HomeMy WebLinkAbout10-31-07
.. REV-1500
, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN FILE NUMBER
DEPAR6~~~T2~~;VENUE RESIDENT DECEDENT 21 06 0730
-. ...-. HARRISBURG, PA17128-0601.___~.___._ _______., I COUNTY CODE YEAR NUMBER
----r::-: - -~--~---------'~----------..,__'_~'_~-------~~,-.,
i DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I SOCIAL SECURITY NUMBER
i Powell, Jean D -t' 174-20-6085
I- +_.___.___,_...~__.______".~__~_______~__.___.________'_ ________.______.__.~_
~ lDATE OF DEATH. (MM-DD-YEAR) .. I DA.TE OF BIRTH (MM-DD-YEAR). . THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
~ 08/12/2006 : 01/09/1927 REGISTER OF WILLS
c (IF APPLlCABLE)'SURVl'vj'NG SPOUSE'S NAME(LAST, FIRST AND MIDDLE INITI.A:i.j------- SOCIAL SECURITY NUMBER
---~1.C>riginalReturn - ------ D 2, Supplemental Retum ~-.
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ll&: ~ III D 4, Limited Estate D 4a, Future Interest Compromise (date of death after
() rr: ll&: 12-12-82)
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:z: ~ ..J ~ 6, Decedent Died Testate (Attach copy D 7. Decedent Maintained a Living Trust (Attach
() It III of Will) copy of Trust)
c( D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between
-_. 12-31-9
tl1!1~SE~()N.~~T' B.~().l?!#.;J;lal;):;#iU.CQMeSPON
NAME
. I- Susan E. Lederer
~ ~ ~iRM NAME~pplicable)- ------,- -----.~---
8 ~ I ~~YI....<?ffices_ of Su~~ E. Lederer_____ ~__I'
tELEPHONE NUMBER
c--- __1- 717/652_-7323 i
1. Real Estate (Schedule A) (1)
REV .1100 EX + '1..00,
.,
.
2, Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5, Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8, Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12, Net Value of Estate (Line 8 minus Line 11)
C)\.1LY
i
D 3. Remainder Return (date of death prior to 12-13-82)
D
o
5, Federal Estate Tax Return Required
8, Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
NFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
I COMPLETE MAILING ADDRESS
4811 Jonestown Rd.
Suite 226
Harrisburg, PA 17109
C,"-,
c::1
~
I
None
~~: ~H:ClA' U~tIY
-j
Co)
I',
(2)
(3)
(4)
None
~L_
None
,.") (-.'
None
, i
(5) 224,528.85
~~_~ t~~
(6) None
co
(7) 1 09 , 7 1 8. 2 0
(8)
334,247.05
(9) 6,874. 70
....-------
(10) 747.13
(11 )
7,621.83
326,625.22
(12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
i 14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
'~----r"-~-' ~----._------------~------~~.._----.-----._------
, SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1 ,2)
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16.Amount of Line 14 taxable at lineal rate
17.Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
326,625.22
x .00
(15)
326,625.22 x .045
(16)
14,698.13
x .12
(17)
x .15
(18)
(19)
14,698.13
20. ~
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
~
Decedent's Complete Address:
TREET ADDRESS
)
1320 Kinglsey Road
CITY
STATE PA
ZIP 17011
Camp Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1) 14,698.13
14,455.99
421.05
Total Credits (A + 8 + C)
(2)
14,877.04
3. InteresUPenalty if applicable
D. Interest
E. Penalty
169.41
TotallnteresUPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is theOVERPA YMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is theTAX DUE
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is theBALANCE DUE
169.41
- ---------..---------
9.50
(3)
(4)
(5)
(5A)
(58)
0.00
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;............................................................................. ~ I
~: ~::::~ :h~e~;:i:~~~s:~~e~:s~~~. .~~~~I. .~.~~. ~.~~. :'~~:':.~~. .~~a.~.~~~~~~.d. .~.~ .i.t~. i.~.~.~~.;..............................~~::::::::::: .-:.....
d. receive the promise for life of either payments. benefits or care?...........................................................
2. If death occurred after December 12. 1982. did decedent transfer property within one year of death without
receiving adequate consideration?................................................................................................................ 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ~ 0
4. Did decedent own an Individual Retirement Account. annuity. or other non-probate property which
contains a beneficiary designation?............................ .n............................ n.................................................. ~ 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.
Under penalties of perjury. I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete, Declaration
pre~er other lt1.."the pers~al.represen~tive is base-.E_on all infor"'.ation of which I"eparer has any_~nowled!!e. .___ ___ _____. , ___ ,___. ______
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
Julia P~well Wagner ....uJ 13 Homestead Lane
~g~'F !~~,g~.~PONSIB~RETURN -- ----A[)DRESS-..farnP-Ij~I. p~J 7011_ - ---, .-----. J-U=.~D~Tt--
Rebecca Powell Vogel
...!~~ PO'l.AJW.. I/CI~_.__.___
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
Susan E. Lederer
6 Homestead Lane
__._ CarTlpJiill-,-PA,17011
ADDRESS
lo-a3 -0 '1
---"OATE'--
~
4811 Jonestown Rd.
Suite 226
Harrisburg, PA 17109
10 - 2. ~ --0,
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. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes not exemot 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. ~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. ~9116
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. ~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.
r I \aLl I SCHEDULE E
~ LCASH, BANK DEPOSITS, & MISC.
COM~~~~~~E~~~~~~~~VANIA PERSONAL PROPERTY
RESIDENT DECEDENT
-~-~-~-- - -~-~-- - -- ~-- ----~ __ -----1_________________
---~-----~--- ----~----~---______rFILE NUMBER----
ESTATE OF Powell, Jean 0 ! 21 _ 06 _ 0730
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1
r--------.-...-----...-
-~._---_..~----_.-.-._~--_._--_.._.__._-_.._--
VALUE AT DATE OF
DEATH
-----------1-----
Regular Shares held at PSECU, Account Number 174-20-6085-S01, titled to Jean D. Powell 5.13
DESCRIPTION
2
Money Handler held at PSECU, Account Number 174-20-6085-S04, titled to Jean D. Powell
0.00
3
Certificate of Deposit held at PSECU, Account Number 174-20-6085-C50, titled to Jean D.
Powell ($66.45 accrued interest)
50,066.45
4
Certificate of Deposit held at PSECU, Account Number 174-20-6085-C50, titled to Jean D.
Powell ($13.29 accrued interest)
10,013.29
5
Certificate of Deposit held at PSECU, Account Number 174-20-6085-C50, titled to Jean D.
Powell ($13.29 accrued interest)
10,013.29
6
Certificate of Deposit held at PSECU, Account Number 174-20-6085-C50, titled to Jean D.
Powell ($13.29 accrued interest)
10,013.29
7
Checking Account held at M&T Bank, Account No. 69289832, titled to Jean D. Powell ($0.05
accrued interest)
9,750.26
8
Regular Savings Account held at Members 1st FCU, Account No. 5733-00, titled to Jean D.
Powell ($0.03 accrued interest)
89.11
9
Investment Savings Account held at Members 1st FCU, Account No. 5733-05, titled to Jean D.
Powell ($11.99 accrued interest)
20,108.21
10
Life Savings Account held at Members 1st FCU, Account No. 5733-04, titled to Jean D. Powell
($1.21 accruend interest)
4,001.21
11
Certificate of Deposit held at Members 1st FCU, Account No. 5733-46, titled to Jean D. Powell
($6.49 accrued interest)
5,006.49
-----~------------------------~-- ------------------
TOTAL (Also enter on Line 5, Recapitulation)
224,528.85
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
m -I FILE NUMBER--====-=---=
: 21 - 06 - 0730
ESTATE OF Powell, Jean D
_._----~._~--~.__.__._.,~-_._._-~_...~-_.~.__._--------~~._-
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
12
13
14
15
16
17
18
19
20
21
22
23
~-_.,._~_.,._----~~-._--_._--
DESCRIPTION
'vALUE AT DATE OF
DEATH
5,006.49
Certificate of Deposit held at Members 1st FCU, Account No. 5733-49, titled to Jean D. Powell
i ($6.49 accrued interest)
Certificate of Deposit held at Members 1st FCU, Account No. 5733-56, titled to Jean D. Powell
($12.57 accrued interest)
10,012.57
I
Certificate of Deposit held at Members 1st FCU, Account No. 5733-58, titled to Jean D. Powell
($12.57 accrued interest)
10,012.57
Certificate of Deposit held at Members 1st FCU, Account No. 5733-59, titled to Jean D. Powell
($5.92 accrued interest)
5,005.92
. Certificate of Deposit held at Members 1st FCU, Account No. 5733-60, titled to Jean D. Powell
($5.92 accrued interest)
5,005.92
Certificate of Deposit held at Members 1st FCU, Account No. 5733-62, titled to Jean D. Powell
($6.49 accrued interest)
5,006.49
Certificate of Deposit held at Members 1st FCU, Account No. 5733-63, titled to Jean D. Powell
($15.04 accrued interest)
10,015.04
Certificate of Deposit held at Members 1st FCU, Account No. 5733-64, titled to Jean D. Powell
($15.04 accrued interest)
10,015.04
Certificate of Deposit held at Members 1st FCU, Account No. 5733-65, titled to Jean D. Powell
($15.04 accrued interest)
10,015.04
Ford Crown Victoria, titled to Jean D. Powell (sale price)
5,000.00
Patriot New (subscription refund)
91.30
Sheperdstown Family Practice (refund)
10.05
Page 2 of Schedule E
i
SCHEDULE E I
I CASH, BANK DEPOSITS, & MISC.
i PERSONAL PROPERTY continued i
~~--_.- -.--_._____-.L.__.__~______
.------. - -------. -----IFiLE NUMBER---~------
! 21 - 06 - 0730
'w
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Powell, Jean D
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
24
DESCRIPTION
VALUE AT DATE OF
DEATH
198.65
check from State Farm (refund of car insurance)
25
Regular Savings Account held at Members 1st FCU, Account No. 261569-00, titled to Jean D.
PowelllTF Michael V. Wagner (disclaimed by Michael V. Wagner)
25.00
26
Certificate of Deposit held at Members 1st FCU, Account No. 261569-41, titled to Jean D.
PowelllTF Michael V. Wagner ($13.29 accrued interest) (disclaimed by Michael V. Wagner)
10,013.29
27
Certificate of Deposit held at Members 1st FCU, Account No. 261569-43, titled to Jean D.
PowelllTF Michael V. Wagner ($6.49 accrued interest) (disclaimed by Michael V. Wagner)
5,006.49
28
Certificate of Deposit held at Members 1st FCU, Account No. 261569-45, titled to Jean D.
PowelllTF Michael V. Wagner ($7.52 accrued interest) (disclaimed by Michael V. Wagner)
5,007.52
29
Certificate of Deposit held at Members 1st FCU, Account No. 261569-52, titled to Jean D.
PowelllTF Michael V. Wagner ($14.74 accrued interest) (disclaimed by Michael V. Wagner)
10,014.74
Page 3 of Schedule E
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I MI SCHEDULE G I
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY !
._._------_.......~_._------_.._._--_....._~----~_._----_.,---~-
ESTATE OF Powell, Jean D
FILE NUMBER
21 - 06 - 0730
I
~_._-_._----~.~~.~----
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
---- -'--.-.----.---.~--- '----.-----r- -;~ I -------r--------
ITEM DESCRIPTION OF PROPERTY I DATE OF DEATH % OF EXCLUSION I TAXABLE VALUE
NUM~, R .. Include th,e name of the transferee, their relationship to decedent I VALUE OF ASSET DECD'S I (IF E:~p, L1CABLE) !
__--+---__. and the ~_a~e of transfer. Allach a copy of the de~ for real estate. ! _ . INTEREST.~_____________._
1 ! Regular Savings Account held at Members 1st FeU, 25,0l100% i 25.00
, Account No. 261573-00, titled to Jean D. PowelllTF
Madison A. Wagner
2
Certificate of Deposit held at Members 1st FCU,
Account No. 261573-45, titled to Jean D. PowelllTF
Madison A. Wagner ($2.60 accrued interest)
3
Certificate of Deposit held at Members 1st FCU,
Account No. 261573-46, titled to Jean D. PowelllTF
Madison A. Wagner ($7.52 accrued interest)
4 Certificate of Deposit held at Members 1st FCU,
Account No. 261573-54, titled to Jean D. PowelllTF
Madison A. Wagner ($14.74 accrued interest)
5 Certificate of Deposit held at Members 1st FCU,
Account No. 261573-61, titled to Jean D. PowelllTF
Madison A. Wagner ($13.29 accrued interest)
6
Regular Savings Account held at Members 1st FCU,
Account No. 261572-00, titled to Jean D. PowelllTF
Matthew K. Wagner
7
Certificate of Deposit held at Members 1st FCU,
Account No. 261572-42, titled to Jean D. PowelllTF
Matthew K. Wagner ($13.29 accrued interest)
8
Certificate of Deposit held at Members 1st FCU,
Account No. 261572-44, titled to Jean D. PowelllTF
Matthew K. Wagner ($6.49 accrued interest)
9
Certificate of Deposit held at Members 1st FCU,
Account No. 261572-46, titled to Jean D. PowelllTF
Matthew K. Wagner ($7.52 accrued interest)
Total of Continuation Schedule(s)
5,002.60 100%
5,002.60
I
!
