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Home My WebLink About07-13-07 . ---I 15056041147 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes ~ PO BOX.280601 ~ Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Yeer INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 7 File Number 0211 Date of Birth 187165131 02202007 06231916 Decedent's Last Name Suffix Decedent's First Name LIST MARION MI G (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 D 1. Original Return D 2. Supplemental Return D 3. Remainder Retum (date of death prior to 12-13-82) D 4. Limited Estate D 4a. Future Interest Compromise D 5. Federal Estate Tax Return Required (date of death after 12-12-82) 00 6. Decedent Died Testate D 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Vllill) (Attach Copy of Trust) D g. Litigation Proceeds Received D 10 Spousal Pover1}l Credit ~ date of death D 11. Election to tax under Sec. 9113(A) . between 12-31-91 and -1-95) (Attach Sch. 0) ~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number EDMUND G. MYERS 7177614540 Firm Name (If Applicable) JOHNSON DUFFIE City or Post OffIce LEMOYNE State PA ZIP Code 17043 REGISTE~ WILLS UUJONL Y ~=: 0 -' t~ 7J L. Ju C: :-o"IO I -_ -I> r- I>~gj . 0) ?;: ~)C ,_ >_, -.J '. ).--..-0 ()-:...: ~ ::0 D...~TEl=ILED w First line of address 301 MARKET STREET Second line of address '"" ::''i: -J i'l Correspondent's e-mail address: Under penalties of P.ll~ury, I declare that I have examined this retum, induding 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. SIGNAT E OF PERSON RESPONSI LE F FILING RETURN DATE Kathleen K Putt to/_I'). 01 17025 EDMUND G. MYERS DATE FJ. J~- (ll 301 MARKET STREET, LEMOYNE, PA 17043 Side 1 L 15[]56[]41147 15[]56[]41147 ---I ~\'t\ ~ 15056042148 REV-1500 EX Decedent's Name: Mar ion G LI S T Decedent's Social Security Number 187165131 RECAPITULATION 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. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested............. 7. 8. Total Gross Assets (total Lines 1-7)....................................................................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H)......................................... 9. 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, of transfers under Sec. 9116 (a)(1.2) X .00 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 0.00 15. 0.00 16. 56,309.54 17. 142,956.96 18. 19. Tax Due................................................................................................................... ~.9. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 141,151.03 16,171.33 50,476.09 207,798.45 6,944.81 1,587.14 8,531.95 199,266.50 199,266.50 0.00 0.00 6,757.14 21,443.54 28,200.68 D 15056042148 --.J , REV-1500 EX Page 3 Decedent's Complete Address: DECEDENrs NAME Marion G LIST STREET ADDRESS 810 North Hanover Street File Number 21-07-0211 CITY I STATE PA IZIP I 17013 Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 25,000.00 1,315.79 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 28,200.68 26,315.79 1,884.89 1,884.89 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income ofthe property transferred;.................................................................................0 b. retain the right to designate who shall use the property transferred or its income;....................................D c. retain a reversionary interest; or..... .............. ..... ............ .... ...... ... ........ ........ ........ ...... ...... ...... .......... ...... ....0 d. receive the promise for life of either payments, benefits or care?............................................................O 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................... .....0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?...... .... .... ..... ... ... ...... ...... .... ...... ......... ...... ............ ...... ... ...... ... ... ... ...... .......... [!] 