HomeMy WebLinkAbout00-0081
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SARAH J CARLSON
27 SOUTH 34TH STREET
CAMP HILL, PA 17011
n______ fold
ESTATE INFORMATION: SSN: 551-70-0046
FILE NUMBER: 2100-0081
DECEDENT NAME: CARLSON LINDA JEAN
DATE OF PAYMENT: 10/02/2007
POSTMARK DATE: 10/02/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 01/17/2000
NO. CD 008768
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $834.40
I
I
I
,
I
I .
! I
I
..
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTORNEY
CHECK# 1141
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$834.40
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-1500 EX (6-00) ,
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
-2L
COUNIY CODE
-9~ 0081___
YEAR NUMBER
.....
Z
w
C
w
o
w
c
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Carlson Linda Jean
DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD- YEAR)
1/17/2000 9/12/1946
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
551-70-0046
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
~ IXJ 1. Original Retum
llC:~l/)D
U D::llC: 4. Limited Estate
wo..U
:z: 00 I.;lX
U D::..J I.AJ 6. Decedent Died Testate (Allach copy of Will)
o..m
~ D 9. litigation Proceeds Received
D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82)
D 4a. Future Inlerest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a lMng Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1-95) D 11. EJection to tax under Sec. 9113(A)IAtlachSchO)
THIS SECTION MVST BE COMPLETED. ALl.CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD Be.DIRECTE.D TO:
NAME COMPLETE MAILING ADDRESS
I-
Z
W
C
Z
o
ll.
In
W
ll:
ll:
o
o
Richard C. Snelbaker
FIRM NAME (If Applicable)
Snelbaker & Brenneman,P.C.
TELEPHONE NUMBER
717-697-8528
44 West Main Street
Mechanicsburg, PA 17055
1. Real Estate (Schedule A)
20,000.00
0.00
0.00
0.00
227,692.22
0.00
'~_2
(1)
OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
-.......
c-:>
CO)
--I
I
1'--.'
~CJ
Ii
z
o
i=
~
:J
.....
ii:
<(
o
w
0:::
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash. Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
6. Jointly O'oM1ed Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
C)
241=;-=692.22
0.00
C)
8. Total Gross Assets (total Lines 1-7)
(8)
48,717.08
10,068.53
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)
58,785.61
188,906.61
0.00
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for v.A1ich an election to tax has not been
made (Schedule J)
(12)
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
188,906.61
z
o
t=-
oe(
t-
::J
0..
:=;;
o
U
x
oe(
t-
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.o ~(15)
x.O ~(16)
x .12 (17)
x.15 (18)
(19)
0.00
11,334.40
0.00
0.00
188,906.61
0.00
0.00
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
0.00
18. Amount of Line 14 taxable at collateral rate
11,334.40
19. Tax Due
20. [K]
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE .SURE TO ANSWER ALL QUESTIONS ON REVERSESJDE AND RECHECK MATH <<
3W4645 1.000
Decedent's Complete Address:
S1REET ADDRESS
27 South 34th Street Ham
Cumberland Count
CITY
Cam Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
PA
ZIP
17011-
(1)
11,334.40
0.00
10,000.00
500.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
10,500.00
0.00
0.00
rotallnterest/Penalty (D + E) (3)
0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
834.40
A. Enter the interest on the tax due.
(5A)
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Pa able to: REGISTER OF WILLS, AGENT
(58)
834.40
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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 prom ise 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? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 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 e""mined this return. including 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 personai representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
S ~ (;;A ~m l-t~(vtn}C
AOORESS .
Yes
No
D
D
D
D
og
og
ug
Oil
~
og
DATE
'f/15/0T-
Sarah . Carlson, Executrix
o PR R 1l-iAN REPRESENTATIVE
B200 Cleary Blvd., Villa 2015, Plantation FL 33324
DATE
It:> 01
Richard C. Snelbaker, Esquire
44 West Main Street, Mechanicsburg, PA 17055
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. 9 9916 (a) (1.1) (i)J.
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. 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 0% [72 P.S. 9 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 4.5%, 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 12% (72 P.S. 9 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.
3W4646 1000
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
REV-1502 EX + (6-98)
ESTATE OF
FILE NUMBER
Linda Jean Carlson
21 00 0081
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
exchanged 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
3.13 acre lot located on Stoney Run Road, Carroll
Township, York County, Dillsburg, PA, sale value (see
attached settlement sheet)
20,000.00
TOTAL (Also enter on line 1, Recaritulation)
$
20,000.00
3W4695 1.000
(If more space is needed, insert additional sheets of the same SiZE)
_.,-_.__.._----.~
---......!.J. S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OM8 No. 2502-0265
SETTLEMENT STATEMENT Titlepro forWindowsl
Schrack and Linsenbach
Law Offices B. TYPE OF LOAN
124 W. Harrisburg Street * P.O. Box 310 o 1. FHA o 2. FMHA o 3. CONV.UNINS.
Dillsburg, PA 17019 04.VA o 5. CONV.INS.
6. FILE NUMBER: ! 7. LOAN NUMBER:
Phone (717)432-9733 Fax(717)432-1053 1842
MORT. INS. CASE NO.:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
! Items marked "(p.o. c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER
HERBERT L. BOMBERGER SARAH J CARLSON. EXECUTRIX OFTHE
MELBA R. BOMBERGER ESTATE OF
:130 STONEY RUN ROAD UNDA JEAN CARLSON
DILLSBURG. PA 17019
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: SCHRACK 8. UNSENBACH I. SETTLEMENT DATE:
3+/- AG.. LOT 2 STONEY RUN ROAD . Jun 22 2007
DILLSBURG. PA 17019 Friday
CARROLL TOWNSHIP. YORK COUNTY PLACE OF SETTLEMENT: 124 WEST HARRISBURG STREET 09:00 AM
TAX PARCEL #20-000-NC-0136S DILLS BURG. PA 17019
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
~OO. Gross Amount Due From Borrower 400. Gross Amount Due to Seller
101. Contract stiles price 20.000.00 401. Contract soles pri~e 20.000.00
102. Personal Properly 402. Personal Properly
103. Settlement Charges (line 1400) 960.50 403.
104. 404. .c.
105. 405.
Adjustments for items paid in advance by seller(s) Adjustments for items paid in odvance by seller(s)
106. City{fown t(IX 6/22/2007 to 12/31/2007 27.88 406. City {fawn t(IX 6/22/2007 to 12/31/2007 27.88
107. CountylCity t(IX 6/22/2007 to 12/31/2007 97.32 407. County/City t(IX 6/22/2007 to 12/31/2007 97.32
108. Assessments 408. Assessments
109. School T(IX 6/22/2007 to 6/30/2007 13.79 409. School T (IX 6/22/2007 to 613012007 13.79
11 O. 410.
111. 411.
112. 412.
i 21.099.49 420. Gross Amount Due to Seller 20.138.99
120. Gross Amount Due from Borrower
200. Amounts Paid By Or In Beholl Of Borrower 500. Reductions In Amount Due To Seller
201. Deposit or earnest money 2.000.00 501. Excess deposit (see instructions)
202. Principal Amount of new loan(s) 502. Settlement charges to seller (line 1400) 205.00
203. Existing loan(s) taken subject to 503. Existing loon(s) taken subject to
204. 504. Payoff of First Mortgoge Loan
205. 505. Payoff of Second Mortgoge Loan
206. CREDIT TO BUYER FOR 50% OF COSTS INCURRED 1.284.83 506. CREDIT TO BUYER FOR 50% OF COSTS INCURRED 1.284.83
207. 507.
