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HomeMy WebLinkAbout06-06-07 (4) --.J 15056041125 REV -1500 EX (06-05) PA Department of Revenue. ~~~~~~~~~~~uaITaxes' .' INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 7 File Number o 0 8 1 Date of Birth 26574 3 153 o 1 1 6 2 0 0 7 09121922 Decedent's Last Name Suffix Decedent's First Name ALEMAN TOMAS MI M (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 [ZJ 1. Original Return D 4. Limited Estate [ZJ D 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113{A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received D D D D 1 8. Total Number of Safe Deposit Boxes 2. Supplemental Return D D 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required B E N JAM I N J B U T L E R 7 1 7 2 3 6 1 4 8 5 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY B U T L E R LAW F I R M First line of address 5 0 0 N T H I R D S T R E E T Second line of address P 0 B 0 X 1 0 o 4 City or Post Office State ZIP Code DATE FIL.~D H A R R I S B U R G P A 1 7 1 0 8 Correspondent's e-mail address:LAWYERS@BUTLERLAWFIRM.COM Under penalties of pe~ury, 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. SIG F PERSO PONSIBLE FOR FILING RETURN STREET SHIREMANSTOWN PA 17011 DATE -3 I'-b 7 ADDR 500 PO BOX 1004 HARRISBURG PLEASE USE ORIGINAL FORM ONLY PA 17108 Side 1 L 15056041125 15056041125 --.J <:N' ~ 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: TOMAS M. ALEMAN RECAPITULATION 26574 315 3 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ....................... . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 3 1 4 3 . 4 3 ...... . 6. Jointly Owned Property (Schedule F) o Separate Billing Requested . . . . . . . 6. 2 8 1 0 o . 4 3 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested. . . . . . . 7. 3 5 4 8 3 . 3 2 8. Total Gross Assets (total Lines 1-7) .......................... . 8. 6 6 7 2 7 . 1 8 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 9 9 6 5. 3 6 ............... . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 8 7 o . 0 0 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 0 8 3 5 . 3 6 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 5 5 8 9 1 . 8 2 13. Charitable and Governmental Bequests/See 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. 5 5 8 9 1. 8 2 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 _ o . 0 0 15. O. 0 0 16. Amount of Line 14 taxable at lineal rate X .012- 5 5 8 9 1 . 8 2 16. 2 5 1 5 . 1 3 17. Amount of Line 14 taxable o . at sibling rate X .12 0 0 17. o . 0 0 18. Amount of Line 14 taxable o . 0 0 at collateral rate X .15 18. O. 0 0 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 2 5 1 5 . 1 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o Side 2 L 15056042126 15056042126 ~ REV-1500 EX page 3 De~edent's Complete Address: File Number 21 07 0081 DECEDENT'S NAME TOMAS M. ALEMAN STREET ADDRESS 108 FRONT STREET CITY I STATE I ZIP SHIREMANSTOWN PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 2,515.13 2,000.00 105.26 Total Credits (A + B + C) (2) 2,105.26 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 409.87 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 409.87 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: Yes No a. retain the use or income of the property transferred; ...................................................................... 0 [Xl b. retain the right to designate who shall use the property transferred or its income; ............................... 0 [Xl c. retain a reversionary interest; or ................................................................................................ 0 [Xl d. receive the promise for life of either payments, benefits or care? ....................................................... 0 [Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 [Xl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 [Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. [Xl 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.