HomeMy WebLinkAbout08-01-07
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15056051047
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
OF1'ICJAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Numbet
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return c;:)
c:;:)
4. Limited Estate
c::)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
2. Supplemental Return
c:::::>>
C)
c:;:) 4a. Future Interest Compromise (date 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 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Da ime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
~
8. Total Number of Safe Deposit Boxes
-
\0
Correspondent's e-mail address:
bed-mereS (j) eJlix.l\et
Under penalties of pe~ury, I declare that I have examined this return, includin9 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.
DATE
7 /3/107
I I
AI PL./!-. ;t/A
Side 1
L
15056051047
15056051047
...J
--.J
REV-1500 EX
15056052048
Decedent's Name: TJI ()1J1 AS. /CPHAl. f) E::
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) c::::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c::::> 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.
Decedent's Social Security Number
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an eleetion to tax has not been made (ScheduleJ) . . .. .... . .. . .. . .. ..... .. 13.
14. Net Value Subjectto 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 under Sec. 9116
(a)(1.2) X .OCL
16. Amount of Line 14.tp~able
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.
19. TAX DUE........................................ .................19.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~~~~
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15056052048
Side 2
c::::>
15056052048
--.J
REV-1500 EX Page 3
Decedent's. Complete Address:
DECEDENT'S NAME
File Number ,;l...1 - f)~ - A 7 S-
f------ - ~-~-
STREET ADDRESS
!fbI/ill/) E", 7#1)/H,fcS
-'~-.. -- - --.,.~---~--------~---_..._---
--
't>;'S HIJIH/H/N'8/1€.{) 2JRlyE
------~--
CITY
-------------,--;---------- ------T7ii----~--------~--------
I STATE p'f I ZIP I 7
I . 050
i I
/IJ E(J#/1A1 /CS,6f1 /l(;'
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
()
t)
---~_-_--~no--_---------
----0-----
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
o
()
o
Total Interest/Penalty ( D + E )
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.
(3)
(4)
(5)
(5A)
(58)
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.
un _ m___
o
o
o
o
o
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
_il
---~.\
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 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
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
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
No
~
!Xl
~
~
~
~
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 PS. 99116 (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. 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 PS. 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-l508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF 7Hf)II1IJ-S, ~1JI,fll> E:
FILE NUMBER
.;J./-/l' -:2 75"
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
~.
3.
J/.
tS:
DESCRIPTION
/95'/ F;eIIilYIMH/,rJ /JU4/L.G NpAlE.I Jl/N' A1YABI7'~6 /l-6F"
sild -/rJ e4My LI &rtbo
(.tee ~~Gt h /'4 &~'U keg h-"hf /J/I/.I't",h- ~1IS'/II"(,fe.l
~'5f'/ RlA/d, an 4/1aclteq/ ht:rd6).
ZfehJ$ ,.f.I'!I"SPhlt/Yf' (s(:c ;fU1izeq! Ii}T olft:/clretl)
rIJ!ef) EXl'rtDJTlDN Xl.T Jqqq I V/N I FmR.IJ.IR6B~AQOSS3
GIPD.b t!DlVlJlll~A! (s~ 1<El.i..iF'jI j!.~ /at!x:J1< II~A7ioAJ
A 'Trll-eN4Z> )
A SS"afe7) (!.oIJII.5,.et!. /AI C!f;I=F,r;:6;' eJ4.A/
/1-1",.11 '",lIi c.red;t p~ 101 c.fl.,~ 84"'+60 E),^ pW'c.,w LU ~f
i fvy, Nf). / Itl",~.
VALUE AT DATE
OF DEATH
~3 9 9'00. /10
,
!'
:l.. 94. so
,
~I 3S5"'./JO
~
S.2. /0
~
3::zo.f)()
(If I"'l'"II'\r"O ~rv''lo'''o i~ noI"U~l'\,.t in~^'" .......I",a.:,.........1 _"'^^.... ...., ."'_ ........-... _:__\
TOTAL (Also enter on line 5, Recapitulation) $ '78; <f 5"/. '0
03/30/2007 12:41
71 7~,t:27 4 7E.
