HomeMy WebLinkAbout05-01-08
REV- 1500 EX (6-00) REV-1500 OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA INHERITANCE TAX RETURN
DEPARTMENT OF REVENUE FILE NUMBER
DEPT. 280601 RESIDENT DECEDENT 21-08-0.0 126
HARRISBURG, PA 17128-0601 -- -- -----
COlMY COllE YEAR IUlIIER
... DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INrTIAL) SOC~SECURITYNUMBER
Z Andes, Orpha K. L. 206-32-4092
W DATE OF DEATH (WM>>YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCAlE WITH THE
C
W 02-01-2008 12-15-1914 REGISTER OF WILLS
0
W (IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MDDLE INrTIAL) SOC~ seCURITY NUMBER
C
w ~I 1. Original Retum 0 2. SUpplemental Return D 3. Remainder Return (dal8 of dealh pior 10 12-13-82)
I-:
~:g;~ 01 4. Umited Eslate 0 4a. Fub.re Heres! Compromise (dale of deeIh IIIler 12-12-82) 0 5. Federal EsIaIe Tax RelIIn Required
olfo
woo [] 6. Decedent Died Testate (Atlach copy of WI) 0 7. Decedent Maintained a Living Trust (AIIadl COVf 01 Tnat) _ 8. Total NIJllber ci Safe Deposit Boxes
J:0:::...J
oc..co
c.. [] 9. Utigatia1 Proceeds Received D 10. Spousal poverty Credit (dale of deaIh ~ 12-31-910 1-1-95) o 11. Election to tax under See. 9113(A) (AIIadl Sch 0)
<(
I- THISSECTlONMUST.BE.COf.lIPLETED".ALLCO~PONOI:NCEANDC()NI9[)amAI,;TAXI"FORMATION.SliOOI..DBEDIRE:CTED.TO:
z NAME COMPLETE MAlUNG ADDRESS
w
c SAMUEL L. ANDES
z
0 FIRM NAM: Of~) P.O. BOX 168
c..
U)
w LEMOYNE, PA 17043
0::: TELEPHONE NUMBER
0:::
0 717-761-5361
0
1. Real Estate (Schedule A) (1) OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) 47,183.92 ,....,
0 (:::J
~O <:;:> :n
3,. Closely Held Corporation, Partnership or Sole-Proprietorship (3) OP ~li.';-'
/(;~ ::.J: 1'1"; c-:>
4. Mortgages & Noles Receivable (Schedule D) (4) (, : ("') >- G,) (,,-::::>
',~- -< (7)~
127,549.81 "'~~Fn I "'j C:J
S. Cash, Balk Deposits & Miscellaneous Personal Property (5) ~> .~ ' - r'~ !-ri
<-,. Cf) - :.CJ \.::J
(Schedule E) /-.
Z 000 C"J
0 39,569.36 OO"'Tl :::- '-n
~ 6. JointlyCNmed Property (Schedute F) (6) p~ ::J: ~~; 2J
D Sepll'ate Billing Requested 'R ...,_0
:o-f ~._ rn
i'. k1ter-Vivos Tra1Sfers & Miscellaneous Non-Probate Property (7) )> ~ c..? C'
::J 'I
... (Schedule G or L)
c: II. Total Gross Assets (tOOlI Unes 1 - 7) (8) 214,303.09
~ !l. Funeral Expenses & Administrative Costs (Schedule H) (9) 4,061.64
W
0:: 10. Debts of Decedent, Mortgage Uabilities, & Uens (Schedule I) (10) 3,023.06
11. Total Deductions (total Unes 9 & 10) (11) 7,084.70
1:2. Net Value of Estate (Une 8 milus Line 11) (12) $207,218.39
1:3. Chaitable and GoYenvnental BequestslSec 9113 Trusts for which an election to tax has rd been (13) 0.00
made (Schedule J)
14. Net Value SUbject to Tax (Une 12 minus Line 13) (14) $207,218.39
SEE INS1RUCTIONS FOR APPUCABLE RATES
Z 15. Amount ci Une 14 taxable at the spousal tax
0
~ rate. or transfers under See. 9116 (a)(l.2) x .0_ (15)
16. Amounl of Une 14 taxable at lineal rate $207,218.39 x.045 (16) $9,324.83
J-,";
::J
Q. 17. Amoonl ci Une 14 taxable at sibling rate X .12 (17)
:E
0 18. AmolIlI ci Une 14 taxable at collateral rate X .15 (18)
0
~ 19. Tax Due (19) $9,324.83
20. 0 ICHECKHEREIFVOUAAEREGllJESTltG ARi:FuNDm:ANovE:RPAv..,ENtI
.>>BESURE TOAt1lSWER ALLQUESTION5Ot11 REVE~E:SIDEANDRECHECKMATH<< ....
