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Home My WebLink About12-14-07 (2) -.J 15056041125 REV -1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 7 File Number o 325 Date of Birth 209209732 03142007' 03141928 OLE K S A J 0 H N MI B Decedenfs Last Name Suffix Decedent's First Name (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 [:&J 1. Original Return D 4. Limited Estate [&J 6. Decedent Died Testate (Attach Copy of Will) D 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach Copy of Trust) o 10. Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULDrBi DIRECTED TO: Name Daytime Telecmone Numberg -=''-J, r ~ :J,; i_L.' 7 1 7 :]~ 7 ~ 7 (:;~Qj .~ I Q ('"') c"-; ;d~ REGIS~R -:}t~"!}LS Usp>NLY ; 23 . (.()7:':' o o 1 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes M E LAN I E W A L Z SCARINGI Firm Name (If Applicable) SCARINGI & SCARINGI, p C s3 ~~~ :0 }_2~ J:'lD :.x l First line of address 2 0 0 0 L I N G L EST 0 W N R 0 A D - . . Second line of address .c- O) Ii SUI T E 106 City or Post Office State ZIP Code DATE FILED-- H A R R I S BUR G P A 17110 Correspondent's e-mail address:MELANIE@SCARINGILAW.COM Under penalties of peQury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, conect and complete. Declaration of preparer other than the personal representative Is based on aU infonnation of which preparer has any knowledge. SIG~UJtE OF PERSON RESPONSI".E FOR FILING RETURN I DAT~ ~1n ~~~~ l'2rII~/{)7 ADDRESS 2544 GOLDEN DRIVE EAST PETERSBURG SIG R F PREP4RER 0 ADORE 2000 LINGLESTOWN ROAD, SUI E 106 HARRISBURG PLEASE USE ORIGINAL FORM ONLY PA 17110 Side 1 L 15056041125 15056041125 --1~ --I 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: JOHN B. OLEKSA RECAPITULATION 209209732 2. Stocks and Bonds (Schedule B) .................................. 2. 168000.00 130695.00 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 8. Total Gross Assets (total lines 1-7) .. .......................... 8. 4 4 8 2 1 . 8 9 2 3 0 6 7 . 0 9 1 5 6 3 3. 5 0 3 8 2 2 1 7 . 4 8 5 8 2 6 3. 6 5 1 6 5 2. 1 3 5 9 9 1 5. 7 8 3 2 2 3 0 1 . 7 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . . . . . .. 6. 7. Inter-VIVos Transfers & Miscellaneous N,QD;Probate Property (Schedule G) U Separate Billing Requested. . . . . .. 7. 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. 3 2 2 3 0 1. 7 0 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 o . 0 0 (a)(1.2) X 15. o. 0 0 - 16. Amount of Line 14 taxable 3 2 2 3 0 1 . 7 0 1 4 5 0 3 . 5 8 at lineal rate X .04..L. 16. 17. Amount of Line 14 taxable o . 0 0 O. 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable o . 0 0 o. 0 0 at collateral rate X .15 18. 19, Tax Due .... . .... ... " .. . . . . . .. ...... .. ...... ...... .... . 19. 1 4 5 0 3 . 5 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT [ZJ Side 2 L 15056042126 15056042126 .....J I _J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 07 0325 DECEDENT'S NAME JOHN B. OLEKSA STREET ADDRESS 3433 HAWTHORNE DRIVE CITY I STATE I ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) (1) 2. CrednslPayments A Spousal Poverty Credit 8. Prior Payments C. Discount 14,503.58 Total Credits (A + 8 + C ) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E) (3) 4. If Une 2 is greater than Une 1 + Une 3. enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Une 20 to request a refund. (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 14,503.58 A Enter the interest on the tax due. B. Enter the total of Une 5 + 5A This is the BALANCE DUE. (SA) (58) 14,503.58 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......... ... ......................... .............. ............... ... 0 00 b. retain the right to designate who shall use the property transferred or its income; - ............................... 0 [&) c. retain a reversionary interest; or ................................... ........ .............. ............................... ........ D 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 [Xl 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 lin trust for' or payable upon death bank account or security at his or her death? ......... D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................... ................ ......... ............. ............. ......................... lXJ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. ~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 zero (O) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemDt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax retum 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. ~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 four and one-half (4.5) percent, 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 twelve (12) percent [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. REV-1502 EX + (6-98) * SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN 8. OLEKSA 21 07 0325 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads. Real DroDertv which is JointJy-owned with riaht of sUlVivorshio must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 3433 HAWTHORNE DRIVE, CAMP HILL, PENNSYLVANIA 17011. APPRAISED BY PAUL ZEIGLER REAL ESTATE, 2550 KINGSTON ROAD, SUITE 321, YORK, PA 17402 SEE ATTACHED DEED AND APPRAISAL. YALUEAT DATE OF DEATH 168,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 168.000.00 i i I I I - [ REV-1503 EX + (6-98) * SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN B. OLEKSA FILE NUMBER 21 07 0325 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. DESCRIPTION SMITH BARNEY ACCOUNT#54J-00837-14-CF3. JOINTLY OWNED WITH PREDECEASED WIFE. FUND HELD IN THIS ACCOUNT WAS LMVfX. 34.796 SHARES. 000 VALUE $70.33. LESS DEBIT ON THE ACCOUNT OF $35.54 T. ROWE PRICE SERVICES, INC. - EQUITY INCOME FUND ACCOUNT 5001321624-2 481.025 SHARES. DOD VALUE $29.20/SHARE COMPUTERSHARE INVESTOR SERVICES - VERIZON COMMUNICATIONS, INC. ACCOUNT NO. C0006688152 - JOINTLY OWNED WITH PREDECEASED WIFE 897.917203 SHARES. DOD VALUE $36.28/SHARE COMPUTERS HARE INVESTOR SERVICES-COMCAST CORPORATION fCMCS ACCOUNT NO. C3013495679. HELD JOINTLY WITH PREDECEASED WIFE 183 SHARES. DOD VALUE $25.83fSHARE. COMPUTERSHARE INVESTOR SERVICES - AT&T, INC.lATT - ACCOUNT NO. C2005751619. JOINTLY OWNED WITH PREDECEASED WIFE. 3.563532 SHARES DOD VALUE $37.21fSHARE COMPUTERSHARE INVESTOR SERVICES - AT&T, INC.lATT - ACCOUNT NO. C3005058391. JOINTLY OWNED WITH PREDECEASED WIFE. 871.042145 SHARES DOD VALUE $37.21/SHARE COMPUTERSHARE INVESTOR SERVICES - AT&T, INC.lATT - ACCOUNT NO. C0010617359. INDIVIDUAL ACCOUNT. .996.476697 SHARES. DOD VALUE $37.21fSHARE ALCATEL-LUCENT/ THE BANK OF NEW YORK. ACCOUNT NO. 0014392526 129.6887 SHARES. DOD VALUE $11.93/SHARE VODOFONE GROUP PLCf THE BANK OF NEW YORK. ACCOUNT NO. 0000476382 218 SHARES. DOD VALUE $26.44/SHARE VALUE AT DATE OF DEATH 2,411.66 14,045.93 32,576.44 4,726.89 132.60 32,411.48 37,078.89 1,547.19 5.763.92 TOT At (Also enter on line 2. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 130,695.00 REV-1508 EX + (6-98) * SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN B. OLEKSA FILE NUMBER 21 07 0325 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. .9. 10. 11. 12. 13. 14. 15. 16. DESCRIPTION ROLLING GREEN CEMETERY; 1811 CARLISLE ROAD, CAMP HILL, PA 17011 2 SPACES REMAINING. VALUED BY CEMETERY AT $1195 PER SPACE SERIES HH SAVINGS BONDS (6 - $1000 BONDS JOINTLY HELD WITH WIFE, MARGARET C. OLEKSA WHO IS PREDECEASED). INTEREST WAS PAID TO THE BELCO COMMUNITY CREDIT CHECKING ACCT RATHER THAN ACCUMULATING SERIES HH SAVINGS BONDS (6 - $500 BONDS JOINTLY HELD WITH WIFE, MARGARET C. OLEKSA WHO IS PREDECEASED). INTEREST WAS PAID TO THE BELCO COMMUNITY CREDIT CHECKING ACCT RATHER THAN ACCUMULATING SERIES HH SAVINGS BONDS (2 - $1000 BONDS). INTEREST PAID TO THE BELCO COMMUNITY CREDIT CHECKING ACCOUNT RATHER THAN ACCUMULATING VALUE AT DATE OF DEATH 2,390.00 6,000.00 3,000.00 2,000.00 GUN COLLECTION - TROP GUN SHOP OFFERED TO PAY $1380 FOR COLLECTION TROP WILL TRY TO RESELL THE COLLECTION FOR $2575. VALUE TO THE ESTATE IS THEREFORE $1380 COIN COLLECTION. SOLD TO DENNIS R. ECKENRODE RARE COINS, INC. OF 20 EAST PENN AVENUE, CLEONA, PA 17042 FOR $5600 REMAINING CONTENTS OF HOUSE AND SAFE DEPOSIT BOX (NOT INCLUDING GUN COLLECTION, COIN COLLECTION, STOCK CERTS OR SAVINGS BONDS WHICH ARE ALL LISTED SEPARATELY HEREIN). ESTIMATE BY EXECUTRIX. HIGHMARK - FREEDOM BLUE PREMIUM REFUND 1,380.00 5,600.00 3,500.00 13.03 COMPUTERSHARE - IDEARC, INC. - DIVIDEND EARNED BY DECEDENT 'PRIOR TO DEATH. CHECK ISSUED AND CASHED AFTER DEATH. 15.07 COMPUTERSHARE - IDEARC, INC. - PAYMENT FOR SHARES TENDERED ON 2/26/07 AT THE RATE OF $33.6575/SHARE. CHECK ISSUED 3/7/07. CHECK CASHED AFTER DEATH, ACCOUNT #C0006688152 VERIZON - CREDIT BALANCE REFUND 1,425.93 16.96 AUTOMOBILE. 2001 BUICK CENTURY. SOLD FOR $2500 TO FREYSINGER PONTIAC, GMC, BUICK, INC. AFTER DOD. VIN#2G4WS52J611281018 KNIGHTS OF COLUMBUS - LIFE INSURANCE POLICY #075659. BENEFICIARY WAS PREDECEASED WIFE, WITH NO CONTINGENTS, SO ESTATE MADE CLAIM MEMBERS 1ST FEDERAL CREDIT UNION - SAVINGS ACCOUNT - JOINT WITH PREDECEASED WIFE. PRINCIPAL $169.67 + ACCRUED INTEREST $.06, ACCOUNT #173814-00 MEMBERS 1ST FEDERAL CREDIT UNION - CERTIFICATE OF DEPOSIT - JOINT WITH PREDECEASED WIFE. PRINCIPAL $600;16 + ACCRUED INTEREST $.80, ACCOUNT #173814-40 INSURANCE OVERPAYMENT TO ESTATE (PAYMENT $303.56 LESS INVOICE FROM AMBULANCE ON 12/28/06 OF $254.26). SERVICES RENDERED PRIOR TO DDD BUT PAYMENT RECEIVED AFTER DOD. 2,500.00 13,356.31 169.73 600.96 49.30 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 44,821.89 Continuation of REV-1500 Inheritance Tax Return Resident Decedent JOHN B. OLEKSA Decedent's Name Page 1 21 07 0325 File Number Schedule E - Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. FINAL PENSION PAYMENT -AUTO DEPOSIT. EARNED PRIOR TO DEATH. PAID 2,520.60 3/30/07. 