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REV -1500 EX + 16~O)
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OF>';C,;',L LISE C~jL'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
2007
0413
NUMBER
...
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i DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
: MALONE, DOROTHY K.
I
! DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
178-16-6232
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
i 04/13/2007
OS/27/1921
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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I (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
11:81 1. Original Return D 2. Supplemental Return
D 4. Limited Estate D 4a. Future Interest Compromise (date of death after
12-12-82)
D 6. Decedent Died Testate (Attach copy D 7. Decedent Maintained a Living Trust (Attach
of Will) copy of Trust)
D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between
1
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
...
z
w IRM NAME (If applicable)
0 3901 Market Street
z Coyne & Coyne, P.c.
0
Q. Camp Hill, PA 17011-4227
ELEPHONE NUMBER
717/737-0464 . )
1. Real Estate (Schedule A) . (1) 129,000.00 ?'YTiClt\L
2. Stocks and Bonds (Schedule B) (2) 1,277,078.98
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
,. ',")
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 426,387.76
(Schedule E) ',:':;1
6. Jointly Owned Property (Schedule F) (6) None 0
z o Separate Billing Requested
0
>= 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 60,198,94
:3
:> (Schedule G or L)
...
ii: 8. Total Gross Assets (total Lines 1-7) (8) 1,892,665.68
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w 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 147,506.83
II:
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1,121.74
i 11. Total Deductions (total Lines 9 & 10) (11 ) 148,628.57
12. Net Value of Estate (Line 8 minus Line 11) (12) 1,744,037.11
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 336,767.63
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1,407,269.48
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
>=
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:> (17)
Q. 17. Amount of Line 14 taxable at sibling rate 733,734.21 x .12 88,048.11
:;
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x 18. Amount of Line 14 taxable at collateral rate
c( 673,535.27 x .15 (18) 101,030.29
...
19. Tax Due (19) 189,078.40
20. 1:81
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
910 S. 28th Street
CITY
Camp Hill
I STATE PA
I
IZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
189,078.40
180,000.00
9,453.92
Total Credits (A + B + C)
(2)
189,453.92
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
375.52
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. reta~n the use or inco:ne of the property transferred;............................................................................... D ~
b. retain the right to designate who shall use the property transferred or Its Income;................................ D ~
c. retain a reversionary interest; or............................................................................................................ D ~
d. receive the promise for life of either payments, benefits or care?........................................................... D [8]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.. .......................... ................................................ ........ ............... .............. D [8]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D [8]
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which
contains a beneficiary designation?............................................................................................................... [8] D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury. I declare that I have examined this return, inciuding accompanying schedules and statements. and to the best of my knowledge and belief. it is true. correct and complete. Deciaratlon
preparer other than the personal representative is based on all information of which preparer has any knowledge.
ADDRESS DATE
14 W oodcrest Drive
Carlisle, P A 17015
''l-Z/-o7
DATE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Lisa Marie Coyne
ADDRESS
DATE
3901 Market Street
Camp Hill, P A 17011-4227
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 3% [72 P .S. S9116 (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 0%
[72 P.S. S9116 (a) (1.1) (ii)]. The statutedoes 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 0% [72 P.S. S9116 (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 4.5%, except as noted in 72 P.S. S9116
1.2) [72 P.S. S9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. S9116 (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.
.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MALONE, DOROTHY K.
FILE NUMBER
21 - 2007 - 0413
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be excnanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
129,000.00
910 S. 28th Street, Camp Hill, Cumberland County, Pennsylvania-- Per HUD-1
TOTAL (Also enter on Line 1, Recapitulation)
129,000.00
OMB NO. 2502-0265 of!"
A. /~ . B. TYPE OF LOAN:
,Y 1DFHA 2.DFmHA 3. ~CONV. UNINS. 4DVA 5. DCONv. INS.
U.S. dEPARTMENT OF HOUSING & URBAN DEVELOPMENT
. 6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT 2007060056 175929019
8. MORTGAGE INS CASE NUMBER:
C. NOtE: This form is furnished to give you a stafement of Bctual seHlement costs. Amounts paid to end by the settlement agent are shown.
Ilems marked '(POC)" were paid outside the closing; they are shown here for informationa' purposes and are not included in the lola/s.
