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Home My WebLink About02-12-08 -., . '" f - t .-J REV-1500 EX(06-05) PA Department d Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 15056041158 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT Ll Oi? Ot$"\ 157-09-6196 12052007 Date of Birth 02051915 DICESARE ALBERT MI A Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW [K] 1 . Original Return D 4. Limited Estate [K] 6. Decedent Died Testate (Attach Copy of Will) D 9. Litigation Proceeds Received Supplemental Return D D 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust .I:l- 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 717-731-9~ ?~:o D 2. 04a. 07. 010. Firm Name (If Applicable) REGISTER -0 J::"~ -u ::E: I)? W CO CRAIG A. HATCH GATES, HALBRUNER & HATCH, P.C. First line of address 1013 MUMMA ROAD, SUITE 100 Second line of address City or Post Office State ZIP Code DATE FILED LEMOYNE PA 17043 Correspondent's e-mail address: C. HA TCHiiJGA TESLAWFIRM. COM 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. Declaration of preparer other than the peraonal representative is based on all information of which preparer has any knowledge. ~~~~N ..2/I//DDA; ~ ~~ I 525 fAIRWAY DRIVE CAMP HILL, PA 17011 51 RE 0 ER lHAN REPRESENTATIVE DATE ,/ ~/// 1/ MUMMA ROAD, SUITE 100 LEMOYNE, PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041158 6M4647 3.000 15056041158 --.J ~ , Estate of 157-09-6196 Executors (Page 1) Name Address Tax ID Patricia A. Ferkile 525 Fairway Drive Camp Hill, PA 17011- 155-32-6431 f -...J 15056042159 REV-1500 EX Decedent's Name:>> ICE S ARE RECAPITULATION ALBERT Decedent's Social Security Number 157-09-6196 A 1. Real estate (Schedule A) . . . . . . . . . 1. 2. Stocks and Bonds (Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . . 2. 0.00 6626.76 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C). . . . . . 3. 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 Non-Probate Property (Schedule G) D Separate Billing Requested . . . . . 7. 0.00 0.00 246923.69 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . 4. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . 9. 0.00 253550.45 13476.70 846.30 14323.00 239227.45 0.00 239227.45 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . 8. 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 u~er Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14,Ui>rable at lineal rate X .O~ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 ta>rable at collateral rate X .15 0.00 15. 0.00 16. 10765.24 17. 0.00 18. 0.00 19. 10765.24 D 0.00 239227.45 0.00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND ~ AN OVERPAYMENT Side 2 L 15056042159 6M4648 2.000 15056042159 -...J r REV-1500 EX Page 3 File Number o d r c I te Add ece en S ompl e ress : DECEDENrS NAME DICESARE ALBERT A STREET ADDRESS 1700 MARKET STREET CUMBERLAND CIlY I STATE I: ZIP CAMP HILL PA 17011- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 10765.24 0.00 10226.98 538.26 Total Credits (A + B + C) (2) 10765.24 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 0.00 0.00 Total InterestlPenalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Plge 2, Line 20 to request I refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WIllS, AGENT 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; c. retain a rewrsionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? .................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes D D B D D D No [K] 00 00 [Xl [Xl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND Fl.E 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. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefidary. F or 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 use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 89116(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. 6M4671 1.000 r COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF SCHEDULE A REAL ESTATE REV-1502 EX + (6-98) FILE NUMBER ~bert A. Dicesare All rell property owned solely or I. I tenant In common must be reported at fair mlrket vllue. Fair market value is defined as the price at \\4lich property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both hailing reasonable knOlMedge of the relevant facts. Reel property which Is JolnUy~ned with rtght of .urvlvorshlp must be dlsclos8d on Schedule F. ITEM NUMBER 1. None DESCRIPTION VALUE AT DATE OF DEATH 3\1\146951.000 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 0.00 r , REV-1503 EX + (~98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER ~bert A. Dicesare All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NLMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 69 Shares 69 Shares of Prudential Financial, Inc. Date of Death average $96.04 per share 6,626.76 3W4696 1.000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,626.76 REV-1504 EX + (6-98) COM\1ONWEAL TH OF PENNSYLVANIA II\tERITANCE TAX RETURN SCHEDULE C CLOSEL Y-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF ~UCI,", L...II::'-A::~I"I FILE NUMBER ~bert A. Dicesare Schedule C-1 or C-2 (including all supporting informlltion) must be attached for each c:IoeeIy-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NLNBER DESCRIPTION VALUE AT DATE OF DEATH 1. None 3W4697 1.000 TOTAL (Also enter on line 3, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 0.00 REV-1507 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INl-ERITANCETAX RETURN RESIDENT DECEDENT ESTATE OF Albert A. Dicesare SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER All property Jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 4, Recapitulation) $ 0.00 3W46AC 1.000 (If more space is needed, insert additional sheets of same size) REV-1506 EX + (6-98) COMMONIIVEAL TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Albert A. Dicesare FILE NUMBER Include the proceeds of litigation and the dale the proceeds were received by the estate. All property Jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER CESCRIPllON VALUE AT DATE OF DEATH None 3W46AD 1.000 TOTAL (Also enter on line 5 RecaDltulation) $ (If more space is needed, insert additional sheets r:l the same size) 0.00 REV-1509 EX + (6-98) COw.1ONVVEA L TH OF F9NSYL V A NL6. N-ERITANCE TAX ~ fa)[lENT CEC8.'l9lT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER A1bert A. Dicesare If an asset was made Joint within one yelr of the decedent's date of delth,lt must be reported on Schedule G. S~IVNGJONT~NT(S) ~M: ADDRESS RaA TIONSHPTO CEC8JEM A Ferkile, Patricia A 525 Fairway Drive, Camp Hill, PA 17011 Daughter JOINTL V.QWNED PROPERTY: LETTER DATE DESCRPT10N OF PROP8m' %OF DA TE OF CEA TH ITEM FOR JOINT t.MDE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DA TE OF CEA TH DEClJS VALLE OF NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR t>UJB~ TENANT JOM JOINTLY-HELD REAL ESTATE. VALLE OF ASSET NT'EREST lJECEDBIlT'S NT'EREST 1 A 6/26/2006 PSECU money market account 427,266.31 50.0000 213,633.16 2 A 6/26/2006 Wachovia Bank checking account 13,988.27 50.0000 6,994.14 3 A 6/26/2006 Wachovia Bank Certificate of Deposit 52,587.77 50.0000 26,293.89 4 A 6/26/2006 PSECU Regular Share account 5.00 50.0000 2.50 TOTAL {AlAn AntArnn linA R - . . . s 246,923.69 (If more space is needed, insert additional sheets of the sal'Tlt size) 3W46AE 