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Home My WebLink About06-13-07 (2) Pfister and Romf'c~! p!~ f;ountants Frederick W. Pfister, C.PA Richard F. Rompalo, C.P.A. John R. Steffee, C.P.A., C.S.E.P 342 North Front Street Wormleysburg, PA 17043 (717) 975-8500 FAX: (717) 975-9952 www.pfisterandrompalo.com P A Department of Revenue Post Assessment Review PO Box 280601 Harrisburg, P A 17128-0601 June 4, 2007 Re: Marian L. Jefferies #198-18-1920 File #21 06 0313 Hello: Marian L. Jefferies died March 22, 2006 and her estate filed a timely REV -1500 along with a payment of$7,168.86. During the process of filing her last income tax returns, as well as the returns for two of her beneficiaries, it became obvious that a 7.35% GMAC bond was significantly understated and that Ms. Jefferies federal tax refund was not listed as an asset. Additionally, our fees for the work we performed for her estate were not deducted from the value of the estate. Therefore, we have included a check for the additional tax and interest of $669.62. The calculation of the amounts due is outlined in the attached schedule. Copies of the original REV-1500 and other pertinent documents have been enclosed for your use. Sincerely, C~,,~~ ~hn ~. Stette,'<:p A, CSEP Cc: Barbara Campbell tj :1 ! l' S \ 1, 11 \ ~ Marian Jefferies REV-1500 Adjustment Net Value Subject to Tax-Original Return Increase in Net Value $70,000 GMAC 7.35% Bond Correct Value 2006 Form 1040 Refund Decrease in Net Value Professional Fees Revised REV -1500 Form 1040 Preparation Form 1041 Preparation Net Value Subject to Tax-Adjusted Lineal Tax Rate Tax Due Tax Paid with Original Return Additional Tax Due Interest - December 23, 2006 - June 7, 2007 166 days x .000219/day x 652.64 Amount Enclosed 159,308.01 (55,498.80) 70,000.00 402.00 (150.00) (150.00) (250.00) 173,661.21 0.045 7,814.75 (7,168.86) 645.89 23.73 669.62 F:\Clients\MJefferies\AdjP Alnheritance.xls TAX INFORMATION 2006 Form 1 099-8 Ameriprise e Financial copy B For Recipient Proceeds 'frGII Broker Transactions KEEP FOR YOUR RECORDS. Recipient: BARBARA CAMPBELL AND RANDAL F LEIBY AS ADMS 322 LINCOLN STREET MARYSVILLE PA 17053-1219 Payer: AMERICAN ENTERPRISE INVESTMENT SERVICES INC. 10 AMERIPRISE FINANCIAL CENTER MINNEAPOLIS MN 55474-9900 EST OF MARIAN L JEFFRIES Taxpayer 10: 20-6909262 OMB No. 1545-0715 Federal 10 Number: 41-1667086 ACCOUNT NUMBER: 64237175 021 SPS ADVANTAGE 4. Federal la. Date of lb. CUSIP 2. Stocks incolle tax Quantity of sale/exch number bonds. etc. withheld 7. Description Shares 06/12/2006 345397SM6 $l1,099.88JE ..00 FORD 7.375% 09 12,000.000 06/1312006 000912105 $3,754.88JE $.00 ACM INCOME FUND 500.000 06/13/2006 989414107 $1,699.94JE $.00 ZENIX INCM 625.000 06/15/2006 37042GV52 $10,OOO.00JE ..00 GMAC 10,000.000 06/15/2006 37042GUH7 $70,OOO.00JE $.00 GMAC 70,000.000 09/22/2006 76931K877 $40,OOO.00JE $.00 RVS FLOAT RT A 3,976.143 10/09/2006 76931K877 $51,457.92JE $.00 RVS FLOAT RT A 5,120.191 JE Please note: The dollar amount reflects gross proceeds. Please read the instructions on the back of this form. If you have questions, please write to the above address or call Ameriprise Brokerage at 1-800-862-7919 or Premier Portfolio Services or Strategic Portfolio Service Advantage at 1-800-967-4377. OGL TXADVA (1Z/2G05J Page: 4 11111111111111111 ~ Joe Roedl ~ 04/21/2006 09:41 AM To: Wayne A Logue/FieldIWH/AEFA@AMEX cc: Subject: Marian Jeffries, client id 20626521 7 001, date of death values IDS Life Insurance Company RiverSource Funds Ameriprise Certificate Company Ameriprise Brokerage 70100 Ameriprise Financial Center Minneapolis, MN 55474 April 21, 2006 WAYNE ALLEN LOGUE STE 200 342 N FRONT ST WORMLEYSBURG, PA 17043-1112 Dear WAYNE ALLEN LOGUE: Thank you for your recent inquiry regarding MARIAN L JEFFERiES's accounts. These are the values of the accounts as of 03/22/2006. SPS Advantage ONE Features Account Number 000605993963021 Total Value $81125.53 Client Name: MARIAN L JEFFERIES Date of Death: 3/22/2006 Account: Valuation Date: 60599396 