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HomeMy WebLinkAbout05-14-08} ~ 15056041147 REV-1500 EX 06 05 PA Department of Revenue ( - ) OFFICIAL USE ONLY County Code Year File Number Bureau of Individual Taxes HaOrrg burg$PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 ~' '^° ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 086 20 4847 12 16 2007 01 13 1920 Decedent's Last Name Suffix Decedent's First Name MI GREEN V. J (If Applicable) Enter Surviving Spouse's Info rmation 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 OVALS BELOW X 1. Original Return j I 2. Supplemental Return ~ I 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 5. Federal Estate Tax Return Required X 6. Decedent Died Testate (Attach Copy of Will) - 7 Oecedenl Maintained a Living Trust $. Total Number Of Safe De Osit Boxes (Attach Copy of Trust) P 9. Litigation Proceeds Received I ! __. 1 p Spousal Poverty Credit (date of death I ~ 11, Election to tax under Sec. 9113(A) between 12-3t-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EARL RICHARD ETZWEILER (717) 234 5600 ra ,-~ ~---, Firm Name (If Applicable) ETZWEILER AND ASSOCIATES First line of address 105 NORTH FRONT STREET Second line of address City or Post Office State ZIP Code HARRISBURG PA 17101 - ~~ REGISTER OF-11iILLS USBdDNLX l , ~. 'e ;~~ ~' t .t J __ == .. , .U^~ ~~ DATE FILED n :; ~. , _- i i Correspondent'se-mail address: REtzweiler@ComCast.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 al{ information of which preparer has any knowledge. SIGNATyRE OF PERSON RESPONSIBLE FOR FILING RETURN neTG ADDRESS ~` di Thomas H. Green 5'--13- o~ 30 Williams Street, Halifax, PA 17032 SIGNATURE OF P1.2EPARER OTHER THAN REPRESENTATIVE DATE ~.~,~~.1~-~`/~_.~,s~~t~~-. Earl Richard Etzweiler ~ r~,~~~~ ~- ADDRESS is 105 North Front Street, Harrisburg, PA 17101 Side 1 15056041147 15056041147 15056042148 REV-1500 EX Decedent's Social Security Number Decedents Name: V. J U h e G Y e e n 0 8 6 2 0 4 8 4 7 RECAPITULATION 1. Real Estate (Schedule A) ............................................................_........................ 1. 2,200.02 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. 3 7 0 0 0 6. Jointly Owned Property (Schedule F) ~ ~ Separate Billing Requested ............. 6. 6 1 6 3 3 7. Inter-Vivos Transfers & Miscellaneous Non Probate Property , (Schedule G) ~ ~ Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ................................................................... - _ _ - g, 3, 1 8 6 3 5 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9. 1, 744.70 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... 10. 149,450.73 11. Total Deductions (total Lines 9& 10) ............................... .................................. 11. 1 5 1, 1 9 5 4 3 12. Net Value of Estate (Line 8 minus Line 11~ ............................._............................ 