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Home My WebLink About06-25-07 '- ,., . :....J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-060 1 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 6q~ Date of Birth 09/26/06 09/06/1920 Decedent's Last Name Steele Suffix Decedent's First Name Rena MI C (If Applicable) Enter Surviving Spouse's Information Below Last Name Suffix Social First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW eEl 1. Original Return <=::) 2. Supplemental Return <=::) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required <=::) 4. Limited Estate <=::) 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 between 12-31-91 and 1-1-95) <=::) <:a:>> 6. Decedent Died Testate <=::) (Attach Copy of Will) <=::) 9. Litigation Proceeds Received <=::) 8. Total Number of Safe Deposit Boxes <=::) 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) Firm Name (If Applicable) ~=NNN,.wNN.w'A-'_-NNA-A-.w--'V_"""-'-'-'-'---'-'-A-_~''.,_.'~W.W_W_" CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATI~ SHOULD BE ~CTED TO: Name[)~ytirTlE'lTE'lIE'lP~~~rTlber~mm.. 'Oi,mFg C. Sheely, Esquire i717-697-7~-o ~ ;:J <;;15 ;Xl .... P 2: t!1?v REGIST~ RiI.LSU~ONLYi,rf:i~ FJ ^ ~.J CJ -'00 C-' (") ()O'l ::l? -, J "'h C'C ...... rn ~ :Q f'5 :0... elf :t'... c..n (::-J w T'~ IAndrew C. Sheely, Attorney at Law First line of address c:ity()r..F'()s.t..~f!i?E'l.m , Mechanicsburg State ZIP Code 7055 DATE FILED 127 South Market Street Second line of address P.O. Box 95 mU~"1 Correspondent's e-mail address:~ndrewc.sheely@verizon.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSO'N RESPONSIBLE FOR FILING RETURN . Jim: ~;Lc!~bA/ ~[d.J/o7 n~R / Laurie E. Miller, Executrix, 70 East Main Street, Newville, PA 17241 J\TU E F ~PA / R R T AN REPRESENTATIVE jlnnRI=<::<:: Andrew C. Sheely, Esquire, 127 S. Market St., PO. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY nATI= 25/0, Side 1 L 15056051058 15056051058 -I --.J 15056052059 REV-1500 EX Decedent's Social 187-16-6035 Number Decedent's Name: Steele, Rena C. RECAPITULATION 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . . 1. 2. 3. 4. 5. 3,927.04 6. 3,786.99 7. 8. 9. 1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 6. Jointly Owned Property (Schedule F) c;::) Separate Billing Requested . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c;::) Separate Billing Requested.. . . . . . . 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10)... ... ...... ... ... .. . ... .... ... .... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) ... . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value 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, or transfers unclor C::ec. 9116 (a)(1.2) X .0 15. 16. Amount of Line 14 .<>v"'Ible at lineal rate X .045 94,059.02 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 94,059.02 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c;::) ('. ~~ ~L 15056052059 Side 2 15056052059 --.J , f1Ii::V-1500 Ex. Page 3 Decedent's Complete Address: DECEDENT'S NAME Rena C. Steele F" 21-06-0923 DECEDENT'S SOCIAL SECURITY NUMBER 187-16-6035 STREET ADDRESS 4837 East Trindle Road CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,232.65 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C ) (2) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 4,232.65 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 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i] c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust fo~' or payable upon death bank account or security at his or her death? .............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] 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. 99116 (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. 99116 (a) (1.1) (iill. 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. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-l503 Ex + (1)97) , f' _ SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RENA C. STEELE FILE NUMBER 21-06-0923 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Rena C. Steele died on Tuesday, September 26, 2006, in East Pennsboro Township, Pennsylvania. 