".'lAPf< t".,1 ALL'::;HOU3E E~::;[I
PAGE 01./04
Mark W. Allshouse, Esquire
4833 Spring Road
Shel1llal1s Dale, P A 17090
Phone: (17) 582-4006
Alw'k@lCh"istianLawverSolution~. com
CHRISTIAN LAWYER SOLUTIONS, Ltc
TO: ('11 (I' /'" l( " SA 'l-/d.. ~ a~'r;~'I/ (0
t~"-
NO: '-79j- -:_,,~!Lj'7.3
FROM: Mark W. Allshouse, Esquire
RETURN FAX NO: (717) 582-7476
RE T/;ollJa;yC.k:h~
NUMBER OF PAGES: 'J! (including this page)
***PRIVILEGED INFO~.TION***
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~~:~t ~.ny I ~i. ;,'~!:~I'(,:~:;t, ,nG~c>:}~:-~s/~D.1:dr;:l;~11;~;-t:~~~i.e;;, t)~~:-"t.<:J~j~)~~\e;':-;i:';:n~':)~.~:;' i~;;
in reliance 0D tne contents e)f this telecop1ed information is stric::)r
~~;~~I~ H~i ;:~~X~l~ ,,::~~:;~:;:~f::~)~~~:~ra ::"':~:~~d~:~~ Z~e ~;j;!o;;::~:
for the ret~r~ cf the ori~inal d0curne~t3 :c us at no ccst :c !O~.
03/30/2007 12:41
71 75:::274 7E,
HAF~f< 1..,.1 ALL'::H]U::;[ E~;CI
F'AGE E12/04
Messenger Service Receipt
Pa Auto License Brokers
6483 Carlisle Pike Suite 104
Mechanicsburg, Pa 17030
717-691-6720
Ill.\J()ic:e :#: 18427
FO~; Cathy L Bartoo
6025 Hummingbird Drive
Mechanicsburg, Pa 17050
717-766-3873
Date: 09/14/06
Time: C:~:: 3 5 PI,/;
Clerks Initials: MJG
Pi.Ie Name: CREDIT
Title # or Date of Birth:
VTN CJl' Drivel:' I s NumbeJ.~
Tag Numbel~ or Eve Color
-v~:-_vl~kQ A]- Qo~ ~-r H
- ~.a..L. J,'".\"ol"...,-, "-/ _ ~_) ,_". ~'C~. ~ .,"
trl- ap..s ac ti el!1
Odometer
Comment.s:
'10666641701
MY8817646ABF
~;t.ate Fees
88 FRIEN.DBHI
Ti tle:l Only
o
'title Fee. . . . . . . . . .
Encuml:-Jra::--lce Fee...
Tag Transfer. " .. . . .
Registration. . . . . . . .
Dup. Fee............
Increase Fee.......
Replacement Fee....
Tax-On $0.00.
2 _;:~ . :: (;
5.00
0.00
This ltem will oe Mailed to you.
0.00
0.00
0.00
0.00
0.00
0.00
0.00
WJl.RNING; Bl,Jxeal.: reQ1.1.1ation requLt's t.hat an.v
item left in our o~fice for 60 days be ~
returned to the Bureau of Motor V~hicles as
u:-1claimed.
Tota.l ~jta.te ?'ef,:;:.
Check #. . . . . . . .
27.50
Cash
I/We swear that I/we have applied for the
above item(s) .
Sex-vi CE' Fees
Messengex Fee. .
Temp Tag Fee _ _ .
Notary Fee. . . . .
Copy!Fax FeE'.. .
Document Fee...
Check or M.O. Fee.
5.00
0.00
5.00
0.00
28.00
0.00
0.00
0.00
Total Service Fee. .
Service Fee Check #.
38.00
.-t '1
Casn
Sworn & subscribed to before me on 09/14/06.
Gra.no Total. . . .
Tot.al Due......
.i\mount ?aid..
Paid in Fu.ll
65.50
65.50
65.50
Not.ary
Sea.1
ErN 2S-1f:A18:'S If this is a bill you MUST l'et.1..~:cn. a ccpy \iJj DaYTnent to qet.
credit. All accounts must be paid by t.he 15t.b of the month ~r no hu:t.her credi.t.
