The URL can be used to link to this page

Home My WebLink About10-01-07 --.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 Fila Number INHERIT ANCE TAX RETURN RESIDENT DECEDENT 2 1 0 7 00599 Date of Birth 209128217 05132007 08281916 Decedent's Last Name Suffix Decedent's First Name TYRRELL MILDRED MI A (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 [!] 1. Original Return o [K] o 6. Decedent Died Testate (Attach Copy of Will) o o o o 4a. Future Interest Compromise (date of death after 12-12-82) 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate 7 Decedent Meintained a Living Trust . (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10 Spousal Poverty Credit (date of death . between 12-31-91 and 1-1-95) o 11. Election to tax under Sec. 9113(A) (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 p..j <.:."::) -; First line of address -.,.-- -' REGISTER OF Wf!-~ USE O~ ",'j ("'") "(-) ~.. I 301 MARKET STREET -0 Second line of address City or Post Office LEMOYNE --C"! DATE F1tED p." w ..) State PA ZIP Code 17043 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, i 's true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. GNATURE OF PERS RESP SIBLE FOR FILING RETURN DATE PATRICE A. TYRRELL , PA 17050 EDMUND G. MYERS DATE 127(ul 301 MARKET STREET, LEMOYNE, PA 17043 Side 1 L 15056041147 15056041147 --.J~ COMMONWEAL TH OF PENNSYL VANIA <e@~~ : SS. COUNTY OF CUMBERLAND AFFIDA VIT I, Carleen S. Jensen, being duly sworn, do hereby depose and state the following: A. I am a Notary Public under the laws of the Commonwealth of Pennsylvania. B. I am employed by Johnson, Duffie, Stewart & Weidner, a law firm, 301 Market Street, Lemoyne, PA 17043. C. On December 28, 2006, Mildred A. Tyrrell executed her Will, copy of which is attached, and Edmund G. Myers and Michelle H. Spangler subscribed their names to the Will as witnesses to Mildred A. Tyrrell's execution of her Will. (See page 7 of the attached copy.) D. ,...~ <= o = r" --' On December 28, 2006, I took the acknowledgment of Mildred A. Tm€D that she "';"'-0 c: signed the Will as her last Will, that she signed it willingly, and that ~l1~~cut~ ~ ::D -J it as her free and voluntary act. ~~~~ -0 ~~Q":;:' J:: ~...J ':D N --l .. On December 28, 2006, I also took the affidavit of Edmund G. )Myers an~ - Michelle H. Spangler that each signed the Will as a witness in the presence of and hearing of Mildred A. Tyrrell, and that to the best of the knowledge of each, Mildred A. Tyrrell was more than 18 years of age, of sound mind and under no constraint or undue influence. E. F. I confirmed the foregoing acknowledgement and affidavit on the last page of the Will as shown on the attachment, inadvertently numbered page 39, and which page inadvertently also included an additional affidavit and acknowledgement which were surplus and unneeded. :302225v2 -'C,I l'On < .~) :~-=) ~~~;, ~:~~I ~u CJ '-'-':,. ..-....-..., I ::":f'"l _ :--:.i.:! r~.-1 :.;:)~ , I 1.. '~J c/~~ ts~~ i~',:: -.'- LL !.~_ (~) J.~...) orT: l~"..i 1~1 (;;'J -.-:-:; 1.. 1 .. ~. (---:..: ,) ;:-......, ,i.! ~J::j C1= ZA~ZZZOt: 'p:::lp:::l:::lUUU pUB sUIdms :::ll:::lM q:J!qM lUdUld8p:::lIMOmpB pue l!AepYJe Ieuo!l!ppe ue P:::lPUPU! oSIe AIlU:::lll:::lApeu! :::l8ed q:J!lJ:I'l\ pue '6t :::l8ed p:::l1:::lqumU AIlU:::lll:::lApeU! 'lU:::lunpepe :::lql uo UMOqS se II!A\. dq! JO :::l8ed lseI :::lql uo l!AepYJe pue lU:::lw:::llip:::lIMolD{:Je 8u!08:::l10] :::lql p:::lUllguO:J I'd ':::l:JU:::lUYU! :::lnpun 10 lU!e1lSUO:J OU ];:lpun pue PU!W punOS]O ':::llie ]0 Sle:::lA 8 I ueql :::llOW seM II:::l.I.IAl. 'V p:::l1PI!W 'q:Jt:;;:l JO :::llip:::lIMOlD{ :::lql ]0 lS:::lq :::lql Ol leql pue 'II:::l.I.IAl. 