18. SAFE DEPOSIT BOX CONTENTS (ALL CONTENTS WITH VALUE WERE LISTED 0.00 SEPARATELY ON THIS INHERITANCE TAX RETURN - EXCEPT POCKET WATCH WHICH WAS INCLUDED IN #7 ABOVE). 19. AUTOMOBILE INSURANCE REFUND 284.00 SUBTOTAL SCHEDULE E 2,804.60 GRAND TOTAL SCHEDULE E $ 44,821.89 REV-1509 EX + (6-9B) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF JOHN B. OLEKSA FILE NUMBER 21 07 0325 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. CHRISTINE M. ESHELMAN 2544 GOLDEN DRIVE EAST PETERSBURG, PA 17520 DAUGHTER B PATRICE A. TALEFF 662 ARLINGTON ROAD CAMP HILL, PA 17011 DAUGHTER c JOHN B. OLEKSA, JR. 341 T A TTLETOWN ROAD AARONSBURG, PA 16820 SON JOINTL y-oWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. C 2002 4 - $1000 SERIES HH SAVINGS BONDS. INTEREST 4,000.00 50. 2,000.00 WAS PAID TO DECEDENT'S BELCO COMMUNITY CREDIT ACCOUNT RATHER THAN ACCRUING 2. A&B 1956 BELCO COMMUNITY CREDIT UNION - CHECKING 1,244.79 33.33 414.89 ACCT NO. 12470 (000 $1244.54 + $.25 DIVIDENDS) 3. A&B 1956 BELCO COMMUNITY CREDIT UNION - SAVINGS 28,538.31 33.33 9,511.82 ACCT NO. 12470 (000 $28,506.13 + $32.18 DIVIDEND) 4. A&8 1956 BELCO COMMUNITY CREDIT UNION - 10 CDS 33,424.48 33.33 11,140.38 COMBINED 000 $33,210.64 + $213.84 DIVIDENDS) TOTAL (Also enteron line 6, Recapitulation) $ 23,067.09 T (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN B. OLEKSA FILE NUMBER 21 07 0325 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of theREV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INQ.UOETHE IWlEOFTHETRANSFEREE, THBRRELATIOHSHlPTO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OFlRANSFER. ATTACH A COPY OFnE DEED FOR REAl. ESTATE VALUE OF ASSET INTEREST ~F APPl.lCAILE) VALUE 1. KNIGHTS OF COLUMBUS - IRA SETTLEMENT 15,633.50 100. 15,633.50 CONTRACT - CERTIFICATE NO. 116868 - BENEFICIARY IS PATRICE A. TALEFF .' TOTAL (Also enter on line 7 Recapitulation) $ 15.633.50 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) * SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN B. OLEKSA FILE NUMBER 21 07 0325 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. NEILL FUNERAL HOMEI INC. (ADVANCED BY CHRISTINE M. ESHELMAN) 9,999.41 2. PEALER'S FLOWERS 480. 13 3. WEST SHORE COUNTRY CLUB (WAKE EXPENSE) 1,287.15 8. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) CHRISTINE M. ESHELMAN 19,110.00 Social Security Numbe~s)/EIN Number of Personal Representative(s) StreetAddress 2544 GOLDEN DRIVE City EAST PETERSBURG State P A Zip 17520 Yea~s).Commission Paid: 2008 2. AttomeyFees RICHARD SENECA ($1412.50); SCARINGI & SCARINGI, PC ($19,110.00) 20,522.50 3. Family Exemption: (If decedents address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees TO CUMBERLAND COUNTY REGISTER OF WILLS (ADVANCED BY 430.00 A TIORNEY SENECA) 5. Accountants Fees 6. Tax Return Preparel's Fees 7. PUBLICATION OF NOTICE - CENTRAL PENN BUSINESS JOURNAL 73.00 8. PUBLICATION OF NOTICE - CUMBERLAND LAW JOURNAL (ADV. BY SENECA) 75.00 9. CAMP HILL SCHOOL DISTRICT 2007/2008 REAL ESTATE TAXES (TO J. MILLER) 1,817.69 10. REAL ESTATE