3 021 3/22/2006 Estimated Values 1'o,c/);,,\ Q{~vl,,: The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. Please note that the values indicated for any Life Insurance product(s) reflect the gross death benefit at date of death, not the cash value. Values for any proprietary DECEASED: MARIAN L JEFFERIES 3/22/06 Form 1 040 Department of the Treasury - Internal Revenue Service 2006 I (99) U.S. Individual Income Tax Return IRS Use Only - Do not write or staple in this space. For the year Jan 1 - Dec 31, 2006, or other tax year beginning , 2006, ending ,20 OMS No. 1545-0074 Label Your social security number (See instructions.) MARIAN L JEFFERIES 198-18-9868 Use the 322 LINCOLN STREET Spouse's social security number IRS label. MARYSVILLE, PA 17053-1219 Otherwise, You must enter your please print ! social security ! or type. number(s) above. Presidential Checking a box below will not change your tax or refund. Election Campaign ~ Check here if you, or your spouse if filing jointly, want $3 to go to this fund? (see instructions). . . . . . . . . . . . . . .. ~ 0 You 0 Spouse 1 X Single 4 Head of household (with qualifying person). (See 2 Married filing J'ointly (even if only one had income) instructions.) If the qualifying person .is a child but not your dependent, enter this child's 3 Married filing separately. Enter spouse's SSN above & full name here. ~ name here.. ~ 5 D Qualifying widow(er) with dependent child (see instructions) ~o~~:~~.. ~f. ~~~~o.n.~ ~.a.~ C.I~~~. ~~~. ~~.~. dep~.~~~~~,. ~.o ~.~t. ~~~~~. ~~~. ~~ : : : : : : : : : : :}- ::~;a:;:I~~: (2) Dependent's (3) Dependent's (4) if on ~ who: social security relationship qualifying. lived number to you child for child with you. . . . . tax credit . did not (see mstrs) live with you due to divorce or separation (see Instrs) . . . Dependents on 6c not entered above . Filing Status Check only one box. Exemptions 1 6a b c Dependents: last name 1 First name If more than four dependents, see instructions. d Total number of exem tions claimed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8a Taxable interest. Attach Schedule B if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a b Tax-exempt interest. Do not include on line Sa. . . . . . . . . . . . . 8b 9a Ordinary dividends. Attach Schedule B if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Qualified dividends (see instrs). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) . . .. . . . . .. . .. . .. . .. ... 10 11 Alimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11 12 Business income or (loss). Attach Schedule Cor C-EZ . . . . . . .. . .. . . . . .. . . . . . . . .. . . . . . .. 12 13 Capital gain or (loss). Att Sch D if reqd. If not reqd, ck here. . . . . . . . . . . . . . . . . . . . . . . . .. ~ 0 13 14 Other gains or (losses). Attach Form 4797. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 14 15a IRA distributions. . .. . . . .. .. ~ I b Taxable amount (see instrs).. 15b 16a Pensions and annuities. . .. [J!!] . b Taxable amount (see instrs).. 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. 17 18 Farm income or (loss). Attach Schedule F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 18 19 Unemployment compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19 20 a Social security benefits. . . . . . . .. ~ 4, 999 .1 b Taxable amount (see instrs) .. 20 b 21 Other income _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 21 22 Add the amounts in the far ri ht column for lines 7 throu h 21. This is our total income. . . .. ~ 22 23 Archer MSA deduction. Attach Form 8853. .. .. . .. . . . .. . . . . . 23 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ. . . . . . . . . . . . . . . . . . . . 24 25 Health savings account deduction. Attach Form 8889. . . . .. . 25 26 Moving expenses. Attach Form 3903. . . .. . . . .. . . . . . . . . . . . . . 26 27 One-half of self-employment tax. Attach Schedule SE . . . . . . 27 28 Self-employed SEP, SIMPLE, and qualified plans. . . .. .. . .. . 