1.0 3198 f2007060056.PFDI2007060056I30)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Michael J. Chervanick Eslale of Dorolhy Malone Countryw'ide Home Loans, Inc.,
910 South 28th Slreel dba America's Wholesale Lender
Camp Hill, PA 17011 P.O. Box 10266
Van Nuys, CA 91410-0266
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I SETTLEMENT DATE:
910 South 28th Streel Chelsea Settlement Services
Camp Hili, PA 17011 June 29, 2007
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
Parcel #12-23-0551-081 3800 Market Street
Camp Hill. PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contracl Sales Price 129,000.00 401. Contracl Sales Price 129,000.00
102. Personal Property 402. Personal Property
103. Settlement CharQes to Borrower (Line 1400) 5,019.41 403.
104. Payoff MortQaQe 404.
105. Payoff Mortgage 405.
Adjustments For lIems Paid By Seller in advance Adjustments For lIems Paid By Seifer in advance
106. Local/County Taxes 06/29/07 to 01101/08 293.71 406. Local/Counlv Taxes 06/29/07 to 01/01/08 293.71
107. School Taxes 06/29/07 10 07/01/07 6.41 407. School Taxes 06/29/07 to 07/01/07 6.41
108. Assessments to 408. Assessments to
109. 409.
110. 410.
111. 411.
112, 412.
120. GROSS AMOUNT DUE FROM BORROWER 134,319.53 420. GROSS AMOUNT DUE TO SELLER 129,300.12
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnesl money 1,000.00 501. Excess Deposit See Inslructions
202. Principal Amount of New Loan s 103200.00 502. Settlement Charges to Seller (Line 1400)
203. Existing loan(s) laken subject 10 503. Existlno loanls) taken sub ectlo
204. 504. Payoff of first Mortgage
205. 505. Payoff of second Mort aQe
206. 506.
207. 507. (Deposit disb. as proceeds)
208. 608.
209. 509.
Adjustments For lIems Unpaid Bv Seller Ad'ustments For lIems Unpeid By Seller
210. Local/County Taxes 10 510. Local/County Taxes 10
211. School Taxes to 511. School Taxes 10
212. Assessmenls 10 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 104,200.00 520. TOTAL REDUCTION AMOUNT DUE SELLER
300. CASH AT SETTLEMENT FROMfTO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower (Line 120) 134,319.53 601. Gross Amount Due To Seller (Line 420 129,300.12
302. Less Amounl Paid By/For Borrower (Line 220) ( 104,200.00) 602. Less Reductions Due Seller (Line 520) (
303. CASH ( X FROM) ( TO) BORROWER 30,119.53 603. CASH ( X TO) ( FROM) SELLER 129,300.12
A-.
Tile undersigned hereby acknowledge receipt of a compleled copy of pages 1 &2 of this stalemenl & any allaehments referred to herein.
Borrower ~~.~~~
Michael J. Chervanick
Seller
L. SETTLEMENT CHARGES
.;OMMISSION Based on Price $ Ii'V % PAID FROM PAID FROM
. ,.sian of Commission (line 700 as Follows: BORROWER'S SELLER'S
to FUNDS AT FUNDS AT
L. $ 10 SETTLEMENT SEITlEMENT
103. Commission Paid al Settlement
704. to
800. ITEMS PAYABLE tN CONNECTION WITH LOAN
801. Loan OriQination Fee % 10
802. Loan Discounl % to
803. to
804. Credit Report 10 Landsate Credit POC:B18.00
805 Processing Fee to Real Choice Mortgage, LLC 250.00
806. Premium Paid 10 Broker bv CHL to Real Choice MortaaQe, LLC POC:L 1548.00
807. Lender Fee 10 Countryvvide Home Loans, Inc.! dba America's Wholes 550.00
808. Tax Service Fee to Countrywide Tax Service Corporation 90.00
809. Flood Check Fee to LandSafe Flood Determination, Inc. 26.00
810. Inveslor Delivery Fee 10 Counlrywide Home Loans, Inc., dba America's Wholes 50.00
811. Credil report reimbursement 10 Real Choice Mortgaoe 18.00
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interesl From 06129107 10 07101/07 @ $ 19.080000/day ( 2 days %) 38.16
902. Mortoaoe Insurance Premium for monlhs 10
903. Hazard Insurance Premium for 1.0 vears 10
904.