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-1508 EX.+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF TOMAS M. ALEMAN FILE NUMBER 21 07 0081 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Citizens Bank - Checking Account No. 6204519119 with accrued interest of $0.00 VALUE AT DATE OF DEATH 2,621.26 2. Coins 377.60 3. SERS - Pro-rated January payment 144.57 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,143.43 REV-1509 EXf (6-98) '* SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TOMAS M. ALEMAN FILE NUMBER 21 07 0081 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 ADDRESS RELATIONSHIP TO DECEDENT A. Tomas Aleman 108 Front Street Lineal Shiremanstown, PAl 7011 B c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY '!oOF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DE CD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 11/15/03 Citizens Bank - Checking Account No. 6202924768 12,898.98 50. 6,449.49 with accrued interest of $0.00 2. A. 8/18/04 Citizens Bank - Time Deposits Account No. 6244730394 43,301.87 50. 21,650.94 with accrued interest of $122.44 TOTAL (Also enter on line 6, Recapitulation) $ 28,100.43 (If more space is needed, insert additional sheets of the same size) REV-1510 EX-+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY ESTATE OF TOMAS M. ALEMAN FILE NUMBER 21 07 0081 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE (IF APPLICABLE) 1, RiverSource - Non-Qualified Annuity No. 9920-5865890 35,483.32 100. 35,483.32 Beneficiaries: Tomas Aleman (lineal) & Rosaura M. Basko (lineal) TOTAL (Also enter on line 7 Recapitulation) $ 35,483.32 (If more space is needed, insert additional sheets of the same size) REV-1511 EX.+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TOMAS M. ALEMAN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 07 0081 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hetrick Funeral Home 5,292.69 2. Larry Baker 230.00 3. Funeral Reception 209.00 4. Church 150.00 5. Minister 50.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Butler Law Firm 3,500.00 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 182.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal - Estate Advertising 75.00 8. The Sentinel - Estate Advertising 166.07 9. Notary Fees 5.00 10. Photocopies 0.60 11. Cordier Antiques & Fine Art - Coin Appraisal 50.00 12. Overnight Mail (estimate) 25.00 13. Cumberland County Register of Wills - Filing Fee 30.00 TOTAL (Also enter on line 9, Recapitulation) $ 9965.36 (If more space is needed, insert additional sheets of the same size) REV-15.12 EX + (12-03) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TOMAS M. ALEMAN FILE NUMBER 21 07 0081 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Urology of Central P A 210.00 2. South Central EMS 660.00 TOTAL (Also enter on line 10, Recapitulation) $ 870.00 (If more space is needed, insert additional sheets of the same size) RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Tomas Aleman Lineal 38,150.16 108 Front Street Shiremanstown, P A 17011 2. Rosaura M. Basko Lineal 17,741.66 5780 Force Road Gillette, WY 82718 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ,~-"" ":' ',* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TOMAS M. ALEMAN SCHEDULE J BENEFICIARIES FILE NUMBER 21 07 0081 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF TOMAS M. ALEMAN I, TOMAS M. ALEMAN, of Lower Paxton Township, Dauphin County, Pennsylvania, being of sound mind, memory and understanding, do make and publish this, my Last Will and Testament, hereby revoking and making void all Wills and Codicils by me at any time heretofore made. ITEM 1. I direct that my Executrix, hereinafter named, pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. ITEM 2. I give, devise and bequeath unto my wife, ROSAURA A. ALEMAN, absolutely and in fee simple, all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and kind and wheresoever the same shall be at the time of my death. ITEM 3. In the