HomeMy WebLinkAbout02-22-08
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes ' . INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
2 1 0 7
055 9
Date of Birth
207078204
o 5 2 4 2 007
09021918
Decedent's Last Name
Suffix
Decedent's First Name
Pie r C e
Dorothy
MI
S
(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
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust L 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
FILL IN APPROPRIATE OVALS BELOW
[&J 1. Original Return
o 4. Limited Estate
[&J
o
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
D a v
d
H
S ton e ,
Esqui re
7177747435
Firm Name (If Applicable)
St one LaFaver
.
Shekl et skI
~._._--_._--~_----':':'~_:1-...-_____
REGISTER OF WILUrU;iE ONLY
C) "
First line of address
.--;-.
I"
.,
(.::::
414
B r
d 9 e
S t r e e t
,I
,
1'_"1
tv
Second line of address
City or Post Office
State
ZIP Code
1'..,)
_[)~TE i'~~P:,-
New
Cumberl and
P A
17070
Correspondent's e-mail address:dstone@stonelaw.net
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 personal representative is based on all information of which preparer has any knowledge.
SIGNATURE ERSON RESPONS FOR F. NG RETURN DATE
/ " 2-2\.o~
New Cumberland
PA 17070
DATE
2-ZI.~
THER THAN REPRESENTATIVE
New Cumberland
PLEASE USE ORIGINAL FORM ONLY
PA 17070
Side 1
L
15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Dorothy S. Pierce
RECAPITULATION
207078204
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.
36489.79
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous NlIDiProbate Property
(Schedule G) U Separate Billing Requested. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7) .......................... . 8. 3 6 4 8 9 . 7 9
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 9 6 9 3 . 1 9
............... .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 2 2 8 2 5 . 5 5
11. Total Deductions (total Lines 9 & 10) . . .. . . .. . . . . . .. .. . . . . .. . . . . 11. 4 2 5 8 . 7 4
12. Net Value of Estate (Line 8 minus Line 11) .........................12. 6 0 2 8 . 9 5
13. Charitable and Governmental Bequests/Sec 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.
6028.95
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.O _ o . 0 0 15. o . 0 0
16. Amount of Line 14 taxable
at lineal rate X .O~ 0 . 0 0 16. o . 0 0
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17. o . 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18. o . 0 0
19. Tax Due 19. o . 0 0
....... . .............................. .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
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15056042126
15056042126
--.J
ReV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Dorothy S. Pierce
STREET ADDRESS
100 Mt. Allen Drive
File Number
21 07 0559
CITY
Mechanicsburg
. STATE
PA
ZIP
. 17055-
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + 8 + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
Total Interest/Penalty ( 0 + 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 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
0.00
0.00
A Enter the interest on the tax due.
(5A)
(58)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
0.00
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 !Xl
b. retain the right to designate who shall use the property transferred or its income; ............................... 0 !Xl
c. retain a reversionary interest; or ................................................................................................ 0 !Xl
d. receive the promise for life of either payments, benefits or care? ....................................................... 0 !Xl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... 0 !Xl
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 !Xl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 0 !Xl
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. !j9116 (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. !j9116 (a) (1.1) (ii)]. The statute does not exempt 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 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. !j9116(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 PS !j9116(1.2) [72 PS !j9116(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. !j9116(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-1508 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Dorothy S. Pierce
ITEM
NUMBER
1.
FilE NUMBER
21 07 0559
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.
DESCRIPTION
SecurChoice-burial trust account #40277
VALUE AT DATE
OF DEATH
15,023.28
2
PNC Bank-Checking Acct. #5140049909
Principal $19,883.87, Int. $1.09
19,883.87
3
PNC Bank-Checking Acct. #5140049909 - Accrued Interest
1.09
4
US Treasury-CSF check
1,581.55
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
36,489.79
REV.1511 EX + (12.99)
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dorothy S. Pierce
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
Parthemore Funeral Home-funeral expenses
1.
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Lawrence C. Pierce Jr.
1.
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 1438 Sconsett Way
City New Cumberland
Year(s) Commission Paid: 2008
State PA
2.
3.
Attorney Fees David H. Stone, Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Relationship of Claimant to Decedent
4.
Probate Fees Cumberland County Register of Wills
5.
Accountant's Fees
6.
Tax Return Preparer's Fees
7
2
3
4
5
PNC Bank-check imaging fee from 6-07 to 2-08
US Treasury-Return of CSF check
Verizon-services at residence
Register of Wills-filing Inheritance Tax Return and Inv.