905. .
1000. RESERVES DEfOSITED WITH LENDER
1001. Hazard Insurance months $ oer month
1002. MortQaQe Insurance months $ oer month
1003. Local/CounlY Taxes months $ per monlh
1004. School Taxes months $ per month
1005. Assessmenls months @ $ per month
1006. months IW $ per month
1007. monlhs @ $ per month
1008. Aooreoale Ad'uslment months Ii'V $ per monlh
1100. TITLE CHARGI!S
1101. Transportation Fee to Outsource
1102. Title Search Fee 10
1103. Title Examinalion Fee 10
1104. Title Insurance Binder Fee to
1105. Document Preparation Fee 10 Deed Preo.
1106. Nolarv Fee 10 Chelsea Seltlement Services 20.00
1107. Atlarney's Fees 10
includes above ;tern numbers:
1108. Title Insurance to Chelsea Seltlement Services 1 003.75
includes aboye Item numbers;
1109. Lender's Coverage $ 103,200.00
1110. OWner's Coverage $ 129,000.00 c.
1111. ALTA Endorsements 10 Chelsea Settlement Services 100/300/8.1 150.00
1112.. Bankruptcy Search Fee 10 Chelsea Settlement Services 15.00
1113.
1114 Express Overnighl Fee to Chelsea Seltlement Services 17.00
1115. Closing Prolection Letter Fee to Slewart Title Guaranty Co. STEWART 35.00
1116. Wire Fee \0 Chelsea Setllemenl Services 15.00
1117. Tax Certification Fee 10 Chelsea Settlement Services 10.00
1118. E-Mail Fee 10 Chelsea SeWement Services 25.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 39.50; Mortgage $ 67.00; Releases $ 106.50
1202. CitylCounty T ax/Slamps: Deed 1,290.00' Mortoaoe Conveyance Fee 1,290.00
1203. Slate Tax/Slamps' Revenue Stamps 1,290.00; MortQaQe 1,290.00
1204. AssiQnmenl RecordinQ Fee -.
1205. Recording Service Fee 10 Chelsea Recordino Account 20.00
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survev 10
1302. Pest Inspection to
1303.
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section Kl 5,01941
By !Ilgnlng pagEl 1 ollhl!l stalement, lhe stQne:lorles aCknowledge receipt of 8 completed copy of page 2 01 'hls two page statement
Certified to be a true copy
Chelsea Settlement Services
Settlement Agenl
( 2007000056/2007060056130 )
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MALONE, DOROTHY K.
FILE NUMBER
21 - 2007 - 0413
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 Edward Jones Investment Account No. 89606728 1,264,078.98
2 Series HH Savings Bond No. D4783397HH 500 500.00
3 Series HH Savings Bond No. D5301858HH 500 500.00
4 Series HH Savings Bond No. M6808600HH 1000 1,000.00
5 Series HH Savings Bond No. M7486021HH 1000 1,000.00
6 Series HH Savings Bond No. M7455665HH 1000 1,000.00
7 Series HH Savings Bond No. M6808601HH 1000 1,000.00
8 Series HH Savings Bond No. M7585894HH 1000 1,000.00
9 Series HH Savings Bond No. M7585895HH 1000 1,000.00
10 Series HH Savings Bond No. M7486022HH 1000 1,000.00
11 Series HH Savings Bond No. M8018913HH 1000 1,000.00
12 Series HH Savings Bond No. M7780406HH 1000 1,000.00
13 Series HH Savings Bond No. M7647604HH 1000 1,000.00
14 Series HH Savings Bond No. M7848364HH 1000 1,000.00
15 Series HH Savings Bond No. M7881797HH 1000 1,000.00
I
I
I
I
TOTAL (Also enter on line 2, Recapitulation)
1,277,078.98
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178-16-'6232
7/;,
DOROTHY K MALONE
910 S. 28THSTRE'ET
CAMP HILL, PA 17frll
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SOUTH 28TH STREET
HILL. PA 17011..,.580.3
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232
D m?OTHY K . MALOtiE
9'cDSZ8TH STREET
CAHPHILL,. .PA 17011
178-16-62::; Z
l'i), L. DNE
2f:nH/ST .
p j\ 17011--"5803
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05
2001
07881797
r,Il,188119lHH
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MALONE, DOROTHY K.
FILE NUMBER
21 - 2007 - 0413
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
DESCRIPTION
VALUE AT DATE OF
DEATH
55,988.20
M&T Bank
Checking Account NO. 57421455
2 M&T Bank
Savings Account NO. 015004200241385
3 M&T Bank
Certificate of Deposit No. 03100391167489
4 M&T Bank
Certificate of Deposit No. 031003913822431
5 M&T Bank
Certificate of Deposit No. 031003914177934
6 M&T Bank
Certificate of Deposit No. 031003914487391
7 M&T Bank
Certificate of Deposit No. 031003914579148
8 Wachovia Bank
Certificate of Deposit No. 247022060952325
9 Wachovia Bank
Certificate of Deposit No. 247022060963639
10 Wachovia Bank
Certificate of Deposit No. 24721206093781
11 Sovereign Bank
Certificate of Deposit No. 0575267398
12 Sovereign Bank
Certificate of Deposit No. 0575393152
13 Sovereign Bank
Certificate of Deposit No. 2335251100
29,872.10
21,131.51
10,020.42
11,021.11
10,025.99
25,033.83
20,000.00
15,003.07
13,000.00
10,020.05
30,046.85
20,035.09
Total of Continuation Schedule(s)
155,189.54
TOTAL (Also enter on Line 5, Recapitulation)
426,387.76
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MALONE, DOROTHY K.
FILE NUMBER
21 - 2007 - 0413
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
14
DESCRIPTION
VALUE AT DATE OF
DEATH
16,040.75
Sovereign Bank
Certificate of Deposit No. 2335296345
15
MidPenn Bank
Certificate of Deposit No. 309001495
25,034.88
16
MidPenn Bank
Certificate of Deposit No. 309001658
20,047.64
17
Contents of House and 1999 Buick LeSabre Sedan -- Per Attached Appraisal
4,054.00
18
PNC Bank
Certificate of Deposit No. 318002153.59
10,012.27
19
PNC Bank
Certificate of Deposit No. 31600226898
80,000.00
Page 2 of Schedule E
~M&rBank
Re: Estate of Dorothv K Malone
Social Security: 178-16-6232
Date of Death: April 13. 2007
499 Mitchell Road, Millsboro, DE 19%6 Mail Code DE-MB-12
Coyne & Coyne PC
Attorneys At Law
3901 Market Street
Camp Hill, Pennsylvania 17011-4227
Dear Sir or Madam:
Per your inquiry dated June 11, 2007, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
1.
Type of Account
Checking Account
Account Number
57421455
Ownership (Names oj)
Dorothy K Malone *
Opening Date
08/28/64
Balance on Date of Death
$55,985.94
Accrued Interest
$
2.26
Total
$55,988.20
2.
Type of Account
Savings Account
Account Number
015004200241385
Ownership (Names oj)
Dorothy K Malone *
Opening Date
01/04/90 Closed 04/30/07
Balance on Date of Death
$29,866.07
Accrued Interest
$
6.03
Total
$29,872.10
5.
3.
Type of Account
Certificate of Deposit
Account Number
031003911867489
Ownership (Names of)
Dorothy K Malone *
Opening Date
01107/03 Closed 05/10/07
Balance on Date of Death
$20,000.00
Accrued Interest
$ 1,131.51
Total
$21,1 31.51
4.
Type of Account
Certificate of Deposit
Account Number
031003913822431
Ownership (Names of)
Dorothy K Malone *
Opening Date
06/28/00
Balance on Date of Death
$10,000.00
Accrued Interest
$
20.42
Total
$10,020.42
Type of Account
Certificate of Deposit
Account Number
031003914177934
Ownership (Names of)
Dorothy K Malone *
Opening Date
07/01/02
Balance on Date of Death
$11,000.00
Accrued Interest
$
21.11
Total
-----------------------------------------------------------------------------------------
$11,021.~1
----- -- ------ ---- - - - ---------- ---- ---- ---- -- ---- ---- -- ------ ---------------------------
.l1smission
6/18/2007 9:48 AM PAGE
1/002
Fax Server
-:~~
-;;5<
'WAcHoVIA.