12. - 1 4 8 , 0 0 9 0 8 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. - 1 4 8 , 0 0 9 0 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) x .00 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable 0 0 0 at lineal rate X .045 16. 0 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0 0 0 19. Tax Due .............................................................. 19. ................................................. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 Side 2 L 15056042148 15056042148 J i REV-1500 EX Page 3 File Number 21 -- Decedent's Complete Address: V. June Green _ _ _ _- _ _ STREET ADDRESS 3607 Chestnut Street CITY ,STATE ZIP Camp Hill j PA j 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A, Spousal Poverty Credit g, Prior Payments C. Discount 3. Interest/Penalty if applicable p, Interest E. Penalty - _ _ - 0.00 ____-- Total Credits (A + B + C) (1) 0.00 (2) 0.00 Total lnterest/Penalty (D + E) (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thepVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5, if Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) g. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) Q , Q Q Make Check Payable fo: REGISTER OF WILLS, AGENT jf . .» •r~«. i~b-x. ., f~?e -. M_~v ~u.7r _.~ . F.. , . ~ ..~. ^.. =:'til. r. ~ 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 :............................................................................. j '~ x' b. retain the right to designate who shall use the property transferred or its income :................................ x c. retain a reversionary interest; or ..............................__.........................................................._................. x . d. receive the promise for life of either payments, benefits or care? ............................................,.............. x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................. ~ ' x 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death3....... x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................. ••••••••••••••••••• ' ' X' IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. _~' +~ i,. ~ .t k~ ~ n3~,i~~C1NY, x. a ~:i 4 ~s .f.::z ., .:Ai. ..1: .. 4i-~.`. _.~ :.k ... i .<-'7i-<ii ..tr_.7 mow-.. :: m 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. §9116 (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)J. The statutedoes not exempts 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. §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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (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. §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. ~. LAST WILL AND TESTAME;;C7T OF V. JUNE GREEN I, V. JUNE GREEN, a resident of Hampton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this instrument to be my Last Will and Testament, hereby revoking any and all wills by me at any time heretofore made. ITEM I: I direct my hereinafter named Executor to pay all my just