Anna R.
tiLE NUMBER
ESTATE OF
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
JOINTLY OWNED PROPERTY
DESCRIPTION OF PROPERTY %OF
LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DATE OF DEATH
ITEM FOR JOINT MADE DECD'S VALUE OF
NUMBER NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET
TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST DECEDENTS INTEREST
15 A 11/15/1991 1/2 interest in 350 shares of Merck & Co. 16,065.00 50.000% 8,032.50
Inc. stock @ $45.90 per share made joint
November 15, 1991
16 A 11/15/1991 1/2 interest in 375 shares of Rayonier Inc. 14.632.50 50.000% 7.316.25
@ $39.02 per share made joint November
15,1991
17 A 11/15/1991 1/2 interest in 400 shares of Consolidated 19.076.00 50.000% 9,538.00
Edison, Inc. stock @$47.69 per share
made joint November 15, 1991
18 A 11/15/1991 1/2 interest in 400 shares of Hershey 21.372.00 50.000% 10,686.00
Company stock @ $53.43 per share made
joint November 15, 1991
19 A 1/15/1991 1/2 interest in 400 shares of Protective 10.480.00 50.000% 5.240.00
Life Corp. stock @ $26.20 per share made
joint November 15,1991
20 A 11/15/1991 1/2 interest in 400 shares of Public 10,416.00 50.000% 5,208.00
Storage Inc. 7.125% Pfd. stock @ $26.04
per share made joint November 15, 1991
21 A 11/15/1991 1/2 interest in 400 shares of Starwood 24,284.00 50.000% 12,142.00
Hotels & Resorts stock @ $60.71 per
share made joint November 15, 1991
22 A 11/15/1991 1/2 interest in 400 shares of Wachovia 22.268.00 50.000% 11.134.00
Corp. 2nd New stock @ $55.67 per share
made joint November 15, 1991
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
Rev-1509 EX+ (6-98)
SCHEDULE F
JOINTLY-OWNED PROPERTY
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEOENT
Lebo, Anna R.
IFILE NUMBER
ESTATE OF
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
JOINTLY OWNED PROPERTY
DESCRIPTION OF PROPERTY %OF
LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DATE OF DEATH
ITEM FOR JOINT MADE DECO'S VALUE OF
NUMBER NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET
TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST DECEDENTS INTEREST
23 A 11/15/1991 1/2 interest in 478 shares of Nuveen Pa. 6,457.78 50.000% 3,228.89
Premo Income Mun. Fund 2 @ $13.51 per
share made joint November 15, 1991
24 A 11/15/1991 1/2 interest in 600 shares of Regency 15.384.00 50.000% 7.692.00
Centers Corp. 7.25% stock @$25.64 per
share made joint November 15, 1991
25 A 11/15/1991 1/2 interest in 600 shares of Verizon 22.122.00 50.000% 11,061.00
Communications stock @ $36.87 per
share made joint November 15, 1991
26 A 11/15/1991 1/2 interest in 650 shares of Investment 8,872.50 50.000% 4,436.25
Grade Muni Incm Fund @$13.65 per
share made joint November 15, 1991
27 A 11/15/1991 1/2 interest in 676 shares of Mid Penn 16.156.40 50.000% 8.078.20
Bancorp Inc. stock @ $23.90 per share
made joint November 15, 1991
28 A 11/15/1991 1/2 interest in 800 shares of Nuveen Pfd. 10.976.00 50.000% 5,488.00
& Conv.lncome Fund 2 @$13.72 per
share made joint November 15, 1991
29 A 11/15/1991 1/2 interest in 878.92 shares of Seligman 12.208.20 50.000% 6,104.10
Income Fund Class A @ $13.89 per share
made joint November 15, 1991
30 A 11/15/1991 1/2 interest in 9,008 shares of Equitable 367.166.08 50.000% 183.583.04
Resources Inc. stock at $40.76 per share
made joint November 15, 1991
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
Rev-1509 EX+ (6-98) W.
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL V-OWNED PROPERTY
continued
Lebo, Anna R.
