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HomeMy WebLinkAbout01-30-07 REV.1500 EX + (6.00) *' l!! :il:<Crn Uii!:il: wIL8 Xi... UILIlI ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 OFFICIAL USE ONLY REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) Acri, Adolph S. Jr. DATE OF DEATH (MM-DD-YEAR) to- Z W Q W o W Q 05-28-2006 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL) 02-09-1941 ~ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of W~I) D 9. Litigation Proceeds Received DATE OF BIRTH (MM-DD-YEAR) D D D D FILE NUMBER II COUNTY CODE YEAR SOCIAL SECURITY NUMBER 2006 181-32-3049 0513 NUMBER THIS RETURN MUST BE FILED IN D PLICATE WITH THE REGISTER OF ILLS SOCIAL SECURITY NUMBER 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10 Spousal Poverty Credit (date of death between . 12-31-91 and 1-1-95) D 3. Remainder Return (date of death . r to 12-13-82) D 5. Federal Estate Tax Return R quired o 8. Total Number of Safe Deposi Boxes D 11. Election to tax under Sec. 91 3(A) (Attach Sch 0) !i NAME ~ William R. Bunt 2 FIRM NAME (If applicable) fa Law Office of William R. Bunt ~ 8 TELEPHONE NUMBER 717-582-8195 1. ReID- Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) D Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) z o ~ ;:) t: 11. 0( o w 0:: 12. Net Value of Estate (Line 8 minus Line 11) COMPLETE MAILING ADDRESS 109 South Carlisle Street POB 336 New Bloomfield, PA 17068 (1 ) 152,000.00 (2) None (3) None (4) None (5) 159,978.74 (6) None (7) 119,301.82 (8) (9) 59,990.41 (10) 22,047.54 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (11 ) (12) (13) (14) 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) z or transfers under Sec. 9116(a)(1.2) 0 .045 (16) S 16. Amount of Line 14 taxable at lineal rate 349,242.6.1 x ;:) 11. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) ~ 0 0 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18) ~ x 19. Tax Due (19) 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT -0 ::x w C) CD '../-' .~-. ) 31,280.56 82,037.95 49,242.61 None 49,242.61 0.00 15,715.92 0.00 0.00 15,715.92 Copyright 2002 form software only The Lackner Group, Inc. Form REV-1 00 EX (Rev. 6-00; Decedent's Complete Address: STREET ADDRESS 20 Hellam Drive CITY Mechanicsburg STATE P A Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 12,000.00 631.58 Total Credits (A + 8 + C) (2) 3. InterestlPenalty if applicable D. -Interest E. Penalty Total Interest/Penalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BlO 1. Did decedent make a transfer and: Yes a. retain the use or income of the property traJ1sferred;.................................................................................. ~ 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? .......................................................... .....................,....................................... 0 o 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ ................ ............... ................ ...... ................................. [!J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE Under penalties of peljury, I declare that I have examined this return, including accompanying schedules and statements, and to tha best of my knowledge and belief, it is true, te. Declaration of other than the rsonal ie ntalive is based on all infonnation of which re arer has an knowled e. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Anita M. Acri ~ 510 Carol Street New Cumberland, PA 17070 ADDRESS ADDRESS 109 South Carlisle Street P.O. Box 336 New Bloomfield, PA 17068 0/ T 15,715.92 12,631.58 3,084.34 3,084.34 KS No ~ ~ [!J [!J o DATE DATE 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 t e use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving souse is 0% [72 P .5. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax 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 se of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P .5. ~9116 (a) (1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted i 72 P.S. ~9116 1.2) [72 P.S. ~9116 (a) (1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A si ling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adopt n. Rev-1502 EX+ (6-98) * SCHEDULE A REAL ESTATE COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF FILE NUMBER 21-2006-0513 Acri, Adolph S. Jr. All real property owned aolely or .. a tenant In common muat be reported at fair market value. Fair market value is defined as the price at which property would e exchanged between a willing buyer and a willing seller, neither being compelled to buy or seU, both having reasonable knowledge of the relevant facts. Real property which la jointly-owned with right of aurvlvorahlp muat be dlacloaed on achedule F. ITEM NUMBER DESCRIPTION 1 All that certain piece, parcel or tract of land situate In Upper Allen Township, Cumberland County, Pennsylvania more particularly - described in Cumberland County Deed Book J34 at Page 279. See attached settlement statement. TOTAL (Also enter on Line 1, Recapitulation) (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. W LUE AT DATE OF DEATH 152.000.00 152.000.00 Form PA.1500 Schec ule A (Rev. 6-96) 8B/21/2ee6 14:36 ,...,... ..... ....... 7177743869 STCH: LAFAVER Sl€J<LE PN3E. 81 ...... HUOoII3llll'tl _ ".1 A. S2ttlefnent Sta'~ment u,s. DeplMlllllofta-..ndU,1w o.vatapment 8. T_ of loM 0"- . fIIO. i!S02-02e5 '--'-. 1lIVI1'JflI\&1 1. OFHA 2. OFnWo 3. IICGlw. UNlI. I 6. FIt NwIW I ~=1IlIIIW I .. MorIpge ....rara tau ~mber 4. nvA 5. nCMv. N. 211 1 !III C. Nota; ~,,=,,;'t'--r.-~.....~..........--uJ:'."~"''':,'''''~~=-''''''' I TlllElqlMISe1lIItnenlSylelrn - ....~"'!"':~~~.:.."-'iU'n'J:...:..'U::....~\.\O: Ip 1t11:140t0tH O. NAME OF 80M0WEJt. ADAM J. GELWICKS ~DRES$: 212 Third Street. ". NIlwCundMr1lnd. PA 11070 f. NAME OF SELLER: 'HE ESTAl! OF ADOlJIH I. ACRI, JR. ADDR~: '10 Carol S1rMt. NtwCumbllland. PI. 11810 F. NM1E OF LENDER: New CMtury Mortgage Corpontlon A/lOm;ss: tlCOO Von Karmln. Suite 1l1Ot.IMM, CA 12612 G PROPER'N ~$S: 1. H"am DIM, "Il'ltcsburg, PA ,.,." UDDM AIle" TCMIIStlID H. SETllaENT AGENT: Cedar Cliff AbItrIGt Aleq,lnc.. TIlIPhont: 717.77407435 FIX: 717.77+311.8 PUCE Of : 414 Bridae ItNet. NNCumbectaml. PA 11070 lsmLE~ ~ ~ 'O~ ;lluN: ltSUMMARYOFSElLEK'STKANSACTION: 100. GROSS AMOUNT DUe' FROM BORROWER 400. OROS$I\MOUNT DUE TO SElLEII lOt CcdItOt HIes IWA 152 000,00 .01, ~... Driot 1ft? Pe 402. p...-ul:tnHleJty 1M 6.199.65 403. -104. 4D4. 105. 'os 152.OGO.00 M--';;;--: for~. MId "'" MIIIl' " lMI!!.nce 108. C\lIIhA\ tam 107 108. SoIloaI... 109. lID. "" 112. 120. G'!2IL.AMOUNT DUE FROlfiiORROWER 200. A~8 PAID IY Oil ON BEHALf OF BOil ROWER 20" 202. P1I . ~:- -~. EtII.... 1IwlI1\ llka/l lutillll to 21M. , AdiIItmen1e for IlwM Dakr IIIi .....11I ~ Oahl1lllli 10 12111106 tl/211111lDOllSOlO7 Hl21/11h12131/1f 81121mtIDotI3OIt1 1fi.17 , 41D.38 153 51&.53 13.05U9 205. 2li8. 201. 2011. 20~ Atfh..~ ,III roi itanIlII uWld b~ 11I1., 210- 211. ClIIIllIv IInI 212. SMMIIU. 213. Sewtt.07101108~1:J& 214. 21S. 216. 211 218. 211. 220. TOTAL PAID IYIFOR iOttliOWU 300. lOAlIIt .. I III!" ILI!_ T PRl'JII ftIl Tn BORRoweR 301. GlOII I 302. less 303. CASH FROM RORRcnlER 58.11 55.429.50 en CASH TO tEllER 13.112.91 15Uaus 13.112J11 14O.m..11 r:s,::-=-':.iZ:~~~~~:'~=:'J=t===~,:~~-=:.".-' ""'........ "'.... __..... ___......... no D NIt J- _..... ..,.,.,....IctIIDIIlU'M r ,. *" __ ......,c-- ~ ..........,.,..,w U1.......... '..... ..............,.... "'-' _.. ~.IIMIlo-....- _.. N'-"'::" MV- .:.... ~_. YIIW:_._"- .'_o_'_IIiLLIIl(&IIlGN&TUIlIi('r- , IfU.IilIjS)NIW."..,.1IG ~ sa&.5IlIIl ~1I\N8Sla: 1MI JIll PAGE e2 ..... M\I~l CaMIl ""........ 430U FIe Nil..... 2I12AGEL.WlCKS p,t,GE 2 Tllt8Exg..... s.IIIIIrnInI $yWII ~08l21nMA III,MIl [U4 PAID FROM PAID fROM 8ORR~RoS SElLER'8 FUND8 AT FUNDS AT SETT\.EMENl 9EmEMENT - ............. U.s. DEPAR1tt1ENT ~ ~ ~INQ AND UIUlAN DEVaOPMEtn" SE11lD1ENT STill J'EMENT L. SETTlEMENT-CHARGI:[ 700. TOTAL ~~ ;', COMMISSION bIteCI on D~ '152.000.00 a 1.000 = 1.120.00 DMsIlln of _nlilllan., t 7OOl. WaWa: 701. I "-515 ao ~ RIIIIIx RelItY AuoclItes 102. . ~ 011 1D RtIIIv 8eJed. Inc. 703. "lIIIt 1OD.ITbIS PAYABL! IN CC NNECTIDN WITH LOAN 801. lMn MIIMMlI ~.. G.., '-SeIed Fundlno B02. ~ nw-.a " 803. Ablll'llillll f'M 10 8e1ac:t FuMina.1nC. 804. Od ~ 10 Select FuMiat. 805. Dllef:)NDFII to New CenlUry IIoItmIn CorDomlon 806. Flood Cert F.. 10 JIM centurY Mortaaal Corool'ltlon 107. Pr\gai.... PM to New CHturw MDliCiia. n loe. T..se.F.. 10 NlWCtnlurv~laeConloraUon &OlI. Fee to New Century Mortaaa. Corvoratlan 810. PnnIIIill!l Fee III SIIIct Funllna.1nc. 111. VSf' fnlm uIdr 1ft RkI Uoo "SlIKt F~dina.1nc. HO. nus REQUIRED 8Y I.ENDER TO IE PAID IN ADVANCE 901. In"resl FlOIIl om 2001 III ..112001 as 902. MoMllIIe 1m for ID M3. H Premill'n foI 10 1J04. 906 1000. RESERVES DEPOSIT ~ WITH LENDER FOR 1001. limn! InslI8nce 2 mo. .. S 47.34*110 1002. MoItaaattnuwe 1'IlO. as ItnO 1003. Tn . me .. I 13.32 hna 1004. . mo. ft I 21AG /InO 1005. SchooI_ 2 mo. e s 136.82 MlO 100g .. 7nlnI 10 NfWCtmurv MOdala. ~l'DOl'Ition noo. T1TLE CHARGES 1101. SeltemenlCI'~l!e 1102 AbIntt or", MlrCIl 1 '03. nlem,,*,,1IaIl 1104. Tille InMlllCle bfldtr I'OS. Ion 1106, NatalYF.,1 1107. Altt1rrrWs fell IiftloIlIdes 811M IIem& No 1'03. III Ctdtt ClIff Abttrad AQlIfttv.lflc. ~.ibCM hmI~ m. 8.slcl 1109. 100.000.00 . "'0. 112.000.0D . ""1.75 1111. ~ 100 End 300 III CedarC"" AbltrHtAaInCY.lnC. 1112 !:ncI900 10 CtdlrCIIffAbstnctAalflcy,lnc. 1113. tel Ctdl' Cliff AbItnc:t M.nev.lnc. 1200. GOVERNMENT REt'.fIROING AND TRANSFER CHARGE' 1201. RMOftInnF_DMIil~:s.so 'MarID..174,SO : ReleasU 1202. DtedSU2UO :MoIta_1 1:!OJ. StlfaTa.lDma! OeIdS1.S20.00 :AibtlaS 12114. , Z06. 1300. ADDIT1OIW. SETTU=MENT CHARGES 1301. 8uNw 1302. Pest MMMIM ,~. T~ F- 10 RtlMu: RlaItv AuocIItII 13Of. ........ _..k. TAW to MIrIItt A. YoIlIlI,lr. 1305. ........ .....u. T_ 10 MartIn A. Yohn, Sr. 1301i. Fed-elrtwh 10 Stane La...., I Sheklltslcl 1307. rn: ~ 10 1Im!!.I.Ifm[' 8htldltlld 13oa. s-.CMlIlIMlI.llIIMbe 10 lIDDerAlIHTownshilt /1../ ' 1400. TOT EJ. CHARGES fenttr on"'" 101 SIclIon J and 5020 Section l<l U81.85 bt ~:' IU)CIJI1lfICA_OFIUYMMDKI.U!It ~.... . t. ~:M==~:~~lZo.~::=::._"""-""''''''._'''''.'''-..--mr- . ~ <r2'/~ . 7:.1 , I //'J.-F;. ~~ I/;;.r!rab .. . 8S/21/2ee6 14:36 7177743869 STCH: LAFAVER Sl-€I<LE $~.OO POC bY Lander 2U4oo 1tJ., 11 Davs III CIIh 9.12O.DO 1500.00 LR LR lR LR LR 300.00 U5 300.00 11.20 alOO 71.1I0 300.00 41.uD LR :113.04 LR 9.... LR LR LR LR JU2 .40.40 273.24 .147.13 a.OII 25.00 1118.75 100.00 MJlD SS.OO 1t1.lll) 1.52..00 1..520.0 ca.aa SUO 125.0 s3f.1J 113'~~ 15.OC 105.ilI 11.856.2! '!'.!!!!!!;<<J~." \I T=-OIGlOW""V !f'.I:i.!N.lU'AT5IoI5N'I'I TOlM& -.- T t.wvI"~~;olii"*"""UfON_CTlOM 5t UIII1AHO =10. ~AU_'ITl\C'" ~-~~-_.. "_1_ ilI_......_t leT'/Ualo1i/1l'MINT. _ OA""~ Rev.1508 EX+ (6-88) * SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH Of PENNSYlVANIA IIlHERlTANCE TAX RETURN RESDENT DECEDENT ESTATE OF Acri, Adolph S. Jr. FILE NUMBER 21-2006-0513 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the right of .urvlvorshlp mu.t be dl.clo.ed on .chedule F. ITEM VJLUEATDATE NUMBER DESCRIPTION OF DEATH 1 Cedar Cliff Abstract Agency, Inc.-refund of real estate taxes 1,586.53 2 Commerce Bank-account no. 032035172 874.74 3 Commerce Bank-account no. 510014608 56,854.84 4 Donegal Insurance-refund 266.00 5 Holy Spirit Hospital-refund 43.00 6 Prudentiallnusrance-refund 18.05 7 Sovereign Bank-account no. 1681730952 82,961.30 8 United Water of Pa.-refund 11.08 9 1994 Pontiac Firebird-sold by private sale 3,400.00 10 1998 Dodge Dakota-sold by private sale 4.900.00 11 Personal property-see attached appraisal 4,665.00 12 Decedent was the sole proprietor of an office supply business at the time of his 4.398.20 death known as Presenters Supply. Presenters Supply did not - own any assets other than a checking account listed on Schedule E and a few accounts receivable listed herein. Due to Decedent's ill health, business was not actively being pursued in 2006. Decedent had the following accounts receivable as of his date of death: HACC $1,791.00 E. L. Hamm $ 554.68 PA Turnpike Commission $1,557.99 Coatsville School District $ 494.53 Total of Continuation Schedule(s) SeE attached page TOTAL (Also enter on Line 5, Recapitulation) 159.978.74 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Sche( ule E (Rev. 6-98) ./ AUG - 1 2006 Comma ce fiB Ie July 29, 2006 William R Bunt, Esquire 109 S Carlisle St POBox 336 New Bloomfield, PA 17068 RE: Estate of: Adolph Acri Social Security #: 181-32-3049 Date of Death: May 28, 2006 Dear Sirs: In reference to the letter regarding the above mentioned Estate, we would like to inform you of the information that we have researched and found. Type: Checking Account #; 032035172 Date Opened: 2/17/93 Primary Owner: Adolph Acri Date of Death Balance: $874.74 Accrued Interest: $.09 Principal Balance: $874.65 Type: Checking Account #: 510014608 Date Opened: 11/6/91 Primary Owner: Presenters Supply Company Authorized Signer: Adolph Acri Date of Death Balance: $56,854.84 Accrued Interest: $7.29 Principal Balance: $56,947.55 . Comme ce "Bale If there are any questions or additional information that is needed, please feel free to contact me at (717) 412- 6130. Sincerely, ~Cf lr>?~ Wanda J Morris Senior elF Specialist Account N; In the name of: Date of Dea Int.(YTD) f Accrued int Other Info: -- .-.---. '- Sovereign Bank Adolph S Acri, Jr TY#: 181-32.3049 . May 28, 2006 . 1681730952 Type: Checking Open date: 4/14/201 3 Adolph S Acri Jr. th Balance: $82,961.30 rom 1/112006 to 5/17/2006 . $671.75 . erest to date of death: $0.00 0356103455 Type: Mortgage Open date: 1/26/19 6 Adolph S Acri Jr. th Balance: $0.00 . rom to : erest to date of death: 1688201464 Type: CD/IRA Open date: 4/14/20 J3 Adolph S Acri Jr th Balance: $3.841.20 rom 1/1/2006 to 4/30/2006 . $38.40 . erest to date of death: $9.66 Beneficiary: Anita Acri 1688240991 Type: CD/IRA Open date: 12/6/20 D4 Adolph S Acri Jr th Balance: $16,758.54 rom 1/1/2006 to 4/30/2006 . $193.63 . erest to date of death: $48.73 Benficiary: Estate of Adolph A Acri Jr. Page 1 of 1 ---- ----~-~ -. ~ ~ ------ ESTATE OF SOCIAL SECURl DATE OF DEATII Account #: In the name of: Date of Dea Int.(YTD) 11 Accrued int Other Info: Account #: In the name of: Date of Dea Int.(YTD) f Accrued int Other Info: Account #: In the name of: Date of De a Int.(YTD) f Accrued int Other Info: . 18/11/2086 14:42 7177894226 KLINGS AUCTIONS INC -.... .-. PA 82 X/lng's jtuctions, Inc. 6334 'WaOBoner's f;ap '1(jJatl LantlisDura, 'P4. 17040 Jt.llceiOPlIcr ani c"rUl'"I ..1 prai.l;tr ,,/iont " 717.i'89-J88J :JaJ( " 717..789-422~ SUBIECT: APPRAISAL OF THE PERSONAL PROPERTY OF ADOLPH S. ACRI JR. DECEASED: MAY 28. 2.006 LISTING OF PROPERTY: COMPUTER EQUIPMENT 1.200. BED, DRESSER, TABLE 200. GUITAR 4~ PLASTIC LAMPS 35. (2) BOOKCASES SO. (2) W ALLHANGlNGS 40. STEREO 150. GLASS I BRASS COFFEE TAB~E 100. UPHOLSTERED FURNITtJ'RE CONSISTING OF: LOVE SEAT, CHAIR, OTTOMAN. RECLINER 300. (4) DININO ROOM CHAIRS 125. taTCHENW ARE. SUfPLIES 125. ITEMS OF CLOTHING 600. LAWN AND GARDEN EQUIPMENT, MOWER. MISC. TOOLS 350. C.D,'S, AND RECORD COLLEcrtON 500. WATER HEATER (STILL IN CARTON> 500. MISCELLANEOUS PIcrURES AND DECOR SO. FOOD. HOUSEHOLD SUPPLIFS 100. MISCELLANEOUS ITEMS 200. S 4,665.00 .. APPRAISER. AUcnONEER Rev.1510 EX+ (6-98) * SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Acri, Adolph S. Jr. FILE NUMBER 21-2006-0513 This schedule must be completed and flied if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM ,ION UI"'. ._, _... T DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE 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 Fidelity IRA account no. 219.166332 3.683.17 3.683.17 2 M&T Bank IRA account no. 035004201739206 55.637.74 55.637.74 3 M&T Bank IRA account no. 035004201909479 39.322.78 39.322.78 4 Sovereign Bank IRA account no. 1688201464 3.850.86 3.850.86 5 Sovereign Bank IRA account no. 1688240991 16.807.27 16.807.27 TOTAL (Also enter on Line 7, Recapitulation) 119.301.82 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schec ule G (Rev. 6-98) . 07/Z7/2006 10:01 FAX 8174745246 . ~_.. ~c~ount Re-Reglstrat1on f'Eltl@ffW July 17,2006 William Bunt 109 South Carlisle St PO Box 336 New Bloomfield, P A 17068-0336 Dear William Bunt: llJ 02 We are responding to your request for infonnation about Adolph Acri's account with Fidelity. The table below lists the account holdings and values as of OS/28/2006. The table below shows the accrued unpaid dividends from SIlnOO6 through 5/2812006 Dividends $12.99 We hope this infonnation is helpful. For questions concerning account holdings or instructions on how to transfer the ownership of the accounts, please call our Inheritor Services Group at 800-544-0003 between 8:00 A.M. and 6:30 P.M. Eastern time Monday through Friday or visit our website at www.fidelity.com. Sincerely, Fidelity Investments OUf file: WOO3761-12JUL06 Brolcltlllge SeMce1 prOllld.d by Fkhlity B1'okeng. Servic.. LLC Member NYSE. SIPC Clearing. cust0d)4 and settlement services b1 Nltlonlll F1nandlll S.rviW$ u.c Member NYSE, S'f'C P.O.1bc 710001. ClnelnNtti, OH 4S277-CI0J4 12:00 302-934-2136 MANDT BANI< RECORDS PA E 02/82 Pm M&l'Bank 499 MICchrl1 Road, Mllllbon, DE 19966 Mail Code DE-MB-12 William R Bunt Attom~ At L.w 109 South Carlisle Street - POBox 336 New Bloomfie)~ PeDDlylvania 17068-0336 Phone {18" '02-4349 FIX (302) '-14.~95S June 23. 2006 Re: Estate q.f: Ado/Dh S Acri J., Social Security: 181-32-3049 Date. of Dtalh: M.qy 28. 2006 Dear Sir or Madam: Per your iDquiry dated June 13,2006, please be advised that al the time of death. the abov&-D8med decedent bad on d it with 1IIis bank the following: 1. T)Ip~ of Account IRA ,(ccoZll'll NfI1'IIbtr 03S~10J7J9106 Ow1wlhip (Nomes oj) Ado/phSAcriJr · AJdph Am Sr. BCMjIckuy · OptJIIl1lg Dal, 04//4/84 Balance on Dart oj'Defllh $54,344.64 Atta"Utd 1n/#t3t J 1,293. /0 To/at ~7.U ..-..-.-..--.,.,..,"'-.--.. --__"'..I~....._._..._------- 2. Type of Account IRA ACCD'UIfI Numb". 03J()(H201909479 Ovmenllip (Names oj) A.dtJlpItSAcriJr - Ado!phAa-iSr. B~ciary. OpIning Dtut 1110/100 Balanoe on Dare of D4ar11 139.1 Jo.BS Acawd lrtt.tIlf J 211.93 Total .-iJ9;J1r.,S.-.-..-.-....---..----.---.-- Please be advised. there WIS no safe deposit box fomifroraiabov~-"*-F;irfurtbtr aca.UDt iDforma' , reprdinl owavsbip, doJuru ancl/or r.lmburltlllent of funds, etc., please caD tb. Meeha1liesburg Ofr.ce'lt 717-3 2031. Sincerely, ~ Nancy CJagen Records Management - -- .------ . . p ~ .. .. Sovereign Bank ESTATE OF Adolph S Acri, Jr SOCIAL SECURITY #: 181-32.3049 DATE OF DEATH: May 28, 2006 Account #: 1681730952 Type: Checking Open date: 4/14/201 3 In the name of: Adolph S Acri Jr. Date of Death Balance: $82,961.30 Int.(YTD) from 1/112006 to 5/1712006 : $671.75 Accrued interest to date of death: $0.00 Other Info: Account #: 0356103455 Type: Mortgage Open date: 1/26/19 6 In the name of: Adolph S Acri Jr. Date of Death Balance: $0.00 . Int.(YTD) from to : Accrued interest to date of death: Other Info: Account #: 1688201464 Type: CDIIRA Open date: 4/14/20 J3 In the name of: Adolph S Acri Jr Date of Death Balance: $3,841.20 Int.(YTD) from 1/112006 to 4/30/2006 . $38.40 . Accrued interest to date of death: $9.66 Other Info: Beneficiary: Anita Acri Account #: 1688240991 Type: CD/IRA Open date: 12/6/2C 04 In the name of: Adolph S Acri Jr Date of Death Balance: $16,758.54 Int.(YTD) from 1/1/2006 to 4/30/2006 . $193.63 . Accrued interest to date of death: $48.73 Other Info: Benficiary: Estate of Adolph A Acri Jr. Page 1 of 1 -- - - _ _ __ n REV.1151 EX+ (12-99) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Acri, Adolph S. Jr. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. Anita M. Acri Social Security Number(s) I EIN Number of Personal Representative(s): Street Address 510 Carol Street City New Cumberland Year(s) Commission paid 2007 State P A Zip 17070 2. Attorney's Fees Law Office of William R. Bunt. 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. FILE NUMBER 21-2006-0513 AMC UNT 3,709.00 21,564.00 17,000.00 772.86 1,175.00 15,769.55 59,990.41 Form PA-1500 Sche( ule H (Rev. 6-98) -- . Rey-1502 EX+ (8-88) '* SCHEDULE H.A FUNERAL EXPENSES continued COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF IFILE NUMBER Acri, Adolph S. Jr. 21-2006-0513 ITEM AMOUNT NUMBER DESCRIPTION 1 Wiedman Funeral Home-funeral 3.709.00 Subtotal 3.709.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedul H.A (Rev. 6-98) Rey-1502 EX+ (6-88) ESTATE OF * SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEAl. TH OF PENNSYLVANIA tlHERITANCE TAX RETURN RESIlENT DECEDENT Acri, Adolph S. Jr. FILE NUMBER 21-2006-0513 ITEM NUMBER DESCRIPTION 1 Camp Hill Apria Health-medical bill 2 Capital Recovery-medial bill 3 Cedar Cliff Abstract Agency, InC.-settlement expenses 4 Comcast Cable-cable service 5 Ed Dyer-electrical repairs 6 Harrisburg Pharmacy-medicine 7 Hess Garage-automobile towing 8 Hess Garage-repairs to Firebird 9 Holy Spirit Hospital-medical bill 10 Larry Barnhouse-review computer files 11 PPL-electric bill 12 Quantum Imagining-medical bill 13 Andrews and Patel-medical bill 14 Shawna Hemperly-housecleaning 15 Smart Clean-clean carpets 16 Thomas L. Hanshaw-reimbursement of expenses incurred in sale of real estate 17 United Water of PA-water bills Copyright (c) 2002 form software only The Lackner Group, Inc. AMOUNT 168.11 74.00 13.056.29 31.09 731.20 9.07 176.11 103.83 43.00 100.00 654.76 35.00 45.00 160.00 140.00 57.84 67.58 Form PA.1500 Schedule H.B7 (Rev. 6-98) -- . Rev.1502 EX+ (6-98) W SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Acri, Adolph S. Jr. 21-2006-0513 ITEM NUMBER DESCRIPTION AMOUNT 18 Verizon-phone bill 69.72 19 Waste Management-refuse service 46.95 Subtotal 15,769.55 Copyright (c) 2002 fonn software only The Lackner Group, Inc. Fonn PA-1500 Schedule H-B7 (Rev. 6-98) - -- ---------- ------------- . , Rev.1512 EX+ (6-88) * SCHEDULE I DEBTS OF DECEOENT, MORTGAGE LIABILITIES, & LIENS COMMONWEAl. TH OF PENNSYLVANIA IIIHERlTANCE TAX RETURN RESDENT DECEDENT Acri, Adolph S. Jr. FILE NUMBER 21-2006-0513 ESTATE OF Includ. unreimbu....d m.dical .xp.ns.s. ITEM WLUEATDATE NUMBER DESCRIPTION OF DEATH 1 Azerty 1,224.64 2 Chase Card Services 266.25 3 Citibank (South Dakota), N.A. 3,000.00 4 Da-Lite Screen Co., Inc. 293.00 5 Discover Financial Services 173.41 6 Diversified Computer Supplies, Inc. 2,303.21 7 H. Wilson Company 618.06 8 PA Department of Revenue-2005lncome taxes due 1,689.00 9 United States Treasury-2005 income taxes due 11,578.00 10 West Shore Tax Bureau-2005 income taxes due 901.97 TOTAL (Also enter on Line 10, Recapitulation) 22,047.54 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Sche jule I (Rev. 6-98) . , . REV.1513 EX+ (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER Acrl, Adolph S. Jr. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal aistributions, and transfers under Sec. 9116(a)(1.2)] FILE NUMBER 21-2006-0513 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SHARE OF ESTATE AMOUN OF ESTATE (Words) $$$) I. Adolph S. Acri, Sr. Essex House, 20 North 12th Street Apt. 330 Lemoyne, PA 17043 Father entire estate Total Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, 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 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Sche ule J (Rev. 6-98)