~lill be crYailt._~(g P~,"'i-i~l ,....."=1"1;,.,...,....-.......+-,..... .-............ ,-,-_-,-
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Service or
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for v.!or).;:. t.J.-:'.E~
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~~m- nlllJlll"Tl'IIW!Ii!IIM;1IBIi2ilOillSilR\ ~_
i i Ii Estimated Payments
i I $195 Ime /11) 6 35010 APR
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1999 Ford Expedition Sport Utility 4D
r .-----.-.~~---.._._.-....._..--.._"._-~-""....
Trade-In Value -.J ---.-.--..-....-..--.----------------....--.----.----..-...-.- ........ ..---...------ .............--.......-.........
Private Party Value
Suggested Retail Value
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II Mileage: 91,000
I I Engine: VB 5.4 Liter
I I Transmission: Automatic
I i Drivetrain: 4WD
t=~-~ L....-.--.~-;..~~--...-.-.-----.-..~;1 ~il
Excellent
$9,030
$8,385
$ 7,490
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Good
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Fair
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~Jlli!l.lll i_III!lIII'W nMllIlil
01
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I lmiiilBlll
mlilllif r
Selected Equipment
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XLT
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Page 1 of 3
Kelley, Blue Book - Private Party Pricing Report - Ford, Expedition
SS,OOOtO^SlO;OOO .,,;:;4.1
Both Newand'Used .~
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I Blue Book Private Party Value
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I~ 111I 11
i I~ ~u ~UI
UHI
07/02/200705:22 PM
Hill
Private Party Value is what a buyer can expect to pay when buying a used
car from a private party. The Private Party Value assumes the vehicle is
sold "As Is" and carries no warranty (other than the continuing factory
warranty). The final sale price may vary depending on the vehicle's actual
condition and local market conditions, This value may also be used to
derive Fair Market Value for insurance and vehicle donation purposes.
Check Vehicle Title History
http://www.kbb.com/KBB 1 UsedCarsl PricingRe port.as px?Manufactu rerld,., e%7 c2 07 8 71%7 ctrue%7 c2 07 894%7 ctrue&Cond ition =Good&Qu izCond itions=O
Vehicle Condition Ratings
Excellent
orx:x:.JD $91030
"Excellent" condition means that the vehicle looks new, is in excellent
mechanical condition and needs no reconditioning. This vehicle has
never had any paint or body work and is free of rust. The vehicle has a
clean title history and will pass a smog and safety inspection. The
engine compartment is clean, with no fluid leaks and is free of any wear
or visible defects. The vehicle also has compiete and verifiable service
records. Less than 5% of all used vehicles fall into this category.
Good
r.:x:Jf.X);',] $81385
"Good" condition means that the vehicle is free of any major defects.
This vehicle has a clean title history, the paint, body and interior have
only minor (if any) blemishes, and there are no major mechanical
problems. There should be little or no rust on this vehicle. The tires
match and have substantial tread wear left. A "good" vehicle will need
some reconditioning to be sold at retail. Most consumer owned vehicles
fall into this category.
Fair
r::x:Ja~TJ $7A90
"Fair" condition means that the vehicle has some mechanical or
cosmetic defects and needs servicing but is still in reasonable running
condition. This vehicle has a clean title history, the paint, body and/or
interior need work performed by a profeSSional. The tires may need to
be replaced. There may be some repairable rust damage.
Poor
a:~~:,<T~T....
N/A
"Poor" condition means that the vehicle has severe mechanical and/or
cosmetic defects and is in poor running condition. The vehicle may have
problems that cannot be readily fixed such as a damaged frame or a
rusted-through body, A vehicle with a branded title (salvage, flood,
etc.) or unsubstantiated mileage is considered "poor." A vehicle in poor
condition may require an independent appraisal to determine Its value.
Kelley Blue Book does not attempt to report a value on a "poor" vehicle
because the value of cars in this category varies greatly.
* Pennsylvania 7/2/2007
Accurate Condition Appraisal Change Condition
Accurately appraising the condition of a vehicle is an important aspect in
determining its Blue Book value. Taking our 16 question condition qUiz
will ensure you know the correct condition rating.