IFILE NUMBER
ESTATE OF
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
JOINTLY OWNED PROPERTY
DESCRIPTION OF PROPERTY %OF
LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DATE OF DEATH
ITEM FOR JOINT MADE DECD'S VALUE OF
NUMBER NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET
TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST DECEDENTS INTEREST
31 A 11/15/1991 1/2 interest in 900 shares of Hartford Finl 78.201.00 50.000% 39,100.50
Svcs Group Inc. @ $86.89 per share made
joint November 15, 1991
32 A 11/15/1991 1/2 interest in Dreyfus Premier State 9,798.78 50.000% 4.899.39
Municipal Bond made joint November 15,
1991
33 A 11/15/1991 1/2 interest in Ford Motor Credit Co. 47.680.00 50.000% 23,840.00
Coupon made joint November 15, 1991
34 A 11/15/1991 1/2 interest in General Motors Coupon 23.437.50 50.000% 11,718.75
made joint November 15, 1991
35 A 11/15/1991 1/2 interest in Neshaminy Pa. Water Res. 5,201.10 50.000% 2,600.55
Auth Rev. Bond made joint November 15,
1991
36 A 11/15/1991 1/2 interest in NFJ Dividend made joint 19,248.00 50.000% 9,624.00
November 15, 1991
37 A 11/15/1991 1/2 interest in Northampton County Pa. 10,000.20 50.000% 5.000.10
Indl. Dev. Bond made joint November 15,
1991
38 A 11/15/1991 1/2 interest in Norwin Pa. Sch. Distr Ser B 10.272.30 50.000% 5,136.15
Bond made joint November 15, 1991
39 A 11/15/1991 1/2 interest in Philadelphia Pa. Hosps & 10.00 50.000% 5.00
Higher Bond made joint November 15,
1991
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
Rev.1509 EX+ (6-98l
SCHEDULE F
JOINTL V-OWNED PROPERTY
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
Lebo, Anna R.
tILE NUMBER
ESTATE OF
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
JOINTLY OWNED PROPERTY
DESCRIPTION OF PROPERTY
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH %OF DATE OF DEATH
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET DECO'S VALUE OF
TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST DECEDENTS INTEREST
40 A 11/15/1991 1/2 interest in PSECU Bank Deposit 24.969.67 50.000% 12,484.84
Program
41 A 3/19/2001 1/2 interest in PSECU Checking Account 12.198.08 50.000% 6.099.04
#0183078874 made joint on March 19,
2001
42 A 2/21/1997 1/2 interest in PSECU regular shares of 577 .33 50.000% 288.67
stock made joint on February 21, 1997
"-
TOTAL (Also enter on Line 6, Recapitulation) 667,151.25
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
PSE(~
December 11,2006
Account # 0183078874
DENNIS E LEBO
2951 CENTRAL AVE
CAMP HILL, PA 17011
Dear MR LEBO:
The following is the status of ANNA R LEBO's account with PSECU as of the date of death.
Joint Owner's Name
Date of Death
Date of Birth
DENNIS E LEBO, JOINT TENANT WIROS
11.07.2006
08.12.1921
Share
S 01
S 04
S 07
C 51
C 56
C 58
Description
Regular Shares
Checking
Money Market
6 Month Certificate
48 Month Certificate
48 Month Certificate
Open date
02.21.1997
03.19.2001
03.07.2006
03.07.2006
03.07.2002
10.07.2002
Balance Accrued Dividend
$ 577.33 $0.11
12,198.08 0.68
7,238.32 5.61
Closed 09.07.2006
Closed 03.07.2006
Closed 10.07.2006
The dividend earned from January 1, 2006 through the date of death was $752.59. The decedent had no loans with
us. We do not have safe deposit boxes for our members.
If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu
prompt, enter 6 and then extension 2227.
Sincerely,
Pennsylvania State Employees Credit Union
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 . 717.234.8484 . 800.237.7328
. Mailing Address: P.O. Box 67013, Harrisburg,PA 17106-7013 . 717.777.2100 (TOO) . 800.472.1}6?JlpD).
This credit union is federally insured by the National Credit Union Administration. Equal Opportunity Lender www.psecu.com
~
cltlgroupJ
SMITH BARNEY
11 North 3rd Srreer, 2nd Floor
Harrisburg. PA 17101
Tel 717 7801700
Fax 717 233 2090
Toll Free 800 237 1700
November 28, 2006
Dennis E Lebo
2951 Central Avenue
Camp Hill PA 17011-4519
RE: Date of Death Balances
Dear Dennis:
Thank you for taking the time to meet wit Ron the other day. We have moved all of the
assets to your individual account. As residual balances come into that account, I will see
that they are transferred as well.
