HomeMy WebLinkAbout02-08-08
..-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 Number Date of Death
OFFICIAL USE ONLY
cm:]JI!JIJWJ IJlII:
1]IIlT['TC Irr
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 07
0667
Date of Birth
195-26-9186
07/09/2007
09/05/1930
Decedent's Last Name
Suffix
Decedent's First Name
MI
MARTIN
ROBERT
l
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social
Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
!:e;>
1. Original Return
c::J
2. Supplemental Return
c:>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::>
c::J 4a. Future Interest Compromise (date of
death after 12-12-82)
c::J 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 Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
C~.
4. Limited Estate
C:::::?
SAllY J. WINDER
Firm Name (If Applicable)
REGISTER OF WILLS USE ONl.Y
()
r)
First line of address
9974 MOllY PITCHER HWY
C~
Second line of address
,.',
ZIP Code
DATE
17257
'-;,..:
Correspondent's e-mail address:
Under penalties of perjury, 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. Declaraiion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
L DATE I-
I. ~ C) /_t2I
SIG~; ::O:;U~~RETU:N'f~{,t1L_71'~.D~______
ADDRESS
SiGNAT~Yb;^~'5T1RctN..~~.t~S~~~TA~VE- _~__~-~__
ADDRESS., ..... I "" I / (
c'1Lt 1 tf (}~ll v f1k1V-1w .~~
PLEASE U E ORIGI
~ATE
_2- \ Sl-C~
Side 1
L
15056051058
15056051058
....J
.-J
15056052059
REV-1500 EX
Decedent's Name:
ROBERT
L MARTIN
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 Subjectto 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 .0_
16. Amount of Line 14 taxable
at lineal rate X .045 239,895.74
17. Amount of line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052059
Side 2
195-26-9186
Decedent's Social Security Number
110,250.00
122,985.52
19,477.54
252,713.06
21,260.40
556.92
21,817.32
239,895.74
239,895.74
10,795.31
10,795.31
15056052059
....J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
ROBERT L MARTIN
'~------""------'_."'----_.- ---'-' --'--- --~_....-._--_...- -- ---.-..-.,------,-. -,._-----
STREET ADDRESS
23 FIREHOUSE ROAD
File Number
DECEDENT'S SOCIAL SECURITY NUMBER
195-26-9186
CITY
WALNUT BOTTOM
rrATE--'
I PA
I ZIP 17266
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
10,795.31
3. InterestJPenalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
------- TotallnterestJPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 ;s greater than Line 2, enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
10,795.31
A. Enter the interest on the tax due.
10,795.31
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 [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 [i]
3. Did decedent own an "in 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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure 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. 99116(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. 99116(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+ (6-9*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
ROBERT A. MARTIN
FILE NUMBER
21 070667
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
REAL ESTATE SITUATE IN SOUTH NEWTON TOWNSHIP, CUMBERLAND COUNTY, PA.
KNOWN AND NUMBERED AS 23 FIREHOUSE ROAD, WALNUT BOTTOM. PA..
110,250.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
110,250.00
""'~ c-___'---._~."""u
JAM 1 '1 2008 p-r
IN RE: ESTATE OF
ROBERT 1. MARTIN, DECEASED
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYLVANIA
: ESTATE NO. 2007-0067
ORDER OF COURT
AND, NOW, this ('1'- day of January, 2008, upon consideration of the within
Petition for Approval of Private Sale of Real Estate, and upon motion of Sally J. Winder,
Esquire, counsel for the Estate of Robert 1. Martin, deceased, it is
ORDERED AND DIRECTED, that the property of decedent located at 23 Firehouse
Road, South Newton Township, Walnut Bottom, Pennsylvania, sl1aIl be conveyed by the
Executors to Robert A. Martin as set forth in the Petition.
By the Court,
---1~/1J
I
1.
A TRUE COPY FROM RECORD
In Testimony wher01. I hereUnto
set my hand and the seal
of said Court at CartisIe. PA
Thir:&r ctay...of ~
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GEORGE L. EBENER & ASSOCIATES
REALTORS
[B
Residential, Commercial & Farms
Appraisals . Sales . Rentals
.I,S
REAL TOR;':
430 East King Street, Shippensburg, PA 17257
(717) 532-8530 (717) 532-3430
October 2. 2007
Sally J. Winder, Atty.
9974 Molly Pitcher Highway
Shippensburg, P A 17257
RE: Appraisal Report
Of
Robert L.Martin Estate
23 Fire House Road
Walnut Bottom, PA 17266
Dear Sally:
In accordance with your request by phone and then by fax, I personally inspected the above
captioned property with their son Robert Martin on October I, 2007, to estimate the Market
Value of the property.
Market Value is defined as "The most probable price which a property should bring in a
competitive and open market under all conditions requisite to a fair sale, the Buyer and Seller
each acting prudently and knowledgeably and assuming the price is not affected by undue
stimulus."
The value shown had been arrived at after careful study of the location, type of improvements,
their physical condition and their present use. Therefore, I believe it to reflect a true measure of
the Market Value as of July 9, 2007.
VALUE REPORTED: 23 Fire House Road Property
One Hundred TenThousand Two Hundred Fifty Dollars
$ 110,250.00
I hereby certify that I have no financial interest, present or contemplated, in the property and that
neither the employment to make the appraisal nor the compensation therefrom is contingent upon
the value reported.
This property was appraised as a whole, subject to the Contingent and Limiting Conditions
outlined herein.
Submitted by,
Charles L. Wenger, GRI
Broker / Partner
P A Certification # BA-OO I 849-L
GEORGE L. EBENER & ASSOCIATES
REALTOR
APPRAISAL REPORT
OF
ROBERT L. MARTIN
ESTATE
LOCATED
AT
23 FIRE HOUSE ROAD
WALNUT BOTIOM
PENNSYLVANIA
17266
FOR
SALLY J. WINDER, ATTY.
9974 MOLLY PITCHERmGHWAY N
SmPPENSBURG
PENNSYLVANIA
17257
AS OF
JULY 9, 2007
BY
CHARLES L. WENGER, GRI
430 E. KING STREET
SmPPENSBURG
PENNSYLVANIA
17257
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROBERT L. MARTIN
FilE NUMBER
21 070667
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 DESCRIPTION
1. CITIZENS BANK, ACCOUNT IN THE NAME OF DECEDENT, ACCT NO. 6100792536
2. CITIZENS BANK, ACCOUNT NO. 6100795675
3. CITIZENS BANK, ACCOUNT NO. 00006140718120
4. CITIZENS BANK ACCT. 00006250390155
5. 1995 OLDSMOBILE CUTLASS SIERRA AUTOMOBILE
6. SAVINGS BONDS, SEE ATTACHED LIST
VALUE AT DATE
OF DEATH
11,919.02
66,307.60
14,777.40
12,954.79
1,000.00
16,026.71
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size) .