5,007.521 100%
5,007.52
10,014.74 100% 10,014.74
1
1
I 100% 10,013.29
10,013.29
25.001 100%
10,013.291 100%
1
!
5,006.49 100%
25.00
10,013.29
5,006.49
5,007.521 100%
5,007.52
~-____-..L____I___ 64,6~0.27__
TOTAL (Also enter on line 7, Recapitulation) I 109,718.20
'W
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Powell, Jean D
. FILE NUMBER
21 - 06 - 0730
10
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
-. ----u~-~~SCRIPTION OF PROPERTY - - 'DA;E OF DEATH D~CO&S ~LUSION .
Include the name of the transferee, their relationship to decedent VALUE OF ASSET INTEREST I (IF E;PLlCABLE) i TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate. .,
Certificate of Deposit held at Members 1st FCU, 10,014.741 100%, I-----~.:.. -1-0,014.74-
Account No. 261572-53, titled to Jean D. PowelllTF
Matthew K. Wagner ($14.74 accrued interest)
I
ITEM
NUMBER
11
: IRA Certificate of Deposit held at PSECU, Account No.
174-20-6085-C50, Jean D. Powell, owner, Julia
Wagner and Rebecca Vogel, beneficiaries ($31.51
accrued interest)
22,764.01 100%
22,764.01
12
U.S. Savings Bond titled to Jean D. Powell POD Julia
Wagner (do not have a copy of the bond)
13,412.00: 100%
13,412.00
13
U.S. Savings Bond titled to Jean D. Powell POD
Rebecca P. Vogel (do not have a copy of the bond)
13,412.00 100%
13,412.00
i
--~-_...__._.._--_._....~
,
I
------~-
Page 2 of Schedule G
*'
SCHEDU..E H
R.N:RAL.EXPENSES&
AIl\IINSTRATIVE COS1S
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I
------=~-7E ~~~~5:~O;3~__=~=
ESTATE OF Powell, Jean D
-- _.~
Debts of decedent must be reported on Schedule I.
- _.~-
ITEM
NUMBER FUNERAL EXPENSES:
A. 1 Parthmore Funeral Home
DESCRIPTION
.---T--.----
AMOUNT
---~...L
i
I
1,564.50
2
Hayhurst Memorials
122.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
State
Zip
2.
Year(s) Commission paid
Attorney's Fees Law Offices of Susan E. Lederer
3,000.00
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
5. Accountant's Fees
6. Tax Return Preparer's Fees
7_ Other Administrative Costs
1
John Beinhaur, Esq. (attorney's fees)
1,500.00
Total of Continuation Schedule(s)
688.20
----_._-~~_.__.__.-._-_.._------~_._--~~-
TOTAL (Also enter on line 9, Recapitulation)
6,874.70
*'
Schedule H
FLnnI Expenses &
~d6veCostsconliruKl
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Powell, Jean D
---21--Auto Lo~ator (advertis~-vehicle)
I
3 I Joe Demuro (accountant)
4 I Regsiter of Wills (copy of file)
5 I Register of Wills (filing fee for disclaimers)
6
stamps
7
Expenses paid by Executrix (car inspection and probate fee at Register of Wills
Office)
8
Register of Wills (additional probate)
I FILE NUMBER
i 21 - 06 - 0730
Page 2 of Schedule H
34.00
150.00
10.00
15.00
31.20
398.00
50.00
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Powell, Jean D
.. _ ___- I~~L~ o':,U~~~ .. .
Include unreimbursed medical expenses.
-~----,._~ -"~--"-'-~
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
.-------.---- ----.
Discover (credit card)
369.04
2
Beverly Healthcare (beautician)
19.75
3
Nephrology Association of Pennsylvania (medical bill)
25.00
4
West Shore EMS (ambulance bill)
146.52
5
Camp Hill Emergency Physicians (medical bill)
29.52
6
Pinnacle Health Home (medical bill)
157.30
- ----- ---------------_._---~--_.~----_.- --
TOTAL (Also enter on Line 10, Recapitulation)
747.13
REV-1513 EX+ ~9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
I 21 - 06 - 0730
L RE LATIONSHIPTO 1 AMOUNT OR SHARE
DECEDENT 'I OF ESTATE
Do Not List Trust..(s)
----T----
I
Powell, Jean D
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1
Julia Ann Sheridan n/k1a Julia Powell Wagner
13 Homestead Lane
Camp Hill, PA 17011
Daughter
1/2 of the Estate
(excluding Michael
V. Wagner's
disclaimed ITF
accounts); Savings
Bond; 1/2 of the IRA
2
Rebecca Jean Powell n/k1a Rebecca Powell Vogel
6 Homestead Lane
Camp Hill, PA 17011
Daughter
1/2 of the Estate;
Savings Bond; 1/2
of the IRA
See Continuation Schedule(s) attached 1
Enter dollar amounts for distributions shown above on lines 15 through 18, as approprirte, on Rev 1500 cover sheE t
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
i
\*
SCHEDULE J
BENEFICIARIES continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
! FILE NUMBER
21 - 06 - 0730
NU~~~------:~ME-AN~ADDRESS OF PERSON(S~ECEI~I~~-PROPERTY i RE~~6~~~~; TO AMO~~~~T~~~ARE
! I Do Not List Trustee(s)
---..----.---.-.---~.~--..-------_____t___-------.------.----
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under i
Sec. 9116(a)(1.2)] i
i
!
Powell, Jean D
I.
3
Madison A. Wagner
13 Homestead Lane
Camp Hill, PA 17011
Grandchild
ITF accounts at
Members 1 st and
1/4 of the Michael V.
Wagner's
disclaimed ITF
accounts at
Members 1 st
4
Matthew K. Wagner
13 Homestead Lane
Camp Hill, PA 17011
Grandchild
ITF accounts at
Members 1 st and
1/4 of the Michael V.
Wagner's
disclaimed ITF
accounts at
Members 1 st
5
Michael V. Wagner
13 Homestead Lane
Camp Hill, PA 17011
I Grandchild
Disclamed his
interest in the ITF
accounts at
Members 1 st
___ __ --.L__
Page 2 of Schedule J
. PSECIIP
5ckt~v ~ E'..; 1.-\rJL vY"\S \ - ~
~"--~ v~ G__ 2 -.,e V1S II
July 27,2007
Account # 0174XXXXXX
AMYMMOYA
C/O SUSAN E LEDERER LAW OFFICES
4811 JONESTOWN RD SUITE 226
HARRISBURG, PA 17109
Dear MS. MOY A:
The following is the status of JEAN D. POWELL's account with PSECU as of the date of death.
Joint Owner's Name
Date of Death
Date of Birth
NONE
08.12.2006
01.09.1927
Share
SOl
S04
C 50
C 50
C50
C 50
C50
Description
Regular Shares
MoneyHandler
60 Month IRA Certificate
60 Month Certificate
60 Month Certificate
60 Month Certificate
60 Month Certificate
Open date
04.06.1987
Balance
$ 5.13
0.00
22,732.50
50,000.00
10,000.00
10,000.00
10,000.00
Accrued Dividend
$ 0.00
0.00
31.51
66.45
13.29
13.29
13.29
07.29.2002
02.11.2005
02.23.2005
02.23.2005
02.23.2005
The dividend earned from January 1, 2006 through the date of death was $2,155.69. The decedent had no loans with
us. We do not have safe deposit boxes for our members.
If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu
prompt, enter 6 and then extension 2227.
Sincerely,
4~f
Meacle Fa~ I
Member Service Representative
Finance Support Unit
Pennsylvania State Employees Credit Union
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 . 717.234.8484 .800.237.7328
. Moiling Address: P.O. Box 67013, Harrisburg, PA 17106-7013 . 717.777.2100 (TOO) . 800.472.1967 (TOO)
This credil union is federally insured by the Notional Credit Union Adrninislralion. Equal Opporlullily Lender www.psecu.com
, 11 M&fBank
~cW~ €./ :t ~ """\ I
499 Mitchell Road, MilIsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
August 6, 2007
Susan E Lederer
Attorney At Law
4811 Jonestown Road, Suite 226
Harrisburg, P A 17109
Re: Estate of' Jean D Powell
Social Securitv: 174-20-6085
Date of Death: AUflUst 12. 2006
Dear Sir or Madam:
Per your inquiry dated July 25,2007, please be advised that at the time of death, the above-named decedent bad on deposit
with this bank the following:
1.
Type of Account
Checking Account
Account Number
69289832
Ownership (Names of)
Jean D Powell *
Opening Date
08/28/64 Closed 10/23/06
Balance on Date of Death
$9,750.21
Accrued Interest
$
0.05
Total
_.w__________ ______ __ ________ ____________ ... ____ __ ________________ __ __. ___ ___MR. ________
$9,750.26
---------.------------------------------ ---------------------------------------------
Please be advised, there was no safe deposit box found for the above decedent.
* If upon reviewing the information above, you believe there are additional accounts not referenced, please provide
us with an account number and/or the name of any possible joint account holder. For any additional information on
the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the
Highland Park Office # 717-737-3322.
Sincerely,
~a:~
Nancy Clagett
Records Management
fvl~
MEMBERS 1st
FEDERAL CREDIT UNION
~cA,\J ~ E ;I:f- Vt.s ~ _ \.:(
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 5733-00
Date Account Established 01/03/1962
Principal Balance at Date of Death $89.08
Accrued Interest to Date of Death $.03
Total Principal and Accrued Interest to Date of Death $89.11
Name of Joint Owner None
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 5733-05
Date Account Established 11/25/1985
Principal Balance at Date of Death $20,096.22
Accrued Interest to Date of Death $11.99
Total Principal and Accrued Interest to Date of Death $20,108.21
Name of Joint Owner None
LIFE SAVINGS ACCOUNT
Account Number/Suffix 5733-04
Date Account Established 02/01/2001.
Principal Balance at Date of Death $4,000.00
Accrued Interest to Date of Death $1.21
Total Principal and Accrued Interest to Date of Death $4,001.21
Name of Joint Owner None
.Opened by transfer of funds from 5733-00.
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-46
Date Account Established 01/18/2005.
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $6.49
Total Principal and Accrued Interest to Date of Death $5,006.49
Name of Joint Owner None
.Purchased by transfer of funds from 5733-05.
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733.49
Date Account Established 01/18/2005.
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $6.49
Total Principal and Accrued Interest to Date of Death $5.006.49
Name of Joint Owner None
.Purchased by transfer of funds from 5733-05.
5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.memberslst.org
5x::J~~ E..J::t~ h5 \~., Ij
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-56
Date Account Established 01/16/2003*
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $12.57
Total Principal and Accrued Interest to Date of Death $10,012.57
Name of Joint Owner None
*Purchased by transfer of funds from 5733-05.
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-58
Date Account Established 01/21/2003*
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death ..$12.57
Total Principal and Accrued Interest to Date of Death $10,012.57
Name of Joint Owner None
*Purchased by transfer of funds from 5733-05.
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-59
Date Account Established OS/28/2004
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $5.92
Total Principal and Accrued Interest to Date of Death $5,005.92
Name of Joint Owner None
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-60
Date Account Established OS/28/2004
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $5.92
Total Principal and Accrued Interest to Date of Death $5,005.92
Name of Joint Owner None
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-62
Date Account Established 01/25/2005*
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $6.49
Total Principal and Accrued Interest to Date of Death $5,006.49
Name of Joint Owner None
*Purchased by transfer of funds from 5733-05.
Sc-~~J~ E. --' ~--+e V"lS Iy - ~'D
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-63
Date Account Established 12/05/2005*
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $15.04
Total Principal and Accrued Interest to Date of Death $10,015.04
Name of Joint Owner None
*Rollover from certificate 5733-48, originally established 12/07/1995.
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-64
Date Account Established 12/08/2005*
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $15.04
Total Principal and Accrued Interest to Date of Death $10,015.04
Name of Joint Owner None
*Purchased by transfer of funds from 5733-00.
CERTIFICATES OF DEPOSIT
Account Number/Suffix 5733-65
Date Account Established 02/03/2006*
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $15.04
Total Principal and Accrued Interest to Date of Death $10,015.04
Name of Joint Owner None
*Rollover from certificate 5733-57, originally established 01/16/2003.
MBERS 1ST FEDERAL CREDIT UNION
~- 'eLM..-
Danielle A. Kline
Insurance Services Specialist
August15,2007
Estate of: JEAN D. POWELL
Date of Death: August 12, 2006
Social Security Number: 174-20-6085
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RETURN OF MONIES FORM - Patient
DATE:
August 16, 2006
FROM:
Shepherdstown Family Practice
2140 Fisher Road
Mechanicsburg, P A 17055
TO:
Estate of Jean Powell
1320 Kingsley Road
Camp Hill, PA 17011
RE:
Patient: Jean Powell
Date of Service: 09/07/05
AMOUNT OF REFUND: $ 10.05
Check Number:
Reason for Incorrect Payment:
o Duplicate Payment
o No Copayment Necessary for Services Rendered
"" Paid By Your Insurance Company
o Overpayment
Others, Please Explain:
Any questions, please contact us at 717-591-0963 ext 226.