Per your request, I have enclosed a copy of the Date of Death Balances for Anna's
account.
Please do not hesitate to contact me at 717-780-1726 with any questions or concerns.
Kindest Regards,
J\ ~
\ iLG
enni r: Conway
Registered Client Service Associate to
Ronald R. Wetzel
Senior Vice President, Wealth Management
Financial Advisor
Cirigroup Global Markers Inc.
THE INFORI.IATION SET FORTH WAS OBTAINED FROM SOCRCES WHICH WE BELIEVE RELIABLE BUT WE DO NOT GUARANTEE ITS ACCURACY OR COMPLETENESS.
NEITHER THE INFOR.\lATION NOR ANY OPINION EXPRESSED CONSTITUTES A SOLICITATION BY US OF THE PCRCHASE OR SALE OF ANY SECURITIES.
For - 724-05218-139 - Anna R Lebo And Dennis Lebo
Symbol\CUSII Description
#BDP BANK DEPOSIT PROGRAM
CHY CALAMOS CONY & HIGH INCOME FD
CMHPR COMPASS CAPITAL III 7.35%
ED CONSOLIDATED EDISON INC
PTPAX DREYFUS PREMIER STATE MUNI BD
EW EATON VANCE L TD DURATION
EHL ENTERGY LA LLC
EQT EQUITABLE RESOURCES INC
EXC EXELON CORP
F.lT FORD MOTOR CREDIT CO Coupon 7.25%
Mature 10/25/11
FRANKLIN TEMPLETON L TD
GENERAL MOTORS Coupon 7.2% Mature
01/15/11
GJM GMAC LLC 7.35%
HIG HARTFORD FINL SVCS GROUP INC
HSY HERSHEY COMPANY
HST HOST HOTELS & RESORTS INC
PPM INVESTMENT GRADE MUNIINCM FD
ITT ITT CORP
MRK MERCK & CO INC
MBP MID PENN BANCORP INC
640847CT40C NESHAMINY PA WTR RES AUTH REV
Coupon 5.75% Mature 03/01/11
NYB NEW YORK COMMUNITY BANCORP
NFJ NFJ DIVIDEND INTEREST &
663549LD30B NORTHAMPTON CNTY PA INDL DEV
Coupon 5.625% Mature 12/15/23
669543FV70B NORWIN PA SCH DIST SER B Coupon 5%
Mature 04/01/31
NQP NUVEEN PA INVT QUALITY MUN FD
NPY NUVEEN PA PREM INCOME MUN FD 2
JQC NUVEEN PFD & CONY INCOME FD 2
717825CQ40E PHILADELPHIA PA HOSPS&HIGHER
Coupon 6.25% Mature 07/01/18
PPL CORP
PROTECTIVE LIFE CORP 7.25%
PUBLIC STORAGE INC 7.125% PFD
RAYONIER INC
REGENCY CENTERS CORP 7.25%
SELIGMAN INCOME FUND CLASS A
STARWOOD HOTELS & RESORTS
STILLWELL FINL
VERIZON COMMUNICATIONS
VERIZON NEW ENGLAND INC 7.00%
WACHOVIA CORP 2ND NEW
FTF
GM.GM
PPL
PLPRD
PSAPRB
RYN
REGPRD
SINFX
HOT
SVQ
VZ
KVZ
WB
Quantity 11/07/06 close
24,969.67 $1.00
1,334.00 $16.94
1,000.00 $25.30
400.00 $47.69
604.49 $16.21
2,410.00 $18.15
1,000.00 $25.33
9,008.00 $40.76
1,494.00 $59.63
50,000.00
$95.36
2,548.83 $13.31
25,000.00
$93.75
1,200.00 $24.19
900.00 $86.89
400.00 $53.43
244.00 $23.14
650.00 $13.65
1,130.00 $53.61
350.00 $45.90
676.00 $23.90
5,000.00
bid 104.022 ask 104.069
1,500.00 $15.86
800.00 $24.06
10,000.00
bid 100.002 ask 100.008
10,000.00
bid 102.723 ask 102.787
2,084.00 $13.62
478.00 $13.51
800.00 $13.72
10,000.00
bid .10 ask .10
1,684.00 $33.63
400.00 $26.20
400.00 $26.04
375.00 $39.02
600.00 $25.64
878.92 $13.89
400.00 $60.71
1,000.00 $25.53
600.00 $36.87
1,000.00 $25.20
400.00 $55.67
THE INFORMA nON HEREIN HAS BEEN
OBT AI NED FROM SOURCES WE PEUEVE
TO BE RELIABLE, BUT DO Ne>T GUAKANHE
ITS ACCURACY OR COMPLETENESS
Rev-1510 EX+ (6-98)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
lebo, Anna R.