~T):D4..4?m1r: 1
Decedenfs Complete Address:
STREET ADDRESS 325 Wesley Drive
CITY Mechanicsburg I STATE PA I ZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) $9,324.83
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestJPenalty (D + E) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
5. If Une 11 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A Enter the interest on the tax due.
(5A)
B. Enter the total ofUne 5 + SA. This is the BALANCE DUE. (58) $9,324.83
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSVVER THE FOLLOVVlNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Ves No
a retain the use or income of the property transferred; ........................................ D D
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . .. D D
c. retain a reversiomry interest; or ....................................................... D D
d. receive the promise for life of either payments, benefits or care? ............................... D D
2. If death occurred after December 12. 1982, did decedent transfer property within one year of death
withoti receiving adequate consideration? . . . . . .. . . . . . . . . . . .. . . . . .. . . . . .. . . .. .. . . . . . . . . . . . .. D D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . . .. D D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D D
IF THE ANSWER TO AI<< OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCtEDULE G AND FILE IT AS PART OF THE RETURN.
Under penSlies ci perjLrY, I decln thai I have 8lGlI1li1ed 1I1is return, including accompanying schedules and sIaIemeI1s, and to 1118 best ci my knaNledg8 and belief, it is true, correct and complete.
Declaratioo ci pr other lIllIl1he 8 is based 00 all inflrmation ci which P arer has any knowIed 8.
SIGNATURE. OF SON SP F R FILING RETURN DATE
'',?o
ADDRESS _,_
Samuel L. Andes, P.O. Box 168, Lemoyne, PA 17043
SIGNATURE. OF ~~r~~SENTATIVE
ADDRESS
Samuel L. Andes, P.O. Box 168, Lemoyne, PA 17043
DATE
'3J ~p>> ("./~
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 3%
[72 P.S. ~9116 (a) (1.1) Q)).
For dates of death on or after Jcnay 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is OOk [72 P.S. ~9116 (a) (1.1) Qi)).
The statute does not exemDt a transfer to a surviving spouse tTom tax, and the statutOI)' 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 0% [72 P.S. ~9116(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 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate l.mposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(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.
STFPA42021F.2
REV-1503 EX + (1-97) (I)
!COMMONWEALTH OF PENNSYLlMIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Andes, Orpha K. L.
21-08-00126
All property Jolntly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1.
1,924 shares of Unum Provident Corporation at $23.38 per share
$44,983.12
35 shares of MetLife at $62.88 per share $2,200.80
TOTAL (Also enter on line 2. Recapitulation) $ 47,183.92
(If more space is needed, insert additional sheets of the same size)
STFPA42021F.4
tomputershare
Computershare Investor Services
250 Royall Street
Canton Massachusetts 02021
www.computershare.com
SAMUEL LANDES
ATTORNEY AT LAW
PO BOX 168
LEMOYNE PA 17043
March 19, 2008
Company:
Registration:
Holder Account Number:
Our Reference:
UNUMPROVIDENT CORPORATION
ORPHA K LANDES
CO000005835
UNM/0080220767/31/65572
Dear Shareholder:
Thank you for contacting Computershare, the transfer agent for Unumprovident Corporation. We
appreciate the opportunity to be of service to you.