Reference ID: 20n273
Wachovia Bank N.A.
Balance Confirmation Services
POBox 40028
Roanoke, YA24022-73l3
ec/\
, \~
.Vnt> ~
~ ~ . / 1'y
June 18, 2007
COYNE & COYNE
ATTN:USANUUUECOYNE
ATTORNEYS AT LAW
3901 MARKET STREET
CAMP HILL. P A 17011
SUBJECT: Verification I Confinnation of Account and Balance Infonnation provided for:
Customer: DOROTHY K MALONE (SSN# 178-1~6232)
Date of Death: April 13, 2007
DeDosit Account Information
Account Account Date ofDeatb Average Date Matuily Interest Accrued YTD Date
Type NIHDher Balance Balance"' Opened Date Rate Interest Interest Paid Closed
CERTIFICATE OF DEPOSIT 247022060952325 $20,000.00 111l/1999 12/112007 2.96 $24.34 $196.48
LEGAl.. TITLE: DOROTHY K MALONE
e'ER TlFICATE OF DEPOSIT 247022060963639 S15 ,003 07 1!I8/1999 ] 2/812007 2.96 S9.73 $147.40
LEGAL TITLE: DOROTHY K MALONE
CERTIFICATE OF DEPOSIT 247412061093781 $13,000.00 3115/2000 lVIS/2ooS 3.87 SI.33 $167.04
LEGAL TITLE: DOROTHY KMALONE
· o.le to system limitalions, we can only provide a twelve month average balance on depository accoo.nts.
ilsrnisSion
- =--::. ~ ~
-~-
.-"- --.
WAcImvrA.
6/18/2007 9:48 AM PAGE
.. Date of death balance does not include accrued interest.
2/002
Fax Server
Reference ID: 20n273
.. J f date of death OCcurrs on a weekend or a holiday, date of death balance does not include any iransacticm that were
made during that time period.
~ j Shaub
Jennifer Straub
Servicenter Associate
Phone: (540)563-7323
l~ js
MID PENN BANK
Making things happen Jor you.
June 28, 2007
Coyne & Coyne
3901 Market St.
Camp Hill, P A 17011-4227
c~.~.~_____.
.....-..iUJ
Re: Estate of Dorothy K. Malone
ssr',,: 178-16-6232
Date of Death: April 13, 2007
Dear Ms. Coyne:
In response to your recent request for information on the accounts of Dorothy K. Malone, we have
researched our files and enclosed is th~ necessary data:
Account #: 309001495 - Certificate of Deposit
Account Name: Dorothy K. Malone
Date Opened: 3/11/2002
Date Closed: 5/2/2007
Balance DOD: $25,000.00
Balance Accrued Interest DOD: $34.88.
Total DOD Balance: $25,034.88
Joint Ownership Name: N/A
Accoun: #: 309001658 - Certificate of Deposit
Account Name: Dorothy K. Malone
Date Or'ened: 4/312003
Date Cl9sed: 5/8/2007
Balance DOD: $20,000.00
BalancE Accrued Interest DOD: $47.64
Total DaD Bi.Jan~-~-: $29,C47.64
Joint Ownership Name: N/A
If you have any questions, please call me at 717-692-7163.
Sincerely,
C<-2..QJ))l~.O- ~\~.