'V p:::llpI!W JO 8U!1e:::lq pUB 10 ;}:Ju:::ls:::l1d :::lql U! SS:::lUl!M e se II!A\. :::lql p:::lu8!s q:Je;} leql1:::l[liuedS 'H :::lII:::lq:J!W ~UB Sl:::lA~ '0 PunUIp3 JO l!AepYJe :::lql )(OOl os[e I '900Z '8Z l:::lqUl:::l:J:::la uO I- g;;d LLOL; Ll.. S c..~ C,;, 'pe AlelunIoA pue :::l:::l.g l;}q se l! ~cr...<_. r- C1: Z <... ~!m~fl~ lel.{l pUB 'AlliU!II!M l! p:::lu1i!s :::ll.{s leql 'mA\. lseI 1:::ll.{ se II!A\. :::lql p:::lu8!s =:J D:: r:. c ~s !Bql 89~1. 'V p:::l1PI!W]0 lU:::lw1ip:::lIMOmpe :::lql )(OOl I '900Z '8Z l:::lqW:::l:J:::la uO = 0 c:.::.., c--~ '3 0J 'a ("Ado:J p:::ll.{:JBPB :::lquo L J8Bd ;}:::lS) 'II!A\. l:::lq]O UO!ln:J:::lx:::l S.[pllAl. 'V p:::l1PI!W Ol S:::lSS:::lUl!M se mA\. :::lqlol S;}tIIllU l!:::ll.{l p:::lq!1:Jsqns 1:::lI8ID!dS 'H :::lIPl.{:J!W pID! Sl:::lAW '0 PunUlp3 pID! 'p:::lq:Jelll~ S! q:J!l.{M ]0 Ado:J 'mA\. l:::lq P:::llU:J:::lX:::l Ip.I.IAl. 'V P:::llPI!W '900Z '8Z l:::lqUl:::l:J:::la uO ':J TtOL I V d ':::luAOUl:::l1 '!:::l:::ll!S !:::l)(mw IOt 'Ulll] M'BI 'B 'l:::lUP!:::lA\. ~ ll'BM:::llS ':::lYJua 'uosuqOf Aq p:::lAo[dw:::l Ule I '8: ''B!lleA[ASUU:::ld JO l.{H'B:::lMUOUlWO:J :::ll.{Uo SM'BI :::lqll:::lpUU :J!Jqud A1elON 'B Ul'B I 'V :liu!MOIIO] :::lql :::ll'BlS pue :::lsod:::lp Aq:::l1:::ll.{ op 'mOMS AInp 8U!:::lq 'U:::lSU:::lf 's U;};}Il'B:J 'I l.IA ValddV GNV'llI3JIWil:J.!IO ALNilO:J .SS : J~P("- VINV A 'IASNN3:d .!IO HL'lV3:MNOWWO:J ) "! G. I make this Affidavit to confirm to the Register of Wills of Cumberland County that the original of the attached Will (pages 1-7 and 39) was duly, regularly and properly signed, witnessed, acknowledged and sworn to as the Will of Mildred A. Tyrrell. &~~ 1CJ-- Carl n S. Jensen Sworn to and subscribed before me, a Notary Public, on this . ; d da~ oj June, 2007 kud/% Notary P ic I a13-tJ /;;< 0 II . f My Commission Expires: c~TH OF PENNSYLVANIA NoIarial Seal MagaretE.~ ~ BorP. ...... 30. 2011 My CornI'l'1IsSkJn ElcpIreS ,v-, ber' Pennsylvania Association of Notaries Mem . :302225v2 @@~ Last Will and Testament OF MILDRED A. TYRRELL I, MILDRED A. TYRRELL, of Hampden Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS 1"".""" C':) r) <=> I direct that all expenses of my last illness and funeral and all legal debts be~ from ~y ~~ --0 '"- Estate as soon as practical after my death., j}~ g ~ - [.,. :D --J ___ c/) 7' ') (-") J) -0 -j 0 -:::r-, ::c: ,'~,...,,(= - ~ -' ::D t-V - -; -n p ARTICLE II TANGIBLE PERSONAL PROPERTY I give and bequeath my motor vehic1es(s), household and personal effects and other tangible personalty of like nature together with any existing insurance thereon, but excluding any cash or securities, unto my daughter, PATRICE A. TYRRELL. If my daughter predeceases me, I give and bequeath the same unto my son, TIMOTHY N. TYRRELL and my grandson, MATTHEW P. TYRRELL, to be divided in kind as they may agree. If either predeceases me, then I give and bequeath the same unto the survivor. In case of disagreement between the beneficiaries as to the disposition of any item or items, my Personal Representative is authorized to make the division, having due regard for the personal preferences of the beneficiaries, but making the division in as nearly equal shares as the Personal Representative deems practical. I direct that the expense of W .&:'" packing, shipping, insuring and delivering any such property to a beneficiary hereunder shall be paid from my Estate as an administrative expense. ARTICLE III REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatever nature and wherever situate, in equal shares unto my daughter, PATRICE A. TYRRELL, my son, TIMOTHY N. TYRRELL and my grandson, MATTHEW P. TYRRELL, subject to the provisions of Article IV hereafter. If any of these beneficiaries predecease me, I direct that the share of the deceased beneficiary shall pass to the surviving beneficiary or beneficiaries in equal shares, or