122.985.52
Page: 1 Document Name: untitled
9- Is-07
Command ===> RMAB 08/15/0~
CUSTOMBR-TO-ACCOUNT RELATIONSHIP BROWSE 10: 35: 4:;
195-26-9186 ROBERT L MARTIN
ReI Cd p/S/O Appl Account Number Trlr Balance
Stm PR D/I/R Prod Ct11 Ctl2 Ct13' Ct14 Brnch Status Date Cycle
PRI INn P 1M 61007925~6 AVAIL 11919.02
A/D D 003 0001 0060 0000 0000 299 NORMAL OPENING 01/25/1985 B13
PRI IND P 1M 6100795675 AVAIL 66307.60'
A/P A/B' D 052 0001 0060 0000 0000 299 NORMAL OPENING 03/29/1980 B13
PRI IND P PL 0195269186
D 0001 0060 0000 0000 000 NORMAL OPEN 11/03/2006
PRI IND P ST 00006140718120 AVAIL 14777.40
A/S A/D D 324 0001 0060 0000 0000 299 DORMNT OPENING 09/18/1997 013
PRI IND P ST 00006250390155 IR AVAIL 12954.79
D 411 0001 0060 0000 0000 299 NORMAL OPENING 11/03/2006 033
PRI IND P SD 00600029900013747
D 0001 0060 0000 0000 00299 RENTED OPENED 02/25/2000
PF1-Fwd PFS-CustAcctBr PF8-CustAddr PF11-CustSvc PF14-AcctNonLeg
PF2-Bkwd PF6-CustRel PF9-SesSetUp PF13-AcctLegTtl PF21-Top
RMPCABS1 RM3004 I: LAST PAGE LAST
.......~V\"A",.,'" -
Calculated Value of Your Paper Savings Bond(s)
Page 1 of3 .
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 08/2007
Tota~ Prke Totaf Vafu~ ~ ota~ Interest VTD Interes.t
$2,250.00 $15,637.08 13,387.08 0.00
.~~;:;;-~~~~_:::...;-:,:;-
Bonds: 1-120 of 120
Sed~! . Issue Next Final Issue !nte:-est Interest Vatu€: r-tc.
# Senes Genom Date A.ccn~a! ~laturfty Price Rate
NA E $25 10/1975 10/2005 $18.75 $114.40 $133.15 M
NA E $25 10/1975 10/2005 $18.75 $114.40 $133.15 M
NA E $25 . 10/1975 10/2005 $18.75 $114.40 $133.15 M
NA E $25 10/1975 10/2005 $18.75 $114.40 $133.15 M
NA E $25 09/1975 09/2005 $18.75 $114.40 $133.15 M
NA E $25 09/1975 0912005 $18.75 $114.40 $133.15 M
NA E $25 09/1975 0912005 $18.75 $114.40 $133.15 M
NA E $25 OW1975 09/2005 $18.75 $114.40 $133.15 M
NA E $25 0~/1975 09/2005 $18.75 $114.40 $133.15 M
NA E $25 08/1975 08/2005 $18.75 $114.40 $133.15 M
NA E $25 08/1975 08/2005 $18.75 $114.40 $133.15 M
NA E $25 07/1975 07/2005 $18.75 $114.40 $133.15 M
NA E $25 01/1975 07/2005 $18.75 $114.40 $133.15 M
NA E $25 01/1975 07/2005 $18.75 $114.40 $133.15 M
NA E $25 07/1975 07/2005 $18.75 $114.40 $133.15 M
NA E $25 07/1975 07/2005 $18.75 $114.40 $133.15 M
NA E $25 07./1975 07/2005 $18.75 $114.40 $133.15 M
NA E $25 07/1975 07/2005 $18.75 $114.40 $133.15 M
NA E $25 06/1975 06/2005 $18.75 $114.40 $133.15 M
NA E $25 06/1975 06/2005 $18.75 $114.40 $133.15 M
NA E $25 06/1975 06/2005 $18.75 $114.40 $133.15 M
NA E $25 06/1975 06/2005 $18.75 $114.40 $133.15 M
NA E $25 05/1975 OS/2005 $18.75 $114.08 $132.83 M
NA E $25 05/1975 OS/2005 $18.75 $114.08 $132.83 M
NA E $25 05/1975 OS/2005 $18.75 $114.08 $132.83 M
NA E $25 05/1975 OS/2005 $18.75 $114.08 $132.83 M
NA E $25 04/1975 04/2005 $18.75 $112.82 $131.57 M
NA E $25 04/1975 04/2005 $18.75 $112.82 $131.57 M
NA E $25 04/1975 04/2005 $18.75 $112.82 $131.57 M
NA E $25 04/1975 04/2005 $18.75 $112.82 $131.57 M
NA E $25 03/1975 03/2005 $18.75 $112.82 $131.57 M
NA E $25 03/1975 03/2005 $18.75 $112.82 $131.57 M
NA E $25 03/1975 03/2005 $18.75 $112.82 $131.57 M
NA E $25 03/1975 03/2005 $18.75 $112.82 $131.57 M
NA E $25 03-/1975 03/2005 $18.75 $112.82 $131.57 M
NA E $25 02/1975 02/2005 $18.75 $112.82 $131.57 M
NA E $25 02/1975 02/2005 $18.75 $112.82 $131.57 M
NA E $25 02/1975 02/2005 $18.75 $112.82 $131.57 M
NA E $25 01/1975 01/2005 $18.75 $112.82 $131.57 M
httn.//v.TI:lIIUJ trP~C;:IIT\lrljrP('t ...""fP.r' I~D r'D"; ~~
Calculated Value of Your Paper Savings Bond(s) Page 2 of3
NA E $25 01/1975 01/2005 $18.75 $112.82 $131.57 M
NA E $25 01/1975 01/2005 $18.75 $112.82 $131.57 M
NA E $25 01/1975 01/2005 $18.75 $112.82 $131.57 M
NA E $25 01/1975 01/2005 $18.75 $112.82 $131.57 M
NA E $25 12/1973 12/2003 $18.75 $109.73 $128.48 M
NA E $25 12/1973 12/2003 $18.75 $109.73 $128.48 M
NA E $25 12/1973 12/2003 $18.75 $109.73 $128.48 M
NA E $25 12/1973 12/2003 $18.75 $109.73 $128.48 M
NA E $25 11/1973 11/2003 $18.75 $113.01 $131.76 M
NA E $25 11/1973 11/2003 $18.75 $113.01 $131.76 M
NA E $25 11/1973 11/2003 $18.75 $113.01 $131.76 M
NA E $25 11/1973 11/2003 $18.75 $113.01 $131.76 M
NA E $25 11/1973 11/2003 $18.75 $113.01 $131.76 M
NA E $25 10/1973 10/2003 $18.75 $113.01 $131.76 M
NA E $25 10/1973 10/2003 $18.75 $113.01 $131.76 M
NA E $25 10/1973 10/2003 $18.75 $113.01 $131.76 M
NA E $25 10/1973 10/2003 $18.75 $113.01 $131.76 M
NA E $25 09/1973 09/2003 $18.75 $113.01 $131.76 M
NA E $25 09/1973 09/2003 $18.75 $113.01 $131.76 M
NA E $25 09/1973 09/2003 $18.75 $113.01 $131.76 M
NA E $25 09/1973 09/2003 $18.75 $113.01 $131.76 M
NA E $25 08j1973 08/2003 $18.75 $112.99 $131.74 M
NA E $25 oat1973 08/2003 $18.75 $112.99 $131.74 M
NA E $25 08/1973 08/2003 $18.75 $112.99 $131.74 M
NA E $25 08/1973 08/2003 $18.75 $112.99 $131.74 M
NA E $25 08/1973 08/2003 $18.75 $112.99 $131.74 M
NA E $25 07/1973 07/2003 $18.75 $112.71 $131.46 M
NA E $25 07/1973 07/2003 $18.75 $112.71 $131.46 M
NA E $25 06/1973 06/2003 $18.75 $111.45 $130.20 M
NA E $25 06/1973 06/2003 $18.75 $111.45 $130.20 M