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@ 2007 Kelley Blue Book Co., Inc, All rights reserved, May-Aug 2007 Edition, The
specific information required to determine the value for this particular vehicle was
supplied by the person generating this report, Vehicle valuations are opinions and may
vary from vehicle to vehicle, Actual valuations will vary based upon market conditions,
specifications, vehicle condition or other particular circumstances pertinent to this
particular vehicle or the transaction or the parties to the transaction, This report Is
intended for the individual use of the person generating this report only and shall not
Page 2 of 3
Kelley. Blue Rook - Private Party Pricing Report - Ford, Expedition
07/02/200705:22 PM
be sold or transmitted to another party. Kelley Blue Book assumes no responsibility
for errors or omissions. (v.07072)
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http://www.kbb.com/KBB/ UsedCarsl PricingRe port.aspx?Manufactu rerld.. .e%7 c2 07871%7 ctrue%7 c2 0 7 894%7 ctrue&Cond ition =Good&Qu izCond itions= 0
Page 3 of 3
REV.l509 EX'. (1.97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNS\ "VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
7#/)I>>~ ~#'+tJ)
F.
FILE NUMBER
~/- IJ' - ~ 75"'
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. .r If. JH ES J: 7#tJIJIAtS
~A' SAh~"'&" 8~~bF A!L>.
.lFN~~~,#I1.11 /7"2 S
Soi1
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 number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. C ; t"C4 f!o""merce ~AlfR CJu..ek/1i A-Ut. ND-
~ GOO 3 .:t ()D 9 0 7 B
p,. ; raG; po" ~:J. 37, If) ~237. 8/ ~II i. 9/
Aut'. ~",t. .01 ~).
(S~e vlllullti:hJ /eA'e.r 4 #ackd)
TOTAL (Also enter on line 6, Recapitulation) $ //3', r I
May 30, 2007
Commerce
eBank
Charles E. Shields, III
Attorney at Law
6 Clouser Road
Corner of Trindle and Clouser Roads
Mechanicsburg, PA 17055
RE: Estate of: Ronald E. Thomas
Date of Death: 2/14/2006
SS#080-30-8261
Dear Sir or Madam:
The Date of Death information on the above referenced is as follows:
Account
Title
Balance
As Of 2/14/2006
Accrued
Interest
Checking Account
32009078
Ronald E. Thomas or
James J. Thomas
$237.80
$0.01
Through our research, we found that the decedent did not maintain any other accounts or a safe deposit box with our
institution.
If you need further information, please feel free to contact me directly at 1-888-751-9000 Ext.3376.
Sincerely,
COMMERCE BANK, N.A.
t,~~ n
Regulatory Support Services
RIiV-1511 EX+,(12-99) _
, .~j.J~;~.
~~
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF 7J.//J/I1,f5, ;f'/J/JI,fLLJ E.
FILE NUMBER
;2/-1/(, - ~ 75'
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A,
B.
1.
2.
DESCRIPTION
1.
FUNERAL EXPENSES:
~ye-rs Funeral J./f)fYIe, 8f mec-h4Ylic.sb"rj
(J,.ingf'ich me.-rnDria.1s
Tr/"tlle J',or/(J Ct.-mete".)
~.
3.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) JIfMES:r: 7'.i/pAlA-J"
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address .tf2.f SA-milLE .dltlbGE ;e~HIJ
City J:: l'/()tA State /l11 Zip I 7" Z~
Year(s) Commission Paid:
Attorney Fees CHA-/li.ES E. SH/~fZ-OS 1lL
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
4,
5,
6,
7.
B.
,.
/~,
/I.
I ~.
Probate Fees QNL.4 or'9;na.f j 50S ue of .short C.t.,r-h'h'ca...t~
Accountant's Fees ~ ( )
b-A-JiY ~/luaf., A ceD/J.lJrA/Ji ('"hin.
Tax Return Preparer's Fees 'fio e. A1A-/1.8LE .57:, nJ4!F'CIIAhIC.5 8Ulfu, ,all- 171~$
Phof,C/Jf;a. fr,lfI1 'Rea'IS~ f)f W;\\S
Il-tltli-h'''l/a/ $k,.f tJe.rf;t;'ca:tes
1fa'a'/f,"M61 I'Nlhll-fe. ~~
h (,"I Fee.?:i A'$f;.skr ,/ H//~
/ldI'Hh's/r /'n CuIH btr/AluI ili w :};urAIZ!
