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HomeMy WebLinkAbout01-22-08 (2) -I 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 File Number 207 1 4 2 Date of Birth 278247503 032 1 200 7 1 2 1 9 1 9 2 7 Decedent's Last Name Suffix Decedent's First Name MI Hal G 1 a d e (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 [&I 1. Original Return o 4. Limited Estate 00 o 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes W i a m Firm Name (If Applicable) R Swinehart E s q 570 286 777 7 REGISTER OF WILLS USE.ONL Y W i e s First line of address MuoloNoonSw n e h art y 240- 246 Ma r k e t S t r e e t Second line of address City or Post Office State ZIP Code PA.1jE FILED [,) ,;>" ~...~ Sun bur y PA 17801 Correspondenrs e-mail address: Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, ij is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSO RESPO LE F R FILING RETURN D TE J. '17/fPr ADDRESS 716 Twin Hill Road S T~~~REPRESENTATIVE ADDRESS 240-246 Market Street Sunbu PA 17801 DATE I"'I"}.~ ? Sunbury PLEASE USE ORIGINAL FORM ONLY PA 17801 Side 1 L 15056041125 15056041125 -I ~ --.J 15056042126 REV-1500 EX Decedenfs Name: Glade Hall RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous N,2D;Probate Property (Schedule G) U Separate Billing Requested . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 11. 'Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) " '" ........ ..... 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a}(1.2}X.O _ 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .012- 5 9 6 8 2 . 2 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ... . . . .., " . . ........... . .,. . .... . ..... . . '" . " . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 ~c: ~ ~:t::> ~t7 Decedent's Social Security Number 278247503 60000.00 3 6 7. 2 0 6 0 3 6 7. 2 0 6 8 5. 0 0 6 8 5. 0 0 59682.20 o . 0 0 59682.20 o . 0 0 2685.70 o . 0 0 o . 0 0 2685.70 D 15056042126 .....J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 07 1142 DECEDENTS NAME Glade Hall STREET ADDRESS 3018 Thome Road CITY I~TE I ZIP Seneca Falls 13148 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 2,685.70 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penal~, T otallnterest/Penalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in avalon Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 2,685.70 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) A. Enter the interest on the tax due. 2,685.70 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 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an Oin trust for" or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (Ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the stEtutOry 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. 99116(a)(1.2)1. 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)l. 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)J. 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 Glade Hall 21 07 1142 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 iointlv-owned with riaht of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION All those two (2) certain lots ofland siuate in Lower Frankford Township, Cumberland County, Pennsylvania, as follows: VALUE AT DATE OF DEATH Parcel Number 1: Containing one and Two Hundred Five Thousandths (1.205) acres, more or less, and being described according to a subdivision plan for Francis X. Bender, Jr. by GJ. Betz, R.S. dated February 1, 1977 and recorded in Plan Book 30 at Page 87, and being designated as lot numbered 5, Section A; Parcel Number 2: Containing One and Two Hundred Five Thousandths (1.205) acres, more or less, and being described according to a subdivision plan for Francis X. Bender, Jr. by G.I. Betz, R.S. dated February 1, 1977 and recorded in Plan Book 30 at Page 87, and being designated as lot numbered 6, Section A; 60,000.00 Proceeris of Sale (see attached settlement sheet) ; I TOTAL (Also enter on line 1, Recapitulation) \ $ (If more space is needed, insert additional sheets of the same size) 60,000.00 ( I I. FHA SeIlI_ Sl8Iema . u s. 0 0/-'. IIId Urblll o...l Form U8 H\JD . 