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Home My WebLink About02-01-08 . t -riiI!I- '.1 -I 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 21 07 1007 Date of Birth 215-28-1757 11/04/2007 11/06/1930 Decedent's Last Name Suffix Decedent's First Name MI Coldren Virginia M (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 La; 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate 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 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 NumbW) <eo 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes Andrew H. Shaw, Esquire Firm Name (If Applicable) (717) 243l- B 35 '-," REGisTEiiiOF-W'L.L.~roilE oN!..Y . to' :::- :~ '"'^ ;"IC I Law Office of Andrew H. ShawJ P.C. First line of address 200 S. Spring Garden St. -;1 Second line of address 'J.) Suite 11 City or Post Office State ZI P Code (::j DATE FILED Carlisle PA 17013 Correspondent's e-mail address:ashawlaw@comcast.net Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge. DATE e:2~/-O'g ADORE DATE ..2-/- Og /7) /70 3 L 15056051058 Side 1 15056051058 --.J l --.I 15056052059 REV-1500 EX Decedenfs Name: VirginiaO M Coldren 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) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 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 tihe spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .O~ 16. Amount of Line 14 taxable at lineal rate X.O 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 0.00 15. 555,491.39 16. 0.00 0.00 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 215-87-1757 Decedent's Social Security Number 15056052059 162,675.00 0.00 0.00 0.00 15,558.48 0.00 382,907.73 561,141.21 3,928.47 1,721.35 5,649.82 555,491.39 0.00 555,491.39 0.00 24,997.11 0.00 0.00 24,997.11 .....J REV-1502 EX+ (6-9* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Virginia M. Coldren FILE NUMBER 21-07-1007 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 facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 6 Strawberry Drive, Carlisle, PA 17013 162,675.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 162,675.00 . ~EV-150,8 E;+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Virginia M. Coldren FILE NUMBER 21-07-1007 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 Personal Effects VALUE AT DATE OF DEATH 500.00 2 2002 Buick LeSabre 7,985.00 7,073.48 3 PNC Bank Account # 51-4018-2558 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 15,558.48 Kelley Blue Book - Private Party Pricing Report - Buick, LeSabre III Kelley Blue Book . ":"'!~IJS!.ED.~~~~ advertisCl'nent. Quick Dealer Price Quote Search Used Car Listings -;[--~~I;P"-.!l:"'~r USED CARS '1 Home> Used Cars> 2QO. > 6uiCk > ke500re > C.ustom Sedon 4D > Equipment 2002 Buick LeSabre Custom Sedan 40 Trade-In Value Private Party Value Suggested Retail Value Photo Gallery Compare Vehicles NEUJ! Review Consumer Ratings Find Your Next Car Specifications ~ Shopping Tools Free CARFAX Record Check Auto Loan from 6.65% APR Compare Insurance Rates Payment Calculator Extended Warranty Quote Print For Sale Sign BUY A USED (AR on Blue Book Classifieds'" Buick LeSabre 30 Miles or less ZIP Code 17013 To View Ads, Click SEll YOUR USED (AR on Blue Book Classifieds'M Reach millions of shoppers on kbb.com, Cars.com, and other popular sites. Find out more, Click FIND THE RIGHT CAR Compare Used vs. New $5,000 to $10,000 Both New and Used Sedan To View List, Click BLUE BOOK';; PRIVATE PARTY VALUE Condition, Excellent Good Fair NEXT STEPS: Search local listings Sell Your Sedan Value $8,575 $7,985 $7,260 Read Reviews Change Equipment Dual Front Air Bags Front Side Air Bags ABS (4-Wheel) Power Seat Page 1 of3 List Your Car for Sale FINANCING & INSIJRANCE Print This Page @ Estimated Payments $ 158 Imo @ 6..