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. No [!] [!] [!] [!] [!] [!] For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemDB 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-1S08 EX+ (8-88) . . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONMALTH OF PENNSYl.VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIST, Marion G FILE NUMBER 21-07-0211 Include the proceeds of lijigetion end the data the proceeds were racaived by the estate. All property jolnUy-owned with the right of survlvol1lhlp must be dlec:loeed on schedule F. ITEM NUMBER DESCRIPTION 1 The Church of God Home - Reimbursement of Client Account VALUE AT DATE OF DEATH 6,504.58 2 2006 Federal Income Tax Refund 30.00 3 Medicare Reimbursement for Prescriptions 492.57 4 RiverSource - Long Term Care Insurance 1,520.00 5 United Health Care - Reimbursement of Services 240.00 6 Wachovia Bank, N.A. High Performance Money Market Account 1010127460062 131,387.58 7 Pa Treasury Department - Annuity Payment - Final Annuity Payment 976.30 TOTAL (Also enter on Line 5, Recapitulation) 141,151.03 (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.1~ EX+ (6-98) . COM~TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER LIST, Marion G 21-07-0211 If an ...at wa. made joint within one year of the dacedenf. dete of deeth. It mu.t be reported on echedule G. SURVIVING JOINT TENANT(S) NAME A. Kathleen Putt ADDRESS RELATIONSHIP TO DECEDENT Niece 950 Wertzville Road Enola, PA 17025 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 DECD'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 1 A 1/3/1975 Wachovia Bank, N.A. Checking Account 32.342.66 0.500% 16.171.33 1000613759611 TOTAL (Also enter on Line 6, Recapitulation) 16.171.33 (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+ (8-98) . . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMON\M:AL 1li OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIST, Marlon G FILE NUMBER 21-07 -0211 This schedule must be completed end filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM - - , .-.-. , DATE OF DEATH % 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 Amerprlse Annuity - RlverSource Fixed Annuity 50.476.09 50.476.09 Value Plus Beneficiary: Kathleen Putt, Niece Valuation of Accounts at Death of Death Is attached TOTAL (Also enter on Line 7, Recapitulation) 50.476.09 (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-1161 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIST, Marion G Debts of decedent must be reported on Schedule I. FILE NUMBER 21-07 -0211 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 642.34 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attomey's Fees Johnson Duffie 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 306.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 996.47 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 6,944.81 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rey-1502 EX+ (8-88) . *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIST, Marion G FILE NUMBER 21-07 -0211 ITEM NUMBER DESCRIPTION AMOUNT 1 Gingrich Memorials 125.00 2 Hoss's Restaurant - Funeral Luncheon 163.13 3 Zimmerman Auer Funeral Home, Inc. 517.34 Subtotal 805.47 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (8-18) *' SCHEDULE H-87 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIST, Marion G FILE NUMBER 21-07-0211 ITEM NUMBER 1 DESCRIPTION Cumberland County Register of Wills Office - Filing Fes for PA Inheritance Tax Return ($15.00) and Inventory ($15.00) AMOUNT 30.00 2 Reserves: For additional administrative expenses 500.00 3 The Cumberland Law Journal - Notice of Estate Administration 75.00 4 The Patriot News Company - Notice of Estate Administration 147.90 5 USPS - Shipment of Decedents Clothes to Beneficiary 80.44 Subtotal 833.34 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) R.v-11112 EX+ (8-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMON'llol:AlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIST, Marion G FILE NUMBER 21-07 -0211 Include unreimbura.d