APPRAISAL TO PAUL ZIEGLER (ADVANCED BY ATTY SENECA) 200.00 11. ADDITIONAL DEATH CERTIFICATES (ADVANCED BY S&S, PC) 296.00 12. ADDITIONAL SHORT CERTIFICATES (ADVANCED BY S&S, PC) 92.00 13. ADDITIONAL DEATH CERTIFICATES $35 OF WHICH ADV. BY CHRIS ESHELMAN 53.00 14. GAS EXPENSE - UGI - TO 11/24/07 ($112.69 OF WHICH ADV. BY C. ESHELMAN) 1,130.64 15. IMPROVEMENTS TO HOUSE (CARPET, DRYVIT, PUMP FOR AIR CONDITIONER) 983.42 16. LAWN/ YARD CARE & MAINTENANCE - TO 11/15/07 494.00 17. VERIZON - PHONE BILL (18.05 OF WHICH ADVANCED BY C. ESHELMAN) 69.85 18. BOROUGH OF CAMP HILL FOR SEWER BILL 85.00 TOTAL (Also enter on line 9. Recapitulation) $ 58263.65 (If more space is needed, insert additional sheets of the same size) JOHN B. OLEKSA Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent Page 2 21 07 0325 File Number Schedule H - Funeral Expenses & Administrative Costs - 87. ITEM NUMBER AMOUNT 19. 20. 21. 22. 23. 24. 25. 26. 27. DESCRIPTION TRASH REMOVAL - PENN WASTE (89.22) AND TIGER (193.40) PA AMERICAN WATER TO 12/2107 YARD SALE ADVERTISEMENT TO PNCO (ADV. BY CHRISTINE ESHELMAN) BELCO COMMUNITY CREDIT FOR SAFE DEPOSIT BOX RENTAL PPL ELECTRIC UTILITIES CORP. TO 10/23/07 (255.01 OF WHICH ADV. BY C. E.) USPS-CERTIFIED MAIL FOR BONDS. (ADVANCED BY CHRISTINE M. ESHELMAN) ADMIN. EXPENSES (COPY, FAX, POSTAGE) (AOV. BY ATTY SENECA) ADMIN. EXPENSES (COPY, FAX, POSTAGE) TO S&S, P.C. TO 11/20/07 PRESENT OWNER LIEN SEARCH ON REAL ESTATE (ADV. BY S&S, P.C.) 282.62 253.33 33.20 45.00 368.74 5.94 12.80 38.23 25.00 SUBTOTAL SCHEDULE H-B7 1,064.86 REV-1512 EX + (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN B. OLEKSA FILE NUMBER 21 07 0325 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. GOLDEN L1VINGCENTER - WEST SHORE. (WEST SHORE HEALTH & REHAB CTR.) FINAL STATEMENT FOR LIVING COSTS IMMEDIATELY PRIOR TO DEATH. VALUE AT DATE OF DEATH 500.00 2. UROLOGY OF CENTRAL PA. P.O. BOX 7043, LANCASTER, PA 17604. FOR SERVICES RENDERED PRIOR TO DEATH IN THE AMOUNT OF $205. LESS 100% REIMBURSEMENT FROM INSURANCE OF $205. 3. A & M SERVICE CENTER FOR CAR INSPECTION - SERVICE ON 2/28/07 ADVANCED BY CHRISTINE M. ESHELMAN 0.00 240.62 4. 2007 COUNTY AND TOWNSHIP REAL ESTATE TAXES TO JANET MILLER. CHECK DATED PRIOR TO DEATH BUT CASHED AFTER DEATH. 844.11 5. LEGAL FEES TO RICHARD SENECA FOR UPDATES TO ESTATE PLANNING DOCUMENTS PRIOR TO DATE OF DEATH 62.50 6. 2007 PERSONAL TAX TO JANET MILLER. CHECK DATED PRIOR TO DEATH BUT CASHED AFTER DEATH. 4.90 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 1 652.13 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OFPERSON(S) RECEIVING PROPERTY Do Not List Tru$tee(s} OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under See. 9116 (a) (1.2)] 1. CHRISTINE M. ESHELMAN Lineal 105,067.24 2544 GOLDEN DRIVE EAST PETERSBURG, PA 17520 2. PATRICE A. TALEFF Lineal 120,700.75 662 ARLINGTON ROAD CAMP HILL, PA 17011 3. JOHN B. OLEKSA, JR. Lineal 96,533.71 341 T A TTLETOWN ROAD AARONSBURG, PA 16820 . . ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COV~R SHEET $ REV.'513EX<* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOHN B. OLEKSA SCHEuULE J BENEFICIARIES FILE NUMBER 21 07 0325 (If more space is needed, insert additional sheets of the same size)