1. Prudential Financial, Inc. Common Stock 24 shares certificate form certificate Number PRU004447 total shares valued at $75.78/share at date of death $1,818.72 TOTAL (Also enter on line 2, Recapitulation) $ 1 , 818 . 7 2 (If more space is needed, insert additional sheets of the same size) CJ r-'I ~ ~ '" (,,) ~>iil:;.tii CJ o *~:Q~ ru ~. ~~~~ ~ ~ !!l>iZ~ ~ .... .~~~Z' III!:i S!:!>-uO ~.. ,.~ ifil:; Z a. o .ffi Z lQ <5 H U :;;;;;~o VI ~ ~ i3 ~ ~ <5 (,,) '" o ~ ru F-o w lQ r:I':J j!:~ Z e if o z Z ~ ;; 0 ~ l!:: ~ o ~ Iii U ~ ~ . . Uo- ",.; N :l\~ Cr-.. \~ C') . N ,-N :g: ~ ;i .. ;1>1:- if .!! :~ U i~! Co '0 ~ ~~ ... . 'v C') CN .- LL - to .- ..... 'C C>> -Or-.. ::s~ '- A. ru '" ",z oQ ~ >- ~~ WW >0 ~z ~~ "'w U o .,; o LU ::J ~ c< to '" ~ it REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF RENA C. STEELE 21-06-0923 FILE NUMBER 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 DESCRIPTION VALUE AT DATE OF DEATH 1. Wachovia Bank, N. A. Account #1010008236315 Date of Death value 3,927.04 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,927.04 ..~ ...~ WACHOVIA. Consolidated Statement 02 1010008236315 752 30 o 9 116,680 c: Crown Classic Banking 9/15/2006 thru 10/17/2006 Account number: Account owner(s): 1010008236315 RENA C STEELE Account Summary Opening balance 9/15 Deposits and other credits Interest paid Checks Other withdrawals and service fees Closing balance 10/17 $8,795.12 1,590.11 + 1.08 + 4,869.16 . 1,590.11 . S3,927.04 Deposits and Other Credits Oat' Amount D'$~iption 10/02 1,590.11 AUTOMATED CREDIT US TREASURY 303 RR RET CO. ID. 3031736071061002 PPD 10/17 1.08 INTEREST FROM 09/15/2006 THROUGH 10/1712006 Total $1,591.19 Interest Number of days this statement period Annual percentage yield earned Interest earned this statement period Interest paid this statement period Interest paid this year Checks Number Amount Date Number 1207 273.60 9/29 1210 1208 2,628.70 1 0/04 1211 1209 1,195.00 9/29 1212 33 0.17% $1.08 $1.08 $13.18 Amount Date Number 10/03 Total 10/12 1 0/12 150.00 350.00 271.86 Amount Date $4,869.16 \ WACHOVIA BANK, N.A., MECHANICSBURG page 2 of 5 REV-1509 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF RENA C. STEELE FILE NUMBER 21-06-0923 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. Laurie E. Miller 70 East Main Street Newville, PA 17241 Daughter B C. JOINTLY.OWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF ANANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTl V-HELD REAL ESTATE. VAl UE OF ASSET INTEREST DECEDENTS INTEREST 1. A, 06 / 02 WACHOVlA BANK Account #1010092968330 Rena C. Steele, Laurie E. Miller, Jt. Ten $7,573.99 50% $ 3,786.99 TOTAL (Also enter on line 6, Recapitulation) $ $ 3,786.99 (If more space is needed, insert additional sheets of the same size) ,;.. ~~ WACHOVIA Consolidated Statement 03 1010008236315 752 30 F a 9 116,681 9/15/2006 tllru 10/17/2006 Crown Classic Banking Other Withdrawals and Service Fees Date 10/12 Amount Description 1,590.11 ACH RETURN REASON: GOVT. DEPOSIT PER DEATHNOTIFICATION ORIGINATOR: RR RET FOR DATE OF: 10/02106 Total $1,590.11 High Performance Money Market Account number: Account owner(s): 1010092968330 RENA C STEELE LAURIE E MILLER Account Summary Opening balance 9/15 Deposits and other credits Interest paid Closing balance 10/17 $6,760.48 811.41 ... 2.10+ 57,573.99 < ~ ~ t: Deposits and Other Credits t Date 10102 Amount Description 811.41 AUTOMATED CREDIT BENEFIT PAYMENTS PENSIONS CO. 10.9186063000 061002 PPD 2.10 INTEREST FROM 09115/2006 THROUGH 10/17/2006 $813.51 10/17 Total Interest Number of days this statement period Annual.percentage yield earned Interest earned this statement period Interest paid this statement period Interest paid this year 33 0.33"- $2.10 $2.10 $413.76 ~, ':'; \ WACHOVIA BANK, N.A., MECHANICSBURG page 3, of 5 REV-1510 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY RENA C. STEELE FILE NUMBER 21-06-0923 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. DESCRIPTION OF PROPERTY ITEM INCLUOE lliE NAME OF lliE TRANSFEREE, lliEIR RELATIONSHIP TO OECEOENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER lliE DATE OF TRANSFER. ATTACH A copy OF lliE OEED FOR REAL ESTATE. VALUE OF ASSET INTEREST {IF APPLICABLE) VALUE 1 Hartford Life Annuity - contract #71161 9622 Date of death value $96,16~ .91 100% $96,16 TOTAL (Also enter on line 7 Recapitulation) $ $96,168.91 8.91 (If more space is needed, insert additional sheets of the same size) . ........'