event that my wife, ROSAURA A. ALEMAN, should predecease me or if she and I should die as a result of a common disaster or under such circumstances that it is difficult or impossible to determine who died first, I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and kind and wheresoever the same shall be at the time of my death unto my children, TOMAS ALE~~ and ROSAURA M. BASKO, equally, share and share alike. In the event that one of my children should not then be living, his or her share shall be distributed to his or her children, if any, in equal shares, or if none, the entire rest, residue and remainder of my estate shall be distributed to my surviving child. .-7. '-., C:-l c:~) --l [',,) ~::- = ITEM 4. I hereby nominate, constitute and appoint my wife, ROSAURA A. ALEMAN, to be the Executrix of my estate. In the event that she is unable or unwilling to serve in this capacity, I then nominate constitute and appoint my son, TOMAS ALEMAN of Mechanicsburg, Pennsylvania, and my daughter, ROSAURA M. BASKO of West Virginia, Co-Executors of my estate. My Executrix (or Co-Executors as the case may be) are specifically relieved from the duty or obligation of filing any bond or bonds. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this 2'1 day of c/t:Jz-nu.~;! , A.D., 1985. ~ /) 1# / p~ /Jt. a(O~a-z.-1-/ TOMAS M. ALEMAN WITNESS; 2 /) / ,', /~ tJ Lt I) /7l- -c:Cc,,- residing at 30\\$1. C~"-) ,r::;h-<-SP ~L<---, k<-(f (?, /7/ (0 /-"~:;'" / ! l.. _/, A;,!L-"i.:c. ...'LJ ( (~, \ J residing at 0_;,:, /c< '.'7 ,/ ," / 1 \:5' / .'. _."t. (: f..-/ C.~7-~ I / /~tj'_#'L---l?'C",<l.-"'?o"""" . (SEAL) .-,) O>:,.?(." L..#-/L-V"'.J / //', /',' , . !... tc t. (C'", ;:;~;'''7 C , .1)7 /-;'-'; ,.., ~.. .,..- ./ /' (';/' :{ COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF DAUPHIN WE ~OMAS M ALE~ .r<~) /j. Ie'. ,-ol ,V /',vpp :..). .'~;-L n1 /"-/v : the Testator and the . hz / , I /7 " . %74rA:t4' . U/~ ./ TOMAS M. ALEMAN ~flJ flveL- Witness /I -- r--X/ //'Ld'~') '. ) I '- , Witness / ,./!.:...... . e. ,\/,.7-<- <7.. r---'" Subscribed, sworn to and acknowledged before me by T~S M. ALE~, th~, Test.a:?r and ~b9cFibed ansI sworn to before me by /{~,;tj;?/,,( [/ 15 ((/~C/i./ and I/j,t'//-':". /~'Z;j{'!4!.1'-/l/, the witnesses, this ...2!i.!.....day of -J.4?vv/1/!.<, 1985. 7 / ~ -3- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ALEMAN TOMAS 108 FRONT STREET SHIREMANSTOWN, PA 17011 -------- fold ESTATE INFORMATION: SSN: 265-74-3153 FILE NUMBER: 2107-0081 DECEDENT NAME: ALEMAN TOMAS M DA TE OF PAYMENT: 04/13/2007 POSTMARK DATE: 04/12/2007 COUNTY: CUMBERLAND DATE OF DEATH: 01/16/2007 NO. CD 008018 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: TOMAS ALEMAN CHECK# 0996 INITIALS: WZ SEAL RECEIVED BY: TAXPAYER $2,000.00 GLENDA FARNER STRASBAUGH REGISTER OF WillS ~ ;~~~ gJ~~~IT '* BOX INVENTORY PA Department of Revenue Social Security or Death Certificate Number Date of Death 48500041046 PLEASE USE ORIGINAL FORM ONLY County Code Year File Number 2riJS7Y3J53 2-1 0/ /02007 Suffix o. 7 00 0 <6' / Decedent's Last Name First Name A L EN AN ToMAS ADDRESS OF DECEDENT STREET: /03 F r(}1l i Sire ef CITY: Sh I rtf>l '1n5--ivWf'l STATE: PA ZIP CODE: 7~ i) NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME: Be /).)'ttml" J B u.+/er STREET ADDRESS: S-O 0 N. I h. 'ra ~+ / I:l-t~ FL CITYi-J (jJr.'.s ~ V.r1 NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. NAME: BelJ,;.lm,/, :T BIIi-f1fr RELATIONSHIP: A f/t>01::J STREET ADDRESS: roo N, Thil't/ ~r, /21-J, Pi- CITY: !/llrr:J ~ 1A./'..9 STA~A b. NAME: -r:o ^" . r /1 [. RELATIONSHIP: / I I'"" > ,.., hilt 4/} CX( c....-hr .s O/l STREET ADDRESS: 10 f1 Fn/l/- .> -rr~ < t CITY: STATE: 5 h"e""'~'lffr,.".,,.. f'/A RELATIONSHIP: 1> r<1 n ch M tJ." "'?