The folloWing provides the information you requested for account number C0000005835, as of the close of
business on February 1, 2008:
Share Balance: 1,924
Value Per Share: $23.38
Total Dollar Value of Shares: $44,983.12
A.ccording to our records, this account was opened on November 14, 1986 with 481 shares. The closing
price on that date was $27.50 per share.
Should you have other account related questions, please call us at (800) 446-2617 during regular business
hours.
~
Service Representative
Enclosure: None, Received Documents
REV-1508 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLW41A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Andes, Orpha K. L.
21-08-00126
Include the proceeds ci 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 VALUE AT DATE
NUMBER DESCRIPTION I OF DEATH
1.
Money market account #50-0378-3787 at PNC Bank, N.A.
$15.267.45
2.
Ready Access Certificate of Deposit #31200260277 at PNC Bank, N.A.
$6,483.37
3.
Certificate of Deposit #31800317685 at PNC Bank, N.A.
$40,807.13
4.
Certificate of Deposit #31500194383 at PNC Bank, N.A.
$35,581.17
5.
Certificate of Deposit #31300238521 at PNC Bank, N.A.
$3,310.62
6.
Certificate of Deposit #31600237143 at PNC Bank, N.A.
$11,194.99
7.
30 Series E U.S. Savings Bonds (see list attached)
$12,915.08
8.
Miscellaneous items of furniture and personal property
$2,000.00
TOTAL (Also enteron lineS. Recapitulation) $ 127,549.81
(If more space is needed. insert additional sheets of the same size)
STFPA42021F.9
Total Banking Statement
PNC Bank
For the period 01/05/2008 to 02105/2008
ORPHA K ANDES
SAMUEl LANDES
707 HILLTOP DR
NEW CUMBERLAND PA 17070-1723
We value your relationship with PNC.
For questions about your account,
please call1-866-PNC-4000.
o PNCBANK
Primary account number: 51-4000-1358
Page 1 of 2
Number of enclosures: 0
a For 24-hour banking, and transaction or
interest rate information, sign on to
'It PNC Bank Online Banking at pnc.com.
For customer service call1-866-PNC-4000
between the hours of 6 AM and Midnight ET.
Para servicio en espai'iol, 1-866-HOLA-PNC
Moving? Please contact us at 1-866-PNC-4000
I2!S:I Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
g Visit us at pnc.com
.!23
~
~
TDDterminal: 1-800-531-1648
For hearing ilnpilir-ed clients only
Relationship Overview
Bank Deposit Accounts
Description
Interest Checking
Performance Money Market
Certificate( s) Of Deposit
Total Deposits
Account Number
51-4000-]358
50-0378-3787
Tot<ll of 5
Deposit Balance
19,207.65
15,267.45
97,377.28
]31,852.38
Senior Premium Plan
Interest Checking Account Summary
Account number: 51-4000-1358
Balance Summary
Beginning
balance
16,350.50
Deposits and
other additions
2,857.15
Checks and other
deductions
Ending
balance
19,207.65
.00
Average monthly
balance
Charges
and fees
16,844.35
Interest Summary
Annual Percentage
Yield Earned (APYE)
Number of days
in interest period
Average collected
balance for APYE
Interest Paid
thi s period
0.30%
16,844.35
4.40
32
Activity Detail
Deposits and Other Additions
Date
Amount Description
66.75 Direct Deposit - Fedvainsur
Vain Treas 220 XXXXXXXXXXX0003
1,512.00 DiI-ect Deposit - Soc Sec
US Treasury 303 XXXXX4092A
1,274.00 Direct Deposit - VA Benefit
US Treasury 220 06923253 10 10
4.40 Interest Payment
01/09
02/01
02/01
02/05
Orpha K Andes
Samuel LAndes
Please see the Activity Detail section for
additional information.
