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HomeMy WebLinkAbout02-20-08 (2) .-J REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 15056041158 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year 21 07 File Number 0623 ENTER DECEDENT INFORMATION BELOW' Social Security Number Date of Death Date of Birth 162-22-0606 06172007 06051927 Decedent's Last Name Suffix Decedent's First Name MI MEALS MARY JANE (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 [[] 1. Original Return D 4. Limited Estate [[] 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) Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust D- 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 02, D4a o 7. 010. 5. Federal Estate Tax Return Required RICHARD C. SNELBAKER 717-697-8528 Firm Name (If Applicable) ~::; SNELBAKER & BRENNEMAN, P.C. REGIS Qf)WILLS UsE=ONL Y -c~. ::0 -" 0) "1 ;" co ',:> --- N o -~ .:-./~; '\ First line of address 44 WEST MAIN STREET P.O. BOX 318 ,.,.- Second line of address C) .. City or Post Office State liP Code DATE FILED N MECHANICSBURG PA 17055 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, SIGNATURE; OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS "~7i:{~ (: 'li}.;.1 11 /L JEFf A. A S, EXECUTOR SIGNAT E PR ER 0 ER THAN REPRESENTATIVE 1045 ENGLISH DRIVE, 1704. C. SNELBAKER, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG, PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041158 6M4647 3.000 15056041158 ---1 .J-{ --.J 15056042159 REV-1500 EX Decedent's Name:M E A L S RECAPITULATION MARY JANE Decedent's Social Security Number 162-22-0606 1. Real estate (Schedule A) 2. Stocks and Bonds (Schedule B) . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C). 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E). 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . 1. 128000.00 . 2. 14230.48 . ;3. 0.00 . 4. 0.00 . 5. 35199.06 . 6. 0.00 . 7. 0.00 . 8. 177429.54 . 9. 24682.20 10. 486.19 11. 25168.39 12. 152261.15 13. 0.00 14. 152261.15 9. Funeral Expenses & Administrative Costs (Schedule H). 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 11. Total Deductions (total Lines 9 & 10). . . . 12. Net Value of Estate (Line 8 minus Line 11) . 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . 14. Net Value Subject to Tax (Line 12 minus Line 13) 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 .0D- 0 . 00 16. Amount of Line 14 taxable at lineal rate X .01f..5 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 152261.16 0.00 0.00 19. TAX DUE . . . . . . 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042159 6M4648 2.000 15. 0.00 16. 6851.75 17. 0.00 18. 0.00 19. 6851.75 W 15056042159 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME MEALS STREET ADDRESS File Number 0623 MARY JANE CUMB RLAND COUNTY CITY MECHANICSBURG STATE Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 0.00 0.00 0.00 Total Credits (A + B + C) (2) 6851.75 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 0.00 Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box 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) A. Enter the interest on the tax due. (5A) 6851.75 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 6851.75 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 reversionary 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 D D D D D No 00 00 00 [X] 00 00 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. F or 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 PS. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. 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. 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. 