(r< STAJf4 ZIP CODE: 17/() ZIP CODE: 17 '0 I c. NAME: ZIP CODE: (-'/4 I M ,'n.r L tl.lfr(/._ FcVr !?o a. J STREET ADDRESS: I/- 27 / (J/J/()fl CIl)'j Hc,rr,'>.hv NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: C,'/,' 2 enJ B tVl Jc.. STATE: ;PA ZIP CODE: /7JJI t..J 17 J U /), 0/\ De p-.r 11' R c /J... ~ CJTY: STATE: ZIP CODE: II()fr:$buJj PA 1,1/1 DATE AND TIME OF LAST ENTRY 1. S 'H. C\. +hz..c:hl. , I TITLE UNDER WHICH BOX IS REQUESTED /vmcU A/ern(l(lSr. O( !?cs,().Vft:>..A. Ale ~ee.. ~Jblh-ll . NAME OF PERSON MAKING LAST ENTRY NUMBER OF BOX 3 5 NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. NAME: T 6,." q 5' A/em Q/I b. NAME: ~. /4.'Vl4.; STREET ADDRESS: / 0 5' CITY' Sl . It .rU'1M5..ft,,,," M. A le('l\ 61"\ STREET ADDRESS: / 0 >J H-4n -r frD') +- Sf s'l)f: 5 f-rc e t ST~lf CITY: 5h, r(t7\.6n5 k....,I'l ZIP CODE: '70, , ZIP CODE: (7c II NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY Lt:iJr{, If yes, a. Date of will: M'Od, SttrctJ.. / - z q - f~ F4,rC~vk YES 0 NO WAS A WILL IN THE BOX? b. Name and address of personal representative, if named in the will NAME: fro 54"1"~ /I. A /ha.f1 (rf.(..t) /4 ;II -':.J } TH...... "-- ,(}lr"I...... &, t~~a....r" fV1 .~ . CITY: !J"Ji:.P S-h,.rt.r(!(;f'\S /1-VV'l STREET ADDRESS: {eer rv-."t S-t c. Name and address of attorney, if any NAME: I? "r. (). 14. D. BoA. -t /~r S~E: ZIP CODE: IfFI STREET ADDRESS: S'D" IV. 7h I rJ. . .> I- I /2fi. F I.- ZIP CODE: /71171 CIT):, I-fllrr,'.s b", STATE: PA L 48500041046 48500041046 MI f1 ~ - /c.kr- -ra ....'(I'LJ A k'l'l{Vl poll ....J REV-485 EX SAFE DEPOSIT BOX INVENTORY Page 'L of 7- INSTRUCTIONS .~~ (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of u.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ITEM ITEM DESCRIPTION NO. J. N () /\ t.. 2.. /1t0l\.e. 3 NDnc., 1. p/J/l.e- tJ. Jlr<:/1 <... t~ >e.c... ct1/acAeJ /. > / { .""p/~k..J ~'I &"'.r./L 7. Su.. I\:tta ( hL). ~- }vi:> c PG.f-(iJ' t:>{ h() V'ltlk. c... - ~~~ tt thtc.k~J I CERTIFY/~~ER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECl:, D COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE...DEPOSIT BOX INVENTORY: SIGN7 j///Vff~ rNAT~ ~ '--""7" ~ . ~ ~ PRINT NAME f- B tAl I{I'" PRINT NAME AND CHECK APPJ;OPRIATE BOX BELOW: Bel} JAM;" 7 0"14-' A ("V\I'W\ PRINT TITLE t' ts. -k.. k DATE CHECK APPROPRIATE BOX: I/-/lur"tr . ( 1.- ;--O'r ~ Execulor(lrix) 0 Administrator(lrix) Estate Representative 0 Joint owner of safe deposit box NOTE: Attach additional 8'1z" x 11" sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. 9405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of lax information agreements with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. ,-~dl5~{Yrch for 1~. . - ~ Tl\tv Saft~f+tux 4or-6~ ~V - ~(~11~ Ji'e-~{e ~fU1y ~e '1S ~e -c~-{\ ( \2e..j6F'\ for ~ (lube ilIeJ?ItCu1, t-( Cbfi"e5 -L( -{I \ ~ I':> try ~r I ~VYlQS A--!eJfY\-0if) I I ,5 q:{WS ~[Z.e{JI')4vOO\f\'l ~ ~M 1tI~/} Dfez - [-i&r+--k:r~ L.;k ~~Y'Ce Con-t~1 (ftnfflM Wrr&- CM%tje ~61,6&J .- &c}-cASr<fl % ~ of ~ A. 4/~ .- frvj.. W R>ttf-Q ~ 4b Af. (("II~, 11tdP - ~~ ~ VCJrC(,~+- Pfrt I If, /qi.dp - .f de 1r8-tflCilCf [bme~.r:s @Js) - ~(r<- l-try~ ~ ~ L&\-H"lAcd-{O'1 ['f~t~~ -bf(~ In'3i,.JQYlCe ~6->vW5 lM-tr~fh ttM1Ge... ~-J .- Covrt(nCll ~(thl'0J0lttl U ~f\ctSe ~l~ cP-f ~., _ !\fa VV\ t1:dfon 7J~eltc Prf3S fur S-h. 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If I am acting in the ::apacityof an agent or deputy, I certify as follows: (1) None of my personal property is being placed in the Box and I will remove any of my personal property now in the Box; (2) I am acting in accordance with the authority given to me by my principal who is alive; and (3) My statements are made under penalty of criminal or civil prosecution under any relevant laws: BoJliAccount # CS-OI09 Rev.(6102) ill 6102 LL-\J:7V' &:..........,~.. -, ... .