Thank you.
~
Debbie
Last Revised: May 18, 2004
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MEMBERS 1st
FEDERAL CREDIT UNION
~clv~ (3 ~~~~
./
'). 5" - ..:L01
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 261569-00
Date Account Established 03/16/2005
Principal Balance at Date of Death $25.00
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest to Date of Death $25.00
Name of Trustee Michael V. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261569-41
Date Account Established 03/16/2005
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $13.29
Total Principal and Accrued Interest to Date of Death $10,013.29
Name of Trustee Michael V. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261569-43
Date Account Established 03/16/2005
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $6.49
Total Principal and Accrued Interest to Date of Death $5,006.49
Name of Trustee Michael V. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261569-45
Date Account Established 12/08/2005
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $7.52
Total Principal and Accrued Interest to Date of Death $5,007.52
Name of Trustee Michael V. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261569-52
Date Account Established 03/16/2005
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $14.74
Total Principal and Accrued Interest to Date of Death $10,014.74
Name of Trustee Michael V. Wagner
~~RAL(:D~~
DanielJe A. Kline
Insurance Services Specialist
August 15, 2007
Estate of: JEAN D. POWELL
Date of Death: August 12, 2006
Social Security Number: 174-20-6085
5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org
-Sc:J~J.vLt G --t.~ ~ ~.b
~
COMMlIlIiIEAL TH OF PEllCSY'L VANIA
DEPARnlENT OF REVENUE
IlUREAUDF INDIYIIIIAL TAXES
DEPT. 2886D1
HARRISBURG, PA Inza-06Dl
..
MATION NOTICE
AND
.<.AVERRESPONSE
FILE NO. 21 06
ACN 06152
DATE 10-13
TYPE OF
-- a lIP r.....,
EST. OF JE,l\N D POWEll
S.S.'BO. 174-20-6085
D~tEOF DEATH 08-12-2006
COUNn, " CUMBERLAND
REIIIT PAYHENT AND FORtIS
REGISTER OF WILLS
CUMBERLAND CD COURT HOU~
CARLISLE ~ PA 17013
MICHAEL V WAGNER
13 HOMESTEAD LN
CAMP HILL PA 17011
HEtlBERS 1ST FeU.... providlcl the 1Jepet t-.l ..Uh theln~lan l1stMt .t.lotr. Nhlc:h hU'heM used in
calcul.ting the POtllnt1.1 tllx rlua.ThlIir ~s lndloata that lit the ..th ,of -th8 'WxMa deoecI.nt. l/UU ...... joint 0IlI'Iltr~
thls eacaunt.IfYGU..*-1thi.s In~t:lOf\.ls1naa~.P1eUa'iabta1n ri'tWnIlOl"NCtian.tn. 'the f'l_lal instltut1an. attJtcl
to this fontanel l"llturnltto the IIbowt 1IdcIress. This 8lllIIOUnt t. .iBaDla. lnllC~J ...._ ,dth the I........l~l_Lwsof' the COl
of Ptnn-.ll1111'1i.. Question.,~ 1..~"'b!f'~4n'P'~\!!1;--'^,-'-'-'''-;_'_'_'':_''''''_'_'~''''''i.. ........ . _..........._._......___....__.._..........._._...... ...
COMPLETE PART 1 BELOW I( I( WSEE REVERSE SIDE FOR FlUNG AND PAYMENT INSTRUCTIONS
Acco...t No. 261569-41 u.t. '03-1,6-2005 To tns.ur..prgper CAdit to l/UUr 8Cl:OUn.t,
EsbIbUIIhId (V oapias of thlsnotiOlt ...st a .~
~tu ttaRtlglstar ofIUl1s. .._
100,013..29 PlIftIfb un "hIJIstar of Iflll.,~.
100~OO
10,013..29
.045
450.6'0
TAXPAyeR .'RESPONSE
Account 'BaJ..nCa
P.~t TIIQb1;a
AIIount Subject to Tax
Tax Rate
Potential Tax Ow
x
x
MIn'E: If t;a)C ~ts .,.. ..... within 1
U, ~ths of thIt "cIiInt's data of _
l/UU ~ dlIdiuct - 5Z dbcount of the ax
- inlwrU__ talt .....111 ~ daU
!tine (,) _tn. aftar th8 data of *-tho
PART
[!]
A. 0 Th8 8bow lnfara.tlan and talK ... is OOl'TllCt.
1. Vou IIaY chaosa tu radt~ tDh Ragi!ltarof 1f111s Itlth tNo cop1_s of' thls notlca to of
· dl_t or _lei lntarast;. or l/UU ~ dlIIc:k bOx ...- and return this noticttto thtt hglsttu
lUll. aneI en oi'flc.:1ll1 -__1: ..111 .be lnuad by tta PAo.prta.nt of ~.
J. 0Th8 IIbav8 ....t has bean or ,dll be reportacl end btlC palcf wIth thtt PQmsylY81lla Inharitanc.:. lllX r
tu befUad .by' tta daced8nt"s MJprasantllt1Vl1.
C. 0 Th8 IIbova .info. raft1Gr1 i~.l'TIlCt and/Dr~ts anddaductions ...r.. paid by YGU.
You IIUS't OOIIPlata PART ~ 8IldIor PART i!J baloN.
[CHECK ]
ONE
BLOCK
ONLY
PART If .You ktcticat. . diffarotrlnt tax rateJ pI.... state,yCJUr
[!/ Ntlatiot\alh1p to clllc:adent:
TAX RETURN -COftPUTATIOM OF '.T'AX ONJO:EN'r~T AC~tL
LINE 1. Date es6i)lIihiHf-' "i-' -.'-.-.........~....",~.._...,..,....,.~_._~...._,..".;~.;v_ ,'.....",-"'....,.,.:",_.._
2. AccoWIt Balanoe 2
3. Parcant Taxabl. 3 X
If. .-,...t Subject to TII)( 4,
5. Deb and Deductions 5-
6. .-,...t Taxabla 6
7. Tax Rata 7X
8. Tax~ 8
PART
[!J
DATE PAID
~
DEBTS AND DEDUCTIONS CLAIMED
II - ---
I
. -
.
II
-
--
PAYEE
DESCRIPTION
AMOUNT
Sc:~~dJ~ EJ'l~ ~ d.-l
COlIlOlWEALllf OF PEIlHSVlVANIA
DEPAImENT DF REVEJrIJE
BUREAU OF DlDlVIDUAl TAXES
DEPT. zaD6D1
IWlRISIlURG. PI. lnza-D6&l
INFORMATION NOTICE
'. AND
TAXPAYER RESPONSE
FILE NO. 21 06.
ACN 061521
DATE 10-13'
TYPE OF
EST. OF JEAN D POWEll
S.S. 'NO. 174-20-6085
DATE OF DEATH 08-12-2006
'~CUMBERLAND
REtUT PAYItENT AID FDRttS
REGISTER OF WILLS., ..
CUMBERLAND CO COURT HOUS
CARlISLE1 PA 17013
MICHAEL V WAGNER
13 HOMESTEAD LN
CAMP HILL PA 17011
ttEl1BERS 1ST FCU . . 'hnPf"DVlclecl the....~ ..lth thlI lnfor-tlan llst.d bttllllfllhiClhhua..nUSlld in
ca1culat:1ngu. po't8ntialtaxdua. Thelr~ ll'lllicau thata'1; thlI.dIatttJ of~__ dIIcadant. YGU--.~1nt _r-/benaf
'this --"'1:. Uyau faIll 'this Infor..tlan'bSncarr.ctiPlIIIttIII obtUn,wr'..l:tUn.carractlan"*"- thlI fm-i"l1nst:1tution. attacl
to this for-. ...s return it: to the 'lIibovaeddnua. Tl'Iis -.-1: Is t:axIIb1a in ~. ..11:11 ,the Inlw.r-i~ TID< t.n of' the CO!
Df "-,"~1""iII..,,. .QuuUons .Ml)""~~..-lU...,,{71:n m~ ,_._ ...__ .'........'~___......._....
COMPLETE PART 1 BELOW . . .. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTION!
ACCO\.I\t No. 261569-43 Data 03-16"'2805 To lM!re proper cMldlt; to YD\Il"' accioant,
EstlIbUsNld CZl ClIP1.. Df thIs nDtiae MIS't lICe: OIlt ~
~t tD. the "isbrr of WUlc. ....
PQ1Ible tD: ....lst:er Of 111:11$. Aaerrt"'.
Account 8elW1C8
Percent Taable
Mowit Subjec1: to TeX'
'rllX Ritt. '
Potential T1I)( DIa
)(
5..006.49
100.011
5,,:006.49
..04.5
225.29
'TAXRAY..__eGN$E
NOTE: If tJu( ,..,..ts .,.. __ lf11:11ln .
(5) _ths Dfthll ......,t;.$ date of_
10IIU -.y dIIduct: . 5% dl~ofthe tax
""'1nheI"'1~ - dlIlIlfl~,.... did
nhw (,) _tns.aftar' tile dII~ of dee'th
)(
4. 0 n.. Mow i:nfoI"llltt1on...s__l.~M'!lIa't; .
1.Vou..y ctiDo..taI'1llli'ttPllYllllnt~'~~star,OHtJ.U'''ltn tIoIg,'CllP.ie. of' ttdsncrtiae to 0
a dl_t Dr lIVCiid tntw.s1:~ar.~,_ .llhIiakbcix........, ...tum this hDt1ce. tatha Registll
lUlls .8f1Ct 8n DHlc1al -.-.nt ,IIW..bti.lnuadbythe PI. ~t of Rav-..
B. Ern. 8bova .~ has beM or vW. .. I'1IPDf"tlId .., tax peid .,1'th the PamsYlII'8nla Inharit8nca TlIlC
to t. fUecI'by the dlKll.nt....l"IIPra.-ntlltlve.
C. 0 The IIbCIw Inforwat:1onb inc:orTact and/or-dabts MIt clecIuction. If8l"l1pa!Jl by YOU.,
You 1IUst: COIIplatePART [~lancvDr- PART .[!]ba1ON. .
PART If :you:lndiCllta adlffalWlt_rat.1 -Plaa data your
I!J ralatlonstd,p to daced8nt: .
TAX RETURN -. COIfPUTAT%ONOF TAx .ONJO%NT /TRUST ACCOUNTS
t:IIiE''T:-'1Ii'fi' Ei'tli.bl1.~'~-r:c.:_~ _,,_
2. Account ..BeJ..1ce2
3. f'ercent Taxable 3X
4. ~t. Subject to TIIX ,.
5. Debt. anc:Ihcluctions 5-
6. AIIount TlIXlIble 6
7. TIIXRlit. 7X
S. TIIXDua 8
[CHECK ]
ONE
BLOCK
ONLY
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUN'
5c~0~ C~~ ~ d.-<i
cotIIlOtIIlEAL TH OF PENIlSVLVANU
IlEPARTItENT OF 'REVaAIE
BUREAU OF INJUVIllUAL TAXES
DEPT. zao6Dl
HARRISIIIJRG, PA 171Zll-D601
'*
INFORMATION NOTICE
AND
TAXPAVERRESPONSE
FILE NO. 21 06-
ACN 06152.
DATE 10-13-
TYPE OF
-_ EX In elf-..,
MICHAEL V WASNER
13 HOMESTEAD LN
CAMP HILL PA 1701.1
EST. OF JEAN D POWELL
S.S.NO. 174-20-6085
D4TE OF DEATH 08-12-2006
COUNTY CUHlERLAND
REMrr PAYHEHT AND FORttS
REGISTER OF WILLS
CUMBERLAND CD COURT HDUS
CARLISLE 1 PA 17013
HEHBERSlST FCU... pruvicllld the D~:""t..~t with thtIinforeatian listed I:MrI_whlab has ..... USIId in
calculaUng the ~U.ltaxdua. Th81r,,-n1s 1ndiatll thftwt :tM dMthofthe IIboft ~t, lIGU...... jolat _,.~
this IIClCaUI'lt. 'U'wU'-lthia .lnt=or.wti.an is .lDaa~p__.abtaht..rdttwncor..-t.lan '.fnIII'thafu-J.lillnstltut1an, .1I1::taC:I
tothis'fol'll~ratumlt to the '--aaddras.nds -=count is .~!n_r__ with the IIItMarlar-:r_.a..s of the tOI
of~lMMf.. 'Gi.sti_.a,y"'anss...d ~ .CCft~"7ll'1-13ZT;"------"-""-'-'-'----"-"---- '_" _...._..._.......... . .... .
COMPLETE PART 1 BELOW . . I( SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
AccouttNo. 261569-45 DIrta 12-08-2005
.EsbibJ.l....,
x
5.1007.52
10.8.00
5.10'07 ,,52
.;045
ZZ5.M
TAXPAY8t;tE$PONSE
To i....... Jllroper .Ilred.lt to lIGUr llCCOUl'lt,
(Z) capi.. of this notice -.an IKt. . F BIIO
.....tto the bg1s1:er of Wills. HIlke,
PQlIbl. tin ....ister of lUlls, AGent"".
Aacocmt ..~
P........,tT~.
AIIount $ubJtlCt to Tax
Taxbt.
Potentla1TaxDua
x
PART
[!]