208. 50B.
209. 509.
i Adjustments lor items unpaid by seller Adjustments for items unpaid by seller
210. City{fown t(IX 510. Cily{f own t(IX
211. CountylCity t(IX 511. CountylCity t(IX
212. Assessments 512. Assessments
213. School T(IX 513. School Tex
214. i 514.
215. 515.
216. . 516.
217. 517.
21 B. 518.
219. 519.
220. Total Paid BylFor Borrower 3.284.83 520. Total Reduction Amount Due Seller 1.489.83
1300. CASH AT SETTLEMENT From{fo BORROWER 600. CASH AT SETTLEMENT TolFrom SELLER
1301. Gross Am\. due from borrower Oine 120) 21.099.49 601. Gross Amount due Seller (line 420) 20.138.99
302. Less Amt paid by/for borrower (line 220) 3.284.83 602. Less reduction in Amt.due Seller (line 520) 1.489.83
303. Cash [8J FROM OTO Borrower 17.B14.66 603. Cash [8J TO o FROM Seller 18.649.16
Buyer or Borrower's SignalUre
Seller's Signalure
HUD-1
,<
,
. ~
L. SETTLEMENT CHARGES Cfise # 1842 Paid From Paid From :!It:
700. Total Sales Commission bfised on Price: $ % ;,i1l
Borrower's Seller's
Division of Commission fit $ Total Funds At
Funds At 1):~
70L ~:'f
~'
702.
703. Commission paid fit Settlement
704.
BOO. Items Payable in Connection With Loan
80L Loan Originfition Fee
802. LO/in Discount
BOl Apprais6.1 Fee to
B04. Credit Repor1to
805. Inspection Fee to
B06. Mortgfige Insurance to
B07. Assumption Fee to !
80B.
BOS.
810.
Bll.
900. Items Required By Lender To Be Pfiid In Advfince
901. Interest from 0.0000 IDay
902. Mortgage Ins. Premium 0 Months to
903. Hfiwrd Ins. Premium 0 Years to
904. 0 Years to
905. 0 Years to
1000. Reserves Deposited With Lender For
1001. Hazard Insurance 0 Months @ t /Month
1002. Mortgage Insurance 0 Months @ $ IMonth
1003. City{fown Taxes 0 Months @ $ IMonth
1004. County Taxes 0 Months @ $ IMonth
1005. Assessments 0 Months @ $ IMonth
1006. School Taxes 0 Months @ $ IMonlh
1007. 0 Months @ $ IMonth
1008. 0 Months @ $ /Month
1100. Title Charges
1101. SetlJement or closing fee SCHRACK & L1NSENBACH 75.00
1102. Abstract or title search SCHRACK & L1NSENBACH 75.00
1103. Tille Examination
1104. Tille Insurance Binder
1105. Document preparation
1106. Notary fees JANET S. GORE 5.00 5.00
1107. Attorney's fees SCHRACK & L1NSENBACH 518.50
(includes above items No.:)
110B. Title Insurance u
(includes above items No.:)
1109. Lender's coverage $
1110. Owner's coverage $
1111.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Recording Fees: Deed $ 42.00 Mortgage $ Release $ 42.00
1202. City/Countytaxlstamps : Deed $ 200.00 Mortgage $ 200.00
1203. State toxlsto.mps : Deed $ 200.00 Mortgage $ 200.00
1204. EXEMPLlFIO\TION to Recorder of Deeds 25.00
1205.
1300. AdditioOfiI SetIJament Chmges
1301. TAX CERTIFICATION to ;' MADELINE HARBOLD, T A'l< COLLECTOR 20.00
1302.
1303.
1304.
1305.
1400. Totfil Settlement Chmges (entet on lines 103 & 502, Sections J & K) 960.50 205.00
7 :~
I'
,
~l
Parties agree that no liability is assumed by Settlement Agent for the accuracy of information furnished by others as shown on the HUD-1 Settlement Statement.
HUD CERTIFICATION OF BUYERS AND SELLERS
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and
disburse n m count b me in this transaction. I further certi that I have received a copy of the 0-1 Settlement Statement.
, ~~
~-9~M) ~~kd'~)
Buyer Borrower's ig ature
SeUer's New Address & Phone:
and accurate accoupt of thi !ransa t1on. I have caused or will cause the funds to be disbursed In accordance with thl!
!
Settlement Agen. , ate
WARNING: It is a crime to knowingly make false statements to the United Slates on this or any similar form. Penalties upon conviction can include a fine and Imprisonment. For delalls
see Title 18: U.S. Code Section 1001 and Section 1010..
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Linda Jean Carlson
FILE NUMBER
21 00 0081
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
VALUE AT DATE
OF DEATH
1
1991 Ford Van
value assigned by Executrix
1,500.00
2
1996 Jeep Cherokee
appraised value (see attached appraisal)
12,000.00
3
Central PA Hematology & Medical Oncology Assoc.
refund due the decedent for medical expenses paid
439.49
4
Erie Insurance
refund unused premium on renters insurance policy
141.00
5
Erie Insurance
unused premium refund due decedent on automobile
insurance
503.00
6
Fulton Bank
checking account #3629-34862
9,984.60
7
George Carlson
payment due the decedent as ordered in Divorce Decree
dated June 1998.
69,381. 62
8 Household
goods retained by family memebers
865.00
9 PA Department of Revenue
revenue refund
29.00
10 Pennsylvania Blue Shield
refund unused premium on medical insurance
865.50
11 The Vangaurd Group
prime money market account # 9923008928
130,783.01
12 United States Treasury
refund due on Income Tax
1,200.00
3W46AD 1.000
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
227,692.22
~
- --
ENGL/tND
Chrysler A~ Plymouth
Jeep 'f...' Eagle
6039 CARLISLE PIKE. MECHANICSBURG, PA 17055
OFFICE & SERVICE (717) 766-7686 . PARTS (717) 766-0247 . FAX (717) 766-7151
~ . '-\ . O~
~ 'v\..J\\ ~ Y\"\. i *" yYl Cy t. \J Y) C ~ V" '"
l\-... ~ \ Of 9 ~ :r~ \: f c..~ (1'; Q Vw. Sf \) '~~ \- ~ dT 9'- "1/ /.)
#' ;:J't..Jr .r~~S)TL ').Yl/ toxl eJv/If'~l os ~jh~..) ~
CO (;f) eV'l~iVlQ u/-.J\'1"\ \.J~ ~
a Ii' ~ l"n "1f, L \-f'tt N..i
(Jet...; ~ ,< L<..h VI- ~ -<4 ...c/.~
f~yJ~.r \ <i t.kj
Cn r Ii.. ~ '1 J..\ ~\ t) Y) e,t"
OV"t ~'~ S> ~ '(~ Q Co~.) e ~
51.. ~J. \J Y"h \tu
d
hOt) ~ ~Cllvt ()\.. C(ffr~1-.rot.-~l~\-Y I J. Q~~.u"\;
Su0 f l.\: N. f\ :D. 'f\. 0~ e ~ c:'\.ly 9"" u
r ~ '0'( vtt\ f ~~14
~~r
ENG~ND
Chrysle~ Plymouth
. Jeep
ARNOLD NEWMAN
SALES MANAGER
6039 Carlisle Pike
Mechanicsburg, PA 17055
(717) 766-7686, Ext. 122
FAX 766-7151
REV-1511 EX + (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Linda Jean Carlson
ITEM
NUMBER
A.