Reserve for closing expenses
FILE NUMBER
21 07 0559
Zip 17070
Zip
AMOUNT
13,849.15
2,000.00
2,000.00
106.00
18.00
1,581.55
8.49
30.00
100.00
(If more space IS needed, insert additional sheets of the same size)
TOTAL (Also enter on line 9, Recapitulation) $
19,693.19
REV-1512 EX + (12-03)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dorothy S. Pierce
FILE NUMBER
21 07 0559
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Mobile X-rays-services rendered
8.61
2
Discover-debt of decedent
2.99
3
Messiah Village-room and board from 12-01-06 to 5-23-07
22,813.95
TOTAL (Also enter on line 10, Recapitulation) $
22,825.55
(If more space is needed, insert additional sheets of the same size)
orotw lerce
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Lawrence C. Pierce, Jr. Son Lineal 0.00
1438 Sconsett Way
New Cumberlannd, PA 17070
2 James C. Pierce Son Lineal 0.00
1234 Capital Street
Harrisburg, PA 17102
3 Stephen J. Pierce Son Lineal 0.00
1428 Maplewood Drive
New Cumberland, PA 17070
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
''''''''''.'*
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
D h S P'
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 07 0559
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
DOROTHY S. PIERCE
I. Dorothy S. Pierce. of LeMoyne. Cumberland County,
Pennsylvania. revoke any and all prior wi lis and declare this to be
rnyLastWill.
F LRSJ': :
<\11 of my debts and the expenses of my last
! Iness. funeral and burial shall be paid out of my Estate.
SF:J~QNR :
J devise and bequeath all of my estate of every
nature what')oever nnd wherever situate. together with all Insurance
r L' 1 a tin g the I' e t (). t n my h u s ban d, Law r e nee C. Pie r c e. Sr. pro v i din g
hI.:' suni\'es ine by thirty (30) days.
TJ:lJRP:
S h 0 u J d rn y h lj s ban d . Law r e nee C . Pie [' c e , Sr.
pre'!"'C't'rt',C me Ill' die (In Ill' hef.'re the thir'tieth da.\ fOlll)wing IllY
"':"1 t h .
'J C' \ i " ''': 1 n db", q ! I e Ii t h a 1 I u f m.v est;l t e () f eve r Y TJ d t 1I r e .'! n d
\ '](:~ I ,-' \ ',~ r sit ILl t e t n\! e t he I' A i t h d n)1 n d a I I 1 n s u ranee reI iI tin g
t h l;' r >,' i (). r I) in \' I: h i I d r en, J ;'1 III e s C. Pie r c e. L ,'1 W r e nee ('. Pier c e. J!'..
:1fl<l c.;t,';.f1en J. PIC:rc,:. in '-''-Iu:11 .;hal"_'''; p,-'r ',rirpes, shdr<:.'lnd ';h;l['('
,1 i i L .'
1 "
, 11 ,"{ i 1 t....; In
, Iii Ii)' .\ f1 '1 n d fl ( ) t
1 "
- ,
J(,jrlt tL'!1ants.
FQURTH:
Nt, interest in Income or principle shall he
EI " <.; j go n 11 h J ie' h y . 0 r a va i I a b 1 (;' t n any () n chit \' in? il ('] a i rn Elf.' a j fI S t Ii
h t' n l' fie i it r \ h e f 0 ! e a ,-' t U fi] P Ii \. m (' n t t (1 the hen e f i cia n
II fIff :
....] I
feoera] .
state and other death ta\es
payahle hecilllst: of my death on the property forming my gross estate
f(lr tEn purpose:, <:lIa]] he paio out of thE' principle (If 01,' prubate
c<.,tate ju',t 11'; if the\' were my debts. and none of thost: taxes sha] I
he chilrged against my beneficiaries.
~I~_Iff :
appoint my son. Lawrence C. Pierce. Jr.. as
FXectltor of this Wi] I. but if for any reason he fai Is to gllal if) or
ceases tf) act. t appoint my son, Stephen J. Pierce. as Executor In
his place to carry out the provisions of this Will.
I direct thf.tt
no fiduciary shal I be required to give bond.
~f,YE~TH :
I acknowledge a duplicate of this Will which.
f(,r all intents and purposes, shall be considered to be an original
of my last Will in the event that the original cannot he located at
tht' time uf my death.
IN WITNESS WHEREOF. 1. Dorothy S. Pierce. as and [In my
last Wi]], have hereunto set my hand and seal this
-2 '.)]
,.I} clay of
Lx' ( t 0\ b{ ~
A.D.. 1993.
I
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- t)OR01:H\-:-~S .F }flUf
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T h t' p r t' C e din II ins t r U (II C n t. en n s i s tin ~ (1 f t his and t ',\ () (.::)
other tvpt'\\rittcn pages. was SIGNED. SFAIFD. PllBJ ISHfD and DECl -\PED
h\ the rth\IYC-narned Testator. as and [(If hi s Last Wi J I. in the
pre S C' TI C (' n f us. w h Ci. ] n his pre s e nee and i-i t h j s r e q II cst and ] nth e
presence of each other. hit\'c hereunto St't our names as attt'sting
witnesses:
,j
(;75111 l?,i, (./ .
~i~-t
~rC'CL ,:j1fd~.L
Na C'
\
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Add ft~.'i s
Address
,
.)
A (XN9WJ ,J; DGJ'U;:NT
C(H.l\M)'.'~.'F\T TH or PP....1\.,S\'] \'-\'\I~.
S5
CO{T\,TY OF ('llMRf R 1<\ \1)
T. D'lJothy S. Pierce. Te"-tatrix. whose name is signed to
t IH' at t a ( h e di lIst r Hill t' n t. tlCl \. j n g h e end 1I l.v q LI <l J j fie d i:l l' cur din g t (j
law.
du hert'by acknowledge that
signed and executed the
instrument as my LHst will; that I signed it willingly; and thAt 1
signed it as my free and voluntary act for the purposes therein
expressed.
" j~ ~/,)
-- .: ~_-t-~~,. ~~~A----.. ._..l_=~~~~:::==~
DOROTHY S. PIERCE
(SEAL)
Sworn to and suhscrihed
before me this 51:).lday
of De eel)', b-t'(-
1993.
)~~!fl*~fI ~3l1-
( Sf \1 )
Notana' Seal
c ",lotal)' PubliC
v....1V!'\ A Byrne". ' ' ".and COUnty
....'il... J" rd Bore' eumtl6. nr.t:.
Ne\I-: C;;,'iltY.;l'.a.. I" nin>s Od. ~. hJ~
./ C;cmrn,,,:,:,,n ,_xt-'""~ - -. es
'" ~ -:;:- ~\iOll of No~n
-ylv6lJi"~
,.",.,',oc.r. PAf'll'lS
!\ f FJ:. J'A Y ~l T
COMMONWEALTH OF PENNSYLVANIA
5S
COUNTY OF CUMBERLAND
We, C:,~(i
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and
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r<v \ , \
the witnesses whose names are signed to the attached instrument,
being duly qualified, according to law, do depose and say that we
were present and saw Testatrix sign and execute the instrument as
his Last Will; that she signed willingly and that she executed it
as her free and voluntary act for the purpose therein expressed;
that each of us in the hearing and sight of the Testatrix signed
the Will, as witnesses, and that to the best of our knowledge, the
Testatrix was at that time eighteen (18) or more years of age, of
sound mind and under no constraint or undo influence.
"~~Nlsf& c,
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(,2. Cs..... ~' __ '__ ;"-,-_ I _.J
?~ c-i.rfTNEss--=1-------- u_
Sworn to and subscribed
before me this 31~r day
o f ~'(. t' I) I b.( . - , 1 9 9 3 .
/ ! .- J.
), ,Cltf-\ \~1-/~~;1
NOT ARY UBL I C {
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l<3!hynA B,"'~'~::;::::::ary Public
New Cl;:''Ji::~~:j {ion: Curn:,e,:JnC County
M; CC'~' ".. 0:0'1 E:x;:)ir'~ W. 2>\,1990
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"''''".M) '*
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
SAFE DEPOSIT BOX
INVENTORY
Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE
21
FILE NUMBER
07 -0559
SOCIAL SECURITY (RlKlulredl OR DEATH CERTIFICATE NUMBER (only if SSN is unknown)
207-07 -8204
. DECEDENT'S NAME (LAST, FIRST, MIDDLE)
DOROTHY S. PIERCE
. ADDRESS OF DECEDENT (STREET)
414 BRIDGE STREET
DATE OF DEATH
OS/24/2007
(CITY)
NEW CUMBERLAND
(STATE)
PA
(ZIP CODE)
17070
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
(NAME)
DAVID H. STONE, ESQUIRE
(STREET NAME)
414 BRIDGE STREET
(CITY)
NEW CUMBERLAND
(STATE)
PA
(ZIP CODE)
17070
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING
a. (NAME) (RELATIONSHIP)
DAVID H. STONE, ESQUIRE ATTORNEY FOR THE ESTATE
(STREET NAME) (CITY) (STATE)
414 BRIDGE STREET NEW CUMBERLAND PA
b. (NAME) (RELATIONSHIP)
(ZIP CODE)
17070
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
c. (NAME)
(RELATIONSHIP)
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
. NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
(NAME)
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
I NAME OF PERSON MAKING LAST ENTRY
LAWRENCE C. PIERCE, JR.
DATE OF CONTRACT TO RENT BOX NUMBER OF BOX
02/23/1981 63N
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. (NAME)
DOROTHY S. PIERCE (DECEASED)
(STREET ADDRESS)
DATE AND TIME OF LAST ENTRY
5/25/2007 0:00 am
. TITLE UNDER WHICH BOX IS REQUESTED
LAWRENCE C. PIERCE & DORTHY S. PIERCE & L '
b. (NAME)
LAWRENCE C. PIERCE (DECEASED)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
(CITY)
(STATE)
(ZIP CODE)
. NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY
DAVID H. STONE, ATTORNEY FOR THE ESTATE
WAS A WILL IN THE BOX? 0 YES i1 NO If yes, a. Date of will:
b. Name and address of personal representative, if named In the will
(NAME)
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
C. Name and addre.. of attorney, if any
(NAME)
L
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
SAFE DEPOSIT BOX INVENTORY Page
2 of --L-
INSTRUCTIONS
The Department is authorized under federal law ,42 U.S.C. 9 405(c), to use the decedent's Social Security number in
administering this state tax law. The Department uses Social Security numbers to establish a decedent's identity and
ensure proper credit for tax payments.
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
designated by name of company, certificate number, date of certificate, name in which stock is registered, and
number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and
type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book,
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible.
(8) All other contents.
ITEM ITEM DESCRIPTION
NO.
1 THE BOX WAS EMPTIED OUT THE DAY AFTER MRS. PIERCE'S DEATH BY LAWRENCE C. PIERCE, JR, POA. THE ONLY ITEM
THAT WAS IN THE BOX AND WAS REMOVED WAS A PRUDENTIAL INSURANCE COMPANY OF AMERICA LIFE INSURANCE
POLICY (#D51 763322).
i
I CERTIFY UNDER PENALTY OF PE JURY THAT THE ABOVE RECORD is PERSON RECEIVING COPY OF
CORRECT AND cmn>t.ETE TO THE BEST OF MY KNOWLEDGE AND BELiEF. SAFE DEPOSIT BOX INVENTORY:
SIGNATURE r .0 SIGNATURE
-
i .~ -
PRINT NAME - L- ' . V PRINT NAME AND CHECK APPROPRIATE BOX BELOW.
DAVID H. STONE, ESQUIRE
PRINT TITLE I DATE I CHECK APPROPRIATE BOX:
ATTORNEY FOR THE ESTATE I [] Execctoritnx) 0 Adm,n,stralOritnx)
I ~. (( 0~ o Estate Representative 0 JOlnl ov-ner of safe de~os.1 box _._n..J
._---_.~-----.- ------
NOTE: Attach additional 8'/," x 11" sheet(s) if necessary or use duplicates of this page of form.
1'( I (b4bfl1611
T-635 P.DDl/DDl F-D7D
Secu~1
AaminisleT'f:(/ and endor.WJd by tbe
Jtmnsy/vatlia Fun'-7Ul Din:(.:/or$ As...\OcicltiOrt
February 20,2008
David H. Stone, Esquire
414 Bridge Street
New Cumberland, P A 17070
Dear Anomey Stone:
In response to your rect.>J1t r~quest in regard to Dorothy Pierce, SS# 183-
16-1170, Account Number 40277, the value of her SecurChoice Funeral Trust Account as
of her date of death (May 24,2007) was $15,023.28.
If we can be offurther assistanc~, please feel tree to contact our office.
Sincerely,
'~a, ()Q./vvv)~
Ruth A. Carrera
SecurCboicc
Trust Administrator
7441 Allentown Blvd. .~. HalTiiburg. PA 17112
PRE-NEliD mUST A~D INSURANCE OFFICE; 800 -69 2-6 068 <, 717.545.7360 FAX
www.unichoicecoop.com WEBSITE
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o PNCBAT\K
June 21, 2007
David H. Stone
414 Bridge Street
P.O. Box E
New Cumberland, P A 17070
RE: Estate of Dorothy S. Pierce, deceased
SSN: 207.07.8204
DOD; 5/2412007
0e8J' Mr, Stone;
In response to your request for Date of Death balances for the customer noted above, our
records show the fo])owing:
CheckiDg Account
Account#S140049909
Established 10/0111956
DOROTHY S PIERCE
DOD balance; $19,883.87 + $1.09 accrued interest
Safe Deposit Box
#63N
L C PIERCE
DOROTHY S PIERCE
Established 03/14/1987
LOcated:
NEW CUMBERLAND BRANCH
331 BRIDGE STREET
NEW CUMBERLAND, P A 17070
(717) 774.2982
Page 1 of2
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Please note that this office only provides date of death balances for deposit accounts
(mAs, CDs, Checking and Savings accounts). We do Dot pr~s any finandal
transactions or provide statements. If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~~
R.achel1e.Wells
1~800-762-1775
P7-PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
Page 2 of2
Member FDIC
TOTRL P.02
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