1 I )2.~ 8. F;1e ........... RE2lII7 7. lINn IUnbIr F'.~ No.. 1 L MaIlpgaI_ ( ) 3. Comt. Ihtn. C_ ,..,. ~ l .VA 5. CcIw. ..... Co Thlllarm II bnlIIIed 10 . ....... ,he .. ~....1W 1nlorm.1DnaI """"'_..... lOW not ftllld"ln 1Ie- p.o.Co _ 0...... 01 D. H_ _ Addr.-olllomJ... &. "'-... AcIdr_ 01 SdIr: Haft' .. DLSOJr Daft ~ GLADS .. DJiL 16 'l'1. '1'0. CIJlC~ C/O 1It:LLDII.. SWIIIIDJl2 CAIlLISU, PA. 17015 2tO-24' ~ S~ 5U111UU, PA. 17801 TIN F. N_1IId AdchN 01 LoIndtr (J, ~~ U. . 137 au .ILL RoaD RO". LO'IS 5 . . BUDD IV8DXV:tlIOIr, .. 30, PG 87 LOND t"UIID'Qa 1!01lIIIUP CIlICInLUD ~. .....n.vum H. SIItr'I ~I Aganr. Fau: a 'UL.~ L SIlIInwIl 0aIa: ,.. 01 .......... 9 souU IlaBOY_ 5t;. Ja1l1la1l7 11, 2001 5 SOV'l'II IWIDVa nun TIN 25-1730531 Cadide. 'A. 17013 CULI8LIl. "'1n.VU%& P you IIaI 01__......,.,. COlla. Amounla paid '" _ by'" ___.. _ II-... ......",......"1 )' J. SUMMARY OF BORROWER'S TRAN9ACTtON It. SUMMARY OF SllLLER'S TRANSAC'nOCll 100 aro. ...._llUa../IIIII ~ 101 Col*___ lot F'InonaI p/lllllllr 103 SIIlIImInI c:twgeo loam II.. 1400) 104 105 40lI ............ ~To.... &0,000.00 401 ConnIISIIaa.... 401 ,....... '*"*" 1,278.00 AlII .tOe 401 ~ ......."'........- - ~.... 10: <<IT eoo.nty ra.. IOl 401 __ 10: U7.20 _ 'ha 'ro-Ratioa ~o IS-Jaa-OI 41D 411 411 &1, 't5. 20 ... er..".... Dua 10..... A"-"''-pIIld",._,,_ 'Do CIIy""""'_ 10: \07 C...., _ 10: 101 __ra lD: .08 1'0 'C'o-Rati_ to 15-010-01 tlO III 112 120 Or-. Ant_. llUa..,.,. Bo_ -=--=-- 200 _......., a... .......or___ 201 DIflClIi''''___ 202 F'rlnClpll_ III new~" 2113 ExIIllng laen(a) _....111 204 201 206 207 201 201 - ~1II__DuaTll'" SOl e-.... <-lr--..) 5CII ,.....~.ID _ (11M I. SIll e-.IOIII(aJ............ III 5CM ...,.. 01..........._ 501 ...,.. 01_ ............. 501 fIR 501 501 ~"-upM/IlIy ,.,., 510 ~.... 10: 511 eo.ny_ 10: 5.2 __ 10: 51' lIUVBD 514 13S out BILL 1m ... ($275.00) IfUVD 5/1 137 au JlILL LOt! ...., ($275.00) 51. !IOU 511 SBCUUn D-.o8%7 135 cwr BILL NO" 51' SBCVUn Daoarr U7 OAK BILL 51. o . 00 520 ToIIII AoduclIan. '0 AmI Due s.lI. ~ lor _ upa/d","'" 2.0 CIIyII""",'_ 10: 21 . CounlI' ~ ro: 212 __ 10: 213 2'4 1350U OLL ~ 1lU'I ($275.00) 215 U7 OAIC .xu. un MII'1' ($275.00) 21' 217 SIlCUll:r~~ DIPOSn:' 135 OAIC IlILL 211 SECllltIn DUOSII' 137 OAIC BILL 219 220 T_ PIId ByJI'or lorroww ======~=-- 300 CUll Al ''''_l'fomITo 8_ JO' G,,*.IIIOIII''''U. 'rom barro_ (fino 120) 302 L.......1lIIllI poId byIlor _ tllOlll II.. 220) lDI Cult eX)""" ( ) To Bo~ 600 eaall AI !I4IIIIonanI1'oII'rom .... 51, U5 .20 801 G'a...'_nllO..... flam (In. 420) I /0 . 00) 802 LoIn rwluI:IonI in lUIIIU1l cMI ,.... (from 'M 520): U, US .20 SaI C..( )1'rolII (X) ToSlllllr I =-=========-- pMI '0,000.00 367.20 60,367.20 - 3,315.70 lfJU:VD lQU:VD NO" BOn 3,315.70 =--=-~ 60,3&7.20 /3.315.70) 57,051.50 ===-:.a:::z:::::::=:2I.- IHlJD.l 700 TOIlI Sa/eslBtobr'a Comm. based on price: Division 0/ Commls3lon ("", 7(0) as (ollows: 10 10 L SCTTLEMENT CHARGES 60,000,00 " . 