1.000 REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~bert A. Dicesare SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 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 I/Q.LCE Tl€ ~ OF Tl€ TRANSFEREE, Tl-EIR RELATIONSHP TO DEceoENT /IH) DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER Tl€ClAlEOF"IRAN9FER. ATTACHACOPt' OF TI-E DEeo FOR REAl ESTATE. VALUE OF ASSET INTEREST (F APPLICABLE) VALUE 1. None TOTAL (Also enter on line 7, Recapitulation) $ 0.00 (If more space Is needed, Insert additional sheets of the same size) 3W46AF 1.000 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA It+ERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Albert A. Dicesare SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Fiori's Flowers (funeral flowers) 449.40 2 Baldassari Regency 487.30 Total from continuation schedules 11,960.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 580.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach e>eplanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. None TOTAL (Also enter on line 9, Recapitulation) $ 13,476.70 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Albert A. Dicesare 157-09-6196 Schedule H Part 1 (Page 2) Item No. Description Amount 3 Gruerio Funeral Home (funeral) 11,960.00 Total (Carry forward to main schedule) 11,960.00 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INl-ERITANCE TAX RElURN RESIDENT DECEDENT ESTATE OF Albert A. Dicesare Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE lIABiliTIES, & liENS FILE NUMBER ITEM NlJ.1BER cescRlPTlON VALUE AT DATE OF DEATH 1. West Shore EMS-ALS (medical bill) 846.30 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 846.30 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONVVEAL TH OF PENNSYLVANIA IIII-ERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~bert A Dicesare NUMBER I NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [indude outright spousal distributions. and transfers under Sec. 9116 (a) (1.2}) Patricia A. Ferkile 525 Fairway Drive Camp Hill, PA 17011 1 ~l of Residue: 239,227.45 RELATIONSHIP TO DECEDENT Do Not List Trustee(s} Daughter FILE NUMBER AMOUNT OR SHARE OF ESTATE 239,227.45 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16, 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 3W46AI 1.000 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 COMMONWEALTH OF PENNSYLVANIA INl-ERITANCE TAX RElURN RESIDENT DECEDENT EST ATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN REV-1514 EX+ (12-03) Check Box 4 on REV.1500 Cover Sheet FILE NUMBER ~bert A. Dicesare This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax retum. D Will D Intervivos Deed of Trust D Other LIFE ESTATE INTEREST CALCULATION NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE Life or 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. Actuarial factor per ap~riate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interest table rate - U 3 1/2% D 6% D 10% 0 Variable Rate 0.00000% 3. Value of life estate (Line 1 multiplied by Line 2) ............................. $ Term of Years Term of Years Term of Years Term of Years Term of Years 0.00 0.00000 0.00 ANNUITY INTEREST CALCULATION NAME(S) OF LIFE ANNUIT ANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAY ABLE 1. Value of fund from which annuity is payable .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. Check appropriate block below and enter corresponding (number) . . . . . . . . . . . . . . . . . . . Frequency of payout -0 Weekly (52) a Bi-weekly (2U Monthly (12) D Quarterly (4) 0 Semi-annually (2) Annually (1) OOther () 0 3. Amount of payout per period ....................................... $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . 5. Annuity Factor (see instructions) Interest table rate -0 3 1/2% D SOlo 0 10% D Variable Rate 0.00000% 6. Adjustment Factor (see instructions) ................................... 7. Value of annuity -If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Term of Years Term of Years Term of Years Term of Years 0.00 0.000 0.00 0.00 0.00000 0.00000 0.00 0.00 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) 3W46AJ 3.000 REV-1647 EX+ (9-00) SCHEDULE M FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 48 on Rev-1500 Cover Sheet ESTATE OF FILE NUMBER ~bert A. Dicesare This schedule Is appropriate only for estates of decedents dying after December 12,1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future Interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future Interest and attach a copy to the tax return. o Will 0 Trust 0 Other I. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decendents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. n Limited rlaht of withdrawal n Unlimited riaht of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) . . . . . . $ 0.00 3. Value of line t~ring ~se [j';opriate tax rate Check One SOlo, 3%, 0% . . . . . . . . . . . . . . . $ 0.00 (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check one 06% o 4.5010 . . . . . . . . . . . . . . . . $ 0.00 (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) . . . . . . $ 0.00 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) . . . . . . $ 0.00 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . .......... . . . . . $ 0.00 3W46AN 1.000 (If more space Is needed, insert additional sheets of the same size) f . COpy OF THE CERTIFIED DEATH CERTIFICATE OF THE DECEDENT .. LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. e for this certificate, $6.00 Certification Number P 13998611 Date Issued HI05-I43 REV 1112006 1YPE1~'TIN PERNANENT lllACK INK COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE RLE NUMBER 1>7Cb".SA (L E: &. lllIIII oIl1i11l (Month. 2-5-1915 10. Rece: A!TI!rican Indian. BIecIc. Y/lllI~. , wtrrTE 14. ~=1);.~~' Married. 15. Svrviving Spcuse (If wifl. give me~n nvme) WIDOWED PENNSYLVANIA 17b. County CUMBERLAND 17C. 0 Yes. 0Icedenl Lived In 17d.1!g No.DeoedentL,,"d~~MP HILL Actual L...,. of TWJ c~ I Bar 19'~~f:lr~mONI 21lb.lnrns~iRmoryDRiVE:~AMP HILL, PA 17011 21.. Place of DiIPC)Sion (Name of cemote<y. cremetory... _ DIact) EWING CEMETERY ASSOC. 21d..Iffl'"'" ~'C:OT~IHZip ~ EWtNt;, NJ 0~28 HOME 311 CHESTNUT AVE TRENTON,NJ MD 23b. License Number m/) It U rQr- 23c. 011. Signed (Month. da)'. yea') Iz.-r --07 26. Was Casll R'l-)'> Modicel EXllm;ne, I ~,fo' I R...on Cl:hor than ero"'alion 0' Dona1ion? LlVos f8fNo r- ~ ist cmdIions.. any, l01Iing" Iho CIUSllIsIed on Iino IL E/Ur h llNllEIlLYING CAlISE =-~..~~tho CAt\) e-E'/L- I Appmoimale inI.rY8I: : Dnm " Death I I I I I I I I I I , , , , I PN~U.rroN1-14 C,AC-Hex JA 28. Did Tobacco Use Call1tbul.lo Death? o Yes [) ~abty o No 18" Unlmev.." 29. " Female: o Not pregnant wIIh1n pas! year o ~ at fune of doalt1 o Not p~nt. b'Jl ~I wilhin 42 days ofd!!alh o Not prognent.1M pregnant 43 doys to 1 yea, boI.... death o U_ t JlIe9"8nt within.... pasl yea' 32c. Place of InjI."l': Horne. Fa.... &reel. ~'c!0IV. ()tI;ce BuiliIing. etc. IS-if';) . Pan II: Enter other oionificanl condIIians conItIlUIina to _. but noI reslAling In !he undertyinv tauS<! g'Yen .. P"" I. (fl V J ~=~=~ a. AWTE"" fl.F:~PrfL!tTDP-7 Due 10 (or IS . consaquance 01): b. PLEUf2A, L- &FFUi Jl>N~ Due " (or as a consaquance 01): c. NoAl SMALJ ('t ELL WNGr Due " (or as . c:onse<Jltr1ClI 01): F.A1: L.U IL/? d. ~ ~ o ~ 321. RTransporIaliClOllnjuly (Speci!y) o DriYer I Opelllo' 0 Passenger OP!!d"lril!n 0Iher . SpeCIy: 330. Certifior (chedr only one) 3313. Signalu.. and Tille of c.~ /\ f) _ ~ . ~=(~=:'~IIle~onc;-.::,,:~~_~~~~~":,~_________________ 0 .. __P' y ~{P7 I . Pronoonclng III1d c:ortIIyIng pllpidIn (~ - pronouncing - and certifying 10 cause of deaIh) JZ5. 33c. License Numbe, 33d Dale Sion.d (Mont~. dav. ...'1 . ::.. ~ ~;;.,.:: - occuned or the Ilme, dalo, ond place, III1d due to the causo(s) and m.nnor IS sta1ed_ - - - - - - - - - - - - - - - - - (Y)l) 4- U KY J i. _ S- __ 6 '7 On the basis of ...mlnorlon and I or invosllgallon.ln my opinion. dealh occurred at the lime, dlllo. and pi.... and d...lo the ceuse(.) and.."".., H sl.led_ 0 34. Nama and Add!ess of P.""" Who ComolEtod Cau.. of De"~ 01.." 211 T,'rO: P.,rt 35 R~'- ' , and DismCt~ 0 Q . <:2 :J60~ .~O 7,A PA ..c ~j;p G-14.;;r;r,qt'2- fVl [) ... { .-" I I..,L I ) 1t).!2 I I:.~ VOl. s~~ N+\.\/~...\p~ ~~~ i 1 O,,.,.,.;'",n p....~ No 0 () 7. i f.J () .!\ Dv.s ONo 31._ofDoaIh czfNaftlral O~ o -- 0 PencIng InvesIIgaIion o SuIcide 0 CoI*l Not ba IletefrniMd 32tl. Tme oflnjuly 329. Location of lnjuly (S:~.t. oily! 10\\". slate) -W 300. Wos .. "'*'PsY Porfonned7 Ov.s ~ 3Ilb. W- AuIopay FinlJngs /WaiIabIe PIlar to CompIatIon of Cause of DeaIII? cv -D M. LAST WILL AND TESTAMENT OF ALBERT A. DICESARE 3: ITI :0 ~; Q Ill, :0 z - n ti CXl 0 ~~""~ ZrnO~ '1-1:0-< ~r~r- ~~ffi~ ~~~~ < '" 0 en ;)::1IT11T1 ])",:0:0 :II !(:5 i ~ Q t ill en ~ ~ ;g o c... ITI q > &; ttJ ~ .'f o H () ttJ {J} ):0 ~ ((( 0 Mj i -- ..-.. ~ ~ )~ ,~~- ~ ,~, ~ ~ ~ ~ ~~- --- '-" ?4 (<< ~ ) t:Y --- ..-.. q~ ~ ~ ""","",">I ~~- ~ J~,t \~ ~ 1 el (((~ ~ -- '-' T ~ . -lIIOt$t-mill ttnO @~~t(jtmRnt OF ALBERT A. DICESARE I, ALBERTA. 01 CESARE, now residing at 1538 Cham bers Street, in the Township of Hamilton, County of Mercer and State of New Jersey, being of sound and disposing mind and memory, do hereby make, publish and declare this my Last Will and Testament, hereby revoking all Wills and Codicils at any time heretofure made by me. FIRST: I order and direct my Executrix hereinafter named, to ray my debts, expenses of my last illness, funeral and testamentary expenses as soon after my decease as may be convenient. 1 also direct that any and all inheritance or estate taxes which may be assessed or imposed in any way by reason of my death with respect to any and all property taxable as part of my estate be paid as expenses of administration and not as a charge on the beneficiary or beneficiaries of such property. SECOND: Provided that my wifE, LETIZIA C. DICESARE, now residing in Hamilton, New Jersey, survives me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal or mixed, of whatsoever kind and wheresoever the same may be situate, of which I may die seized or possessed, or in which I have any interest, to my wifE, LETIZIA C. DICESARE, PROVIDED that if my wife shall predecease me or die within thirty (30) days of my death, I give, devise and bequeath all the rest, residue and remainder of my estate to my daughter, PATRICIA A. FERKILE, now residing in Camp Hill, Pennsylvania, and FURTHER PROVIDEr that if my daughter shall predecease me or die within thirty (30) days of my death, I give, devise and bequeath her share to my surviving grandchildren in equal shares. THI RC: I hereby nominate, constitute and appoint my wife, LETIZIA C. frCESARE, Executrix of this my Last Will and Testament, to serve without being required to furnish any bond or security for the faithful perfurmance of her duties. In addition to all powers granted by the law of the State of New ~rsey, my Executrix shall