II-tll'erflsl/t' I/; L'4"'h~/e E yeh:n, cJenf/J1e! .D J')
(/ / r.see f$,/t7/1ttpj7D.I1
TOTAL (Also enter on line 9, Recapitulation) $ 2~, 'rl.J, ?:J...
Claimant
/ypAlE
AMOUNT
'K, S"O{). Of)
,r
;l~ 33S" {')o
~ " bO .(;>o
~
.2, LIS/., 7'1
;
~, LlS/" 7'1
IVOA"E
~ ;. 'I. /)f)
'1f)o.~o
~
'4. po
'I ~ "pt)
-1)-
1&/S.~o
~75. of)
! If) 7.. 99
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
(If more space is needed, insert additional sheets of the same size)
S(!.J../ E 2). If, &/1t'vl.
J:sT ~c?Jt~/!l44/[#d>~. FI~~AI~. ,;2/~~~ -~75"'
13.tCj/r;.m~.1 ~.. ~wfi~tlklf-}j/~) ~3 :u..S7
,
l't _/ltt. .1. //. 9~
/s:I~~J/tk ~~ &Aj;.) ~3.S3
,16'11f(r;~ .[.{~~i . _u.._._.._..~~.IJO_
..~Z~_~.~L?~~___Mh~M___~_""~_M"" .............__~_________....~.._....._____._.~_._.....___...._.....__.__~. .. _.~~ 7 f:~d~........~.
. {lc.I~~-:--~.L~.~A.a4.L..- .......... ... - .._......'i~//
Lf_;___~_~_~~.J'&!.:.4_.._{JL~_~L____.. ... / 3 ~ ZS-
----~----.---~-~_-~rJ!.M-~-~---lM-&ni-lft;@-)-.-.. ~.3.3/_ 50
--===~~=~====----- --~-
.. . .'-.;Lf./JJ/.t;.-.--~ ..1:IPLMp~L__ . .... _~3g,r"F
~' ~~ ~~~
~ ~ -~t- - - -,- -.-.----~--.----.---.--.---------------------- M__ -... . ----~--- -- ------.-~- --- ---
. ~~-+--&d::-~~-.~-~--(1,t--~/k.~J------ ____ _. ___ _.. ____ __ _.___~~_~tf-_-M~_ .._
. .~j~=~i:3::~)~~?:~~===-:>-==-~:;;:~...
-~J.--~tJl!?-.---~....---. .. . -...... ._..~~.. f~.___
I
~tJd !tJl'/L ~L~.Lj'}'/. V2
3/. fL.Itljl-....~~.m(~[~)M/4tt..... .4.~..~~
3g,~ _I1!.M~~. ....(~~.l ~/ 3~.Z.f
, ,,#.. '1!'
.J~.r......~...~~ /.2."~
J'I, ......~IL~~I~f~. (t:.s.l1"ml. ~l{..zo
4f'.~ 1n41'i( .1IJ1u..;& .all. ~ ~J5 ~,,/P
REV.1512 EX+'(12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF -r// wAA1"
/ '7 I,,, no./ ~1f,1-lD E.
FILE NUMBER
~/- tP' - til7S-
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
:1.
3.
~
.s.
~.
7.
~
~
/P,
/1.
I'#'.
1.3.
I'/.
IS:
II,.
/1.
/8'.
J9.
OltJ,
,;J/,
01:(.
~3.
DESCRIPTION
f(JL- ~~
~ c/~ ~'J k. (~bek,s~~~).
IGJl6 JnM2~ f ~ ~. - iJt ~
~ /1J"~ ,M,me~. ~. ~~~.)
flwtm ~ $~ (~;J~)
/JI~/i (~~I)
~ tf.hL (~ ~q)
j/ R72./ Z" 11/
flwlsHI ~ IJ~ (6w~)
~
~ PItt (t!Auit ~)
~1. &4W4.