0.00 Plld From Borrower'1 Fundi It s._nt 701 702 703 704 ConvniSIJiOn paid at Sett1emen1 SELL2R 'HARRlUlTS NO REAL!rY COMMISSIO. DUB. 705 BOO /lems Payable In Connection With Loan: (Morlgage AmI: .00 , .00 , 0.00) 801 Loan Originallon Fee B02 loan Discount 803 Appraisal Fee 804 Cred,' Report 805 Lende"s Inspection F.. 806 Monglgl InsurlW1C8 Applleallon Fee 807 Assumpllon F.... 8ce 809 810 811 900 lIema Required By Lender To 8e Paid In Advance: 9Q 1 In'oresl From 10 0.00 0.00 '0 10 to to to per day . 902 Mangag. Insu""",,, p,.mlum lor 903 Hazard Inswanc. Premium for month, to yells to years 10 904 005 1000 Reserves Deposited With Lender: 1001 H...",d insurance 1 002 Morlglge insurance 1003 City propeny lax.. 1004 Counly prop.ny I.... 1005 Annual ....,men's 1006 1007 School 18"'" 1008 1100 Title Charges: 1101 SeI1Iem.nl orcrosng 'ee 1102 AbslraC1 or IItle..lII'Ch mOL ,. mos. . mos. . mos. t9 mos. t9 mo.. <It mos. (f mos.~ pQl' month per month por monlh por month pet mon.. per mortlh per menII1 Pilr mOr11h 10 10 1103 r.u. ..aminallon 1104 Ti~"n...rance binder 1105 OocrJrl\el\l preparalion 1106 NotIory t.... 1107 Anomoy'st"". Oneludes abOve itema numbers: II ce nae 1".",,_ (Includ.. _ i10ms numbers: 1 109 Londer's Coveragl 1110 Owner. Coverage 1111 1112 1113 1200 Government Recording and Trans!er Charges: 1201 Recortlng f_: Deed $ 7 8 . 00 ; 1202 Cltylcounly/stamps: Deed $600.00 : 1203 Stalelaxl.lamps: Deed $600.00 ; 10 10 10 10 10 FRSY ABJ) TILEY 600.00 to Closing SlONlce Lefter (Frey & nloy lor Comw1th. Land n~el SO $60,000 : ReIe.... 78.00 600.00 Mortgage: Morlgego: $ Morigllgl: $ 1204 1205 1300 AddlUonal Settlement Charges: 1301 Survey 10 1302 Poalln.plCllon to 1303 Current Ta.es due from a."owerlSeler 1'- 1305 fA INHERITANCE TAX - TO REGISTER OF WILLS: 1306 FILING FBE FOil INHEIUTARCE tAX RI!:TUIlH - ~ llEGISTBll OF 'HILLS 1307 FILING FEE FOil INVENTORY - TO llEGZStER OF lfILLS 1400 Total Settlement Charges (enter oollnes 103, Section J and 502, Seclion K) 1,278.00 Page No. 2 Paid f,am 700 Seu.'. Fund. at 701 Sellle",.... 702 703 704 705 800 801 802 803 804 805 806 807 808 3 810 811 900 901 902 903 904 905 1000 fOOl 1002 1003 1004 1005 1006 1007 10ce 1100 1101 1102 1103 1104 1105 1106 P.O.C. 1107 1106 1109 1110 1111 1112 1119 1200 1201 1202 600.00 1203 1204 1205 1300 1301 1302 1303 1304 2,685.70 1305 lS,OO 1306 l5.00 1307 3,315.70 1400 /HUD-I Pagl NQ. 31 CERTIFICATION I direct and authorize 1Ile Comptlay 10 make cistribulions Indicated lor my acx:ounl on the attached HUD.1 SellIemanl Statemenl, approvlng the tax proralkms indICated therain, and LI'lderstand that prorallons wala based on flgures lor the precedlng year, or esllmotas for the current year, and in the BYent 01 any change for the ClllTen! year. all neC8ss8IY adJBS1n1enls must be made between SeJler and Borrower direct; likewise any DEFICIT In delinquent laxes will be reimbursed to Attomeymtte by Selier. I have carefully ravlewed 1IIe HUD-1 Setttemenl SlaIement and to !he beat of my knowledge and befoe/,Ills a true and accurate statemenl of all receipts and disbursllIIl8nls made on my account or by me in this lransac:llOll. Ilurther certify thaI I have received a copy of the HUO-1 Selllement Slatemenl. 9 f/~ Borrower. ~k(AjLf1ftJYJ ~ Selle.. To the best 0' my knowledge, !l1e HU0-1 Settlement Statement which I have prepared Is a true and aCCIJrale account of lI1e funds whiCh were received and have been or will be disbursed by !he undersigned lIS part 0' the settlement of !hie transaction. #(J_7:~ S .", III ~. d C;; .J<'.tP,,9j> Date WARNING; tt ia a crime 10 knowingly make falsa statamenls to lI1e United Stalea on this or any other similar form. Penala.s upon conviction can Include flne and Imprisonment. For details see: Title 18 U.S. Code Seellon 1001 and SeelIon 1010. INFORMATION REPORnNQ ON REAL ESTATE