have full discretionary power, without order or approval of any court, to take any action desirable for the administration of my estate, including the following powers: to sell at public or private sale, any real or personal property belonging to my estate at whatever prices and upon whatever terms she shall deem advisable; to retain, invest or reinvest in any property without responsibility for diversification and without being restricted by any rule of law or court limiting investments; to tvld any securities in the name of a nominee; to compromise any claims to the same extent I could, if living; and to distribute in kind or in cash, or partly in each, even if shares be composed differently. FOURTH: In the event that my wi.fJ?, LETIZIA C. DICESARE, does not survive me, does not qualify or having qualified ceases to serve as such for any reason whatsoever, then in that event, I hereby nominate, constitute and appoint my daughter, PATRICIA A. FERKILE, substitute Executrix, with all of the duties and powers hereinbefore stated in ARTICLE THIRD of this, my Last Will and Testament, and I direct that no bond or security be required of her for the faithful perfurmance of her duties. FIFTH: If any part of my estate shall become payable or distributable at any time to any of my grandchildren who shall then mt have attained the age of Twenty-One (21), then, I give, devise and bequeath his or her share of my estate to my hereinafter named Trustee, IN TRUST NEVERTHELESS, to hold and administer the same until my grandchild attains the age of Twenty-One (21) and to pay to or for the benefit of my grandchild so much, all or none, of said trust both income and principal, as my Trustee, in his uncontrolled judgment and discretion, shall consider necessary or advisable for the health, support, maintenance and education of my grandchild, until he or she shall attain the age of Twenty-One (21) at which time the remainder of his or her respective share of my estate, with the accumulations if any, shall be paid and distributed to him or her, or if he or she dies before attaining the age of Twenty-One (21), upon his or her death to his or her executors or administrators, to be administered and distributed as part of his or her estate. -2- SIXTH: I hereby nominate, constitute and appoint my brother-in-law, ALBERT A. REMOLI, Trustee of this my Last Will and Testament, to serve without being required to furnish any bond or security for the faithful perfurmance of his d utles . IN WITNESS WHEREOF, I have hereunto set my hand and seal this __I / day of Tv' L f , Nineteen Hundred and Eighty-Four. (LSl rJift'lrft! (1;r?'7<7_<< A (' A R . DICESAR The foregoing W ill, consisting of fuur typewritten pages, including this page and the following affidavit, was signed, sealed, published and declared by ALBERT A. DICESARE, the Testator, as and for his Last Will and Testament in the presence of each of us, present at the same time, and who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. /1 'J/' ,1\ / Cl'\ a,"", i:l~ ;6;- Residing at ~~~~;-t-ry, /~~/ t Ct,. 0.,1 /. :~~Residing at}~ __,1A._cu," 1h.- y2, I, ALBERT A. DICESARE, the Testator, sign my name to this instrument this -'-2- day of Ji-' L \/ , 1984, and being first duly sworn, / do hereby declare to the undersigned authority that I sign and execute this instrument as my Last Will and that I sign it willingly and that I execute it as my free and voluntary act for the purposes therein expressed, and that I am 18 years of age or older, of sound mind, and under no constraint or undue influe nce. ~x-tJ >t~ 6?~~ A . DICESARE -3- / 1;[A.