fllldslffl uwU /5~ (~~)
~ ~ (tJ1dd t1uI)
t(~ ~ad~
au,eJi ~~rt
fludAhV t#tJu /JaM (t'Ju;~)
/J1fjAl~ d#1EA./tt - (See IPr';'4/ elI/IHI ~ltt:"e 4I/adrul)(h;'1l1)
TD IS~ /tI1f1Ii A.( &Y ~)
[zr€hl PEt.GT€lJJ - - '
13tut/.t /J/tH/It Am. ( ttvv /J~)
/8~ /JIP1d din, (&w~)
~/'il ~ /lJim (/# ~ k)
/dWn-t /I~ am. (~&tv~)
VALUE AT DATE
OF DEATH
~
.;1.1'1: ..J I
~
;z (p. stf'
') J". 9S'
rr
Ist!",2S"'
fr 3.sz:;. 9.3
'/ ?o. SI
,.
P? ~ 7, JfH)
f
1"7. ~'1
~ ~. 'Ij
'if
LIS h 4~
~ ,2(). Sf'
~3S 7. I/~
~
7 "oS: ~.2
/
~ II. 0'/
f '3, 7'1
~3S{).tf3
~/J> 9/.3.3tP
/
~ 3S7J.. L/.J
-[-~-J
'3SV.I/.j
~ .3.sz:;J. 1/3
~J>P
~
9/ 9LJ S. /2
TOTAL (Also enter on line 10, Recapitulation) $ 3 '1,/ ~ 0 tj, II
(If more space is needed, insert additional sheets of the same size)
",-=--=="
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLAIM
In Re: The Estate of:
Court File No: 21-06-0275
RONALD E THOMAS
Deceased
4) The facts upon which this claim is based:
This claim is based on an account for credit evidenced by the attached Affidavit of Account
Stated.
5) Decedent's address: 429 SAMPLE BRIDGE RD ENOLA, PA 17025
6)
Date of Death:
02/14/06
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and affirm under the penalties of
perjury that they Information and representations made herein are true and correct
to the best of my knowledge, information and belief.
Dated: '11 l1v1
1hvG
Leah Schenkenbe~g/Jessica Larbs - zed Representalive-in-Fact For MBNA America
Written notice of claim was given to Personal Re resentative and/or his/her counsel
as stated below:
JAMES JOSEPH THOMAS
Name
429 SAMPLE BRIDGE RD
Address
ENOLA. PA 17025
City/State/Zir:! h
S/;:JI () f.:,
Date notice ail~d
,-_..,"- ..
't
IN RE ESTATE OF: RONALD E THOMAS
AFFIDAVIT OF ACCOUNT
The undersigned, being fIrst duly sworn deposes and states the follows:
1. Your AffIant is authorized by the Claimant as its Authorized Representative-
In-Fact to make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect
to the decedent. Your Affiant is familiar with these records and accounts and
reviews them as a regular part of his /her duties.
3. The Decedent purchased merchandise in the amount of $ 18637.22
evidenced by account number 74973522475648
4. The unpaid balance does not include any post-death late payment charges,
accrued interest, collection costs or attorney's fees.
Further your affIant sayeth not
MBNA America.
By:
Leah Schenke~_
Jessica Lerbs _
MBNA America
P. O. Box 15137
Wilmington, DE 19850-5137
Subscribed and sworn before me
This ct:<.{ day of ~ ' 20 8h.
(-)
--?~=2
- ~". .. '..J
..~ ~~~~ ~
-~.~~:~ ~
~
.~ .; ~.-~
: (~2 ';'Ti
1>,___ _
:-:'J
STEPHANIE A. JOHNSON
NOTARY PU8UC - MINNESOTA
MY COMMISSION EXPIR!S 1.31-08
8106
5/1612006
1'-0
=
C::;')
C='''\
(-
(:=
z
:r) i:;'~
;--,'-, (-)
c;:) C)
~?_~ L~~
i-rot n-l
~ C) l...-.J
I
(.J1
-0
-..
~-,:,~~~
.--- "
;-_:~~
:~~...':; (~~~;
1'0
1'0
.s:-
1563490
REV-1513 EX'/- (9-00*,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF . 4.r" ~ ,,"'/ A / "
-r#PAhr.>, ,c.v'Vn/AJ E:
FILE NUMBER
,;2/ - PIP - ;1. 7 S-
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
:;.