TRANSACTIONS THIS HUO SETilEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMATION (BOXES E. G. H. I. M AND LINE 401) AND 1$ BEING FURNISHED TO THE INTERNAL REVENUE SERVICE. IF YOU ARE RECUIRED TO FILE A RETURN. A NEGLIGENCE PENALTY OR OTHER SANCTION WILL BE IMPOSED ON YOU IF THIS ITEM IS RECUlRED TO BE REPORTED AND THE INTERNAl REVeNUE SERVICE DETERMINes THA T IT HAS NOT BEEN REPORTED. Solicll8llon 01 nN Sell.r is required by law to provida the Allomey/Cornpany with hiSl!wr COlt8c:1lallpayer ldentiflcation nlImb.... If correct taxpayer identitlcaUon number Is nOI provided, he/she may be subject 10 civ" or criminal penalties Imposed by law. Certll\catlon 01 TIM ItfICalion number shown in Ihls statemanlla my correcllaxpaYlr Identiflcallon number. TAX PRO-RATION ADDENDUM Dafe of Pro-Ration: Borrower Sell... ASSESSMENT, $51,420.00 (COMBINED) 2007-2008 Scheel Rell E.tOle Tax 2007.2008 School Rail e.lal. Tax- Face ~007-2008 School Raal e.t.... T.... POI Day 168 Day. Pre-paid = 14.194 m~ls $829.21 52.26560 $380.62 P.O.C. JMUlry 18. 2001 See SelIlellllnt Slleet Line. Numbers 110, 410 _ 1303 for Re.'hI of 111'. Addendum. 2008 CO. & Twp./BOr. Real ESlal. Tax EST. 2008 CO. & Twp./Bor. Real Eolate Tax- Face EST. 2008 CO. 8. Twp./Bor. Real E&1a18 Tax- Per Day EST. 14 Oay. Pre-paid = 2.645 mi~s $154.52 $0.42334 $5.93 P.O.C. Purchaser owe!: 168 Days pro-paid School Less 14 DaY" pr.."aid Co. 8. TwpJBor. Lass 2~. discount 380.62 15.93) 374.69 7.49 367.20 REV-1508 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Glade Hall FILE NUMBER 21 07 1142 Include the proceeds of litigation and the date the proceeds were received by the es';ale. All property jointly-owned with right of sUlVivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Adjustments for items paid for in advance in connection with the sale of real estate, as follows: Pro-ration of real estate taxes VALUE AT DATE OF DEATH 367.20 TOTAL (Also enter on line 5, Recapitulation), $ (If more space is needed, insert additional sheets of the same size) 367.20 REV-1511 EX... (12-99) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Glade Hall SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 07 1142 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: ~ 2. Attomey Fees i 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) I Claimant ~ Street Address ~ City State Zip I Relationship of Claimant to Decedent \ 4. Probate Fees Cumberland County Register of Wills 55.00 5. Accountant's Fees , 6. Tax Retum Preparer's Fees I 7. Cumberland County Register of Wills, Agent - 1 % realty transfer tax 600.00 8. Cumberland County Register of Wills - inheritance tax return & inventory filing fee 30.00 , I - TOTAL (Also enter on line 9, Recapitulation) i $ I 685.00 (If more space is needed, insert additional sheets of the same size) ""'-"" "'. '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Glade Hall SCHEDULE J BENEFICIARIES FILE NUMBER 21 07 1142 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. Rebecca Rorke Lineal 716 Twin Hill Road residue of estate Sunbury, PA 17801 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 1. None 0.00 B. CHARiTABLE AND GOVERNMENTAL DISTRIBUTIONS I 1. None 0.00 I I i TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) $ 0.00 STATE OF NEW YORK) SURROGATE'S COURT) COUNTY OF SENECA) Control# 28 EXEMPLIFICATION FILE#: 2007-22194 FILE NAME: Glade Hall I, Rosemarie Capozzi, Chief Clerk of the Seneca County Surrogate's Court, being a Court of Record, do hereby certify that the copies of the documents listed below, were compared to the original records of the Court filed in the Surrogate's Office