-K: 1\ duly sworn, db each he' , '~'~~~" the witnesses being first declare to the undersigned authority that the Testator signs and executes this instrument as his Last Will and that he signs it willingly and that each of us states, that in the presence and hearing of the Testator, he/she hereby signs this Will as witness to the Testator's signing, and that to the best of his/her knowledge the Testator is 18 years of age or older, of sound mind, and under no constraint or undue influence. ,// ( ----- 6~ //~ W ltnesS ..l. j~ ~ . ~:~ '-'< ~. '- r:.x.:. ~ '- > State of New ..ersey: County of MeJ:l:er : Subscribed, sworn to and acknowledged before me by ALBERT A. SS: DICESARE, the Testator, and subscribed and sworn to before me by ,1/ '-) 1.' this ,.Krl IT., \ ' \.A.k "Ti'ii and day of ~'a 'J c!"." ,,\(. ~'~d.' \.. , witnesses, ~ (f ., l~ti')~;ii K. 8Ml ATTORNEY-AT-LAW STATE OF NEW JERSEY \~'t'- '", -4- PA REV-1500 SCHEDULE B STOCKS and BONDS 8 Prudential (pmputershare + 051836 Computershare PO Box 43033 Providence Rhode Island 02940~3033 Within the US. Canada & Puerto Rico 800 305 9404 Outside the US, Canada & Puerto Rico 7325123782 www.computershare.com == iiiiiiiiii ;;; iiiiiiiiii - iiiiiiiiiii - - - !i!!!i!ii!i!! iiiiiiiiiii !!!!!!!! iiiiiiiiiii iiiiiiiii iiiiiiiiiii iiiiiiiiiii - I/MPORTANT TAX RETURN DOCUMENT ENCLOSED I *********** AUTO**5-DIGIT 17011 o00ooo168/000051836 ALBERT DICESARE 525 FAIRWAY DR CAMP HILL PA 17011-2023 1...111.11111..11..11.1111..1.111.....1.1..11...1.1.1.11111..1 Holder Account Number C0003209351 IND - !i!!!i!ii!i!! iiiiiiiiiii !!!!!!!!!! IIIIIIIII1III Record Date Check Number SSNmN Certified Nov 26 2007 0002883424 Yes 001 ego 1 07.00MLNGEQS-'Q 1.PRU.232449J91OS183610518361i Prudential Financial, Inc. · Combined Dividend Payment J 2007 Tax Form.1099.DIV Form 1099-DIV Dividend Confirmation Payment Date I (Keep for your records) 21 Dee 2007 CI D 'pt" I Participating I ass escn Ion Shares/Units COMMON 69 Dividend I Gross I Deduction I Rate Dividend ($) Amount ($) $1.15000 79.35 0.00 Deduction I Type N1A Net Dividend ($) 79.35 79.35 Year-To-Date Paid 79.35 0.00 _ 46UTX PRU + 002CS70004 OORX6A(1 ) PlEASE CASI-IDEPOSIT THIS CHECK PROMPTlY. , . PA REV-lSOO SCHEDULE F JOINTLY OWNED PROPERTY .. ~~~... WACHOVIA Reference ID: 2291266 Wachovia Bank N.A. Balance Confirmation Services POBox 40028 Roanoke, VA 24022-7313 January 10,2008 PATRICIA FERKILE 525 FAIRWAY DRIVE CAMP HILL, PA 17011 SUBJECT: Verification / Confirmation of Account and Balance Information provided for: Customer: ALBERT DICESARE (SSN# XXX-XX-6196) Date of Death: December 5, 2007 Denosit Account Information Account Type Account Number Date of Death Balance Average Balance. Date Opened Maturity Interest Accrued YTD Date Date Rate Interest Interest Paid Closed CERTIFICATE OF XXXXXXXXXXXOl79 DEPOSIT LEGAL TITLE: ALBERT A DICESARE PATRICIA ANN FERKILE $52,543.36 9/20/2006 9/20/2008 $44.41 $2,296.07 CHECKING XXXXXXXXX5672 LEGAL TITLE: ALBERT A DICESARE PATRICIA ANN FERKILE $13,988.15 8/9/2007 $0.12 $1.53 * Date of death balance does not include accrued interest. · If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were ma edUri~g~~ ) c Ulre Servicenter Associate Phone: (540)563-7323 11; dm 0000 000614 . ...j . PSEC,'LtI'- [,i,J, :~+' ~:,,-/-.... ;;~~';- :<,?o;:;<', "'- . '.