~50f0 APR Get a Pre-Owned Loan from 6.65% APR Your Credit Score for Free Get a Free Insurance Quote advertisement http://www.kbb.comlKBBIU sedCars/PricingReport.aspx?Manufacturerld=7 & Y earId=200... 11/7/2007 More Photos Average Consumer Rating (61 Reviews) Vehicle Highlights Mileage: Engine: Transmission: Drivetrain: 21,000 V6 3.8 Liter Automatic FWD Selected Equipment Standard Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FM Stereo Cassette Optional Kelley Blue Book - Private Party Pricing Report - Buick, LeSabre VIEW ANOTHER VEHIClE Single Compact Disc Select Year... Blue Book Private Party Value Or Search by Category Or Change ZIP Code Private Party Value is what a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "As Is" and carries no warranty (other than the continuing factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. Vehicle Condition Ratings Check Vehicle Title History Excellent [lOr~lr_l(1 $8,575 ''Excellent'' condition means that the vehIcle looks rlf:W, is in (IKce!l('nt rnechamcal condition and needs no fhis vehicle has never had any paint or body work and IS free of rust vehicle has ('-J clean title hIstory and will pass a smog and sClfety inspection, The engini." compartment is clean, with no fluid leaks an(1 is free of ;.,ny wear or visible defects. The vehicle also has complete and verifiable servKe records. Less than 5% of ail userJ vehicles fail into this category. Good 0000 $7,985 "Good" condition means that the vehicle is free of any major defects. This vehicle has a clean titie history, the paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. There should be little or no rust on this vehicle. The tires match and have substantial tread wear left. A "good" vehicle wiil need some reconditioning to be sold at retail. Most consumer owned vehicles fail into this category. Fair ....'%1I'-~1!I-. t,,,,,f~:.,.,_,"U $7,260 T,':!ir" condition means that the vehicle has sorne rnechanrcal or cosmetic defects and needs servicing but is still in !,p('J(:;onahie runnlf19 conditIon, This vetlicle has a clean title history! the paint, (Jody and/or lnterior necej work perfonnpi1 by a professional. The tires may need to be i'I:,:piarec!. fhere rnclY be SOITl€' repairable rust darnage. Poor '*-~ 61 N/A "Poor" condition means that the vehicle has severe mechanical and/or cosmetic defects and is In poor running con<.Htion. The vehIcle may have problems that cannot be readily FIxed such as a damaged rrarne or a rustecl-through body. A velllcle With a branded titie (salvage, fioocl, etc.) or unsubstantiated rrdleage is considered "poor, A vehicle in poor condition may require an independent appraisal to determine its value, Kelley Blue Book does not at:l:ernpt to report a value on a "poor" vehiclp because thp value of cars in this category varies greatly. * Pennsylvania 11/7/2007 Accurate Condition Appraisal Change Condition Accurately appraising the condition of a vehicle is an important aspect In determining Its Blue Book value. Taking our 16 question condition quiZ will ensure you know the correct condition rating. NEXT STEPS: Search Local Listings Sell Your Sedan http://www.kbb.com/KBBIU sedCars/PricingReport.aspx?Manufacturerld=7 & Y earId=200... Page 2 of3 1117/2007 Kelley Blue Book - Private Party Pricing Report - Buick, LeSabre @ 2007 Kelley Blue Book Co., lnc. All rights reserved. Nov"Dee 2007 Edition. The specific information required to determine the value for this particular vehicle was suppfied by the person generating this report. Vehicle valuations are opinions and may vary from vehicle to vehicle, Actual valuations will vary based upon market conditions, specifications, ve/licle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the individual use of the person generating thIS report only and shall not be sold or transmitted to anot/ler party. Kelley Blue Book assumes no responsibility for errors or omissions. (v.07112) Email This Page Page 3 of3 RSS fZ.l3 About Us Careers FAQ Contact Us Site tlj2.