NA E $25 07/1973 07/2003 $18.75 $112.71 $131.46 M
NA E $25 06/1973 06/2003 $18.75 $111.45 $130.20 M
NA E $25 05/1973 OS/2003 $18.75 $111.14 $129.89 M
NA E $25 05/1973 OS/2003 $18.75 $111.14 $129.89 M
NA E $25 04/1973 04/2003 $18.75 $111.14 $129.89 M
NA E $25 04/1973 04/2003 $18.75 $111.14 $129.89 M
NA E $25 04/1973 04/2003 $18.75 $111.14 $129.89 M
NA E $25 03/1973 03/2003 $18.75 $111.14 $129.89 M
NA E ,$25 01/1973 01/2003 $18.75 $110.81 $129.56 M
NA E $25 01/1973 01/2003 $18.75 $110.81 $129.56 M
NA E $25 12/1972 12/2002 $18.75 $109.58 $128.33 M
NA E $25 12/1972 12/2002 $18.75 $109.58 $128.33 M
NA E $25 12/1972 12/2002 $18.75 $109.58 $128.33 M
NA E $25 12/1972 12/2002 $18.75 $109.58 $128.33 M
NA E $25 12/1972 12/2002 $18.75 $109.58 $128.33 M
NA E $25 11/1972 11/2002 $18.75 $109.30 $128.05 M
NA E $25 1i/1972 11/2002 $18.75 $109.30 $128.05 M
NA E $25 1;1./1972 11/2002 $18.75 $109.30 $128.05 M
NA E $25 11/1972 11/2002 $18.75 $109.30 $128.05 M
NA E $25 10/1972 10/2002 $18.75 $109.30 $128.05 M
NA E $25 10/1972 10/2002 $18.75 $109.30 $128.05 M
NA E $25 10/1972 10/2002 $18.75 $109.30 '$128.05 M
NA E $25 10/1972 10/2002 $18.75 $109.30 $128.05 M
NA E $25 09/1972 09/2002 $18.75 $109.30 $128.05 M
http://www. treasurydirect.~ov/BC/SBCPrice
Calculated Value of 'Your Paper Savings Bond(s) Page 3 of3
NA E $25 09/1972 09/2002 $18.75 $109.30 $128.05 M
NA E $25-09/1972 09/2002 $18.75 $109.30 $128.05 M
NA E $25 09/1972 09/2002 $18-.75 $109.30 $128.05 M
NA E $25 09/1972 09/2002 $18.75 $109.30 $128.05 M
NA E $25 08/1972 08/2002 $18.75 $109.30 $128.05 M
NA E $25 0&/1972 08/2002 $18.75 $109.30 $128.05 M
NA E $25 08/1972 08/2002 $18.75 $109.30 $128.05 M
NA E $25 08/1972 08/2002 $18.75 $109.30 $128.05 M
NA E $25 07/1972 07/2002 $18.75 $109.02 $127.77 M
NA E $25 07/1972 07/2002 $18.75 $109.02 $127.77 M
NA E $25 06/1972 06/2002 $18.75 $107.79 $126.54 M
NA E $25 05/1972 OS/2002 $18.75 $107.44 $126.19 M
NA E $25 05/1972 05/2002 $18.75 $107.44 $126.19 M
NA E $25 05/1972 OS/2002 $18.75 $107.44 $126.19 M
NA E $25 04/1972 04/2002 $18.75 $107.44 $126.19 M
NA E $25 04/1972 04/2002 $18.75 $107.44 $126.19 M
NA E $25 04/1972 04/2002 $18.75 $107.44 $126.19 M
NA E $25 04/1972 04/2002 $18.75 $107.44 $126.19 M
NA E $25 04/1972 04/2002 $18.75 $107.44 $126.19 M
NA E $25 0~/1972 03/2002 $18.75 $107.44 $126.19 M
NA E $25 0~/1972 03/2002 $18.75 $107.44 $126.19 M
NA E $25 03/1972 03/2002 $18.75 $107.44 $126.19 M
NA E $25 03/1972 03/2002 $18.75 $107.44 $126.19 M
NA E $25 02/1972 02/2002 $18.75 $107.42 $126.17 M
NA E $25 02/1972 02/2002 $18.75 $107.42 $126.17 M
NA E $25 11/1971 11/2001 $18.75 $107.61 $126.36 M
NA E $25 01/1969 01/1999 $18.75 $118.52 $137.27 M
Totals for 120 Bonds 2 250.00 13387.08 15,637.08
Notes
NI Not Iss ued
NE Not eligible for payment
PS Includes 3 month interest penalty
MA Matured and not earnlnQ interest
/lo6er t J.. marIA 1/'
fJ () r'<l.- D /JJ 0.. rt J ;j
http://www.treasurydirect.gov/BC/SBCPric-.e.
Calculated Value of YOur Paper Savings Bond(s)
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 08/2007
wtt1t~t F?r-:ce
To.ta~ Value
Totai Interest
$56.25
389.63
333.38
~"'~'.",;,,!,,'.'->'":'~
Bonds: 1-3 of 3
Page 1 of 1
YTD ri~f.:,z~"est
$0.00
Sedaf #
Issue :t:o.'tere...... Interest Va!"''''' Ne-=
Price .. -- H.ate '-"- .<.~
Issue Next Final
Series Denam
Date Accrual Maturity
E $25 08/1973 08/2003
E $25 01/1973 01/2003
E $25 12/1972 12/2002
Totals for 3 Bonds
Q5110158508
Q5067534955
Q5061557087
Nates
NI Not 155 ued
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earnina interest
Dora !J.. ma~tJ i7
Or
t?o6er t ).. jJ1iU-tJi1
http://www.treasurydirect.govIBCISBCPrir:e
$112.99
$110.81
$109.58
333.38
$131.74 MA
$129.56 MA
$128.33 MA
$389.63
REV-1509 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTlY-OWNED PROPERTY
ESTATE OF
ROBERT L. MARTIN
FILE NUMBER
21070667
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. ROBERT A. MARTIN
23 FIREHOUSE ROAD
WALNUT BOTTOM, PA
SON
B. KAREN D. WINTER
37 SUBDIVISION ROAD
NEWVILLE, PA 17241
DAUGHTER
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY 'Io0F DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY~HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 10/30/90 SAVINGS BONDS, SEE ATTACHED LIST 19,330.32 50 9,665.16
2, B 03/30/80 SAVINGS BONDS, SEE ATTACHED LIST 19,624.76 50 9,812.38
TOTAL (Also enter on line 6, Recapitulation) $ 19,477.54
(If more space is needed. insert additional sheets of the same size)
Calculated Value of Your Paper Savings Bond(s)
rage 1 OJ'+
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 08/2007
Tota~ P'r~ce Total Va~ue Totaf Interest Y i D Interest
$3 243.75 19,624.76 16 381.01 $474.95
Bonds: 1-173 of 173
Seriaf . Issue Next Fimd issue Interest Interest Vaiue r~{
:# Serres Denoro Date Accruai iViaturity p.';r... Fta tE:
_ !l'_,_
NA E $25 03/1980 09/2007 03/2010 $18.75 $79.48 4.00% $98.23
NA E $25 03/1980 09/2007 03/2010 $18.75 $79.48 4.00% $98.23
NA E $25 03/1980 09/2007 03/2010 $18.75 $79.48 4.00% $98.23
NA E $25 04/1980 10/2007 04/2010 $18.75 $79.48 4.00% $98.23
NA E $25 04/1980 10/2007 04/2010 $18.75 $79.48 4.00% $98.23
NA E $25 04/1980 10/2007 04/2010 $18.75 $79.48 4.00% $98.23
NA E $25 04/1980 10/2007 04/2010 $18.75 $79.48 4.00% $98.23
NA E $25 04/1980 10/2007 04/2010 $18.75 $79.48 4.00% $98.23
NA E $25 04/1980 10/2007 04/2010 $18.75 $79.48 4.00% $98.23
NA E $25 05/1980 11/2007 OS/2010 $18.75 $80.48 4.00% $99.23
NA E $25 05/1980 11/2007 OS/2010 $18.75 $80.48 4.00% $99.23
NA E $25 05/1980 11/2007 OS/2010 $18.75 $80.48 4.00% $99.23
NA E $25 05/1980 11/2007 OS/2010 $18.75 $80.48 4.00% $99.23
NA E $25 12/1979 12/2007 12/2009 $18.75 $81.45 4.00% $100.20
NA E $25 12/1979 12/2007 12/2009 $18.75 $81.45 4.00% $100.20
NA E $25 12/1979 12/2007 12/2009 $18.75 $81.45 4.00% $100.20
NA E $25 12/1979 12/2007 12/2009 $18.75 $81.45 4.00% $100.20
NA E $25 11/1979 11/2007 11/2009 $18.75 $81.45 4.00% $100.20
NA E $25 11/1979 11/2007 11/2009 $18.75 $81.45 4.00% $100.20
NA E $25 11/1979 11/2007 11/2009 $18.75 $81.45 4.00% $100.20
NA E $25 11/1979 11/2007 11/2009 $18.75 $81.45 4.00% $100.20
NA E $25 11/1979 11/2007 11/2009 $18.75 $81.45 4.00% $100.20
NA E $25 10/1979 10/2007 10/2009 $18.75 $80.51 4.00% $99.26
NA E $25 10/1979 10/2007 10/2009 $18.75 $80.51 4.00% $99.26
NA E $25 10/1979 10/2007 10/2009 $18.75 $80.51 4.00% $99.26
NA E $25 09/1979 09/2007 09/2009 $18.75 $80.51 4.00% $99.26
NA E $25 09/1979 09/2007 09/2009 $18.75 $80.51 4.00% $99.26
NA E $25 09/1979 09/2007 09/2009 $18.75 $80.51 4.00% $99.26
NA E $25 09/1979 09/2007 09/2009 $18.75 $80.51 4.00% $99.26
NA E $25 08/1979 02/2008 08/2009 $18.75 $82.49 4.00% $101.24
NA E $25 08/1979 02/2008 08/2009 $18.75 $82.49 4.00% $101.24
NA E $25 08/1979 02/2008 08/2009 $18.75 $82.49 4.00% $101.24
NA E $25 08/1979 02/2008 08/2009 $18.75 $82.49 4.00% $101.24
NA E $25 08/1979 02/2008 08/2009 $18.75 $82.49 4.00% $101.24
NA E $25 08/1979 02/2008 08/2009 $18.75 $82.49 4.00% $101.24
NA E $25 07/1979 01/2008 07/2009 $18.75 $82.49 4.00% $101.24
NA E $25 07/1979 01/2008 07/2009 $18.75 $82.49 4.00% $101.24
NA E $25 07/1979 01/2008 07/2009 $18.75 $82.49 4.00% $101.24
NA E $25 07/1979 01/2008 07/2009 $18.75 $82.49 4.00% $101.24
httn.!!ufVJW tn~::l~llrvilirecLQovIBC/SBCPrice
8/23/2007
.dced Value of Your Paper Savings Bond(s) Page 2 of 4
NA E $25 06/1979 12/2007 06/2009 $18.75 $82.49 4.00% $101.24
NA E $25 06/1979 12/2007 06/2009 $18.75 $82.49 4.00% $101.24
NA E $25 06/1979 12/2007 06/2009 $18.75 $82.49 4.00% $101.24
NA E $25 06/1979 12/2007 06/2009 $18.75 $82.49 4.00% $101.24
NA E $25 05/1979 11/2007 OS/2009 $18.75 $82.26 4.00% $101.01
NA E $25 05/1979 11/2007 OS/2009 $18.75 $82.26 4.00% $101.01
NA E $25 05/1979 11/2007 05/2009 $18.75 $82.26 4.00% $101.01
NA E $25 05/1979 11/2007 OS/2009 $18.75 $82.26 4.00% $101.01
NA E $25 05/1979 11/2007 05/2009 $18.75 $82.26 4.00% $101.01
NA E $25 04t1979 10/2007 0412009 $18.75 $81.29 4.00% $100.04
NA E $25 04/1979 10/2007 04/2009 $18.75 $81.29 4.00% $100.04
NA E $25 04/1979 10/2007 04/2009 $18.75 $81.29 4.00% $100.04
NA E $25 04/1979 10/2007 04/2009 $18.75 $81.29 4.00% $100.04
NA E $25 03/1979 09/2007 03/2009 $18.75 $81.29 4.00% $100.04
NA E $25 03/1979 09/2007 03/2009 $18.75 $81.29 4.00% $100.04
NA E $25 03/1979 09/2007 03/2009 $18.75 $81.29 4.00% $100.04
NA E $25 03{1979 09/2007 03/2009 $18.75 $81.29 4.00% $100.04
NA E $25 03/1979 09/2007 03/2009 $18.75 $81.29 4.00% $100.04
NA E $25 02/1979 02/2008 02/2009 .$18.75 $83.29 4.00% $102.04
NA E $25 02/1979 02/2008 02/2009 $18.75 $83.29 4.00% $102.04
NA E $25 02/1979 02/2008 02/2009 $18.75 $83.29 4.00% $102.04
NA E $25 02/1979 02/2008 02/2009 $18.75 $83.29 4.00% $102.04
NA E $25 02/1979 02/2008 02/2009 $18.75 $83.29 4.00% $102.04
NA E $25 01/1979 01/2008 01/2009 $18.75 $83.29 4.00% $102.04
NA E $25 01/1979 01/2008 01/2009 $18.75 $83.29 4.00% $102.04
NA E $25 01/1979 01/2008 01/2009 $18.75 $83.29 4.00% $102.04
NA E $25 12/1978 12/2007 12/2008 $18.75 $83.28 4.00% $102.03
NA E $25 12-/19.78 12/2007 12/2008 $18.75 $83.28 4.00% $102.03
NA E $25 12/1978 12/2007 12/2008 $18.75 $83.28 4.00% $102.03
NA E $25 12/1978 12/2007 12/2008 $18.75 $83.28 4.00% $102.03
NA E $2~ 11/1978 11/2007 11/2008 $18.75 $83.00 4.00% $101.75
NA E $25 11/1978 11/2007 11/2008 $18.75 $83.00 4.00% $101.75
NA E $25 11/1978 11/2007 11/2008 $18.75 $83.00 4.00% $101.75
NA E $25 11/1978 11/2007 11/2008 $18.75 $83.00 4.00% $101.75
NA E $25 11/1978 11/2007 11/2008 $18.75 $83.00 4.00% $101.75
NA E $25 10/1978 10/2007 10/2008 $18.75 $82.05 4.00% $100.80
NA E $25 10/1978 10/2007 10/2008 $18.75 $82.05 4.00% $~00.80
NA E $25 10/1978 10/2007 10/2008 $18.75 $82.05 4.00% $100.80
NA E $25 10/1978 10/2007 10/2008 $18.75 $82.05 4.00% $100.80
NA E $25 10/1978 10/2007 10/2008 $18.75 $82.05 4.00% $100.80
NA E $25 09/1978 09/2007 09/2008 $18.75 $82.05 4.00% $100.80
NA E $25 09/1978 09/2007 09/2008 $18.75 $82.05 4.00% $100.80
NA E $25 09/1978 09/2007 09/2008 $18.75 $82.05 4.00% $100.80
NA E $25 08/1978 02/2008 08/2008 $18.75 $84.06 4.00% $102.81
NA E $25 08/1978 02/2008 08/2008 $18.75 $84.06 4.00% $102.81
NA E $25 08/1978 02/2008 08/2008 $18.75 $84.06 4.00% $102.81
NA E $25 08/1978 02/2008 08/2008 $18.75 $84.06 4.00% $102.81
NA E $25 08/1978 02/2008 08/2008 $18.75 $84.06 4.00% $102.81
NA E $25 08/1978 02/2008 08/2008 $18.75 $84.06 4.00% $102.81
NA E $25 08/1978 02/2008 08/2008 $18.75 $84.06 4.00% $102.81
NA E $25 07/1978 01/2008 07/2008 $18.75 $84.06 4.00% $102.81
NA E $25 07/1978 01/2008 07/2008 $18.75 $84.06 4.00% $102.81
NA E $25 07/1978 01/2008 07/2008 $18.75 $84.06 4.00% $102.81
NA E $25 06/1978 12/2007 06{2008 $18.75 $84.04 4.00% $102.79
~rn.17007
calculated Value of Your Paper Savings Bond(s) Page 3 of4
NA E $25 06/1978 12/2007 06/2008 $18.75 $84.04 4.00% $102.79
NA E $25 06/1978 12/2007 06/2008 $18.75 $84.04 4.00% $102.79
NA E $25 06/1978 12/2007 06/2008 $18.75 $84.04 4.00% $102.79
NA E $25 06/1978 12/2007 06/2008 $18.75 $84.04 4.00% $102.79
NA E $25 05/1978 11/2007 OS/2008 $18.75 $83.78 4.00% $102.53
NA E $25 05/1978 11/2007 OS/2008 $18.75 $83.78 4.00% $102.53
NA E $25 05/1978 11/2007 OS/2008 $18.75 $83.78 4.00% $102.53
NA E $25 05/1978 11/2007 OS/2008 $18.75 $83.78 4.00% $102.53
NA E $25 04/197.8 10/2007 04/2008 $18.75 $85.52 3.84% $104.27
NA E $25 04{1978 10/2007 04/2008 $18.75 $85.52 3.84% $104.27
NA E $25 04{1978 10/2007 04/2008 $18.75 $85.52 3.84% $104.27
NA E $25 04{1978 10/200704{2008 $18.75 $85.52 3.84% $104.27
NA E $25 04/1978 10/2007 04/2008 $18.75 $85.52 3.84% $104.27
NA E $25 03/1978 09/2007 03/2008 $18.75 $85.52 3.84% $104.27
NA E $25 03/1978 09{2007 03/2008 $18.75 $85.52 3.84% $104.27
NA E $25 03/1978 09/2007 03/2008 $18.75 $85.52 3.84% $104.27
NA E $25 03{1978 09/2007 03/2008 $18.75 $85.52 3.84% $104.27
NA E $25 02/1978 02{2008 02/2008 $18.75 $107.18 4.00% $125.93
NA E $25 02/1978 02{2008 02/2008 $18.75 $107.18 4.00% $125.93
NA E $25 02/1978 02/2008 02/2008 $18.75 $107.18 4.00% $125.93
NA E $25 02/1978 02/2008 02/2008 $18.75 $107.18 4.00% $125.93
NA E $25 02/1978 02/2008 02{2008 $18.75 $107.18 4.00% $125.93
NA E $25 01/1978 01/2008 01/2008 $18.75 $107.18 4.00% $125.93
NA E $25 01/1978 01/2008 01/2008 $18.75 $107.18 4.00% $125.93
NA E $25 01/1978 01/2008 01/2008 $18.75 $107.18 4.00% $125.93
NA E $25 12/1977 12/2007 12/2007 $18.75 $107.18 4.00% $125.93
NA E $25 12/1977 12/2007 12/2007 $18.75 $107.18 4.00% $125.93
NA E $25 12/1977 12/2007 12/2007 . $18.75 $107.18 4.00% $125.93
NA E $25 12/1977 12/2007 12/2007 $18.75 $107.18 4.00% $125.93
NA E $25 12/1977 12/2007 12/2007 $18.75 $107.18 4.00% $125.93
NA E $25 11/1977 11/2007 11{2007 $18.75 $106.83 4.00% $125.58
NA E '$25 11/1977 11/2007 11/2007 $18.75 $106.83 4.00% $125.58
NA E $25 11{1977 11{2007 11/2007 $18.75 $106.83 4.00% $125.58
NA E $25 11/1977 11{2007 11{2007 $18.75 $106.83 4.00% $125.58
NA E $25 1011977 10{2007 10{2007 $18.75 $118.18 4.00% $136.93
NA E $25 10/1977 10/2007 10{2007 $18.75 $118.18 4.00% $136.93
NA E $25 10/1977 10/2007 10/2007 $18.75 $118.18 4.00% $136.93
NA E $25 1011977 10/2007 10/2007 $18.75 $118.18 4.00% $136.93
NA E $25 09/1977 09/2007 09{2007 $18.75 $118.18 4.00% $136.93
NA E $25 09{1977 09/2007 09/2007 $18.75 $118.18 4.00% $136.93
NA E $25 09/1977 09/2007 09/2007 $18.75 $118.18 4.00% $136.93
NA E $25 09/1977 09/2007 09{2007 $18.75 $118.18 4.00% $136.93
NA E $25 09/1977 09{2007 09{2007 $18.75 $118.18 4.00% $136.93
NA E $25 08/1977 08/2007 $18.75 $120.92 $139.67 ~
NA E $25 08/1977 08/2007 $18.75 $120.92 $139.67 ~
NA E $25 07/1917 07{2007 $18.75 $120.92 $139.67 ~
NA E $25 07/197"'1 07/2007 $18.75 $120.92 $139.67 ~
NA E $25 07/1977 07/2007 $18.75 $120.92 $139.67 I'
NA E $25 07/1977 07{2007 $18.75 $120.92 $139.67 I'
NA E $25 07/1977 07{2007 $18.75 $120.92 $139.67 r
NA E $25 07/1977 07/2007 $18.75 $120.92 $139.67 r
NA E $25 07/19T1 07{2007 $18.75 $120.92 $139.67 I'
NA E $25 06/1977 06/2007 $18.75 $120.95 $139.70 r
NA E $25 06/1977 06/2007 $18.75 $120.95 $139.70 ~
http://www.treasurydirect.gov/BC/SBCPrice
8/23/2007
Calcuhtcd Value of Your Paper Savings Bond(s) Page 4 of 4
NA E $25 06/1977 06/2007 $18.75 $120.95 $139.70 ~
NA E $25 05j1977 OS/2007 $18.75 $120.65 $139.40 ~
NA E $25 05/1977 OS/2007 $18.75 $120.65 $139.40 ~
NA E $25 03/1977 OS/2007 $18.75 $120.65 $139.40 ~
NA E $25 OS/1977 OS/2007 $18.75 $120.65 $139.40 ~
NA E $25 04/1977 04/2007 $18.75 $119.29 $138.04 ~
NA E $25 04/1977 04/2007 $18.75 $119.29 $138.04 ~
NA E $25 04/1977 04/2007 $18.75 $119.29 $138.04 ~
NA E $25 04/1977 04/2007 $18.75 $119.29 $138.04 ~
NA E $25 03/1977 03/2007 $18.75 $119.29 $138.04 ~
NA E $25 0:;/1977 03/2007 $18.75 $119.29 $138.04 ~
NA E $25 03/1977 03/2007 $18.75 $119.29 $138.04 r
NA E $25 03/1977 03/2007 $18.75 $119.29 $138.04 ~
NA E $25 03/1977 03/2007 $18.75 $119.29 $138.04 ~
NA E $25 0211977 02/2007 $18.75 $119.29 $138.04 ~
NA E $25 02/1977 02/2007 $18.75 $119.29 $138.04 ~
NA E $25 02/1977 02/2007 $18.75 $:119.29 $138.04 ~
NA E $25 02/1977 02/2007 $18.75 $119.29 $138.04 ~
NA E $25 01/1977 01/2007 $18.75 $119.29 $138.04 ~