B.
3W46AG 1.000
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
Central PA Cremation Society
funeral expense
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Sarah Carlson
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 8200 Cleary Blvd., Villa #2015
City Plantation
State FL
Zip 33324
Year(s) Commission Paid:
2.
Attorney Fees
Snelbaker & Brenneman, P.C.
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Sarah Carlson
Street Address 8200 Cleary Blvd., Villa 2015
City Plantation
Relationship of Claimant to Decedent DAUGHTER
State FL
Zip 33324
4.
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
BellAtlantic
phone service
2
Carroll Township
litigation fees from December 1999 to January 2000
Total from continuation schedules
FILE NUMBER
21 00 0081
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
AMOUNT
402.00
6,192.00
7,500.00
3,500.00
264.00
300.71
42.00
30,516.37
48,717.08
Estate of: Linda Jean Carlson
551-70-0046
Schedule H Part 7 (Page 2)
3
Cumberland Law Journal
advertising Executrix Notice
75.00
4
Decker Surveying, Inc.
survey services
450.00
5
Fulton Bank
service fees
166.70
6
Greenawalt & Company, P.C.
preparation of 2006 Fiduciary Income taxes
315.00
7
Greenawalt & Company, P.C.
preparation of 2005 Fiduciary Income taxes
315.00
8
Greenawalt & Company, P.C.
preparation of 2004 Fiduciary Income taxes
385.00
9
Greenawalt & Company, P.C.
preparation of 2003 Fiduciary Income taxes
375.00
10
Greenawalt & Company, P.C.
preparation of 2002 Fiduciary Income taxes
350.00
11
Greenawalt & Company, P.C.
preparation of 2001 Fiduciary Income taxes
495.00
12
Greenawalt & Company, P.C.
preparation of 2000 Fiduciary Taxes
275.00
13
Greenawalt & Company, P.C.
preparation of Individual Income taxes
175.00
14
Kevin Cashman
mowing on property' on Stoney Run Road
125.00
15
L.G. Connor
real estate appraisal fee
350.00
16
Litigation proceeds
paid as settlement of litigation re sale of property
1,500.00
17
Patriot News
newpaper ad
78.10
18
Patriot News
advertising Executrix notice
105.80
19
Pennsylvania American Water
66.97
Total (Carry forward to main schedule)
5,602.57
551-70-0046
Estate of: Linda Jean Carlson
Schedule H Part 7 (Page 3)
20
Pennsylvania Dept of Revenue
income tax due on 2006 Fiduciary taxes
90.00
21
Pennsylvania Dept of Revenue
income tax due on 2003 Fiduciary taxes
20.00
22
PPL Electric
electric service
147.26
23
Register of Wills
short certificate
3.00
24
Register of Wills
filing fee for Inheritance Tax return
15.00
25
Settlement charges
associated with the sale of lot on Stoney Run Road
A. transfer tax - $200.00
B. Notary Fees - $5.00
C. Credit to buyer for 50% of costs incurred -
$1,284.83
1,489.83
26
Snelbaker & Brenneman, P.C.
attorney fees in Stoney Run Road property litigation
21,794.99
27 UGI
gas service
196.72
28
United States Treasury
income tax due on 2006 Fiduciary taxes
157.00
29
Reserve
for filing fees, accounting fees and other costs
associated with the administation of the Decedent's
estate
1,000.00
Total (Carry forward to main schedule)
24,913.80
REV-1512 EX + (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Linda Jean Carlson
FILE NUMBER
21 00 0081
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.
DESCRIPTION
VALUE AT DATE
OF DEATH
Anna Carlson
reimbursement for auto insurance premium paid on behalf
of the Decedent
214.00
2
BellAtlantic
phone service
178.34
3
Ed Maloy
apartment rent per lease agreement which ended 3/31/2000
850.00
4
Erie Insurance
renters insurance premium
90.00
5
Futlon Bank
visa credit card # 4301731700109877
514.37
6
Health South
medical expenses
4,196.14
7
Jason Carlson
two months rent which was being paid by the Decedent per
an agreement between parties
600.00
8
Madeline Harbold, Tax Collector
real estate taxes due on property located on Stoney Run
Road
121.28
9
Palm Beach Atlantic College
titution fee for son Jason Carlson per agreement between
parties
2,245.25
10 Pennsylvania American Water
water service
32.90
11 Pennsylvania Dept of Revenue
Individual Income tax due
50.00
12 PPL Electric
electric service
50.65
13 Sarah Carlson
reimbursement for auto insurance premium paid on behalf
of the Decedent
289.00
Total from continuation schedules
636.60
3W46AH 2.000
TOTAL (Also enter on line 10. Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
10 068.53
Estate of: Linda Jean Carlson
551-70-0046
Schedule I (Page 2)
Item
No. Description
Amount
14 Suburban Cable
cable TV service
27.96
15 UGI
gas service
180.68
16 Universal Card Services Corp
credit card debt
410.00
17 York Waste Disposal
trash service paid in the amount of $25.92 less refund
received in the amount of $7.96
17.96
Total (Carry forward to main schedule)
636.60
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Linda Jean Carlson
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2))
Anna M. Carlson-Steinhardt
C/O Sarah Carlson
8200 Cleary Blvd., Villa #2105
Plantation, FL 33324
1
One Third of Residue: 62,968.87
2 Jason Carlson
2326 SW Newport Isles Blvd.
Port St. Lucie, FL 34953
One Third of Residue: 62,968.87
3 Sarah J. Carlson- Pint
8200 Cleary Blvd., Villa #2015
Plantation, FL 33324
One Third of Residue: 62,968.87
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Son
Daughter
FILE NUMBER
21 00 0081
AMOUNT OR SHARE
OF ESTATE
62,968.87
62,968.87
62,968.87
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46A11.000
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the saPle size)
$
0.00
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
LAST WILL AND TESTAMENT
I, LINDA JEAN CARLSON, of the Township of Hampden, County of
Cumberland and Commonwealth of Pennsylvania, being of sound and
disposing mind, memory and understanding,cdo make, publish and
declare this as and for my Last will and Testament, hereby
revoking and making void all former wills and codicils by me at
any time heretofore made.
FIRST. I order and direct that all my just debts and
funeral expenses be paid by my Executrix or Executors, as the
case may be, hereinafter named, as soon as conveniently may be
done after my decease.
SECOND. If I should die before May 1, 2000, I give and
bequeath unto my son, namely JASON CARLSON, a sum of money equal
to the unpaid cost of his education at Palm Beach Atlantic
College. If I should survive beyond May 1, 2000, of if I have
prepaid all of my son's educational expenses, I order and direct
that the foregoing bequest shall lapse and become void.
THIRD. I give, devise and bequeath all the rest, residue
and remainder of my Estate, real, personal and mixed, whatsoever
and wheresoever situated, in equal shares unto my three (3)
children, namely, SARAH J. CARLSON, ANNA M. CARLSON and JASON
CARLSON, share and share alike, absolutely.
If any of my said children should predecease me and leave
issue to survive me, I order and direct that the share of such
deceased child shall be distributed unto her or his issue per
stirpes by representation and not per capita.
If any of my said children should predecease me and leave no
issue to survive me, then and in that event, I order and direct
that the foregoing beneficial provisions for such deceased child
shall lapse and said residuary estate shall be distributed unto
those persons otherwise entitled to share herein based upon an
equal division among or between my said children.