-/ ;> 1/96 I ''---- ~ Citizens Bank 525 William Penn Place Suite 153-2618 Pittsburgh, P A 15219 February 12,2007 BUTLER LAW FIRM BENJAMIN J. BUTLER P.O. BOX 1004 HARRISBURG P A 17108-1004 Estate of TOMAS ALEMAN Date of Death: Jan 16,2007 SSN: 265-74-3153 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, ~~~ (~~ Robert Roos Operations Services ~:E Citizens Bank" Account Number 6202924768 Account Title TOMAS M ALEMAN OR TOMAS ALEMAN POA Date Opened 11/15/2003 Account Type Checking Principal Balance as of DaD $12898.98 Interest from Last Posting to DaD $.00 Account Balance as ofDOD $12898.98 YTD Interest to DaD $.00 ~.:E Citizens Bank'M Account Number 6204519119 Account Title TOMAS ALEMAN SR OR ROSAURA ALEMAN Date Opened 6/5/2003 Account Type Checking Principal Balance as of DOD $2621.26 Interest from Last Posting to DOD $.00 Account Balance as of DOD $2621.26 YTD Interest to DOD $ .39 a Citizens Bank- Account Number 6244730394 Account Title TOMAS ALEMAN POA OR TOMAS ALEMAN SR Date Opened 8/18/2004 Account Type Time Deposits Principal Balance as ofDOD $43179.43 Interest from Last Posting to DOD $122.44 Account Balance as ofDOD $43301.87 YTD Interest to DOD $.00 CORDIER ANTIQ!lES & fine art AUCTIONS APPRAISALS .ESTATES Appraisal Report The Estate of Tomas M. Aleman c/o Tom Aleman 108 Front Street Shiresmantown, Pennsylvania 17011 Prepared for: Benjamin Butler Butler Law Firm 500 North Third Street Harrisburg, P A 17101 Prepared by: David J. Cordier Ellen E. Miller Cordier Antiques & Fine Art 2151 Market Street Camp Hill, Pennsylvania 17011 Phone: (717) 731-8662 Fax: (717) 731-9830 Table of Contents Title Page Table of Contents Summary Analysis Conditions of Appraisal Certification Purpose of Report Method of Valuation Definition of Value Basis of Appraisal Description Appraiser Qualifications Value Listings 1 2 3 4 5 5 6 6 6 6 6 7 Appendix A Page: 2 of 9 Summary On February 21,2007, at the request of Benjamin Butler, Butler Law Finn, I personally inspected the assets of The Estate of Tomas M. Aleman, 108 Front Street, Shiresmantown, Pennsylvania. Value Fair Market Value The Fair Market Value for the property in total is: $377.60 This is not the appraisal report. The appraisal report must be read in its entirety. Page: 30f9 Analysis Analysis The value of 40% and 90% silver coinage in the appraisal was calculated using the February 20, 2007 value of silver of$13.81 per ounce. Page: 40f9 Conditions of Appraisal The value stated in this Appraisal Report is based on the best judgment of the appraiser given the facts and conditions available at the date of the valuation. The use of the report is limited to the purpose of determining the value of personal property for Estate Tax purposes. Any additional research or testimony required by the client or the court will be billed at the current rates. Disclosure of the contents of the report is governed by the Standards and Practices of the Certified Appraisers Guild of the America. Certification of Report Neither David J. Cordier, Ellen E. Miller, Cordier Antiques & Fine Art nor any of its employees have any present interest in the subject property. No prohibited fee was accessed for this report. David J. Cordier and Ellen E. Miller of Cordier Antiques & Fine Art have successfully completed the personal property appraisal certification program with the Certified Appraisers Gild of America .and are members in good standing. This report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice and with the Standards and Practices of the Certified Appraisers Guild of America which has review authority of this report. David J. Cordier and/or Ellen E. Miller have personally examined the subject property. The statements of fact contained in this report are true and correct to the best knowledge and believe of the appraiser. ClL"-- t: ~--'-' By: Ellen E. Miller, C.A.G.A. Cordier Antiques & Fine Art Page: 50f9 Purpose of the Report The purpose of this report is to determine the value for Estate Tax purposes for Butler Law Firm. Harrisburg. Pennsylvania. Method of Valuation The method of valuation used for this appraisal is the Fair Market Value. Definition of Value Fair Market Value Under the United States Treasury regulation 1.170-1c Fair Market value is defined as: The price at which the property would change hands between a willing buyer and a willing seller. neither being under compulsion to buy