NA E $25 01/1977 01/2007 $18.75 $119.29 $138.04 ~
NA E $25 01/1977 01/2007 $18.75 $119.29 $138.04 ~
NA E $25 01/1977 01/2007 $18.75 $119.29 $138.04 ~
NA E $25 01/1977 01/2007 $18.75 $119.29 $138.04 ~
NA E $25 12/1975 12/2005 $18.75 $116.00 $134.75 ~
NA E $25 12/1975 12/2005 $18.75 $116.00 $134.75 ~
NA E $25 11/1975 11/2005 $18.75 $115.71 $134.46 ~
Totals for 173 Bonds 3,243.75 16 381.01 $19,624.76
Notes
NI Not Iss ued
NE Not eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earning interest
/(are/J !) mart> /J
http://www .treasurydirect.gov/BC/SBCPrice
8/23/2007
:alculated Value of Your PapersavIngs Bond(s)
:alculated Value of Your Paper Savings Bond(s)
Page 1 of 4
:alculator Results for Redemption Date 08/2007
Total Price Total Value Total Interest VTD Interest
$6,512.50 19,330.32 $12,817.82 $508.84
'onds: 1-170 of 170
Serial # Series Denom Issue Next Final Issue Interest Interest Value
Date Accrual Maturity Price Rate
k96115223ee EE $75 05/1990 11/2007 OS/2020 $37.50 $55.44 4.00% $92.94
k95382386ee EE $75 04/1990 10/2007 04/2020 $37.50 $55.44 4.00% $92.94
k96115224ee EE $75 05/1990 11/2007 OS/2020 $37.50 $55.44 4.00% $92.94
k95382387ee EE $75 04/1990 10/2007 04/2020 $37.50 $55.44 4.00% $92.94
k95382388ee EE $75 04/1990 10/2007 04/2020 $37.50 $55.44 4.00% $92.94
k96272982ee EE $75 07/1990 01/2008 07/2020 $37.50 $55.44 4.00% $92.94
k96272983ee EE $75 07/1990 01/2008 07/2020 $37.50 $55.44 4.00% $92.94
k96272981ee EE $75 07/1990 01/2008 07/2020 $37.50 $55.44 4.00% $92.94
k9716333gee EE $75 08/1990 02/2008 08/2020 $37.50 $55.44 4.00% $92.94
k97163340ee EE $75 08/1990 02/2008 08/2020 $37.50 $55.44 4.00% $92.94
k97186795ee EE $75 09/1990 09/2007 09/2020 $37.50 $53.61 4.00% $91.11
k97186796ee EE $75 09/1990 09/2007 09/2020 $37.50 $53.61 4.00% $91.11
k8907423ee EE $75 08/1989 02/2008 08/2019 $37.50 $59.19 4.00% $96.69
k89038423ee EE $75 07/1989 01/2008 07/2019 $37.50 $59.19 4.00% $96.69
k89038422ee EE $75 07/1989 01/2008 07/2019 $37.50 $59.19 4.00% $96.69
k89038424ee EE $75 07/1989 01/2008 07/2019 $37.50 $59.19 4.00% $96.69
k93565562ee EE $75 11/1989 11/2007 11/2019 $37.50 $57.30 4.00% $94.80
k93565563ee EE $75 11/1989 11/2007 11/2019 $37.50 $57.30 4.00% $94.80
k93604280ee EE $75 12/1989 12/2007 12/2019 $37.50 $57.30 4.00% $94.80
k93604282ee EE $75 12/1989 12/2007 12/2019 $37.50 $57.30 4.00% $94.80
k93604281ee EE . $75 12/1989 12/2007 12/2019 $37.50 $57.30 4.00% $94.80
k96242694ee EE $75 06/1990 12/2007 06/2020 $37.50 $55.44 4.00% $92.94
k96242693ee EE $75 06/1990 12/2007 06/2020 $37.50 $55.44 4.00% $92.94
k89001620ee EE $75 06/1989 12/2007 06/2019 $37.50 $59.19 4.00% $96.69
k8900161gee EE $75 06/1989 12/2007 06/2019 $37.50 $59.19 4.00% $96.69
k88972873ee EE $75 05/1989 11/2007 OS/2019 $37.50 $59.19 4.00% $96.69
k88972872ee EE $75 05/1989 11/2007 OS/2019 $37.50 $59.19 4.00% $96.69
k86855167ee EE $75 03/1989 09/2007 03/2019 $37.50 $59.19 4.00% $96.69
k93522856ee EE $75 10/1989 10/2007 10/2019 $37 .~O $57.30 4.00% $94.80
k93522857ee EE $75 10/1989 10/2007 10/2019 $37.50 $57.30 4.00% $94.80
k93491920ee EE $75 09/1989 09/2007 09/2019 $37.50 $57.30 4.00% $94.80
k93491921ee EE $75 09/1989 09/2007 09/2019 $37.50 $57.30 4.00% $94.80
k89074422ee EE $75 08/1989 02/2008 08/2019 $37.50 $59.19 4.00% $96.69
k86904133ee EE $75 04/1989 10/2007 04/2019 $37.50 $59.19 4.00% $96.69
k86904134ee EE $75 04/1989 10/2007 04/2019 $37.50 $59.19 4.00% $96.69
k86834532ee EE $75 02/1989 02/2008 02/2019 $37.50 $61.14 4.00% $98.64
k86738823ee EE $75 01/1989 01/2008 01/2019 $37.50 $61.14 4.00% $98.64
k86834531ee EE $75 02/1989 02/2008 02/2019 $37.50 $61.14 4.00% $98.64
k86738822ee EE $75 01/1989 01/2008 01/2019 $37.50 $61.14 4.00% $98.64
k86693894ee EE $75 12/1988 12/2007 12/2018 $37.50 $61.14 4.00% $98.64
k86693892ee EE $75 12/1988 12/2007 12/2018 $37.50 $61.14 4.00% $98.64
k86693893ee EE $75 12/1988 12/2007 12/2018 $37.50 $61.14 4.00% $98.64
__-'"....~ __..tnr"I"Dr"n..:__ 5l/,y,,/nn7
a Value ot Your .Paper ::>avings Bond(s) Page 2 of 4
lEgee EE $75 03/1989 09/2007 03/2019 $37.50 $59.19 4.00% $96.69
887ee EE $75 07/1988 01/2008 07/2018 $37.50 $63.09 4.00% $100.59
886ee EE $75 07/1988 01/2008 07/2018 $37.50 $63.09 4.00% $100.59
125ee EE $75 08/1988 02/2008 08/2018 $37.50 $63.09 4.00% $100.59
126ee EE $75 08/1988 02/2008 08/2018 $37.50 $63.09 4.00% $100.59
166ee EE $75 09/1988 09/2007,09/2018 $37.50 $61.14 4.00% $98.64
165ee EE $75 09/1988 09/2007 09/2018 $37.50 $61.14 4.00% $98.64
487ee EE $75 10/1988 10/2007 10/2018 $37.50 $61.14 4.00% $98.64
488ee EE $75 10/1988 10/2007 10/2018 $37.50 $61.14 4.00% $98.64
665ee EE $75 11/1988 11/2007 11/2018 $37.50 $61.14 4.00% $98.64
664ee EE $75 11/1988 11/2007 11/2018 $37.50 $61.14 4.00% $98.64
794ee EE $75 03/1988 09/2007 03/2018 $37.50 $63.09 4.00% $100.59
793ee EE $75 03/1988 09/2007 03/2018 $37.50 $63.09 4.00% $100.59
792ee EE $75 03/1988 09{2007 03/2018 $37.50 $63.09 4.00% $100.59
440ee EE $75 04/1988 10/2007 04/2018 $37.50 $63.09 4.00% $100.59