1I.11'E: tf 'tax ~ts _ .... within 1
CS) _thsof' the ~l .L .t.s datil of^ _
lIGU . w.)' dIIdUct. . 5Z d1aocaunt of the tIIx
- JNie,.lar-tax dull ..ill __ dall
nine (9) .xrihs after the datil of' death.
A. 0 The IIbove infarMtiWtBlllf__ 11- ~t.
1. You -.y .ahDase1lD r-it~'tathe~istltr of IUUs with two capillS oi' this notica to III
· dl-..,t or _Ill ~DI".ftIlI '. .check box ..... wncI nriurnthis notlae to the RlIgistlll
WUls and ., oHlc1al.....--..t..Ulbe is.. taN the PA Ilep., teent: Qf~.
I. Q1he above.sat has "-' orwUlbereportlld and tIIx paid with the PennsyIV8l'ilw Inhltriw- TlIX I
to be filed: by the ~ .....t.s ......--tIIUv..
c. 0 The IIboWI ~ bincarreot ..slur' dabts wncIdtlclul::U_ ...... paid taN You.
V_ -etCOliPl.tII PMr [!J W'ldIorPART (!] I:Mrlllll.
1:f YCXI1rld1cat. . d.i:f"'~ taKrat., Plea8a '$'bRa ~
relationShip to c:leCed.nt:
[CHECK ].
ONE
BLOCK
ONLY
PART
[!J
TAX RETURN -ctlMPtrTATtOHOF TAx. JOiNT~AtcOQN;r$'
..'---"_..,.-,......,..,..'^'....,.~^'..... .,-_..-......,.~.~___.....".N....,.____..........._..._''''''^>~_~~.
LINE 1. o.t. Eri8bUahad 1
2.. ACCOWtt .8a1anca 2
3. Par-aant TaaIlla 3 X
4. AIiow\tSW:Jllct to Tax '4
5 ..,..,t. ...cIDaductiohs 5-
6. Aaow\t TIlXIlble6
7. Tax Rate 7)(
8. Tax Due a
PART
I!I
DATE PAID
PAYEE
DESCRIPTION
AMOUNT
t
~~~V~E )t~~~q
COHMONlrEAt. TH OF PEIlNSYLYANLl
DEPARTMENT OF AE\IENUE
8UAEAU OF. IICIIIVIDlIAl TAlCES
DEPT. 2ll.ll6Dl
HARRIS8l.JR;, PA 17128-11601
-.
XNFORMAT~ON NOT~CE
AND
TAXPAYER RESPONSE
FILE NO. 21 G6
ACN 06152
DATE 10-15
TYPE OF
',~1I4S P IEP t_,
MICHAEL V WASNER
13 HOMESTEAD LN
CAMP HILL PA11011
EST. OF JEAN D POWELL
S.S. NO. 174-20-6085
DATE OF DEATH 08-12-2006
COUNTY CUMBERLAND
REMIT PAYIfENT AND FOIHS
REGISTER OF WILLS
CUMBERLAND CO COURT HOU~
CARLISLE~ PA 17013
MEltBERSlST . FCU ... provided the llepe~ witil the'infoi'Mtlan 11stl1d bel".,.,. Mhlch hIlS ~ lISlJd in
caloullrtirqJ thePOt.ntlal, tax due. TMt...,"-Mls Ind1cate ttat at the'dAtil ,of the...,. ~, yau __ . Joint ---/b8naf
tilb -..nt. If",ou, 'fMlthis.~IIIl;tsinoot-rtlot"P~.'.t.a.bl'"""tt.noa"rwG'tiDn fnlathe .fiMnolal.. insUtIrtlGn, .ttac
to tills fig,...8hlf '.Nltumit to tta -- ...,....Thb~hbllllllb1. in _~ Ifltil the Inheria.- T_ ..... of the Co
Of~l_l.~"'-~an,.~ bit. .,_., <<I~ftlnrI cnn''l''li713t1.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FtLING AND PAYMENT tNSTRUCTION!
Accoq,t No. 261569-52D11t.03-16-~005 To intlUnl ,PI"Ol*'" cnKflt to lHM" -=cMa'tt.
'Ectl.bll11fwd (2)oopwof til1.c notice .-.1:.111".;;- . ..~
. ~. to the ..lata,. of.Ula. '1ttIk.
10.,014.74 fJeIIbl. to: ~ of lUlls. ~.
"UtO.'OO'
10,.014.74
.045
450.'6'6 .
TAXPAY'~;It~$PONSE
Account.~
PIlrcentTlPCIibl.
AMount !kDjectto Tax
Tax .Jtate
Potential T.x'~
X'
x
NlJTE: If tax~b .,.. ...."i1:hin ~
(5) _tils of the dacadant's drie of ..
yau .." ~ . S% dl~of U. tall
An!tlnharl'taMa tax dIa 11111 bacoIilt, dltl!
nlnil t'9)_tfIS afblr 1:ha drie o"f' dAth.
PART
[1]
A. 0 The Iibove' ini'o.-..tian .., _due lScOrract.
1. You.. llhooR to ~1t ~1:r:Ih '~ofllil1s ,,11t1 tIlio oopias of tilis.nGtice to 01
· .dll11ClO11lJt or a'lIoicf intantst,-.OI" ,-=_ 'CtiIiClt 'box-." 8hlf ,..tumtills notice to UlaRealsbIJ
"ills .., ... offlc!ti .....ftI!IIIt .Ifill'" issued by the PA 1Japart.ant of R_.
a. I2(The lIbrwIl .1ISlI8t ... ~ 01'" lfilllMtrllPOr't:8d 8hlf tax P111d vitil tha PllllftSYlVMi. Imaritllnca T1lIC I
tobafiled ..by the dac:edant.s N1Praaantatln.
[ Cl(eCK ]
OME
BLOCK
ONLY
c. 0 The above. info ,...Uon ih,1ncorl"ttCt WldI. .. fir' .Hbts..8hlf daductl_ wa,.. paid by yau.
You .aJSt 'ODIIIPleblPART t!J Bl'IdIlII" PART{!] bel.ow.
If yau indicate.. df:'fll1'"'lllfrl tax rat.~p1ea_ .state~CIU/""
re1iItlonatilp'to dec:lldMtt:
PART
[!J
TAX RETURN ""CCJMP-UT.lT;tOHOFT~ ON~~:tlffT~r.rsr~~.,
LINE'-i-. Dat;~li""~""'-'l'~."---".' . .."...__.--......._.._..,"",..,-.~".-...,-"..,."..,.,..
2. Account ,8al8nce 2
3. Pel"CMrl T~1e 3 X
". Aaount Subject to Tax ft
5. DIibt. mdDtlduct10nss _
6. Aaourrt TllXIIble 6
7. Tax Rat. 7 X
8. Tax Due 8
PART
l!l
DATE PAID
DEBTS AHDDEDUCTtONS CLAtMD
PAYEE
,-
DESCRIPTION
AMDUNT
5~U~E/ '"I~~~, d.o,
I
IN RE: ESTATE OF
JEAN D. POWELL, deceased
FILE NO. 2006-00730
In the Office of the Register of Wills
Clerk of Courts of Common Pleas Orphans'
Court Division, Cumberland County,
Pennsylvania
DISCLAIMER and RENUNCIATION
WHEREAS, JEAN D. POWELL died on August 12,2006 a resident of
Cumberland County, Camp Hill, Pennsylvania;
WHEREAS, JEAN D. POWELL, during her lifetime executed a Will on
September 17,1982;
WHEREAS, JULIA ANN SHERIDAN nlk/a JULIA POWELL WAGNER and
REBECCA JEAN POWELL nlk/a REBECCA POWELL VOGEL became the
Executrices of the Estate of JEAN D. POWELL by Grant of Letters issued by the
Cumberland County Register of Wills on August 18, 2006;
WHEREAS, Item II. of the Will of JEAN D. POWELL states as follows: "I
give, devise, and bequeath all my possessions and estate of every nature and wherever
situate to such of my issue, per stirpes, as survive my death by sixty (60) days."
WHEREAS, JULIA ANN SHERIDAN n/k/a JULIA POWELL WAGNER has
executed a partial disclaimer of her share of the Estate of JEAN D. POWELL,
specifically disclaiming her right to the funds that were held In Trust For MICHAEL V.
WAGNER;
WHEREAS, JULIA ANN SHERIDAN n/k/a JULIA POWELL WAGNER has
three (3) children, MICHAEL V. WAGNER, MADISON A. WAGNER, and
MATTHEWK. WAGNER;
- 1 -
WHEREAS, less than nine (9) months have elapsed since the date of death of
JEAN D. POWELL and the undersigned Disclaimant, MICHAEL V. WAGNER, has not
accepted any of assets or other probate property of the Estate of JEAN D. POWELL nor
has he exercised any control as beneficial owner over any such property or any interest
therein;
WHEREAS, the Disclaimant acknowledges that the effect of the execution of
this Disclaimer and Renunciation is that the property that otherwise would have been
distributed to him will now pass to his siblings, MATTHEW K. WAGNER and
MADISON A. WAGNER; and,
NOW, THEREFORE, I, MICHAEL V. WAGNER, an adult beneficiary residing
at 13 Homestead Lane, Camp Hill, Pennsylvania, do hereby exercise the rights granted to
me in the Pennsylvania Probate, Estate and Fiduciaries Code, 20 Pa. C.S.A. 6201 et seq.,
to DISCLAIM & RENOUNCE my interest as a beneficiary of the Estate of JEAN D.
POWELL as follows:
1. I hereby renounce and disclaim all right, title, and interest in the Estate of
JEAN D. POWELL.
2. I understand that as a result of this Disclaimer I will have no right, title, or
beneficial interest in or to the assets of the Estate of JEAN D. POWELL.
IN WITNESS WHEREOF, intending to be legally bound hereby, I have hereunto
set my hand this ~ day of mo... "
, 2007.
ii~
sa~ZvA1l0 l). tAJO~Y"\U)
MI HAEL V. WAGNER
- 2 -
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF eLl- Hl &. r II] ,,-d.
: ss
On this, m~ J ~ ' 2007, before me a notary public, the undersigned
officer, personally app ed ICHAEL V. WAGNER, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument, and
acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
COMMONWEALTH OF PENNSVL'/AN'"
NOTARIAL SEAL Public
STEPHANIE NEBl, NO~:~~ CountY
Camp HiI~~~~~jan. 25. 2011
My comnii ____
\~~'YJd Wfi-
T ARY PUBLI
- 3 -
::X::~vllL E:J.1:~M5 dS- J- ~
IN RE: ESTATE OF
JEAN D. POWELL, deceased
FILE NO. 2006-00730
In the Office of the Register of Wills
Clerk of Courts of Common Pleas Orphans'
Court Division, Cumberland County,
Pennsylvania
DISCLAIMER and RENUNCIATION
WHEREAS, JEAN D. POWELL died on August 12,2006 a resident of
Cumberland County, Camp Hill, Pennsylvania;
WHEREAS, JEAN D. POWELL, during her lifetime executed a Will on
September 17,1982;
WHEREAS, JULIA ANN SHERIDAN n/k/a JULIA POWELL WAGNER and
REBECCA JEAN POWELL n/k/a REBECCA POWELL VOGEL became the
Executrices of the Estate of JEAN D. POWELL by Grant of Letters issued by the
Cumberland County Register of Wills on August 18, 2006;
WHEREAS, JEAN D. POWELL held four (4) accounts In Trust For MICHAEL
V. WAGNER, her grandson;
WHEREAS, less than nine (9) months have elapsed since the date of death of
JEAN D. POWELL and the undersigned Disclaimant has not accepted these assets nor
has he exercised any control as beneficial owner over any such property or any interest
therein;
WHEREAS, the Disclaimant acknowledges that the effect of the execution of
this Disclaimer and Renunciation is that the property that otherwise may have been
distributed to him will now pass to the ESTATE OF JEAN D. POWELL;
NOW, THEREFORE, I, MICHAEL V. WAGNER, an adult beneficiary residing
at 13 Homestead Lane, Camp Hill, Pennsylvania, do hereby exercise the rights granted to
me in the Pennsylvania Probate, Estate and Fiduciaries Code, 20 Pa. C.S.A. 6201 et seq.,
- 1 -
to DISCLAIM AND RENOUNCE certain of my interests as a beneficiary of the
following In Trust For accounts:
1. I hereby renounce and disclaim all right, title and interest to:
a. Members 1 st FCU Account Number 261569-41
(estimated value of$10,013.29)
b. Members 1st FCU Account Number 261569-43
(estimated value of $5,006.49)
c. Members 1 st FCU Account Number 261569-52
(estimated value of $10,014.74)
d. Members 1st FCU Account Number 261569-45
(estimated value of$5,007.52)
2. I understand that as a result of this Disclaimer I will have no right, title or
beneficial interest in these assets.
IN WITNESS WHEREOF, intending to be legally bound hereby, I have hereunto
set my hand this ~ day of r<) <J... ~
, 2007.
~~ J. lA\r~0
MI HAEL V. WAGNER
-2-
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF d I m.b" rIa,,)
: ss
On this, rYl(J~ J1 ' 2007, before me a notary public, the undersigned
officer, personally appe ed MICHAEL V. WAGNER, known to me (or sattsfactonly
proven) to be the person whose name is subscribed to the within instrument, and
acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
COMMONWEALTH Of PENNSYLVANIA
NOTARIAL SEAL
STEPHANIE NEBL, Notary Public
Camp Hill Bora, Cumberland County
My mi ion EllDires Jan. 25 2011.