LASTLY. I nominate, constitute and appoint my eldest child,
namely, SARAH J. CARLSON, to be the Executrix of this, my Last
will and Testament, but if for any reason she should fail to
qualify as such Executrix or cease so to serve, then and in that
event, I nominate, constitute and appoint my other two (2)
children, namely, ANNA M. CARLSON and JASON CARLSON, to be the
Executors hereof, each and all to serve without bond or other
security as a condition of qualification hereunder.
IN WITNESS WHEREOF, I, LINDA JEAN CARLSON, have hereunto set
my hand and seal to this, my Last Will and Testament which
consists of two (2) typewritten pages to which I have affixed my
signature this J~~ day of December, A.D., One Thousand Nine
Hundred Ninety-nine (1999).
~ ~41,", C~)
~lnda Jea Carlson
The preceding instrument, consisting of this and one (1)
other typewritten page, identified by the signature of the
Testatrix, was on the date thereof signed, sealed, published and
declared by LINDA JEAN CARLSON, the Testatrix therein named, 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 suhscribed our nam~~
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
B-vg. ~
-2-
;iP.~~..~.....-............-.",,-,.."'_~<"-"
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
........."-,---,,,.'"-~--............,',"""....:,----..,.....'...""'...,.....,
.----""--"-'''''.-'-'''.--.~----_._........__.....~.- ,
:. !tI,~
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND)
SSe
We, LINDA JEAN CARLSON, RICHARD C. SNELBAKER and JANE J.
COONEY, 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 Testament 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
witnesses and that to the best of his or her knowledge the
Testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
witness
i1'w[~~s ~
Subscribed, sworn to and acknowledged before me by LINDA JEAN
CARLSON, the Testatrix, and subscribed and sworn to before me by
RICHARD C. SNELBAKER and JANE J. COONEY, witnesses, this I~~~
day of December, 1999.
- ~~ y( 'JrA
Notary Pu i
NotarIal Seal
SUMn L Zych. Notary Public
MgetIMIC."!OOI'g Boro. Cumberland County
\\,11)' Commission Expires Nov. 24, 2003
Moo;{1Qr, i:>er\7iSytvBniii Association of Notaries
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
SNELBAKER RICHARD C
44 W MAIN ST
C)
;":';0
:.:0
=+~o
'::;; i~~;
,",,"
c.::.
=
--J
o
(1"1
n
N
-.!
Date: 12/27/2007
MECHANICSBURG, PA 17055
:;;::,
.1 c-.-....,
, ,
-'~....
:.;~
-j5
---I
CJ
o
\D
,
;-j
-~
RE: Estate of CARLSON LINDA JEAN
File Number: 2000-00081
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per thE AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
1/17/2008
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~'; ~,.G ~ e
"'. . . _H'P') jl
- . . . , . j '! - .?:iUt. .
X .., m:("~" t.., ~''t(4)1_.~' .'1' J
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
Cumberland County - Register of wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/27/2007
SARAH J CARLSON
......,
c.-:J
=
--.l
CJ
f"~1
27 SOUTH 34TH STREET
CAMP HILL, PA 17011
(J
N
-.J
~.,
~~ 0
o
\.0
RE: Estate of CARLSON LINDA JEAN
File Number: 2000-00081
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(:2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
1/17/2008
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~,- C.~ "if /)
" . . '.. " 4>~ ,i';' i- o,l/
,I - ~L&L 'l4~P?t;t-L/JtI&':tJ~?lL
/" /
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHE:R/T ANCE: AND ESTATE TAX
OFFICIAL RECEIPT
SARAH J CARLSON
27 SOUTH 34TH STREET
CAMP HILL, PA 17011
----~--- fold
ESTATE INFORMATION: SSN: 551-70-0046
FILE NUMBER: 2100-0081
DECEDENT NAME: CARLSON LINDA JEAN
DATE OF PAYMENT: 12/31/2007
POSTMARK DATE: 12/31/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 01/17/2000
NO. CD 009125
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $632.26
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTORNEY
CHECK# 1143
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$632.26
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
" ...
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX OIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
C-,-r,y'- ~-\ (',It&Trl~EfllF INHERITANCE TAX
- "AP.PRArSEME+lT, '-'ALLOWANCE OR DISALLOWANCE
:OF- I)EIiUCTIONS AND ASSESSMENT OF TAX
I ~.
20n1 n-::-(' 1') 1
t.::~ t ........-' L..
Pi;; I: 05
DATE
ESTATE OF
DATE OF DEATH
12-17-2007
CARLSON
01-17-2000
FILE NUMBER 21 00-0081
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 02-15-2008
( See reverse side under Objections)
Amount Remittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
f~!_~~~~~_!~l~_~l~~______~___~~!~!~_~~~~~_~~~!!~~_~~~_!~~~-~~~~~~~--~--------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CARLSON LINDA J FILE NO. 21 00-0081 ACN 101 DATE 12-17-2007
CLE;~!<
RICHARD C SNELBAKER
SNELBAKER & BRENNEMAN
44 W MAIN ST
MECHANICSBURG
C~,C
('1 i' "
Vi'
PA 17055
TAX RETURN WAS: ( ) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12.
13.
14.
Net Value of Tax Return
*'
REV-1547 EX AFP (06-05)
LINDA
J
( X) CHANGED
SEE ATTACHED NOTICE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
20,000.00
.00
.00
.00
227,692.22
.00
.00
(8)
(9)
(10)
45,217.08
10,068.53
(11)
(12)
(13)
(14)
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
247,692.22
1;1;.781; 1>1
192,406.61
.00
192,406.61
If an assessment was issued preViously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
NOTE:
19. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
04-14-2000
04-14-2000
10-02-2007
DISCOUNT (+)
INTEREST/PEN PAID (-)
105.26
421.05
.00
RECEIPT
NUMBER
AA425453
AA425454
CD008768
INTEREST IS CHARGED THROUGH 01-01-2008
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
(15)
(16)
(17)
.00 X 00 =
192,406.61 X 06 =
.00 X 00 =
.00 X 15 =
(19)=
.00
11,544.39
.00
.00
11 ,544.39
11,360.71
183.68
448.58
632.26
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. f:-J;'
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUEl
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
AMOUNT PAID
2,000.00
8,000.00
834.40
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
'"
REV-1470 EX (6-66)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
FILE NUMBER
REVIEWED BY
ACN
2100-0081
101
Linda J. Carlson
Destiny S.R.8rown
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
H 83
The claim for the family exemption has been disallowed. The claimant must be a spouse
or if no spouse. a parent or child Iivina in the same household as the decedent as of the
date of death.
ROW
Page 1
Pa. o.e. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Name of Decedent: LINDA JEAN CARLSON
Date of Death: 1/17/2000
File Number: 21-00-0081
Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete: . . . . . . . . . , . . . . . . . . .. 0 Yes Ii] No
2. lfthe answer is No, state when the personal representative
reasonably believes that the administration will be complete:
Approximately 6 months
3. If the answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court? . . . . . ., 0 Yes 0 No
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
informally to the parties in interest? ............................... 0 Yes 0 No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and ay, be attached to this report.
Date
1/6/08
Capacity: DPersonal Representative 12] Counsel
Richard C. Snelbaker
Name of Person Filing this Form
"jillJ
(' \.,':' i II'
""'i'lCdO
'''I''
)>""7(""
II.._.....) ~j
Snelbaker & Brenneman, P.c.