:JAMFS .:r: #//)/I1/1-S
1ft-I( ~4l11jJk IJr/? ,f7~
IfMk:t,,t1/f. /70;/.S"
If/)# /ft-j) 7#'t:'J/HM
/I?'l ~'/f f411~ If'~
JtJ~f/J'JiI1Sk0 /J1.l) .,,1./IS8
cSOh
St!>n
AMOUNT OR SHARE
OF ESTATE
Y2.
Y..t..
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Jalii ViII anb Uftafanttni nt
RONALD E. THOMAS
BE IT REMEMBERED, that I, RONALD E. THOMAS, of Hampden Town-
ship, Cumberland County, Pennsylvania, being of sound and
disposing mind, memory and understanding, do hereby make, publish
and declare this instrument to be my Last Will and Testament,
hereby revoking and making null and void any and all prior wills
and Testaments and Codicils or writings in the nature thereof by
me at any time heretofore made.
FIRST:
I direct that all my just debts, inheritance and
estate taxes, if any, and the costs of administrating my estate
be paid as soon as conveniently may be after my death.
SECOND:
All the rest, residue and remainder of my estate,
be the same real, personal or mixed of whatsoever nature and kind
and wheresoever situate, including any property over which I may
have any power of appointment, I give, devise and bequeath unto
my beloved sons, to wit: JAMES J. THOMAS and RONALD W. THOMAS,
equally, share and share alike, per stirpes.
THIRD:
I nominate, constitute and appoint my son, JAMES
J. THOMAS to be the Executor of this my Last will and Testament.
If the said Executor shall fail to survive me, or is otherwise
unwilling or unable to act, then I hereby appoint my son, RONALD
W. THOMAS as successor Executor. I vest my said Executor with
full power and authority to sell, transfer and convey any
.,.....,.."',.....,I""'\-~"I'.,. ,..I"'"\~,
l:-'.L..V.t:-'~..... '-;t, ...etA...&..
...."yo ~"""''''''~'''1''''Il~'
'-'.L. 1;'c.... .0...,......11".4,...... ,
T..Th; ,....1.."
n.L.I .....vJ..L
T Tn ~"'tT I""\.Ta7'n .::t. +-
.... "'....t.A..J. .....,.,,,....... '--
the time of
mu
....1
death at such time and price and upon such terms and conditions
(including credit) as the Executor may determine. Such sale
shall be at public or prIvate sale and shall not requIre approval
of the Court. No fiduciary acting hereunder shall b~ required to
post bond or enter security in any jurisdiction.
IN WITNESS WHEREOF, I the said RONALD E. THOMAS, have to
this my Last Will and Testament, contained on two (2) sheets of
paper, subscribed my name and affixed my seal, this 29th day of
March, Nineteen Hundred Eighty-Eight (1988).
,au CI /I~
RONALD E. THOMAS
Signed, sealed, published and declared on the day and of the
date hereinabove by RONALD E. THOMAS, the Testator above named,
as and for his Last will and Testament, in the presence of us,
who at his request, in his presence, and in the presence of each
other, all being present at the same time, have hereunto
subscribed our names as witnesses.
p
u
I
~.'////G~;~4? ~ /~
~~- //f/'
~J;2 q fh J,,1(J//){ .1: tI~ .
ADDRESS
jJ /L/,/L- ~1J.r-rD\.f'U
blAME
,
\
da,;/),Gi"{;'\{,{t/ <'"r-
e/
J
/uJ
Iii -
/ljI/t1!
?
GEORGE M. HOUCK
(1912-1991)
Register of Wills
Cumberland County Court House
1 Court Square
Carlisle, PAl 70 13
Dear Register of Wills:
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrindle 0JUi Clouser Roads
MECHANICSBURG, PA 17055
TELEPHONE (717) 766-0209
FAX (717) 795-7473
July 31, 2007
Re: Estate of Ronald E. Thomas, deceased
Docket No.: 21-06-0275
Please find enclosed for filing 2 copies ofthe Inheritance Tax Return for the Ronald E.
Thomas Estate as well as cash in the amount of $15.00 for the filing fee.
Thank you for your kind attention to this matter.
CES/mjj
Enclosures
Very truly yours,
~[:~r
Charles E. Shields, III
Attorney-At- Law
o
So
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N
..
c.n
co