Jt~(1qj,~l1~
OTARYP IC
- 3 -
5~\At G -.J r-Ti-t YV[ s d. ~- -Q?t
IN RE: ESTATE OF
JEAN D. POWELL, deceased
FILE NO. 2006-00730
In the Office of the Register of Wills
Clerk of Courts of Common Pleas Orphans'
Court Division, Cumberland County,
Pennsylvania
DISCLAIMER and RENUNCIATION
WHEREAS, JEAN D. POWELL died on August 12,2006 a resident of
Cumberland County, Camp Hill, Pennsylvania;
WHEREAS, JEAN D. POWELL, during her lifetime executed a Will on
September 17, 1982;
WHEREAS, JULIA ANN SHERIDAN nJk/a JULIA POWELL WAGNER and
REBECCA JEAN POWELL nJk/a REBECCA POWELL VOGEL became the
Executrices of the Estate of JEAN D. POWELL by Grant of Letters issued by the
Cumberland County Register of Wills on August 18, 2006;
WHEREAS, Item II. of the Will of JEAN D. POWELL states as follows:
"I give, devise, and bequeath all my possessions and estate of every nature and wherever
situate to such of my issue, per stirpes, as survive my death by sixty (60) days."
WHEREAS, JEAN D. POWELL was survived by her issue, JULIA ANN
SHERIDAN nlk/a JULIA POWELL WAGNER and REBECCA JEAN POWELL nlk/a
REBECCA POWELL VOGEL;
WHEREAS, JULIA ANN SHERIDAN nlk/a JULIA POWELL WAGNER has
three (3) children, MICHAEL V. WAGNER, MADISON A. WAGNER, AND
MATTHEWK WAGNER;
WHEREAS, MICHAEL V. WAGNER has disclaimed and renounced any and all
rights to the following In Trust For accounts:
1. Members 1 st FCU Account Number 261569-41
- 1 -
(estimated value of $1 0,0 13 .29)
2. Members 1st FCU Account Number 261569-43
(estimated value of $5,006.49)
3. Members 1st FCU Account Number 261569-52
(estimated value of$10,014.74)
4. Members 1st FCU Account Number 261569-45
(estimated value of $5,007.52)
WHEREAS, the effect of Michael V. Wagner's disclaimer is that these assets are
now assets of the Estate of JEAN D. POWELL;
WHEREAS, less than nine (9) months have elapsed since the date of death of
JEAN D. POWELL and the undersigned Disclaimant has not accepted any of the assets
or other probate property of the Estate of JEAN D. POWELL nor has she exercised any
control as beneficial owner over any such property or any interest therein;
WHEREAS, the Disclaimant acknowledges that the effect of the execution of
this Disclaimer and Renunciation is that the property that otherwise may have been
distributed to her will now pass to her issue, MICHAEL V. WAGNER, MADISON A.
WAGNER, AND MATTHEW K WAGNER;
NOW, THEREFORE, I, JULIA ANN SHERIDAN nJk/a JULIA POWELL
WAGNER, an adult beneficiary residing at 13 Homestead Lane, Camp Hill,
Pennsylvania, do hereby exercise the rights granted to me in the Pennsylvania Probate,
Estate and Fiduciaries Code, 20 Pa. C.S.A. 6201 et seq., to partially DISCLAIM AND
RENOUNCE certain of my interests as a beneficiary of the Estate of JEAN D. POWELL,
-2-
specifically the following accounts which became part of the Estate of JEAN D.
POWELL when MICHAEL V . WAGNER disclaimed the accounts:
1. I hereby renounce and disclaim all right, title and interest to:
a. Members 1 st FCU Account Number 261569-41
(estimated value of $10,013.29)
b. Members 1st FCU Account Number 261569-43
(estimated value of $5,006.49)
c. Members 1st FCU Account Number 261569-52
(estimated value of$10,014.74)
d. Members 1st FCU Account Number 261569-45
(estimated value of $5,007.52)
2. I understand that as a result of this Disclaimer I will have no right, title or
beneficial interest in only these estate assets.
IN WITNESS WHEREOF, intending to be legally bound hereby, I have hereunto
set my hand this -1L.day of rn~
,2007.
II")
WITNt:SS:
V)/l!le /)} 1Jf1~1 ftR--
~ C1rvrv s81~~
ULIA ANN SHERIDAN
~ P~WQ~
nI mLIA POWELL WAGNER
- 3 -
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF [,_{ 'rYJbl"r/and
: ss
On this,m(i~ / y' , 2007, before me a notary public, the undersigned
officer, personally a eared JULIA ANN SHERIDAN n/k/a JULIA POWELL
WAGNER, known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument, and acknowledged that she executed the same for the
purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL .
STEPHANIE NEBl, Notary Public
Camp Hill Boro, Cumberland County
My C ., , ~.~~P.~~~.~~n. 25, ~
\ ~mJ tiF
OTARYPUBL C
- 4-
fvl~
MEMBERS 1st
FEDERAL CREDIT UNION
.sC~cRvlt.- G-
./
--r~~S 1-5
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 261573-00
Date Account Established 03/16/2005
Principal Balance at Date of Death $25.00
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest to Date of Death $25.00
Name of Trustee Madison A. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261573-45
Date Account Established 03/16/2005
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $2.60
Total Principal and Accrued Interest to Date of Death $5,002.60
Name of Trustee Madison A. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261573-46
Date Account Established 06/05/2006
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $7.52
Total Principal and Accrued Interest to Date of Death $5,007.52
Name of Trustee Madison A. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261573-54
Date Account Established 03/16/2005
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $14.74
Total Principal and Accrued Interestto Date of Death $10,014.74
Name of Trustee Madison A. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261573-61
Date Account Established 03/16/2005
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $13.29
Total Principal and Accrued Interest to Date of Death $10,013.29
Name of Trustee Madison A. Wagner
~MBERS 1ST FEDERAL CREDIT UNION
Lm~lk ~-OU~
Daniel/e A. Kline
Insurance Services Specialist
August 15, 2007
Estate of: JEAN D. POWELL
Date of Death: August 12, 2006
Social Security Number: 174-20-6085
5000 Louise Drive · Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . W'Nw.members1st.org
Sc,~ c\J.t G-) ::r~ W\ ~
COIIMOMIIEAL lH OF PEHIlSYLVANIA
DEPARTHEHT OF REVENUE
BlEAU OF INDIVIDUAL TAXES
IIEPT. za0601
HARlISIURC, PI. 17128-0601
rNFORMATrON NOTrCE
.., AND
TAXPAYER RESPONSE
FILE NO. 21 06-
ACN 061S2f
DATE 10-13-
TYPE OF
MADISON A WAGNER
13 HOMESTEAD LN
CAMP HILL PA 17011
EST. OF JEAN D POWELL
S.S. RD. 174-20-6085
DATE OF DEATH 08-12-2006
CDUNTY CUMBERLAND
REHIT PAYHENT AND FORltS .
REGISTER OF WILLS
CUMBERLAND CD COURT HOUS
CARlISLE,PA 17013
"EMBERS lST FaI.... pnwidlld tha o.pa, ~.t .tin the infol'8tlon lisUd ballll/ whlClb .... .,." UMd In
CllIlcuJ.atlngthll pohntl.1t11lc ... ThelrMlCOrds IndiDlltlt thftwt thlI ..in of tha..,. d8cedmt. you__ ;joint ~1blInei':
thb _t. If 'YOU *-1 this Intol'8tiara biJ-..._t, ~dIt8in ..dtt.n ca..r-.otian ~thllfin8n=1a! Inst"ltutian. a'tt8cl
to this foa....W1d MItum it to thlI abova lIdclAss. lbb ~1stlllC.blllin _..-- with thll1nhel-lbnClll Tax ~ of tha CDI
of-~~lveni.. .. _.~-... ... ......... _ 0.&11....(~ 711 1587cr-.....~_....~----_._-_._...........,."--~...v"......... '. ""._ ....."'.v._._..................._._.__ ,,,..... .
COMPLETE PART 1 BELOW... SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Acco&.nt No. 261573-45 Data 113-16-2005 T~ ilUlUl'ep.....,.cr'IICIU to YWl" _t,
Es'bb1111hMl (Z) ~i_ of thisnDtioe. ~ .IKICC.L ..
,~t to thlI .~af.ll1.. tl8k.
""1. to: "Re81Mw of 11111., ~.
ACOCU'It ~
Parcent T__la.
AIIount Subject to TlU
TlU Raitt.
Potent1~ Tax Due
x
x
51002.,60
l.QO~,OD
51002.60
.':OltS
225.'12.
TAXPAVCRRESPONSE
HOTE: If tax ~ts .... ... wUMn t
(3) _ths Df tha ---.t.s date of_
you .. deduct . 5% dl_t of thll tIIlc
~ .inherH__. tIIlc .. .111 ~. r.Iiell
nine (9) _tM aftJI..thlt date of death.
PART
[!)
~~/ :::;t::':~.:~~,'.~ .~,~"~~,~:~~~~=~:~,~' ~;:;,n~,~:::-~::~~;~~~~~ " ~ : ":~. :'~.~:' :'. ~, ~:~.~: ~.~~E::=.~2:~.:~:3=':~~~::'~.,U'=:.. .:~~":~
.. 0 The --.. in~~ end tax duels ~t.
. 1. V_ .. ~ to I'81t~ to thehlJbtll.. of.IIUb with tIoIocap1esof this.nDtice to III
· di~ or _id mtJll'1tSt. or ltOU.. ahealc bait ...- and return thl.notlCll1 to thlI ResrlstaJ
Nll1s end an affJ.cle1 -__.tIdU beislUllCt by the PI. IlllpartliMt of lhIIianue.
.. ~ abow _t .... *'-' 0" will be rllPOrUld end tIIlC paid with hPems,lI/MH lnherltence TII)( I
to be fIled by U. cIeo.dent.. ..ep.......urtlv..
c. 0 The abow Infonla. ~ i~ 8I'ldf.or~ wnddeducU- .... paid by . YOU.
You ~ DDlIIPDta P.tRT I!.J andfar PART l~J bellll/.
[CHECK ]
ONE
BLOCK
ONLY
PART
[!]
DATE PAID
DEBTS ANDDEDUCTI'ONS CLAIMED
PART I.fyou 1ndicata acliffarent tax...t., plea. ctate;a,our
~ ' rabtionstUp to o.c.dent:
TAX 'RETURN -COMPUTATION OF. TAX ON JO!HT/TRUSr ACCOUN1"$;
LiNEI: Dri. ESt1IbUshed 1
2. Aocount. 'w.nc. 2
:5. P.rcent Taxllbl. :s X
4. AIIount Subject -to Tax 4
5. Dtlbts and Daduct.lons 5-
6. ~tT~b 6
7. Tax 'Rat. 7 X
8. TlU nu. 8
PAYEE
DESCRIPTION
AMDUNl
5cl~~vG.. \l--.) ~ ~ 3
COHIfONWEAlTH OF PENNSYLVANIA
IlEPARTMEHT OF IlEVENlIE
IUREAU OF IHDIVIIlUAl TAXES
DEPT. 28116111
1WlRISatIRG, PA 17128-06111
..
XNFORMATrON NOTreE
. . AND
TAXPAYER RESPONSE
FILE NO.. 21 06,
ACN 06152E
DATE 10-13-
TYPE OF
MADISON AWA9NER
13 HOMESTEAD LN
CAMP HILL PA 17011
EST. OF JEAN D POWELL
S.S.NO. 174-20-6085
DATE OF DEATH 08-12-2006
COUHTY CUMBERLAND
REHIT PAYIIENT AND FORMS .
REGISTER OF WILLS
CUMBERLAND CO COURT MOUS
CARLISLE..PA 17013
ttEH8ERS 1ST FCU has Pnw1.ded the ......t.nt.l'ttl1M .info..-tian Itst.d .lIIdlw lIhicltlhasbMn use 1n
calcu1atlne the potwlthal tu: due. Thair rw:ords indican thet at the ..cIIIItUl of .u. .........~t. yau ...... ajoirrt -lbIInafi
this _to Ifyau~lth1s 1l'lfor8tian is incorract. p:wu. abtain.wr1ti8n ~tian .~ .tha 'ftn.ncbtl lnsUtuUan, trtbIct
tit this fo... .WId I'1Itum it tit the IIbcww eddrus. This RCCUIt 15 "~ In ..~..ith 1M 1ill:Ierlmn. Tax l...s of the CaI
of. ~lV8nJa_ .. Q'IIelltians..., ..... ----..-":eaUing "c:n7) ..7a7,..uu.....
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 261573-46 o.t-06-05-2006 To. 1ns\ra jIrGpltr' Cntdit tit l/DUl"RCCUIt,
EabltflislMlcl (Zlcapiu Dfth1s: nrJtHe.-.t IlCCDIIII ."
..,..,t tit tha btJbtar ofVm.. .lwt.
PlMlb1e tD; "bgls_ Df "Ub, Agent"'.