Address
44 West Main Street, Mechanicsburg, PA 17055
717-697-8528
O~ : I J [:;H! L - Ntf(' BUaZ
Telephone
,':"'-;
i-I i'~'; i ,i' ,r :,'
F~r;,.NirJ.1Qj f,~j;I9,J{jPf:..
.....u'''-., "'-'_,;:....
r-\
COMMON~~L~OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX OIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
INHERITANCE TAX
RECORD ADJUSTMENT
C': (' _'
"u 1 \:
; \
\8
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
, .
\ f
('.C
\.-/1\
RICHARD C SNELBAKER
SNELBAKER & BRENNEMAN
44 W MAIN ST
MECHANICSBURG
r."_j
PA 17055
01-04-2008
CARLSON
01-17-2000
21 00-0081
CUMBERLAND
101
Amount Remitted
*'
REV-1593 EX AFP (03-05)
LINDA
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment.
--+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
---------------------------------------------------------------------------------------------------------------------------------------
REV-1593 EX AFP (03-05)
ESTATE OF CARLSON
LINDA
.. INHERITANCE TAX RECORD ADJUSTMENT ..
ACN 101
J FILE NO. 21 00-0081
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
ADMINISTRATIVE CORRECTION
1. Real Estate {Schedule A}
2. Stocks and Bonds {Schedule B}
3. Closely Held Stock/Partnership Interest {Schedule C}
4. Mortgages/Notes Receivable {Schedule D}
5. Cash/Bank Deposits/Misc. Personal Property {Schedule E}
6. Jointly Owned Property {Schedule F}
7. Transfers {Schedule G}
S. Total Assets
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/
Miscellaneous Expenses {Schedule H}
10.
ll.
12.
13.
14.
Debts/Mortgage Liabilities/Liens {Schedule I}
Total Deductions
Net Value of Tax Return
{9}
ClO}
{l}
{2}
{3}
{4}
{S}
{6}
{7}
20,000.00
.00
.00
.00
227,692.22
.00
.00
{S}
48,717.08
10,068.53
ell}
Cl2}
Charitable/Governmental Bequests; Non-elected 9113 Trusts {Schedule J}
Net Value of Estate Subject to Tax
TAX:
15.
16.
17.
IS.
Amount of Line 14 at Spousal rate ClS}
Amount of Line 14 taxable at Lineal/Class A rate Cl6}
Amount of Line 14 at Sibling rate Cl7}
Amount of Line 14 taxable at Collateral/Class B rate ClS}
19. Principal Tax Due
TAX CREDITS:
DATE
04-14-2000
04-14-2000
10-02-2007
+
INTEREST/PEN PAID {-}
105.26
421.05
26.31-
NUMBER
AA425453
AA425454
CD008768
BALANCE OF UNPAID INTEREST/PENALTY AS OF 10-03-2007
Cl3}
Cl4}
. DO X DO
188,906.61X 06
.OOX DO
. DO X 15
Cl9}
AMOUNT PAID
2,0!J0.00
8,000.00
834.40
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
*
IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. I
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE '0
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.} D
DATE
01-04-2008
247,692.22
58,785.61
188,906.61
.00
188,906.61
.00
11,334.40
. DO
.00
11,334.40
11,334.40
.00
326.84
326.84
".. .
REV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
Linda J. Carlson
REVIEWED BY
Eunice Baker
ITEM
SCHEDULE NO.
FILE NUMBER
ACN
EXPLANATION OF CHANGES
The family exemption has been reinstated on the above account.
ROW
2100-0081
101
Paqe 1
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-1607 EX AFP (03-05)
. ~ . I ,....,. r'
;,r,: 5:5
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-22-2008
CARLSON
01-17-2000
21 00-0081
CUMBERLAND
101
LINDA
J
RICHARD C SNEpBAKER
SNELBAKER & BRENNEMAN
44 W MAIN ST
MECHANICSBURG PA 17055
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
~
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ***
ESTATE OF CARLSON
LINDA
J FILE NO. 21 00-0081
ACN 101
DATE 01-22-2008
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-03-2008
PRINCIPAL TAX DUE: 11,334.40
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-14-2000 AA425453 105.26 2,000.00
04-14-2000 AA425454 421. 05 8,000.00
10-02-2007 CD008768 26.31- 834.40
12-31-2007 CD009125 326.84- 632.26
TOTAL TAX CREDIT 11,639.82
BALANCE OF TAX DUE 305.42CR
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 305.42CR
*
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN *1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
Pa. o.e. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSVL VANIA
Name of Decedent: LINDA JEAN CARLSON
Date of Death: 1/17/2000
File Number: 21-00-0081
Pursuant to Pa. O.c. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . .. IllVes D No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. If the answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court? . . . . . .. 0 Ves III No
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
informally to the parties in interest? ............................... IZ]Ves DNo
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and m attached to this report.
-~
Date
3/25/08
'0
Capacity: DPersonal Representative IZ]Counsel
Richard C. Snelbaker
Name of Person Filing this Form
i--
N
Snelbaker & Brenneman, P.c.
Address
44 West Main Street, Mechanicsburg, PA 17055
-'-
717 -697 -8528
Telephone
Form RW-IO rev. 10.13.06
~
INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COUNTY, P7~rJk2~Nlf.\ G: ]3
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF CUMBERLAND
Sarah J. Carlson, Executrix
File Number 21-00-0081
.1"
l)H~;,-::',:' I', , Y,J\"\ i~
Personal Representative(s) of the Estate of LINDA JEAN CARLSON
deceased, depose(s) and say(s) that the items appearing in the following inventory include all ofthe 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 this inventory.
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. ~ 4904 relating to unsworn falsification to
authorities.
~~ ~~.Yu l '-f. iCceculv\\{
Sarah J. Carlson, Executrix
8200 Cleary Boulevard, Villa #2015
Plantation, FL 33324
Attorney -- (Name) Richard C. Snelbaker
(Address) 44 West Main Street, Mechanicsburg, PA 17055
(Telephone) 717-697-8528
(Supreme Court I. D. No) 6355
DATE OF DEATH
LAST RESIDENCE
DECEDENT'S SOC SEC. NO.
27 S. 34th Street, Camp HilI, Hampden Twp., P A 17011
T FIGURES MUST BE TOTALED I
1. 1991 Ford Van, valued assigned by Executrix
2. 1996 Jeep Cherokee, appraised value
3. Central PA Hematology & Medical Oncology Assoc., refund due the decedent for medical expenses
551-70-0046
01/17/2000
4. Erie Insurance, refund unused premium on renters insurance policy
5. Erie Insurance, refund unused premium on automobile insurance policy
6. Fulton Bank, checking account #3629-34862
7. George Carlson, payment due the decedent as ordered in Divorce Decree dated June 1998
8. Household goods retained by family members
9. PA Department of Revenue, revenue refund
10. Pennsylvania Blue Shield, refund unused premium on medical insurance
11. The Vanguard Group, prime money market account #9923008928
12. United States Treasury, refund due on income tax
13. 3.13 acre lot located on Stoney Run Road, Carroll Township, York County, Dillsburg, PA, sale value
1,500.00
12,000.00
439.49
141.00
503.00
9,984.60
69,381.62
865.00
29.00
865.50
130,783.01
1,200.00
20,000.00
(Attach additional sheets as needed)
TOT AL:
247,692.22
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. C.S J 330/(b))
Form RW-09 rev. /0. /3.06
\tY
RECEIPT AND RELEASE
WHEREAS, Linda Jean Carlson, late of Hampden Township,
County of Cumberland and Commonwealth of Pennsylvania, died on
January 17, 2000, having first made her Last Will and Testament
in writing probated before the Register of Wills of said
Cumberland County on January 25, 2000, and Letters Testamentary
were issued on the same date to Sarah J. Carlson now Sarah J.
Carlson-Pint, the Executrix named in the Last Will and Testament
of said Decedent;
and
WHEREAS, said Executrix has entered upon and completed her
administration of said Decedent's Estate as set forth in her
First and Final Account attached hereto, and intends to
distribute the net balance of the assets of said Estate to the
persons named in the Statement of Proposed Distribution also
attached hereto, both of said documents being incorporated herein
by reference thereto; and
NOW KNOW ALL MEN BY THESE PRESENTS, that we, Sarah J.
Carlson-Pint, Anna M. Carlson-Steinhardt and Jason Carlson, being
the principal legatees and distributees named in the Will of said
Decedent and the persons entitled to share in the residuary
distribution of the Estate of said Decedent, do hereby declare
(,
and$ay that we, and each of us, have examined the attached
r'.~~
LAW OFFICES (
SNELSAKER & '..
BRENNEMAN, P.C. ..
1
~
Account and Statement of Proposed Distribution, and find the same
to be true and correct, and in strict accordance with the terms
and provisions of said Will, and we do hereby acknowledge
that we, and each of us, this day have, had and received of and
from Sarah J. Carlson-Pint, Executrix of the Estate of Linda Jean
Carlson, the cash, personalty and/or real estate set opposite our
names in the above Statement of Proposed Distribution, in full
satisfaction, payment and discharge of all such sum or sums of
money, legacies and bequests, share or shares, purports and
dividends which were due, owing and payable and belonging to us,
and each of us, by any means whatsoever, for or on account of our
full share, part or dividend of the Estate of Linda Jean Carlson,
Deceased.
NOW, THEREFORE, we, and each of us, the said Sarah J.
Carlson-Pint, Anna M. Carlson-Steinhardt and Jason Carlson, do by
these presents, remise, release, quit-claim and forever discharge
the said Sarah J. Carlson-Pint, her heirs, executors and
administrators, of and from our said shares or dividends of the
Estate aforesaid, and of and from all actions, suits, payments,
accounts, reckonings, claims and demands whatsoever, for or by
reason thereof, or of any act, matter, cause or thing whatsoever,
from the beginning of the world to the day and date of these
presents.
AND, desiring to avoid the delay and expense of the
settlement of said Estate by filing the foregoing Account of said
LAW OFFICES
SNELBAKER &
BRENNEMAN. P.C.
2
administration in the Office of the Register of Wills of said
Cumberland County and by having the balance in the hands of the
Executrix, as shown by said Account, distributed by the Court of
Common Pleas of Cumberland County - Orphans' Court Division, we,
and each of us, do hereby agree that the foregoing Account and
Statement concerning the matter of settlement may be recorded
with the same effect upon us, and each of us, as if the same had
been reported upon by said Court, in a decree of distribution
made on such proposed Statement of Distribution by the said Court
of Common Pleas - Orphans' Court Division.
AND in consideration of the aforesaid settlement being made
without the aid of such Court of Common Pleas - Orphans' Court
Division, that we, and each of us, the said Sarah J. Carlson-
Pint, Anna M. Carlson-Steinhardt and Jason Carlson do hereby
agree that if any debts or demands other than those included in
the above referenced First and Final Account, as hereinbefore set
forth, shall be hereafter recovered against the Estate of said
Decedent and be legally payable out of the same, that we, and
each of us, will return to the said Executrix such amounts
thereof as may be necessary to pay such debts or demands.
LAW OFFICES
SNELBAKER Be
BRENNEMAN. P.C.
3
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
this
t~
IN WITNESS WHEREOF, we have hereunto set our hands and seals
da y 0 f V'v'-av-(: L.-,
WITNESSED BY:
2008.
~'- /-7'/ 17 _/~
'--)~\_~ ~
Sarah J. Carlson-Pint
fr\ ~~
Carlson-Steinhardt
(SEAL)
C't'._.A....",,'1
Anna M.
(SEAL)
4
STATE OF FLORIDA
COUNTY OF cfim./Jl!t~jve
On this the /.5 day of
SSe
/:7/#d'
2008, before me, a
Notary Public in and for said State and County, the undersigned
officer, personally appeared Sarah J. Carlson-Pint, Anna M.
Carlson-Steinhardt and Jason Carlson, known to me (or
satisfactorily proven) to be the persons whose names are
subscribed to the within instrument and acknowledged that they
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto se
Notary Public
seal.
.....n. ................................._-,
:. RAYMOND G. MAGNO
; #.~p~:",. Comm#D00627081
. "~{I~'''''
: ~?r~" ~\ EJ<jJltes1m2011 I:
; ~..~\t_.~;:, ,tj :
: ~~r;iU...~:.~~ Acdda Notary Aaan..1nc :
'.......; _.J ~.. ..................... !I.U ~.....,.....,.......u
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
5
LAW OFFICES
SNELBAKER &
BRENNEMAN. P.C.