.J
Jessica Kerwin
Member FDIC
Corporate Headquarters: 349 Union Street, Millersburg, PA 17061. (717) 692-2133 · www.midpennbank.com
Appraisal for the Estate of Dorothy K Malone
910 South 28th Street, Camp Hill, PA 17011
LIVING ROOM
Blue colored wing back chair - worn
Console stereo
Sessions Banjo Clock
Pair of end tables & coffee table
Sofa - worn
Pair of brass style table lamps
Cloverleaf shaped table
Seiko clock
RCA ColorTrak TV - old
White colored wing back chair
Small table
Misc. glass container - cracked
2-Drawer, box front, Queen Anne chest
Stool
Table/lamp
Chai r with ottoman
Umbrella stand & canes
Misc. pictures
Misc. knick-knacks
Misc. contents ofliving room
DINING AREA
7 - Pi cce dinette set
Microwave stand
Shark battery powered small vacuum cleaner
Notre Dame clock
Misc. contents of dining area
May 3, 2007
5.00
1.00
225.00
35.00
2.00
5.00
15.00
10.00
20.00
10.00
5.00
2.00
65.00
5.00
6.00
6.00
3.00
10.00
10.00
15.00
85.00
1.00
10.00
2.00
10.00
Malone appraisal
Page 2 of 4
KITCHEN
Toaster 2.00
Wooden chair 2.00
Cookware 5.00
Utensils 2.00
Flatware 3.00
Misc. everyday dishes 5.00
Stool 2.00
GE refrigerator 60.00
Sharp Carousel microwave 10.00
Stand 2.00
Misc. contents of kitchen 15.00
MIDDLE BEDROOM
4-Picce bedroom suite 125.00
Linens 10.00
ROLlnd end tale 3.00
Radio 1.00
Pair of dining room chairs 4.00
Alarm clock 2.00
Telephone 1.00
Misc. contents of bedroom 15.00
DEN
Small table 3.00
Magazine rack 4.00
Rust colored chair 2.00
Floor lamp 8.00
Telephone 3.00
Malone appraisal
Page 3 of 4
Small table
Cloc k
(2) 2-Drawer file cabinets
Carel table
Dining room chair
Scales
Shredder
Mahogany cabinet
Safe
Desk
Desk chair
Mise. contents of den
Din i ng room chair
Upri ght vacuum cleaner
3- Spool back chairs
Dehumidifier
Elect ric heater
Oak stand
Oak stand
May tag washer and dryer - old
Iron i ng board
Met;d shelving
Wardrobes
Trestles
DEN - continued
2.00
2.00
15.00
2.00
2.00
2.00
8.00
35.00
40.00
5.00
1.00
10.00
REAR BEDROOM
2.00
BATH
12.00
BASEMENT
60.00
25.00
2.00
40.00
40.00
40.00
1.00
5.00
4.00
1.00
Mal()ne appraisal
Page 4 of 4
BASEMENT - continued
Dollv
Mise. hand tools
Dehumidifier
Floor polisher
Mise. contents of basement
5.00
5.00
25.00
1.00
10.00
199() Buick LeSabre Custom 4-door - 24,059 miles - full power
transmission problem - good condition body and interior
2,800.00
APPRAISAL TOTAL $ 4,054.00
This Fair Market Value appraisal is true and correct to the best of my ability as an
auctioneer and appraiser with 35 years experience.
Mem bel': Certified Appraisers Guild of America
W. K. Dusty Chapman, CAGA - $ 225 - invoice Dick & Mary Grove, 14 Woodcrest Dr.,
Carlisle 17115
S e p, 2 i , 200 i 9 : 56 AM
PNC BANK 412-i62-i149
No,0112 P,2
0PNCBAl\K
June 21, 2007
Lisa Marie Coyne
390 t Market Street
Camp Hill, PA 17011-4227
RE: Estate of Dorothy K. Malone, deceased
SSN: 178-16-6232
DOD: 4/13/2007
Dear Ms. Coyne:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Certifieates of Deposit
Account #31800215359
Established 08101/2001
DOROTIIY K. MALONE
DOD balance: $10,000.00 + $12.21 accrued interest
Rate: 3.20%
Maturity Date: 8/1/2007
Interest paid monthly from issue
Account #31600226898
Established 05/1512002
DORTHY KMALONE
DOD balance: $80,000.00 + $0.00 aoorued interest
Rate: 4.64%
Maturity Date: 6/15/2007
Intereit paid monthly fonn issue
Please note that this office only provides date of death balances for deposit accounts
(lRAs, CDs, Checking and Savings accounts). We do not process any fiDanclal
tranuctionl or provide statements. If you need assistance with any of these items.
please can ] -8g8~PNC-BANK (l-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~ tU1lh-
Rachelle Wells
1-800-762-1775
P1-PFSC-Q4-F
~fimAve.
Pitmurgh PA 15219
Member FDIC
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
MALONE, DOROTHY K.
