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Home My WebLink About07-13-07 .-J 15056051058 REV-1500 EX (06-05) PA Department of Revenue *' Bul8au of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0001 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 21 06 File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 00991 Date of Birth 199-32-0812 10/16/2006 05/01/1941 Decedent's Last Name Suffix Decedent's First Name GETZ CONNIE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Getz Paul Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW <a> 1. Original Retum 2. Supplemental Retum C) 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required C) C) 48. Future Interest Compromise (data of death after 12-12-82) C) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C) 10. Spousal Poverty Credit (date of death C) 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SEcnON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number C) 4. Limited Estate C) <:8) C) 6. Decedent Died Testata (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes Paul R. Getz (717) 530-9678 Finn Name (If Applicable) r------------------------------, ! REGISTER OF WILLS USE ~y log i SO-.l , ".-::0 C-- IJ--o,....... S ; iI \" J . ~'E~:~ I "',. ::0 W , ciS :7;. ( ! 00 -0 ' I ")001 3 I L._____._____~1@$~-----.Q)_-1 --i .. ~ +'" N First line of address 618 East Orange Street Second line of address City or Post OIIice Shippensburg State PA ZIP Code 17257-2144 Correspondent's e-mail address:pcgetz@eathhlink.net Under penalties of perjury, 18 that I have examined this retum, Including aocompanylng schedules and statements, and to the best of my knowledge and belief, it Is true, correct and ration of preparer other n th personall8presentaUve is based on all information of which pl8parer has any knowledge. SIGNA lURE OF PERSON 51 ING DATE 07/11/07 ADDRESS 618 East Orange St., Shippensburg, PA 17257 144 SIGNA lURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 .-J 15056051058 MI B MI R ::0 r-r, (J C) _ L'J '-:J t:'T1 oJ c) -r\ --r\ c"5 III l /) (y~ ) --.J 15056052059 REV-1500 EX Decedenfs Name: CONNIE B GETZ RECAPITULATION 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or SoIe-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) Separate Billing Requested . . . . . .. 6. 7. Inter-VIvos Transfers & Miscellaneous Non-Probate Property (Schedule G) ""-: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 COMPUTAnON - SEE INSTRUcnoNS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See. 9116 (a)(1.2) X .oJL 42,564.62 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE........... ........................................ ......19. 20. FILL IN THE OVAL IF YOU ARE REQUE&nNG A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedenrs Social Security Number 199-32-0812 0.00 34,271.25 0.00 0.00 17,002.77 0.00 0.00 51,274.02 8,709.40 0.00 8,709.40 42,564.62 0.00 42,564.62 0.00 0.00 15056052059 ---I REv-1500 EX Page 3 Decedent's Complete Address: 21 FIle Number 06 00991 DECEDENTS NAME DECEDENrS SOCIAL SECURITY NUMBER Connie B. Getz 199-32-0812 STREET ADDRESS 618 East Orange Street CITY I STATE I ZIP Shippensburg PA 17257-2144 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CredilslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits ( A + B + C ) (2) 0.00 3. InterestlPenaIty if applicable D. Interest E. Penalty TotallnterestJPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the dilference. This is the OVERPAYMENT. Fill In oval on Page 2, Une 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. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 0.00 0.00 0.00 0.00 0.00 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ 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 ~ 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 RelirementAccount, 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. 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. 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. ~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-1502 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDULI A REAL ESTATE ESTATE OF Connie B. Getz FILE NUMBER 06-00991 AI rHl property ownecIloIeIy or.. a tenant In common mUlt be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a wiRing buyer and a willing seller, neither being compeled to buy or sell, both having reasonable knowledge Ii the relevant facts. Real property which .. JoIntIy-owned with right of lurvlvol'lhlp must be dlsc:losed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None 0.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1S03 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT leNIDULI 8 STOCKS & BONDS ESTATE OF Connie B. Getz FILE NUMBER 06~00991 All property JoIntly-owned with right of IUMvonlhlp must be dlscloled on Schedule F. ITEM NUMBER 1. DESCRIPTION 20,000 BERKS COUNTY MUNICIPAL AUTHORITY, 5.62% due 05/15/2012 (value based on par) VALUE AT DATE OF DEATH 20,000.00 2. 