.00
As of 02/05, a total of $7.47 in interest was
paid this year.
There were 4 Deposits and Other Additions
totaling $2.857.15.
FORM953R-l005
Total Banking Statement
~ For 24-hour information, sign on to PNC Bank Online Banking
~ on pnc.com.
Account number: 51-4000-1358 - continued
Daily Balance Detail
Date Balance
01/05 16,350.50
For the period 01/05/2008 to 0210512008
ORPHA K ANDES
Primary account number: 51-4000-1358
Page 2 of 2
Date
01/09
Balance
W,117.25
Date
021 0 I
Balance
19,:.w:L2;'
.::s~
Date
02/0:'
Balance
19,207.t15
Senior Premium Plan
Performance Money Market Account Summary
Account number: 50-0378-3787
Orpha K Andes
Please see the Activity Detail section for
additional information.
Balance Summary
.00
Endi ng
bal ance
15,267.1;,
Charges
and fees
Beginning
balance
15,2'12.35
Deposits and
other additions
25.10
Checks and other
deductions
Average monthly
balance
1:',2.13.13
.00
,,,,
.l~
Average collected
balance for APYE
1:',243.13
Interest Paid
this period
As of 02/05, a total of $50.10 in interest was
paid this year.
Interest Summary
Annual Percentage
Yield Earned (APYE)
1.89%
Number of days
in interest period
2:'.10
Activity Detail
Deposits and Other Additions
Date Amount Description
02/05 25.10 Interest P:\yment
There was 1 Deposit or Other Addition
totaling $25.10.
Daily Balance Detail
Date Balance
01/05 15,212.35
Date
02/05
Balance
15,267.4:'
Certificate. of Deposit
Investment
number
31600237143
Orpha K Andes
Description Maturity date Interest Original or Current
rate renewal value value
Re:\dy An'ess en 04/14/2008 :'-!",O% tl,3(t1.7'1 tl,4S:D7
8 Month(s) Fixed R:\te 05/10/2008 '1.9.' % 40,000.00 40,807.1:1
12 Month(s) FL'led Rate 0:'/31/2008 :1.11 lff, 34,8n.:.O 3;',:'8 \.17
18 ~f(lllth(s) Fixed Rate 11/19/2008 3.Hl % 3,2:HI.49 :',310.tl2
Orpha K l Andes
Description Maturity date Interest Original or Cu rrent
rate renewal value value
13 Month(s) Fixed R:lte 03/ 17/2008 4.22 % 10,748.17 11,191.99
Total current value 97,377 .28
Investment
number
312002tl0277
:11800317G85
31500194383
:'1300238521
Bank 1057
Redemption Date:
Cus tomer NaIlle:
Address 1:
Address 2:
Address 3:
Tax ID No:
PZ Sequence No:
03/07/:2008
ORTHA K L ANDES ESTATE
SAMUEL L ANDES EX
707 HILLTOP DRIVE
NEW CUMBERLAND PA 17070
41-6573052
00022-0307-113634
FWtonBank.
LISTENING.
Bond Detail
Branch Name 22
Denomination Series Type Issue Date Value Interest
$100.00 E 01/1978 $513.80 $438.80
$100.00 E 05/1979 $412.12 $337.12
$100.00 E 05/1979 $412.12 $337.12
$100.00 E 04/1979 $408.16 $333.16
$100.00 E 04/1979 $408.16 $333.16
$100.00 E 03/1979 $416.32 $341.32
$100,00 E 02/1979 $416.32 $341. 32
$100,,00 E i2/1978 $416.28 $341. 28
$100.00 E 12/1978 $416.28 $341. 28
$100.00 E 11/1978 $415.16 $340.16
$100.00 E 11/1978 $415.16 $340.16
$100.00 E 10/1978 $411.24 $336.24
$100.00 E 10/1978 $411.24 $336.24
$100.00 E 09/1978 $419.48 $344.48
$100.00 E 09/1978 $419.48 $344.48
$100.00 E 08/1978 $419.48 $344.48
$100.00 E 06/1978 $419.40 $344.40
$100.00 E 06/1978 $419.40 $344.40
$100.00 E 05/1978 $418.32 $343.32
$100.00 E 05/1978 $418.32 $343.32
$100.00 E 04/1978 $425.08 $350.08
$100.00 E 04/1978 $425.08 $350.08
03/1978 ,
$100.00 E $434.16 $359.16
$100.00 E 03/1978 $434.16 $359.16
$100.00 E 01/1978 $513.80 $438.80
$100.00 E 02/1978 $513.80 $438.80
I
$100.00 E 02/1978 $513.80 $438.80
Signature:
bdclcrmd.rpt
Bank, 1057
Branch Name 22
Redemption Date:
03/07/2008
Cus tomer NclIlle:
ORTHA K L ANDES ESTATE
Address 1:
SAMUEL L ANDES EX
Address 2:
707 HILLTOP DRIVE
Address 3:
NEW CUMBERLAND PA 17070
Tax ID No:
41-6573052
PZ SequenCE! No:
00022-0307-113634
Denomination Series Type Issue Date Value Interest
-
$100.00 E 02/1979 $416.32 $341. 32
$100.00 E I 01/1979 $416.32 $341.32
$100.00 E 01/1979 $416.32 $341.32
$12,915.08 $10,665.08
Signature:
bdclcrmd.rpt
REV-1S09 EX + (1-97) (I)
COMMONWEAlTH OF PENNSYl.~
INHERITANCETAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
FILE NUMBER
Andes, Orpha K. L.
21-08-00126
If an asset was made joint within one year of the decedent's date fA death, It must be reported on Schedule G.
SURVMNG JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Samuel L. Andes
P.O. Box 168
Lemoyne, PA 17043
Son
B.
c.
JOINTLY -OWNED PROPERTY:
lE11ER Dl\TE DESCRIPTION Of PROPERTY %OF Dl\TE Of DEATH
ITEM FOR JOINT MADE IncUle name 01 tiIa1:laIlnstitt.tfon lnI baric aGDIIilU1ter or sirrilar lder4IfyIng 1UTter. !lATE Of DEATH DECO'S IDU.UE OF
NUMBER TENANT JOINT Atlach deed lor jolr/ly-hekl real eslate. IDU.UE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 11-16- Money Market account #990066795 with Fulton Bank $13,450.36 50% $6,725.18
1983
2. A 8-1 0- Certificate of Deposit #0220141482 with Fulton Bank $23,464.32 50% $11,732.16
2001
3. A 9-30- Certificate of Deposit #0220211493 with Fulton Bank $42,224.04 50% $21,112.02
2003
TOTAL (Also enter on line 6, Recapitulation) $ 39,569.36
(If more space is needed, insert additional sheets of the same size)
STFPA42021F.1D
Fulton Bank
LISTENING.
February 22,2008
Samuel L. Andes
525 North Twelfth Street
Lemoyne, Pennsylvania 17043
Dear Mr. Andes:
RE: Orpha K.L. Andes, deceased February 1, 2008
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
Money Market # 9900-66795, open 11/16/1983, date of death balance
$13,449.92 plus accrued interest $ .44, joint with Samuel L. Andes.
DATE OF DEATH
CD# BALANCE
022-0141482 $23.410.92
* joint with Samuel L. Andes.
022-0211493 $41,604.67
* joint with Samuel L. Andes.
ACC
INT
$53.40
RATE
3.78%
OPEN
8/1 0/200 1
ROLL OVER
2/10/2008
MATURITY
3/1 0/2008
$619.37
4.35'%
9/30/2003
9/30/2007
3/30/2008
If you should have any further questions, please do not hesitate to contact me at (717)
291-2437.