....c: ... .--..---.......,....-..,....... ..........-,...................... ...........................,...-.. ........... ..."".......... .......... ........... ...".-....-,.-...-.'. ......,.---....'..-.-... .-.. ...."."..-.... . "';" . mne"lIi reellmE SeJe'Qt lIaria61e "11 n uil., mlal\1.II.~~i.~.g.~.I.......~.S.'.Ii...!mll.i.Q.g......1111~.m.IPt Date: 10/16/06 Contract Number: 00254 RENA STEELE 70 E MAIN ST NEWVILLE, PA 711619622 ...... ......b.: ......--:...,.,:-:.:-:-:..-:':.:".:-:-:-:.:-::....:.:':-:-:_.:.._-..-:.:..._......,-::- .".-':::::-::--:::.::::-::::.:-:::.:::z:-::::::..::-:':-. . :<:>:-:;-> ::) ><>><<:-::'::':-- -,::::. . .:-' ,--:,-- ::::::::>:::-::>:':::-:-':::-::::,,:::>-:::: ,::':. :,:::::. -'-:-:: :::::::::::::'::-'::.,':<::'::::-::::::-:-:-::,-:: ,::.:::,:-:::::>:,<- :::\::-/::--<: "~THE' · HARTFORD ... :"":-'.' -: - - ~:,. 17241 MARK E STRUBE WACHOVIA SECURITIES LLC-PCG 5201 SIMPSON FERRY RD MECHANICSBURG, PA 17055 :':::-:-:':':-:-:.-:-:-...:::-:.:.:.:.:-:<-.-::----:.'.-.>':..:...:::-:--:":".' ::_C' '_'::'-':'_:':: ':..' '_':'. ::'_' __: . .'. .__:_. HartfordLife. .. .. .. . I nv~\>tlT:lent Products Services. ~~~f~~;Z~~~~P102-9()85 .. .. ~. O.artfordlrivestor.com 00441 Annuity Client Service Center 1-800-862-6668 Monday through Thursday 8:00 a.m. to 7:00 p.m. and Friday 9:15 a.m. to 6:00 p.m., Eastern time Transaction Detail PAGE 2 OF 2 Trade Date Sub-Account Name Transaction Description Dollar Amount Unit Value Units Transacted 10/16/06 ADVISERS 10/16/06 CAP APPREC FUND REBAL OUT FUND REBAL OUT $72.24 1.149106 $2.16 2.121226 62.866 1.018 As or 10/16/06 Sub-Account Name HTFD GROWTH HTFD TR BOND DIVIDEND GRW STOCK ADVISERS CAP APPREC Value By Sub-Account Total Units x 10939.579 9709.639 9291 . 193 14101 . 154 25107.060 4533.647 Unit Value 1.318637 1.485672 1.552582 1.022990 1.149106 2.121226 = CurrenfValue $14,425.33 $14,425.34 $14,425.34 $14,425.34 $28,850.67 $9,616.89 * F I XED ACC VALUES SHOWN AS DOLLARS Total Contract Value ~ a.y.f!1.~~.~...~.y....f.t!.I.~.~.~...................... ............................................................................. ............................................................ .......~u~~~ccount Present Allocation of Please use this stub to make additional payments Name Allocation this Payment RENA STEELE 70 E MAIN ST NEWVILLE, PA 17241 $96,168.91 Contract Number: 711619622 Purchase Amount $ Please make your checks payable to: Hartford Life Total 100% 100% o Invest this payment as shown Under "Present Allocation" in the chart to the left. o Invest only this payment as I have indicated in the chart to the left. Please retain my "Present Allocation" instructions as shown. Z o Invest this payment as I have indicated to the left and invest any future .' payments in accordance with this new allocation. o Changing Address? Check box, note new address on reverse, a'fh return to us in the enclosed envelope. _1 HE HARTFORD 'REV-1511EX. (1'097) .' I . ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT RENA C. STEELE SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-06-0923 Debts of decedent must be reported on Schedule I. ITEM NUMBER A, B, FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT MYERS-BARNER FUNERAL BOME $6,126.00 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions LAURIE E. MILLER, EXECUTRIX Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative/s) 70 E. MAIN STREET Street Address ANDREW C. SBEELY, ESQUIRE, PER AGREEMENT Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant City U.WUTT.T Ii! . Year(s) Commission Paid: 2, 3, Attorney Fees Street Address City Relationship of Claimant to Decedent 4, Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS - PROBATE FEES 102.00 5. Accountant's Fees 6, Tax Return Preparer's Fees 7. $ 0.00 State It a Zi~7"41 $ 700.00 State Zip FILING FEES FOR INBERITANCE TAX RETURNS 15.00 Reserves to conclude administration of Estate, including preparation of decedent's first and final accounting, costs, pottage $ 500.00 TOTAL (Also enter on line 9. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7,443.00 MYERS-HARNER FUNERAL HOME, INC. 1903 MARKET STREET Mrs. Laurie Miller 70 East Main Street Newville PA 17241 Services for Rena C. Steele October 2, 2006 Graveside Service Casket Cash Advanced Newspaper Notice/Local Newspaper Notice/Out-of-Town Certified Copies CAMP HILL, PENN"YLVANIA 17011 LOCALLY OWNED AND OPERATED October 16, 2006 ~ . Total due within thirty days, please: $ 94.00 49.00 48.00 OlJ r , t\/d~) / /?oJj~/ IL I 0 1. e~. (D , I Ij (; , 4.. (n (/' , i ~. ROBERT H, HARNER SUPERVISOR TELEPHONE 717-737-9961 $ 3,575.00 $ 2,360.00 $ 191.00 $ 6,126.00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17G13 Rece~pt Date: Rece+pt Time: Recelpt No.: 10/19/2006 16:08:43 1046044 STEELE RENA C Estate File No. : Paid By Remarks: 2006-00923 MILLER JEFFREY R AJW ________________________ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 7885 Total Received......... 60.00 15.00 12.00 10.00 5.00 ---------------- $102.00 $102.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN REV- 15'2 EX; (1-97) ~, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RENA C. STEELE SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-06-0923 Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION AMOUNT Country Meadows - final bill $4,199.64 TOTAL (Also enter on line 10, Recapitulation) $ 4, 19 9 . 64 (If more space is needed, insert additional sheets of the same size) -.\~\\y MJ~:~ ^ .'\~~-" ... _Va O:'V- .. · - I.. - .....", I' _... ~ ~; , - ,"'-. _, , -, n v, .. ,- , v@ Retirement Communities Country Meadows of West Shore IV Rena Steele's Open Account Analysis At November 13,2006 Services Period Amount Due Room and Board September 1- 29,2006 $ 3.667.23 Pharmacy August and September 2006 496.71 Misc.-Beautician, Late Charges Less Meal Credit August and September 2006 35.70 Grand Total Due $ 4,199.64 I declare and affirm that the information and representations made in the above claim and the account are true and correct according to my knowledge, information and belief. AA..l / 1(, M~ ~. Mizak VP- Finance Accounting and Information Services Date Country Meadows Home Office. 830 Cherry Drive. Hershey, PA 17033 Phone: (717) 533-2474. Fax: (717) 533-6202. www.countrymeadows.com ~J.1513~ (1-:9l\ ESTATE OF NUMBER I. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES RENA C. STEELE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Laurie E. Miller 70 E. Main Street Newville, P A 17241 Patricia A. Daley 3405 East Jameson Road Raleigh, NC 27604 FILE NUMBER 21-06-0923 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) DAUGHTER DAUGHTER AMOUNT OR SHARE OF ESTATE 1/2 Rest, Residue and Remainder of of Estate per Will 1/2 Rest, Residue and Remainder of Estate per Will ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additiona~sheets of the same size) ." ~ \ () \s> O,()3 LAST WILL AND TESTAMENT OF 0 g :.0 (- 0''' It" ;'::;; ~ ) CO) ",::" j <"..:I .......) RENAC. STEELE '~2q ~ ~ "'. ~ ~ U) ;.,~.: S~ .:.1 '"")Q -0 l:A'i"l 1, RENA C. STEELE, of 4060 Llsbum Road, Med~~csb"Cll"g,,;~ i-'~ :-< :0 .r- :.