of the County of Seneca, and in my care and custody as the Chief Clerk of the Surrogate's Court, and that the same are full, exact and correct transcripts therefrom, and of the whole of each original record. Last Will and Testament of Glade Hall, deceased, dated Feb. 6, 2001, late of Seneca Falls, Seneca County, New York (Date of Death March 21,2007) (Date of Probate Oct. 25, 2007); Petition for Probate and letters Testamentary filed Apri/10, 2007; letters Testamentary issued Oct. 25, 2007 and filed Oct. 31, 2007 and Decree of Probate dated Oct. 25, 2007 and filed Oct. 31, 2007 STATE OF NEW YORK) SURROGATE'S COURT) COUNTY OF SENECA) ;.',,','\!.H'i "'ft ,:'~ 'r'~" "'i .\.~. ~~.-".,.~Iqt~~/;I' .. - .> ''$ . ,'"., ..'~ .... _ "t. -I ~ ,,;,..' .... ".t.~~ :1'[1! 1.. .1" · .~~ ~ '~4 /' ,. ~ If< · ~ :~.. '~(l; \. ~ ...: J '~- ~ ;. J' w{ : ,.". '.1'" f'L. '1' : ~ ~ . ". ..- ",. .. . . . .~ . IN TESTIMONY WHEREOF, f have hereunto set my hand, and affix the seal of the Seneca Surrogate's Court on November 27, 2007. ./) // /' ~ 1.... .r,' Rosemarie Capozzi, Chief Cler ':,.,/ I, Dennis F Bender, Presiding Judge of the Surrogate's Court, do hereby certify that Rosemarie Capozzi, the person attesting the above certificate, is Chief Clerk of the Surrogate's Court, that his/her signature to the attestation is genuine, that he/she is the legal custodian of the records and files of the Court, and that the certificate and attestation are in due form. STATE OF NEW YORK) SURROGATE'S COURT) COUNTY OF SENECA) ....t- i I...., 'd\\O''I. ~~~q~>"", ." rd"> .' -~ ~~" "-:.; .1 ~!# .... .t. ......, t /r~ i 1.....II~, ~~\ : q.. ~ 'I. (, t.. \l!"t .. ..,/, ~ . .,.. : '>~~ \ ,< ,;' .:;:- f ., t.JI ... ."1-- .. , ....: ~, if I' -.'. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the Seneca Sutrogate's Court on November 27,2007. ., / / I I .' ;l Dennis F Bender, Surrogate I, Rosemarie Capozzi, Chief Clerk, of the Seneca County Surrogate's Court, do hereby certify that the Honorable Dennis F Bender, is the Surrogate of Seneca County, duly commissioned and qualified, and the Presiding Judge of the Surrogate's Court, and that his/her signature to the foregoing certifj' '" uine. . I. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the Seneca Surrogate's Court on November 27, 2007. Rosemarie Capozzi, Cli1ef CIeri( (Facsimile signature may LIe used pursuant to Section 2609 of the Surrogate's Court Procedure Act) . C2CO)';((), / 9 .. JLast Will anb \lCestament 3J, GLADE HALL of the Town of Seneca Falls, in the County of Seneca and State of New York being of sound mind and memory; do make, publish and declare this my last Wtll anb rEestament, in manner fOflowing, that IS to say. jf t rst. I direct that all of my Just debts, funeral expenses, all expenses in the administration of my estate, an all inheritance taxes, if any, be paid out of the residue of my estate, without apportionment among the legatees and devisees hereinafter named. ~econb. All of the rest, residue and remainder of my estate, both real and personal and wheresoever situate, I give, devise and bequeath to my daughter, REBECCA LYNN HALL, absolutely and forever ij[btrb. For reasons personal to me, I am providing no bequest to my four children, Glade Hall. Jr., Daryl Jean Anderson, Ellen Louise Leo and Lawrence Andrew Hall jfourtb. For reasons personal to me, my former wlfe, Virginia Jean Talcott, whom I was divorced from in the 1970's, is to receive nothing from my estate. jfdtb. I direct that my Executrix hereinafter named serve without bond or other security for the faithful performance of her duties. ,_: -...; CIl ~,l ~ --'-' .::J .