350 shares INGERSOLL RAND L TO @40.775 14,271.25 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 34,271.25 REV-1505 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI C-' CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF Connie B. Getz 1. Name of Corporation Not applicable Address FILE NUMBER 06-00991 State_ Zip Code State of Incorporation Date of Incorporation Total Number of Shareholders City 2. Federal Employer 1.0. Number 3. Type of Business 4. Business Reporting Year ProducUService STOCK TYPE TOTAL NUMBER OF PAR VALUE NUMBER OF SHARES VALUE OF THE VotlnglNon-VotIng SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 0 Yes 0 No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes 0 No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? . . . .. 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedenfs death? ....0 Yes 0 No If yes, provide a copy of the agreement. 10. Was the decedenfs stock sold? .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes 0 No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedenfs death? ................... 0 Yes 0 No If yes, provide a breakdown of distributions received by the estate, induding dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . .. 0 Yes 0 No If yes, report the necessary information on a separate sheet, induding a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid eadl year. Ust those dedared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) .' REV-1506 EX+ (9-00* COMMONVllEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF Connie B. Getz FILE NUMBER 06-00991 1. Name of Partnership Not ap,pllicable Address Date Business Commenced Business Reporting Year State Zip Code City 2. Federal Employer 1.0. Number 3. Type of Business Product/Service 4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $ 5. PARTNER NAME PERCENT PERCENT BALANCE OF OF INCOME OF OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. 0 Yes 0 No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes 0 No Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. If yes, 0 Transfer 0 Sale Percentage transferred/sold Consideration $ Date 10. \/Vas there a written partnership agreement in effect at the time of the decedent's death? . . . . ., 0 Yes 0 No If yes, provide a copy of the agreement. 11. Was the decedent's partnersh~ in1erest sold? ....................................... 0 Yes 0 No If yes, provide a copy of the agreement of sale, ete. 12. Was the partnership dissoNed or liquidated after the decedent's death? ................... 0 Yes 0 No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... 0 Yes 0 No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . .. 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOl LOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnersh~ Income Tax retums (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair mar1<et value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. .. REV-1507 EX+ (6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI D MORTGAGES & NOTES RECEIVABLE FILE NUMBER 06-00991 All property jolntly.owned with right of survivorship must be disclosed on Schedu" F. ESTATE OF Connie B. Getz ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH NONE 0.00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 .' . REV-1508 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT leNIDULI I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Connie B. Getz FILE NUMBER 06-00991 Include the proceeds of litigation and the dale the proceeds were received by the estate. All property jolntly-owntcl with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PATRIOT FEDERAL CREDIT UNION, Chambersburg, PA, the following deposit accounts: a. Savings Account #2140720, ID 00 with interest accrued to DOD b. Christmas Club Acct #2140720 ID 15 with interest accrued to DOD a 1,046.78 42.54 c. Money Market Acct #2140720 ID 20 with interest accrued to DOD Draft Account #2140720 ID 25 (no interest) 6,036.67 5,633.40 2. FRANKLIN COUNTY PA TEACHERS CREDIT UNION, accounts as follows: a. Acct. #15nO ID 15 including interest accrued to DOD b. Acct. #15nO ID 16 including interest accrued to DOD 1,500.34 2,398.05 3. NEA, undeposited check 30.00 4. Cumberland County PA, compensation as voting clerk at primary election 127.00 5. Scotland Family Practice, refund 20.00 6. H & R Block, final pay 167.99 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 17,002.77 .' REV-1509 EX+ (6-98* COMMONV\lEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI F JOINTLy-oWNED PROPERTY ESTATE OF Connie B. Getz FILE NUMBER ()6...