FILE NUMBER
21 - 2007 - 0413
ESTATE OF
! Jackson Life Annuity
Policy NO. 5965755
(Beneficiary: Alberta Thompson-- Sister)
This schedule must be c~lllple!ed _and filed if the ans....,~~io an~questions 1 throug~_4_()n page 2 is yes.
DESCRIPTION OF PROPERTY I DA F 0 % OF
Include the name of the transferee, their relationship to decedent and the date of transfer.I' TE 0 EA TH, DECO'S EXCLUSION TAXABLE VALUE
Attach a copy of the deed for real estate. ,VALUE OF ASSETIINTEREST (IF APPLICABLE)
I
--60,198.94f-
I
60,198.94
ITEM
NUMBER '
TOTAL (Also enter on line 7, Recapitulation)
60,198.94
SCHEDULE H
FUNERAL EXPENSES &
ADIVIINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MALONE, DOROTHY K.
I FILE NUMBER
21 - 2007 - 0413
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
1.
Reception
2.
Honorarium and Ushers
3.
Obituaries
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Mary Ellen Grove
Social Security Number(s) I EIN Number of Personal Representative(s):
XXX-XX-2111
Street Address 14 W oodcrest Drive
City Carlisle
Year(s) Commission paid
Zip 17015
State P A
2.
Attorney's Fees
COYNE & COYNE, Pc.
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Alberta Thompson
Street Address 910 S. 28th Street
City Camp Hill State P A Zip 17011
Relationship of Claimant to Decedent
Sister
4.
Probate Fees
Register of Wills
5. Accountant's Fees
6.
Tax Return Preparer's Fees Richard S. Simpson, III, CPA
7.
1
Other Administrative Costs
Cumberland Law Journal
2
Filing Fee-- Inheritance Tax Return
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
225.00
175.00
352.70
64,000.00
64,000.00
3,500.00
800.00
1,500.00
75.00
15.00
12,864.13
147,506.83
."
. .
,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MALONE, DOROTHY K.
3
Patriot News
4
Postage
5
Cleaning Supplies for House
6
Cleaning House for Sale
7
Mowing of Grass-- Dick Grove
8
Office Supplies by Executrix
9
Mileage for Executrix @ $A8/mile
10
Bank Charges for Checks
11
Reserves
12
Wayne Noss-- Removal of Storm Debris
13
Supplies for Sale of House
14
Death Certificates
15
Kemper Insurance -- Homeowners
16
Woof Appraisal Groupn Real Estate
17
Claude Wolfe & Son Apprasers
18
Extra Bank Deposit Slips
Office Supplies-- Printer Ink for Executrix
19
20
Income Taxes Due and Owing
21
Stock Brokers Commissions
Schedule H
Funeral Expenses &
Adninis1rative Cos1s continued
FILE NUMBER
21 - 2007 - 0413
Page 2 of Schedule H
121.02
41.00
100.00
300.00
350.00
93.00
960.00
25.00
5,000.00
25.00
71. 00
60.00
655.00
300.00
225.00
9.50
28.61
3,500.00
1,000.00
~
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MALONE, DOROTHY K.
Include unreimbursed medical expenses.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
ITEM DESCRIPTION
NUMBER
1 Uncleared Checks
2 PAWC
3 PPL
4 Comcast
5 Holy Spirit Hospital
6 Verizon
7 James McMillen, MD
8 Sewer and Trash
FILE NUMBER
21 - 2007 - 0413
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
500.00
137.29
147.05
50.00
21.49
47.41
131.00
87.50
1,121.74
RItV.1513 EX+ (9.00)
~
ESTATE OF
NUMBER
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
MALONE, DOROTHY K.
FILE NUMBER
21 - 2007 - 0413
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
DiLNot L1sLTrustee(s)
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Alberta
II.
Sister
2
Mary Ellen Grove
Niece
AMOUNT OR SHARE
OF ESTATE
I 40% of Residual
40% of Residual
336,767.63
Enter dollar amounts for distributions shown above on lines 15 through 18. as appropriate, on Rev 1500 cover she~t
!
NON-TAXABLE DISTRIBUTIONS:
iA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Our Lady of the Blessed Sacrement, Catholic Church --20% of the Residual
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEElr
336,767.63