or compulsion to sell and both having reasonable knowledge. Basis of Appraisal Valuation Date The date of valuation for determining the value estimation is February 23.2007. Date Appraisal Conducted This appraisal was conducted on February 21, 2007. Limitations of Property There were no limitations on use or disposition of this property. Description An itemized list with descriptions is in Appendix A. Page: 60f9 CORDIER ANTIOUES & FINE ART Cordier Antiques & Fine Art was established in 1984. The company specializes in appraisals of antiques, fine art and personal property, estate liquidations and the auction and sale of fine antiques, art and real estate. Cordier Antiques & Fine Art maintains memberships in the Certified Appraisers Guild of America, the Antiques and Collectibles Dealers Association, Inc., the Antique Dealers Association of Pennsylvania, the Pennsylvania Auctioneers Association and the National Auctioneers Association. Cordier Antiques & Fine Art has conducted appraisal clinics for such organizations as the Harrisburg Area Community College's Older American Days, the Questers, Rohrer Bus Antiquing Road Show Tour, Millersburg Historical Society, Friends of Fort Hunter, West Shore Country Club and the Friends of the Pennsylvania State Museum. Cordier Antiques & Fine Art is an underwriter for the Antiques Road Show on WITF Public Television. DAVID J. CORDIER. C.A.G.A. CERTIFIED APPRAISER David J. Cordier is co-owner of Cordier Antiques & Fine Art located in Camp Hill, Pennsylvania. Mr. Cordier has been an antiques and jewelry dealer since 1980 and an appraiser since 1990. David Cordier of Cordier Antiques & Fine Art has successfully completed the personal property appraisal certification program with the Certified Appraisers Guild of America. Mr. Cordier is a graduate ofWinterthur Museum's Winter Institute, a graduate level program in American Decorative Arts. David Cordier has attended classes in the fine and decorative arts at George Washington University, Washington D.C. and the appraisal studies program at New York University, New York. Mr. Cordier studied the arts and decorative arts in Pennsylvania at Penn State University and holds a Master's degree in Business Administration from Penn State Capital Campus. Mr. Cordier is a writer for the Harrisburg Patriot News reporting on antiques and related events in central Pennsylvania. He also wrote a bi-weekly feature column "Eye on Antiques" for the Sunday Patriot News from 2001 to 2006. ELLEN E. MILLER. C.A.G.A. CERTIFIED APPRAISER Ellen E. Miller joined Cordier Antiques & Fine Art in 2000. Ms. Miller holds a Bachelor's degree in Marketing from Shippensburg University and a Master's degree in Business Administration from Temple University. Since joining Cordier Antiques & Fine Art, Ms. Miller has been the Director of Internet Sales, conducting research and documentation of inventory, maintaining client relationships and managing an international customer base. She has been responsible for the sale of several large collections via Internet auction including classic automobiles, antique toys, sports memorabilia and autographs. Ms. Miller has successfully completed the personal property appraisal certification program with the Certified Appraisers Guild of America. Prior to joining Cordier Antiques & Fine Art, Ms. Miller worked in the printing industry in sales and administration. Page: 7 of 9 - Appendix A Fair Market Value 1. $115.00 46 90% silver quarters in paper roll. Includes one Standing Liberty and 45 Washington with the following dates: 1934, 1937, 1938, 1940, 1941, (2) 1942,(3) 1943,(5) 1944,(2) 1945, 1946, 1947, 1950, 1951, 1952, 1953,1954,1956, (2) 1959, 1960, (3) 1961, (5) 1962, (3) 1963, and (6) 1964. Most worn. 2. $33.00 13 90% silver quarters. Includes 1942, 1943, 1956, (2) 1957, 1960, 1963, (6) 1964. 3. $5.00 Four 90% silver Roosevelt dimes. Includes 1947, 1954, 1956, 1960.1 4. $5.00 Four 90% silver Mercury head dimes. Includes 1923, (2) 1943, 1944. 