~P ~Jjedia Center .n"jvertisin9 Buy tf"ie 8uoK Privacy Policy Copyright & Trademarks @ 1995-2007 Kelley Blue Book Co., lne. http://www.kbb.com/KBBIU sedCars/PricingReport.aspx?ManufacturerId=7 & Y earId=200... 11/7/2007 o PNCBANK Priority 50 Plus Account Statement PNC Bank For the period 10/05/2007 to 11/08/2007 Primary account number: 51-4018-2558 Page 1 of 3 Number of enclosures: 0 VIRGINIA M COLDREN JO ANN E REICHARD 6 STRAWBERRV DR CARLISLE PA 17013-4418 Q For 24-hour banking, and transaction or interest rate information, sign on to 'It PNC Bank Online Banking at pnc.com. For customer service call1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espal'iol, 1-866-HOLA-PNC Moving" Please contact us at 1-888-PNC-BANK I2!SI Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Ie Visit us at pnc. com ~ III TDDterminal: 1-800-531-1648 For hearing impaired clients only Give the gift ofPNC Bank Visa@ Gift Cards this holiday season. by a participating PNC Bank branch for more details. Priority 50 Plus Interest Checking Account Summary Account number: 51-4018-2558 Perfect for everyone and available in whole dollar amowlts up to $500. Stop Virginia M Coldren Jo Ann E Reichard Balance Summary Please see the Activity Detail section for additional information. Beginning balance Deposits and other additions 3,456.57 Checks and other deductions 1,817.43 Ending balance 7,073.48 5,434.34 Average monthly balance 5,803.69 Charges and fees .00 Transaction Summary Checks paid/ withdrawals Check Card POS signed transactions Check Card/Bankcard POS PIN transactions 9 o o Total ATM transactions PNC Bank ATM transactions Other Bank ATM transactions o Annual Percentage Yield Earned (APYE) 0.10% Number of days in interest period Average collected balance for APYE I nterest Paid this period As of 11/06, a total of $4.27 in interest was paid this year. Interest Summary 33 5,803.69 .52 Activity Detail Deposits and Other Additions Date Amount Description 10/12 750.00 Direct Deposit - Pension Metlife - P&Sc. XXXXX9191 11/01 1,567.05 Direct Deposit - Ar Ann Pay DFAS-Cleveland XXXXX1757 11/02 1,139.00 Direct Deposit - Soc Sec US Treasury 303 XXXXX0084D 11/06 .52 Interest Payment There were 4 Deposits and Other Additions totaling $3,458.57. FORM953R-1005 Priority 50 Plus Account Statement IQ] For 24-hour information, sign on to PNC Bank Online Banking ~ on pnc.com. Ac:count numher: 51-4018-2558 - continued For the period 10/05/2007 to 11/06/2007 VIRGINIA M COLDREN Primary account number: 51-4018-2558 Page 2 of 3 Checks and Substitute Checks Check Date number Amount paid 1 8 ~l() 1892 * 1893 18~) 1 1895 25.00 25.00 :.0.00 loll.00 25.21 1Oilo 10 '10 10/12 1021 10,"19 Reference number 088172~(~2 O;~,~172(_.I~" 1 083/1~]SO O.'?