43gee EE $75 04{1988 10/2007 04/2018 $37.50 $63.09 4.00% $100.59
167ee EE $75 05/1988 11/2007 OS/2018 $37.50 $63.09 4.00% $100.59
'166ee EE $75 05/1988 11/2007 OS/2018 $37.50 $63.09 4.00% $100.59
,247ee EE $75 06/1988 12/2007 06/2018 $37.50 $63.09 4.00% $100.59
.246ee EE $75 06/1988 12{2007 06{2018 $37.50 $63.09 4.00% $100.59
.888ee EE $75 07/1988 01/2008 07/2018 $37.50 $63.09 4.00% $100.59
.690ee EE $75 09/1987 09/2007 09/2017 $37.50 $65.10 4.00% $102.60
.691ee EE $75 09/1987 09/200709/2017 $37.50 $65.10 4.00% $102.60
,07gee EE $75 12{1987 12{2007 12/2017 $37.50 $65.10 4.00% $102.60
,080ee EE $75 12/1987 12/2007 12{2017 $37.50 $65.10 4.00% $102.60
,078ee EE $75 12/1987 12/2007 12/2017 $37.50 $65.10 4.00% $102.60
1238ee EE $75 11{1987 11/2007 11/2017 $37.50 $65.10 4.00% $102.60
123gee EE $75 11/1987 11{2007 11/2017 $37.50 $65.10 4.00% $102.60
1622ee EE $75 01/1988 01/2008 01/2018 $37.50 $65.10 4.00% $102.60
!243ee EE $75 02/1988 02{2008 02/2018 $37.50 $65.10 4.00% $102.60
!242ee EE $75 02{1988 02{2008 02{2018 $37.50 $65.10 4.00% $102.60
1-68gee EE $75 09/1987 09/2007 09/2017 $37.50 $65.10 4.00% $102.60
J980ee EE $75 10/1987 10/2007 10/2017 $37.50 $65.10 4.00% $102.60
J981ee EE $75 10/1987 10{2007 10/2017 $37.50 $65.10 4.00% $102.60
i411ee EE $75 07/1987 01/2008 07/2017 $37.50 $67.17 4.00% $104.67
i40gee EE $75 07{1987 01/2008 07/2017 $37.50 $67.17 4.00% $104.67
i410ee EE $75 07/1987 01/2008 07/2017 $37.50 $67.17 4.00% $104.67
l280ee EE $75 08/1987 02{2008 08{2017 $37.50 $67.17 4.00% $104.67
l16gee EE $75 01/1987 01/2008 01/2017 $37.50 $69.27 4.00% $106.77
}304ee EE $75 04{1987 10/2007 04/2017 $37.50 $67.17 4.00% $104.67
B03ee EE $75 04/1987 10/2007 04/2017 $37.50 $67.17 4.00% $104.67
7157ee EE $75 08/1986 02/2008 08{2016 $37.50 $83.61 4.00% $121.11
7156ee EE $75 08{1986 02{2008 08{2016 $37. SO $83.61 4.00% $121.11
7155ee EE $75 08/198602/2008 08/2016 $37.50 $83.61 4.00% $121.11
1427ee EE $75 07/1986 01/2008 07/2016 $37.50 $83.61 4.00% $121.11
1428ee EE $75 07/1986 01{2008 07/2016 $37.50 $83.61 4.00% $121.11
3112ee EE $75 09/1986 09/2007 0912016 $37.50 $81.24 4.00% $118.74
3584ee EE $75 10/1986 10/2007 10{2016 $37.50 $81.24 4.00% $118.74
3585ee EE $75 10/1986 10{2007 10{2016 $37.50 $81.24 4.00% $118.74
3916ee EE $75 11{1986 11/2007 11{2016 $37.50 $69.27 4.00% $106.77
3915ee EE $75 11/1986 11/2007 11/2016 $37.50 $69.27 4.00% $106.77
J490ee EE $75 12/1985 12/2007 12/2015 $37.50 $86.04 4.00% $123.54
31j5ee EE $75 02/1985 02/2008 02/2015 $37.50 $91.02 4.00% $128.52
3114ee EE $75 02/1985 02/2008 02/2015 $37.50 $91.02 4.00% $128.52
504gee EE $75 01/1985 01/2008 01/2015 $37.50 $91.02 4.00% $128.52
5048ee EE $75 01/1985 01/2008 01/2015 $37.50 $91.02 4.00% $128.52
7695ee EE $75 12/1984 12/2007 12{2014 $37.50 $91.02 4.00% $128.52
"'" trp<>CllM.lrt,rppt tTrndAf"'tC:::Af"'P";"". nt""""J""^A_
Calculated Value of Your Paper Savings Bond(s) Page 3 of4
k41197694ee EE $75 12/1984 12/2007 12{2014 $37.50 $91.02 4.00% $128.52
k69240037ee EE $75 12/1986 12{2007 12{2016 $37.50 $69.27 4.00% $106.77
k69240038ee EE $75 12/1986 12/2007 12/2016 $37.50 $69.27 4.00% $106.77
k62823917ee EE $75 11/1986 11/2007 11/2016 $37. SO $69.27 4.00% $106.77
k5552319gee EE $75 02/1986 02/2008 02/2016 $37.50 $86.04 4.00% $123.54
k5536180gee EE $75 01/1986 01/2008 01/2016 $37.50 $86.04 4.00% $123.54
kS5361808ee EE $75 01/1986 01/2008 01/2016 $37.50 $86.04 4.00% $123.54
k54197243ee EE $75 08/1985 02/2008 08/2015 $37.50 $88. SO 4.00% $126.00
k54197525ee EE $75 09{1985 09/2007 09/2015 $37.50 $86.04 4.00% $123.54
k51839938ee EE $75 10/1985 10/2007 10/2015 $37.50 $86.04 4.00% $123.54
k51839937ee EE $75 10/1985 10/2007 10/2015 $37.50 $86.04 4.00% $123.54
k51840264ee EE $75 11{1985 11/2007 11/2015 $37.50 $86.04 4.00% $123.54
k51840265ee EE $75 11/1985 11/2007 11/2015 $37.50 $86.04 4.00% $123.54
k51840491ee EE $75 12/1985 12/2007 12/2015 $37.50 $86.04 4.00% $123.54
k55523198ee EE $75 02/1986 02/2008 02/2016 $37.50 $86.04 4.00% $123.54
k060266798ee EE $75 03/1986 09/2007 03/2016 $37.50 $83.61 4.00% $121.11
k06026679gee EE $75 03{1986 09/2007 03/2016 $37.50 $83.61 4.00% $121.11
, k060280942ee EE $75 04{1986 10{2007 04{2016 $37.50 $83.61 4.00% $121.11
k060280941ee EE $75 04/1986 10{2007 04/2016 $37.50 $83.61 4.0~% $121.11
k060280687ee EE $75 05/1986 11/2007 OS/2016 $37.50 $83.61 4.00% $121.11
k060280685ee EE $75 05/1986 11/2007 OS/2016 $37.50 $83.61 4.00% $121.11
k060280686ee EE $75 05/1986 11/2007 OS/2016 $37.50 $83.61 4.00% $121.11
k62824050ee EE $75 06/1986 12/2007 06{2016 $37.50 $83.61 4.00% $121.11
k62824051ee EE $75 06/1986 12/2007 06/2016 $37.50 $83.61 4.00% $121.11
k49329280ee EE $75 07{1985 01/2008 07/2015 $37.50 $88.50 4.00% $126.00
k4932927gee EE $75 07/1985 01{2008 07{2015 $37.50 $88.50 4.00% $126.00
k49329093ee EE $75 06/1985 12/2007 06/2015 $37.50 $88.s0 4.00% $126.00
k49329092ee EE $75 06/1985 12/2007 06/2015 $37.50 $88.50 4.00% $126.00
k4639842gee EE $7505/1985 11/2007 OS/2015 $37.50 $88.50 4.00% $126.00