IFllE NUMBER
ESTATE OF
This schedule must be completed and liled lIthe answer to any 01 questions 1 through 4 on the reverse side 01 the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Diane lebo - gift of cash within one year of death 3.850.00 3.000.00 850.00
2 PSECU Money Market Account #0183078874 7.238.32 3.000.00 4,238.32
made joint with son, Dennis E. lebo on March 7,
2006
TOTAL (Also enter on Line 7, Recapitulation) 5.088.32
(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 G (Rev. 6-98)
REV-1151 EX+ (12-99)
.~
~
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Lebo, Anna R.
Debts of decedent must be reported on Schedule I.
I FILE NUMBER
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 8,061.90
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Earl Richard Etzweiler 6,727.28
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation) 14,789.18
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
Lebo, Anna R.
I FILE NUMBER
ESTATE OF
ITEM
NUMBER DESCRIPTION
1 Hoover Funeral Home, Inc. - funeral bill
AMOUNT
8,061.90
Subtotal
8,061.90
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Hoover Funeral Homes, Inc.
118 South Market Street 103 West Main Street
Millersburg, P A 17061 fax 692-4599 or 362-9845 Elizabethville, P A 17023
(717) 692-3298 Forethought Funeral Planning (717) 362-8522
Bradley S. Boyer, Supervisor Nathan Corl Minnich. FD Robert M. Stianche, Jr. Supervisor
www.hooverfunera1hODles.com
Monday, December 11, 2006
Dennis E. Lebo
2951 Central Ave
CampHiII, PA 17011
Dear Dennis,
Thank you for selecting our funeral home to provide services for your famUy during your bereavement I
hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends.
The following is a summary of the service charges as previously explained and provided in written form
and herein indicated as PAID-IN-FULl.
Anna R. Lebo
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED
lESS: Total Payments
CURRENT BALANCE
$8.061.90
8,061.QO
$0.00
If th~re questions or concerns that remain unanswered, please call me.
Si e1y, H
~ 'IV\~
Robert . che, Jr.,F.D.
Supervisor
Hoover Funeral Homes, Inc.
118 South Market Street 103 West Main Street
MHlersburg. PAftl82-4599 or 362 -.- ~viHe. PA 17023
(717) 692Sl1l111lought Funeral PlaM~7) 362-8522
Bradley S. Boyer, ~.Lbex1 MftIIIIr;tIND Sa&nc:he, Jr. Supervisor
www.hooverfuneralhomes.oom
No. 078874
SERVICES FOR Anna R. Lebo
DATE OF DEATH November 7, 2006
PlACE OF DEATH HCR Manor Care
DATE OF STATEMENT November 7, 2006
DATE OF SERVICE November 10, 2006
CHARGE OF SERVICES SELECTED
1. ProfHsIonaI ServIces
ServIces of Funeral OIrecIDr $
Embalming $
Other Preparation of Body $
$
$
2. F..... & equipment
Use of Facilities & Staff for VIewIng I Visitation $
Use of Facilities & Staff for Funeral ~ $
Use of FaciII1Ies & Staff for Memorial ~ $
Use of Equipment & Staff for GnIveeIde Service $
Use of Equipment & Staff for Church ServIce - S
Use of Equipment and staff for church - S
3. AutorncJtM equipment
Transfer of Remains 10 Funeral Home $
Hearse 10 Cemetery I CrematDry $
Use of IImouslne(s) for services $
Sedan $
Service I UtiHty VehIde S
$
TOTAL SERVICE CHARGES
MERCHANDISE
Casket (or altemative oontainer)Sutter
Oesc. Steel Brown
Outer Burial Container Concrete with plastic
Desc. Concrete
Acknowledgment Cards
Register Book
Prayer Cards
Memorial Folders
CloUting
Family Flowers
Cremation Um
TOTAL MERCHANDISE CHARGES
SPECIAL SERVICES
Forwarding to:
Receiving from:
Immediate Burial.