AcccuIt hlllnce
PerC*\tTlIXIIble
AMwtt Sub_t to Tu:
Tu:RIlte
Pot.,Ual Tu: Due
'J{
x
5..007.52
1.0.~!O"
5;007.52
.045
225.34
TAXPAYER. 'RESPONSE
MIITE; If tu:.,.."..ts .... ... M1th1nt
(3) -mhs of tM dan_t.s data of_
you ~. daduot . S%d1-=-t 'o.f the tu:
~ lrihillr1~ tax due 1f111 .'--e deli
niM (9) aanths aftar tha data o.f dllatn.
PART
[!J
E~ :;~~-' ~:~~:,: .::~~:--: ~~ ~:. ~'_-'_~~:I~~ ," ;:.~:: ;:~~:I~~'~~:~~::~~~~~l:: _2:' ~.~:~~~~~:~:::~==Ir:~~:~:~.:: ~;~~.7:.~;_~~~,~:~::~~__
A. 0 The wbow lnfo....tlan and tu: due Is corl"llCt.
1.. Yau '~chO_ ttJ ,...it~t to the RltglsDr of II1Us trlth bIo capas .c;f thlsnatiCII tit at
· dlt1C01a'1t or lIIIOld lntarast. or yOU ~ check box .".. and ...turn ttdsl106ca.tD the Rag!stltt
II111s and .n offlchal __t Ifill be lslRlad by the PI. ~. of Rev_.
I. ~Tha IIbova ._t hu b..-. Dr '1111 be I"IIPDrtad and tax paid ..itt. the PamsylllWlill Inharltance TIIlt r
to be fll<<f by the dIlc8dlmt"'s M1Pra_tIItlva.
C. 0 Thallbova 1nforat1on lsil'lCOr'MlCt ..vor cW:lts anddllclulrt10ns ......,..id by yOU.
Yau auat CIIlIPlan PART III and/or PART [!J belov.
If you .u,diDlri.. difierw1t tu:....te.. plee_ state YOW"
....l.t1on....1p toclececMnt:
[CHECK ]
ONE
BLOCK
ON LV
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAItT
[!J
TAX RETURN -COIlPUTAT1ON OF TAX ON JO%NT/'rRUSTACCOO,ftt$t;
-LDfrLDat. EifebTI~--""--r--"''''-~_.~~_._'.__._'-''._''''
2. Accowrt:Ba1.111\C1J 2
3. Percent T-.ble 5 X
.... AIIDw1tSub.iect to Tax ...
Ii. DlIb"t. andDaclucUons 5-
6. AIlowtt TlIXIlbl. 6
7. Tax illite 7 X
8. Tu: Due a
PAYEE
DESCRIPTIDN
AMOUNT
>cJ~J.v~ G-.-J .:t~ k-j L\
COfIlllIltffEALlM OF PENNSYLVANIA
IlEPARTtIENT OF REVEJIUE
IIUREAU OF INDIVIIIlJAL TAXEs
IIEPT. 2&D6Dl
KARRISBURG, PI.. 1712&-06Dl
*'
XNFORMAT~ON NOT~CE
AND
TAXPAYER. R.ESPONSE
FILE NO. 21 06,
ACN 061521
DATE 10-13'
TYPE OF
__ EX ." U'..I
MADISON A WAGNER
13. HOMESTEAD LN
CAMP HILL PA 17011
EST. OF JEAN D POWELL
S.S. NO. 174-20-6085
DATE OF DEATH 08-12-2006
COUNTY CUMBERLAND
REMIT PAYMENT AND FORtiS
REGISTER OF WILLS
CUMBERLAND CO COURT HOUS
CARLISLE, .PA 17013
IEtlBERS 1ST FaJ hes pnw1r.lllcl ttw 1IIlplI'"'-nt Nith tta 1ftfo~U5Ud bltlawMhlcb ......, URd 1ft
ca1culAttlJ1lJ ttapotwltlal tIIx dUll. n.lrNCal'l'.ls 1nd1cabl tbat -.t tM dIIeth oftta """dlIaed8nt. 'W11 __joint: _~.
thIs IICcowtt. tfWUfMl'thl.1ft~tion Is lMornCt,.,pleUe..1ibtalnwrl'tt8n arrw:t:1an .~ttw i'1MnciaJ.lnft1tut1an. attacI
tD thIs 'fora and,..tum U ,totta . above ......... lbb.....t is t:IIMIib1e 1ft UU. 4l.._1I1.th the .:tfthlIrlu.- TlIlClaNsoftta Cae
.of'~S..~c....,_....._~~ ..,.~.o(?l7.).-M?-lt'5W.........,.....
COMPLETE. PART 1. BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTION!
ACCOWtt No.. 261573-54 Data 03-16-2005
Es'bb11....
10,014. .7;4
In,o. ;ltD.
10,0.14..74
.'045
4'5'0..66
TAXPAYSRRESPONSE
Aceowtt 8a1-..
'.l"'C'tIft't TllXIlbla
AIIowIt Subject to Tax
Tax Rata
Potential Tax.Du.
x.
To lMunt praper cradit tD your _t,
tz:) copi_ of th1sno1;.\a .lIUft. accolI!PW1lo
.~tD .theReP.... ofltllls. .....
POIIbl. tln"'Rllcflstar of NUIs. ....~.
x
1lDlE: If tIIlC ,...,ts era ... lIithin i
(3) IIIlnUts of theduldlnt'. dltte of del
~ __deduct. SC dl-.nt of 1M. tIIlC
Any lnhari__ tIIlC due ..111 ~.1Ia1J
nlna (9) _the _f_ the date of dIIeth.
PART
[!}
U~~:Z::."';~~ ,~;~~'~~~:::~~_~~:r;~~~: .~::. ~:S.~: ~..~: ' '. ~~ ~..~, ..:,~:~::~ .;;' =..;':. ~~.":~"'sr'~~~':~:~~:~lE~~~:~~;3.?:;;;:~
I.. 0 1'ha ..,.,. 1nfo.-..t1an andtlllC .. isDON'tIe't.
1. YOIIU)' chDci.. to raalt p.-nt to ttw "'lstar' of WUllJwlth tMo aapHs of tfds noUca m 01
· dl-..t oravold lntllraet, or you __ c:heck box "." _ .ratum thi.notice to 1M Resr1stel
lIUls and an offield .~ will be iasued by 1M PA Dap.. tM..t of ~.
I. 13' n.lIbovtl ....-t has bun or win be l'1lPDrtlld and UK paid lIith 1M PwvtSYlvania IrIhlIr-it.ace lID: I
to be fll.llClbllthe clecacIInt's rap,.._tIIti"..
c. 0 n.abova info.. ,...Uon is incoN'lJ!:. t ....v.. or~.' . . '. and 'daduct:1ans_ra,paid bllllOU.
'toullUftCOllPl.te PART [] andIorPARt l!.I ba1GK.
PART If you lndioat. ad!.ffllrMt _raU,I>>'" ~.YDUI"
I!I re:Lationstllpto cIltc....t: . .
TAX RETURN -cotlPUTATtON OFTAx.QN JODn'~ ~$j
LINE 1. Oat. En.bliSlwcl 1 .' .. "- .
2. Account.Bahnce 2
! . PItr'C8nt TllXIIbh 5 X
4. Allaunt Subject to Tax 4
5. DIibt. -.cI.o.ctuctlons S-
6. Mount TllXlIb1a 6
7. Tax Rat. 7 X
8. Tax Due 8
[CHECK ]
ONE
BLOCK
ONLY
PART
I!]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT
.5c~v'-rL G- ~ M .5
~
, '
COtlIIONlIEAL TH OF PENNSYLVANIA
IEPARTIEMT OFREIIENUE
IUIlEAU OF lHDIVIDIW. TAXES
IEPT. 280601
HARRISIIURG, PA Inza-0fi81
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 06
ACN 06152
DATE 10-13
TYPE OF
MADISON A WASHER
13 HOMESTEAD LN
CAMP HILL PA 17011
EST. OF JEAN D POWELL
S.S.HO. 174-20-6085
DATE OF DEATH 08-12-2006
COUNTY .CUMBERLAND
REIfIT PAYItENT AND FORMS
REGISTER OF WILLS
CUMBERLAND CO COURT HOU~
CARlISlE1 PA 17013
Account ~
Pltrctlnt TmaIbla
AIIountSUbjact to Tax
Till( bte
PotMt1ll1 Tax Due
PART
I!J
HEHBERS 1ST FCU "ttprovSdiM the..,.. b-.tttlth ttilt1ftforRtian llstlll.t bltlawllhich tas ..., '1IRd In
~laulat:1l111 .the JIOt8nt.\a1 tmc'due. Thall" 1'aCOr:1.tlr. Ind1catathat:lIt ttiIt'''thof'.'tM.1ltIow dIIHdant, ~...,.. . joint 1IIlIrIIII"n.nti
this -.nt.. J:f'~--I.thb1nf:a"'Uan1atnai:ttI"eCt,. .~abtaln,.!'11:1iin"OOI'TlICUon :m. thefinwlClal InstttlltiOn.attac
to this fonI ..-.cI,..twn It.to ttiltllbaw '~Th1.--..m: .Is taiaIbl.il In aooora.- tilth the 1I1her-l~T_ t..wttof tha Co
ofP_IIlI.w-la. ~...."._ an_red"br-wml1ll-t7t7,..~:;-"", _.. '"_'''__'_''''' ..
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT :rNSTRUCT:tON~
Account No. . .261573-61 hi. 03~16-2005 To'1nIiaM prape,. credit to 1/IIUr IICCOunt,
EIrbblJ... C!l ClIIpfu of this not_ MISt lICCQI.....
~ iD tfla "'1..,. oflllUs. tlaka
10 I 013 .:29P113!1iDi.twu """1~ of 1111'1.. ....t"'.
10.0 .'00'
1:0,013.29
.' ....1'5
'~.'6'0 ."
TAXPAYiea...,R.ESPOHSE
x
x
HOlE: If - ~. .,.. ... within 1
(S),1IIlInthlt of thlI. .......1:.. daW of _
JIlIU .. .dIduot a R dl~t of the tmc
.*", tnt.dw- tax -- will ~ _lj
nil. (9) __tn. .ftar- the data of _tho
[CHECK]
ONE
BLOCK
ONLY
B. Grn. IIbDve ....t bft .a.- or lfiU blt rllPQ1 bod and tax paid with the ~lvanla Inher-itmce Tax r
toblt fUad by ttiIt ~t.s "'Pr-mtiYll.
C. 0 ThaIlbDve. inforaa. . tlan. i~lncorrac:t 8ndIDr dabU and decfucctlans ..... paid .a., ~.
You -tCDllPlata . PART 1!J BndIorPARt [!jbelDll.
If :lfOU1ncfiClaU . d1f:fat ~Jt tax nrh.IFJleaa stat..:your
ra18tionshlp to cIac::ec:I..~ti
I.. 0 1:Iw IIbDve 1nforaetlan and tax dua is COI',..ct. .
1. You...c..-. to ,...It ~t.tD.thIl Raglstllr o'fNll1s.lflth 'bID coplHDtithis not1~ to at
· d$--.n:or avoid iftt8,...t. or you ... cMclt box "A" ..-.cI rwtum thi. nOt:lca to thsbglstar
"Uls and an oHlclal __t Ifill be iSlRladby t1w.PADlpart!lan.t of Ravanue.
PART
[!]
TAX RETURN - ~AT!ONOF.TAXON JOItr{/1'RU$T ACCOU~.
'TDie"T:- Dat;--Est.bl1sMc1- 1'.-.--....-'-'........-......-....... .
2. Account 8aJ.Mca 2
3. p~ TllXlIble 5 .)(
4. Amuni SUb:Jilct -1:0 Tax ,.
.5. hbt. ,'anclDiIduotlons 5' _.
(,. AIIount T__1. 6:
7. TIIl(Rate 7 X
8. T_~ 8
PART
[!J
DATE PAID
PAVEE
DESCRIPTION
AMOUNT
i
F
~1~
MEMBERS 1st
FEDERAL CREDIT UNION
s C~ ~\J ~ G.) '-:l.~. hS
G -. \0
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 261572-00
Date Account Established 03/16/2005
Principal Balance at Date of Death $25.00
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest to Date of Death $25.00
Name of Trustee Matthew K. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261572-42
Date Account Established 03/16/2005
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $13.29
Total Principal and Accrued Interest to Date of Death $10,013.29
Name of Trustee Matthew K. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261572-44
Date Account Established 03/16/2005
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $6.49
Total Principal and Accrued Interest to Date of Death $5,006.49
Name of Trustee Matthew K. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261572-46
Date Account Established 02103/2006
Principal Balance at Date of Death $5,000.00
Accrued Interest to Date of Death $7.52
Total Principal and Accrued Interest to Date of Death $5,007.52
Name of Trustee Matthew K. Wagner
CERTIFICATES OF DEPOSIT
Account Number/Suffix 261573-53
Date Account Established 03/16/2005
Principal Balance at Date of Death $10,000.00
Accrued Interest to Date of Death $14.74
Total Principal and Accrued Interest to Date of Death $10,014.74
Name of Trustee Matthew K. Wagner
M~~LA~{(Q:~
Danielle A. Kline
Insurance Services Specialist
August 15. 2007
Estate of: JEAN D. POWELL
Date of Death: August 12, 2006
Social Security Number: 174-20-6085
5000 Louise Drive . P.o. Box 40 . Mech::micsburg, Pennsylvania 17055 . (717) 697-1161 . 'vV'vV'vv.members1st.org
, , ,
..scA;~clv~ GJ:I..~ r., l
ClIMKOIlWEALTH OF PENNsYLVANIA
IlEPARTIENT OF IlEVEl<IIE
IUREAU OF INDIVIDUAL TAXES
IEPT. 2aD6Dl
HARRISBURG, PI< Una-Q6al
..
%NFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 0.6-
ACN 061521
DATE 10-13'
TYPE OF
_JII45I1...~)
MATTHEW K WASNER
13 HOMESTEAD LN
CAMP HILL PA 17011
EST. OF JEAN D POWELL
S.S.BO. 174-20-6085
DATE OF DEATH D8-12-2006
COUNTY CUMBERLAND
REKIT PAYItENT AND FDRItS
REGISTER OF WILLS
CUMBERLAND CO COURT HDUS
CARLISLE. PA 17013
MEH8ERS lSTFCU has PI"lWidlId the lleIperaet lff'ttt ttw Intor.t!an lisbd _low ..tich has ~ IIMCf in
oa1.alWltlnjJ tIwl PDtMt-1al 'buc dua.Thelr ,...,... ~thet.ttile dHthDi'tha IIboWl Raul....l. _ ..... . jaint_rlbenltf:
tltl. _t.1#;_ nu' 1hls, ~t!alh :lnco"'_t,.p~.taht wri'ttwl oor.ntetion."....tha fu-la11nstltsrtlon, 8t:tIId
to thls faMl..s. nItum.1t 1:D u,..-.ov. SIlldMIIIs. .1hB -mu,UIaIbla bI_I__..,lttltile Inheriw- Tille ....sDi' tha ea.
of ~1_1I.. ..a-UI2I.. 1tBlt-lMl- _.-arB ~ cdll.... Cn:'I') m-tIlU). ,-.--------..-,..---...---..... ................
COMPLETE PART 1 BELOW )( )( )( SEE REVERSE SIDE FOR FlUNG AND PAYMENT INSTRUCTIONS
Account No. 261572-42o.te 03-16-20.05 To .1nanpl"qNIl" orwfit tD ~ ~,
EaUlbU..... ell copies ofttlb notl_....t H.~ ..
~ttD tile ~ of lUlls. MIlk_
1:0.013.29 panble tD: __1.... of lUlls. ..,t"".
100 .10
10.0.13.29
.0'45
4'50 .6'0.
TAXPAY:ERRESPONSE
Accowit .h1tInca
P-Nl8Irl: T__la
~t SUb;t.ct to Tax
Tax IbItIJ
Potant1a1 Tax .~
PART
ill
x
x
NOTE: If'tlIx ~ts aMi ... ,.,ittlln 1
(5) *-ltha of 1ha ......t.s cIIrtlt Di' ..
- ItBlt .dlIduot . R di-*nt ofttw 'buc
_i"'l~ UDc dla will bile-. ~I
nine (9) aonttas aftar tha dlttaDi' dHth.
~~:~ ,~;': :~~~~:' ;~~~~:~..::'7;- ~::~~~~"'~ ~~__:~.~~:'_ ~ .._~. ~ '. ~~.__. ~_"'.. . ,~._.. ~:,-,,~,~__:'_."~:..'. ':~:~~~~r~;~~~=:::;~:~:'~;I :~~:?~~ ~]:~~:~:~~
4. 0 'Ow above 1nfor8tiDn ... tlIx "is oorr-.c:t.
1. You.. ~ to ,..at ...-nt' tDtha Aao1starDflflUs ..ittltNo copies of this 1'ID~lca to III
e dlSCDU11t or _id ln~.. Dr _.. chacIt bDx .... 8l'IcJ rwtumttllsno.t:ica to tile RIIg1st8r
lUlls'" an ofl'ic1al ~. .,Wbtt bBUMi by tha PA Daperblsrlt of Revanlla.
I. @'Thaabova...t hn bMn Dr tdU - rtIPOrWcl ... tax paid with tha PennsYlvania Inheriw- Tille I
to be fit_ by the dllcadant".s 1"1IPI_ltaUva.
c. 0 The above i~. Uon 1~r'T'aCt: andi'orri'ldebtsand dtlductlans ...rs PlIid by you.
You IIUS't CDIIIIP1ab PM'[" I!.I ancVar PM!' I!J below.
[CHECK ]
ONE
BLOCK
ONLY
PA.RT
~
DATE PAID
DEBTS AlfDDEDUCTIONSCLAIMED
PART If :fDU indicate adi-tt.r.m ~ rat-.I Plella ctatayour
[!/ raltttiONlhlp'to dR.Mnt: .... .. '. .'. .... ....... ..' '. '. .... .,
TAX RETURN -COMPuTATIONOF. TAXON JOJ:NTi'TatISTACcouNrs,
'''LINE 1. o.t;-eatllbush;d---- 1
2. Account '8abnCIl 2
3. ParclIntTaX.bla S X
4. Aaount SUb.:t.ct to Tax 4
.5. o.ota III'1CfDaduCti.ons .5-
,. Mount T8XIIb1a ,
7. Tax R.t. 7 X
8. Tax~ 8
PAYEE
DESCRIPTIDN
AMOUNT
. , ,
~J~. c;.) ~.~'1
COIIIlCIIIIIEAL Tll OF PENIlS'tLVANU
DEPARTMENT OF AEVBIlE
IIUREAU OF IHDlVIIJUAL TAXEs
1lEPT. 2aD61J1
HARR~, PI. 171za-06Dl
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. ZI D6.
ACN 061521
DATE lO-l~.
TYPE OF
an-J14S n UP,"',,,
MATTHEW K WAGNER
13 .HOMESTEAD LN
CAMP HILL PA 17011
EST. OF JEAN D POWELL
S.S. HO. 174-ZD-6085
DATE OF DEATH 08-1Z-Z006
COUNTY CUMBERLAND
REHIT PAYIIEHT AND FORtIS
REGISTER OF WILLS
CUMBERLAND CO COURT HOUS
CARLISLE, PA 17013
ItEItBERS 1ST FCU ..... Pl'DVidMJttiellepa~t with ttwlrifo....tion UlIUd HlDlllllh1ch has been used in
~cu1atinsrttw po'blntilll todua. Tlwlr,...rds indic:atathat at ttw dMth o-fttw....,. ~, ~ __. joint ~lbeMf;
this -*.. If~ .haL thblrifo..-tlanuincornot, p~ abtain .,..1~ CDl"1'1Nltlan,"'" ttwif~la1 'instItution" at:twlI
1:D this. fanI -.I ,...,. it 1:D ttw .1IbDve'ar.IIiINS.. 1bla ~ls t:aIcIIba In .au..-- lfUb '1halnMrl"-- ;r. L-..oi' ttw eo.
of~wlv.illr; .lIuntlons -..y tRl ../.....ood.1>1.111... em) 'o,"'asrr.~-'--"'--""-'-----""."--"'-""---'_._---
COMPLETE PART 1 BELOW .. .. .. SEE REVERSE SlUE FOR FILlNG AND PAYMENT INSTRUCTIONS
Accowtt No'. 261572-44 Data 03-16-Z005 To 1__.praper cr.cnt tit YGUr_to
E-.t.bU.-..ct (V oapla of ttd..11Iftb .m: "" ~ .. '"
~'1:D ttw Ralbtar at,"u.. ....
PIIhb1. 1:D: ""IhIlJ1111ar af IUU., AgeM'".
Account 8a1.nce
~tTiuc1Ib~
Mount Subject: to TIIX
TIIX Rate
Pot....tial TIIX Dua
x
x
5,006.49
'nO.DO
5,006.49
.045
Z25.'.29
TAXPAY,ER . 'RESPONSE
1In'E: If to ~ta .,.. ... within t
(3) _ths of ttw "OlIdam:<<s.t. o-f del
wullllli dlilduct a 5% dl_t of tIw to
MIl .lntiIlt-.it.noe talc ... .Ul '-"daU
nJn. ,~9) -.an-tits aftar ttw data of ..th.
PART
[!]
[:.-~::r:.:::'_'::"'~-~:'~:._'_~: '~~'~:.: ~ ,T. ".~ '~~,~:':.' : . ,<,,' '.. "'__~:,_._,_~_ __ _:"_','. _~.-:-_~ .~'~_.~-~~.:._~~~L ~'_:~ '-'.' '(~~:~~~~.:~~~'
A. 0 n. above JnforMtian __ t:aIc dua is CIClrAOt. .
1. You...,. ~ 111 ~It ~ to tIw -.rliitarof1l1Us .,lthtMctciap1es o-f this notlc:a 111 at
· du-..t or- avoid intanm:, or yOU -.y '.ciI1aIaik belle.... __",turn thlsnotl_ totha hglstar
Ifllls and - Dffic:1el_..,t "W be ,lac.&!.by ttw PA IllIpartlMnt of ......
[CHECK ]
ONE
BLOCK
ONLY
.. (3"The mow ....t ... ~ or- ifIll bto reportacl __ tax paid with ttw Pm:lMyll1anS. lnharItance Tax r
to ba. fUedby ttw "'"udau1:'s l'tIP.....,tati"..
C. 0 The IIboIle infa....tian i1r~t 8'1d/or debts .-.Jdacluctl_..."' paid by 3/OU.
You .m: CllIIIPlata PART III andIor- PART @J ba.lDIlI.
PART If you 1ncI~ca'ta . cfif.......t tIIX reta, p~_ stata,CIIir
~.. re1atioMh!p to ~ti . . .. ... ....... ..... .'
TAXR~URN-Cf.'lfiIp~~TJONOF. .TAX.oN JOINT/.'J'RU$T ACCOUNrs,
iINE'f~" ht;.-Erilibi1~~""'''- .. 1 . . '. '--
2. Accol,nt ..8a1Mtca .2
3. Pltrcent T...~ 3 X
4. AIIowlt SUbject: to TIIX 4
5 .o.bts .ndDMluct1ons 5-
6. Mount TIIXIIb~ ,
7. TlIXhb 7 X
6. TIIX Dua 8
PART
~
DATE PAID
PAYEE
DESCRIPTION
AMOUNT
I
, , \
.s~~~~ G J <;b:k;.-.., 9
COMIIOM1IEALTlf OF PEhWSYLVAtlIA
IEPARTIIENT OF REIIENUE
IlIlEAU OF IHmVIIlUAL TAXES
IIEPT. 2886Dl
HARRISBUR;. PA 17128-D681
..
INFORMATION NOTICE
. AND
TAXPAYER RESPONSE
FILE NO. 21 06
ACN 06152
DATE 10-13
TYPE OF
...-. ", .r_,
MATTHEW KWASNER
13 HOMESTEAD LN
CAMP HIll PA 17011
EST. OF JEAN D POWELL
S.S. NO. 174-20-6085
DATE OF DEATH 08-12-2006
COUNTY CUMlER~AND
REJfIT PAYltEHT AND FORtIS
REGISTER OF WILLS
CUMBERLAND CO COURT HOU~
CARLISLE, PA 17013
HEJtBERS 1ST FCU has provided tM ~ bIIIIiiIol.1.wlttdMinforwRlon l1s1:'M1'-1l1N lIhlah has. ~ used In
calcu1.tlna the PDtlIntlal tlIx dua. Their .--.... indlcat1t u.tlrt.'tillJ death of. the 'Iibovll.decadlnt. l/IIU....... jGfnt_l"l'*-f
. thl. ~t. ..Ifl/llU*-1 th18 1~t:1an 18. u-r.r.ct. .P.... .ob1a,ln 1I1"ltteft CIIM".ot:ion .'~ :the:n~iel Jnstftut:lan.. attllc
to thi. fDrw Bnd I"IItum it: to the IIboftllCldnilh. ThbllllClCl&lllt i. ~ .In _rdlincelflth h.1nMri~T_ ~. of the Co
ofP....l_I..~_,_,,__rM~.n-?~-m-tIH.?r. . ....~""_...."....._
COMPLETE PART 1 BELOW . . . SEE' REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTION!
ACCOWtt No. 261572-46 hilt 02-03-2006
E.t.bli....
x
5,007.52
. "lOti ,'00
5,007.52
\ .....,045
'225~S4
TAXPAYER-RESPONSE
To i__'P\"OPlII" cMldlt.w l/IIUr 8lCCDUftt,
lie) oopla Clfthis notioe I&I8t ....~;r J ....
~. tD the ".lstlu-of. 1I1U... ....
~. tD: -"lstar- of lUlls, Ae-nt"'.
Accow1t 8a1...,.
ParcMt TlUclibla
Mowri.$ubject . to Tax
TlIX Ritta
Potanti1tl Tax Ika
x
PART
[!]
1lDTE: .If.'tIDe~ts _ ... within 1
($) _Us Dftha 1 1 r.t.. eta of del
lIQU IIIi:r .~ a5%dlsaouritof the tlIx
.~ '1nherl~ tax due '.111__ *1J
n1na C'l _ttls aftar the data.f "th.