( ., JLa5tlp., I hereby appoint my daughter, REBECCA LYNN HALL, If living, If not. my friend, Lee M. Brandt, executrix of this, my last Will and Testament, with full power and authority to sell and convey, lease or mortgage real estate; hereby revoking all former wills by me made. 3Jn 'Witness Wbereof, I have hereunto subscribed my name the loTI:! day of February, in the year Two Thousand and One. ./.'JJ~ IJ~ GLADE HALL We, whose names are hereto subscribed, 1190 ~erttf!, that on the &:,-rtftay of February, 2001, GLADE HALL, the testator above name, subscribed his name to this Instrument in our presence and in the presence of each of us, and at the same time, in our presence and hearing, declared the same to be his last Will anb mestament I and requested us, and each of us, to sign our names thereto as witnesses to the execution thereof. which we hereby do in the presence of the testator and of each other, on the day of the date of the said Will, and write opposite our names our respective places of residence. ~AJ~ reSidingat_Wa-~,~,~~ C" h~ t :1'1-'1' " .. r~-,{ . '. . ........, ,I ,.l -, ..... j',., I" r ( 0'1/.'<. f ;k .' /. ..,.... / v" I (l</ ~{ t...J . I' , ( , \ "'-.- .....-.. residing at {)t {,~ ~,. \ C)oo7-d-ozA~ . ~ ,.,"- AFFIDAVIT OF WiTNESSES ~)'.~i : SU~r- ~ ,if STATE Of NEW YORK, COUNTY OF SENECA, 5S. Each of the undersigned, Christine A. Deal'07 ,QPR 10 f' j: I residing at 2874 County Road 121, Seneca Falls , and Richard E. Swinehart residing at Packwood Road, Waterloo respectively, being individually and severally duly sworn, did depose and say that: The foregoing last will and testament was subscribed in our presence and sight by Glade Hall, the Testator named therein. The undersigned witnessed :he execution of said will of Glade Hall on ':he 6th day of February, 2001, at 54 FALL ST, PO BOX 299, SENECA FALLS, NY 13148-0299. At the time the instrument was so subscribed, the Testator declared said instrument to be his last will and ~estament. The undersigned thereupon signed their names as witnesses at the end of said will at the request of the Testator, in the presence of the Testator and F:21ch ocher. At r:he time of so executing said will, in our cespective opinions, the Testator was at least eighteen years of age, and 'Nas of sound mind, memory and understanding, under no constraint, duress, fraud or undue influence, and in no respect incompetent to make a valid will. In our respective opinions, the Testator was able to read, write and converse in the English language, and was not suffering from any defect of sight, hearing or speech, or from any other physical or mental impairment which ItJOL:ld affect his capacity to make a valid will. Each of us 'Nas acquainted with the Testator, and we make this affidavit at his request. Said will was shown to us at the time this affidavit was made, and we examined it as to the signature of the Testator and our signatures. Said will was executed as a single, original instrument, and not in counterparts. Said will was executed by the Testator and witnessed by us under the supervision of RICHARD E. SWINEHART, an attorney-at-law admitted to practice in the State of New York, who stated that the formal requirements of the New York Estates, Powers and Trusts Law regarding the ceremony of execL:tion and aetestation of a will had been l~~ed_and sati3fied. Witness rh!fJ.-~f]{.~ Xi ,J[~JL Witness =e'ler'ally subscribed3.nd s't/orn February, 20Cl. ,-~",-.tIJ-L It,-el;t~ U . t::ljuJ--{>7~' to before me this 6h day of ANTOINmE D. LARSON NOTARY PUBLIC, STATE OF NEW YORK QUALIFIED IN SENECA CO~!'f').~O}~ 0 I MY COMMISSION EXPIRES ~