Very truly yours,
lDf~b~
Karen D. Hillegas
Credit Inquiry Processor
CONFIDENTIAL
.....J._w_
.-_.. --.
FultonBank
!his information is. fur~sh:d .~~ a m~tter of business courtesy
In answer t? .~OU~ 111 QllW)', ana is tDr YOiX confidential use only.
No res~nslbi1ity IS assumed try this l'<lnx or any of its officers.
AfJ' ~~~~ 2ra~exp'ri1:-'dA~~~WepA tOl9'~~ without n(1tic~.
12S YEARS AND Sfl,L LI STE N I N G.
fultonbonk.com
1-800-FULTON-4
REV-1511EX + (1-97) (I)
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRAnVE COSTS
ESTATE OF
FILE NUMBER
Andes, Orpha K. L.
21-08-00126
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1.
Auer Memorial Home & Cremation Services, Inc. $738.4 7
Rolling Green Cemetary (interment fees) $845.00
Diane Andes (post-funeral reception) $645.48
Ray E. Houck (honorarium) $100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Nane of Personal Representalive(s)
Social Security Number(s) I E/N Number of Personal Representalive(s)
Street Address
City Stale Zip
Year(s) Commission Paid:
2. AttomeyFees
3. Family Exemption: (If decedent's address is not 1he SiII1El as claimant's, attach explanation)
ClaimlIlt
Street Address
City Slate Zip
Relationship of Clalmant to Decedent
4. Probate Fees Register of Wills $325.00
5. Accountant's Fees
6. Tax Return Prepa-er's Fees
7.
Bank service fee $40.00
Vital Records (death certificate) $27.00
U-Haul Storage Center (storage fees) $196.84
Easy-Move (moving services and apartent clean out) $350.00
Unum Annuity Services (refund) $20.1 9
Cumberland Law Journal (advertising) $75.00
The Sentinel (advertising) $134.68
Morgan Stanley (fees for sale of Unum stock) $563.98
TOTAL (Also enter on line 9, Recapitulation) $ 4,061.64
(If more space is needed, insert additional sheets of the same size)
S1FPA42021F.12
REV-1512 EX + (1-97) (I)
GOMMONWEALTH OF PENNS'ffi/AN1A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABILlTIES, & LIENS
ESTATE OF
ALE NUMBER
Andes, Orpha K. L.
21-08-00126
Include unralmbUlsed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Bethany Assisted Living (final bill less refund)
AMOUNT
$2,291.00
2.
Millenium Pharmacy
$78.40
3.
Pulmonary Care Physicians
$135.00
4.
U.S. Treasury (2007 taxes)
$408.00
5.
Quantum Imaging
$1.71
6.
Pa. Department of Revenue (2007 taxes)
$89.00
7.
Yankee Magazine (subscription)
$19.95
TOTAL (Also enter on line 10, Recapitulation) $ 3,023.06
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.13
REV-1513 EX + (9-00)
CCJ.4MOtME4lTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Andes, Orpha K. L.
FILE NUMBER
21-08-00126
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trostee(s) OF ESTATE
L TAXABLE DISTRIBUTIONS pnclude outlight spousal distributions, lllId transfers
under Sec. 9116 (a) (1.2)J
1. Samuel L. Andes, P.O. Box 168, Lemoyne, PA 17043 Son 1/3
2. Eugene B. Andes, 938 E. Rodgers Avenue, Fayetteville,
Arkansas 72701 Son 1/3
3. Thomas A. Rosenberg, 70 Bridgewater Drive, Marlton,
NJ,08053 Grandson 1/12
4. Jane L. Rosenberg, 746 S. Front Street, Apt. 1,
Philadelphia, PA 19147 Granddaughter 1/12
5. Samuel!. Rosenberg, 93 Grattan Street, Apt. 2-L,
Brooklyn, NY, 11237 Grandson 1/12
6. Daniel M. Rosenberg, 805 Collings Avenue,
Co/lingswood, NJ, 08107 Grandson 1/12
ENTER 00lLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE, ON REV-1500 COVER SHEET
n. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
none
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. none
TOTAL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
"
(If more space IS needed, Insert additional sheets of the same SIZe)
STF PA42021 F.14
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WILL
OF
ORPHA K.L. ANDES
I, ORPHA K.L. ANDES, of Mechanicsburg, Cumberland County, Pennsylvania, declare
this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my
gravemarker and all expenses of my last illness, and any and all taxes and assessments
imposed by any governmental body as a result of my death, whether on property passing
under this will or otherwise, shall be paid from my residuary estate as soon as practicable
after my decease as a part of the expense of the administration of my estate.