-,~6t;~)~2() 086585576 Check number 1896 18~)7 1898 1899 Amount 50.00 35.00 10.00 93 .to Date paid I }'()2 10 "19 10/31 lliOI Reference number 1)2,S33 J ]131'1 l_l28~ ll)'fll (l8~1t 2~_i ~i,'{j) U:!1_~132,~;-)6 ., Gap in check sequence Date 10'29 Amount Description There were 9 checks listed totaling $445.61. There was 1 Banking Machine Withdrawal totaling $200.00. Banking/Check Card Withdrawals and Purchases 200-<)0 A T1\I Wit hdl'awal 105 Noble Blvd Carlisle P A Online and Electronic Banking Deductions There were 12 Online or Electronic Banking Deductions totaling $1.171.82 Date lO. 05 10.09 1016 10 '17 10' 18 10'29 Amount Description I2.00 2.00 158.30 260.15 117.38 99.00 11'01 50,8(; Direct Payment - Renewal The Sentinel XXXXX8073 Direct Payment - Oct Priority 50 Plus XXXXXl281 Direct Pannent - Premiumpav liSAA P&C XXXXX0610 Direct Payment - LTC Ins JH/ Fbk XXXXX 1923 Direct Payment - Elee Bill Pp XXXXXX2007Ws Direct Payment - Direct DB S Middleton Twp 01017056 Oiled Payment - Centr::l] PA Come::lst Ccnlr;)] ~17822701 Oiled Panncnl- Dehits Str::lwhelTY Courl 100006 P::lYmenl,E-Check Check Pn11t Fia Cardselvices 1901 Direct Paymcnt - Telecom Emharq XXXXXXXXX 1725 Direcl Payment - Rencwa] The Sentinel XXXXX807:1 Direct Payment - Noy Priorit,- 50 Plus XXXXX.1281 , . 1 1'02 11. 05 125.00 271.21 1105 1105 11'05 () L 92 1:2,00 2.00 Daily Balance Detail Date 10 05 10 '09 10 '10 10 '12 Bal ance 5,122.31 5,120.31 5,370.31 6,070.31 Date 10'16 ]0 Ii 10' ] 8 10' I~) Balance 5,912.01 5,(,51. 89 5,531.51 5,171.30 Date 10/21 ]0/29 10/31 11/01 Balance 5,37130 5,075.30 5,03530 6.156.09 Date II '02 1]05 II,'OG Balance 7,120,tl9 7.0i2.~lC. 7,073.18 1\ fake your holiday shopping easy and rewardiJlg this year when you use your PNC Rank Visa'R:' Check Card or PNC Rank Visa(~:' Platinum Crcdit Carel. Acccpted at morc than 20 million locations ,,-orldwide and on1U1C. Have a goal'l Get a plan. Come in for your complimentary financial ass('ssmenf. You have a better chance of realizing your goals when you write them down. That includes fmancial goals. A PNC Financial Consultant can help you create a plan for education expenses, a new home, retirement and any dream you have. Call1-800-PNC-6111, visit us at pnc.com or stop by the nearest PNC Bank Branch. Nllt FDIC Inmrel!. May LII,e Value. Nil Rank Guaranlee. Impllrtant Invedor Informalilln: Securities ami hrokerage senices are prmided hy PNC Investments LLC, member FINRA and SIre. Annujties and other inslUlIllCe products are oflered by PNC InslUlInce Services. LLC a licensed insurance agency. R,EV-1510 E~+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Virginia M. Coldren FILE NUMBER 21-07-1007 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DE CD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLlCABLEI VALUE 1. Pentagon FeU Account # 576708 31,345.96 100 0.00 31,345.96 2. Met Life Account 550059191 351,561.77 100 0.00 351,561.77 100 100 100 TOTAL (Also enter on line 7 Recapitulation) $ 382,907.73 (If more space is needed, insert additional sheets of the same size) Pentagon Federal Credit Union Superior Rates. Proven Service': Box 1432, Alexandria, VA 22313-2032 1-800-247-5626 www.PenFed.ol'2 CONSOLIDATED STATEMENT Prepared for Member Member Number Statement Period VIRGINIA M COLDREN 576708 10/07/2007 THRU 11/07/2007 VIRGINIA M COLDREN 6 STRAWBERRY DR CARLISLE, PA 17013-4418 '''I III." 11I",11I11,1 II,,'..'.' ",.", II" ,.11....1111,',',' Page 1 of 1 REGULAR SHARE ACCOUNT Joint OwnerJO ANNE REICHARD, BNF .Account Number 576708-01-0 Date Description Shares Paid in or Withdrawn other Charges Share Balance 10/07/07 PREVIOUS BALANCE 11/07/07 DIVIDEND 0.08 78.72 78.80 ANNUAL PERCENTAOE YIELD EARNED: 1.20% based on 31 days ANNUAL PERCENTAGE YIELD (APY): 1.20% OCTOBER; 1.10% NOVEMBER MONEY MARKET SAVINGS ACCOUNT Date Account Number 1322249-03-6 Description Shares Peid in or Withdrawn Other Charges Share Balance 10/07/07 PREVIOUS BALANCE 10/09/07 CHECK NUMBER 10/22/07 CHECK NUMBER 11/07/07 DIVIDEND 127 130 40,365.41 -1,487.06 -f',E,A/. cS'r.rAy 38,878.35 -7,532.39 -rCiDf) /-It7h1G 31,345.96 107.34 31,453.30 ANNUAL PERCENTAGE YIELD EARNED: 3.56% based on 32 days OCT APY:<$10K: 3,36%; $10K-$49,999: 3.62%; $50K-$99,999: 3,75%; $100,000+: 3.91% NOV APY: < $10K: 3.10%; $10K-$49,999: 3.31 %; $50K-$99,999: 3.44%; $100,000 +: 3.60% 5.29% APR NEW & USED CAR LOANS WHEN APPLY ONLINE. ASK FOR DETAILS & APPLY TODAYI YEAR TO DATE DIVIDEND SUMMARY YEAR TO DATE CERTIFICATE PENALTY IRA CONTRIBUTION 1- 2006 1,367.69 0.00 0.00 YEAR TO DATE MM FINANCE CHARGES MM IRA CONTRIBUTION - ~.. 