-.,." the financial link January 7, 2008 ALBERT DICESARE PATRICIA FERKILE 525 FAIRWAY DR CAMP HILL PA 17011-2023 Dear Albert Dicesare: As of December 5, 2007, your account balances were as follows: (S 1) Regular Share (S4) Checking Share (S7) Money Market $5.00 $0.00 $427,266.31 If you have any questions, you may reach us between 7 a.m. to 5 p.m. Monday through Friday or Saturday 8 a.m. to noon at 717.234.8484 in Harrisburg or toll-free number 800.237.7328. Please enter 5 and then 5 again at the menu prompt to speak with a Member Service Representative. ~, Heather D. #460 Member Service Advisor Member Services PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 . (717) 234-8484 . (800) 237-7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 . (717) 777-2100 (TOO) . (800) 472-1967 (TOO) Web Address: www.psecu.com Savings federally insured up to $100,000 by the National Credit Union Administration. " J .. PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COSTS ,. u .. [lRUERIO IluNERAL II]oME Toni Gruerio NJ. Lie. No. 2634 OwnerlManager Funeral Director Jude Curini N.J. Lie. No. 4082 Funeral Director December 11, 2007 Mrs. Patricia Ferkile 525 Fairway Drive Camp Hill, PA. 17011 Statement of Funeral Expenses for: Albert A. DiCesare Date of Death: December 5, 2007 Funeral Home Charges: $4,475.00 $3,960.00 $313.00 $1,350.00 $10,098.00 All Professional Services and Facilities Charges: (See statement of goods and services for detailed itemization) Casket: Tarragon Stationery Items and Other Merchandise: Automotive Equipment: Cash Advances Items: Ewing Cemetery Association 10 Certified Death Certificates at $ 6.00 each St. Raphael-Holy Angels Filing Pa. Certificate Times Trentonian Pallbearers Total Cash Advance Items: $ $ $ $ $ $ $ 675.00 60.00 425.00 35.00 260.00 182.00 225.00 Total Funeral Charges: Total Amount Due: ~'~ ~c..~~ / / :1 ~I Yf ;( 1)0 f- /rt ;:~ !.J .. AACP-. I V. ---. /J R- JL:f(-- / 02- ____..-.~..r".-.--.._-- $1.862.00 $11,960.00 $11,960.00 311 Chestnut Ave. . Trenton, NJ 08609 . Phone (609) 393-4966 . FAX (609) 393-5359 If ., .. Ct:> <. 00 <::':) C":) .r--., ~ - ....) '. -..; o. '----.' Z o CO N '} "".! Q: (', " \~ a.. ~ N - " ;".'J ." '-", \ f'- :l) ",t{ r5 ~ '-I V) ''-.\ f- r~ .~ \ I '\ , I t "', ',z~ ~ -:-),- ~ '<.;::, III III Q) <lJ E ... "'0 c- ~ "'0 Z <( U ) o '""" Cl) ~8 ~..... , ~I.O s~ ~2 . .. -.\. . 0 -.v WO ~ ~~ ~ al <f> ,V"\ 00 ~ o o r-... ,... ) \ '~ r- \..,; 25 c .... ro ~~ L. IV) f-o-- -N aJ I :IN cO-- :l)1V) >- <(0-- ..,,0 . - ...c ~~ ~ ~ c: Lr) 0 ~..!:;; .--0.. 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DESCRIPTION AMOUNT TAX TOTAL DELIVERY PHONED WIRE SERVICE - IN OUT BIRTHDAY ANNIVER. CARD r--..... ( I) C'l_.t1/ttL- "'-...-'" WORK l CITY \ ~!Jhanlv WfHP/ STATE ZIP --. jl \~ ~K ~ j033 VD0211 2 pI VOO212 3 pI. '~-..h96 .. .J ... WESTSHOREEMS-ALS 205 GRANOVIEW AVE SUITE 211 CAMP HILL, PA 17011 Phone #: (800) 367-0512 Federal Tax 10: 23-2463002 ~ WEST SHORE :'IFR(JE:'-iCY MEDICAL SERVICES INSURANCE: MEDICARE B FEP 157096196A R01320142 PATIENT NUMBER: CALL NUMBER: DATE OF CALL: TIME OF CALL: CALLER: FROM: TO: 67459 3096187A 12/04/2007 MOEN ECAR PATIENT NAME: ALBERT DICESARE 3096187A MANORCARE HEALTH SERVICES HOLY SPIRIT HOSPITAL ALBERT DICESARE 525 FAIRWAY DR CAMP HILL, PA 17011 REASON(S) FOR TRANSPORT Respiratory Distress INVOICE DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT PARAMEDIC INTERCEPT A0999 1.0 797.87 797.87 EKG ELECTRODES (4PK) A0396 1.0 4.94 4.94 GLUCOSE BLOOD A0394 1.0 6.74 6.74 PERIPHERAL IV A0394 1.0 36.75 36.75 T >tal Charges 846.30 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT Total Credits 0.00 PLEASE PAY THIS AMOUNT - INVOICE DUE UPON RECEIPT -.. $846.30 RETURNED CHECK FEE - $31.00 DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT AMOUNT DUE 846.30 PATIENT NAME: DICESARE. ALBERT A CALL NUMBER 3096187 A AMOUNT $ . PATIENT NUMBER: 67459 BILLING DATE: 01/03/2008 ENCLOSED THESE SERVICES ARE NOT COVERED BY MEDICARE AND ARE YOUR RESPONSIBILITY . VISA VISA ND . CARD ., II" .. *** END OF ATTACHMENTS ***