HomeMy WebLinkAbout02-23-07
-.J
15056041147
REV -1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX280601
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 1 0 6
00684
Date of Birth
201162618
05282006
07281927
Decedent's Last Name
Suffix
Decedent's First Name
MI
SHILLOW
PATRICIA
A
(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 0 2. Supplemental Return
0 4. Limited Estate 0 4a. Future Interest Compromise
(date of death after 12-12-82)
~ 6. Decedert Died Testate 0 7. Decedent Maintained a living Trust
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o
o 8. Total Number of Safe Deposit Boxes
o 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
RICHARD E. CONNELL
7172328731
Firm Name (If Applicable)
BALL MURREN AND CONNELL
REGISTER OF WILLS USE eNL Y
First line of address
2303 MARKET STREET
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
CAMP HILL
PA
17011
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATYRE 9F PERSON RESPONSIBL~ F~R FILlN_Gf~roRN D~TE.. ,
.. . -<-;. A_ J-/ ,-:::::~:l_e Kathleen M. Hellam,",0~~/t' 7
ADDRE S -' ,
205 Lantzy Road,
SIGNATURE OF :~_~A~~;~_ 'r~l:N R
-- . - --- ,/
Richard E. Connell
DATE
') /,' ) /1/ "7
. ."t.. i /--,,~, l.
ADDRESS
2303 Market Street, Camp Hill, PA 17011
L
Side 1
15056041147
15056041147
-.J
....J
15056042148
REV-1500 EX
Deceden,,:'s Name
SHILLOW, PATRICIA A.
RECAPITULATION
1. Real E~~e(Schedu~
2. Stocks and Bonds (Schedule
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).. 3.
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)..
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested..
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 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)
12. Net Value of Estate (Line 8 minus Line 11)..
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)
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
170,159.05
16.
17.
18.
19. Tax Due..
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
L
Side 2
15056042148
Decedent's Social Security Number
201162618
1.
168,375.36
14,000.00
2.
4.
5.
:500.00
6.
2,172.71
7.
8.
185,048.07
13,!543.69
9.
10.
1,345.33
14,889.02
170,159.05
11
12.
13.
14.
170,159.05
7,657.16
7,657.16
~
15056042148
....J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Shillow, Patricia A.
STREET ADDRESS
484 Brighton Place
File Number 21 - 06 - 00684
CITY
Mechanicsburg
STATE ---- [ZIP-- -- - -- -
PA 1 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pnor Payments
C Discount
(1)
7,657.16
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
0.00
Total Interest/Penalty (0 + 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.
(3)
(4)
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
7,657.16
7,657.16
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and:
a. retain the use or income of the property transferred; .............................................
b. retain the right to designate who shall use the property transferred or its income;..
c. retain a reversionary interest;
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?
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?....... ................. liU
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
1 -. ~!
x
~. -
1 -" I
-!
1)(.1
,- -
X
. x~
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 PS S9116 (a) (1.1) (i)J.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P .8. S9116 (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 PS. S9116 (a) (1.2)J.
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 (45) percent,
except as noted in 72 PS S9116 1.2) [72 PS S9116 (a) (1 )J.
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 PS S9116 (a) (13)]. 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.
SCHEDULE A
REAL ESTATE
COMMONWf Al Tj-j OF PI:NN8YLV^NIA
INHEHITANGL TAX RI TURN
RESIDfN I llf CElll.NT
ESTATE OF Shillow, Patricia A.
FILE NUMBER
21 - 06 - 00684
-.. -- ---- ------ ...--- ---- ---- -- -
___ n_. ___ .._ _ _... ____ ..___ ...____ __ ___ _
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 knowled~le of the relevant facts Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
484 Brighton Place
Mechanicsburg, PA 17055 (Upper Allen Twp.)
Tax ParcellD #42-24-0791-164
168,375.36
Legal Description Attached
Selling Price
Gross Amount due Seller
Reduction in Amount Due Seller
Net Amount from Sale
$ 169,900.00
171,087.04
2,711.68
$ 168,375.36 (Per HUD-1 (attached))
TOTAL (Also enter on Line 1, Recapitulation)
168,375.36
EXIllBIT 'A'
ALL THAT CERTAIN condominium unit situated in Brighton Place, A Condominium (The
Condominium), Upper Allen Township, Cumberland County, Pennsylvania, designated as Unit No.
484 in the Declaration of Condominium dated October I I, 1990, recorded October 12, 1990 in
Cumberland County Misc. Book 388, Page 265, and the Plats and Plans dated October II, 1990,
recorded October 12,1990 in Cumberland County Plan Book 61, Page 93, as amended by the First
Amendment to Declaration of Condominium of Brighton Place, a Condominium, dated October 30,
1991, recorded November 7, 1991 in Cumberland County Misc. Book 407, Page 92 and Plat
recorded in PIan Book 63, Page 98, and the Second Amendment to the Declaration of Condominium
of Brighton Place, a Condominium, dated November 22, 1991, recorded November 27, 1991 in
Cumberland County Misc. Book 407, Page 1169 and the Third Amendment to Declaration of
Condominium of Brighton Place, a Condominium, dated March 2, 1992, recorded March 2, 1992 in
Cumberland County Misc. Book 413, Page 59 and Plat recorded in Plan Book 64. Page 12 and the
Founh A.mendment to Declaration of Conduminium of Brighton Place, a Condominium, dated May
21, 1993, recorded May 21,1993 in Cumberland County Misc. Book 444, Page 985 and Plat
recorded in Plan Book 66, Page 34 and the Fifth Amendment to Declaration of Condominium of
Brighton Place, a Condominium, dated August 10, ! 993, recorded August 11, 1993 in Cumberland
County Misc. Book 451, Page 517 and Plat recorded in Plan Book 66, Page 100 under the Provisions
of the Uniionn Condominium Act of the Commonwealth of Pennsylvania (Act of July 2. 1980. P.L.
286. No. 82) (the Act).
TOGETHER with all the right, title and interest of, in and to the Common Elements as more fully set
fonh in the aforesaid Declaration of Condominium and Declaration Plan, as amended from time to
time.
UNDER AND SUBJECT, nevertheless, to easements, restrictions, reservations, conditions and tights
of way ofrecord or visible upon inspection of premises.
I-'revlOus eOl[lOns are OOsole[e
A. Sett,lement Statement
S. Type of Loan
TOrm HUlJ~l (:.:1mb) reT HanaOOOK 4;;SUO,~
1. DFHA 2. DFmHA 3. ~ConY. Unins. , 6. File Number I 7. Loan Number IS. Mortgage Insurance Case Number
4. OVA 5. OCony. Ins. 2007008
C. Note: Items marked '(p.o.c.)" :..~;; ~~;'d ~utside the closing; they are shown h~re for i~;~r:;;atio~ ~~~poses and are not included in the t~tals. /" TitleExpress Settlement System
WARNING: It IS a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon
conviction can include a fine and imprisonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010. Printed 02/09/2007 at 16:03 CTD
D. NAME OF BORROWER: Barbara S. Areati
ADDRESS 38 Granada Ave. W., Lindenhurst, NY 11757
E. NAME OF SELLER Kathleen M. Hellam, Executrix of the Estate of Patricia A. Shillow
ADDRESS: 484 Brighton Place, Mechanicsburg, PA 17055
F. NAME OF LENDER: Integrity Bank
ADDRESS: 3345 Market street. CamD Hill. PA 17011
G. PROPERTY ADDRESS: 484 Brighton Place, Mechanicsburg, PA 17055
UDDer Allen TownshiD
H. SETTLEMENT AGEW: Absolute Abstract, LLC, Telephone: 717.432.7102 Fax: 717-432.1535
PLACE OF SETTLEMENT: 125 West Harrisbura street. Dillsbura. PA 17019
I. SETTLEMENT DATE: 02/09/2007
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales price 169.900.00 401. Contract sales price 169.900.00
102. Personal Property 402. Personal Property
103. Settlement charaes to borrower (line 1400) 3.230.75 40J
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes 406. Citv/town taxes
107. County taxes 02/09/07 to 12/31/07 420.07 407. County taxes 02/09/07 to 12/31/07 420.07
108. School taxes 02/09/07 to 06/30/07 630.06 408. School taxes 02/09/07 to 06/30/07 630.06
109. Sewer 02/09/07 to 03/31/07 56.66 409. Sewer 02/09/07 to 03/31/07 56.66
110. HOA Fee (Feb) 02/09/07 to 02/28/07 80.25 410. HOA Fee !Feb) 02/09/07 to 02/28/07 80.25
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 174317.79 420. GROSS AMOUNT DUE TO SELLER 171.087.04
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnest money 2 000.00 501. Excess Deposit (see instructions)
202. PrinciDal amount of new loans 75 000.00 502. Settlement charaes to' seller (line 1400\ 2.711.68
203. Existina loan Is) taken subiect to 503. Existina loan Is) taken subiect to
204. 504. Payoff of First Mortaaae Loan
205. 505. -
206. 506. ,
207. 507.
208. 508.
209. 509.
Adjustments for items unDaid bv seller Adjustments for items unDaid bv seller
210. City/town taxes 510. Citv/town taxes
211. County taxes 511. County taxes
212. School taxes 512. School taxes
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 77.000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 2711.68
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Grass amount due from borrower (line 120\ 174317.79 601. Gross amount due to seller (line 420\ 171.087.04
302. Less amounts paid by/for borrower (line 220\ 77 000.00 602. Less reduction amount due seller !line 520\ 2.711.68
303. CASH FROM BORROWER 97.317.79 603. CASH TO SELLER 168375.36
U.S. Department of Housing and Urban Development
OMS Approval No. 2502-0265
SUBSTITUTE FORM 1099 SEllER STATEMENT: The information contained herein IS important tax information and is being furnished to the Intemal Revenue Service. If you are required to file a return,
a neglrgence penalty or other sanctIOn WlII be Imposed on you If thiS Item IS reqUired to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of this transaction.
You are required by law to provide. tne seWement agent (Fed. Tax 10 No: 71-0911 067)with your. correct taxpayer identification number. If you do not provide your correct taxpayer identification
number, you may be subject to "'Vii Dr cnmlnal penalties Imposed by law. Under penalties of pe~ury, I certify that the number shown on this statement is my correct taxpayer identification number.
TIN_-_-__/_-_
SEllER(S) NEW MAiliNG ADDRESS:
SEllER(S) PHONE NUMBERS:
SELLER(S) SIGNATURE(S):
(H)
(W)
t-'reVlOUS ealtlons are OOSOlete
u.s. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
TOrm "'UU-, {~/~ti} rer HanaOOOK 4~Uo.L
. I it e XDress ettlement :ivstem rinte o : 7 at TO
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $169,900.00 = BORROWER'S SELLER'S
Division of commission (line 700) as follows: FUNDS )\T FUNDS AT
701 $ to SETTLEMENT SETTLEMENT
702. $ to
703. Commission paid at Settlement
704. Transaction Fee to RElMAX A-1 Realtv. Inc. 200.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Oriaination Fee %
802. Loan Discount %
803. Appraisal Fee
804. Credit ReDort
805. Lender's Inspection Fee
806. Mortaaae Aoolication Fee
807. Assumotion Fee
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to (cj)$ /dav
902. Mortaaae Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. (al $ /mo
1002. Mortqaae Insurance mo. (cj)$ /mo
1003. Citv Prooertv Tax mo. (cj) $ /mo
1004. County Property Tax mo. (cj) $ /mo
1005. School taxes mo. (cj) $ /mo
1009. Aaareaate Analvsis Adiustment 0.00 0.00
1100. TITLE CHARGES
1101. Settlement or c10sinq fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Deed Preparation to Absolute Abstract LLC 115.00
1106. Notarv Fees to Chris Damron 5.00 10.00
1107. Attornev's fees
(includes above items No: )
1108. Title Insurance to Absolute Abstract. LLC 1,203.75
(includes above items No: BASIC RATE )
1109. Lender's Policv 75.000.00 -
1110. Owner's Policv 169.900.00 -1.203.75
1111. End 100, End 300 End 900 to Absolute Abstract, LLC 150.00
1112.
1113. ClosinaSvcLtr to Absolute Abstract, LLC 35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordina Fees Deed $ 38.50 . Mortaaae $ 54.50 . Release $ 93.00
1202. CitY/County tax/stamps Deed $1 699.00 . Mortaaae $ 1.699.00
1203. State Tax/stamos Deed $1 699.00 . Mortaaae $ 1.699.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Sewer (1st Quarter) to Upper Allen Township 100.00
1302. 2007 Countv/Municioal Tax to Marlin Yohn. Sr. Treasurer 470.33
1303. Tax Certification Fee to Marlin A. Yohn Sr. 5.00
1304. HOA Fee (Feb) to Brighton Place 112.35
1305. Pest Inspection to Interstate Termite & Pest Control 45.00
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K) 3.230.75 2711.68
File Number: 2007008
TIE S S
PAGE 2
P d 02/ 9/200 1603 C
I have carefully reviewed the HUD-1 Settlement tatement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my accounl
or b e in this transaction. I furthpertity th I ave received a copy of the HUD-1 Settlement Statement.
~ //\ U -,
HUD CERTIFICATION OF BUYER AND SELLER
~-:2~~~
WARNING: IT is A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN iNCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TinE 18:
u.s. CODE SECTION 1001 AND SECTION 1010.
SETnEMENT AGENT:
,~
~~
SCHEDULE B
STOCKS & BONDS
COMMONWFAL Hi OF PeNNSYLVANIA
INHERITANCllAX Rl~!UI~\N
HESICH N I DEel D[ NT
ESTATE OF Shillow, Patricia A.
FILE NUMBER
21 - 06 - 00684
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM I
NUMBER I
DESCRIPTION
UNIT VALUE
VALUE AT DATE
OF DEATH
Series HH Bonds - (See Attached) 14,000.00
Total Redeemed Amount $ 14,000,00
TOTAL (Also enter on line 2, Recapitulation)
14,000.00
--
Bond Serial Issue
Number Date
[p 03 349 393 HH Jl02 93
fD 03 349 394 HH 110293
D 03 349 395 HH 0293
J ij
:In 03.349 396 HH 1102 93
In 03 349 397 HH 1102 93
,In 03 349 398 HH 1102 93
liD 03 349 399 HH 1102 93
'In 03 349 400 HH 1102 93
1M 00876060 HH t0987
:1M 00 876 061 HH 1109 87
1M 00 876 062 liB ]/09 87
1M 00 876 063 HH '~9 87
[M 00 876 064 HH 1109 87
JM 00 876 065 liB Jl09 87
1M 00 876 066 HH 1109 87
1M 02 221 009 HH Jl09 87
.1M 02 221 010 HH ::1[0987
1M 02 221 011 HH 1109 87
-
j
I
i
I
l
J
I
'.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
(;OMMONWltl.LTfI OF PI.NNSYLVANIA
INHF"HIIANCf: TAX RFTUHN
m SI[kNr mer DENl
ESTATE OF Shillow, Patricia A.
I
- .-'-- ..- -- --- -. --.. .-- .-.--
- 'FILENUMBER-
_ _J 2_1 -_06 -~0684
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
Miscellaneous Personal Property
- - - r-------
. VALUE AT DATE
OF DEATH
TOTAL (Also enter on Line 5, Recapitulation)
500.00
500.00
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE. TAX RETURN
RESIDENT DECEDENT
--~
-- -- -
ESTATE OF
Shillow, Patricia A.
FILE NUMBER
I 21 - 06 - 00684
I
--- ---- --- - ----- ...- --
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
- - ----- - -
Kathleen M. Hellam
ADDRESS
RELATIONSHIP TO DECEDENT
A
205 Lantzy Road
Mechanicsburg, PA 17055
Daughter
JOINTLY OWNED PROPERTY
ITEM i LETTER
NUMBER ,FOR JOINT i
I TENANT
DATE
MADE
JOINT
I~clu~e ~~me~9~a9,~lfI~2t~~~!r?~~b~~~t~co~nt nU~ber
or similar identifying number. Attach deed for jointly-held real
!e~tat~ ____ __ _
M& T Personal Savings
15004200220107
j-- -- - ~ - % OF
I DATE OF DEATH DECD'S:
VALUE OF ASSET INTEREST
----I
525.07 50%
DATE OF DEATH
VALUE OF
DECEDENTS INTERE.ST
01/01/1990
262.54
2
I
I i
07/01/1990 ! Belco Community Credit Union
Account Number 432770
1) Regular Savings
j
5.00 i 50%
2.50
3
07/01/1990 Belco Community Credit Union
Account Number 432770
2) Checking
3,815.33! 50%
1.907.67
j
_ L_
TOTAL (Also enter on line 6, Recapitulation)
2,172.71
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRA 1lVE COSTS
COMMONWLAI IH Of- I'ENNSYl VANI^
INHFnl1 ^NI~F r AX RF 1 URN
HI SI[l['" 1 DECH)f NT
- I _ __ ___
ESTATE OF Shillow, Patricia A.
FILE NUMBER
21 - 06 - 00684
Debts of decedent must be reported on Schedule I.
-- ----- ----
ITEM
NUMBER FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
A. Malpezzi Funeral Home
2 Garden Bouquet - Flowers
3 Honorarium - Rev. Chester Snyder
4 I Post-funeral reception
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
I Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State
Zip
2.
Attorney's Fees
Ball, Murren & Connell
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 F'ees
Cumberland Co. - Register of Wills 8/2/06
5. Accountant's Fees
6.
James Bruzga, CPA - Preparation of final lifetime return _
Tax Return Preparer's Fees
7. Other Administrative Costs
Condo Fees - Brighton Place
TOTAL (Also enter on line 9, Recapitulation)
8,210.40
214.12
150.00
83.27
800.00
310.00
400.00
888.10
13,543.69
Schedule H
Funeral Expenses &
Administrative Costs contiuJed
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Shillow, Patricia A.
2
PP&L - Electric
3
United Water
FILE NUMBER
_ J 2~ -~6 ~.. 0~684
349.19
76.28
1,669.74
122.00
50.00
108.79
100.00
11.80
4
Real Estate Taxes - 2006
5
i Homeowners Insurance - Erie Insurance ($172.00 less $50 rebate)
6
Trash
7
Condo selling costs
8
Condo - floor repair for sale
9
Ball, Murren & Connell - Costs Advanced
Page 2 of Schedule H
,~
~
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWlAI TH 01 PENNsYI_VANIA
INHERITANCE lAX RL JURN
RFSIl)I-NT llLCFDLNT
ESTATE OF Shillow, Patricia A.
FILE NUMBER
21 - 06 - 00684
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION AMOUNT
Prescription - Neighbor Care
573.11
2 1/2 of Refund of unearned pension for June 2006 - deposited May 2006. Charged out of Belco
account June 2, 2006.
772.22
TOTAL (Also enter on Line 10, Recapitulation)
1,345.33
REV-1513 EX+ (9-00)
*,
COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Shillow, Patricia A.
U_ I FILE NUMBER
21 - 06 - 00684
r-
NUMBER
NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
- --
SHARE OF ESTATE
(Words)
AMOUNT OF ESTATE
(S$$)
I.
TAXABLE DISTRIBUTIONS[include outright spousal
I distributions, and transfers
I under Sec. 9116 (a) (1.2)]
Kathleen M. Hellam
Daughter
one-third
2 Susan S. Poff
Daughter
one-third
3 James D. Shillow, Jr.
Son
one-third
I
I
I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Re~ 1500 cover sheet
II.
NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
! NOT BEING MADE
I
I
18 CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET1
-- ---.. ---... ---- ___ -1_
0.00
LAW OFFICES OF
;TEPHEN J. HOGG
401 E. LOUTHER STREET
CARLISLE, PA 17013
WILL OF
Co,()
~
PATRICIA A. SHILLOW
I, PATRICIA A. SHILLOW, of Camp Hill, Cumberland
County, Pennsylvania, declare this to be my last Will and
hereby revoke all prior wills and codicils.
1. I direct that all my just debts, funeral
expenses, gravemarker and administrative expenses shall
be paid from my residuary estate as soon as practicable
after my death.
2. I direct that all inheritance, estate, transfer,
succession and death taxes of any kind whatsoever which
may be payable by reason of my death shall be paid out of
my residuary estate.
3. I direct that my entire estate be distributed as
follows:
A. I leave my entire estate of whatever nature and
wherever situate to my, husband, James D.
Shillow, Sr., should he survive me.
B. Should my spouse predecease me, I then leave
my entire estate to be divided equally among
my three children, Kathleen M. Hellam,
Susan S. Poff and James D. Shillow, Jr.
C. Should any of my children predecease me, then
that child's share shall pass to his or her
children equally.
D. I give those articles of my personal property
and effects to the persons designated in a
separate memorandum which I shall place with my
Will.
4. I appoint Kathleen M. Hellam, as Executrix of
this my last Will. If she should predecease me or cease
to act in such capacity, I name Susan S. Poff to so
serve.
5. The Executrix of this Will shall have the power
to distribute my estate in kind or in cash, or partly in
either.
.'
,
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///1-
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LAW OFFICES OF
'TEPHENJ. HOGG
101 E. LOUTHER STREET
CARLISLE, PA 17013
6. I direct that no Executrix acting under this
Will shall be required to enter bond in any jurisdiction.
IN WITNESS ~E.REOFI .1 have hereunto set my hand this
/Sd. day of ,ADct?.q,J~/L I 1992.
a~~c/~~fi~
PATRICIA A. SHILLOW
~/If
....S';-JI C!--
LAW OFFICES OF
;TEPHEN J. HOGG
101 E. LOUTHER STREET
CARLISLE. PA 17013
The preceding instrument consisting of this and two
other pages was on the day and date hereof signed,
published and declared by PATRICIA A. SHILLOW, as and for
her last Will in the presence of us, who at her request,
in her presence and in the presence of each other have
subscribed our names as witnesses hereto.
~a1( YJ 7. (]tLAA<..UL
LAW OFFICES OF
:TEPHENJ. HOGG
101 E. LOUTHER STREET
CARLISLE, PA 17013
ACKNOWLEDGMENT
Commonwealth of Pennylvania
ss
County of Cumberland
I, PATRICIA A. SHILLOW, the testatrix, whose name is
signed to the attached or foregoing instrument, having
been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as
my last Will; that I signed it willingly and as my free
and voluntary act for the purposes therein expressed.
a-2Z~~ // ./L 4:~//J
PATRICIA A. SHILLOW
Sworn to or affirmed and acknowledged before
P~TRICIA A. SHILLOW, the testatrix, this ,.s~ da
~C'.J.".~..J..J.v , 1992.
/
me by
of
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t;~f~~~~~~~";""';~[!~~~p~ VIT
Commonwealth of Pennsylvania
ss
County of Cumberland
We, Ski( lev t. I!qr5 rand 0'u.s.QI1 /11, ()at1v-er ,
the witnesses wHose names are signed to the attached or
foregoing instrument, being ?uly qualified according to
law, do depose and say that we were present and saw the
testatrix sign and execute the instrument as her last
Will; that the testatrix signed willingly and executed it
as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing
and sight of the testatrix signed the Will as a witness;
and that to the best of our knowledge the testatrix. was
at that time 18 or more years of age, of sound mind and
under no nstrai t or undue influence.
.. ~Cvt/L 711, CtuI>>JL-.
Sworn to or af~rmed and subscribed to before me by
witnesses, this 15 day of 17~~~~ ,1992.
~ '>on-'!',', ~~ ;','.'\'~'l.;
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J ;}_>T:&.~:'"~' :':;'J~'r:-,,,,,"-'_"!:',i}l~:-> _",: ,',' :~l:' :-;-i',;,;
INVENTORY
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
Kathleen M. Hellam
Personal Representative(s) of the Estate of Shillow, Patricia A.
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
tmy ~,~e;:~et~~~t~~,::;e~~~~e~~~~i;h~t~~I:~e~';'te- } ~~ t, ~.;1ja';>>'( . _il {/4 / -<
ments herein are made subject to the penalties of
18 Pa.C.S. S 4904 relating to unsworn falsification to }
authorities.
File Number 21 - 06 - 00684
Attorney -- (Name)
(Firm)
Richard E. Connell, Esquire
Ball, Murren & Connell
(Supreme Court /.D. No.) 21542
(Address)
(Telephone)
2303 Market Street Camp Hill, P A 17011
(717) 232-8731
DATE OF DEATH
5/28/2006
LAST RESIDENCE
484 Brighton Place
Mechanicsburg, PA 17055
I FIGURES MUST BE TOTALED I
DECEDENT'S SOC SEC NO
201-16-2618
Personal Property
Series HH Bonds - (See Attached) 14.000.00
Total Redeemed Amount $ 14,000.00
Miscellaneous Personal Property 500.00
Total Personal Property
$14,500.00
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$182,875.36
INVENTORY
(continued)
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
File Number 21 - 06 - 00684
DATE OF DEATH
5/28/2006
cAST RESIDENCE
484 Brighton Place
Mechanicsburg, PA 17055
DECEDENT'S SIX SEC. NO
201-16-2618
Real Estate
484 Brighton Place
Mechanicsburg, PA 17055 (Upper Allen Twp.)
Tax ParcellD #42-24-0791-164
168.375.36
Legal Description Attached
Selling Price
Gross Amount due Seller
Reduction in Amount Due Seller
Net Amount from Sale
$ 169,900.00
171,087.04
2,711.68
$ 168,375.36 (Per HUD-1 (attached))
Total Real Estate
$168,375.36
2