DIrect Cremation
1400
500
200
$ 2.100.00
400
400
$ 800.00
200
300
100
$
$
$
$
$
$
$
$
$
$
$
$
$ 600.00
$ 3,500.00
2500
1075
25
25
$ 3,625.00
S
$
$
$
$
$
$ 7,125.00
TOTAL OF SPECIAL CHARGE
TOTAL FUNERAL HOME CHARGES
(This lotal does not include cash advances)
DISCLOSURES
If any law. cemetery cremalory or oUter requirements have required an
embalming or the purchase of any items, the law or requirement is
explained below.
STATEMENT OF FUNERAL GOODS AND 101
SERVICES SELECTED
Charges are only for those items you selected or that are required.
If we are requireC:I by law or by a cemetery or aematory to use any
item. we will explain reasons in writing below.
If you selected a funeral that may require an embalm~. such as a
funeral with viewing. you may have to pay for embalrillng You do
not have to pay for embalmioo you did not approve if )'C?U
selected a~ements such as direct cremation or immediate
burial. If we charge for embalming, we will explain why below.
CASH ADVANCES
Cartifled Copies of DeaUt Certificate # 5
Clergy
Music
Cemetery
Newspaper Notices Patroit News obit
Newspaper Notices UD Sent
$
$
$
$
$
$
$
Seasonal Spray . $ 150
W 1.- arrangment (GuI}....N~.u<(. ..... ') $ 45
cutiiii9 Of the slone monument :7 $ 85
Hairdresser $ 25
lax on ftower arrangement $ 11.70
TOTAL CASH ADVANCES $ 936.90
We Charge you for our services In oblalnlng (specify cash 8dv8nce ltilms:)--
30.00
100
50
300
140.20
Free
SUMMARY OF EXPENSES
TOTAL ALL rrEMS $ 8,081.90
Sales Tax (if Appl @ 0 $
GRAND TOTAL $ 8,081.90
Less Payment made $
$
BALANCE DUE Jan 9. 2007 $ 8,081.90
BIWNG TO Dennis E. Lebo
2951 Central Ave CampHill. PA 17011
I hereby adcnowledge that I have the right 10 anange the final service for
the person named above. and I authorize this funeral establishment to
perform services, furnish goods, and incur outside charges soecifted In
this Statement I acknowledge that a Casket PrIce Ust and a Outer Burial
Conlalner Price List were made available 10 me and that a copy of the
General Price List was given 10 me prior to my making financial
arrangements.
TERMS OF PAYMENT
Fun payment is due no later than January 9, 2007
If any payment is not paid when due. an unanticipated LATE CHARGE of
1.5% per monlh (ANNUAl.. PERCENTAGE RATE 18%) will be added 10 the
unpaid balance. I agree to pay Ute Balance due listed on this statement.
plus any Late Charge. In the event I default in payment to this funeral
establishment. I agree lD pay reasonable atlDmey fees and all court costs in
addition 10 any Late Charge appDcable. I understand and agree that I am
assuming personalllablHty for aU the charges set forth in 1hIs slatllm8nt, and
that is in addition to the liability imposed by law upon the estate of the
deceased. By my signature below. I hereby agree 10 an of the above and
acknowledge receipt of a signed copy of this Statement AddlUonal tenns of
pa~ent are:
DISCLAIMER OF WARRANTIES
Our funeral home makes no representations or warranties regarding caskets
or outer burial containers. The only warranties. expressed or implied.
granted in connection with goodS sold with the funeral service are the
express written warranties. if any, extended by the manufacturer thereof. No
oUter warranties including the implied warranties of merchantability or fitness
for particular purpose are extended by the seller.
"
Slpd
SSN
SSN
rea to provide aU the services,
on this statement
By
Rev-1512 EX'" (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Lebo, Anna R.
IFILE NUMBER
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 East Pennsboro Ambulance Service, Inc. - stretcher transport
VALUE AT DATE
OF DEATH
120.00
2 Humana - monthly insurance premium
58.46
3 Verizon - final telephone bill
10.24
TOTAL (Also enter on Line 10, Recapitulation)
188.70
(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)
*'
SCHEDULE ,J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Lebo, Anna R.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
I.
1
Dennis E. Lebo
2951 Central Avenue
Camp Hill, PA 17011
Son
2
Diane Lebo
2951 Central Avenue
Camp Hill, PA 17011
Daughter-in-Law
FILE NUMBER
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
100% of
Residue
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Form PA-1500 Schedule J (Rev. 6-98)
0.00