medlcsl .xpen.... ITEM NUMBER DESCRIPTION 1 Alexander Spasic M.D., Family Medicine LLC VALUE AT DATE OF DEATH 74.39 2 Continuing Care 205.73 3 Continuing Care - Costs for prescriptions 808.67 4 Cumberland Goodwill Rescue 26.25 5 Lancaster HMA Phys 98.10 6 Phil Haven 48.57 7 State Employee System 325.43 TOTAL (Also enter on Line 10, Recapitulation) 1,587.14 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule I (Rev. 6-98) REV.1513 EX+ (8-00) *' SCHEDULE .J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER LIST, Marion G NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal <listributions). and transfers under Sec. l1116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) I. 1 Mildred C Myers 4671 42nd North Avenue Saint Petersburg, FL 33714 Clinton A Orris 225 East Locust Street Mechanicsburg, PA 17055 Sister 2 Nephew 3 Kathleen K Putt 950 Wertzville Road Enola, PA 17025 Niece 4 Patricia L Yeager 7342 Fishing Creek Valley Road Harrisburg, PA 17112 Grand Niece FILE NUMBER 21-07 -0211 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) 50% of Residue $10,000 Specific Bequest 50% of Residue $10,000 Specific Bequest Total Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Copyright (c) 2002 form software only The Lackner Group, Inc. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE Form PA-1500 Schedule J (Rev. 6-98) 0.00 ESTATE OF MARION G. LIST SCHEDULE OF EXHIBITS EXHIBIT A Last Will and Testament of MARION G. LIST signed and dated May 2nd, 2003. EXHIBIT B Wachovia Bank, NA. Performance Money Market Account Date of Death Letter EXHIBIT C Wachovia Bank, NA. Checking Account Date of Death Letter EXHIBIT D Ameriprise Annuity Date of Death Letter :303194 - BXlllBlT A -- WILL OF MARION G. LIST I, MARION G. LIST, of Lower Paxton Township, Dauphin County, Pennsylvania, declare tllls to be my Will and revoke all prior Wills and Codicils. FIRST: Tangible Personal Property. I give all tangible personal property owned by me at my death and all insurance policies on such property as follows: (a) To my sister, MILDRED C. MYERS, ofSt. Petersburg, Florida, provided she survives my death by thirty days, the following items: 1. The chest in my living room used as a cocktail table. 2. My photographs and photograph albums. (b) The balance (including any item under subparagraph (a) the bequest of which has lapsed), in as nearly equal shares as is practicable, to my sister, MILDRED C. MYERS, and my niece, KATHLEEN K. purr, of Enol a, Pennsylvania, or to the survivor of them, living on the thirty-first day following my death. If neither my sister nor my niece survives my death by thirty days, this bequest shall lapse and pass instead to the ENOLA FIRST CHURCH OF GOD, Sherwood Drive, Enola, Pennsylvania, or its du1y constituted successor. (c) My Executor shall pay, as an expense of settling my estate, all costs of delivering such tangible personal property, including the costs of packaging, delivery and insurance. SECOND: Specific Bequest to Clinton A. Orris and Patricia L. Yeflier. . To the extent the value of my residuary estate available for distribution exceeds $100,000.00, I give and bequeath such excess, up to but no more than $20,000.00, in equal shares to: (a) My nephew, CLINTON A. ORRIS, of Mechanics burg, Pennsylvania, provided he survives my death by thirty days. In the event my nephew fails to survive my death by thirty days, this bequest to him shall lapse and pass instead as a part of the residue of my estate; and C:u..WORK\WILLS\G042703B.WPD ~ - .,. (b) To my great-niece, PATRICIA L. YEAGER, of Harrisburg, Pennsylvania, provided she survives my death by thirty days. In the event my great-niece fails to survive my death by thirty days, this bequest to her shall lapse and pass instead as a part of the residue of my estate. THIRD: Residue. I give the residue of my estate in equal shares to my sister, MILDRED C. MYERS, and my niece, KATHLEEN K. PUTT, or to the survivor of them, living on the thirty-first day following my death. If neither my sister nor my niece survives my death by thirty days, this bequest shall lapse and pass instead to the ENOLA FIRST CHURCH OF GOD, or its duly constituted successor. FOURTH: Spendthrift Provision. Until distributed, no gift or beneficial interest shall be subject to anticipation or to voluntary or involuntary alienation. FIFTH: Death Taxes. I direct that each beneficiary under my Will and each person receiving nonprobate property which is subject to federal, state or other death taxes, shall pay the federal, state and other death taxes attributable to such beneficiary's or such person's share of my taxable estate. My Executor may, but need not, determine the death taxes payable with respect to any share or shares and make payment of them by deducting the amount of such death taxes from the share or shares prior to making distribution thereof to any beneficiary or person. SIXTH: Administrative Powers. My Executor shall have the following powers in addition to those conferred by law until all property is distributed: (a) To retain any real or personal property in the form received and to sell it at public or private sale. (b) To manage real estate. (c) To purchase all forms of property without being confined to so-called legal investments and without regard for the principle of diversification. (d) To exercise any option or rights arising from ownership of investments. F:\L WORK\WILLS\G042703B.WPD - 2 - ___~'Ii!A:l_---_.....tJb._...~~~~""...J -- ~ ~ (e) To compromise claims without order of court or consent of any legatee. (f) To distribute in cash or in kind. (g) To employ accountants, agents, investment counsel, brokers, bank or trust company to perform services for and at the expense of my 'estate and to carry or register investments in the name of the nominee of such agent, broker, bank. or trust company. The expenses and charges for such services shall be charged against principal or income or partly against each as my Executor may determine. My Executor is expressly relieved of any liability or responsibility whatsoever for any act or failure to act by, or for following the advice of, such accountants, agents, investment counsel, brokers, bank or trust company, so long as my Executor exercises due care in their selection. The fact that an Executor may be a member, shareholder or employee of any accounting, investment or brokerage fIrm, agent, or bank. or trust company so employed shall not be deemed a conflict of interest. Any compensation paid pursuant to this subparagraph shall not affect in any manner the amount of or the right of my Executor to receive commissions as a fIduciary. (h) With respect to the interest vesting in a benefIciary who, in the opinion of my Executor, is incapacitated by reason of age (other than minority) or illness (mental or physical) when such interest vests in him or her: to hold the interest during his or her incapacity and to invest the interest and all accumulations thereon; to apply so much of the income and principal as my Executor deems advisable for such benefIciary's benefit for any reason without considering other funds available to him or her; and to deliver the balance of principal and income to the beneficiary at such time as he or she gains capacity. In addition, at any time to pay the entire interest to the Guardian of the estate of the incapacitated beneficiary to hold for his or her benefIt. The receipt of a Guardian or such other person as may be selected by my Executor to receive a distribution under this subparagraph shall be a full and complete discharge to my Executor. SEVENTH: Definitions. (a) The words "Executor" and "Guardian" when used herein shall include all genders and the singular and plural as the context may require. (b) Paragraph headings in this, Will are for reference only and shall not affect the meaning, construction or effect of this Will. P:\L WORK\WILLS\G042703B.WPD - 3 - EIGHTH: Power of Appointment. I decline to exercise any power of appointment given to me under any Will, Codicil or Deed of Trust. NINTH: Executor. I appoint my niece, KATHLEEN K. PUTT, Executor. Ifmy niece fails to qualify or ceases to act for any reason, I appoint my great-niece, PATRICIA L. YEAGER, Executor in her place. My Executor shall not be required to post security in any jurisdiction. ~ WITNESS WHEREOF, I have hereunto set my hand thisPl~day of , if ' 2003. ~~ ~ON G. LIST The preceding instrument, consisting of this and three other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by MARlON G. LIST, the testatrix therein named, as and for her last Will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. ~Rr:::.~~ll \:i(~-l]?~ NANCY L. B STLINE F:\LWORK\WILLS\G042703B.WPD -4- V'7J:~..TT"'ZJ~......... _... .....a...I.. "'l...._ ,&. _.. ... _ ~......... . ...7-...---------~----------..--.-. ( 88.: ) COUNTY OF CUMBERLAND I, MARION G. LIST, being the testatrix whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the foregoing instrument as my last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the PUIpOses therein OXJ ~~ ~1>N G. UST Sworn or affirmed to and acknowledged ~:!9re me by the testatrix named above this ~ffi1y of ,2003. HOT A R fA L SEA L Francea T. Vaughl'l, Notary Public HlftlpdenTwp., Cumberland COUlty My COIImJaalon Explrso Sept. 15. 2008 COMMONWEALTH OF PENNSYLVANIA ) ( 8S.: COUNTY OF CUMBERLAND ) WE, GEORGE A. VAUGHN, III, and NANCY L. BISTLINE, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last Will; that she signed it willingly; that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as witnesses; and that to the best of our knowledge, the testatrix was at the time eighteen or more years or age, of sound mind, and under no constraint or undue influence. ~~/~$ . RGE A. DGRN, III ~l~rf.~ NANCY L. B TLINE Sworn or affirmed t~!Od acknowledged before me this c2 oay of ~-CC 11 ' 2003. AM1CP.tf (j j;;;..(r t<J"otary Public NOTARIAL SEAL France. T. Vaughn, Notary Publlo Hampelen Twp., Cumberland County My Commlulon Explrsli Sepl16, 2003 P:\L WORK\WILLS\G042703B.WPD - BXHIBlt B -- /,ax Transm1BB10Il ~/~O/~UUI ~U;VU ~ ~~uc L/VV.:l r 4A Ot:a VOl . 'WAcB.uvIA. ReferencelD: 1973125 Wac:hovia Bank N.A. BaIanc. Confirmation Services PO B",,400lS Roanoke, VA 24022.73 13 March 16,2007 JOHNSON DUFFIE STEWART & WEIDNER 301 MARKET STREET POBOX 109 LEMOYNE, PA 17043.0109 SUBJECT: Verification/ ConfiImation of Account and Balance Infonoation provided for: Customer: MARION G LIST (SSNII187-16-S131) Date of Death: February 20, 2007 Account Type Aoc:oual ltombet I>eooait Accomt IDformation Date ofDoalh A_ Dolo Maturity Ialate&, Acorued YTD Da.. BaIaace BaI...... Opuod Dale Rate Inlorool In_I Paid Qoaod CHECKING 1000613759611 LEGAL TTIlE: MARION G. LIST KATHLEEN K. PUTT 132,341.46 1/3/1975 SI.20 S5.31 CHECKING 1010127460062 LEGAL TTIlE: MARION G. LIST POA. KATIn..EEN K. PUTT CLOSING BALANCE: S131632.86 S131,166.04 11124/2006 S221.S4 S772.44 3/1412007 .0.. to .,.tom limiIaliDu, we can IlIlly provide a .....Ive lIICl8Ih __ balaace CIl depoaillxy ......als. - BXll1Bl1' C - rax TranSID1SS10Il ~/~O/,VV' ~V:~V AM ~fiUC L.fVV':> rlJ.A oc~ vta . 'WAcmJvIA RoferencelD: 1973125 Wachovia Bank N.A. Balance Confirmation Service. POBox 40018 Roanoke, VA 24022-7313 March 16, 2007 JOHNSON DUFFIE STEWART & WEIDNER 301 MARKET STREET POBOX 109 LEMOYNE, PA 17043-0109 SUBJECT: Verification I Confumation of Account md Balance JDformation provided for: CuIltOIllel": MARION G LIST (SSN# 187-16-5131) Date of Death: February 20, 2007 Account Type ""COUlll Number Deoosit Aeeount Information Dat. ofDealb A_. Date Matud.ty Ia_t Accrued Y1D o.te B&Wu:o lI&Iuco" Opeaod Dat. Rate Int....t Inte_ Paid Clooed OIECKlNG 1000613759611 LEGAL TITLE: MARION G. LIST KATHLEEN K. PUTT $32,341.46 113/1975 S1.20 SUI OIECKlNG 1010127460062 LEGAL TITLE: MARION G. UST POA-KATHLEENK. PUTT CLOSING BALANCE: S131632.86 S131,166.04 1112412006 S22U4 sn2." 3/1412007 . Due to "}'110m limitatloaa, .... COIl CIlly provide . twelve D1IlIlth aYOlIIe boluco an depooitory BCcounta. -- B)(1l1B1rr D - Ameriprise ~ ."- Financial April 20, 2007 KATHLEEN KAY PUTT 950 WERTZVILLE ROAD ENOLA, PA 17025 Dear KATHLEEN K.A Y PUTT : RiverSource Life Insurance Company RiverSource Funds Ameriprise Certificate Company Ameriprise Brokerage 70100 Amerlprise Financial Center Minneapolis, MN 55474 Thank you for your recent inquiry regarding MARION G LIST's accounts. These are the values of the accounts as of 02/20/2007. Account Information Annuities - Post 1985 Account Number 930019045499004 P/O 930024775148004 930071841165004 93007194528 9 004 Annuities - Post 1985 Account Number 930019045499004 P/O 930024775148004 930071841165004 93007194528 9 004 Ownershio Individual Individual Individual Individual " Total Value $0.00 $10363.18 $20079.84 $20033.07 . 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 mut1,1al funds include accrued dividends as applicable. Values provided for brokerage products are manually calculated, and should be used as estimates only. The prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a service to its clients. Actual values used in preparation of tax returns or for planning purposes should be verified by your legal and accounting advisors. We appreciate the opportunity to be of service to you. Please contact us if you have any questions. Sincerely, Judy Wiens Death Settlements Processing Team 70100 Ameriprise Financial Center Minneapolis, MN 55474 1-800-862-7919, Option S,l Insurance and annuities are issued by RiverSource Life Insurance Company, an Ameriprise Financial company. Ameriprise Brokerage is provided by Ameriprise Financial Services. Inc. Ameriprise Financial Services.. Inc. M,::amMI'1\14Cn JERRY R. DUFFIE RICHARD W. STEWART C. ROY WEIDNER, JR. EDMUND G. MYERS DAVID W. DELucE JOHN A. STATLER JEFFERSON J. SHIPMAN JEFFREY B. RETTIG KEVIN E. OSBORNE RALPH H. WRIGHT, JR. MARK C. DUFFIE JOHN R. NINOSKY MICHAEL J. CASSIDY MELISSA PEEL GREEVY ROBERT M. WALKER WADE D. MANLEY ELIZABETH D. SNOVER KELLY 1. BONANNO LAW OFFICES JOHNSON DUFFIE OF COUNSEL HORACE A. JOHNSON F. LEE SHIPMAN (1965-2006) Wli.TTEH'S .EXT No. llA .EMAIL dlw(i';jdsw .com July 12, 2007 Register of Wills Office Cumberiand County Courthouse One Courthouse Square Cariisle, PA 17013 Dear Register: Estate of Marion G. List Date of Death: February 20,2007 Q Your File No.. 21-2007 -0211 ~ ~ Our File No. 14825-1 IJ:Eo 'C". "J> F;=; '.:'; ~ ::0 "'" /~ (f) ^ "DO -0 Enclosed for filing please find the following documents for the above referenced decedent? ~ ." = '0 -1 .. )> 2 Original PA Inheritance Tax Returns. There is remaining tax due in the amount of 1,884.8~ Estate Check No. 1007, made payable to Register of Wills, Agent is attached to the Return. Inventory. 2 copies of Page 1 of the Inheritance Tax Return and 2 copies of Page 1 of the Inventory. We ask that you please time-stamp and return these copies to us in the enclosed, self addressed stamped envelope. Estate Check No. 1008 payable to Register of Wills in the amount of $30.00 representing the filing fee for the Return and Inventory. RE: I'.) c:::J c:::J ......, c.... <= r- ",Af -",rn 61 C'J C,')'C1 (~r) :1'") _--t iJ fT'rm :r.I C:J f';.. C,J " -,.., '., C") ["1"1 : ~-') 1. 2. 3. 4. Thank you for your assistance in this matter. Should you have any questions, or require any additional information, please feel free to contact us. Very truly yours, JOHNSON, DUFFIE, STEWART & WEIDNER ~\U~ Dana Wieseman Estate Administration Paralegal Ene. cc: Kathleen Putt, Executrix :303775 301 MARKET STREET P.O. BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 WWW.}DSW.COM 717.761.4540 FAX: 717.761.3015 MAIL@JDSW.COM JOHNSON, DUFFIE, STEWART & WEIDNER, p.e. ... . ~ \\"~~ 1iilS~ l ..'I .. ~ ~ (Il\ ~\ \. \1 ::!\ Ih.__ NO _,00 - .... as 2 fI) fI) .s (.) .. ... .... u.. " " ~~ " v... II 11 .. .,t' 1 ;." . >J' j , '.... "':/l . ~ > L' , ".. "" . III'''''-.,~' '.~;; " J. 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