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HomeMy WebLinkAbout09-04-07 11 .. .-J 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 Year INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 6 File Number 1125 QJlte of Birth 188124437 12132006 05151921 Decedent's Last Name Suffix Decedent's First Name MI STANSFIELD CHARLES E (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 o 1. Original Return o 4. Limited Estate [K] o 6. Decedent Died Testate (Attach Copy of Will) D 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82) 0 4a. Future Interest Compromise D 5. Federal Estate Tax Return Required (date of death after 12-12-82) 00 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) D 10 Spousal Poverty Credit ~date of death D 11. Election to tax under Sec. 9113(A) . between 12-31-91 and -1-95) (Attach Sch. 0) 9. Litigation Proceeds Received iORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number GREGORY K. RICHARDS ESQ. 7175333280 Firm Name (If Applicable) JAMES, SMITH, DIETTERICK & 134 SIPE AVENUE ~C) .:.>,-- "-~~-~ ::0 n--, (:--,; c) ~ r ) ,- . ~. J First line of address Second line of address ;g HUMMELSTOWN State PA ZIP Code 17036 DATE At-ED City or Post Office a Correspondent's .mail address: Gerald L. Stansfield Gregory K. Richards, Esq. , Hummelstown, PA 17036 Side 1 L 15056041147 15056041147 --1~ -.J 15056042148 REV-1500 EX Decedent's Name: Charles E. Stansfield 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) D Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1-n.................................................................. 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 ~ 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 1'4'iBX8ble at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 0.00 15. 1,792,554.78 16. 0.00 17. 20,000.00 18. 19. Tax Due....................... ....... __............................... ........................... n...... ............. 19. 20. Fill IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 Decedent's Social Security Number 188124437 12,898.93 310,761.44 8,800.79 1,559,619.69 1,892,080.85 29,273.20 50,252.87 79,526.07 1,812,554.78 1,812,554.78 0.00 80,664.97 0.00 3,000.00 83,664.97 D 15056042148 -.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-06-1125 DECEDENT'S NAME Charles E. Stansfield STREET ADDRESS 299 E. Green Street CITY I STATE !ZIP Shiremanstown PA 17011-6718 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 0.00 (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is thEOVERPAYMENT. 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 theTAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is theBALANCE DUE (3) (4) (5) (SA) (58) Make Check Payable to: REGISTER OF WILLS, AGENT 83,664.97 0.00 83,664.97 83,664.97 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes o o o o o 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 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. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;............................................................................. b. retain the right to designate who shall use the property transferred or its income;................................ c. retain a reversionary interest; or........................... .................................u ........................... __., .............. d. receive the promise for life of either payments, benefits or care?.......................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................. ................................................................................... No o D D o D o For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statutmoes not exemota 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 orfor the use of the decedent's siblings is twelve (12) percent [72 P .5. 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.1503 EX....(6-98) . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF All property JOIntly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 177.5 shares of PNC Financial Services Group, Inc- 72.67 12,898.93 valued per public listing TOTAL (Also enter on line 2, Recapitulation) 12,898.93 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-15GB EX+~6-9B) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF 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 DESCRIPTION 1 PNC Bank checking account # 5140237221 - valued per letter dated July 20, 2008 VALUE AT DATE OF DEATH 3.717.49 2 PNC Bank checking account # 5140241378 - valued per letter dated July 20,2007 2.763.17 3 2000 Lincoln Towncar - valued Per sales price 9.000.00 4 2004 Chevrolet Silverado - valued per Kelley blue book - good condition 14.005.00 5 AIG American General - life insurance proceeds on the life of Carol S. Swanson - decedent was a 36% beneficiary of policy 9.000.00 6 Pioneer Investments IRA Acount # 00705229795 - estate is beneficiary - valued per 211.314.10 7 Pioneer Investments IRA Acount # 06202583966 - estate is beneficiary - valued per 60.961.68 TOTAL (Also enter on Line 5, Recapitulation) 310.761.44 (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) ~''''EX+._I . COMMONWEALT1-f OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED PROPERTY Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF 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 A. Gerald L. Stansfield ADDRESS RELATIONSHIP TO DECEDENT Son 6 Randi Road Enola, PA 17025-1821 B. Bryan W. Stansfield 303 Allen View Drive Mechanicsburg, PA 17055 Son C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSE'" INTEREST DECEDENTS INTEREST JOINTLY-HELD REAL ESTATE. 1 A 4121/1997 Pioneer Small Cap Value Fund - valued 17,601.58 50.000% 8,800.79 per letter dated January 23,2007 TOTAL (Also enter on Line 6, Recapitulation) 8,800.79 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule F (Rev. 6-98) Rev-1510 EX+.(6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM .................... u. IIUI'I OF. ,...... ...., I Y DATE OF DEATH % OF DECD'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 Brian H. Graeff - gifts made during 2006 12,000.00 3.000.00 9.000.00 2 Bryan W ~ Stansfield - 1.2% interest in Stansfield 13,063.37 3.000.00 10.063.37 Family Limited Partnership gift made 01/02/2006 3 Bryan W. Stansfield - gifts made during 2006 4,800.00 4.800.00 4 Gerald L. Stansfield - 1.2% interest in Stansfield 13.063.37 3.000.00 10,063.37 Family Limited Partnership gift made 01/02/2006 5 Gerald L. Stansfield - gifts made during 2006 13.200.00 13.200.00 6 Gloria L. Stansfield - gifts made during 2006 12.000.00 3.000.00 9,000.00 7 Roellen M. Stansfield - gifts made during 2006 12.000.00 3.000.00 9.000.00 8 Sandra K. Graeff - 1.2% interest in Stansfield 13.063.37 3.000.00 10.063.37 Family Limited Partnership gift made 01/02/2006 9 Sandra K. Graeff - gifts made during 2006 13.200.00 13.200.00 10 193.13 units of Federated Capital Reserve Money 193.13 193.13 Market - titled in the Charles E. Stansfield Living Trust U/AlD 2/9/96 held in the Pershing LLC Account No. 4NP-409697 valued per letter dated January 31,2007 11 591 shares of Goldcorp Inc New Common - titled 16.941.02 16,941.02 in the Charles E. Stansfield Living Trust U/AlD 2/9/96 held in the Pershing LLC Account No. 4NP-409697 - valued per letter dated January 31, 2007 Total of Continuation Schedules See attached pages TOTAL (Also enter on Line 7, Recapitulation) 1.559.619.69 (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.1510 EX+. (6-98) *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S TAXABLE EXCLUSION 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. 12 2,360 shares of Healthsouth Corp - titled in the 57.135.60 57.135.60 Charles E. Stansfield Living Trust U/AlD 2/9/96 held in the Pershing LLC Account No. 4NP-409697 - valued per letter dated January 31, 2007 13 Personal Property - appraised by Ziegler Auction 1.130.00 1.130.00 Co per letter dated 01/18/2007 14 Personal Property - appraised by The 775.00 775.00 Sportmen's Connection per letters dated 12/30/2006 15 Personal Property - appraised by The 1.045.00 1.045.00 Sportmen's Connection per letters dated 01/03/2007 . 16 Personal Property - sold at auction 760.35 760.35 17 Pioneer Equity Income Fund - titled in the 56.985.71 56.985.71 Charles E. Stansfield Living Trust dated 02/09/1996 valued per letter dated January 23, 2007 18 711.485 units of Pioneer Mid Cap Value Fund - 16.300.12 16,300.12 titled in the Charles E. Stansfield Living Trust dated 0210911996 valued per letter dated January 23,2007 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule G (Rev. 6-98) Rev-1510 EX... (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S TAXABLE EXCLUSION 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. 19 Pioneer Small Cap Value Fund - titled in the 1,622.58 1,622.58 Charles E. Stansfield Living Trust dated 02/09/1996 valued per letter dated January 23, 2007 20 1,103.251 units of Pioneer Value Fund - titled in 18,655.97 18,655.97 the Charles E. Stansfield Living Trust dated 0812411978 valued per letter dated January 23, 2007 21 594 shares of PNC Financial Services Group, Inc 43,165.98 43,165.98 - titled in the Charles E. Stansfield Living Trust U/AlD 2/9/96 - valued Per public listing 22 Real Estate located at 15 East Main Street 110,033.00 110,033.00 Shiremanstown, PA · titled in the Charles E. Stansfield Living Trust dated February 9, 1996 valued per tax assessment * coman level ratio $96,520*1.14 = 110,033 23 Real Estate located at 220 East Main Street. 214,160.00 214,160.00 titled in the Charles E. Stansfield Living Trust dated February 9, 1996 valued per tax assessment * coman level ratio $187,860*1.14 = 214,160 24 Real Estate located at 299 East Green Street 187,815.00 187,815.00 Shiremanstown, PA - titled in the Charles E. Stansfield Living Trust dated February 9, 1996 valued per tax assessment * coman level ratio $164,750*1.14 = 187,815 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule G (Rev. 6-98) Rev.1510 EX.. (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'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. 25 Real Estate located at 302 East Main Street, 155,416.00 155,416.00 Shiremanstown, PA - titled in the Charles E. Stansfield Living Trust dated February 9, 1996 valued per tax assessment * comon level ratio $136,330*1.14 = 155,416 26 1,400 shares of Rite Aid Corporation - titled in 7,483.00 7,483.00 the Charles E. Stansfield Living Trust U/A/D 219196 held in the Pershing LLC Account No. 4NP-409697 - valued per letter dated January 31, 2007 27 Stansfield Family Limited Partnership - 3.00% 35,556.65 35,556.65 held as general partner titled in the Charles E. Stansfield Living Trust dated February 9, 1996- valued per letter dated January 31, 2007 28 Stansfield Family Limited Partnership - 36.73% 435,331.98 435,331.98 held as limited partner titled in the Charles E. Stansfield Living Trust dated February 9, 1996 - valued per letter dated January 31, 2007 29 2,181.867 units ofT. Rowe Price Service 80,554.53 80,554.53 Small-Cap Stock Fund account 5001008135-7- titled in the Charles E. Stansfield Living Trust, U/DIT dated 2/9/96 valued per letter dated February 8, 2007 30 817.144 units ofT. Rowe Price Small-Cap Stock 30,168.96 30,168.96 Fund account 7207-0 - titled in the name of Charles E. Stansfield U/DIT dated 9nn8 valued per letter dated February 8, 2007 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV.1151 ex,.. (12.99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stansfield, Charles E. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-06-1125 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) "attached 12,054.55 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. Attorney's Fees James, Smith, Dietterick & Connelly, LLP 15,000.00 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 396.33 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,822.32 TOTAL (Also enter on line 9, Recapitulation) 29,273.20 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev.1502 EX... (6-98) . SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Headstone engraving 300.00 2 Malpezzi Funeral Home - Funeral Costs 10.828.76 3 Malpezzi Funeral Home - additional funeral expenses 233.91 4 Mechanicsburg Club - funeral luncheon 691.88 Subtotal 12.054.55 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1512 EX.. (6-98) . . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Stansfield, Charles E. FILE NUMBER 21-06-1125 ESTATE OF Include unrelmburaed medical expen.... ITEM NUMBER DESCRIPTION 1 Bank of America - final payment VALUE AT DATE OF DEATH 56.77 2 Crystal J. Snyder - Payment in full for nursing services 1.200.00 3 PNC Bank Loan Account Number 40-01-008110124054 - 1/2 of joint obligation - valued per letter dated August 24, 2007 39,604.10 4 U. S. Treasury - 2006 balance personal income tax 9,392.00 TOTAL (Also enter on line 10, Recapitulation) 50,252.87 (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) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Charles E. Stansfield 188.12-4437 12/13/2006 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Crystal J. Snyder Friend $20,000 specific 20,000.00 340 N. 72nd Street bequest Harrisburg, PA 17111 2 Sandra K. Graeff Daughter real estate located at 562,858.59 32 A Young Road 299 East Green Charlton, MA 01507.1560 . Street; 1/3 residue 3 Bryan W. Stansfield Son real estate located at 589,203.60 303 Allen View Drive 220 East Main Street; Mechanicsburg, PA 17055 1/3 residue 4 Gerald L. Stansfield Son real estate located at 640,492.59 6 Randi Road 15 East Main Street Enola, PA 17025.1821 and 302 East Main Street; 1/3 residue Total 1,812,554.78 1 INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland Gerald L. Stansfield Personal Representative(s) of the Estate of Charles E. Stansfield } 55 } File Number 21-06-1125 I verify that the statements made in this Inven- tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. S 4904 relating to unsworn falsification to authorities. deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of is inventory. I'..) o C~ }l ~ ~ r >;0 o-J Gerald L. Stansfield } , - ;-, f-,-' .) J_I (-) () ;.~~ :-':h j=o '" --I -0 -,- -.l;l:!& Attorney - (Name) (Firm) (Address) (Telephone) ~335 Gregory K. Richards Esq. James, Smith, Dietterick & Connelly, LLP 134 Sipe Avenue, Hummelstown, PA 17036 717/533-3280 (Supreme Courti.D. No.) DATE OF DEATH 12/13/2006 LAST RESIDENCE 299 E. Green Street Shiremanstown, PA 17011-6718 FIGURES MUST BE TOTALED DECEDENT'S SOC. SEC. NO. 188-12-4437 Personal ProDertv Cash......................................................................... ..... .... ........ ..... Personal Property......................................................................... Stocks/Listed.... ............. ................. ......... .................................. .... Stocks/Closely Held...................................................................... Bonds.......................................................................................... ... Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... All Other Property......................................................................... 278,756.44 32,005.00 12,898.93 Total Personal Property... ..... ..... ............................ 323,660.37 Total Real Property.............................. ..... ........ ..... Total Personal and Real Property......................... NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. e.s. S 3301 (b)) Form RW-09 Rev, 10-13-2006 INVENTORY REGISTER OF WILLS OF CUMBERLAND r COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } File Number 21-06-1125 DATE OF DEATH 12/13/2006 LAST RESIDENCE 299 E. Green Street Shiremanstown, PA 17011-6718 DECEDENT'S SOC. SEC. NO. 188-12-4437 Cash .Pioneer Investments IRA Acount # 00705229795 - estate is beneficiary - valued per 211,314.10 Pioneer Investments IRA Acount # 06202583966 - estate is beneficiary - valued per 60,961.68 PNC Bank checking account # 5140237221 - valued per letter dated July 20, 2008 3,717.49 PNC Bank checking account # 5140241378 - valued per letter dated July 20, 2007 2,763.17 Total Cash 278,756.44 Personal PrODertv 2000 Lincoln Towncar - valued per sales price 9,000.00 2004 Chevrolet Silverado - valued per Kelley blue book - good condition 14,005.00 AIG American General -life insurance proceeds on the life of Carol S. Swanson - decedent was a 36% beneficiary of policy . 9,000.00 Total Personal Property 32,005.00 Stock I Listed 177.5000 shares PNC Financial Services Group, Inc - valued per public listing 12,898.93 Total Stock / Listed 12,898.93 (Attach additional sheets if necessary) Total Personal Property and Real Estate 323,660.37