6M4671 1.000 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE REV-1502 EX + (6-98) ESTATE OF FILE NUMBER Mary Jane Meals 21 07 0623 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 ofsurvivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 128,000.00 Property located at 590 Brighton Place Upper Allen Township, Cumberland County, Mechanicsburg, PA 17055, sale value (see attached settlement sheet) TOTAL (Also enter on line 1, Recapitulation) $ 128,000.00 3W46951.000 (If more space is needed, insert additional sheets of the same size) t'reVlous eOlllons are OOS'..iIete . -~~... A. g~ttklnent Statement form HUU-'I pmoJ ref HanaOOOK qjU:>.L U.S. Department of Housing and Urban Development B. Type of Loan OMB Approval No. 2502-0265 lexoires 11/30/2009) 1. DFHA 2. DFmHA 3. DConv. Unins. I 6. File Number I 7. Loan Number I 8. Mortgage Insurance Case Number 4. OVA 5. DConv. Ins. PY007-161RCS 0039804810 C. Note: I hiS form IS lumlshea 10 give you a 5 a ement 0 ac ual settlement cos~s. AmOUn!S palo 10 ana oy me settlemen agent are shown. I TitleExpress Selllement System lIems marked "(p.o.c.)" were paid outside the closing: Ihey are shown here for Information purposes and are not inc;luded in the totals. WARNING: II is a crime to knowingly make false stalemenls to the United States on Ihis or any olher similar form. Penalties upon conviction can include a fine and imorisonmenl. For details see: Tille 16 U. S. Code Section 1001 and Section 1010. D. NAME OF BORROWER: Mary S. Dreibelbis ADDRESS: E. NAME OF SELLER: Estate of Mary Jane Meals ADDRESS: F. NAME OF LENDER: ERA Home Loans ADDRESS: 3000 Leadenhall Road Mount Laurel. NJ 08054 G. PROPERTY ADDRESS: 590 Brighton Place, Mechanicsburg, PA 17055 Upper Allen Townshio H. SETTLEMENT AGENT: Pyramid Land Transfer LLC, Telephone: 717-960-1122 Fax: 717-960-1123 PLACE OF SETTLEMENT: 3915 Market Street. Camo Hill. PA 17011 I. SETTLEMENT DATE: 10/31/2007 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales mice 128 000.00 401. Contract sales mice 128000.00 102. Personal Prooertv 402. Personal Property 103. Selllement charnes to borrower (line 140m 2 983.53 403. 104. 404. 105. 405. Adiustments for items oaid bv seller in advance Adiustments for items paid bv seller in advance 107. Countv taxes 1 0/31/07 to 12/31/07 76.12 407. County taxes 10/31/07 to 12/31107 76.12 108. School Taxes 10/31/07 to 06/30/08 1.063.27 408. School Taxes 10/31/07 to 06/30/08 1 063.27 109. 4th Qtr Sewer 10/31/07 to 12/31/07 67.39 409. 4th Qtr Sewer 10/31/07 to 12/31/07 67.39 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 132190.31 420. GROSS AMOUNT DUE TO SELLER 129.206.78 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deoosit or earnest money 5 000.00 501. Excess Deoosit/see instructionsl 202. Princioal amount of new loans 100 000.00 502. Selllement charoes to seller Iline 140m 10.704.91 203. Existina loan Is) taken subiectto 503. Existino loan/s) taken subiect to 204. 504. Pavoff of First Mortaaae Loan 205. 505. 206. 506. 207. 507. 208. 50B. 209. 509. Adiustments for items unoaid bv seller Adiustments for items unoaid bv seller 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 105.000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 10704.91 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120\ 132.190.31 601. Gross amount due to seller /line 420\ 129.206.78 302. Less amounts oaid by/for borrower lIine 22m . 105000.00 602. Less reduction l!mount due seller /line 52m 10.704.91 I 303. CASH FROM BORROWER 27190.31 603. CASH TO SELLER 118.501.87 SUBSTITUTE FORM 1099 SELLER STATEMENT: The Informalion contained herein Is important tax Information and Is being furnished to the Internal Revenue Service. If you are required 10 file a retum. a negligence penally or olher sanction will be Imposed on you if this ilem Is required 10 be reported and the IRS delermlnes that il has not been reported. The Contracl Sales Price described on line 401 above conslilules Ihe Gross Proceeds of Ihis transaction. SELLER INSTRUCTIONS: If Ihis real estale was your principal residence', file Form 2119. Sale or Exchange of Principal Residence. for any gain, with your Income lax relum; for olher transactions. complete Ihe applicable parts of Form 4797. Form 6252 andlor Schedule 0 (Form 1040). You are required by law \0 provide the setUement agent (Fed. Tax 10 No; ) wilh your correct taxpayer idenlification number. If you do nol provide your correctlaxpayer identification number, you may be subjecllo civil or criminal penalties imposed by law. Under penalties of perjury, I certify thatlhe number shown on this statement is my correct taxpayer idenlificalion number TIN: SELLER(S) SIGNATURE(S); SELLER(S) NEW MAILING ADDRESS: J ODsorete TOlll1 nut..1- r \,,)IVU1 '1;;1 . 