debts, funeral expenses, administration expenses and inheritance, estate, succession or excise taxes, which I may owe or may become due on account of my death, as soon as may be convenient after my decease. ITEM II: I give, devise and bequeath all the rest, residue and remainder of my estate, be it real, personal or mixed, of whatever nature and wheresoever situa*_e which I may own or have the right to dispose of at the time of my deceased to be divided equally among my three hereinafter named children: 1. Linda J. Bunn, of Orange Park, Florida. 2, Thomas H, Green, of Halifax R. D. ~~3, Pennsylvania. 3. Katheryn J. Green, of Market Street, Camp Hill, Pennsylvania. A. If any of my aforesaid children should predecease me or die simultaneously with me, then I give, devise and bequeath said share to the issue of such cYiild, per stirpes. 1. If any of such children are minors at the time of my decease, then I nominate, constitute and appoint the surviving parent of said child Guardian of the estate of such child until attaining majority, without being required to file bond for the performance of his duties, with discretion to invest such share or shares in any manner he deems appropriate and with ~~_ '~ ,~~_.~wJ (SEAL) V . •, JUNE GREEN A h the right to use income and such portion of the principal as he may deem appropriate for the support, maintenance, health, education and welfare of such minor grandchild prior to attaining majority. ITEM III: I hereby nominate, constitute and appoint my son, Thomas H. Green, Executor of this my Last Will and Testament, with full power in his discretion to do any and all things necessary for the complete administration of my estate, with full power to sell at public or private sale and without order of court any real or personal property belonging to my estate, and to compound, compromise or otherwise settle oi- adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate as fully as I could if living. A. If my said son should predecease me or die ;~imul- taneously with me, or be unable or unavilable to serve as Executor, then I nominate, constitute and appoint my daughter, Linda J. Bunn, Executrix, with the same power and authority as given my said sun. IN WITNESS WHEREOF', I have hereunto set my hand and seal to this my Last Will and Testament this ~5~~ day of March A.D., 1979. ~ ~.c-wiz. ~~}%c-Z...~n.J (SEAL) V. June Green V Signed, sealed, published and declared by the above-named V. June Green, as and for her Last Wi11 and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, we believing her to be of sound and disposing mind, memory and under- standing, have hereunto subscribed our names as witnesses thisi,,~~day of March,. D.,~ 1979. ~r ~ j y1 ~. Rev-1503 EX+ (6.98) scHEOU~E s STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Green, V. June 21-- All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Series E $25.00 U.S. Savings Bond #Q6150078431 E 138.04 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 2 Series E $25.00 U.S. Savings Bond #Q6161231452E 138.04 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 3 Series E $25.00 U.S. Savings Bond #Q6177595343E 138.04 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 4 Series E $25.00 U.S. Savings Bond #Q6177595343E 139.40 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 5 Series E $25.00 U.S. Savings Bond #Q6184826610E 139.70 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 6 Series E $25.00 U.S. Savings Bond #Q6191285690E 139.67 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 7 Series E $25.00 U.S. Savings Bond #Q6203237618E 139.67 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 8 Series E $25.00 U.S. Savings Bond #Q6210976440E 139.67 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Total of Continuation Schedules See attached pages TOTAL (Also enter on Line 2, Recapitulation) 2,200.02 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1503 EX+ (8-98) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Green, V. June 21-- ITEM NUMBER CUSIP NUMBER DESCRIPTION VALUE AT DATE UNIT VALUE OF DEATH 9 Series E $25.00 U.S. Savings Bond #Q6223926604E 128.45 owned by Decedent and her husband, Lynn K. Green, i who died January 15, 1979 i 10 Series E $25.00 U.S. Savings Bond #Q6223931876E i 125.93 owned by Decedent and her husband, Lynn K. Green, who died January 15,1979 11 Series E $25.00 U.S. Savings Bond #Q6232513541 E 106.27 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 12 Series E $25.00 U.S. Savings Bond #Q6246559054E i 106.27 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 13 Series E $25.00 U.S. Savings Bond #Q6254344850E 104.58 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 14 Series E $25.00 U.S. Savings Bond #Q6277296346E 102.81 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 15 Series E $25.00 U.S. Savings Bond #Q6286422111 E 102.81 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 16 Series E $25.00 U.S. Savings Bond #Q6292313932E 103.79 owned by Decedent and her husband, Lynn K. Green, ', who died January 15, 1979 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1503 EX+ (6.98) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Green, V. June 21-' ITEM NUMBER CUSIP NUMBER DESCRIPTION T VALUE AT DATE UN{T VALUE OF DEATH 17 Series E $25.00 U.S. Savings Bond #Q6292498044E 102.81 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 18 Series E $25.00 U.S. Savings Bond #Q6302564233E ~ 104.07 owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 TOTAL (Also enter on Line 2, Recapitulation) 2,200.02 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 12/2007 Page 1 of 1 'gat rice a cue oat r~~°es ~° ~t~°et $337.50 $2,200.02 $1,862.52 $71 84 Bonds: 1-18 of 18 5e~•il ris se [Veit irsl 1 Isere ~a~ ~~~ ~ to Q6223926604E E $25 12/1977 12/2007 $18.75 $109.70 $128.45 MA Q6150078431E E $25 01/1977 01/2007 $18.75 $119.29 $138.04 MA Q6277296346E E $25 07/1978 01/2008 07/2008 $18.75 $84.06 4.00% $102.81 Q6223931876E E $25 01/1978 01/2008 01/2008 $18.75 $107.18 4.00% $125.93 Q6161231452E E $25 03/1977 03/2007 $18.75 $119.29 $138.04 MA Q6210976440E E $25 10/1977 10/2007 $18.75 $120.92 $139.67 MA Q6203237618E E $25 09/1977 09/2007 $18.75 $120.92 $139.67 MA Q6191285690E E $25 08/1977 08/2007 $18.75 $120.92 $139.67 MA Q6184826610E E $25 06/1977 06/2007 $18.75 $120.95 $139.70 MA Q6177595343E E $25 05/1977 05/2007 $18.75 $120.65 $139.40 MA Q6151229038E E $25 02/1977 02/2007 $18.75 $119.29 $138.04 MA Q6232513541E E $25 03/1978 03/2008 03/2008 $18.75 $87.52 4.26% $106.27 Q6246559054E E $25 04/1978 04/2008 04/2008 $18.75 $87.52 4.26% $106.27 Q6254344850E E $25 05/1978 05/2008 05/2008 $18.75 $85.83 4.00% $104.58 Q6286422111E E $25 08/1978 02/2008 08/2008 $18.75 $84.06 4.00% $102.81 Q6292498044E E $25 10/1978 04/2008 10/2008 $18.75 $84.06 4.00% $102.81 Q6292313932E E $25 11/1978 05/2008 11/2008 $18.75 $85.04 4.00% $103.79 Q6302564233E E $25 12/1978 06/2008 1?!2008 $18.75 $85.32 4.00% $104.07 Totals for 18 Bonds $337.50 $1 862.52 $2 200.02 NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earnin interest http://www.treasurydirect. gov/BC/SBCPrice 1 /412008 ., `'~'~ - ~. ~' ~. [y''".-, ~ _ _ E9~. ® K N ~ro r .$~ r_ ~6 y "1 ![' r~s-P~o\-- vac.. ~ ~~~ . 1 r i\ ~ rs~" ~ f i'.BLE ` •."' T.'3!F-~ T2T ~t T`r1'.'fiHE^"T v 3I~~°3»3Pb7}~v1~&W~Ev 5~'S'@: - .,~I - ~.\ ~:6ti--. -M:-\~~ l AT THE ORIGINAL MATIJ RITY HEREOF WILL PAY k ~~ TaMkS V .)UN~ GF:iE~N G>~aU '~~~~5 3E~iz7 G!iESTntu7 STREEI ~'~ Gk~~~' HI ~ PE NNA 17G lI U~t Mid ~fl~? ~ S ERI E E ~ AT THE ORIGINAL MATURITY HEREOF WILL PAY - _ "l.","..P'~ ~,` Id~~ ISSUE .DJ1TE - ° ~J WHVCH 15 7Hf EiS57 DAY-0F . C~86-2Q-484? ~O MRS Y JUNE GREEN GAU il>2925 NOV _l!!~T~ ___`__ 3bU7 CHESTNUT STREET 'IMO~H4~=_-_, iYEARI DAMP ~ili.l FENNA I7t~I1 ~'j,~`'y+g~+I5r4 / HATING sTA~MP. 1 1 OR MR INUUEPFNpEMCE HALT. ~ERIE5 E issuE ~ar~ WNICH IS y7HE F'1gR~5T DAY--OF ' 415Ci ~° 1~ /2 fsl ~ ~'DATiN6 STAMP LYNN K GREEN t~'sG., PA*:-'~~~- Tws wi~E na«s :.ow.wr~oimmrw Nn ~oN:lui ~vu °NO.gi.'r. u.o is sus. - - - ecaeeo.NOwTEO,,vlocEUTEacuw ~oucwmclnc~Inor NxwEN>'maa~cmn. - - - - TpEA MpEMRTMENT ~~ ~~_~,...,.~~ Q 6 3 0 2 5 6 4 2 3 3 E WASHINGTON $e.Maiy M'OI`im.a y LYNN K GREEN - tlfi C~. i~J~..~'- .PR.D11041%Uto ul.M,.enalllrrer MIII~.rE as,rRlaEO..AeII,n.. ,IfLr IO iH[TER.IS ArWNMdffONi a. A WL K Wi ONtT K WIT INS ." LCWOED MOOARp. MDOEEIVA®M frpllOMN6 Yl.EWfp NNYEIR TMEPEEOf. °~'~ .~.~.~~cQ 6 292 313 93~ E w - _.~ _ - _ ~` - - - 1 - - ~+~ AT TH£ ORIGINAL MATURITY HEREOF WILL PAY - ~~^ _E " - - VtH4CH 15 SHE FtR57'DAY OF-. _.: 086-'20-~484'~' _ .. TolfiRS Y JUNE 6REElr1 GAU x2925 .OGT_ 19?Es_ __-- ~~ 3607 GHES'tNtUT' STREET r•.roMTMIr----;tr~.nl CAMP H I ll PENNA 170I1 ~#~~y1~5~C~1A~y~ ~~U"Tw'TS `TI 1 pATI~1G 6TAMP j 1 r ~ ~ OR 1~'t IYNN K GREE1~t H~~I,. PA..-' -.- ..•__ -., MK roIronMUU YHOEII YITMD111TY Or bNO ACL AS 1YMrnp.Alm H{W~- .' - xcr m TNC er.I.IS..ocoNVa.o~s sTA.cs or. rt rlu. ~e Flo oN.Y I. ou.v IN- NGE.HALL scm~roANOOArto.AMOO[RTEINOM wrclxulrtorwwlulEUr4 __ - SgA4UY~ ~N.MTMEMT ~- DIES E ~~~ i~.tt. ~.~--~~~- Q 6 2 9~ 4 9 8 0 44-E t~...~ ~1 - - "AT THE ORIGINAL MATURtTY HEREOF WILL PAY oae-Za-4~~ ?o~fRS V Jilin 6KEE~+t GAU i~292S 3b07 GNESTNU7 STREET GAMP HILL PGNNI- 17~I1 [Nt !!R L1fNN iC GREED ISSUE DATE WHICH IS?HE FIRST DAY OF ,~u~ YgT~ (MONTHI~ _~ NEAR)-~ YYi,R ~w/y~ (~y y1-fpi)YS ls~ I~~i. V! ~i~ ~ 1 44TIN0 STAMP ~ . H#sG., Plr:. waswlwn ~muweca wniiem~er iowDwci:AS.Drwem.awensui- xcr rD Txc.Trms.wD ro.Dmows sT.rzi T. rc awu ec vwlu Dxl. n unv w- iGeleEOYDDNW,uIDOf1NLYDeYAa aCCDPT Cr MMICM TNC4rOi. - ' WASMINDTON TiSA9URY DCTaiDU[ilT ~I. N- .~-~--~.~~.. Q 6 2 7 7 29 6 3 4-~ E .T mru)/bn.vvq - I p ~^~QER>E~Li - -==~1ES E tHt MR iwYNR! !~ GR~.E.ht AT tNE ORIGINAL YATURI7Y HEREOF W)LL PAY ~~ t}8C'`10--~r8t4? ~O MRS V JU11tE GREEN G,RU 02'92.5 36U'1 CHESTNUT S~i~EET CA~4P Hlll PEt~t~A I7it11 ISSUE DATE WfilCIl 1S THE FJ&ST OAT OF ' Mt-Y 1'S~Tis (MOfJtlil ~.~~__ IYS/.~ii ~... .•4I50 t7D~~~,~a l~ 5/3Ir7u 1 enrwo srn,-+~ 1 it$~. i'A , -- Lr _'_ _ -" Txrs DOwDrslssumueicaavixiaaTarT iv eoa~i cues awEwocD, •xi lswa- -- '~ii0lxfi[awSM000NDlIOeSfiwiCO I EVfIro OwY KOVIy Ix• - - INDEP6MIJENGE HALL Iew.xD Dwrw.naD DCUVCacerrul a~,iomac accuerw MNiCal TwwcrDp. ..- _ - -_ . ~ERIE~ E TAFASVRYD[Ma1MCNi . ~' ~n ~ ~ / ~ ~ ~ ~ ~ ~ ~ ~ a ^ ~~ }~ wASNINGTON ~ -iyw ~I.tM L/1fT ~QJ LL~~-- . _ - - . -sw....,yoAr euay._-_ . ......... .......... ...~.:.,,... .. -~a...~m,.~m.~„~..,Iliti' ~~ ~ v_ . Y;~, 4 2h'' ISSUE DATE WHICH IS THE fIR57 DAY OF - ?oMf(t(~'.t J~~('3U,~~~. I~~,EtP{3 GAU Ctc9:t5 _AF'R__1~7`~__-- -~, „! ~IJV R lv ~2 L..J ~~rt~~ ~ t ~4~~.~ IMONTH) --- IYEAft) «~ GAt~F~ Nll.l F~ N~sl+ I.7t~11 ; 4150 U~. 14lR u ISJDES-1~GE:(CE HALL - SERIES E _ e x~/s L......L. ..II,r.-: '' i~-~- y- <n ~i(+~/~Uih£.~(yiT"S.. t ~. ~ DATING STA1.1P it 4 LYNN K GR E-Efit . HE;GN. PA..`~ Tw5/OX„~'g4U50 VNOCR AUTNORltYOr Tv BONG ACT. AS AMCNO[0. cMD144V/- - ~ - noCONDINON45tAiLD of. Wilt /[VALDONLT r -- - -_ SCRI/m AXO DATCO~AX00CLMCRC48YAN CGLLOWIHGX[CCIPi Of RgtICNi TnLR[!0& - -.. TAEASUR/CLPAR'MEYT ~. ~. ~.~.~,.~~ ~ 6 24 6 5 5'9 0 5-~ E - - ~ WASHINGTON Srs.Naya/G6ri~~uvy .- _ ~d ~ , - .r~ ~'" AT THE ORIGINAL MATURITY HEREOF WILL PAY ~Q~~~i)j - ISSUE DATE -=-~ WHICH IS 7HE fiHST DAY DF - " 'U$b-~8-r4~s47 ~o t#RSyY .~fjU~tE~7~G~kEEN C x GAU t~24Z5 MJk1t__19T~__--- '~ ~~ ! ~ril'~.~~YR/T JT~G,~ f 1MO17TH1 - 1Yr:AA1 CAMP H~Li. PENNA 17t~1Y ;'4y1^5t3 ~~~, - ~ t1 ®YE~W~IRI'S . ', 3/ 9t? T OATINGSTAMP ' • 0 9 - flR -M~t LYNN K GREEN ~tfi~. -PA.,~` ~:.. .> ---:. ___ - -- - n«s XDNVaasucv uRDrR AUrNVwrtw mT eoXV An A4 Arewem,AXDrsaus- INDEPENDENCE-I{AlL anroT~E TEaXS .wvcaXMrroelsSmE w. RMU xvAUV Olr4T rr DULT IN- - su+lemANVD.vm,.NDDLwERmm roLwrDXD SxcLlnor roaEXr TNUCroR. A - " - - SERIES E ,nuxvrAmeEf4T '• ~. N' ~~~.,.~~ 6 2~ 2 5 ~ 3 5 41 E~~ - -: - Src+ra.