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Home My WebLink About10-29-07 (2) , ...J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes . PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 2\ V( 0'2" Date of Birth 195-26-5145 February 20, 2007 21, 1932 Decedent's Last Name Suffix Decedent's First Name MI Steele Richard G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW <., 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate ;::;R:; c:::::; 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::::; 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes Andrew C. Sheely, Esquire 717-697-7050 Firm Name REGISTER OF WILLS USE ONLY C. Sheely, Attorney at Law First line of address Mechanicsburg 7055 (::J C"') --I f'-.-) ~ 127 South Market Street Second line of address P.O. Box 95 or Post Office State ZIP Code (11 o Correspondent's e-mail address:.andrewc.sheely@verizon.net Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ["lilT<=: )~~? RF~. eth D. Steele, Executor, 1929 Fisher Road, Mechanicsburg, PA 17055 ::~%JP~ER ~~ENTATIVE Andrew C. Sheely, Esquire, 127 S. Market St.,PO. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY nATF 10/2-5/07 L 15056051058 Side 1 15056051058 --.J -.J 15056052059 REV-1500 EX Decedent's Name: Steel~, Richard G. RECAPITULATION 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . " 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) C::> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::J Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . " 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10).. . . .... ... ... ... . . ... '" .. . .... '" 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) .. . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers uncle. ~ec. 9116 (a)(1.2) X .0 15. 16. Amount of Line 14 bV"lble at lineal rate X .045 128,985.88 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number 5145 30,021.13 62,047.39 50,113.53 142,182.05 12,922.79 273.38 13,196.17 128,985.88 5,804.36 15056052059 -.J RE,V-1500 EX. Page 3 Decedent's Complete Address: DECEDENT'S NAME Richard G. Steele DECEDENT'S SOCIAL SECURITY NUMBER 195-26-5145 STREET ADDRESS 4 Pocono Drive CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5804.36 5200.00 273.68- 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) 5473.68 Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) 330.68 A. Enter the interest on the tax due. 330.68 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i] c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust fo~' or payable upon death bank account or security at his or her death? .............. 0 [i] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [i] 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)l. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 PS. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER RICHARD G. STEELE 21-07-0277 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Belco Community Credit Union Account #XXXXX90 Saving Account $ 11,176.07 2. Belco Community Credit Union Account #XXXXX90 Checking Account $ 18,845.06 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 30,021.13 Co~~~~2n !II L getting you there STATEMENT OF ACCOUNT Page 2 MAIN OFFICE: 403 N. 2nd Street P.O. Box 82 Harrisburg, PA 1 7108 JOINT OWNERS ACCOUNT NUMBER XXXX90 SOCIAL SECURITY /I RICHARD G. STEELE STATEMENT PERIOD From To 0201 0201 0209 0216 0216 0218 0228 , PREVIOUS BALANCE ~ ~ SAVINGS * PREAUTHORIZED AUTO TRANSF PHONE TRANSFER VIA BELLE PAYMENT VIA OFFICE/MAIL * PREAUTHORIZED AUTO TRANSF PHONE TRANSFER VIA BELLE DIVIDEND THE ANNUAL PERCENTAGE RATE IS 1.00 THE ANNUAL PERCENTAGE YIELD IS 1.00 THE ANNUAL PERCENTAGE YIELD EARNED IS 1.00 070201 070228 1.00 0 NEW BALANCE 471650 476650 656650 2611897 2616897 1116897 1117607 1. 00 9260.50 0228 1117607 0201 0201 0201 * 0202 PREVIOUS BALANCE ~ ~ CHECKING DRAFT PAID 4313 PREAUTHORIZED AUTO TRANSF PREAUTHORIZED WITHDRAWAL 1230959590 PP ELEC BILL ACH DRAFT -35000 -5000 -15128 452407 41740'7 412407 397279 0202 4312 -2 23 394456 * VERIZON ARC CHECK PYMT- TRACE . 