5. $3.25 Four 90% silver Buffalo (Indian Head) nickels. Includes 1923, (2) 1936, 1937. 6. $22.00 Two 90% silver Peace dollars. Includes 1923 and 1925. 7. $22.00 Two 90% silver Liberty Head (Morgan) silver dollars. Includes (2) 1890. 8. $8.25 Four 40% silver Kennedy half dollars. Includes 1966. (2) 1967 and 1968. 9. $15.00 Three 90% silver 1964 Kenneday half do liars. 10. $15.00 Three 90% silver Franklin half dollars. Includes 1952, 1962 and 1963. 11. $30.00 Six 90% silver Walking Liberty half dollars. Includes 1936, 1941, (2) 1943, 1944 and one illegible (possibly 1918). 12. $5.00 Three $1.00 silver certificates. Includes Series 1957, 1957 A, and 1957 B. Worn. 13. $50.00 Five 1953 Series $2.00 red seal notes. Includes 1953, (2) 1953 B (consecutive) and (2) 1953 C (consecutive). 14. $10.00 Six 1976 Series $2.00 green seal notes. One uncirculated with single fold mark. 15. $15.00 Series 1934 0 $5.00 blue star silver certificate. Minor creasing. Page: 80f9 16. $5.00 Series 1963 A $1.00 note. Uncirculated. 17. $15.00 Series 1974 $5.00 note. Uncirculated. 18. $1.10 Spendable coin. Includes 1979 Susan B. Anthony dollar and 1965 Eisenhower dime. 19. $2.00 1963 Spanish Franco peseta. 20. $1.00 Cuban Series 1957 one peso note. Wom. $377.60 Total Page: 90f9 . ~ RIVerSOUrce..~ ~ RlverSource Ute Insurance Company 829 Ameriprise Financial Center Minneapolis, MN 55474 February 2~ 2007 RiverSource Distributors, Inc. (Distributor), Member NASD. Insurance and annuity products are issued by RiverSource Life Insurance Company. Tomas Aleman 108 Front Street Shiremanstown P A 17011 Contract Owner(s): Tomas M Aleman Contract Annuitant: Tomas M Aleman Contract Number(s): 9920-5865890 Dear Tomas Aleman: Thank you for contacting us regarding this annuity contract, issued by RiverSource Life Insurance Company. Please accept our condolences for your loss. We have received correspondence from you requesting the date of death value. The date of death value on January 16. 2007 is $35,483.32. The cost basis is $26,000.00. If you have any further questions or service needs, please contact RiverSource Life Insurance Company Client Services at 800-333-3437, Monday through Friday from 8:00 a.m. to 7:00 p.m., CST. Sincerely, Limfa 'WiLliams Linda Williams Senior Service Representative. Encl. PLEASE NOTE THE FOLLOWING STATEMENT IS APPLICABLE TO THIS ESTATE When a tax is imposed upon a transfer of jointly owned property by right of survivorship (see Schedule F) or a taxable inter vivos transfer (see Schedule G), the deductions will be allowed to the transferee only to the extent that the transferee has actually paid the deductible items and either the transferee was obligated to pay the deductible items or the estate subject to administration by a personal representative is insufficient to pay the deductible items. The transferee must show that the same debts are not also claimed by an executor, administrator, or other personal representative handling the administration of the decedent's estate. BUTLER LAW FIRM 500 North Third Street Twelfth Floor Harrisburg, PA 17101 Tel: 717.236.1485 Fax: 717.236.7777 lawyers@buderlawiirm.com Mailing Address: Post Office Box 1004 Harrisburg, PA 17108.1004 Ronald D. Butler June 4, 2007 Jana Butler Toole Benjamin J. Butler Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Tomas M. Aleman No. 2007-00081 Dear Sir or Madam: I have enclosed two originals and one copy of a Pennsylvania Inheritance Tax Return and one original and one copy of an Inventory for the above referenced estate. I have also enclosed a $30.00 check for filing fees and a $409.87 check for inheritance tax due. Please time stamp the enclosed copies and return them to me in the enclosed self-addressed stamped envelope. I have also enclosed an original and one copy of a Status Report Under Rule 6.12. Please time stamp the copy and return it to me in the enclosed self-addressed stamped envelope. ?X~-- Benjamin J. 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