28 29 Self-employed health insurance deduction (see instructions). . . . . . . . . . . . . 29 30 Penalty on early withdrawal of savings. . . . . . . . . . . . . . . . . . . . . 30 31 a Alimony paid b Recipient's SSN. . .. ~ 31 a 32 IRA deduction (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . 32 33 Student loan interest deduction (see instructions) . . . . . . . . . . 33 34 Jury duty pay you gave to your employer. . . . . . . . . . . . . . . . . . . 34 35 Domestic production activities deduction. Attach Form 8903 . . . . . . . . . . . . . 35 36 Add lines 23 - 31 a and 32 - 35 . . .. . . . .. . . . .. .. . .. .. . . . . . . .. . . . .. . .. . . . . . . . . . .. . .. . . . . . . . . . . . 37 Subtract line 36 from line 22. This is our ad'usted ross income. . . . . . . . . . . . . . . . . . .. ~ BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. FDIA0103L 09/18/06 Income 1,196. 122. Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld. If you did not get a W-2, see instructions. 281. Enclose, but do not attach, any payment. Also, please use Form 1040-V. o. 1,599. Adjusted Gross Income o. 1 599. Form 1040 (2006) Form 1040 2006) Tax and Credits Standard Deduction for - · People who checked any box on line 39a or 39b or who can be claimed as a dependent, see instructions. · All others: Single or Married filing separately, $5,150 Married filing joi ntlX or Qualifying widow(er), $10,300 Head of household, $7,550 Other Taxes Payments If you have a qualifying child, attach Schedule EIC. Refund Direct deposit? See instructions and fill in 74b, 74c, and 74d or Form 8888. Amount You Owe Third Party Designee Sign Here Joint return? See instructions. Keep a copy for your records. Paid Preparer's Use Only MARIAN L JEFFERIES 198-18-9868 38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39a Check {oo You were born before January 2, 1942, D Blind. Total boxes If: D Spouse was born before January 2, 1942, D Blind. checked ~ 39a 1 b If your spouse itemizes on a separate return, or you were a dual-status alien, see instrs and ck here ~ 39b 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin). . . . . . . . . . . . . . . . . . . . . 41 Subtract line 40 from line 38. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 If line 38 is over $112,875, or you provided housing to a person displaced by Hurricane Katrina, see instructions. Otherwise, multiply $3,300 by the total number of exemptions claimed on line 6d . . . . . . . . . . . . . . .. 42 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 43 44 Tax (see instrs). Check if any tax is from: a DForm(s) 8814 b D Form 4972. . . . . . . . . . . . . . . . . . . . . . . .. 44 45 Alternative minimum tax (see instructions). Attach Form 6251. . . . ... . . . .. . . . . .. . .. . .. . .. 45 46 Add lines 44 and 45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ~ 46 47 Foreign tax credit. Attach Form 1116 if required. . . . . . . . . . . . 47 48 Credit for child and dependent care expenses. Attach Form 2441 . . . . . . . . .. 48 49 Credit for the elderly or the disabled. Attach Schedule R. . .. 49 50 Education credits. Attach Form 8863. . . . . . . . . . . . . . . . . . . . . . . 50 51 Retirement savings contributions credit. Attach Form 8880. . 51 52 Residential energy credits. Attach Form 5695. . . . . . . . . . . . . . . 52 53 Child tax credit (see instructions). Attach Form 8901 if required. . . . . . . . . . 53 54 Credits from: a D Form 8396 b D Form 8839 ~ Form 8859. . 54 55 Other credits. Check applicable box(es): a DForm 3800 b D ~~br c DForm 55 56 Add lines 47 through 55. These are your total credits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 56 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0-. . . . . . . . . . . . . . . .. ~ 57 58 Self-employment tax. Attach Schedule SE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 58 59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137. . . . . . . . . . . . . . . . .. 59 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required. . . . . . . . . . . . . . . . . .. 