021000024606565 ACH DRAFT VZ WIRELESS ARC ARC - TRACE. 021000024753200 ATM WITHDRAWAL 4 MARKET PLAZA WAY MECHANICSBURG PA PHONE TRANSFER VIA BELLE PHONE TRANSFER VIA BELLE DRAFT PAID DRAFT PAID PREAUTHORIZED WITHDRAWAL UNITED WATER PEN WATER BILL PREAUTHORIZED WITHDRAWAL CUNA MUTUAL LIFE CML INS CO DRAFT PAID DRAFT PAID PREAUTHORIZED AUTO TRANSF PHONE TRANSFER VIA BELLE DRAFT PAID 4311 -7146 387310 0202 0206 W430067921 -40000 347310 0209 0209 0212 0212 0214 4314 4315 0020797347 -4000 -180000 -25000 -12604 -3 94 343310 163310 138310 125706 121812 0214 9CLDEBITS -20000 101812 0214 0215 0216 0218 0221 4316 4317 -998 -642 -5000 1500000 -4 25 TOTAL FINANCE CHARGE YEAR-TO-DATE for all loans . 100814 100172 95172 1595172 1590647 4318 TOTAL DIVIDEND YEAR- TO-DATE for aU savings except IRA. Dividends shown, if $1 0 or over, wUI be reported to the Internal Revenue Service for this calendar year. "INDICATES EFFECTIVE DATE NOTICE: See reverse side for important information. 0702039 BELCO Community Cl'edit Union L getting you there :s I A I t:.Mt:.N I U'" AL.L.UUN I Page 3 MAIN OFFICE: 403 N. 2nd Streit P.O. Box 82 Harrisburg. PA 1 7108 t# JOINT OWNERS RICHARD G. STEELE S ATEMENT PERIOD From To * DIRECT DEPOSIT us TREASURY 303 SOC SEC DIRECT DEPOSIT 3031036030 117600 0301 * A753132824 176139 1884386 022-8 LUCENT PEN PHTS DIVIDEND 120 THE ANNUAL PERCENTAGE RATE IS 0.25 THE ANNUAL PERCENTAGE YIELD IS 0.50 THE ANNUAL PERCENTAGE YIELD EARNED IS 0.20 0.20 070201 070228 0.25 S2 7731. NEW BALANCE 1884506 0228 ------------------------ CLEARED DRAF SUMMA 4313 4314 4315 4316 4317 4318 TOTAL DIVIDEND YEAR - TO-DATE for aU savings IXClpt IRA. Dividends shown, if $10 or oVlr. wiD bl ~d to thl Intimal RlVlnul Servicl for this callndar Vlar. .INDICATES EFFECTIVE DATE 11. 96 TOTAL ANANCE CHARGE YEAR- TO-DATE for aUlaans. 0.00 NOTICE: SlI ravenl sidl for important information. 0702040 REV-1509 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RICHARD G. STBBLB 21-07-0277 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Angela Brungard 1515 Orr Bridge Road Mechanic.burg, PA 17050 Granddaughter B. C. JOINTLY.OWNED PROPERTY: 5 LElTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INClUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMLAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. AlTACH DEED FOR JOINTL V-HELD REAL ESTATE. VAL UE OF ASSET INTEREST DECEDENT'S INTEREST 1, A. MEMBERS FIRST CREDIT UNION SavIngs Account.f:288DUO-OO Angela Brungard, Jt. Ten $ 302.05 100% $ 302.05 A 08102/08 MEMBERS FIRST CREDIT UNION 11 month cer1IIIcate - Account " I"" Angela Brungard, Jt. Ten $ 5,147 .95 ~OO% $ 5,147.95 A 08/02106 MEMBERS FIRST CREDIT UNION 11 month certlllcate - Account Le_ Angela Brungard, Jt. Ten S,147 .95 00% $5,147 .95 . A 08/02106 MEMBERS FIRST CREDIT UNION 11 month certlftcate - Account l.- Angela Brungard, Jt Ten $ 5,147.95 00% $5,147.95 . A MEMBERS FIRST CREDIT UNION 11 month certlftcate - Account~ ~ Angela Brungard, Jt. Ten $ 5,147 .95 00% $5,147.95 A O8I02/Ofi MEMBERS FIRST CREDIT UNION 11 month certlllcall:e - Account #2889DO- n Angela Brungard, Jt Ten $ 5,147 .95 100" $5,147.95 TOTAL (Also enter on line 6, Recapitulation) $ 2. 3. 4 6. (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLy-oWNED PROPERTY ESTATE OF RICHARD G. STEELE 21-0F.f~8'flr If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Angela Brungard 1515 Orr Bridge Road Mechanicsburg, PA 17050 Granddaughter 8 c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INQUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VAlUE OF ASSET INTEREST DECEDENTS INTEREST 7. A, 08/02106 MEMBERS FIRST CREDIT UNION 7 month certillcate - Account~5 Angela Brungard. Jt. Ten ..132 .92 00% $ 5.132.92 8. A 08/02/ MBABERS FIRST CREDIT UNION 7 month certillcate - Account~ Angela Brungard. Jt. Ten $ 5.132.92 100% $ 5.132.92 9. A 08/02/06 MBABERS FIRST CREDIT UNION 11 month certillcate- Account~ Angela Brungard. Jt. Ten $5,147.95 100% $5,147.95 10. A 08/02/06 ~BERS FIRST CREDIT UNION 11 month celtlllcate - Account~ Angela Brungard. Jt. Ten $ 5.147.95 100% $5,147.95 11. A 08/02/06 MBABERS FIRST CREDIT UNION 11 month celtlllcate- Account~ Angela Brungard. Jt. Ten $5,147.95 100% $5,147 .95 12. A 08/02106 ~BERS FIRST CREDIT UNION 11 month celtlllcate - Account~ 1 Angela Brungard. Jt. Ten $5,147.95 100% $5,147.95 13. A 08/02106 MBABERS FIRST CREDIT UNION 11 month celtlllcate - Account~ Angela Brungard, Jt. Ten $ 5.147.95 100% $5,147 .95 TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER RICHARD G. STBBLB 21-07-0277 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUOE"!liE NAME OF "!liE TRANSFEREE. "!liEIR RELATlONSHIP TO OECEDENT ANa DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER "!liE DATE OF TRANSFER. ATTACH A copy OF "!liE OEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IIF APPLlCABLEI VALUE 1. Lincoln Annuity - account #LBFl138693 Date of death value 50,113.5 3 100% S50,113. TOTAL (Also enter on line 7 Recapitulation) $ $50,113.53 53 (If more space is needed, insert additional sheets of the same size) 10/3/2007 10:08:18 AM PAGE 2/002 Fax Server Lincoln Benefit Life Company P.O. Box 94212 Palatine, IT... 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 LINCOLN BENEFIT LIFE AN ALLSTATE COMPANY October 3, 2007 Andrew Sheely Attorney at Law 127 South Market Street Mechanicsburg, PA 17055 Re: Contract No: Richard G. Steele LBF1138693 Dear Mr. Sheely: We have been requested to complete IRS Form 712 with regard to the above referenced contract. The purpose pf Form 712 is to provide an estate or donor with the value of a life insurance contract or its Proceflds as of ~ certain date (usually the owner's date of death or date of transfer of the contract). This contract is an annuity contract, which is not reportable on IRS Form 712. The following information is provided for estate purposes only as of the date specified: Date of Death: Annuity Value* as of Date of Death: Cost Basis: Named Beneficiary: February 20, 2007 $ 50,113.53 $ 45,000.00 Kenneth Steele, Debra Mason Trust, David Connors *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 48371. Sincerely, Robin Gay Sr. Claim Examiner REV-1511 EX+ (12-99). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ITEM NUMBER A. RICHARD G. STEELE 1. FUNiiilj8~fiS~NERAL HOME B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE N'!~O 7 _ 02 7 7 Debts of decedent must be reported on Schedule I. DESCRIPTION KENNETH D. STEELE, EXECUTOR Street Address Social Security Number(s)/EIN Number of Personal Representative(s) 1929 FISHER ROAD MECHANICSBURG, State ~Zip 17055 City Year(s) Commission Paid: 2. M~m~~~ ANDREW C. SHEELY, ESQUIRE, PER AGREEMENT 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent 4. Probate Fees State _Zip CUMBERLAND COUNTY REGISTER OF WILLS 5. Accountant's Fe~ 6. Tax Retum Pre parer's Fe~ 7. FILING FEES FOR INHERITANCE TAX RETURNS AND PETITION Reserves to conclude administration of Estate, including preparation of decedent's final income tax return, costs, pos age TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert add~ional sheets of the same size) AMOUNT $ 9,656.79 $ 0.00 $ 2,500.00 $ 136.00 $ 30.00 $ 600.00 12,922.79 We sincerel)' appreciate the confid~nec you have plqced in llS and will continue to assist you in every way we caO'. ~lease . ~l free to contact US if you have any questions in regard to this statement. ; . 11m r0L1.0\\'1~O I~ AN ITEMIZF.D STATEMcl'T 01' TilE SI':RV1('r.~, F AC'IUTIES, AUTOMOTiVe EQUIPMENT. " A}ID ~ERCH.'\~DlSE TlIAT YOli SELECTED WIIE~ ~AKING THE r:L~ERAL ARRM';UE~ENTS. 1:. ~F'ESSIO!\AL SERVIU':S ~rviees ",fFun..:rlll Dir~clor'SI"rr . ~ ~QTOMOTlVE EQl;IPMt;..U oPl.ohown transportation. . ., . r FuNERAL HOME SERVICf. (:u..\R(a:s .~E(:Tl:;D MF.RCIIASI)IS.:: st:clClIskel . ., . . . . Gtwdian Vault . RNlster racknge . JIiaa Case: .'. THE COST OF O\TR SERVICES, EQrlrME~T. Al"P MI':R(:IIA!\I)I!\F. TUA T vor IIA V~ SEl.ECTED . . . . . . . . . . . . . . . 57793.00 ~nm TIME fUNERALARRANUF.Mr.:'l'rs YiERI': MA()I~. WE ADVA/>;CH> CElnAI~ PAn1F.KTS TQ CVQERS AS AN ACCOMMODATION. THE FOLlOWll'G IS A~ ACCOll:-ITIl\G fOR TI lOSE ('J (ARUE$. ~IJ ADVA~CES o,enlni Crave. . . ~fjc:d Dealh Certificales . 1iewspaper Nulices - Patriot. . '\I(ewspllper 1'o:1ltkcs . Allenluwn, ~spapcr Ntlliccs .. Floridll . qcraYlMilSS Onering. . . . Fiowers. . . . . . . . TOTAL CASU AI)\iA~CES A~D SPECIAL CHARCES . . CO:\'TRA<;:T PRICF, . . . . . . . ....ORY ~0/2007 S~njor Citilen Discount - Trad all services. O~t20i2007 f'a)'menl .Cumh ('ty . . . TOTAL A:\toUJ'liT DU:, . . . . . Malpezzi Funeral Home 8 Markel Plaza Wa)' Mechanicsburi, fA 17055 (71 7)697-4696 t.iarch 20, 2007 Kpn 0, Steele lt29 Fisher Road ~hanicshuri, PA 17055 The Funeral Service for Richard G. Steele $3865.00 $185.00 S405O.00 $2675.00 $89'.00 $78.00 $9,,00 $1200.00 $60,00 $101.23 $118.56 $98.00 $200.00 $371.QO $2148.19 $9941. 79 S.IS'.Qo S.t 00.00 $96~. '9 .pd {j/ 1//;ill7 t" , I{)1lJ . ,:~'::, : j,., j , . .~.I . " '0&1,.... '. .i: i :.fi ., t. .... ,; .:'. \:< ::" ' ":.'1" 'i ., " ."'f REV-1512 EX+(1-97) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT RICHARD G. STEELE FILE NUMBER 21-07-0277 ESTATE OF Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1, American Homepatient AMOUNT 56.04 2. Berman & Rabin, P.A.- American Homepatient 160.84 3. Berman & Rabin, P.A.- American Homepatient 56.50 TOTAL (Also enter on line 10, Recapitulation) $ $ 2 7 3.38 (If more space is needed, insert additional sheets of the same size) BERMAN & RABIN, P.A. Attorneys At Law 10660 Barkley Overland Park, KS 66212 P.O. Box 11311 - 66207-1011 Fax: (913) 649-2335 May 3, 2007 RICHARD G STEELE 806 GRANTHAM RD MECHANICSBURG PA 17055 Re: Your indebtedness to: AHOM-Phillipsburg Balance: $56.50 Our File No. A0723357-1O Dear Mr. STEELE: This office represents the above referenced creditor. At this time, no attorney with this firm has personally reviewed the particular circumstances of your account. Unless you dispute this debt, or any portion of it, within 30 days after you receive this notice, we will assume that it is valid. If you notify us in writing within the 30 day period that you dispute this debt or any portion of it, we will obtain verification of the debt or a copy of any judgment and mail it to you. If the above creditor is not your original creditor and you submit a written request within the 30 day period for the name and address of the original creditor, we will supply such information. to you. If you do dispute this debt in writing in the 30 day period, we will pend collection until we send you verification. If you contact QUI' office please call MS.Harris @ (913) 652-9382 or toll fre~ at 888-652-9382. .. ------.. . .. - ... ...-.. ---.' -- -, - -._....- .---- -..---..--.,....-.....--.---- This c,?mmunication is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose. Sincerely, BERMAN & RABIN, P.A. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Please return with your payment. RICHARD GSTEELE Account No.: .A0723357-1O Returned Mail Only.. No Correspondence P.O. Box 7401 Shawnee Mission, Kansas 66207 ~ AMERICAN HOMEPATIENT@ Philipsburg Billing Center 200 Shady Lane Philipsburg, P A 16866 jllllllll~1 July 24, 2007 2291.479 AtlQount #: 06-57-50 Patient Name: RICHARD G STEELE Resp Party: RICHARD G STEELE 06271019814 Date. of Service 02/08/2007 Balance $46.04 RICHARD G STEELE 806 GRANTHAM RD MECHANICSBURG, P A 17055-5880 For Billing Questions, Call (800) 494-8500 Late -Fee-- ----$4fll)(}.- _u.___ . S~I.UQUSLV P;\S1 DUll; $56.04 Dear RICHARD G STEELE, As of this date, we have not received the payment required on your account. Your account is now seriously delinquent and has passed the terms to which you agreed. Since we luive 1I0t heard from you, it appears that you are avoiding timely payment on your account. If payment is not made we mllst make a decision to forward your account to a collection agency or attorney to seek recovery on your outstanding balance. Please help us avoid these actions by sending in your payment immediately. If you have a problem with your account please contact us at the phone number listed above. Your prompt attention 10 this notice is needed. If you have already made payment on the account please disregard this notice and thank you for allowing us to be of service to you. Sincerely, . American HomePatient For Billing Questions, Call (800) 494-8500 PLEASE RETURN BOTTOM PORTION WITH YOUFt PAYMENT (ALLOW 7-10 DAYS FOR POSTAL DE!LIV!ftY) .. :':':'.~.:".:'~ ~.~_:.... .. :~-- ~ --" ~ ~_:."- ~ -- ._.:"~-~:"~:':.~~_:..~..~~. .. ........ ...... .. ......:..~.. .. .... .......... ...... .. .. .. .. ...... ":': .. .. ---.:-'".. .. ~~~:..~,:.-,::-~.;,_..._~~_:-:_~~-~:,=-,,-,:~.~._.._.:.-..~--=.:....- ~_":_-- "':. .~~~~~9!r:'T:E:E ...... ...\1 06-57':"50 Date of Service: 02/08/2007 ~... .wrlteyQ.llr eqolluM #I on yQ!lIr Clheokl make .P*yQI.,to: A,....Ii.~'n"'.m&_t..nt ~ For qr.c1tt ~4 "y;lUelnttl.rr!!,QIIt th....oe.I<>W o VISA 0 MasterCard 0 Discover PAINT NAME ON CARD OAAO NUMBER --'ccv # EXPIRATION DATE Send all correspondence to: American HomePatient Philipsburg Bilhng Center 200 Shady Lane Philipsburg, PA 16866 111111,11111111111111111111 SIQNATURE Self Pay 3 . Serious IV Past Cue .47D _ ??D4 -r 8 BERMAN & RABIN, P.A. Attorneys At Law 10660 Barkley Overland Park, KS 66212 P.O. Box 11311 - 66207-1011 Fax: (913) 649-2335 June 6, 2007 RICHARD G STEELE 806 GRANTHAM RD MECHANICSBURG PA 17055 Re: Your indebtedness to: AHOM-Phillipsburg Balance: $160.84 Our File No. A0729014-1O Dear Mr. STEELE: This office represents the above referenced creditor. At this time, no attorney with this firm has personally reviewed the particular circumstances of your account. Unless you dispute this debt, or any portion of it, within 30 days after you receive this notice, we will assume that it is valid. If you notify us in writing within the 30 day period that you dispute this debt or any portion of it, we will obtain verification of the debt or a copy of any judgment and mail it to you. If the above creditor is not your original creditor and you submit a written request within the 30 day period for the name and address of the original creditor, we will supply such information to you. If you dq dispute this debt in writing in the 30 day period, we will pend collection until we send you verification. If you C~lllact o~r office please call Ms. Snavely @ (913)6.52::9382~r toILfree_llt__.. ___ ---------S88.;.652-9-'Sz:--- -- ----- This communication is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose. Sincerely, BERMAN & RABIN, P.A. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Please return with your payment. RICHARD G STEELE Account No.: A0729014-1O REV-1513 EX+ (9.00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEClICHARD G. STEELE 21-07-0277 FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)1 KENNETH STEELE Son 33.33% Rest, Resi 1929 Fisher Road and Remainder of Mechanicsburg, P A 17055 Estate per Will DAVID P. CONNORS, SR. Son-in-law 16.67% Rest, Resi 6406 Glenwood Street and Remainder of Mechanicsburg, P A 17055 Estate per Will DAVID P. CONNORS, JR. Grandson 8.33 % Rest, Resid 413 Pitt Street and Remainder of Carlisle, PA 17013 Estate per Will TIMOTHY CONNORS Grandson 8.33 % Rest, Resid 6406 Glenwood Street and Remainder of Mechanicsburg, PA 17055 Estate per Will ANGELA BRUNGARD Granddaughter 16.67% Rest, Resi 1515 Orrs Bridge Road, Apt. 28 and Remainder of Mechanicsburg, P A 17055 Estate per Will MICHELE MASON Granddaughter 16.67% Rest, Resi 806 Grantham Road and Remainder of ENTER DOLLAR w...maDsb~T~. ~JBOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-15IilstailRpIlllEWilI II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ due due ue ue due due (If more space is needed, insert additional sheets of the same size) Richard Steele Estate Kenneth D Steele, Administrator 1929 Fisher Rd Mechanicsburg, PA 17055 1004 60-809912313 -+ /.&; ?~..?DATE I $ 72J10., cgz ~ til S"""" F..tu'n - DOLLARS r t~:lI. DR PAY TO THE e . .L..r /1 /" <1 1)/. A.. ~ ORDER OF 6:!JrO "r {)L/;//5 / ':f~~ ~~~~~- l!!~$l. . www.belco.o". ~ (717)232-3526 - (800)642-4482 d:. ~ /7 FOR,iP'7'~r :[";'\(.r ,r""c..c. 1;." ZI'O]-t:?2.77 __~ ~. ----U---2!. -: 2:11. :1801111 7-: 0008bOb 1. 5L,1I. 1.00L, " 'I,\;~ " ':.'f"":" , .., , . II " " WILL I, RICHARD G. STEELE, of, Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I give all my automobiles, and all other articles of personal and household use, together with all insurance relating thereto, to my children, KENNETH STEELE and DEBRA MASON, if they survive me by thirty days, to be divided among them as they may agree. For items they do not desire, I ask my Executor to give any of my personal items that the children of my deceased daughter, LINDA CONNORS, may desire to them, provided my Executor deems the same to be appropriate for them. Any personal items not taken as set forth herein, shall be sold and the proceeds added to my residuary estate. ITEM II. I give all the residue of my estate, real and personal, in equal shares, as follows: A. I give One Third (1/3) of my estate to my son, KENNETH STEELE. Should he not survive me, his share is to go to his children, per stirpes. B. I give One Third (1/3) of my estate to the family of my deceased daughter, LINDA CONNORS, as follows: One Half (1/2) of the same to her husband, ~IlGS . DAVID ll. CONNORS and One Hiil1f (1/2) to be divided in equal shares to her children, :5rtt&S DAVID P. CONNORS and TIMOTHY CONNORS. If any of the above-named should predecease me, their share is to be added to the survivor's named. . Page 1 of 5 Pages. C. I give One Third (1/3) of my estate, IN TRUST to KENNETH STEELE, as TRUSTEE for the DEBRA MASON SPECIAL NEEDS TRUST to be held, administered and distributed as a separate TRUST as follows: The express purpose of the SUPPLEMENTAL NEEDS TRUST AGREEMENT is to provide the extra and supplemental care of DEBRA MASON in addition to and over and above the benefits that she otherwise receives or shall receive as a result of her or her family's disability from any local, state, or federal government, including but not limited to benefits from Pennsylvania Department of Public Welfare, Access Medical, Medicare, Medicaid, Social Security Disability, Social Security Supplemental Income, or from any other private agency providing services or benefits for which she or her spouse may be entitled. The Trust Estate shall not be used to provide basic food, clothing, and shelter, nor be available to the beneficiary for conversion for such items, unless all local, state, and federal benefits have been fully expended for such purposes. It is my express purpose to establish the Trust so that the Trust Estate is not considered an available resource of DEBRA MASON for purposes of any local, state, or federal benefits, and any and all provisions herein shall be construed accordingly. It is my intention that distributions of income and/or principal from the Trust Estate shall be used only to supplement, not supplant, any benefits to which DEBRA MASON may be entitled under any governmental program, and if the existence of this Trust should at any time be used by any governmental agency ~as an excuse for denying DEBRA MASON such benefits, then the Independent, Tr"ustee, appointed Page 2 of 5 Pages. pursuant hereto is authorized, in his sole and absolute discretion, to terminate the Trust Estate as though DEBRA MASON had died at that time. The decision of the Independent Trustee in this regard shall be final, binding, and conclusive on all persons who might have an interest in the Trust Estate. Upon DEBRA MASON'S death, the Trustees shall pay and distribute the remaining balance of the Trust Estate and any accrued, accumulated, or undistributed net income thereon, to the children of DEBRA MASON, namely, MICHELE MASON and ANGELA BRUNGARD. Said trust shall be maintained as a singular TRUST for the health, education and welfare of the younger of the children until such time as she may reach the age of Twenty-three (23) at which time the TRUST is to be terminated and divided equally between the two children. ITEM III. No interest in income or principal shall be assignable by, or available to anyone having a claim against, a beneficiary before actual payment to the beneficiary. ITEM IV. All federal, state, and other death taxes payable on the property forming my gross estate for tax purposes, whether or not it passes under this will, shall be paid out of the principal of my residuary estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. ITEM V. I authorize my executor: A. to retain and to invest in all forms of real and personal property, regardless of (i) any limitations imposed by law on investments by executors or trustees, (ii) any principle of law concerning delegation of investment responsibiHty by executors or . . trustees, or (iii) any principle of law concerning investmenfdiversification; , Page 3 of 5 Pages. B. to compromise claims and to abandon any property which, in my executor's opinion, is of little or no value; to borrow from, and to sell property to others, and to pledge property as security for repayment of any funds borrowed; C. to sell at public or private sale, to exchange or to lease for any period of time any real or personal property, and to give options for sales or leases; D. to join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; E. to use administrative or other expenses of my estate as income tax or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; and F. to distribute IN KIND and to allocate specific assets among the beneficiaries in such proportions as my executor may think best, so long as the total market value of any beneficiary's share is not affected by such allocation. These authorities shall extend to all real and personal property at any time held by my executor and shall continue in full force until the actual distribution of all such property. All powers, authorities, and discretion granted by this will shall be in addition to those granted by law and shall be exercisable without leave of court. ITEM VI. I appoint my son, KENNETH STEELE, executor and trustee under this , . will. No personal representative appointed hereunder shall be required to give bond or furnish sureties in any jurisdiction. Page 4 of 5 Pages. . . ITEM VII. The term "executor" and "trustee" or any pronoun used to indicate the executor, trustee, any other fiduciary or any beneficiary shall be deemed to apply to one or more than one person or corporation and to the masculine, feminine or neuter gender as the case may be. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last will, this 'I day of S -y I: ,2005. t~~ ~ Eti ~~(SEAL) RICHARD G. STE LE . SIGNED, SEALED, PUBLISHED, and DECLARED by the above, as and for's last will, in the presence of us, who thereupon at request, in presence and in the presence of each other, have hereunto subscribed our names as witnesses. [fL Dp~ C/~ ~t/t 1/ , / Page 5 of 5 Pages. 1 I STATE OF PENNSYLVANIA) ss: COUNTY OF DAUPHIN ) We, ~II~ De!2.0~CL :-Ja~e.s &. H O~a" ~ r. witnesses, respectively, whos n~mes are signed to the attached or foregoing instrument, being first duly sworn do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his last will and that he had signed willingly and that executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the will as witness and that to the best of our knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. and the Testator and l~ ~~ ~< -'6 RICHARD G. STEELE SUBSCRIBED, sworn to or affirmed, and acknowledged abo~amed Testator and by the witnesses whose names ~. r""") """" , 2005. before me by the appear above on Notarial SelII Path PaIII Thomas. Notary Public 8~()f ~rg, Dauphin County My Commission Expires Mar. 24, 2001 Member', Pennsylvania Association or Notaries ~ . . 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