ITEM II. I give, devise, and bequeath all of my possessions and estate of every
nature and wherever situate to those of my issue, per stirpes, as survive my death by sixty
(60) days.
ITEM III. I appoint my son, SAMUEL L. ANDES, executor of this my last will. Should
my said son predecease me or otherwise fail to qualify or cease to serve as executor of this
my last will, I appoint my daughter, KAREN ANDES ROSENBERG, executrix of this my last
will.
ITEM IV. In addition to the other powers and authorities granted to my personal
representative by Pennsylvania Law and by the other terms and provisions of this will, I
hereby give to my personal representative the following powers and authorities effective
without court approval and until actual distribution of all property: to compromise any claim
or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind,
and in such manner as my personal representative may determine and at valuations finally
to be fixed by them; to invest in all forms of property, including any stock or other
securities in any corporate fiduciary or its successor without restriction to investments
authorized for Pennsylvania fiduciaries, as my personal representative deems proper,
without regard to any principle of risk or diversification; to retain any or all assets of my
estate, real or personal, without regard to any principle of risk or diversification; to sell at
Page 1 of 3
public or private sale, to exchange, or to lease for any period of time, any real or personal
property and to give options for sales, exchanges, or leases, for such prices and upon such
terms or conditions as my personal representative deems proper; and to allocate receipts
and expenses to principal or income or partly to each as my personal representatives deem
proper in their sole discretion.
ITEM V. I direct that my personal representatives and fiduciaries shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this ~ l> ~ day of
- 4~lik)(;
, 1997.
I
~F fi.rtfsR~.v
ORR A K.L. AN ES
The preceding instrument, consisting of this and one other typewritten page, each
identified by the signature of the testatrix, was on the date thereof signed, published, and
declared by ORPHA K.L. ANDES, the testatrix therein named, as and for her last will, 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.
/] P .
l m 1 ~..Q LL.-
Amy Rose i
Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA
)
( SS.:
)
COUNTY OF CUMBERLAND
The undersigned, being the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as
my free and voluntary act for the purposes therein expressed.
~1dt ~ L' 1J4t..t--J-'
ORPH K.L. A DES
Sworn or affirmed to and acknowledged
before me by the testatrix named above
this 3o~ day of oc.T08e-R , 1997.
.I~
Notary 'Pubiic
NOTAR 5eAl. PUbUC
LYNN EHRENfE~ eounty i
lemoyne Boro~ ~vnlres AuO.17 ,2000
My Comm\sslon ~.
L---
II
COMMONWEALTH OF PENNSYLVANIA
)
( SS.:
)
COUNTY OF CUMBERLAND
WE, WENDY CHESBRO and AMY ROSELLI, the witnesses whose names are signed to the
attached or foregoing instrument, being duly qualified according to law, do depose and say that we
were present and saw the testatrix sign and execute the instrument as her last will; that she signed
it willingly and that she executed it as her free and voluntary act for the purposes 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 testator was at that time 18 or more years of age, of sound
mind, and under no constraint or undue influence.
Sworn or affirmed to and
acknowledged before me this
3o-tS- dayof Oc.1"l>B8<. , 1997.
3