60 61 Advance earned income credit payments from Form(s) W-2, box 9 . . . . . . . . . . . .. . . . . . . . .. 61 62 Household employment taxes. Attach Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 62 63 Add Ii nes 57-62. This is our total tax. . . . . . . .. . . . .. . . . .. . . . . . . .. . . . .. . .. . . . . . . . . . . . . . . . . . .. ~ 63 64 Federal income tax withheld from Forms W-2 and 1099..... 64 372. 65 2006 estimated tax payments and amount applied from 2005 return. . . . . . . . 65 66a Earned income credit (EIC). . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 66a b Nontaxable combat pay election. . . .. ~ 66 b 67 Excess social security and tier 1 RRTA tax withheld (see instructions). . . . . . 67 68 Additional child tax credit. Attach Form 8812. .. . . . . . . . . . . .. 68 69 Amount paid with request for extension to file (see instructions). . . . . . . . .. 69 70 Payments from: a D Form 2439 b D Form 4136 c D Form 8885 70 71 Credit for federal telephone excise tax paid. Attach Form 8913 if required. . . 71 30. 72 Add lines 64, 65, 66a, and 67 through 71. These are yourtot8l peyments............................................................ ~ 73 If line 72 is more than line 63, subtract line 63 from line 72. This is the amount you overpaid. . . . . . . . . . . . . . . . 74a Amount of line 73 you want refunded to ou. If Form 8888 is attached, check here. ~ D ~ b Routing number. . . . . . .. XXXXXXXXXX ~ c T e: Checking D Savings ~ d Account number. . . . . . . . 75 Amount of line 73 ou want a plied to our 2007 estimated tax. . . . . .. ~ 75 76 Amount you owe. Subtract line 72 from line 63. For details on how to pay, see instructions. . . . . . . . . . . . . . . n Estimated tax enalt (see instructions ................... n Do you want to allow another person to discuss this return with the IRS (see instructions)Z . . . . . . . . .. X Yes. Complete the following. Designee's PREPARER Phone PerSOnal identification name ~ no. ~ number (PIN) ~ Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) IS based on all information of which preparer has any knowledge. Your signature Date Your occupation Daytime phone number Pa e 2 1 599. 6 400. -4,801. 3,300. O. O. O. O. O. O. 402. 402. 402. ~ Spouse's signature. If a joint return, both must sign. ~ RETIRED Date Spouse's occupation Date ~~eta~~~~s ~ JOHN R. STEFFEE CPA Firm's name PFISTER & ROM PALO P. C. ~~ll~::,r~I~~ed)~ 342 NORTH FRONT STREET ~?~rz;Jeand WORMLEYSBURG PA 17043 Check if self-employed EIN 23-2492478 Phone no. (717) 975-8500 Form 1040 (2006) FDIA0112L 11/07/06 REV.115OO EX + (6-00) ~lf OFFICIAL USE ONLY * COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 FILE NUMBER II INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W (,J W C I DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) i Jefferies, Marian L I I DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 06 llll NUMBER i 03-22-2006 I 09-23-1920 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 198-18-9868 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w .. ,,$., ull:" wo..u %00 ull:-' 0..111 0.. c( 4a. Future Interest Compromise (date of daath after 12-12-82) [Xl 6. Decedent Died Testate (Attach 7, Decedent Maintained a Living Trust (Attach '--' copy of Will) copy of Trust) , n 9. Litigation Proceeds Received 10. SpOusal Poverty Credit (date of death between 'Un 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I '--' '---' 12-31-91 and 1-1-95) t,iMtS"SECTIeN'Musn&,caMPtEl:ED;oAI:;L':CORRESP.CiJNDENCE'JAND~~NF.JH~~N~~_~~~~~:.:" , 1 NAME I COMPLETE MAILING ADDRESS Patricia R. Brown, Esq. FIRM NAME (If applicable) i SALZMANN HUGHES PC i 354 Alexander Spring Road, Suite 1 I Carlisle, PA 17013 I i I I{IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) L!J 1. Original Retum U 4. Limited Estate 2. Supplemental Return n ~ 3. Remainder Retun (date of death prior to 12-1~) [J 5. Federal Estate Tax Return Required 8. Total Number of Safe DepOsit Boxes .. z w c z o G- ., w II: II: o U I TELEPHONE NUMBER I I 717-249-6333 I (1 ) None (2) 81,125.53 (3) None (4) None (5) 14,170.00 (6) 9,632.01 (7) 62,673.10 (8) (9) 7,047.90 (10) 1,244.73 OFFICIAL USE ONLY 167,600.64 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o ~ <( ..I ::l l- ii: <( (,J W It: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 0 Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (11) 8,292.