~:~'.~'~~ ;~::'~ ~~:-~":::~:";~;~.~~ :~;-~:~':.,: '2~:~~ ~ ~~_~ i::_~ ~ ~_~~~. ......:L ".~~~ ~_ ~;.:L ~~. :~ :~~2~:~~:~~~J.:'+:.:~=7~. .~.w~=:~~:';
A. 0 The IIboft infaraat:1on __ 'tIDe dua ls~t.
1. You IIIQ/ ~... ~ ,...lit: ~to .'theRqbtar .of 1Ii11slflth tlIID DOfIi.s of thbnDtiaa to at
· dl-.rt Of' -uJ lntllrut, 01" l/OU aa:r IihaOIcbox ..- .and ...tumth'1s notice to the hgiRe.
lUlls and en official _.....t tdll bltlnu.db, the PI. blIP" bn.o1t of RawnIa.
8. E'f The IIbcIva ....t has bean Of' win be raported and tlIx paid with the Pann~lV8nl. lri1aritanca Tn I
tD bit ~l1ad b, the d8cat:Ian1:'s ......-.-tlItiva.
c.O The IIbcIva infDrwa'tlan isinaalT'llCt WldIor-dllbts and dIIduotions _. paid .b)o YClU.
You -* CCIIIPlataPART [!J and/Ol" PART [!J bItlow.
PART If :vouindicata . d1'ffeNtn tax .ra'l:a,p1a_ stat.7DU1'"
~ ra18t1onshtp. to dtlciedant:
TAX RETURN .-cc:lHPUTATtON DF TAXON JOINTITtlIJSTACCOt.JH:rS,!
"CDfr1';"'Da"'ltl Estcilshed --1',-,,:-..- ., -
2. ACCOWIt W.... 2
3. Percent TIIXIIb1e S X
4. AllDunt Subjac.t to Tax lit
5. Dabt. ,'IInd'Deductions 5-
6. AIto\nt TlIXtIbh 6
7. Tu Rata 7. X
8. Tax Due 8
[CHECK ]
ONE
BLDCK
ONLY
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT
. , ,
5C-~dJ~ S ~ v, \0
CDllfIOHIIEALTH OF PEIlNSYLVAHU
II:PARTIlENT OF AEVEJIE
BUllEAlI DFINDIVIDUAL TAXES
1lEPT. ZSD6Dl
llAllRISIURG. PA Inza~lI6ll1
*'
rNFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 06
ACN 06152
DATE 10-13
TYPE OF
._845 EX '!" I_I
MATTHEWK WAGNER
13 HOMESTEAD LN
CAMP HUt PA 17.011
EST. OF JEAN D POWELL
S.S. NO. 174-20-6085
DATE OF DEATH 08-12-2006
COUNTY CUMBERLAND
REHIT PAYHEHT AND FORttS
REGISTER OF WILLS
CUMBERLAND CO COURT HDU~
CARLISLE, PA 17013
Accawd BIll....
PaMl8l'lt T__la
AIIow\t Sub.:tact to Tax
Tax Rat.
Potant1a1 Tax Due
PART
[!I
HElBERS 1ST FCU *-' providllll the JIlIpart..twt ._1th ttie~ianU8'tlid be1aitllh1ch '- beM US8CI in
aalculating tM. rmtwatial. tax dua. . Thatr..~rds indiaata. tba1: at 1tle cIDttI of .ttw IIbowt. ~t. yau ..,... a jalnt: _1"1benri
this~. If>>'llU~thls lnfol_thn i..lncol"rect,. p~;abtalnlmitt.'U="'l'llC1:hn.frae tiwt fu..clal lnstltutian. IIttac
to this faMl .1Ind I"'8'tum it to tMlIIblIV.........Thls IIaOOUfttb tlDclb1e In .allOAr___itn the lINrim- T_ .....0* the Co
of PMWitIylYMth.....Qarii_....,..... ...._rwcI..~"fft") ..... 8e1. ....._..~__......_.... _... .____~__........__....___........
COMPLETE PART 1 BELOW Jl . I( SEE REVERSE SInE FOR FILING AND PAYMENT INSTRUCT:tON~
~t No. 261572-53 Data 03-16-2085
Eatabl18had
10,014.74
'lOO.Oo.
1,0,'014.74
.045
450.66
TAXPAYER RESPONSE
x
To JntIunt P/'"OPIIt' c:redi t'to YDUrllCCOUl'lt
(Zl 0GP1- of this not_..st _ a;__
~tD the ..Rllgistllr ~lfills. HlIka
PIInblatzn "Rwgistar of 11111., .A88nt".
x
HlJTE: 'U tax ~.b ___..lthin
(3) ..ntls D'f the ~ a'llellt". data of de:
.~~ . dMIuc:t. a s:c di-.t of the tax
Any Jnhad"-- tIDe dua will ~ dill
rUr. C,)_ttts aftar the data D'f dutto
..:. :~~~:-..~ ;" ;.~:_~: :~:';. -~:~ ~=;;~~~.~-,~ ~~:~";r'2~ ~:~~.;.-~-; _ ~~ _~~"L~C~. }~i~~:'~:~~~:: .~ _~: ~~2i~ :' "~:. '. :~'~:~:;Z~:Z~::[~:t'",~.~
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1. Vou...--.. 'to I'..U .~t to the "lstar O'f lfllls wl1tl t..capla. of this natiCll to ~
arl1_t 01" _ld lntanIst. pr yau.. .ClMCk .box -;.- IIndMltum this nDtiCll to the Ilqlst.
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'to.. filed by the decadent"s M1PMIRl'ItII.tfva.
[CHECK ]
ONE
BLOCK
ONLY
c. 0 TIw abow. '. infanlatlan is' lnca. rr.ct ancVOI'.~tsllndcMduct1ans ..... paicl by ~.
You ..st ClllIIPuta PART 1!J..v0l" PART ~~.
PART If )IOU ~icata . diiffa,.,..t tax Mlta, plaasa statayour
f!l ralatiOnllhipto dacadam: .'. . ..'
TAX RETURIt- ~At':UJlfOF TAX .'ON ..JOtNT?TRQStACCOUl\IT$i
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2. ~t .BaJ..anca 2
3. Perc.nt r"'1e 3X
ct. biount S<<.lbjact to Tax 4
5. Dilbts:andDaductions 5-
, . AIIountTlUCllbl. 6.
7. Tax Rata 7 X
8. Tax au. 8
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. t ,
JULIA P WAGNER
13 HOMESTEAD LANE
CAMP HILL, PA
187-38-0833
Redemption Date:
09/20/2006
17011-
Transaction Number:
Serial Number
Series Denom
Issue
Date
Issue Price
Interest Earned
6113263059
Redemption
Value
00013544959
EE
$10,000.00 07/ 1987
$5,000.00
$8,412.00
$13,412.00
Total number of bonds redeemed: 1
Highland Park Office
344 South 10th Street
Lemoyne, PA 17043
(717) 737-3322
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG,'PA17128-060~
., '. -;\
Telephone
(717) 787-3930
FAX (717) 772-0412
May 15, 2007
i ,_
p :
Julia P. Wagner
13 Homestead Lane
Camp Hill, Pa 17011
Re: Estate of JEAN D. POWELL
File Number 2106-0730
Dear Sir or Madam:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before November 12,2007. Because
Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional
extension(s) will be granted that would exceed the maximum time permitted.
---, ./"""
/- ! -----
I) SinceFe.L~-
/ t.. J" /il ( "
~~oZ--LL- / t'~-'7J~)r-<--'
vJi'
Claudia Maffei, Su~rvisor
Document Processing Unit
Inheritance Tax Division
COMMOhJWEAl TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
. ,D~PT.t2S0601
HARRISBURG. PA 17128.0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WAGNER JULIA POWELL
-------- fold
ACN
ASSESSMENT
CONTROL
NUMBER
101
ESTATE INFORMATION: SSN: 174-20-6085
FILE NUMBER: 2106-0730
DECEDENT NAME: POWELL JEAN D
.
DA TE OF PAYMENT: 11/08/2006
POSTMARK DATE: 1 1 /08/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/12/2006
REMARI<S: JULIA WAGNER
REBECCA VOGEL
CHECI<#510
SEAL
TOTAL AMOUNT PAID:
INITIALS: WZ
RECEIVED BY:
TAXPAYER
REV.1162 EX(11-96)
NO. CD 007403
AMOUNT
--------
I $8,000.00
I
I
I
I
I
,
I
I
$8,000.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
, . OEiA~MENT OF REVENUE
BURE U OF INDIVIDUAL TAXES
DEPT. 280601
HARRI BURG. PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WAGNER JULIA POWELL
13 HOMESTEAD LANE
CAMP HILL, PA 17011
--..----- fold
'. ".
ESTATE INFORMATION: SSN: , 74-20-6085
FILE NUMBER: 2106-0730
DECEDENT NAME: POWELL JEAN 0
DATE OF PAYMENT: 10/02/2007
POSTMARK DATE: 10/01/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 08/12/2006
REMARKS:
CHECK#567
SEAL
REV-1162 EX(, 1-96)
NO. CD...008771
ACN
ASSESSM ENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
INITIALS: CAJ
RECEIVED BY:
REGISTER OF WILLS
I
I
I
I
I
I
I
I
I
AMOUNT
$4,516.99
.
" " ~ "
$4:;516.99
GLENDA FARNER STRASBAUGH.
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
_. ~I'PT, 2iD601
HARRISBURG. PA 17128-0601
6
REV-1162 EX11196)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 008467
POWELL REBECCA JEAN N/K/A
6 HOMESTEAD LANE
CAMP HILL, PA 17011
~ _hu.~ bl'"
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101
$1,939.00
ESTATE INFORMATION: SSN: 174-20-6085
FILE NUMBER: 2106-0730
DECEDENT NAME: POWELL JEAN 0
DA TE OF PAYMENT: 07/30/2007
POSTMARK DATE: 07/30/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 08/12/2006
TOTAL AMOUNT PAID:
$1,939.00
REMARKS:
CHECK# 557
SEAL
INITIALS: CJ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
.. ..
WILL
OF
JEAN D. POWELL
I, JEAN D. POWELL, of Lower Allen Township, county of cumber-
land, and state of Pennsylvania, declare this to be my last will
and revoke any wi 11 previously made by me.
Item I. I direct that all my just debts and funeral expenses
including my gravemarker and all expenses of my last illness,
and any and all taxes and assessments imposed by any governmental
body as a result of my death, whether on property passing under
this will or otherwise, shall be paid fram my residuary estate
as soon as practicable after my decease as a part of the expense
of the administration of my estate.
Item II. I give, devise, and bequeath all my possessions
and estate of every nature and wherever situate to such of my
issue, per stirpes, as survive my death by sixty (60) days.
Item III. I appoint my daughters, JULIA ANN SHERIDAN and
REBECCA JEAN POWELL, or the survivor of them, co-executrices of
this my last will.
Item IV. I direct that my personal representatives shall
not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this /7 C1. day of .s .:.rflii:;?? i. <'t- , 1982.
ra~~.. cr;z_.ed:
Jearj. D. powell
page 1 of 2 pages
The preceding instrument, consisting of this and one
other typewritten page, each identified by the signature of the
testatrix was on the date thereof signed, published, and declared
by JEAN D. POWELL, the testatrix therein named, as and for her
last will, in the presence of us, who at her request, in her
presence, and in the presence of each ~her, have subscribed our
names as witnesses hereto.
~ V/7;:=
page 2 of 2 pages
.
. " "...
COMMONWEALTH CF PENNSYLVANIA )
( SS.:
COUNTY OF CUMBERLAND )
I, JEAN D. POWELL, the testatrix whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my last will, that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes
therein expressed.
,"/ C
(--/-t-c1-?1'/ f:),
Sworn or affirmed to and /
acknowledged before me by /
Jean D. powell, thr testatrix
this !1):!\ day of :M.p.ltyrdQlfi 1982.
':)'ou~c-l~
Lt\ \ (\n~it {)
Notary ~c LOU ANN ZITTO, Notory Public
I alT'''''I''~. r.1.'mhll!..r"nrl County, Pit.
.... r~-...,!O:;;r'll, F......j..flt: A.nr-if 7 tnoA,
COMMONWEALTH CF PENNSYLVANIA )
( S8.:
COUNTY OF CUMBERLAND )
WE, SAMUEL L. ANDES and GEORGE A. VAUGHN I III I the witnesses
whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that
we were present and saw the testatrix sign and execute the instru-
ment as her last will; that she signed it willingly and that she
executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the testatr x
signed the will as witnesses; and that to the best of our knawledg ,
the testatrix was at that time 18 or more years of age, of sound
mind and under no constraint or undue influence.
M.~
f? - aJ~p::
~ /~
SWorn or affirmed to and
acknowledged before me by
samuel L. Andes and ~j9rge A.
vaughp,. III., this i1;t.\ day
of )U--Q. fl-lt m IU)l' 1982.
\.b\l~ l V1 ::?(}ili
Notary Pub c
LOU ANN ZITTO. NotAry Public
temO'/:1p., r.'!mhe..l~nd County. Pa.
,^A,v r.(I""rni~~.i(w ['-"';rf;'''' A~..il 7 ,.-,~: