HomeMy WebLinkAbout12-14-07
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15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
.
County Code Year
INHERITANCE TAX RETURN 2 1 0 7
RESIDENT DECEDENT
File Number
00484
Date of Birth
201161267
04182007
Decedent's Last Name
HARRISON
Suffix
SR.
Decedent's First Name
FREDERICK
MI
L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
181 1. Original Return 0 2. Supplemental Return
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3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
o
4. Limited Estate
o
4a. Future Interest Compromise
(date of death after 12-12-82)
o
1
8. Total Number of Safe Deposit Boxes
o
6. Decedent Died Testate
(Attach Copy of Will)
o
7. ~f:~~~o~:~i~~~)a Living Trust
o
9. Litigation Proceeds Received
o
10 Spousal Poverty Credit (date of death
. between 12-31-91 and 1-1-95)
o
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRADLEY L. GRIFFIE, ESQUIRE 7172435551
Firm Name (If Applicable)
GRIFFIE & ASSOCIATES
REGISTER O,?~ILLS USE ~Y
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First line of address
200 NORTH HANOVER STREET
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Second line of address
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City or Post Office
CARLISLE
State
PA
ZIP Code
17013
,
DAYE FILED
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C d t' "I dd b g r iff i e @ g r iff i e 1 a w . com
orrespon en s e-mal a ress:
Under penalties of perjury, I declare t I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief
it is true, corre t and complete. Declar tion of preparer other than the personal representative is based on all information of which preparer has any knowledge. '
SIGNATU 0 ERSON RE BL FOR Fill TURN DATE
Linda L. Horn
DATE
Bradley L. Griffie, Esquire
1.1- I
07
17013
Side 1
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15056041147
15056041147
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15056042148
REV-1500 EX
Decedent's Name:
HARRISON, FREDERICK L. SR.
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)................
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested............. 7.
8. Total Gross Assets (total Lines 1-7)....................................................................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H)......................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)................................ 10.
11. Total Deductions (total Lines 9 & 10)...................................................................... 11.
12. Net Value of Estate (Line 8 minus Line 11)............................................................. 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13).................................................
14.
47,070.57
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17 . Amount of Line 14taXable
at sibling rate X .12
18.. Amount of Line 14 taxable
at collateral rate X .15
15.
47,220.57
16.
17.
18.
19. Tax Due..................................... ........ ......... ........ ...................................... .......... ....... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side2
L
15056042148
Decedent's Social Security Number
201161267
5.
51,792.21
51,792.21
4,336.64
385.00
4,721.64
47,070.57
2,124.93
2,124.93
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15056042148
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 07 - 00484
DECEDENT'S NAME
Harrison, Frederick L. Sr.
STREET ADDRESS
26 Wheatfield Drive
CITY I STATE IZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
2,200.00
(2)
Total Credits (A + 8 + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
2,124.93
2,200.00
0.00
75.07
0.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.................................................................................. 0
b. retain the right to designate who shall use the property transferred or its income;.................................... 0
c. retain a reversionary interest; or.................................................................................................................. 0
d. receive the promise for life of either payments, benefits or care?.............................................................. 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?......................................................................................................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?...................................................................................................................... 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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No
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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. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. S9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 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 P.S. S9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Harrison, Frederick L. Sr.
FILE NUMBER
21 - 07 - 00484
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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 2002 Buick (Private third party sale) 8,000.00
2 Veteran's Affairs contribution 100.00
3 PA State Camp Patriotic Order Sons of America contribution 75.00
4 Sovereign Bank Checking Account No. 3381137735 2,238.85
5 Soverein Bank Money Market Account No. 3384056744 10,245.85
6 Sovereign Bank Certificate of Deposit No. 3385171685 10,276.28
7 Sovereign Bank Certificate of Deposit No. 3385171693 10,276.28
8 Sovereign Bank Certificate of Deposit No. 338517719 10,276.28
9 HMA-Physicians Management Refund 57.75
10 Tax Refund (Commonwealth of Pennsylvania) 245.92
TOTAL (Also enter on Line 5, Recapitulation) 51,792.21
'.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Harrison, Frederick L. Sr.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 - 07 - 00484
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES:
A. 1 Hollinger Funeral Home & Crematory Inc. 385.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Griffie and Associates 2,750.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 326.00
5. Accountant's Fees Reserved for 2007 Personal Return 150.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs
Advertising - Cumberland Law Journal 75.00
,
TOTAL (Also enter on line 9, Recapitulation)
4,336.64
*'
Schedule H
Funeral Expenses &
Adminis1rative Cos1s continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Harrison, Frederick L. Sr.
I FILE NUMBER
21 - 07 - 00484
1
Advertising - The Sentinel
150.64
2
Reserves
500.00
Page 2 of Schedule H
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Harrison, Frederick L. Sr.
FILE NUMBER
21 - 07 - 00484
Include unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER AMOUNT
1 West Shore EMS 50.00
2 Carlisle Regional Medical Center 150.00
3 Carlisle Regional Medical Center 185.00
TOTAL (Also enter on Line 10, Recapitulation) 385.00
REV-1613 EX+ (9-00)
'.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Harrison, Frederick L. Sr.
I FILE NUMBER
21 - 07 - 00484
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF EST A T
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS [include outright sfrousal
oistributions, and ransfers
under Sec. 9116 (a) (1.2)]
1 Linda J. Horn Daughter 100%
121 Oriole Drive
Carlisle, PA 17013
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
E
LAtST l~VILL AtND TESTAtl\\fENT
OF
FREDERICK L. HARRISON, SR.
I, FREDERICK L. HARRISON, SR., of 26 Wheatfield Drive, Carlisle,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my Last Will and Testament,
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hereby revoking and making void all previous Wills and Codicils heretofore made by me.
FIRST
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I order and direct my Executor hereinafter named to pay all of my just debts,
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funeral expenses and expenses involved or connected with the administration of my estate
as soon after my death as is reasonably possible. I direct my Executor to pay all
inheritance, estate, succession and legacy taxes, to which my estate or the transfer of any
property hereunder may be subject, and to charge such taxes as part of the expenses of the
administration of my estate, being deducted and paid from the residue of my estate and
not to be deducted in any manner from any specific bequests made herein. However, my
Executor need not accelerate and pay those unmatured obligations which, in his, her or its
opinion, it might be proper and more advantageous to retain or renew and pay as they
become due and payable. If I do not own a burial plot or a grave marker at the time of my
death, I authorize my Executor/Executrix, in his, her or its sole discretion, to purchase a
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street
Carlisle, PA 17013
Page 1 of 8
100 Lincoln Way East, Suite D
Chambersburg, PA 17201
burial plot and to erect a suitable grave marker at my grave, and to expend sums from my
estate for this purpose.
SECOND
I give, devise and bequeath my entire estate together with all insurance proceeds
thereon of whatsoever nature and wheresoever situate to my daughter, LINDA L.
HORN, provided she survives me by sixty (60) days. I direct my Executor/Executrix to
divide among such beneficiaries all personal property of a sentimental or family nature
(excluding cash, stocks, bonds and the like), including but not limited to jewelry,
household goods, antiques, furniture and memorabilia, in accordance with a separate
memorandum which I may place with my Will or deposit with my attorney. In the
absence of such disposition by memorandum, I direct that the said tangible personal
property be divided between my residual beneficiaries with due regard for their personal
preferences in as nearly equal shares as practical, with the value of such dispositions
being credited to the share of each respective recipient. If the said beneficiaries do not
agree to the division of the personal property provided for hereunder, the decision of my
Executor/Executrix, including the decision to sell the property at public or private sale
and distribute the proceeds therefrom as provided hereinafter, shall be final and
conclusive on all parties.
THIRD
I have specifically not provided for any distribution of my estate to my children,
CATHERINE L. JOHNSON, FREDERICK L. HARRISON, JR. and SHARON L.
HARRISON, not out of want of affection, but because I have provided for them during
200 N. Hanover Street
Carlisle, PA.. 17013
GRIFFIE & A.SSOCIATES
A.ttorneys At LaH'
Page 2 of 8
100 Lincoln Vray East, Suite D
Chambersburg, PA 17201
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my lifetime as I desired.
It is my specific instruction and desire that there be no
additional distribution from my estate to my named children.
FOURTH
Should my daughter, LINDA L. HORN, predecease me or die on or before the
sixtieth (60) day following my death, then I give, devise and bequeath my entire estate
together with all insurance proceeds thereon of whatsoever nature and wheresoever
situate in equal shares to my son-in-law, R4.RRY J. HORN, provided he survives me by
sixty (60) days, per stirpes. I direct my Executor/Executrix to divide among such
beneficiaries all personal property of a sentimental or family nature (excluding cash,
stocks, bonds and the like), including but not limited to jewelry, household goods,
antiques, furniture and memorabilia, in accordance with a separate memorandum which I
may place with my Will or deposit with my attorney. In the absence of such disposition
by memorandum, I direct that the said tangible personal property be divided between my
residual beneficiaries with due regard for their personal preferences in as nearly equal
shares as practical, with the value of such dispositions being credited to the share of each
respective recipient. If the said beneficiaries do not agree to the division of the personal
property provided for hereunder, the decision of my Executor/Executrix, including the
decision to sell the property at public or private sale and distribute the proceeds therefrom
as provided hereinafter, shall be final and conclusive on all parties.
FIFTH
I grant my Executor/Executrix the following powers in addition to and not m
limitation of such powers as my Executor/Executrix shall hold by law:
GRIFFIE & ASSOCIATES
A..ttorneys At Law
200 N. Hanover Street
I Carlisle, PA~ 17013
100 Lincoln Way East, Suite D
Chambersburg, PA. 17201
Page 3 of 8
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(a) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
(b) To Jam m any corporation, partnership, recapitalization, merger,
reorganization or voting trust plan; to delegate authority with respect thereto;
to deposit investments under agreements and pay assessments; and generally
to exercise all rights of investors, including but not limited to, the voting of
shares.
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(c) To manage, operate, repair, improve, mortgage or lease on any terms any real - )._
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estate held or owned by my estate.
(d) To operate any business that I may own at my death.
(e) To invest any funds of my estate in any stocks, bonds, notes or other securities
or property, real or personal, without regard to the principle of diversification
or any other statute or general rule of law in his, her or its absolute discretion,
it being my intention to give my Executor/Executrix the broadest investment
powers possible, providing such investments do not unnecessarily prevent the
prompt settlement of my estate.
(f) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my Executor/Executrix shall see fit in his, her or its
absolute discretion.
(g) To borrow money for the payment of taxes or for any other proper purposes in
the administration of my estate, and to mortgage or pledge estate assets as
security.
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCI4TES
A.ttorneys At Law
Page 4 of 8
100 Lincoln Way East, Suite D
Chambersburg, PA 17201
(h) To compromise claims without court approval including, but not limited to,
any controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
(i) To distribute in cash or in kind upon any division or distribution of my estate.
G) To undertake any and all acts deemed necessary and proper by my
Executor/Executrix for the proper, advantageous and prompt management or
the settlement of my estate.
(k) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to him, her or it may seem best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last Will and
Testament.
SIXTH
No interest of any beneficiary of my estate, either in income or in principal, shall
be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall
any beneficiary have the power in any manner to charge or encumber his interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my ExecutorlExecutrix for the liability of such
beneficiary.
1200 N. H.anover Street
Carlisle, PA. 17013
GRIFFIE & ASSOCL4.TES
Attorneys At Law
Page 5 of 8
100 Lincoln Way East, Suite D
Chambersburg, PA 17201
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SEYE1\TH
1 nominate, constitute and appoint my daughter, LINDA L. HORN, as Executrix
of this my Last Will and Testament. In the event my daughter is deceased, unable or
unwilling to serve or shall cease to serve for any reason whatsoever, then 1 nominate,
constitute and appoint my son-in-law, BARRY J. HORN, as Executor of this my Last
Will and Testament. I direct that my Executor/Executrix shall not be required to give or
post bond for the faithful performance of his, her or its duties in this or any other
jurisdiction.
EIGHTH
1 hereby declare it to be my expressed desire that my Executor/Executrix employ
the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and
assistance regarding this my last Will and Testament, they having considerable
knowledge of my affairs, views and wishes respecting any matters that may arise at the
probate of this instrument, the administration of my estate, and the execution of the
powers herein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of eight (8) typewritten pages, the first five (5) of which
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bear my signature on the side margin, for purpose of identification, this ' .J..Y-
day of-7( t7'i ()vb)"l
,
, 2006.
WITNESS:
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FREDERICK L. HARRISON, SR.
GRIFFIE & _A.SSOCIATES
Attorneys At Law
200 N. Hanover Street
Carlisle, PA 17013
Page 6 of 8
100 Lincoln Way East, Suite D
Chambersburg, PA 17201
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA:
: SS.
COUNTY OF CUMBERLAND
I, FREDERICK L. HARRISON, SR., the Testator 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 and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the purposes
therein expressed.
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FREDERICK L. HARRISON, SR.
Sworn or affirmed and acknowledged before me by the Testator this
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NOTARIAL SEAl.
ROlIN J BASSETT
NolIry PuIlllc
CMUSlEBOROUGli, CUMlJERlANDCOUNTY
.., CommIJIioII E".17. 2007
200 I,T. Hanover Street
Carlisle, PA 17013
GRIFFIE & A.SSOCIATES
Attorneys A.t Law
Page 7 of 8
100 Lincoln Way East, Suite D
Chambersburg, PA 17201
AFFIDA VIT
COMMONWEALTH OF PENNSYL V A~l4.:
: SS.
COUNTY OF CUMBERLAND
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the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw the Testator sign and
execute the instrument as his Last Will and Testament; that he signed willingly and that
he executed it as his free and voluntary act for the purposes therein expressed: that each
subscribing witness in the hearing and sight of the Testator signed the Last \Vill and
Testament as witnesses and that to the best of our knowledge the Testator was at the time
18 or more years of age, of sound mind and under no constraint or undue influence.
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Sworn or affirmed and subscribeCloefare me by J~ Ill.:! c~ JJ.~ i. ')
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and "cSt (uJ /--{'l.--'{
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GRIFFIE & ASSOCIATES
Attorneys At Law
Page 8 of 8
100 Lincoln 1-"ay East) Suite D
Chambersburg) PA 17201
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SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
Page
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(1 )
(2)
Cash: Report totai only
Stocks: List in detail every common or preferred certificate, warrant or othel' rights found in box, Stocks are to be designated bv
name of company, certificate number, date of certificate, name in which stock IS registered, and number of shares and class of stock
Obligations of U.S, Government: Number of items, date of Issue, face value, names in which registered and type of ownershlD,
i.e, Jointly held, payable on death, etc
(3)
(4)
(5)
Bonds: Designate by name, amount, serial number, or othel' designation (Bearer Bonds)
Bank and Savings and Loan Passbooks: State name of depositor number of boo~, last date appearing in book. name of bank
and branch, and balance
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(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as pOSSible
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible
(8) All other contents.
(9)
Return completed form to:
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT 280601
HARRISBURG, PA 17128-060'1
ITEM DESCRIPTION
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I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS
CORRECT AND COMPLE ST OF MY KNOWLEDGE AND BELIEF.
SIGNATURE
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RIN I NAME AND CHECK APPROPRIATE BOX BE LOiN'
1 J'^c;U,., L. >( t"\
I ""nm ""Ii "/ n C",ec,^""Rm'",^" 00'
~ Executor(tnx) D Admlnlstrator(tnx)
D Estate Representative 0 Jomt owner of safe deposit box
NOTE: Attach additional 81[," x 11" sheet(s) if necessary or use duplicates of this page of form. i
The Department is authorized by law, 42 U,S,C, 3405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws, The Department uses the
Social Security number to identify the decedent and personal representatives of the estate, The Commonwealth may also use the information in exchange of tax information agreements
with Federal and local taxing authorities, The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for officiai purposes.
... Sovereign Bank
Su,(;ces.~is COTllich;"U:..:rt, Wi" ,:{~~ lx'dpJJ(ft.l,h1(..,1tiJf..:'1t;.rl>;
Court Ordered Processing / MA 1 MB3 02-10
P.O. Box 841005
Boston, MA 02284
May 30, 2007
Griffie & Associates
Attorneys and Counselors at Law
200 N. Hanover St.
Carlisle, P A 17013
RE: Estate of: Frederick L. Harrison, Sr.
Date of Death: April 18, 2007
Dear Mr. Griffie:
Per your request, enclosed please find the account information as of date of death for the
above-named decedent. Please note the balances do not include accrued interest.
If you should have any further questions, please do not hesitate to call.
Very truly yours,
r n c:---- ----.
~. / \ '. <. ---J.--'--'--
}'M~ r" .C>n~
,/ \' .' ,i, n ,
'\,,-,1 '-./ ~ .
"J \
Linda Spavento
T earn Leader
Court Order Processing
(617) 533-1789
(617) 533-1931-fax
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Frederick L Harrison Sr.
201-16-1267
April 18, 2007
Account #: 2894019633 Type: Savings
In the name of: Fred L Harrison, Linda L Horn POA
Date of Death Balance:
Int.(YTD) from 1/1/2007
Accrued interest to date of death:
Other Info:
Open date: 4/30/1998
to
$0.00
4/18/2007
$0.00
$0.00
Account #: 3381137735 Type: Checking
In the name of: Fred L Harrison, Linda L Horn POA
Date of Death Balance: $2,238.85
Int.(YTD) from 1/1/2007 to 4/13/2007
Accrued interest to date of death: $0.01
Other Info:
Open date: 2/17/2004
$2.57
Account #: 3384056744 Type:
In the name of: Fred L Harrison
Date of Death Balance:
Int.(YTD) from 1/1/2007 to
Accrued interest to date of death:
Other Info:
Money Market
Open date: 9/25/2006
$10,245.85
4/4/2007
$18.27
$156.43
Account #: 3385171685 Type:
In the name of: Fred L Harrison
Date of Death Balance:
Int.(YTD) from 1/1/2007 to
Accrued interest to date of death:
Other Info:
CD
Open date: 9/25/2006
$10,276.28
3/28/2007
$28.50
$133.91
Account #: 3385171693 Type:
In the name of: Fred L Harrison
Date of Death Balance:
Int.(YTD) from 1/1/2007 to
Accrued interest to date of death:
Other Info:
CD
Open date: 9/25/2006
$10,276.28
3/2812007
$28.50
$133.91
Page 1 of 2
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Frederick L Harrison Sr.
201-16-1267
April 18, 2007
Account#: 3385171719 Type:
In the name of: Fred L Harrison
Date of Death Balance:
Int.(YTD) from 1/1/2007 to
Accrued interest to date of death:
Other Info:
CD
Open date: 9/25/2006
$10,276.28
3/28/2007
$28.50
$133.91
Page 2 of 2