~ 159,308.01 0.00 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) (12) 13. Charitable and Govemmental Bequests/Sec 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) (13) (14) 159,308.01 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 20. D 0.00 7,168.86 0.00 0.00 7,168.86 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15, Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) or transfers under Sec. 9116(a)(1.2) z 0 (16) 1= 16.Amount of Line 14 taxable at lineal rate 159,308.01 x .045 <( I- ::l ll. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) ~ 0 u 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) x ~ 19. Tax Due (19) .>>'SE;SORJ;.TO'.ANSWER.,Att QUESTIONS ONiREVERSE;SIDE,ANO''RECRECK.MATH:<< " -. . - '- .' ... ',- - " ',... --" "'. - ". . . ,- -.-.' ..' ", . .:- -, - ;-..~. .'. ".: .-.' - ..' - -' Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00: RIIY-1503 EX+ (8-981 . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT oeCEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER 21-06-0313 ESTATE OF Jefferies, Marian L All property jolntly-owned with rtght of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 IDS - SPS Advantage One 81.125.53 , SI~ qt,{.,~.'l~ - ?": ;:... TOTAL (Also enter on Line 2, Recapitulation) 81.125.53 (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 B (Rev. 6-98) Rev.150a ex+ {6-9al *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY C~1li OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Jefferies, Marian L FILE NUMBER 21-06-0313 ESTATE OF Include tile proceeds of litigation and the date the proceeds _re received by the estate. All property Jolntly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 U.S. Savings Bonds - Series HH, issued March 1994 (list attached) VALUE AT DATE OF DEATH 11.500.00 2 1995 Mercury Sable 1.775.00 3 Miscellaneous personal property 895.00 '.,'." . ,co' ,;, r.'";':'.'! '0 "~ TOTAL (Also enter on Line 5, Recapitulation) 14.170.00 (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) Rev.1509 ex+ (6-98) . SCHEDULEF JOINTL Y -OWNED PROPERTY COMMONWEAI.TH OF PeNNSYLVANIA INHeRITANCE TAX REllJRN RE8IDEHT DECEDENT ESTATE OF Jefferies, Marian L FilE NUMBER 21-06-0313 If an _ was made joint w1l1lln one year of lIle decedent's dete of de.IIl, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Barbara E. Campbell ADDRESS RELATIONSHIP TO DECEDENT daughter 322 Lincoln Street Marysville, PA 17053 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 DECEDENrSINTEREST JOINTLY-HELD REAL ESTATE. 1 A 10/22/2003 M&T Bank - checking account 1.721.28 50.000% 860.64 2 A 4/10/1992 M& T Bank - savings account 4.853.04 50.000% 2.426.52 3 A 5/23/1994 M& T Bank - certificate of deposit 5.012.12 50.000% 2.506.06 4 A 10/12/1994 M& T Bank - certificate of deposit 7.677 .57 50.000% 3.838.79 TOTAL (Also enter on Line 6, Recapitulation) 9.632.01 (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 F (Rev. 6-98) Rev.1510 ex+ (6-981 . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEAL III OF PENNSYLVANIA INHeRITANCE TAX RETURN RESIDENT DECEDENT Jefferies, Marian L FILE NUMBER 21-06-0313 ESTATE OF 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. ITEM DESCRIPTION OF PRU....1::.K I Y DATE OF DEATH 'l(, OF DECO'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 Thrivent Financial for Lutherans - IRA contract 62.673.10 62.673.10 #3657696 -t!c~': ''';,. .-',. TOTAL (Also enter on Line 7, Recapitulation) 62.673.10 j:; (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 G (Rev. 6-98) REV.1151 EX+ (12-99) *' SCH;EDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECeDeNT FILE NUMBER 21-06-0313 ESTATE OF Jefferies, Marian L Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attomey's Fees SALZMANN HUGHES PC 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees c'___t ,_.l b. ;:-., ",.. LJ~ 7. Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. h.t ,/ .t - n l AMOUNT 1,239.35 5,000.00 302.00 ~ 506.55 7,047.90 Form PA-1500 Schedule H (Rev. 6-98) Rev-1H2 EX+ (6-98) . .SCHE:DULEH-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYl. VANIA INHERITANCE TAX RETURN RESlOEHT DECeDENT Jefferies, Marian L FILE NUMBER 21-06-0313 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Hoss's - funeral luncheon 338.50 2 Myers Funeral Home 858.50 3 Pealers Flowers 42.35 Subtotal 1,239.35 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) *' SCH'EDULE 'H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlOENl' DECEDENT ESTATE OF Jefferies, Marian L FILE NUMBER 21-06-0313 ITEM NUMBER DESCRIPTION AMOUNT 1 Amy Leiby - apartment cleanup 200.00 2 Cumberland Law Journal - estate notice publication 75.00 3 Ray A. Lecrone Auctioneer - appraisal fee 50.00 4 Register of Wills - filing fee 30.00 5 The Sentinel - Legal - estate notice publication 151.55 Subtotal 506.55 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev.1512 EX+ (6-98) *' SCH'EDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlOeNT DECEDENT Jefferies, Marian L FILE NUMBER 21-06-0313 ESTATE OF Include unrelmbursed medical expel1ll8S. ITEM NUMBER DESCRIPTION 1 Bank of America - Visa account VALUE AT DATE OF DEATH 111.69 2 Comcast 3 Holy Spirit Hospital 4 Moffitt Heart Vascular Group 5 Olga Caldwell - nursing/home care 6 PP&L 7 UGI 8 Willow Mill Vet - pet expenses 4.61 124.00 14.32 500.00 37.18 138.33 314.60 TOTAL (Also enter on Line 10, Recapitulation) 1,244.73 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule I (Rev. 5-98) REV-1513 EX+ (9-001 ESTATE OF NUMBER I. 1 2 3 4 5 *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Jefferies, Marian L NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERlY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] FilE NUMBER 21-06-0313 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) RELATIONSHIP TO DECEDENT Do Not UsI Trustee(sl Barbara Campbell 322 Lincoln Street Marysville, PA 17053 Daughter 1/2 remainder Christopher Leiby 312 S. Broad Street Mechanicsburg, PA 17055 Grandchild 5,000.00 Christopher M Leiby P.O. Box 259 Enola, PA 17025 Grandchild 5,000.00 Danielle Leiby 905 Thornton Drive Mechanicsburg, PA 17055 Grandchild 5,000.00 Hunter Leiby 905 Thornton Drive Mechanicsburg~ PA 17055 Grandchild 5,000.00 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 through 18. as appropriate. on Rev 1500 cover sheet 20,000.00 40,000.00 II. NON-TAXABLE DISTRIBUTIONS: A_ SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ,'.', ',.'c.."."", """R-'::.c'::;i;-;.' TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 /"nnvrinhl (ro' ?002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE .J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Marian L Jefferies 198-18-9868 03/22/2006 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Jaiden X.J. Leiby Grandchild 10,000.00 clo Barbara Campbell, Trustree 322 Lincoln Street Marysville, PA 17053 7 Randal F. Leiby Son 1/2 remainder P.O. Box 259 Enola, PA 17025 8 Timothy Leiby Grandchild 10,000.00 905 Thornton Drive Mechanicsburg, PA 17055 Total 20,000.00 1 C'\l h ~ ~ Cl cow Olr-- ~C) or- 0 r-- <C """" 0 .....1- \.'~ ~ E tJ) or- ~ 2 0 o <.0 ~ 0.. f:I-) 0 ~ tJ) i:::3 Jiitlsel-l 9 ,..-0 S.~g 1..,; -" ./~~ W en 8 0 ::r:: E-J p:; en 8 (Y) p:; H 0 rl W H U ()lQ 2 H enr-- p:; :s 0 rl .::r:: U W i:Ll i:Ll en .::r:: 0 08 Cl.l .::r:: 20 0 p:; .::r::::r:: W 2 W HE-J H W E-J p:;p:; en H en W8 H ~ H (1)0 H ~ 2U p:; en W 8 .::r:: 2 p:; U rl U ell .~ :> CIl ~ ~ !:: II) ell 5~E-< o..5c; ..... :> ~ ::~:g ....... o \0 o I 00 N ....... r- ....... C-- c::: .i"-'- c...:. - - -=- - - - - - - -. - -J= - \\--,i.~ -- --:'-rf l.::... -- ~ - - - -- - ..::.. - - - :::- :: - - - - - - -:::: - ,- -