~NaMnevrX.y,- - - - -.. IL AF - ~ ~~~ AT 7HE OR1gNAL 17Y yEfrEO PAY ISSUE DATE WHICH !5 THE fHtST OAY OF -^ - OBb-20-kB47 „ Ta MRS. V .TUNE GREEN CAU 02925 JAN .1978 ~ 367 CHESTNUT STREET -t-Ms~r4~=~=~_~~•~,~~-- GAM P t!2 LL PENNA I7011 ~r"415 U ~'., 1/2b/7 ~- nwnHO 67AMP 1. - °: flR MR LYNN K GREEN HBO. f~A .,.~`~ ---- TRS~prO a Rg11[D tlle/R AvtNDerYM 10M9 /ICr. A! RYIXDED. RNelatw. lNOEPENDENCf ;HALL ~~ Ain o~Arm ~ ur~iX4'un a. Ir 4nu ~/ Xal4w oxLr r euLT IN- - - t Iltcm4Dr MYYEXT Txawa ~~~ S~~IES 1'i ~ ~5 ~°~`"' ~ r«•A~ Q 6 2 2 3 9 31 8 7 6 E,--- ~ K ~~~~ ~~ih1YV_~ IA,__}° k ~r k': _~ r. `, 46 b~C•`"' ~~1 /1 - .....-.- r~~aa. T a~vo.,,, z T^ :.~ ~ ~ r...T ...sW~ -~ e.. ~t ._ ~ _ _ _ '`~ AT THE ORIGINAL MATURITY HEREOF WILL PAY GF-t--rU-4t~7 .<5.1~"gE~Cs.^b3~g'w"~~..-'S~~_: ~t -'°<'-~.~3~~` ••,£;- T2'. '..~~C+13p6*~RZ'"~a3k~~b12'{SH-'SS\F'~3~$S55~.8.~'Tim"„aa~5795~~+?~'(yE,/ry~'y(~~~~1.~ ~ AT SHE ORIGINAL MATURITY HEREOF WILL PAY `%-~`.., u~'~~\ ~ ,~~ ~~'r~~R~q~y`~~I~~~~.'d'''-~;l~? 5~~~~ ~ ~ ~ ~ ~~ L ~~~ ~~~ ~ ISSUE DATE , . 4 a, .-_ .-.~ ---`..'~"~'°~"~` WHICH IS THE FIRST DAY OF - 1V 7 - - _ ON M (M ) - - IYEARI i , `~ ... .. E, ~ a `ti k.J ~.t *~ Lj L)L"'T'v1N~~1T6 I ' ./ 1 / ~~ iLlp G P ; ~ Lt, Nr LYhifti; t. ~..icr. E~3 NF:C3~. 1''~~..- i an-e.o nlsw<n n«wnAUrwinrr or <wrr eorio. ;. ~.,o.wa. rou+swe. ~ - x<, .n <~<.<~.s ~.n<~.~„o., ,..,<o <a. n .,u 1dDEPENDENGE HALT ~ s<.u<o ..o oA«n. ASOUanx+cuo ouanxc.cc<wra<naMUi <nOssow - ._ `~ : SERLES ~ '' ~n~ ~~ ~ ~% ~ 6 ~ 512 2 9 0 3.8. E ,~ ~: y - ' AT THE ORIGINAL MATURITY HEREOF WILL.PAY. ~_' - - ~'~_ 1CENTENNIAL 1978. ,~ 7S SUE DATE ` WfItC# ]5 T~,rQ~ST bRY OFD - / l> Y~ ~E~T C~ESTNl1fi ST~FET. ~-: CA!~~ HILL ~~-SV~{A 17G;11 '~41~~ ''°` ~.. L# ~E~ ~=6 ... T , '. - \ OAT1M6-SIAMP ~ ti ~-~ ~/ .'.; ~ ~ - -- _ - ( <MlWMRffin<o tl~wl AtlMOllrttw wno ner.~..awn.it~r6saur --- = SA~EI±E '~EtiCE ~~. -. l~~ rceR w.wc+<nsr,r cuwa,rv~<.. nl[wow ~- _ - - _- __ AT THE ORIGINAL MATURITY HEREOF WILL lAY mil ~,,' ~ --i~q ISSUE DATE ~`--`- - - WHICH l5 THE #IRST DAY-0F -- ~~E:~--tU~4~4 ~6 ti I G N ~ ~ T ?diii S ~ ar, t`E ~ -INOIJTH~y. -,,~~~,-~ G ~ f ; F~ H ~ L L F' a-.I~i 1~ ~ ~. to i :t ,~'~I is tr `~'~, Lev t~l,l. ~: ;;;;l~ltfi7 ~ '; "I ' cAT1HG srAMP < < ,. .: nw<wwswwn n.a<n tuMOena ~ •rr wee ~cr.as+w.oso..~oew.. '•. INOEPEMC+EI~E FtAL1 ~{ .rscrm na rats uwca.a+we< v+rto . x wu • wm wn a w.. ur. ~~i' scwao wln m<n.~wo oiuvau-r~w w<una ~w<w lwauw. ~, ~~~RIES E `' ,,,~IT ~.~,~ :~ ~ 613. X31. ~ 5 ~_E ~- p, r _ .. .~~„~ ~+r A ~ _."~, Z •. ' i'*31<d'3SS a,'a;S,Z.,R`. T„"ES`i9° 2 R- T.••"a^""~3'SS'F~'e'~'3iT"'E~ S3SE33ffi~EEBJII966dS~5*ie°3d^'3.1T~~E~.~ ~'~~, Y ~ ~[ T~` `'~P \ '[ AT TH£ ORrGiNAL MATURITY HEREOF SWILL PAY ~F I~~~ ~~'~. .1~~~r ~` ~'1 `~Y% ~~F ISSUE D A T E , ~ ~ ,~/ WHICH IS THE FIRST DAY OF IG ~' '~... ~ .3C1P,i Cs (,~`..L_ ~ i'~ 1..,__:C1 UC..7 L...7- `_1.1[l J __ oh _, fi i. - I 1, ~rt t ~. ~ i C.i i ~. ~{ :: ~' [ ~ I n~ ra enal » {: 1, h': (-' r', 1 L F s: ~ Pv:-. j 7 ~i 1 i. 