'UIl........"'....." ,~__._ JEPARTMENT OF HOUSING AND URBAN DEVElOPMENT TTLEMENT 5T A TEMENT File Number: PY007-161 TI E S I S PAGE 2 - It e xoress ett ement jystem JfTTLEMENT CHARGES PAID FROM PAID FROM J. TOTAL SALES/BROKER'S COMMISSION based on Drice $128 000.00 @ 6.000 = 7,680.00 BORROWER'S SELLER'S Division of commission /line 70m as follows: FUNDS AT FUNDS AT 701. $ 7 680.00 to ERA-NRT, Inc. SETTLEMENT SETTLEMENT 702. $ to 703. Commission paid at Settlement 7,680.00 704. Transaction Fee to ERA-NRT, Inc. 165.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Orioination Fee % 802. Loan Discount % 803. Aooraisal Fee 804. Credit Reoort to FNMA CBC (P.O.C.l 19.95 Buver 805. Lender's Insoection Fee 806. MortQaQe Application Fee to ERA Home Loans (P.O.C.l 500.00 Buver 807. Assumotion Fee 808. Flood Cert Fee to STARS (P.O.C.l 19.50 Buver 809. Document Preoaration Fee to ERA Home Loans (P.O.C.l85.00 Buyer 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 10/31/2007 to 11/01/2007 @$ 17.7800/day 1 Davs LR 17.78 902. Mortoaqe Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. @$ Imo 1002. Mortqaoe Insurance mo. @$ Imo 1003. City Property Tax mo. @$ Imo 1004. County Property Tax mo. @$ 37.35 Imo 1005. School Taxes mo. @$ 132.91 Imo 1009. Aooreoate Analysis Adiustment 1100. TITLE CHARGES 1101. Settlement or closina fee 1102. Abstract or title search 1103. Title examination . 1104. Title insurance binder 1105. Document Preoaration 1106. Notary Fees to Pyramid Land Transfer. LLC 22.00 1107. Attornev's fees to Snelbaker & Brenneman POC (includes above items No: I 1108. Tille Insurance to Pyramid Land Transfer, LLC 998.75 (includes above items No: I 1109. Lender's Policy 100,000.00 .. 1110. Owner's Policy 128.000.00 - 998.75 1111. END 1003008108.1 to Pyramid Land Transfer. LLC 200.00 1112. Insured Closino Letter to Pyramid Land Transfer, LLC 35.00 1113. Document Retrieval Fee to Pyramid land Transfer, llC 50.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordinq Fees Deed $ 38.50 . Mortqaoe $ 70.50 . Release $ 109.00 1202. Citv/County tax/stamos Deed $1,280.00 . Mortqaae $ 1 280.00 1203. State Tax/stamos Deed $1.280.00 . Mortoaoe $ 1,280.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey 1302. 1303. Wire Transfer Fee to Pyramid Land Transfer llC 10.00 1304. Overniaht Packaqe to Pyramid land Transfer lLC 20.00 1305. 2007-08 School Taxes to Marlin Yohn tax collector 1 594.91 1306. Reimburse Resale Cert to Robert Willig 50.00 1307. November Monthly Dues to Bri!:lhton Place Condo Assn. 76.00 1308. 4th Otr Sewer to Upper Allen Township 100.00 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Sec.Uon J_~lnd.502~ction Kl 2.983.53 10704.91 HUD CERTIFICATION OF BU"ND SELLER I have carefull~ reviewed the HUD-l Setllement Slatement and to the best of my knowledg0 h. ellef. it is a true and accurate statement of all receipts and disbursements made on my account or by me In thiS transaction. I further certify (hat I have received a copy of Ihe HUD-l Setllement Stale,lien, /)11 ~ ~ Jx.J}1' -' l' ll--1A--l . U /lOA ~ Mary ~. urelbelb'c)'~ . .-- ~Jta ft!Io~ exe[.{,j00 ~iS I WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTIO~' CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. / /c/2,'!Ol- DATE If By: REV-150:i EX +' (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Mary Jane Meals 21 07 0623 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIP110N 1. Sovereign Bancorp,Inc. 628 shares of common stock valued at $22.66 per share VALUE AT DATE OF DEATH 14,230.48 TOTAL (Also enter on line 2, Recapitulation) $ 14,230.48 3W4696 1.000 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Mary Jane Meals FILE NUMBER 21 07 0623 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 500.00 Commonwealth of Pennsylvania 2006 property tax rebate 2 Internal Revenue Service refund on 2007 federal tax return 83.49 3 Public School Employees' Retirement System final pension payment 129.60 4 Teamsters Pension final pension payment 248.00 5 1989 Pontiac sale value 100.00 6 AAA Auto Club membership refund 56.70 7 Comcast Cable refund on cable service 31.77 8 Westfield Insurance premium refund on auto insurance 54.00 9 Haar's Auction proceeds from sale of household goods 2,402.25 10 Central Pennsylvania Conference of United Metholdist Church two certificates of deposit each with a face value of $10,000 each 20,149.60 11 Sovereign Bank 5,877.54 checking account #1681715082 12 Sovereign Bank 5,566.11 savings account #1684005943 3W46AD 1.000 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 35,199.06 REV.1S11 EX+ (10-06) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Jane Meals ITEM NUMBER A. FILE NUMBER 21 07 0623 Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAL EXPENSES: Malpezzi Funeral Home, Inc. funeral services Total from continuation schedules B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. Name of Personal Representative(s) Street Address City State lip Year(s) Commission Paid: Attorney Fees Snelbaker & Brenneman, P.C 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 4. Claimant Street Address City State lip Relationship of Claimant to Decedent 5. Accountant's Fees Probate Fees 6. Tax Return Preparer's Fees 7. 1 7W46AG 1.000 Register of Wills filing fee for Inheritance Tax Return 2 Upper Allen Township sewer expense Total from continuation schedules TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ AMOUNT 8,053.18 180.00 2,500.00 306.00 15.00 100.00 13,528.02 24.682.20 Estate of: Mary Jane Meals 162-22-0606 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Gingrich Memorials cemetery inscription 180.00 Total (Carry forward to main schedule) 180.00 Estate of: Mary Jane Meals 162-22-0606 Schedule H Part 7 (Page 2) 3 PPL Electric electric service 94.32 4 United Water Pennsylvania water service 49.19 5 Brighton Place Condo Association association dues 228.00 6 Haar's Auction auctioneer's commission on sale of household goods 960.90 7 A Clean Sweep condo cleaning 255.80 8 Settlement charges associated with sale of property for Brighton Place 1. Realtor's commission - $7,680.00 2, Transfer tax - $1,280.00 3. 2007-08 school taxes - $1,594.91 4. Certification - $50.00 5. Upper Allen Sewer - $100.00 10,704.91 9 Register of Wills short certificates 12.00 10 Reserve for filing fees, accounting fees and other costs associated with the administration of the decedent's estate 1,000.00 11 Patriot News advertising Executors' notice 147.90 12 Cumberland Law Journal advertising Executors' notice 75.00 Total (Carry forward to main schedule) 13,528.02 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Jane Meals SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 07 0623 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. Brighton Place Condo Association association dues 79.80 2 Upper Allen Township sewer expense 100.00 3 York Waste Disposal trash service 43.50 4 PPL Electric electric service 58.49 5 United Water Pennsylvania water service 23.96 6 Verizon phone service 30.44 7 Holy Spirit Hospital medical services 150.00 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 486.19 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marv Jane Meals 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Jeffrey A. Meals 1045 English Drive Lebanon, PA 17042 FILE NUMBER 21 07 0623 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER I 1/3 of residue as per Item Third of Will One Third of Residue: 50,753.72 Son 50,753.72 2 Robert A. Meals 642 Randall Circle Hummelstown, PA 17036 1/3 of residue as per Item Third of Will One Third of Residue: 50,753.72 Son 50,753.72 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 3W46AI 1.000 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) $ 0.00 Estate of: Mary Jane Meals 162-22-0606 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 3 Suzanne J. Schwartz 748 Mt. Gretna Road Elizabethtown, PA 17022 1/3 of residue as per Item Third of Will One Third of Residue: 50,753.72 Daughter 50,753.72 4 Lisa A. James (formerly Lisa A. Schwartz) 11254 Evans Trail, Apt 203 Beltsville, MD 20705 Bequest per Item Second of Will Granddaughter 5 Jessica Potteiger 490 Indian Rock Circle Elizabethtown, PA 17022 Bequest per Item Second of Will Granddaughter 6 Troy L. Reynolds HJ1355 SCI Camp Hill, P.O. Box 200 Camp Hill, PA 17001-0200 Bequest per Item Second of Will Grandson ~ LAW OFFICES SNELBAKER. BRENNEMAN & SPARE -- ._--_.-.~-"'" LAST WILL AND TESTAMENT I, MARY JANE MEALS, of the Borough of Mechanicsburg, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executor or Executors, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I order and direct my Executor or Executors, as the case may be, hereinafter named, to set aside from my net distributable estate a sum of money being the lesser of ( a) ($15,000) Dollars, or (b) ten per centum (10%) of my net distributable estate, which sum I give and bequeath in equal parts unto the following three (3) persons, namely, LISA A. SCHWARTZ (my grand-daughter), JESSICA POTTEIGER (my grand-daughter) and TROY REYNOLDS (my step-grandson), share and share alike, absolutely. THIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate, real personal and mixed, whatsoever and wheresoever situated in equal shares unto my three children, namely, ROBERT A. MEALS, SUZANNE J. SCHWARTZ and JEFFREY A. MEALS, share and share alike, absolutely and in fee simple. If any of my said children should predecease me and leave lawful issue to survive me, I order and direct that share of such deceased child shall be distributed unto his or her issue per stirpes by representation and not per capita. If.any of my said children should predecease me without leaving issue to survive me, I order and direct that the foregoing distribution to any such deceased child shall lapse and that my residuary estate shall be distributed unto those beneficiaries otherwise entitled hereunder. ,W OFFICES ~El8AKER. lENNEMAN k SPARE LASTL Y. I nominate, constitute and appoint my son, namely, JEFFREY A MEALS, to be the Executor of this, my Last Will and Testament, but if for any reason he should fail to qualify as such Executor or cease so to serve, then and in that event, I nominate, constitute and appoint my other two children, namely, ROBERT A. MEALS and SUZANNE 1. SCHWARTZ (or either of them in the event that one should fail to qualify or cease so to serve), to be the Executors hereof, each and all to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, MARY JANE MEALS, have hereunto set my hand and seal to this my Last Will and Testament, which consists oftwo (2)) typewritten pages to each of which I have affixed my signature this htJ~ day of February, A.D., Two Thousand Two (2002). YrJ, ~d'~ ~ M Y Jane Meals (SEAL) The preceding instrument, consisting of this and one (1) other typewritten pages each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by MARY JANE MEALS, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ~~ ~a~ -2- COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND SS. ) We, MARY JANE MEALS, RICHARD C. SNELBAKER and JANE J. COONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ ~mes~ Subscribed, sworn to and acknowledged before me by MARY JANE MEALS, the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. COONEY, the witnesses, this G ~ day of February, 2002. ~A-~~ Notary bb . Notarial Seal Susan L Zych. Notary PubJk: M~ Boro, Cumberland County My Comm/SSiOn Expires NO'l. 24, 2003 bet. Pennl!!y1llanla AsSClClafuJn of Notaries LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE