HomeMy WebLinkAbout02-23-07
-1
15056041114
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
:2/ (j{Q
llo7
Date of Birth
210-26-9721
08132006
02201934
Decedent's First Name
MI
Decedent's Last Name Suffix
BENDER
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
RAYMOND
T.
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
UD 1. Original Retum D 2. Supplemental Retum
D 4. limited Estate D 4a. Future Interest Compromise (date of
death after 12-12-82)
D
CJ
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
D
D
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
D
o
CJ
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
STEPHEN D. TILEY
Firm Name (If Applicable)
717-243-5838
':~J
;~~~
"". i-----'
-'-.' "'~' .../
FREY & TILEY
First line of address
5 SOUTH HANOVER STREET
Second line of address
City or Post Office
State
ZIP Code
::0
--j
::D
-6A TE FILED
(} ~il
. (:"')
..... r"l""l
( --e
CARLISLE
PA
17013
HOUSE ROAD, CARLISLE, PA 17013
DATE
Feb.-2..a- 2006
D. TILEY, 5 SOUTH HANOVER STREET, CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041114
15056041114
-1
>,
-.J
15056042115
REV-1500 EX
Decedent's Name: RAYMOND T. BENDER
RECAPITULATION
1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or SOle-Proprietorship (Schedule C) . . . . .
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . .
6. Jointly Owned Property (Schedule F) DSeparate Billing Requested . . . . . . . .
7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property
(Schedule G) DSeparate Billing Requested. . . . . . . .
8. Total Gross Assets (total Lines 1-7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
210-26-9721
Decedent's Social Security Number
1.
2. NONE
3. NONE
4. NONE
5.
6. NONE
7.
8.
9.
145000.00
127851.00
291705.00
564556.00
28633.00
9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . .
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/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . .. 13.
14. Net Value Subjectto 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, or
transfers under Sec. 9116
(a)(1.2) X.O 0
16. Amount of Line 14 taxable
at lineal rate X .0 ~
17. Amount of Line 14
taxable at sibling rate X . 12
18. Amount of Line 14 taxable
at collateral rate X . 15
15.
16.
173003.00 17.
34 9 3 7 2 . 00 18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
Side 2
15056042115
15056042115
13548.00
42181.00
522375.00
0.00
522375.00
0.00
0.00
20760.00
52406.00
73166.00
m
-.J
REV.1500 EX Page 3 210-26-9721
Decedent's ComDlete Address:
DECEDENTS NAME
RAYMOND T. BENDER
STREET ADDRESS
File Number
21-06-00767
k58 STONE CHURCH ROAD
CITY
CARLISLE
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
73166.00
88000.00
3658.30
Total Credits (A + B + C) (2)
91658.30
3. Interest/Penalty 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.
Filii" avalon Page 2, Line 20 to request a refund. (4)
0.00
18492.30
5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
0.00
A. Enter the interest on the tax due.
(SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D 0
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . .. D 0
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " D 0
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? " D 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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. ~9116 (a) (1.1) (i)].
For dates of death on or atter 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 .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 use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half
(4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 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.
217
REV.1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Ravmond T. Bender 21-06-00767
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
458 Stone Church Road
Lower Frankford Township, Cumberland County. Pennsylvania
Single Family Residence acquired by deed dated November 9.1990, and
recorded November 15. 1990, in the Office of the Recorder of Deeds in and for
Cumberland County. Pennsylvania, in Deed Book "W." Volume 34. Page 311.
Property sold at public auction to Robert W. Failor, Jr., and Kaye N. Failor. (The
Executrix and her husband) See copy of deed and settlement sheet attached.
145,000
TOTAL (Also enter on line 1 Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
145.000
Cf~ ~ JD
, .
.l~':.~r ( II
Tax Parcel No.: 14-05--0423-018C
THIS INDENTURE
MADE THE I t:t day of December in the year of our Lord two thousand six (2006)
BETWEEN KAY FAIWR, a/kJa KAYE FAIWR, Executrix of the Estate of RAYMOND T.
BENDER, of Lower Franliford Township, (Carlisle) Cumberland County, Pennsylvania,
Deceased. party of the fIrst part,
GRANTOR,
AND ROBERT W. FAILOR, JR., and KAYE N. FAlWR, husband and wife, of
210 Stone House Road, Carlisle, PA 17015, Cumberland County, Pennsylvania, parties of the
second part,
'"
GRANTEES,
WHEREAS, Raymond T. Bender died unmarried on August 13,2006, seized in fee of
the hereinafter described real estate, and by his Last Will and Testament dated March 13,2001,
since his death duly proved and remaining of record in the Office of the Register of Wills, in and
for Cumberland County, at Carlisle, Pennsylvania, and filed to Estate No. 21-2006-0767,
provided, inter alia, as follows:
"FOURTlf: I hereby nominate, constitute and appoint my niece Kay
Failor of 217 Stonehouse Road, Carlisle, Cumberland County, Pennsylvania,
as Executrix of this my Last Will and Testament In the event of the
renunciation, death, resignation or inability to act for any reason whatsoever
of my said niece, I nominate, constitute and appoint my sister Beverly Stets
of Bloserville, Cumberland County, Pennsylvania, as Executrix of this my
Last Will and Testament I further direct that no bond or other security shall
be required of any Executor or Executrix appointed in this Will for the
performance of his, her or its duties in any jurisdiction in which he, she or it
may be called upon to act. The terms Executor or Executrix may be used
interchangeably in this Will and shall refer to any Executor or Executrix
appointed in this will, or any other Administrator appointed by a court of
competent jurisdiction."
WHEREAS, Letters Testamentary in the Estate of Raymond T. Bender, Deceased, were
issued by the Cumberland County Register of Wills to Kay Failor, on August 30, 2006, without
the requirement that any bond be posted by her, which Letters Testamentary remain in full force
and effect, and,
WHEREAS, Section 3351 of the Probate Estate and Fiduciaries Code (20 Pa. C.S.A.
3351) gives personal representatives the power to sell at public or private sale any real property
not specifIcally devised, and,
WHEREAS, a life estate in the hereinafter described property was specifIcally devised to
Nancy L. Bender pursuant to paragraph THIRD (A) of the Last Will and Testament of Raymond
T. Bender, Deceased, however, the said Nancy L. Bender predeceased the said Raymond T.
Bender and pursuant to the Last Will and Testament of Raymond T. Bender, the specific bequest
fag, J of3 r..,,( r.-:""'! ~ r.. "l,"'r-g
lJu'J.. ./"'1" J lJ'lJtt.\JO
of the hereinafter described property thereby lapsed. The said N~cy L. Bender died on January
".;25, 2006. An inheritance tax return was filed in connecti~n with her death to Cumberland
County No. 21-2006-0457. "
NOW THIS INDENTURE WITNESSETH, that the said Grantor for and in "
consideration of the sum of One Hundred Forty Five Tho~and- $145,OOO.OO)--Dollars lawful
money of the United States, to them in hand paid by the said Grantees, their heirs and assigns, at
and before the sealing and deliver hereof, the receipt whereof is hereby acknowledged" have
granted, bargained, sold, aliened, released and confirmed, and by these presents, do grant,
bargain sell, alien, release and confirm unto the said Grantees, their heirs and assigns,
ALL THAT CERTAIN piece or parcel of land situated in the
Township of Lower Frankford, County of Cumberland, and
Commonwealth of Pennsylvania, more particularly bounded and described
as follows:
BEGINNING at a point on the cul-de-sac end of a private street or
road at the dividing line between Lots Nos. 4 and 3 as shown on the
hereinafter mentioned Plan of Lots; thence along said dividing line
between Lots Nos. 4 and 3, North 12 degrees 16 minutes West, a distance
of 103 feet to a point at lands now or formerly of Elwood D. Smith, Jr.,
thence along said latter land, South 76 degrees 9 minutes 32 seconds West
a distance of 230 feet to a point at the dividing line between Lots Nos. 4
and 5 as shown on the hereinafter mentioned Plan of Lots; thence along
said dividing line between Lots Nos. 4 and 5, South 23 degrees 5 minutes
32 seconds East a distance of 150.19 feet to a point marking a corner
common to Lots Nos. 4, 5, 1 and 2 as shown on the hereinafter mentioned
Plan of Lots; thence along the dividing line between Lots Nos. 4 and 2 as
shown on said Plan of Lots, North 88 degrees 35 minutes 42 seconds East
a distance of 166.40 feet to a point on the aforementioned cul-de-sac end
of a private street or road; thence along said cuI-de-sac and on a curve to
the right having a radius of 50 feet, an arc distance of 110 feet to a point
on the same at the dividing line between Lots Nos. 4 and 3 as shown on
the hereinafter mentioned Plan of Lots, the Place of BEGINNING.
BEING Lot No. 4 as shown on the Subdivision Plan of Lots
entitled "Final Subdivision, Chester Stone" recorded in the Office of the
Recorder of Deeds, in and for Cumberland County in Book 34, Page 76.
TOGETHER with an undivided one-half interest in the land
comprising the private street or road as shown on the hereinafter
mentioned Plan of Lots to be owned, developed, maintained and used in
common with the owner or owners of Lot No. 3 as shown on the
hereinafter mentioned Plan of Lots.
BEING the same premises which Chester Stone, single person, by
deed dated November 9, 1990, and recorded November 15, 1990, in the
Office of the Recorder of Deeds, in and for Cumberland County, at
Carlisle, Pennsylvania, in Deed Book "W," Volume 34, Page 311, granted
and conveyed to Raymond T. Bender, whose Estate is the Grantor herein,
which deed is. "a corrective deed, correcting erroneous provisions
concerning a private driveway set forth on a prior deed recorded in
Cumberland County Deed Book "R," Volume 34, Page 1017.
TOGETHER with all and singular ways, waters, water-courses, rights, liberties,
privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in anywise
appertaining, and the reversions and remainders, rents, issues and profits thereof; and also all
the estate, right, title, interest, use, trust, property, possession, claim and demand whatsoever of
the said Raymond T. Bender at and immediately before the time of his death, in law. equity or
otherwise howsoever, of, in, to or out of the same:
Pagel of j
BOOK 277 PACE4670
TO HA VB AND TO HOLD, the said buildings, hereditaments and premises hereby
granted and released, or mentioned and intended so to be, with the appurtenances, unto the said,
Grantees, their heirs and assigns, to and for the only proper use and behoof of the said Grantees,
their heirs and assigns, forever.
AND the said Grantor does covenant, promise and agree, to and with the said Grantees
their heirs and assigns, by these presents, that he the said Grantor, has not done, committed, or
knowingly or willingly suffered to be done or committed, any act, matter or thing whatsoever
whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached,
charged or encumbered, in title, charge, estate, or otherwise howsoever
WITNESS:
WITNESS the due execution hereof the day month and year first above written.
On this, the J>:L. day of December, 2006, before me, the undersigned officer,
personally appeared KAY FAILOR, a/k/a KAYE FAILOR, Executrix of the Estate of RAYMOND
T. BENDER, Deceased, of Lower Frankford Township, Cumberland County, Pennsylyeu.4a. .,.:~~
~wn to me (or satisfactorily proven) to be the person whose name is subscribed to t '"~~!iN1:~#.' ,,,,--to
lnstrument, and acknowledged that she executed the same in the capacities therein ~ .' . .ki":~~f.:ti~~..
the purposes therein contained. '. .~.. ij~>';;~ .:
IN WITNESS WHEREOF, I hereunto set my Iumd and official seal." .:{.r ~1J~
.,fl~u '~.~..... .J.:~f~-
c! .""t'.,!~t~.. '.~~:'..~ :.;
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f iJ's _0... . 1:0 (SliD?!,"
([,.)I
)f.ld '
Commonwealth of Pennsylvania
County of Cumberland
NOTARIAL SEAL
TRISHA A. UESS, Notary NIIict
Borough of Carlisle, CIInb. Ccmty, PA
My C'AXnmiIsion Expires May 20, 2010
~~m.&mem
Raymond T. Bender, Deceased
~
(SEAL)
(SEAL)
alkla e Failor, Executrix of the Estate of
Raymond T. Bender, Deceased
}ss.
1 do hereby certify that the precise residence and complete post office address of the
within named Grantees ~ 210 Stone House Road, Carlisle, Pennsylvania 17015.
-I9n;:r.:oc-:l","Clr-=CC~
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5Iphen D. TileaEsquire
Ai:om~ for Gr~tees
i ~ ~2!
~~. i ~ ( Certi fy this to be recorded
s; :::J~
~ ZI 2 i In Cumberland County ~ A
i ~ ~'~;"~<:}0~:~~~--~ Jt.;r--
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67jRecorder of Deeds
BOOK
------
( ) ,. FHA SetUement Statement. U. S. eeoartment of HDlIslJ D and Urblll DeveloPl!l8l1t Form US HUe. 1 Pace No. 1
( ) 2. FmHA 8. File Number 7. Loan Number 8. Mortgage Insurance
( ) 3. Conv. Unlns. Case Number
l ~ 4. VA
5. Conv. Ins.
C. This lonn is fumish8d to give you a statement of actual settlement costs. Amounts paid to and by tha settlement agent ara shown. Items marked '(p.o.c.)' were p81d DlItslde 01
lIIe c:lMInl" thev are shown h_ for informational DUrDOSIS and are not Inc:lucled In the lOtllls.
D. Name and Address of Borrower: E. Name end Address of SeDer:
ROBERT W. FAILOR, JR. ESTA'tI!: OF RAYOND T. BENDER, DECEASED
KAYE R. FAILOR KAY FAILOR a/k/a KAYE FAILOR, EDCU'tRIX
210 STORE HOUSE ROAD LA'tE OF LOWER FRAHKP'ORD 'tOWHSHIP
CARLISLE, PA 17013 CUMBERLAND COUN'tY, PENNSYLVANIA
TIN
F. Name !WI Address of Lander , G. Property LocaUon
RIA 458 S!rORE CHURCH ROAD
LOWER FRAHKFORD 'tOWNSHIP
CUMBERLAND COUN'tY, PEDSYLVANIA
H. Seller'a Settlement Agent: FREY & ULEY I. SetUement Dale: Place of Settlement:
5 Sou~b Hanover u. December 8, 2006 5 SOU!rB BAHOVER S!rREE't
TIN 25-1730538 Carlisle, PA 17013 CARLISLB, PENNSYLVAlfIA
J. SUMMARY OF BORROWER'S TRANSACTION
K. SUMMARY OF SELLER'S TRANSACTION
100 Gnla. AmcMmt Due From Borroww 400 Grou AmDunt Due To Sen.
101 ConlnIct..... price 145,000.00 401 ConIrllCt SIll.. prk:e 145,000.00
102 Peraonel property 402 Pereonal property
103 Setllemenl chergeatrom (Un. 1400) 1,488.50 403
104 404
105 405
Adju81mellts for Itllma paid by SIllIer In 1IdvarIc;a: Adjustments for IIBms p8kJ by seier In advance:
108 CItyItown tuea to: 408 Cltyllown taxis to:
107 Co~ty taxaa 10: 407 CDUnty tax.. to:
108 Aaulaments to: 408 Assessments to:
1~ 'lax PrO-Ra~ioD to 8-Dec-06 816.85 409 'tax Pro-Ra~ion ~o 8-Dec-06 816 .85
110 410
111 411
112 412
120 Grou Amount Due From Borroww 147,305.35 420 Groll Amount Due to Seller 145,816.85
200 AnlClllnts hIcI By Or In Behalf Of Borro_r 500 Reductlcln8 In Amount Due To Sel....
201 Oepollt or eemeat money 14,500.00 501 Exceu deposit (_Inatruc:llona) 14,500.00
202 Princ:ipallUIlCllII'It of MW Ioan(s) 502 Settlement chllgH 10 MIler (line 1400) 1,450.00
203 Exi8tIng Iaan(s) taken subject to 503 ExIstIng Ioan(s) lBkll1 subject to
204 504 Payoff of llret mortgage loan
205 505 Payoff of second martg.1oan
208 506
207 507
208 508
~ 509
Ad}u$tments for Items upaId by stiller Adjustments for Its". upaJd by seller
210 Cltyltown taxes 10: 510 CItyAown l8XII to:
211 County tuea to: 511 County tues . 10:
212 Assessments to: 512 As_nls to:
213 513
214 514
215 515
216 518
217 517
218 518
219 519
220 TatIlI hIcI ByIFor Borrower 14,500.00 520 TGtaI Reductions to Amt Due Seller 15,950.00
-
300 Cah At Setllement FromfTo Borrower: I 600 C.h At Settlement TalFrom Seller: I
301 Groll amount duelrom borrower (Bne 120) 147,305.35 601 Grass amount 10 seller fram (line 420) 145,816.85
302 Lau amounts paid bylfor borrower (from line 220) (14,500.00) 602 Lass reductions In amount due seller (from line 520): (15,950.00)
303 Cull (X) From ( ) To Borrower 132,805.35 603 C.h ( ) From (X) To Seller 129,866.85
-
!HUO.,
700 Total SaleslBroker's Comm. based on price:
DMsIon of CommIssion (line 700) .s follows:
10
10
701
702
703
704 CommIssion paid at SelUemenl
705 ACUCTIRIlR' S COMMISSION
800 Items Payable In Conn~tJon WIth Loan:
801 Loen OrIgination Fee
802 Lolll\ Discount
803 Appr8lsaJ Fee
804 Credit Report
805 Lend.,.. inspection Fee
806 Mortgage IIlSIII'lII\C8 ApplIcatIon Fee
807 AsunplIon Fee
80s
809
810
(Mortgage AmI:
.00 ,
.00 ,
to
to
to
to
to
811
900 Items Required By Lender To Be Paid In Advance:
801 lnt.-eIt From to
902 Mongage InIurance Pnm1Ium for
903 Huard Insurance Pr8mIum lor
904
905
1000 Reserves Deposited With Lender:
1001 Huard InIurInce
1002 Mortgage InsW8IlC8
1003 CIty property tax..
1004 County property taxes
1005 Annuli aueIIlIllIfllB
10116
1007 School taxes
1008
1100 Title Charges:
1101 Selllement or doling f.
1102 Absnct or tlUe -.ch
to
11 03 Title sramlnallon
1104 TIlII /nIuance binder
1105 Ooalment ptel*'allOl1
1106 Notary Ieee
1107 Attorney's fHl
(lnc\Ud8s 8bove Items runbenI:
1108 TItle lnS\lr8llCe
to
to
to
10
to
to
to
~ S~EMENTCHARGES
lU,DOD.DO
., .
Paid From
Borrower's
Fundi at
Settlement
0.00
0.00)
0.00
0.00
per day.
rnonthIlO
years to
years to
mo.. .
mos. .
mos. .
mos. .
mo.. .
mos..
mo.. .
mos. .
per month
per month
per month
per month
per month
per month
per month
per month
FREY AND TILBY
WAIVED
Closing Servk:e Latter (Frey & TIley for Comwtth. Land Title)
$0
$ 145,000
{1ncludeI8bove items runbenI:
11 09 Lender's Cll\/lJrIlg8
1110 Owners Coverage
1111
1112
1113
1200 Government Recording and Transfer Charges:
1201 Aec:ordIngf...: Deed $38.50 ;
1202 Cltylc:ounlylatamps: Deed $1,450.00 :
1203 SIal8 taxIstamps: Deed $1, 450. 00 ;
lZ04
1205
1300 Additional Settlement Charges:
1301 SuMIy to
1302 Pestlnspeclfon 10
1303 Cutrenl Taxes clue from BorrowerlSeller
Mortgage:
MortgIlllB: $
Mortgage: $
; AlIle....
38.50
1,450.00
1304
1305
1306
1307
1400 Total Settlement Charges (enter onllnes 103, Section J and 502, Section K)
1,488.50
Page No. 2
PaIcI From 700
Seller'.
Funds at 701
Settlement 702
703
704
P.O.C. 705
800
801
802
803
804
805
808
807
808
3
810
811
900
901
802
903
804
905
1000
1001
1002
1003
1004
1005
1006
1007
1008
1100
1101
1102
1103
1104
1105
1106
P.O.C. 1107
1108
1109
1110
1111
1112
1113
1200
1201
1202
1,450.00 1203
1204
1205
1300
1301
1302
1303
1304
1305
1306
1307
1,450.00 1400
I HUD-l
Page No. 31
CERTIFlCA nON
J direct and authorize the Compnay to make distributions indicated for my account on the attached HUD-1 Settlement Statement, approving the tax prorations
indlcaled therein, and understand that prorations were based on figures for the preceding year, or estimates for the current year, and in the event of any change
for the current year, all necessary adjestments must be made belWeen SeUer and Borrower direct; likewise any DEFICIT In deDnquent taxiS will be reimbursed to
AttorneylTltle by Seller.
I have carefuUy reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, It Is a true and accurate statement of all receipts and
disbursements mad on my account or by me In this transacllon. I further certify that I have received a copy of the HUD-1 Settlement Statement.
.uJl~-t: ~ g~......
~'" . ~.
unt of the funds which were received and have
To the best of my knowl , the HUD-1 Settlement Statement which I have prepared Is a bue and accurate
been or will be disbursed by the undersigned as part of !he settlement of ItlIs transacllon.
~t.
...
.A .. '7~
~"7~~ ~I.b
":;l ~ 6.
Data
WARNING: It Is a crime to knowingly make false statements to the Unlt8d States on this or any other similar fonn. Penalties upon conviction can include fine and
Imprtsonment. For details see; TIUe 18 U.S. Code SectIon 1001 and Section 1010.
INFORMAllON REPOR11NG ON REAL ESTATE TRANSACTIONS
THIS HUe SETTLEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMAllON (BOXES Eo G. H, I, M AND LINE 401) AND IS BEING FURNISHED TO
THE INTERNAL REVENUE SERVICE. IF YOU ARE REQUIRED TO FILE A RETURN, A NEGLIGENCE PENAL TV OR OTHER SANCTION WILL BE IMPOSED
ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE INTERNAL REVENUE SERVICE DETERMINES THAT IT HAS NOT BEEN REPORTED.
SollcltBUon of TIN
Seller Is required by law to provide the AttomeylCompany with hlslher correct taxpayer Identification number. If correct taxpayer Identlllcation number is nol
provided. he/she may be subject 10 civil or criminal penalties imposed by law. .
Certification of 11M
Under penalties of perjury, I certify that the taxpayer idenUflcatlon number shown In this statement Is my correct taxpayer ldenllflcatlon nlnlber.
Seller
Seller
TAX PRO-RATION ADDENDUM
on. of Pro-Ratlan:
Borrower
Seller
ASSESSMENT:
$108,900.00
2006-2007 School Real Estate TIX
2006-2007 School Real Estate TIX- F_
2006-2007 School Real Estate TIX- Per Day
205 Days Pre-paIcI.
13.365 min.
$1.455.45
53.ll7664
$815.21
P.O.C.
December .. 20llI
S.. Settlement Sheet
Unes Number8110,
410 and 1303 for
Rn. of this
Addendum.
2008 Co. & Twp./Bor. Real Eltale TIX
2006 Co. & TwpJBor. Re81 Ellale TIX- Face
2006 Co. & Twp./Bor. Real Estate TIX- Per Day
24 Days Pre-paIcI..
2.557 mins
$278.48
$0.78290
518.31
P.O.C.
Purchaser owes:
205 Days !"-pald Sc:haol
Plus 24 Days Pre-pafd Co. & Twp./Bor.
Lass 2% discount
815.21
18.31
833.52
16.67
816.85
217
REV-15G8 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ravmond T. Bender
Include the proceeds of litigation and the date the proceeds were received by the estate.
All Drooertv Jolntlv-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21..()6-00767
ITEM
NUMBER
1.
2.
3.
4.
DESCRIPTION
M&T Bank, One West High Street, Carlisle, PA 17013 (See letter attached.)
Checking # 702021 - Principal ($32,683.61)
Checking # 702021 - Interest to DOD ($0.18)
Savings #15004201166251 Principal ($56,987.27)
Savings #15004201166251 Interest to DOD ($101.64)
Capital Blue Cross - Refund ($133.44)
Cresscare Medical, Inc. - Reimbursement for Lift Chair ($854.00)
1991 Chevrolet Truck VIN 1 GCDK14HIME16766 Sold to Executrix and husband. See
title and Rufe Chevrolet valuation attached ($4,775.00)
1992 Plymouth Acclaim VIN 1P3XA46KINF248127 Sold to benefiCiary Beverly A. Stets. See
title and valuations from Edmunds.com, Kelly Blue Book and NADA attached. ($1,525.00)
Household furnishings. Sold at public auction November 11, 2006. See Dan Hershey's
Auction Service statement attached. ($28,773.25)
Refund - Embarq (telephone service) ($2.58)
Adams Electric Cooperative - Return of Capital ($26.75)
Nationwide Ins. - Refund Homeowner's Insurance ($368.00)
Adams Electric Cooperative - Refund ($34.38)
Lancaster HMA Phys. Mgmt. - Refund ($210.00)
Adams Electric Cooperative - Annual patronage capital allocation paid on account of
Nancy L. Bender. ($123.08)
Adams Electric Cooperative - Annual patronage capital allocation paid on account of
Raymond T. Bender ($345.66)
Federal Tax Credit for telephone excise tax paid ($30.00)
Lift Chair ($427.00 - Distributed In-Kind)
Television ($450 - Distributed In-Kind)
VALUE AT DATE
OF DEATH
32,684
56,987
102
133
854
4,775
1,525
28,773
3
27
368
34
210
123
346
30
427
450
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
127,851
~
PI M&TBank
499 Mitchell Street, Millsboro, DE 19966
September 19, 2006
Stephen Tiley
Attorney At Law
5 South Hanover Street
Carlisle, PA 17013-3385
RE: Estate of Raymond T. Bender
Date of Death: August 13, 2006
Social Security No.: 210-26-9721
Dear Mr. Tiley:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
1. Account 1YPe..................-.........Checking Account
Account Number....................... 702021
Ownership (Names ofl...............Raymond T. Bender
Opening Date.......................... .09/01/67 (account closed 08/30/06)
Balance on Date of.Death..........$32,683.61
Accrued Interest
$
0.18
Total................................... ....$32,683.79
2. Account 1YPe...........................Savings Account
Account Number.................... ...1500420 1166251
Ownership (Names ofl...............Raymond T. Bender
Opening Date......................... ~ .03/20/98
Balance on Date of.Death........ ..$56,987.27
Accrued Interest
$ 101.64
Total................................... ....$57,088.91
. Page 2
September 19, 2006
The above named decedent did not have a safe deposit box.
For any additional information on the above accounts, including ownership,
statements and closures please contact our High Street Carlisle branch at 717-240-4536.
Sincerely,
~UJV~
Charlene Warrington, Records Management
1-888-502-4349
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1: - Chevrolet, 1500 Pickup
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RUFE CHEVROlET INC.
1601 Ritner Highway
Carlisle, P^ 17013
.'...7~.
Bus. Phone (717) 243-5021
Bus. Phone (877) 243-5021
FAX (717) 243-7436
E-Mail: rufechevOaol.com
Quick Dealer Price Quote
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_.~
1991 Chevrolet 1500 Picku~ Long Bed
Trade-In Value r------ .-..- .. ......- ----~~~~.~..~~=.=.=~=--------.-.-
Private Party Value BLUE BOOKa SUGGESTED RETAIL VALUE ~WHAT'$ T ~
.'. ,..-...--- -.-._'-"--~"--
Suggested Retail
Value
____ __r______.__
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Vehicle Details Change Equipment
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Condition
Value
Excellent
J. WHA~'S: THIS: ~
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Engine:
Transmission:
Drivetrain:
Mileage:
va 5.0 Liter
Automatic
4WD
25,526
AM/FM Stereo
Selected Optional Equipment
SlIverado Tilt Wheel
Power Windows Cruise Control
Pickup Shell/Cap
Alloy Wheels
. SEU YOUI USED CAR
on Blue Book Classlfiedll™
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I Blue Book Suggested Retail Value
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and a dealer. This Suggested Retail Value assumes that the vehicle has been
fully reconditioned and has a clean title history. This value also takes Into
account the dealers' profit, costs for advertising, sales commissions and
other costs of doing business. The final sale price will likely be less
depending on the vehicle's actual condition, popularity, type of warranty
offered and local market conditions.
Vehicle Condition Ratings
I i
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Excellent
cecco
"Excellent" condition means that the vehicle looks
9/7/2006
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v
If . CCJ1lUIChu8r .,... _ your ....ilI IItId and you want the tIIIe to
be I8l8d u "Joint Tenants WIIh RIght of ~" (On death of one
owner.;tltIe goes to surviving OWIW.)<OHECI(H~ C. ()ItlIrwIeI, the--w,
will be Issued . "T-ma In Cornman" (Oniled1 ofOl18'.awnet'. Intemt Of
decuied owner gou to hIsIher hen oreState)f..:'S.:.~K;. . .
1STU&NDATE:::"+'1F'~UEN.PEcK 0'"
1 ST LIENHOLDER
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STREET~
CITY .~
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STATE
w
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IF THIS IS AN aT, CHECK HERE 0 FINANCIAL
NOTE: FIN REQUIRED INSTlTUTlON NO.
2ND WEN DATE:
"..!.F NO WEN, CHECK 0
2ND WENHOLDER
lO
00
W
'\,)
STREET
_TUllE ClF APPUCAHT OR ~ SIGNER
STATE
ZIP
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NOTE: PIN REOUIAED
....__....., ..... .~~~.~'J"LEClFAU1HClRIZI!D-
Kelley Blue Book -: Suggested Retail l'ncmg Report - PlymOUth, ACClaun
~.~ Kelley Blue Book
. . THE TlUSTED IESOURCE.
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I:IQ.me. > Used Cars > smao. > P1vmouth > &d.aim. > 12.22 > Sedan 40 > I!qulpment
1992 Plymouth Accla.i~ ~~_;Jn 4P
, Trade-In Value
Private Party Value
.. ... ~. . -_.-. ,.~.~. '..'~ "."- ~"""'''''' ."
Suggested Retail
Value
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f Plymouth .:=.1'
tAcclalm ..=J
, 130 Miles or iess:.=J
ZIP Code f17015
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BLUE 8001(1 SUGGESTED RETAIL VALUE ~1j)HAT'S r...,p
Condition
Excellent
Value
$1,825
^ UJHATf$ rfit$?
Suggested Retail Value Assumes
Excellent Condltlon._ More
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: :';:'.J:.ll', .: :~'~:",;';-,,, <.Li;~":'::~"'{':~':t~~tr~\~;. :~. >.: :.i.;~. -,'
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Vehicle Details Change EquIpment
Engine: 4-Cyl. 2.5 Uter
Transmission: Automatic
Drivetrain: FWD
Mileage: 31,000
Selected Standard Equipment
Air Conditioning Power Steering AM/fM Stereo
'::::~~~:'1:;'~~\~~';/::')';:i:.I.~.:~-d~[:':'''l~~.;-~~',...".' .~. ".;~~': ~(~':: ~,.::~)'r'.;:~{" ~: ':;:.:~ \~,;~~:". ':. ',,: "';~ ",.i.'~;')U(ji";:~~;, ~:.):;;~'tJ:!i: ". ";: ,:~ ::~ ~~,"i'!:~"7'- . ';..'~t:_ .:~rr:,~ ~~:~~"/" '.~~~.}!;t'J::':::J't';<'"
Blue Book Suggested Retail Value
The Kelley Blue Book Suggested Retail Value Is representative of dealers'
asking prices and is the starting point for negotiation between a consumer
and a dealer. This Suggested Retail Value assumes that the vehicle has been
fully reconditioned and has a clean title history. This value also takes Into
account the dealers' profit, costs for advertising, sales commissions and
other costs of doing business. The final sale price will likely be less
depending on the vehicle's actual condition, popularity, type of warranty
offered and local market conditions.
Vehicle Condition Ratings
Check Vehicle Title History
Excellent
CooCC $1,825
"Excellent" condition means that the vehicle looks new, Is In excellent
mechanical condition and needs no reconditioning. This vehicle has never
had any paint or body work and Is free of rust. The vehicle has a clean title
hictnrv ;i\nti will f\;IIt;t; " t;mnn ;tnrl c;:!fpt'v incrw=ortinn Th", F'nninp
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1992 Plymouth Acclaim
4 Dr STD sedan ~ 1992 Styles
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. .:fl~~~~:~B~~';u.~~~tt~!J,~~~i;
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...,.........-.
Dr STD sedan
National Base Price
Octlonsl EaulDment
3-Speed Automatic Trlnsmlsslon
I Color Adjustment
light Blue
Realonal Adlustment
for Zip Cade 17013
Mlleaae Adiustment
30,000 miles
Condition Adlustment
1 Outstanding
Total
....";.::;a~~;~~I~';i~;F-::
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$50 $332 $801
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$0 $0 $-1
<'~2
;$.3. '~<~$-17"
$401 $401
$0';' "':$0
$401
$0
$453
$731 $1,196
Certified Used Vehlde
NtA
PrIce AnatMr V.hide
Print Prlvatf! Plrtv Window Sticker I PrInt Dealer Window Sticker
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Vehicle Pricing & Information
nodClguid...cOoi'l\
9/5/2006
Autos . Motorcyck'!' · Boots · CollN,for Cors . Rc'cwation Vchidc-s . Manufac1ut<.:d Home~
The free consumer values on nadaguldes.com are based on the Consumer edition of the
N.A.D.A. Official Used Car Guide @, and should not be utilized for Industry purposes. The
consumer values may vary from the N.A.D.A. Official Used Car Guide values presented to
you by insurance companies, banks, credit unions, government agencies and car dealers
due to vehicle condition, regional market differences and frequency of updates
Low Retail Value
A low retail vehicle may have extensively visible wear and tear. The body may have dents
and other blemishes. The buyer can expect to invest in bodywork and/or mechanical
work. It is likely that the seats and carpets will have visible wear. The vehicle should be
able to pass local inspection standards and be in safe running condition. Low retail
vehicles usually are not found on dealer lots.
Average Retail Value
An average retail vehicle should be clean and without glaring defects. Tires and glass
should be in good condition. The paint should match and have a good finish. The interior
should have wear in relation to the age of the vehicle. Carpet and seat upholstery should
be clean, and all power options should work. The mileage should be within the acceptable
range for the model year.
An Average Retail vehicle on a dealer lot may include a limited warranty or guarantee,
and possibly a current safety and/or emission inspection (where applicable).
High Retail Value
A high retail vehicle should be In flawless condition. All power equipment should be
functional. The paint should match and have a high gloss finish. The carpet and seat
upholstery should be clean and have minimal wear. The engine should start quickly and
run smoothly. The tires should be like new with a spare and jack. The mileage should be
Significantly below the acceptable mileage range for the model year.
A high retail vehicle on a dealer lot should be fully reconditioned and Is likely to Include a
warranty, guarantee or manufacturer certification and current safety and/or emission
inspection (where applicable).
ADVIItTfS1N'
II... ' . · detailed descriptions
1;,
@Copyrlght 2006 NADAguides.com. All Rights Reserved
DAN HERSHEY'S AUCTION SERVICE, LLC
532-4647
Steve Ege
Cell: 717-385-5438
Chris Bream
Cell: 717-226-1920
SELLERS NAME 1- <;~(;.k o{ R(;(Jl~~) -r 601t'kr DATE /rJlfo J>)(,
- (,I I I
ADDRESS 1 ,'I Co., s: ~Ot.-,)~ N ~W'OUtI/ SJr.td. PHONE Z 1./3 - 3 C1 8 I
{
/ OTHER "t1c1lJ,};., 1inJ W~r 4;./JI'::201: P~/"L.J.. tf~~~UCTIONEER % Zo
.' ,. . . J' -P.t..IcJJc
. AUCTION DATEILOCATION 61 Sf Ie IJ/U/()(., CLElRI'-% Z-.
DESCRIPTION OF MERCHANDISE
bvA}! J r. &J04 .Ir~._~>. R,../~.L.J~,. ~ J~ j,~i{, IZ. t.r J, sluL-I~
:r;. "'''';;-1- -r;.A +- I q 1-.., ft)1J fr;thlJ.J. -I-fQ.,/~r
~ At ,vJs P....I)~r3
I ,
I Commission the Auctioneers to sell the merehAnmse to the highest bidder by Public Auction. MerchAndise
to be sold as is & grouped as ~essary to obtain bids. I certify that I am the owner or authorized represen-
tative of the merchandise, goods and or property and have good title and the right to sell and that they are free
. from all incumbrances. I agree to accept all responsibility for p~viding merchantable title and for delivery of
:: ~. I ~ to hold barmlesli the Auctioneerll 21D), cIaima ~ the Dature referred to in
(fT~~NLGN~' , ? ~. / ~~'NATUBE
Total Sales (Clerking Tickets Attached) i ( 81 7 13 r Z ~
R of! ~ ( e~J. It I tf <,. coo
Less Sale Expense:
~ D % Commission Au~tioneer $ 5 7 S'i. (P)'
'Z- %q~~~18PkS::" $ t.. 'I 00, ~
OTHER: /J. Q ti ) ~~ L ~ JJrJI/. t/'-io. ~
TOTAL SALE EXPENSE DEDUCTED $ q 094, (0)
f1 { . SELLERS NET $ 1'1 & '78. fcO
I 1 ~. .,..~ j Cl..&:
I .. 1 ,.., .
L."r .,. L'~~CTfot~ATURE\<'''-'''' ./
SELLERS SIGNATURE
217
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Ravmond T. Bender
FILE NUMBER
21-06-0767
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAM! OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST pF APPlICAIl.E) VALUE
1. M&T Investment Group, One West High Street, Carlisle, PA 1701:
IRA Rollover#AZR104177 See statement attached. ($96,505.23) 96,505 100.00% 96,505
2. Western-Southern Life Annuity Operations Group
P.O. Box 2918, Cincinnati, OH 45201-2918
Contract No. W0020808804 ($157.386.33) 157,386 100.00% 157,386
Contract No. W0020880163 ($37,813.90) 37,814 100.00% 37,814
See Statements Attached.
TOTAL (Also enter on line 7 RecaDitulation) $ 291.705
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
(If more space is needed, insert additional sheets of the same size)
11M&r_Group
M&T Securities, Inc.
2875 Union Road, Suite 30-33, Cheektowaga, NY 14227.
800 724 n88
September 22, 2006
Frey & Tiley
Attorneys at Law
Attn: Stephen D. Tiley
5 South Hanover St
Carlisle, P A 17013
Re: Estate of Raymond T. Bender
DOD: August 13, 2006
M&T Securities, Inc. account AZRI04177
Date of Death Valuation
Descriotion of Security Ouantitv Valuation on Price oer share
DOD
MTB Prime Int'l Fund 8,888.000 $8,888.00 $1.00
Federated Strategic Income 581.280 $13,875.15 $23.87
Fund Class B
Federated American Leaders 2531.148 $21,843.81 $8.63
Fund Class B
Federated Capital 2080.091 $51,898.27 $24.95
Appreciation Fund Class B
~ .2.3
,~ro:)-
We have received the information presented above from sources that we believe to be accurate.
However, we do not guarantee their accuracy. The price per share on valuation date is the closing
price on that date.
Also, requested in your letter was Mr. Bender's annuities held with Western-Southern Life for
contracts W0020808804 and Contract W0020880163. These annuities are held directly with the
annuity carrier. I have foiwarded this request along with the court appointments and death
certificate to Western Southern for processing. Please contact them going forward regarding this
matter.
If you should have any further questions or require any additional information please do not
hesitate to contact me.
ura E. Patton
M&T Securities, Inc.
Ph: 716-651-4759
lpatton@mandtbank.com
Investments: · Are Not FDIC-Insured · Have No Bank Guarantee · May Lose Value
M&T Securities, Inc., Member NASD/SIPC
I})
Western-Southern Life~
09/26/2006
FREY AND TILEY
ATTORNEYS AT LAW
5 SOUTH HANOVER STREET
CARLlSE, PA "17013
Subject: Annuity Contract \1\10020808804 RA YM.OND .BENDER
Western-Southern Life Assurance Company
Dear Mr. Tiley:
Thank you for contacting the Western-Southern Life Assurance Company about this
annuity. The date of death value on 08/13/2006 was $157,386.33.
If you have questions, please call your sales representative or our Annuity Operations
Department at 1-800-926-1702. A representative will be happy to assist you.
Sincerely,
~~
CRYSTAL RICE
Annuity Administrator
Annuity Operations Department
F016
Member. Western & Southern Financial Group.
Annuity Operations Group. PO Box 2918 . Cincinnati. Ohio. 45201-2918
Phone (BOO) 926-1702. Fax (513) 629-1799
I)
Western-Southern Life~
09/26/2006
FREY AND TILEY
ATTORNEYS AT LAW
5 SOUTH HANOVER STREET
CARLlSE, PA 17013
Subject: 'AnnuUyContract W'0020e80163: RAYMOND 'BENDE-R
Western-Southern Life Assura~ce Company'
Dear Mr. Tiley:
Thank you for contacting the Western-Southern Life Assurance Company about this
annuity. The date of death value on 08/13/2006 was $37,813.90
If you have questions, please call your sales representative or our Annuity Operations
Department at 1-800-926-1702. A representative will be happy to assist you.
Sincerely,
o AIN)"1n 0 ~
C~;K:;~E
Annuity Administrator
Annuity Operations Department
F016
Member, Western & Southern Financial Groupe
Annuity Operations Group. PO Box 2918 . Cincinnati, Ohio. 45201-2918
Phone (800) 926-1702 . Fax (513) 629-1799
217
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Ravmond T. Bender
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
FILE NUMBER
21-06-0767
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Ewing Brothers Funeral Home ($6,578.00)
6,578
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Kav Failor. Executrix ($11.388.0C
Social security Number(s) I EIN Number of Personal Representative(s)
StreetAddress
City Carlisle State P A Zip 17013
Year(s) Commission Paid: 2007
11,388
Attomey Fees Frey & Tiley ($9750.00)
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
9,750
State
Zip
Probate Fees (Reimburse Frey & Tiley $310.00)
310
Accountanfs Fees (Included in Attorney's Fees)
N/A
Tax Return Prepare"s Fees (Included in Attorney's Fees)
N/A
The Sentinel- Advertising ($137.03)
137
Cumberland Law Journal - Advertising (Reimburse Frey & Tiley) ($75.00)
75
Register of Wills - Filing Fee for Inheritance Tax Return ($15.00)
15
Register of Wills - Filing Fee for Account ($380.00)
380
TOTAL (Also enter on line 9 Recaoitulation) $
(If more space is nee4ed, insert additional sheets of the same size)
28.633
REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R NT
ESTATE OF FILE NUMBER
Raymond T. Bender 21-06-767
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
VALUE AT DATE
OF DEATH
ITEM
NUMBER
DESCRIPTION
167
1.
Check cleared after death - Personal Checking Account #702021 ($167.15)
2.
Forest Park Health Center (telephone) ($29.68)
30
181
142
40
46
41
142
50
507
40
1,089
700
25
300
60
13
110
44
58
9,095
1,450
-817
35
3.
Kaye N. Failor, reimburse for Moore's Garage bill for vehicle inspections and work ($180.56)
4.
Frey & Tiley - Reimburse for Kepner Auto Ins. ($141.50)
5.
Embarq - telephone ($40.46)
6.
Adam Electric Cooperative, Inc. ($45.57)
7.
Embarq - telephone ($40.98)
8.
Kemper Auto Ins. ($141.50)
9.
Adam Electric Cooperative, Inc. ($49.97)
10.
Frey & Tiley - 1/2 Attorney's fees Nancy Bender Estate. ($506.50)
11.
Embarq - telephone ($40.39)
12.
Cumbo Valley Memrial Gardens - Tombstone for grave of sister, Shirley Ann Bender ($1,089.00)
13.
Roger L. McKeehan - lawn mowing ($700.00)
14.
Frey & Tiley - reimburse for death certificates ($25.00)
15.
S.W. Barrett Real Estate and Appraisal Services ($300.00)
16.
Adam Electric Cooperative, Inc. ($60.38)
17.
Direct T.V. ($13.19)
18.
Kaye N. Failor - reimburse for portable toilets for auction ($110.00)
19.
Adam Electric Cooperative, Inc. ($44.08)
20.
Adam Electric Cooperative, Inc. ($57.99)
21.
Dan Hershey's Auction Service, LLC - Commission - sale of house & personal prop. ($9,094.65)
22.
Transfer Tax due on sale of real estate ($1,450.00)
23.
Net tax pro-ration on sale of real estate (-$816.85)
24.
Kemper Auto Ins. ($35.00)
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the seme size)
13,548
avmon ender -
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(S) OF ESTATE
I. TAXABLE DISTRIBUTIONS Dnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
SEE SCHEDULE J-1 A IT ACHED
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
217
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
R
dT B
SCHEDULE J
BENEFICIARIES
(If more space is needed, insert additional sheets of the same size)
FILE NUMBER
21 06-0767
ESTATE OF:
FILE NUMBER:
BENDER, RAYMOND T.
21-06-0767
SCHEDULE J-l
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP AMOUNT OR
TO DECEDENT SHARE OF ESTATE
NOTE: FIGURES
ARE PRE-TAX
1) Estate of Harriet Sweger Sister 1/4 Residuary
Harriet Sweger Died December 5, 2006 Probate Estate
c/o Thomas E. Flower, Esquire $57,667.50
2109 Market Street
Camp Hill, PA 17011
2) Betty 1. DeWalt Sister 1/4 Residuary
741 Bloserville Road Probate Estate
Newville, P A 17241 $57,667.50
3) Beverly Stets Sister 1/4 Residuary
726 Bloserville Road Probate Estate
Newville, PA 17241 $57,667.50
Heirs of Marie Mckeehan, Pre-Deceased, Sister:
4) Roger L. McKeehan Nephew 1/24 Residuary
15 Mel-Ron Court Probate Estate
Carlisle, PA 17015 $9,611.23
5) Jay L. McKeehan Nephew 1/24 Residuary
1015 Alexander Spring Road Probate Estate
Carlisle, PA 17015 $9,611.23
6) Dale L. McKeehan, Nephew Nephew 1/24 Residuary
1954C Walnut Bottom Road Probate Estate
Carlisle, PA 17015 $9,611.23
7) Barbara 1. Smith, Niece Niece 1/24 Residuary
481 South Spring Garden Street Probate Estate
Carlisle, PA 17013 $9,611.23
8) Brenda Brant, Niece Niece 1/24 Residuary
86 Clay Road Probate Estate
Carlisle, PA 17015 $9,611.23
Page 1 of2
ESTATE OF:
FILE NUMBER:
BENDER, RAYMOND T.
21-06-0767
SCHEDULE J-l
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP AMOUNT OR
TO DECEDENT SHARE OF ESTATE
Heirs of Edgar F. McKeehan, Jr., Pre-Deceased, Nephew:
9) Karol B. Shughart Grand-Niece 1/48 Residuary
9052 Twisted Hickory Road Probate Estate
Bladenboro, NC 28320 $4,805.55
10) Mark D. McKeehan Grand-Nephew 1/48 Residuary
369 Cattail Court Probate Estate
Pennsburg, P A 18073 $4,805.55
Sub-Total: Total of Probate Estate Shares Before Inheritance Tax $230,669.75
11) Kaye N. Failor Niece Beneficiary of
210 Stone House Road IRA and Annuities
Carlisle, PA 17013 See Schedule G
$291,705.00
Total: Total Probate and Non-Probate Taxable Estate $522,374.75
Page 2 of2