k46398430ee EE $75 05/1985 11/2007 OS/2015 $37.50 $88.50 4.00% $126.00
k44088528ee EE $75 04/1985 10/2007 04/2015 $37.50 $88.50 4.00% $126.00
k4408852gee EE $75 04/1985 10/2007 04/2015 $37.50 $88.50 4.00% $126.00
k44088272ee EE $75 03/1985 09/2007 03/2015 $37.50 $88.50 4.00% $126.00
k44088273ee EE $75 03/1985 09/2007 03/2015 $37.50 $88.50 4.00% $126.00
k37314882ee EE $75 05/1984 11/2007 OS/2014 $37.50 $93.60 4.00% $131.10
k37314883ee EE $75 05/198411/2007 OS/2014 $37.50 $93.60 4.00% $131.10
k33962585ee EE $75 06/1984 12/2007 06/2014 $37.50 $93.60 4.00% $131.10
k33962586ee EE $75 06/1984 12/2007 06/2014 $37.50 $93.60 4.00% $131.10
k33962747ee EE $75 07/1984 01/2008 07/2014 $37.50 $93.60 4.00% $131.10
k33962745ee EE $75 07/1984 01/2008 07/2014 $37.50 $93.60 4.00% $131.10
k44061877ee EE $75 08/1984 02{2008 08/2014 $37.50 $93.60 4.00% $131.10
k33962746ee EE $75 07/1984 01/2008 07/2014 $37.50 $93.60 4.00% $131.10
k44062132ee EE $75 09/1984 09/2007 09{2014 $37.50 $91.02 4.00% $128.52
k44088274ee EE $75 03/1985 09/2007 03/2015 $37.50 $88.50 4.00% $126.00
k3731467gee EE $75 04/1984 10/2007 04/2014 $37.50 $96.39 4.20% $133.89
k37314677ee EE $75 04/1984 10/2007 04/2014 $37.50 $96.39 4.20% $133.89
k37314678ee EE $75 04/1984 10/2007 04/2014 $37.50 $96.39 4.20% $133.89
k37314371ee EE $75 03/1984 09/2007 03/2014 $37.50 $96.39 4.20% $133.89
k37314372ee EE $75 03/1984 09/2007 03{2014 $37.50 $96.39 4.20% $133.89
k26792798ee EE $75 02/1983 02/2008 02/2013 $37.50 $131.61 4.00% $169.11
k3396242gee EE $75 02/1984 02/2008 02/2014 $37.50 $99.21 3.67% $136.71
k33962428ee EE $75 02/1984 02/2008 02/2014 $37.50 $99.21 3.67% $136.71
k33942177ee EE $75 01/1984 01/2008 01/2014 $37.50 $99.21 3.67% $136.71
k33942178ee EE $75 01/1984 01/2008 01/2014 $37.50 $99.21 3.67% $136.71
k2502873gee EE $75 05/1982 11/2007 OS/2012 $37.50 $143.25 4.00% $180.75
k25040780ee EE $75 07/1982 01/2008 07/2012 $37.50 $143.25 4.00% $180.75
k25040703ee EE $75 07/1982 01/2008 07/2012 $37.50 $143.25 4.00% $180.75
~..IJ'I"""'lT"l"T .,........................_....-J.:_......_+. ___./T'l."...,'n~"""~ ..
Calculated Value of Your Paper Savings Bond(s)
k26831991ee EE $75 07/1983 01/2008 07/2013
k26055966ee EE $75 09/1982 09/2007 09/2012
k26055783ee EE $75 09/1982 09/2007 09/2012
c280631598ee EE $100 11/1990 11/2007 11/2020
c282274898ee EE $100 12/1990 12/2007 12/2020
c282274897ee EE $100 12/1990 12/2007 12/2020
c28227489gee EE $100 12/1990 12/2007 12/2020
c286209852ee EE $100 01/1991 01/2008 01/2021
c289324797ee EE $100 02/1991 02/2008 02/2021
c289324798ee EE $100 02/1991 02/2008 02/2021
c291098834ee EE $100 03/1991 09/2007 03/2021
c280631597ee EE $100 11/1990 11/2007 .11/2020
c267921273ee EE $100 10/1990 10/2007 10/2020
c267921272ee EE $100 10/1990 10/2007 10/2020
Totals for 170 Bonds
Notes
NI Not Iss ued
NENot eligible for payment
P5 Includes 3 month interest penalty
MA Matured and not earnino interest
/{obert 1. (!Jay" i, n
~'II,mJ.'''' tT"''''''u...,rl;....,,+ ,..~..IDr-/C1T>,...n...:. --
$37.50
$37.50
$37.50
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
6 512.50
$105.00
$139.71
$139.71
$71.48
$71.48
$71.48
$71.48
$71.48
$71.48
$71.48
$69.12
$71.48
$71.48
$71.48
12817.82
4.18%
4.00%
4.00%
4.00%
4.00%
4.00%
4.00%
4.00%
4.00%
4.00%
4.00%
4.00%
4.00%
4.00%
Page 4 of4
$142.50
$177.21
$177.21
$121.48
$121.48
$121.48
$121.48
$121.48
$121.48
$121.48
$119.12
$121.48
$121.48
$121.48
19 330.32
REV-1511 EX+(12-99l*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ROBERT L. MARTIN
FILE NUMBER
21 07 0667
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
FOGELSANGER BRICKER FUNERAL HOME, FUNERAL ACCOUNT
CUMBERLAND VALLEY MEMORIAL GARDENS
8,488.40
1,210.00
2.
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 11,014.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State ,Zip
Relationship of Claimant to Decedent
4. Probate Fees 298.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. GEORGE EBENER & ASSOCIATES, REAL ESTATE APPRAISAL 250.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
21,260.40
REV-1512 EX+ (12-03) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTIES, & UENS
ESTATE OF
ROBERT L. MARTIN
FILE NUMBER
21-07-0667
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
1.
SHIPPENSBURG FAMILY PRACTICE, MEDICAL ACCOUNT
KINETIC IMAGING, FINAL BILL
45.34
2.
15.46
3.
NATIONAWIDE CAR INSURANCE
45.12
4.
5.
NATIONWIDE INSURANCE, HOMEOWNERS
DR. THANE MAURER, ACCOUNT BALANCE
396.00
55.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
556.92
REV-1513 EX+ (fl..OO) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
ROBERT L. MARTIN
FILE NUMBER
21 070667
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 pndude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. ROBERT A MARTIN, 23 FIREHOUSE ROAD, WALNUT BOTTOM, PA SON 50% NET ESTATE
2. KAREN D. WINTER, 37 SUBDIVISION RD., NEWVILLE, PA 17241 DAUGHTER
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 $
(If more space is needed, insert additional sheets of the same size)