to the surviving beneficiary, as the case may be. ARTICLE IV TRUST FOR THE BENEFIT OF MATTHEW P. TYRRELL If my son, MATTHEW P. TYRRELL, survives me and has not attained the age of forty (40) years at the time of distribution of his share, I give, devise and bequeath his share unto my daughter, PATRICE A. TYRRELL, and if she is unwilling or unable to act as Trustee, then unto my nephew, STEPHEN P. REHRER, neither being required to post bond, IN TRUST, in accordance with the following: Trustee shall hold, manage, invest and re-invest the same for the benefit of MATTHEW P. TYRRELL, and shall distribute unto the beneficiary such income and/or principal as Trustee, in her or his sole discretion, deems appropriate for his care, support, maintenance and education. In giving my Trustee this broad discretion, it is my intent to be sure that the share of my Estate for the benefit of my grandson, MATTHEW P. TYRRELL, is distributed at such times and for such purposes as my Trustee, in her or his sole judgment, deems appropriate. For example, my Trustee may distribute a portion of principal and/or income should 2 my grandson, MATTHEW P. TYRRELL, acquire a residence, marry, have children, or pursue endeavors requiring capital investment which are worthy and sustainable. I direct that my Trustee distribute the entire balance of undistributed income and principal unto my grandson, MATTHEW P. TYRRELL, when he achieves the age of forty (40) years. If my grandson, MATTHEW P. TYRRELL, dies before receiving his fmal distribution of all the principal and income of this Trust, I direct that it shall be distributed unto his then-living issue, per stirpes, or as he may otherwise direct by a General Power of Appointment in his Will, or in default of either, then unto my then-living issue, per stirpes. ARTICLE V SPENDTHRIFT PROVISION I direct that the interest of the beneficiaries shall not be subject to anticipation or to voluntary or involuntary alienation. ARTICLE VI POWER TO TERMINATE SMALL TRUSTS If at any time during the continuance of any trust created under this Will~ the Trustee in its sole and absolute discretion determines that the size of any individual trust has.become so small as to be impractical to continue to hold property in trust and uneconomical to continue to administer as a trust, then the trustee may without further authorization distribute the balance of the principal and income in the trust to the beneficiary then entitled to the income therefrom or, considering the age and needs of the beneficiary, the beneficiary's guardian or custodian under the Pennsylvania Uniform Transfers to Minors Act or similar stat law in effect in which the minor beneficiary resides, including a custodian selected by my trustee. Upon such distribution under this section, the 3 .. trustee shall be released from further obligation with respect to the trust and shall not be subject to any claim from any person who may have had a future interest in the trust had the trust continued. ARTICLE VII SUCCESSOR TRUSTEE If at any time during the continuance of any trust created under this Will the trustee transfers its trust business to another entity authorized to do trust business, by merger, consolidation or reorganization, such transferee entity and its successors shall thereupon, without further transfer, substitution, act or deed succeed as trustee hereunder. A successor trustee shall be vested with all the right, title and interest in and to all trust property created under this Will, together with all the rights, powers, duties and discretion herein conferred on the original trustee. A successor trustee shall not be responsible for any act or omission of a prior trustee. ARTICLE VITI POWERS OF PERSONAL REPRESENTATIVE AND TRUSTEE My Personal Representative and Trustee shall have the following powers in addition to those vested in them by law and by other provisions of my Will applicable to all property, whether principal or income, including property held for minors, exercisable without court approval and effective until actual distribution of all property: A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine. B. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. 4 C. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. D. To sell at public or private sale, to exchange, or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. E. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. F. To compromise any claim or controversy. G. To make such elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift, generation skipping or other tax refunds and the payment of such taxes as my Personal Representative and Trustee shall deem appropriate, without obligation to adjust the distributive share of any person thereby affected. H. To combine, without prior court approval, any Trust contained in my Will with any other Trust with substantially similar provisionS, although such Trust may have been created by separate instrument. 5 ARTICLE IX TAXES I direct that estate, inheritance, transfer and other taxes of a similar nature payable by reason of my death, together with interest and penalties thereon, and imposed with respect to any property, whether or not disposed of by this Will, shall be paid out of the residuary estate as an expense of administration. ARTICLE X PERSONAL REPRESENTATIVE I name, constitute and appoint my daughter, PATRICE A. TYRRELL, Executrix of this, my Last Will and Testament. If my daughter, PATRICE A. TYRRELL, fails to qualify or ceases to so act, I name, constitute and appoint my son, TIMOTHY N. TYRRELL, alternate Executor to complete the administration of my Estate. I direct that no Personal Representative appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this.iS!!!...Jo:ay of December, 2006. ~1.~ (SEAL) 6 Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our uames as ~esses. . ~KJ~ ~~~ 4{: ~47--d-v AFFIDA VIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYL VANIA ss. COUNTY OF CUMBERLAND We, MlLDIQ;;D A. TYRRELL, aZv",.l1l rr1'-0 7'l,dlJ.1}t- I-f. 7 ' the Testa1rix and the tnesses, respectively, whose names are signed to the ched or foregomg mstrument, bemg first duly sworn, do hereby and declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of hislher knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. fvt}l~) f1.:El:::! MILDRED A. LL ~*JH1r Witness ~~~ d-4unrl~-4--J WltIf ss :288800 7 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYL VANIA SS COUNTY OF CUMBERLAND We, MILDRED A. TYRRELL, and , the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. MILDRED A. TYRRELL Witness Witness Subscribed, sworn to and acknowledged before me by MILDRED A. TYRRELL, Testatrix, and subscribed and sworn to before me by ~~ IY~/r< and rtfrUJ.L U. ~ r ' witnesses, this gf'b-day of ,.-,2006. ~ I'~ )" ~ - .- No p~biic COiV\N\Ot'IWEAlTH OF PENNSYLVANIA NOTARIAL SEAL C;\RLEEN S. JENSEN, Notary Public LemOine Bora., Cumberland County My Commission ~xDires DII;, 17. 2007 39 --.J lS0Sb042148 REV-1500 EX Decedent's Neme: M ILOREO A. TYRRELL 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~ 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. 92,257.32 16. 0.00 17. 0.00 18. 19. Tax Due..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L lSDSbD42148 Decedent's Social Security Number 209128217 102,117.80 8,915.78 111,033.58 12,520.41 6,255.85 18,776.26 92,257.32 92,257.32 0.00 4,151.58 0.00 0.00 4,151.58 D lSDSb042148 --.J REV-1S00 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME MILDRED A. TYRRELL STREET ADDRESS 1810 SIGNAL HILL DRIVE File Number 21-07-00599 CITY I STATE PA IllP 17050 Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 3,500.00 184.21 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) Total Interest/Penalty (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 S. 