- rn (Lc Ner Allen Tovvnship), Cumberland County, Pennsylvania3re:nnsy~ni~':) (~ ma ~e, publish and declare this as and for my Last Will and Testament, her ~by revoking all other Wills and Codicils heretofore made by me. FIRST: I direct that all inheritance, estate, transfer, succession an, death taxes, as well as my just debts and funeral expenses, of any kind wh ltsoever, which may be payable by reason of my death, shall be paid out of ' he principal of my estate as the same can conveniently be done. SECOND: I give, devise and bequeath all the rest, residue and rer lainder of my estate of whatever nature and wherever situate, including an: . property over which I hold power of appointment and together with any ins rrance policies thereon, unto my husband, DON L. STEELE, provided he sm vives me by thirty (30) days. THIRD: Should my husband, DON L. STEELE, predecease me or dit on or before the thirty-first (31st) day following my death, I give, devise an I bequeath all the rest, residue and remainder of my estate of whatever na ure and wherever situate, including any property over which I hold power of ap )ointment and together with any insurance policies thereon, in equal shares, ur to my daughters, LAURIE E. MILLER, of Newville, Pennsylvania, and Pi .TRICIA A. DALEY, of Raleigh, North Carolina, per stirpes. ~ FOURTH: In addition to all powers granted to them by law and by at! er provisions of this Will, I give the fiduciaries acting hereunder the follow- ing powers, applicable to all property, exercisable without court approval and effc ctive until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of tin e, any real or personal property and to give options for sales, exchanges or lea es, for such prices and upon such terms (including credit, with or without see mty) or conditions as are deemed proper. This includes tile power to give leg LIly sufficient instruments for transfer of the property and to receive the pre ceeds of any disposition. (B) To partition, subdivide, or improve real estate and to enter into agt ~ements concerning the partition, subdivision, improvement, zoning or ma :lagement of real estate and to impose or extinguish restrictions on real est lte. (C) To compromise any claim or controversy and to abandon any (D) To invest in all forms of property, including stocks, common tru ,t funds and mortgage investment funds, without restriction to investments au' horized for Pennsylvania fiduciaries, as are deemed proper, vvithout regard to my principle of diversification, risk or pro-ductivity. (E) To exercise any option, right or privilege granted in insurance po ides or in other investments. (F) To exercise any election or privilege given by the Federal and at] .er tax lavvs, including, but not necessarily being limited to, per-sonal income, 2 -.... gift and estate or inheritance tax laws. (G) To make distributions to my herein named beneficiaries in cas: l or in kind or partly in each. (H) To borrow money from themselves or others in order to pay del ts, taxes, or estate or trust administration expenses, to protect or improve an) property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement pIa l (pension plan, profit sharing plan, employee stock ownership plan, or any otn ~r type of qualified plan) to the extent the plan or the law. FIFTH: 1 nominate and appoint DON L. STEELE, Executor, of thi: , my Last Will and Testament. In the event of the death, resignation or ina Jility to serve for any reason whatsoever of DON L. STEELE, I nominate ane appoint LAURIE E. MILLER, Executrix, of this my Last \\Till and Testa- me 1t. In the event of the death, resignation or inability to serve for any reason wh ltsoever of DON L. STEELE and LAURIE E. MILLER, I nominate and apl oint PATRICIA A. DALEY, Executrix, of this my Last Will and Testament. I d rect that my Executor or Executrix, as the case may be, shall not be required to lost security or a bond for the performance of their duties in any jurisdiction. IN WI'lNESS WHEREOF, I have hereunto set my hand and seal to his, my Last Will and Testament, this Jf. Q day of April, 2000. ~~/(!.. ~ -- _(SEAL) RENA C. STEELE 3 ..... Signed, sealed, published and declared by the above-nanled Testatrix as ane 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 nar \es as attesting 'Witnesses. /.&. A,(. 31ft: ~"6" fI.J? a f70'-( hk/J (! s.,.~ Ad, lress Name it,. iJf!jJ kn ~ ,lfJ?thP-/l/fSDIJ ~4,~ f7I6\ (2.th 'ifM/dM. ~ Ad Lress Name 4