2007 0.00 0.00 MetLife Page 1 of 2 ~ MetLife P.O. Box 10342 Des Moines, IA 50306-0342 1(800) 638-7732 www.metlife.com Overnight Address 4700 Westown Parkway ,Suite 200 West Des Moines, IA 50266-0266 002-0036 VIRGINIA M COLDREN 6 STRAWBERRY DR CARLISLE, PA 17013-4418 1...111...11111....11..11..1..1.1..1...111..1.1111..11...1.1.1 - - Confirmation Statement Account Summary Account Balance on November 12, 2007 $350,811.77 Transaction Date 11/10/07 Transaction Description Unites) this Transaction Systematic Withdrawal Fixed Interest Account Account Number: 5140182558 Routing Number: 031312738 11/12/07 Ending Balances: Fixed Interest Account Messages: Dollar Amount of Transaction Unit Value $750.00 $750.00 $350,811.77 Please review your confirmation carefully. Please notify us of any errors regarding any transaction in your account within 60 days of the receipt of your confirmation. If we are not notified of an error in your account within the timeframe set forth above, any correction will be made at the unit price(s) calculated on the date that we receive notification. You should follow up any oral notice of an error that you provide to us with a written confirmation of the notice. Metropolitan Life Insurance Company ('MLlC') confirms the transactions shown as issuer and agent for the variable separate account. MLlC is providing this confirmation on behalf of the distributor, MetLife Investors Distribution Company, and MetUfe Securities, Inc.or your retail broker dealer. The Ending Balance is as of this statement date. MetLife FOR IRA ACCOUNTS ONLY: Is this a rollover contribution? Yes No If not, for which tax year are you making this contribution? Please make your check(s) payable to: MetLife DO NOT SEND CASH. Write your account number on the check(s) and mail to: Met Life P.O. Box 371537 Pittsburgh, PA 15250-7537 For change of address please complete below: Street Address _ __ _ _ _ _ _.__ _ _ _. _ _ _ _. _ h. ___ __ ___ __ ___ __ __ _. ._____ ._...__ City hhu.__u.____________________ State _uu__ Zip _________. '. 7307CO 11 ~002-0036 000000 ...."..'::.,...::.'.'.,.'.',_.,; .' :,;;...n,,~'j~0..c.,~,,'. "':;' ,.\' -,-",--",-,-,_,-,-,-,-,-,_~,F ~".j~:!i.'."':''";'-'''; ...'" ,," . ',,:,,:,,"~,G'~';"..""';'..i" Mail-in Stub "<.,, " i",,_ ' @8lt, ' I I ,., " 111I111 jll~~I,!I',lil,!,~,I!I.lUI~I,.IIII,:IIIIII~II.I.IIIIIIIIII,1111111/11 1111.11111111111,111111111'111111'1. ,'l'...:.L,. REV-1511 EX+ (12.99>* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Virginia M. Coldren FILE NUMBER 21-07-1007 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. Funeral Reception 1,913.47 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. Attorney Fees 1,500.00 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 515.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,928.47 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Receipt Date: Rece~pt Time: Recelpt No. : 11/07/2007 09:33:54 1050484 COLDREN VIRGINIA M 2007-01007 JOANN COLDREN CJ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name Estate File No. : Paid By Remarks: PETITION LTRS TEST WILL SHORT CERTIFICATE RENUNCIATION JCP FEE AUTOMATION FEE Check# 1902 Total Received......... 460.00 15.00 20.00 5.00 10.00 5.00 ---------------- $515.00 $515.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN ReV-1512 EX+~12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Virginia M. Coldren FILE NUMBER 21-07-1007 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 10. 11. 12. 1. JoAnn Reichard for toilet seat and sign 31.72 2. Waste Management 26.00 3. Millenium Pharmacy 77.47 4. Millenium Pharmacy 15.50 5. Jitterbug (cell phone bill) 87.82 6. Pennsylvania Power and Light 117.19 7. Pennsylvania Power and Light 116.74 8. Sarah Todd Home 852.43 9. Sarah Todd Home 11.53 Strawberry Court for monthly association fee (December, January) 250.00 Pennsylvania Power and Light 118.00 Embarq 16.95 1 ,721 .35 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) v r v .v' v v v ./ ....., ...,0.&.. I. U :J . :J . c:: I .:J U .. ...J t...I '-' .... I _. _. _ _ _ v IICI(1 - v //10 V- i' II tk.~th V- I / (p 14- v- erY) Grvr(. /:{5 tJO -1--1 I ~,.. -to I:Uj.j. C'(jtil; ~uu~ (........::J 1:11- ...&.oj Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 11/09/2007 JoAnn Reichard 433 W. South St Carlisle, PA 17013 Due Date: 11/25/2007 Re: Virginia M Coldren Account Nr: 101900 Date Description Days Quant Rate Charges Payments Balance BALANCE FORWARD 7,532.39 7,532.39 10/14/07 PAYMENT 7,532.39 .00 10/02/07 Beauty & Barber 1. 00 5.00 5.00 5.00 10/02/07 Beauty & Barber 1. 00 5.00 5.00 10.00 10/10/07 Beauty & Barber 1. 00 5.00 5.00 15.00 10/10/07 Beauty & Barber 1. 00 5.00 5.00 20.00 10/17/07 Beauty & Barber 1. 00 5.00 5.00 25.00 10/17/07 Beauty & Barber 1. 00 5.00 5.00 30.00 10/30/07 Beauty & Barber 1. 00 5.00 5.00 35.00 10/30/07 Beauty & Barber 1. 00 5.00 5.00 40.00 10/31/07 Personal Supplies 1. 00 2.50 2.50 42.50 10/31/07 Medical Supplies 1. 00 62.39 62.39 104.89 10/31/07 Cable Television 1. 00 15.00 15.00 119.89 10/31/07 Medical Equipment R 1. 00 75.54 75.54 195.43 11/01/07 Room & Board - Semi 3 219.00 657.00 852.43 flr~ ~pt //D5 /11.1-1 ~J7 ,j, ~Cvc/J1-P/C:' NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NO LATER THAN THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT printed on your statement. Include the ACCT# from the statement on the MEMO LINE of your check. Payments after 11/8/07 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.25% LATE CHARGE PER MONTH ** A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 12/14/2007 JoAnn Reichard 433 W. South St Carlisle, PA 17013 Due Date: 12/25/2007 Re: Virginia M Coldren Account Nr: 101900 Date Description Days Quant Rate Charges Payments Balance BALANCE FORWARD 11/27/07 PAYMENT 11/03/07 Incontinence Suppli 852.43 852.43 852.43 .00 11.53 1. 00 11.53 11.53 P~ 0'1 C1 / IJ--/I~ }lP dV NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NO LATER THAN THE 25TH OF THE MONTH ***** please remit the LAST AMOUNT printed on your statement. Include the ACCT# from the statement on the MEMO LINE of your check. Payments after 12/11/07 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.25% LATE CHARGE PER MONTH ** A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** STE. M. HATFIELD, FA 19440 , ............-...."."........ . ............,.................. .................,..,......... .....................,......... ...................,...,........ ..:AMOtrNmY . .......,......,.............~.. .. ....H........._............. 