ESTATE NO. 21-00-0081
FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED
DISTRIBUTION OF AND BY SARAH J. CARLSON, EXECUTRIX
OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT
OF LINDA JEAN CARLSON, DECEASED, LATE OF HAMPDEN
TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA
arah J. Carlson, Executrix as aforesaid and Accountant herein,
avers as follows:
DATE OF DECEDENT'S DEATH:
DATE LETTERS TESTAMENTARY ISSUED:
January 17, 2000
January 25, 2000
DATES EXECUTOR NOTICE ADVERTISED:
Cumberland Law Journal
Patriot-News
February 11,18, 25, 2000
February 8, 15, 22, 2000
FIRST AND FINAL ACCOUNT
PERSONALTY - PRINCIPAL ACCOUNT
DEBITS
he Accountant charges herself with the receipt of the following items of
Decedent's Personalty valued as of the date of Decedent's death:
1. 1991 Ford Van, valued assigned by Executrix
2. 1996 Jeep Cherokee, appraised value
3. Central PA Hematology & Medical Oncology Assoc., refund due the
decedent for medical expenses
4. Erie Insurance, refund unused premium on renters insurance policy
5. Erie Insurance, refund unused premium on automobile policy
6. Fulton Bank, checking account #3629-34862
7. George Carlson, payment due the decedent as ordered in Divorce Decree
dated June 1998
8. Household goods retained by family members
9. PA Department of Revenue, revenue refund
10. Pennsylvania Blue Shield, refund unused premium on medical insurance
11. The Vanguard Group, prime money market account #9923008928
12. United States Treasury, refund due on income tax
13. Sarah Carlson, reimbursement for cable TV services
14. York Waste Disposal, refund on refuse service
15. PPL Electric, refund
16. Ed Maloy, refund rent paid for April and May 2000
17. Comcast, refund on cable TV service
18. Erie Insurance Group, refund on policy #Q500403846H
19. Sarah Carlson, repayment of loan advanced 11/7/2001
20. Commonwealth of Pennsylvania, refund on Inheritance Tax
21. George Carlson, interest due on Divorce Decree from date of death to 11/30/2004
22. Millville Mutual, premium refund on liability insurance policy
TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS:
Page 1
$ 1,500.00
12,000.00
439.49
141.00
503.00
9,984.60
69,381.62
865.00
29.00
865.50
130,783.01
1,200.00
29.00
7.96
26.25
1,700.00
1.93
54.00
425.00
305.42
14,456.78
63.00
$ 244,761.56
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
PERSONALTY - PRINCIPAL ACCOUNT
CREDITS
he Accountant claims credit for the payment of the following items from
Decedent's Personalty Account:
1. Sarah Carlson, payment of family exemption
2. Fulton Bank, credit card debt
3. Central PA Cremation Society, funeral services
4. ComcasUSuburban Cable, cable TV service
5. Fulton Bank, service fees and check printing fees
6. Jason Carlson, two months rent
7. Ed Maloy, apartment rent for March, April and May 2000
8. Sarah Carlson, reimbursement for insurance premium paid for decedent
9. Universal Card Services, Corp, credit card debt
10. Anna Carlson, reimbursement for insurance premium paid for decedent
11. Health South, medical expenses
12. Patriot-News, advertisement
13. Palm Beach Atlantic College, tuition fee for Jason
14. Register of Wills, Agent, estimated Inheritance Tax payment
15. Ed Maloy, sewer bill
16. Stanley Steamer, carpet cleaning
17. Dave Farhart, home depot supplies for house
18. Universal Services/Geoffrey's mailboxes, mailboxes, faxes, etc
19. Sarah Carlson, loan
20. FedEx, overnight delivery
21. Sarah Carlson, scattering ashes/memorial of mother
22. GMA flowers, memorial
23. Sarah Carlson, reimbursement for notary fees and overnight postage
24. Register of Wills, filing fee for Inheritance Tax return
25. Register of Wills, Agent, Inheritance Tax
26. Register of Wills, additional probate fee
27. Fulton Bank, decedent's expenses paid from checking account #3629-34862
28. PPL Electric, electric service
29. Bell Atlantic, phone service
30. UGI, gas service
31. Pennsylvania American Water, water service
32. York Waste, refuse service
33. Erie Insurance Group, homeowners insurance premium
34. Sarah Carlson-Pint, Executrix commission
35. Snelbaker & Brenneman, P.C., attorney services for estate settlement
36. Snelbaker & Brenneman, P.C., costs advanced:
a. Register of Wills, probate fee
b. Cumberland Law Journal, advertising Executrix Notice
c. Patriot-News, advertising Executrix Notice
d. Register of Wills, short certificates
e. Register of Wills, exemplified letters
37. Reserve for filing fees, accounting fees and other miscellaneous costs
associated with the administration of decedent's estate
TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS:
Page 2
$ 3,500.00
514.37
402.00
56.97
166.70
600.00
2,550.00
289.00
410.00
214.00
4,196.14
78.10
2,245.25
10,000.00
60.00
148.35
15.00
152.47
425.00
17.42
350.00
80.00
59.62
15.00
1,466.66
35.00
3,614.98
218.91
753.08
974.69
149.18
25.92
90.00
6,192.00
7,500.00
487.80
264.00
75.00
105.80
3.00
40.00
1,500.00
$ 49,553.61
PERSONAL TV - INCOME ACCOUNT
DEBITS
The Accountant charges herself with the receipt of the following
income from the investment of Personalty Principal:
1. Vanguard, money market account #9923008928, interest
TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS:
PERSONALTY - INCOME ACCOUNT
CREDITS
he Accountant claims credit for the payment of the following items
from the Personalty Principal Account:
PA Department of Revenue, income tax due on Final Individual Taxes
Greenawalt & Company, P.C., preparation of 1999 Final Individual Taxes
Greenawalt & Company, P.C., preparation of 2000 Fiduciary Income Taxes
Greenawalt & Company, P.C., preparation of 2001 Fiduciary Income Taxes
Greenawalt & Company, P.C., preparation of 2002 Fiduciary Income Taxes
PA Department of Revenue, income tax due on 2003 Fiduciary Income Taxes
Greenawalt & Company, P.C., preparation of 2003 Fiduciary Income Taxes
Greenawalt & Company, P.C., preparation of 2004 Fiduciary Income Taxes
Greenawalt & Company, P.C., preparation of 2005 Fiduciary Income Taxes
10. United States Treasury, income tax due on 2006 Fiduciary Income Taxes
11. PA Department of Revenue, income tax due on 2006 Fiduciary Income Taxes
12. Greenawalt & Company, P.C., preparation of 2006 Fiduciary Income Taxes
TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS:
REAL ESTATE - PRINCIPAL ACCOUNT
DEBITS
he Accountant charges herself with the receipt of Decedent's
Real Estate as follows:
3.13 acre lot located on Stoney Run Road, Carroll Township,
York County, Dillsburg, PA, sale value
Adjustments made at settlement for City, County and School Taxes
TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS:
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
Page 3
$ 17,420.97
$ 17,420.97
$
50.00
175.00
275.00
495.00
350.00
20.00
375.00
385.00
315.00
157.00
90,00
315.00
3,002.00
$
$ 20,000.00
138.99
$ 20,138.99
REAL ESTATE - PRINCIPAL ACCOUNT
CREDITS
he Accountant claims credit for the payment of the following
items from Real Estate Principal Account:
1. Madeline Harbold, Tax Collector, real estate taxes Dillsburg property
L.G. Connor Real Estate, appraisal fee
Carroll Township, litigation fees from December 1999 to January 2000
Decker Surveying, survey services
Snelbaker & Brenneman, P.C., litigation fees
Kevin Cashman, mowing of lot
Millville Mutual Insurance Co., liability insurance on lot
Tax Claim Bureau, 2001 County taxes (late charges plus interest)
Settlement paid to Mr. & Mrs. Jacobs
10. Adjustments made at settlement for transfer taxes, notary fees
and credit to buyer for 50% of costs incurred
TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS:
$ 5,634.01
350.00
42.00
450.00
21,794.99
125.00
665.00
196.65
1,500.00
1,489.83
$ 32,247.48
REAL ESTATE -INCOME ACCOUNT
DEBITS
he Accountant charges herself with the receipt of the
income from the investment of Real Estate Principal Account:
TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS:
$ NONE
$ NONE
REAL ESTATE -INCOME ACCOUNT
CREDITS
he Accountant claims credit for the payment of the following items
from the Real Estate Income Account:
TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS:
$ NONE
$ NONE
LAW OFFICES
SNELBAKER &
BRENNEMAN. P.C.
Page 4
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
RECAPITULATION
ERSONAL TY:
PRINCIPAL ACCOUNT:
Debits
Credits
Balance
INCOME ACCOUNT:
Debits
Credits
Balance
TOTAL PERSONALTY
EAL ESTATE:
PRINCIPAL ACCOUNT:
Debits
Credits
Balance
INCOME ACCOUNT:
Debits
Credits
Balance
TOTAL REAL ESTATE:
OTAL FOR DISTRIBUTION:
Page 5
$ 244,761.56
$ 49,553.61
$ 195,207.95
$ 17,420.97
$ 3,002.00
$ 14,418.97
$ 209,626.92
$ 20,138.99
$ 32,247.48
$ (12,108.49)
$ NONE
$ NONE
$ NONE
$ (12,108.49)
$ 197,518.43
STATEMENT OF PROPOSED DISTRIBUTION
Sarah J. Carlson, Executrix and Accountant herein, proposes to
istribute the balance of the Estate of Linda Jean Carlson, Deceased, to wit:
197,518.43 in accordance with the Last Will and Testament of said Decedent
s follows:
Sarah J. Carlson-Pint
1/3 of residue as per Item Third of Will
Advance Distributions:
March 16, 2000
July 17, 2000
August 15, 2000
July 2, 2001
July 26, 2001
November 7,2001
February 4, 2002
May 6, 2002
August 29, 2002
January 21, 2003
August27,2003
January 13, 2004
May 23, 2004
July 27, 2004
August 25, 2004
January 4, 2005
January 5, 2005
July 26, 2005
September 7,2005
January 27, 2007
Household goods retained In-Kind
1996 Jeep Cherokee retained In-Kind
Cash
5,000.00
12,500.00
100.00
700.00
5,000.00
333.34
65.00
1,200.00
1,200.00
50.00
150.00
100.00
2,000.00
283.33
1,000.00
75.00
5,500.00
23.66
550.00
22.25
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
Anna M. Carlson-Steinhardt
1/3 of residue as per Item Third of Will
Advance Distributions:
March 16, 2000
July 17, 2000
July 2, 2001
July 26, 2001
November 7, 2001
February 4, 2002
June 14, 2002
January 21,2003
June 16, 2003
September 8, 2003
January 13, 2004
March 25, 2004
July 27, 2004
January 4, 2005
January 5, 2005
5,000.00
12,400.00
700.00
5,000.00
333.33
65.00
1,200.00
50.00
1,200.00
150.00
1 00.00
2,000.00
283.34
75.00
5,500.00
Page 6
35,852.58
288.34
12,000.00
17,698.55
39,551.62
65,839.47
65,839.48
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
Anna M. Carlson-Steinhardt (Continued)
July 26, 2005
September 26, 2005
November 22, 2005
January 27,2007
June 25,2007
July 23, 2007
Household goods retained In-Kind
1991 Ford Van, retained In-Kind
Cash
Jason Carlson
1/3 of residue as per Item Third of Will
Advance Distributions:
March 16, 2000
July 17, 2000
July 2, 2001
July 26, 2001
November 7, 2001
February 4, 2002
May 10, 2002
January 21, 2003
September 8, 2003
January 13, 2004
July 27,2004
January 4, 2005
January 5, 2005
July 26, 2005
January 27,2007
Household goods retained In-Kind
Cash
OT AL FOR DISTRIBUTION:
Page 7
23.66
1,049.03
400.00
22.26
2,000.00
2,000.00
5,000.00
12,500.00
700.00
5,000.00
333.33
64.00
1,200.00
50.00
150.00
100.00
283.33
75.00
5,500.00
23.66
22.26
288.33
1,500.00
24,499.53
31,001.58
288.33
34,549.57
65,839.48
197,518.43
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
STATE OF FLORIDA
COUNTY OF ~1{/7;4c; / C
SS:
Sarah J. Carlson, being duly sworn according to law deposes and says:
that she is the Executrix of the Estate and under the Last Will and Testament of
Linda Jean Carlson, Deceased, and the Accountant herein; that there are no
unpaid creditors or claimants of said Estate; that there are no persons
interested in the distribution of said Estate other than as stated in the foregoing
Statement of Proposed Distribution; and that the facts set forth in the foreqoing
First and Final Account and Statement of Proposed Distribution are true and
correct to the best of her knowledge, information and belief.
S w.c,;p ~
Sarah J. Carlson
Executrix and Accountant
......"............. ... ............0......::1
:. RAYMOND Go MAGNO
: "",",,,,,, Com- DD0827GI1
~ ~:~~~.,:%t.~ ....
~ ~.::~~~g l:xplrea 1ntm11
:';; ~..~-~.:::..,.... "'/$ I
: ..;'/~;;;,;.,;~;.'. l-lolida NoIaIy Aan.,,1nc !
".11.. ...,~.. .,;j.:l....41ollii...JJ.. ~.... J,UJ..................w
Page 8
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: LINDA JEAN CARLSON
Date of Death: 1/17/2000
File Number: 21-00-0081
Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is compl~ae: , ....: , .
............ ~ Yes ~ No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
Approximately 6 months
3. If the answer to No. 1 is YES, state the following:
a. Did the personal representative file a final account with the Court? ....... ^ Yes ^ No
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
informally to the parties in interest? ............................... ^ Yes ^ No
d. Copif;s of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and ay be attached to this report.
e 1/6/08
Sign ~rfPerson Filing this Form
Capacity Personal Representative Counsel
Richard C. Snelbaker
Name o(Per son Filing this Form
Snelbaker & Brenneman, P.C.
~,~
i ,J,G
~~ ~tl~'i' L_ ~ ,.~. .
Forr>i7~~Iy,.7~1,'rev:-/0,.13.176'
Haaress
44 West Main Street, Mechanicsburg, PA 17055
717-69?-8528
elephone
INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COMMONWEALTH OF' PENNSYLVANIA 1
COUNTY OF CUMBERLAND f SS
Sarah J. Carlson, Executrix
COUNTY, PI~NNSYLU~NI,A, ,. , ., .,
. I ..: L ; ; ., ., .,
File Number 21-00-0081
•J~ , i,
Personal Representative(s) of the Estate of LINDA JEAN CARLSON
deceased, depose(s) and say(s) that the items appearing in the following inventory include all ofthe 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 this inventory.
I verify that the; statements made in this Inven- ~`~,, T
tory are true and correct. I understand that false state- -` G.,,~~'J "`'"""` 6 ~~~ V~
ments herein are made subject to the penalties of Sarah J. Carlson, Executrix
18 Pa.C.S. § 4904 relating to unsworn falsification to 8200 Cleary Boulevard Villa #2015
authorities. Plantation, FL 33324
Attorney -- (Name) Richard C. Snelbaker
(Supreme Court 1. D. No.) 6355
(Address)_ 44 West Main Street, Mechanicsburg, PA 17055
(Telephone) 717-697-8528
01 ~ 17/2000
LAST RESIDENCE
27 S. 34th Street, Camp Hill, Hampden Twp., PA 17011
FIGURES MUST BE TOTALED I
I. 1991 Ford Van, valued assigned by Executrix
2. 1996 Jeep Cherokee, appraised value
3. Central PA Hematology & Medical Oncology Assoc., refund due the decedent for medical expenses
4. Erie insurance, refund. unused premium on renters insurance policy
5. Erie Insurance, refund unused premium on automobile insurance policy
6. Fulton Bank, checkin€; account #3629-34862
7. George Carlson, payment due the decedent as ordered in Divorce Decree elated June 1998
8. Household goods retained by family members
9. PA Department of Revenue, revenue refund
10. Pennsylvania Blue Shield, refund unused premium on medical insurance
11. The Vanguard Group., prime money market account #9923008928
12. United States Treasury, refund due on income tax
13. 3.13 acre lot located o~n Stoney Run Road, Carroll Township, York County, Dillsburg, PA, sale value
(Attach additional sheets as needed)
Tl1T ~ ~ .
DECEDENT'S SOC. SEC. NO.
551-70-0046
1,500.00
12,000.00
439.49
f 41.00
503.00
9,984.60
69,381.62
865.00
29.00
865.50
130,783.01
1,200.00
20,000.00
_ _ _ _ 247,692.22
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, a~ 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. C.S. ~¢ 3301(b)j
Form RW-09 rev. 10. /3.06
~y