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 S + SA. This is the BALANCE DUE. 4,151.58 3,684.21 (3) (4) (S) 467.37 (SA) (SB) 467.37 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes a 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 [!] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. '1111 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. ~9116 (a) (1.1) (ii)]. The statute does not exemDt 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 (O) 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.S) 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. 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.............. ................. ................... ..................................................... ........... 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 ~ [!] [!] Rov.160B EX+ (8.8Bl . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF TYRRELL, MILDRED A. FILE NUMBER 21-07 -00599 Include the proceeds of litigation and the date the proceeds were received by the estate. All proporty Jolntly-ownocl with thl right of ourvlvorshlp muot bo dlsclosocl on schodulo F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 CORUS BANK - Certificate of Deposit No. 7004975397 - Date of death balance, plus 87.565.05 accrued interest. 2 ING DIRECT - Savings Account No. 2814733 - Date of death balance, plus accrued 4.940.73 interest. 3 PNC BANK - Account No. 51-4019-9894 - Date of death balance, plus accrued 9.461.39 interest. 4 State Employees' Retirement System - Pension payment due decedent for 5/1/07 - 150.63 5/13/07 5 Article II - Tangible Personal Property - Adeemed 0.00 TOTAL (Also enter on Line 5, Recapitulation) 102.117.80 (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) R.v-160' EX+ (8-'8) *' SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEAlTH OF PENNSYLVANIA INHERITANCE T AA RETURN RESIDENT DECEDENT TYRRELL, MILDRED A. FILE NUMBER 21-07 -00599 ESTATE OF If .n a_ wa. mad. Joint within on. y.a. of the d....d.nr. data of d.ath, It muat b. reported on .oh.dul. G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. PATRICE A. TYRRELL 1810 SIGNAL HILL DR. Mechanicsburg, PA 17050 Daughter 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 11/17/99 Janus Investment Fund - Account No. 17.831.56 50.000% 8.915.78 60-203936046 - Date of Death Value TOTAL (Also enter on Line 6, Recapitulation) 8.915.78 (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.1161 EX+ (12-88) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TYRRELL, MILDRED A. FILE NUMBER 21-07 -00599 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT See continuation schedule(s) attached 423.41 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions PATRICE A. TYRRELL Social Security Number(s) I EIN Number of Personal Representative(s): 162-36-9437 Street Address 1810 SIGNAL HILL DRIVE City Mechanicsburg State Year(s) Commission paid 2007 See continuation schedule(s) attached PA Zip 17050 5,000.00 2. Attomey's Fees See continuation schedule(s) attached 3,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Patrice A. Tyrrell Street Address 1810 Signal Hill Drive City Mechanicsburg Relationship of Claimant to Decedent 3,500.00 State Daughter PA Zip 17050 4. See continuation schedule(s) attached Probate Fees 306.00 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 291.00 TOTAL (Also enter on line 9, Recapitulation) 12,520.41 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev.1&02 EX+ (8-18) *' SCHEDULE H.A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TYRRELL, MILDRED A. FILE NUMBER 21-07 -00599 ITEM NUMBER DESCRIPTION AMOUNT 1 Musselman Funeral Home - (Charges prepaid) balance due 423.41 Subtotal 423.41 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1602 EX+ (8-88) *' SCHEDULE H.B1 PERSONAL REPRESENTATIVE'S COMMISSIONS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TYRRELL, MILDRED A. FILE NUMBER 21-07-00599 ITEM NUMBER DESCRIPTION AMOUNT 1 Patrice A. Tyrrell- Executrix Commission 5.000.00 Subtotal 5.000.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B1 (Rev. 6-98) Rev.1602 EX + (1.18) *' SCHEDULE H-82 ATTORNEY'S FEES continued COMMONWEALTH OF PENNSYlVANIA INHERITANCE T IV( RETURN RESIDENT DECEDENT ESTATE OF TYRRELL, MILDRED A. FILE NUMBER 21-07 -00599 ITEM NUMBER DESCRIPTION AMOUNT 1 Johnson, Duffie, Stewart & Weidner - Attorney Fee 3.000.00 Subtotal 3.000.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule H-B2 (Rev. 6-98) Rev-1602 EX+ (8-88) *' SCHEDULE H.B3 FAMILY EXEMPTION continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT TYRRELL, MILDRED A. FILE NUMBER 21-07 -00599 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Patrice A. Tyrrell, Daughter 3.500.00 Subtotal 3.500.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B3 (Rev. 6-98) ReY-1602 EX + (6-98) . SCHEDULE H.B4 PROBATE FEES continued COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT TYRRELL, MILDRED A. FILE NUMBER 21-07 -00599 ESTATE OF ITEM NUMBER 1 DESCRIPTION Register of Wills - Cumberland County AMOUNT 306.00 Subtotal 306.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule H.B4 (Rev. 6-98) Rev-1602 EX+ (8-98) . SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TYRRELL, MILDRED A. FILE NUMBER 21-07 -00599 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal - Legal Advertisement 75.00 2 Register of wills - file Inventory & Inheritance Tax Return 30.00 3 The Patriot-News - Legal Advertisement 186.00 Subtotal 291.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) R.v-1612 EX+ (8.98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT TYRRELL, MILDRED A. FILE NUMBER 21-07-00599 ESTATE OF Includ. unrelmbu...d m.dlcel .xp.n.... ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 American Home Medical - decedent's account 16.50 2 Checks that cleared after death - PNC Bank - Account No. 51-4019-9894 - Check No. 3.662.00 3178 - Erie Insurance -$162.00; Check No. 3179 - Fishing Creek Salem United Methodist Church - Donation - $200.00; Check No. 3180 - Patrica A. Tyrrell - Care of decedent and expenses - $3,300.00. 3 PharMerica - prescription charges 68.02 4 Pinnacle Health Hospitals - (Seidle) - balance not covered by Medicare or PEBTF 2.053.35 5 Quantum Imaging - decedent's account balance 2.06 6 Rite-Aid - prescription charges 15.00 7 West Shore - EMS - charges for transport not covered by Medicare or PEBTF. 438.92 TOTAL (Also enter on Line 10, Recapitulation) 6,255.85 (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 1613 EX+ (9-00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 1 TYRRELL, MILDRED A. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal Clistributions,{ and transfers under Sec. l:I116(a)(1.2)] MATTHEW P. TYRRELL DOB: 8/17/1984 2710 Banbury Drive Enola, PA 17025 RELATIONSHIP TO DECEDENT Do Not List Truste.,sl FILE NUMBER 21-07 -00599 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) ESTATE OF NUMBER I. Grandson One-third residue in Trust. 2 TIMOTHY N. TYRRELL 2170 Banbury Dr. Enola, PA 17025 Son One-third Residue 3 PATRICE A. TYRRELL 1810 Signal Hill Drive Mechanicsburg, PA 17050 Daughter One-Third Residue 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 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)