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HomeMy WebLinkAbout05-02-07 (4) --.J 15D5b041147 REV-1500 EX (OS-05) PA Department of Revenue Bureau of Individual Taxes PO BOX.280S01 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMA nON BELOW Social Security Number Date of Death . OFFICIAL USE ONLY county Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 7 File Number 0151 Date of Birth 191183999 02032007 03111922 Decedent's Last Name Suffix Decedent's First Name MI BAKE ELNORA E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW o 1. Original Return o 4. Limited Estate THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 00 o 6. Decedent Died Testate (Attach Copy of Will) 0 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82) 0 48. Future Interest CO"llromise 0 5. Federal Estate Tax Return Required (date of death after 12-12-82) 0 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 0 10 Spousal Poverl}t CradII idate of death 0 11. Election to tax under Sec. 9113(A) . between 12-31-91 and -1-95) (Attach Sch. 0) 9. Litigation Proceeds Received ~ORRESPONDENT . THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number JAKES D. BOGAR 7177378761 Firm Name (If Applicable) BOGAR << BIPP LAW OFFICES ONE WEST MAIN STREET '-'I First line of address Second line ot address I r....) ""'._.<~ ::i.J CD --1 City or Post Office SB:IREMANSTOWN State PA ZIP Code 17011 DATE FILED o Correspondent's &-mall address: Bobbette L. Larson James D. Bogar DATE 5/' 0 One West Main treet, Shlremanstown, PA 17011 L Side 1 15[]5b[]41147 15D5b[]41147 --.J -J :L5056042148 REV-1500 EX Decedent's Name: Elnora E. Hake Decedent's Social Security Number RECAPITULATION 191183999 1. Real Estate (Schedule A)..............................._.............................._......................... 1. 2. Stocks and Bonds (Schedule B).............................................................._.............. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .......... 3. 4. Mortgages & Notes Receivable (Schedule 0)..............................._......................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested............. 7. 26,005.46 91,508.31 8. Total Gross Assets (total Lines 1-7).............................................................._...... 8. 117,513.77 3,688.13 9. Funeral Expenses & Administrative Costs (Schedule H)..............................._........ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)................................ 10. 244.90 11. Total Deductions (total Lines 9 & 10)..............................._.............................._..... 11. 3,933.03 113,580.74 12. Net Value of Estate (Line 8 minus Line 11)..............................._............................ 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J)..............................._................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13)................................................ 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X ~ 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14"iaXable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 113,580.74 15. 0.00 113,580.74 16. 5,111.13 0.00 17. 0.00 0.00 0.00 18. 19. Tax Due.............................................................._................................................... 19. 5,111.13 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. D L Side 2 15056042148 15056042148 --1 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-07-0151 DECEDENT'S NAME Elnora E. Hake STREET ADDRESS 826 Acrl Road, Mechanlcsburg, East Pennsboro Twp. CITY / STATE 1ZIP Mechanlcsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credlts/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 5,111.13 3,092.62 255.56 3. Interest/Penalty If applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 3,348.18 Totallnterest/Pena/ty (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. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (58) 1,762.95 1,762.95 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;................................................................................ 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? ........... .................. ............................... ................. ......................... .............. Yes No ~ ; 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 after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~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. ~9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-15GI EX+ (8-91) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF COMMONWEAL l1i OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Hake, Elnora E. FILE NUMBER 21-07-0151 Include the proceeds of litigation and the date the proceeds were received by the 88late. All property /oIntly__ned with the rlllht of survlvorahlp must be dJecloHd on schedule F. ITEM NUMBER DESCRIPTION 1 Clearvlew Federal Credit Union - Certificate of Deposit Account No. 10278783-11858, date of death balance $14,801.98, accrued Interest $62.50 VALUE AT DATE OF DEATH 14,864.48 2 Prudential Financial - Alliance Account No. 4351000860044, date of death balance $11,140.98, accrued Interest $0.00 11.140.98 TOTAL (Also enter on Line 5, Recapitulation) 26,005.46 (If more space is needed, additional pages of the same size) CoPyright (c) 2002 form software only The laCkner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ...-:- ~ -- ~ C~~~Ym~ March 1, 2007 James D. Bogar Attorney at Law One West Main Street Shiremanstown, P A 17011 RE: Accounts for Elnora E. Hake, Account # 10278783 Dear Mr. Bogar, Enclosed please find the information that you requested for balance figures as of February 3rd,2007: . Savings account #10278783-0, balance was $10.00 Joint Ownership account with Bobbette Larson. Checking account #10278783-9, balance was $43.15, Joint ownership with Bobbette Larson. Money Market account #10278783-25, balance was $48,545.80, Joint ownership with Bobbette Larson. Certificate of Deposit account # 1 0278783-11858, balance was $14,801.98 plus interest of $62.50, this certificate has no joint owner. Certificate of Deposit account #10278783-21794, balance was $1300.74 plus interest of $5.77, Joint ownership with Bobette Larson. Thank you for providing an original Certified Death Certificate and Short Certificate. I will be closing out the account and sending the receipts showing the transfer of funds to Bobette Larson's account and a check to the Estate of Elnora E. Hake for Certificate #11858 to Mrs. Larson. Please feel free to contact me, if you should have any questions. I can be reached at PH: (800) 926-0003, Ext. 5027. Sincerely, Catherine Sokolowski Senior, Savings Support Representative cc: Bobbette Larson 8805 University Boulevard, Moon Township, PA 15108-2580 teI412-269-3011 toll-free 1-800-926-0003 -~~ --- , Ch~Y!E~ April 19, 2007 James D. Bogar Attorney at Law One West Main Street Shiremanstown, P A 17011 RE: Accounts for Elnora E. Hake, Account #10278783 Dear Mr. Bogar, As per your letter of February 14th, 2007 and April 12th, 2007 requesting the dates the Joint accounts with Bobbette Larson were opened are as follows: Savings, Checking and Money Market accounts opened was July 8, 1997 original note date for Certificate of Deposit number 21794 was November 26, 1999 original note date for Certificate of Deposit number 11858 was July 17, 1997, this was an individual account, no joint owner I apologize for not completing the necessary information in my response on March 1, 2007. If you need any additional information please feel free to contact me, 800-926-0003 ext 5027. Sincerely, {l~~ Catherine Sokolowski Senior Savings Support Representative 8805 University Boulevard, Moon Township, PA 15108-2580 tel 412-269-3011 toll-free 1-800-926-0003 \ Prudential Alliance Account Services The Prudential Insurance Company of America P.O. Box 41582 Philadelphia, P A J 9 J 76 (877) 255-4262 www.prudcntial.com Prudential. Financial lames D. Bogar 1 W. Main St Shiremansto~ P A 17011 Aprilll,2007. FOE: *********0044 Dear Mr. Bogar: Per YOW" request, this letter is to verifY that the balance of Ms. Elnora Hake' s Alliance account on February 3,2007, was $11,140.98. If you have any questions, please contact us at our toll-free number, 1-877-255-4262, Monday through Friday, 8:00 AM to 8:00 PM (EST). Sincerely, ~~. Laura Harrison Client Services Representative BISYS InfOlTnStion Solutions. L.P. f$ the Administrator of the Prudential ARlance Account Settlement Option, a contractual obligation of The Prudentiellnsurance Company of Americll, located at 751 Broad StJWl, Newark, NJ 07102-3777. Check clearing Is ptDvided by Bank One and processing support is provided by Integrated Payment Systems, Inc. Alliance Account balances IUe not insuf&d by the FederalOepos/t Insurance CorporaUon (FDIC). B/SYS Information Solutions, L.P.. Bank