()()991 If In IUIt wu mid. joint within on. year of the decedent's dlte of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. NONE B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF RNANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrs INTEREST 1. A. NONE 0.00 TOTAL (Also enter on line 6, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) .' REV-1510 EX+ (8-98. COMMONIll/EALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT leNEDULI 0 INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Connie B. Getz FILE NUMBER 06-00991 This schedule must be completed and filed if the answer 10 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 lHE TllANSFEREE. THEIR RELATIONSHIP TO DECEOENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER TIE illiTE OF TRANSFER. ATTACH A COPY Of THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPlICABlEl VALUE 1. NONE 0.00 TOTAL (Also enter on line 7 Recapitulation) $ 0.00 (If more space is needed, insert additional sheels of the same size) .. .' REV-1511 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT leHEDULI H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Connie B. Getz FILE NUMBER 06-00991 Debts of decedent mUlt be reported on Schedule L ITEM NUMBER A. B. 1. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Mongul Cemetery Assoc., purchase burial lot Paul Runshaw, open and close grave Fogelsonger-Bricker Funeral Home, services Revs. Fishl and Nelson, honorariums Organist Public Opinion, obituary 250.00 375.00 7,450.00 175.00 50.00 125.00 2. 3. 4. 5. 6. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Paul R. Getz Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 0.00 City Year(s) Commission Paid: . State Zip 2. Attorney Fees 0.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State .Zip Relationship of Claimant to Decedent 4. Probate Fees 151.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Paul R. Getz. reimbursement for Death certificates Paul R. Getz, mileage to Cumberland County Court House 3 trips @40 mi.=120 mi. @ .32 Sollenberger's Messenger Service, notary fee 90.00 38.40 5.00 8. 9. 8,709.40 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) " ." REV-1512 EX+ (12~3) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABltmES, & UENS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Connie B. Gatz 06-00991 Report debCllncurnd by the cIIcedent prior to deeIh which remained unpaid.. of the date of death, Including unrehnburucl medical .xpen.... VALUE AT DATE OF DEATH ITEM NUMBER 1. DESCRIPTION NONE 0.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 , REV-1513 EX+ (9-00) *' SCHEDULE J BENEFICIARIES COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Connie B. Getz FILE NUMBER 06-00991 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 Unclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Paul R. Getz Spouse 100% of net estate 618 East Orange Street, Shippensburg, PA 17257-2144 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 None 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 0.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) . *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K UFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on REV.1500 Cover Sheet ESTATE OF FILE NUMBER Connie B. Getz 06-00991 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will 0 Intervivos Deed of Trust 0 Other LIFE ESTAH INTEREST CAL CUI ATION NAllE(S) OF UFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH UFE ESTATE IS PAYASLE NONE o Life or 0 Term of Years - o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years - 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table ................................................. Interest table rate - 0 31/2% 06% 010% 0 Variable Rate % 3. Value of life estate (Une 1 multiplied by Line 2) ......................................$ 0.00 ANNUl fY IIHEREST CALeUl ATION NAME(S) OF UFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABlE o Life or 0 Term of Years - o Life or 0 Term of Years - o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding (number) .... . . . . . . . . . . . . . . . . . . . . . . Frequency of payout- 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 3. Amount of payout per periOd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................... 5. Annuity Factor (see instructions) Interest table rate - 031/2% 06% 010% 0 Variable Rate % 6. Adjustment Factor (see instructions) ......................................... . . . . . . . . . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax retum. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If mare space is needed, insert additional sheets af the same size) i ~ :. 3East 31[i11 aub ~~slam~nt 1. Connie B. Getz. of Guilford Township. Franklin County. Pennsylvania. being of sound mind. memory and understanding. do make. publish and declare this to be fIlY Last Will and TestafJ1ent. hereby revoking and making null and void all former Wills by file at any time heretofore made. ITEM 1: 1 direct that all my just debts and funeral expenses shall be paid from the assets of my estate as soon as practicable after my decease. ITEM 2: 1 give, devise and bequaath all the rest, residue and remainder of my estate, real and personal, whatsoever and wheresoever situate, to my husband, Paul R. Getz, if he survives file. In the event that my husband, Paul R. Getz, does not survive file or in the event that he and 1 should die simultaneously or approximately so in the same common aceident or disaster or under any circumstances causing doubt as to which of us survived the other, then I give, devise and bequeath all the rest, residue and remainder of my estate, real and personal, whatsoever and wheresoever situate, to my son, Donald L. Yeager, my daughter, Melissa A. Yeager, my daughter, Rae E. Yeager, my stepdaughter, BrendaA. Getz, and my stepdaughter, Christine M. Getz, share and share alike, provided, however. that should any of my said children or stepchildren predecease me, 1 direct that his or her share shall be distributed to his or her issue living at the time of my death, per stirpes, and in default of any such then living issue such share shall be distributed to my other said children and stepchildren, share and share alike, as n ~O ~:n ,"'"'I ~ (") ~~hi :"':"~::o -:= C/'):;:l':: '--(") '--'00 ';-~ c'- '"T1 .-.....J _ . -..., i:~ <:) aforesaid. Page 1 of a Three Page Will ~ c::::t c::::t c:n :r: o -c: I CD ." :Jt :n :::;::J r-r: r;~fC) G2 (:J C'') ::0 '-iu L:.:!fJl ."-' 0 (-'0 ~~ . -, --' -'1 $("5 r- rn ./; C> . -r I - .. 4' ~ "1 ~ .. ITEM 3: In the event that anyone entitled to a share .of my estate.should be a minor at the tUne for distribution to him or her. I constitute and appoint Chambersburg Trust Company. Chambersburg. Pennsylvania. Guardian of any property which passes either under this Will or otherwise to said minor. Said Trust Company. a. Guardian aforesaid. shall. in its sole discretion and without Order of Court. have the power to retain such property in kind or to sell the same. giving good title to any real estate. to invest and reinvest in stocks. bonds or other investments. without being limited to investments which would be legal for minors' funds. and to use principal as well as income from tUne to tUne as may appear to be necessary for the minor's welfare. comfort. medical care. recreation. support and education. without responsibility to the minor or to any person taking care of the minor; and any balance in the hands of said Trust Company. as Guardian aforesaid. shall be distributed to said minor when he or she attains the age of eighteen (18) years. If such minor dies prior to attaining the age of eighteen (18) years said Guardian is authorized in its discretion to pay part or all of his or her funeral expenses and the remaining balance in the hands of said Trust Company. as Guardian aforesaid. shall be distributed to his or her personal representative. In the event the funds held by the Guardian for any minor become. in the opinion of the Guardian. too small for proper and efficient administration. the Guardian. in its sole discretion. may deposit such funds in a savings account in the name of the minor. ITEM 4: I direct that all taxes that may be assessed in consequence of my death. of whatever nature and by whatever jurisdiction imposed. shall be paid from the principal of my residuary estate as a part of the expense of the administration of my estate. Page 2 of a Three Page Will .' . .. . ITEM 5: And I do hereby constitute and appoint my husband, Paul R. Getz, Executor of this, my Last Will and Testament. Should my husband, Paul R. Getz, fail to qualify or cease to act as Executor, I constitute and appoint Cbambersburg Trust Company, Chambersburg, Pennsylvania, Executor of this, my Last Will and Testament. I hereby give and grant unto my Executor full power and authority to sell at either public or private sale any and all real estate owned by me at the time of my death, and to make, execute, acknowledge and deliver a deed or deeds to tbe purchuer or purchasers thereof the same as I could do if living. I direct that my husband, as Executor aforesaid, and Cbambersburg Trust Company, as Executor aforesaid, and the Guardian named herein shall not be required to post bond for the faithful performance of their duties in any jurisdiction. In Witness Whereof, I have hereunto set my hand and seal this ~ day of , 1987. ~~:~~ ( SEAL) Signed, sealed, published and declared by the above named Testatrix as and for her Last Will and Testament in our presence, who, in her presence, at her request and in the presence of each other have hereunto set our hands as attest" witnesses. !):. ,~ .. .v.J 3"2-$" ~~ .... .a-.rt-A4..<;JIv . Address D>. qe,. c;;f. ';1 I.--.... - W~;y Address d . e;4-. /!t).&X61 /J!&lHI-A-lh. ~..//7;UJ Address ' Page 3 of a Three Page Will