25.21 (H) , VIRGINIA - OLDVIRG PROTON IX 40MG TAB 01 * 9.00 .00 00008-0841-81 10/04/07 6500826 1 FLUCONAZOLE 100MG 01 * 2.94 .00 00172-5411-46 10/04/07 6500242 1 FLUCONAZOLE 100MG 01 * 2.94 .00 00172-5411-46 10/16/07 6504845 6 FUROSEMIDE 40 MG 01 * 2.99 .00 00378-0216-10 10/17/07 6508557 FUROSEMIDE 80MG T 01 * 2.60 .00 00378-0232-01 10/23/07 6513813 4 HYDROXYZINE HCL 2 01 * 3.00 .00 50111-0308-01 10/23/07 4030608 ABHR GEL 01 * 9.00 .00 63304-0773-01 10/23/07 6495492 9 RANITIDINE 150 MG 01 * 3.00 .00 00781-2855-60 10/26/07 4030608 12 ABHR GEL 01 * 9.00 .00 63304-0773-01 10/27/07 4030608 12 ABHR GEL 01 * 9.00 .00 63304-0773-01 10/28/07 6495493 9 LEVOTHYROXINE 50 01 * 3.00 .00 00378-1803-01 10/28/07 6513816 RANITIDINE 150MG 01 * 3.00 .00 49884-0544-01 10/28/07 6495494 0 DETROL LA 4MG CAP 01 * 9.00 .00 00009-5191-01 10/28/07 6514430 LEVAQUIN 250MG TA 01 * 9.00 .00 00045-1520-50 * ACTIV TY FOR R D, JOANNE - EICJOAN 10/18/07 Payment-CK#1895 25.21- .00 25.21 25.21 102.68 I YTD MED DEDUCTION >""""""",'CHARGER""""""'>. '>>""'l'Hl'S""MONmr..,'.'.'" 77.47 77.47 I LEGEND FOR MONTH \~~~ \\tl rmml ........................."..............".,.. .................. ....., .., "'" "' ....., ,. . ............................................................ ................ ........ .. '," ",," "," AMOt:INut....l;>tJE:....... ................'............. '--,""'" ............................... .,...... .................,.. ............... ........ ..,....................,............... ....,. .,......,..,.......................,.,.,.... ....'..,.............,......-...',..................................,.-....'....-.. 77.47 77.47 I MED DED FOR MONTH .........,,,......,,..,........ @}o/#i1:l$...~ji~i;l$. + I....................................., ....'...F......,L.......N......Jm......., c. ..E,).....,i:;!.....HA1m,.........,.......,..,..1l:,............. + .00 = ..............,...............-... .. ,.......................-....',......,.. .......0;;,"'.' ...c...'''G.."....... :::~:::f:;,.:,:0~;::::.::.~.....~::::;:::: 102.68 - ....",".' 'c, '." """ "'l"O,'r;A:!:i' """"", """",.. PAYMilIilTS......'..(lREDrr 25.21 PLEASE REMIT PAYMENT TO: MILLENNIUM PHARMACY SYSTEMS, INC. 12450 PERRY HIGHWAY, SUITE 200 WEXFORD, PA 15090 M~LLENNIUM PHCY.SYS.,INC.2880 (H), VIRGINIA LEVAQUIN 250MG TA 00045-1520-50 D, JOANNE Payrnent-CK#l102 ** ACTIV TY FOR R ICHA 11/29/07 9.00 I MED DED FOR MONTH + 111.68 I YTD MED DEDUCTION ...U.rli1"'~WHl."...'.... 9.00 1....................................1 ....................................................................................... ...tj;lIT~~..~~~ + .00 = STE. AA HATFIELD, PA 19440 01 9.00 I LEGEND FOR MONTH .. ................,.............. ... ....,.....................-... ............................... ............................. .. ............................... .....AMbtiNtr'U .. .....-...'........................ ... ....... .-.........", ....... - OLDVIRG * 9.00 - EICJOAN 77.47- k~i~Flrbiti4~ 77.47 77.47 ~~ \~~~.\\tJ \ y\ C!::k^' .00 .,.-..".......--.--.. WQj'l$.'l'~ .00 .00 77.47- PLEASE REMIT PAYMENT TO: MILLENNIUM PHARMACY SYSTEMS, INC. 12450 PERRY HIGHWA Y, SUITE 200 WEXFORD, PA 15090 Invoice Date:11/28/2007, Acct#:STMH1415, COLDREN VIRGINIA, Sarah Todd NC, A, GEORGE BRANSCUM 1'i;?:~~~!%:~4.a~~~ 10/30/2007 6039467 222.00 Sarna External Lotion 0.5-0.5 % 00145-0628-05 $ 6.50 $ 0.00 $ 6.50 OTC Q~<V \ G1. \~\\\ \. \\ f)~ cY! RliV-1513 EX+.(9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Virginia M. Coldren FILE NUMBER 21-07-1007 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Bruce E. Coldren, 7426 Hardisty, West Bloomfield, MI48324 Son 132,936.03 2. JoAnn Reichard, 433 W. South Street, Carlisle, PA 17013 Daughter 132,936.03 3. Donna L. Wainwright, 7505 Meadow Lane, Reading, PA 19606 Daughter 132,936.03 4. Gary R. Coldren, 16860 Beverly Mills Drive, Broad Run, VA 20137 Son 132,936.03 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 (If more space is needed, insert additional sheets of the same size)