One, and Integrated Payment Systems, Inc. 8le not Prudential Financial companies. \ Rev-1509 EX+(8-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED PROPERTY ESTATE OF FILE NUMBER Hake, Elnora E. 21-07-0151 If en UMt wee mllde Joint within one yur of the declldent's dlI1lt of du1h, It muet be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Bobbette L. Larson ADDRESS RELATIONSHIP TO DECEDENT Daughter 826 Acrl Road Mechanlcsburg, PA 17050 B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSEl INTEREST DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 1 A 9/1312005 Belco Community Credit Union - 202.96 50.000% 101.48 Checking Account No. 851768, date of death balance $202.79, accrued Interest $0.17 2 A 9/1312005 Belco Community Credit Union - 37.147.12 50.000% 18.573.56 Certificate of Deposit No. 40323, date of death balance $37,023.96, accrued Interest $123.17 3 A 7/9/1997 Clearvlew Federal Credit Union - Savings 10.00 50.000% 5.00 Account No. 10278783-0, date of death balance $10.00, accrued Interest $0.00 4 A 7/811997 Clearview Federal Credit Union - 43.15 50.000% 21.58 Checking Account No. 10278783-9, date of death balance $43.15, accrued Interest $0.00 5 A 7/811997 Clearview Federal Credit Union - Money 48.545.80 50.000% 24.272.90 Market Account No.1 0278783-25, date of death balance $48,545.80, accrued Interest $0.00 Total of Continuation Schedules See attached DaGeS TOTAL (Also enter on Line 6, Recapitulation) 91.508.31 (If more space is needed, additional pages of the same size) Copyright (c) 2002 fonn software only The Lackner Group, Inc. Fonn PA-1500 Schedule F (Rev. 6-98) .. Rev-1509EX+(HI) . COMMONWEAllli OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED PROPERTY continued ESTATE OF Hake, Elnora E. FILE NUMBER 21-07-0151 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. JOINTLY OWNED PROPERTY DESCRIPTION OF PROPERTY %OF ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEAi~ DATE OF DEATH FOR JOINT MADE DECO'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEeo FOR VALUE OF ASS INTEREST DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 6 A 11/261199S Clearvlew Federal Credit Union _ 1.306.51 50.000% 653.26 Certificate of Deposit Account No. 10278783-21794, date of death balance $1,300.74, accrued Interest $5. n 7 A 1/2812000 Commerce BanklHarrisburg, N.A. _ 5.074.68 50.000% 2.537.34 Checking Account No. 513172536, date 01 death balance $5,074.47, accrued interest $0.21 8 A 1/2812000 Commerce Bank/Harrisburg, N.A. _ 49.869.82 50.000% 24.934.91 Savings Account No. 616119534, date of death balance $49,864.38, accrued interest $5.44 Copyright (c) 2002 fonn software only The Lackner Group, Inc. Fonn PA-1500 Schedule F (Rev. 6-98) Rev-l509 EX+(8-98) . COMMONWEALTli OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED PROPERTY continued ESTATE OF Hake, Elnora E. FILE NUMBER 21-07-0151 11 an asset was made jOint within one year of the decedent's date of death, it must be reported on schedule G. JOINTLY OWNED PROPERTY DESCRIPTION OF PROPERTY %OF ITEM LETTER DATE INCLUDE NAME OF FINANCIAl INSTITUTION AND BANK ACCOUNT DATE OF DEA!Ji DATE OF DEATH NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASS DECO'S VALUE OF TENANT JOINT JOINTl V-HELD REAL ESTATE. INTEREST DECEDENrSINTEREST 9 A 9/812006 Pennsylvania State Bank/Sterling 40.816.55 50.000% 20.408.28 Financial Corporation - Certificate of Deposit, Account No. 9150009793, date 0 death balance $40,000.00, accrued Interest $816.559 *NOTE: This account was established with a transfer of $40,000.00 from an account maintained by the Decedent, which account was jointly owned with Bobbette L. Larson. The account was a jointly owned account, maintained at Commerce BanklHarrlsburg, N.A., same being Account No. 513172536, as referred to in Item No. 7 hereinabove. As such, this Joint account represents a "rollover" from the joint account with Commerce Bank/Harrisburg, N.A., the joint parties being the same. A copy of the Commerce BanklHarrlsburg, N.A. cancelled check written to fund this account Is attached. TOTAL (Also enter on Line 6, Recapitulation) 91.508.31 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) .. -",. ", :..... . ,',,-,,', '" llELc() C()nununitY~UIu~ .. .....L.-ge~;ok!~~.... .,,, "- "'., ,."", i ", '>-"., ::..-,. ~"". ..<_, ;fI ' ......<'-..:::....::.,:i....'.:..,..;,.".. ... ..~.~~lc6.org , . l-~::;'n:~' "~i"\~(':,"'; ">-'.,.'--~ ;:.: ;;.... :~.;',~;'-t. <:.~.- i:i< ,:~~;'~'<,:/.;:-'; ... ~,::>; April 12, 2007 James D. Bogar Attorney at Law One West Main 8treet 8hiremanstown, P A 17011 RE: Estate of Elnora E. Hake 8.8.#: 191-18-3999 Dear Bonnie, Here is the information for the above referenced account. If you need any further information, please call me at 717-720-6407. Sincerely, ~ April Johnson Finance/Processing Representative 8elco Community Credit Union 403 N. 2nd Street, P.O. BoxB2 Harrisburg, PA mOB 717-232-3526 in Harrisburg areaj 717-393-1116 in Lancaster area 800-642-4482 outside of calling area BELCO COMMUNITY CREDIT UNION 1. Name(s) in which the account was held: DECEDENT ESTATE INFORMATION ELNORA E HAKE(PRIMARY) BOBBETTE LARSON(JOINT) 2. Account number: 851768 3. Balance as of date of death: 2/3/2007 Balance Accrued Dividends For 21312007 YTD Dividends Regular Savings: $ $202.79 $ $0.17 $ $0.25 Christmas Club: $ $ $ Whatever Club: $ $ $ Checking: $ $ $ Money Market: $ $ $ IRA: $ $ $ Certificates: Balance Accrued Dividends YTD Dividends For 2/312007 $37,023.95 $123.17 $182.97 $ $ $ $ $ $ $ $ 4. Date the account was initiated: 9/13/2005 Certificate Number 40323 5. Name(s) in which Safe Deposit Box was held: N1A 6. Date the box was initially rented: N1A 7. Branch address at which the box is located: 8. Loan Information: Balance Accrued Interest Per Diem Int VISA Unsecured Loans: $ $ B. Secured Loans $ $ $ $ $ $ C. Mortgage Loans: $ $ Miscellaneous: --- .............. - .~ ~ c~:g~y!&~ March 1, 2007 James D. Bogar Attorney at Law One West Main Street Shiremanstown, P A 17011 RE: Accounts for Elnora E. Hake, Account # 10278783 Dear Mr. Bogar, Enclosed please find the information that you requested for balance figures as of February 3rd,2007: Savings account #10278783-0, balance was $10.00 Joint Ownership account with Bobbette Larson. Checking account #10278783-9, balance was $43.15, Joint ownership with Bobbette Larson. Money Market account #10278783-25, balance was $48,545.80, Joint ownership with Bobbette Larson. Certificate of Deposit account #10278783-11858, balance was $14,801.98 plus interest of $62.50, this certificate has no joint owner. Certificate of Deposit account #10278783-21794, balance was $1300.74 plus interest of $5.77, Joint ownership with Bobette Larson. Thank you for providing an original Certified Death Certificate and Short Certificate. I will be closing out the account and sending the receipts showing the transfer of funds to Bobette Larson's account and a check to the Estate of Elnora E. Hake for Certificate #11858 to Mrs. Larson. Please feel free to contact me, if you should have any questions. I can be reached at PH: (800) 926-0003, Ext. 5027. Sincerely, Catherine Sokolowski Senior, Savings Support Representative cc: Bobbette Larson 8805 University Boulevard, Moon Township, PA 15108-2580 tel 412-269-3011 toll-free 1-800-926-0003 .... Commerce ~Bank February 27, 2007 James D Bogar 1 W Main St Shiremanstown PA 17011 RE: Estate of: Elnora E Hake Social Security #: 191-18-3999 Date of Death: February 3, 2007 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 #: 513172536 Date Opened: 01/28/00 Primary Owner: Elnora E Hake Secondary Owner: Bobbette Larson Date of Death Balance: $5,074.68 Accrued Interest: $0.21 Principal Balance: $5,074.47 Type: Savings Account #: 616119534 Date Opened: 01/28/00 Primary Owner: Elnora EHake Secondary Owner: Bobbette Larson Date of Death Balance: $49,869.82 Accrued Interest: $5.44 Principal Balance: $49,864.38 If there are any questions or additional information that is needed, please feel free to contact me at (717) 412-6134. Sincerely, 1C'. lV~nlrl{~-' Mindi L ~~u-t./' Levy Specialist Commerce Bank I Harrisburg, N.A. PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.com z o i= ii o D.. a:: o o ...J <( o z <( Z LL. C) Z ::; a:: w .... en .... Q Q N 't"" 't"" Q .... 't"" ~ s.. ~ c. 1lI1l1 ~ C) I .;> 0....-0 III-U)- . 1lI C ~ C >,.- 1lI enCU':e cuElIIl:cu ~~~~ -,<t't""U) . 't"" -'= l: lIS :it Q I- Q en Q OW .". !;:f5 I- ~ II) 01- II) wen cD ::)w 't"" 0::0:: CCl OW .". 01- <~ Q W Q 0 Q Oz Q 0:) Q Q. 0< "It CO .". Z 0 C j:: 0 ~ I!! 1lI I- -l en ...l c; w ~ 0:: CU .Q .c 0 1%1 s.. 0 CU ~ 1lI J: >, e LI. I!! 0 c jjj 0 CD W Q Z - W CCl Il. Q 0 a; w Q l- e( 0 M en 1-0:: .... Zw en ::lm Q O:s 0 (J::l Q ~Z II) ..- en 11.1- O~ WO CD 1l.(J 1; j::(J u 10: e( :e CD (J 0) 0) cuO) ~C"') lIScb.... J:'t""Q .~M WCJ)~ llI't""N s.. .. .. OZc .5(1)0 WU)O W cr: .... co O'l 10 I 10 (\") .... I .... ..... .... - CI:l dl E - (J CI:l - C 0 (J dl en IJ CI:l dl Q. - .~ Q) iti (J '(3 c CI:l dl - 0. (/) CJ) '00 - en C CI:l dl ... . E dl ~ -'= ~ 1::: '(3 ::l ... c: - >. dl 0 Ii (J c: dl CI:l a::: - Q) 0 dl >; (J ..Q c: ~ .!2 c: Q. CI:l dl (J (J ~~ E .f: 0 :::: CJ) U ELNORA- HAKE 826 ACRI ROAD Q, Q /_ MECHANlCSBURG. PA 17050 DATE -"\ 0 ,..0\0 ~~~~'\~~I\ ~.e:aV\\< ~^s"v0 ~(l Com erce ~Bank AmeriCII'. Most ConvenIent Bank!' ~ 7-889.YEs-ootU 1816. 60-184/313 08 $ 4oCOCJ ~ I DOLLARS to -- . -- -~- 1:0:1 .30 J.B l. Sa-: 5. ~1.?25:a -~k~d~/l...-____.__-!!: b 1/- J. a ). g. ,l'OOO 1.000000.,1 MEMO c.:s--__ C\:lOIIW(~ u_ CHICle Account:513172536 Check#:1816 Amount:$40,OOO.OO Date Presented:09-11-2006 K1'L 03769089.10 j9jO~~69~D ROS8 Bj PO . 09 j . j 2006 i..~U 09/ j 1 /2006 03"j9.oe040-:-F~IB~Blilt>a2447< PA STI-.TE ai-.NK EN!.:;4 j 9 j .~ TRC=~292~O Ei9.....aS/2aaG. ::::?:':~::~_n-.. RJ3S3 . ; i ~ J ~ :: ; i ~ ~... . :=.: - - - .::-. -~ COHHEJilCE EANJ{ .'. - .. 71 .. . . , 543 PSg 200 9OS06ttOS2 $40000.00A1 REV-1151 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hake, Elnora E. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-07-0151 ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT See continuation schedule(s) attached 558.13 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Bogar & Hlpp Law Offices 2,460.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills, Cumberland County 118.00 5. Accountant's Fees 6. Tax Return Preparer's Fees H&R Block 52.00 7. Other Administrative Costs See continuation schedule(s) attached 500.00 TOTAL (Also enter on line 9, Recapitulation) 3,688.13 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (8-98) . SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEAL 111 OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hake, Elnora E. FILE NUMBER 21-07-0151 ITEM NUMBER DESCRIPTION AMOUNT 1 Myers Funeral Home - Funeral 405.00 2 St. John's Lutheran Church - Funeral Luncheon 153.13 Subtotal 558.13 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (8-88) . SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hake, Elnora E. FILE NUMBER 21-07-0151 ITEM NUMBER 1 DESCRIPTION RESERVES - Costs to conclude administration ot Estate Including tiling tee tor Pa. Inheritance Tax Return and Inventory, preparation ot 2007 personal taxes and review and/or preparation ot fiduciary Income tax returns AMOUNT 500.00 Subtotal 500.00 CoPyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT OECEDENT ESTATE OF Hake, Elnora E. FILE NUMBER 21-07-0151 Include unrelmbu_d mecllcalllXpen_. ITEM NUMBER DESCRIPTION 1 East Pennsboro Township - Personal Per Capita Tax VALUE AT DATE OF DEATH 4.90 2 Pennsylvania Department ot Revenue - 2006 personal Income tax 240.00 TOTAL (Also enter on Line 10, Recapitulation) 244.90 (If more space is needed, additional pages of the same size) CoPyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) . SCHEDULE .. BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER Hake, Elnora E. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal aistributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not LIst TruatM(l) FILE NUMBER 21-07-0151 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. Bobbette L. Larson 826 Acrl Road Mechanicsburg, PA 17050 Daughter Rest, residue and remainder Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Copyright (c) 2002 form software only The Lackner Group, Inc. TOTAL OF PART 1/- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Form PA-1500 Schedule J (Rev. 6-98) LAST WILL AND TESTAMENT OF ELNORA E. HARE I, ELNORA E. RAKE, of Shiremans t own , Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, to my daughter, BOBBETTE L. LARSON, provided that should she predecease me, then to my son-in-law, GARY M. LARSON. SECOND: In addition to al powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to al property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upOll-- such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funqs, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. THIRD: I direct that all inheritance, estate, trans- fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. FOURTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- 2 tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. ~ f'/~-Vl ~ j -e.1( ~~-/ ELNORA E. RAKE (SEAL) Signed, sealed, published and declared by the above- named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address ~J~ ~i,~ Address 3