'T ,'~ 415 {;~ i=_: = 1 If ..PE~IDENCE NAIL "£.-; LYRh k; L;~. ~ E; rs ao»o n ipwm u«ca±wr» sam or *u ~r soaa •c. •z u.a»oao +xDrs sua- ~~ ace;:co:suao.rio~.»a ooui.°nucoir:n ouow~»WS «acc~no. w.vaxi i»incroa arrusum ocwmrcnr ~//~ /~ WnSMfXGTOrr ~ //~~ f /~_~~ ~v 1.7(Cj3'{~/.N~j~~1 (4/~C~ZJys 11 1 , 6ATiI3G STA~P ~ I ~. H~~e--1?l..a Q 617 5~5 3~3 ~r A7 -THE ORIGINAL MATURITY HEREOF WILL PAY. ~ ISSUE DATE 3-~ LL pr ~l~ G /~ A ~ ~ llINICH t5 3f4E ftRSS v.4Y Of - 1o t~R~ 3€ -.3UNE G~t:EEt~ G~,U Ci~925 Ji1~+t ~~?? 36fii7 Ct~E;STNUT STREET -t~TH~=,= _;>~~-- G~LhlF HILL PENi~A 1.7011 ~'y;'4150 _ _ ~ ©~~9WNC37lOdTf'S arr ;6130!?? a GATING bTAa.~ t» 0~ ~ LYNN tC GREEN H~Sf~. Pa ..-'~~ _ ~ was axaao6rsaum turo[Ir AOrrroUffW aaaYaOaU •ct ~•YEaum.Yd5A9. -. - - _ T - -rnmsxc rswa.xocawwrwws .rtw+uxruw onivrcwaw~. -_. _.-. ±~ ^ ,' ~E sAC soar nconw[rnrt ocwrnmw ~ wauwrar`anrcrt aXClsm{;w/~~~{ j{J~~) /~^() -{~/~~] __. `jr ~/` ~~- HL aY.a5MiN6i(IM ~' ~~~~ Cam. .[{-//sj~- V4-~Y ~ 8 ~ .Y-2 V ~~ V ~- I~PC ..._- ~..~' ° dew ~~°' ~, .~~~~~\ AT-THEORIGINALMATURITT HEREOF WILL PAT ~-wr~ _ - ISSUE DATE - 1776 61CENTENNiAL 1978 _. - - !!~ ~} MfHICH k5 THE FIRST DAY W ~-' ~. ~O MRS Y JUNE G~:EEN L~U 0295 AtlG_ 191? -- ~ 3bt7? CHESTNUT STREET -~ws~,=H;:====:r~AR~-~ CAMP HILL PENNA 17u~11 ;4-150 ~'~,+ i7U ~~ad~*T$ , ts~11I7? 1 MT'PIG STRNia 1 », ,- ,,, .... . ~ ~ Q~. MR LYNN K GR1Et~ H$'iR. PA..~' I --- . - C-.~-~ Msewwnawao~ urtuornrYW souo•~.as ago. ulerssos . -. ~'1 ,acrmsat TOUrs cowm*w+s su.co cw.rtwu wu . rou+ -INAIEPENDENCE HALL ~>~~ scram •ao wam. ~rssaursasssvrl ouo.ucwcu.,or rram Trraanas. ~E~I=ES ~ °`. '"11N ~~` ~~ Q 619128 S 6 9 0E~ .Y~ ~. f>r`e a a~ •y t~pr~ r: '!~ E~ ~ ~'=__ e-. .'_~- Yv _ ti"'S'. - ~.. ~ ~~. ~; ,ZCE,~ ~:~ ,~'i3 uT'TAa% SS'S3 ,dG2~ R~+'SL^S'12"S`.,b'ib3L^L3T°~~3SZ;E~ JB~RE'.~SLE~ $° AT THE ORIGINAL MATURITY HEREOF WILL 9AY ~F`°l\ 1~~'~~3 ~a ~I~~f ISSUE DATE ~~>~,~mr °~~.~,~ ~ ~ WHICH 15 7HE FIRST DAY OF T' N`i ~-. ~; 4 .~U t+i E G ... ~ iti ~: a; tJ ii ~ 9 ~ 5~ E ~' 1 t7 T ~'v~1 r,_. Z t~.E~ 1 ~tMOtarl-il-- _ --~Yeaa)-- ~C:t; ~ ~a..__~C ~(£,~~LfF6 y~yN, 6`wVE^~}T'6 11 1 F/ L.l/ ~ f GATING STAMP ~ ~ / Gr<'; Aft WpEpENt iNCE }TALL L Yh! tV f~ (~~C ~ ECt ~F BCD 4xD Dr[D. 4x0 DLWlAfDR1W ~xr OCP,RiYCgT W45+xMGTpy ~'{G~. ix~.,~ ,~ ~ 4D..~ ..~ Duowxcuuiu.l or xrxLlr *xcnnaa (~.N.~~~~~~Q62:0323761.8Er ti ~~J~ -_ _ ~'~~ _AT Tt1E ORIGi_NAL •1ATURITY' HEREOF WIL1 -PAY _ ISSUE DATE -- - WHICH IS THE F7R5T DAY OF ~° ~~~ ~ .~uNE ~~E~N c~u ~~~~~ ,u,.~;,~;.i~~~~:F<1-_ ~6~~7 GE-ESfiUT ST~.EET ,,- G~1~ t HILL PENNA ,; I7~1 i '(~'~L4I5€~ ~t~/'3~l77 _ U C~. J"+F1 .~YNN ii ~~1 ~~fii. ri GY{T r, _ ~N s''r ~- - ~ - -lM6 ayD6R5BN UllDen INIRHWxIYp vaoxD 4LT, •S aueYeta_uo®sux- _ _ _- .-_ ~ xern+xcffMS4xocwonroxs m sor..r xu .c v4uD Dxa. raw ~«- _ _ INDEPE Rf:E 31A4L xwm4+D D4rm.rwcewL+roa raloww xcccn~Dr v+w *xclluD!a _ - .- = T - .~~ . ~~. ~.~.... ~~~ ~ 210 9 7 6 ~ ~ _0 E- - ~~ ~~ =AT THEOAIWNAI MATURITY HEREOF WILL PAY - ~ ~~ U8t-t0-4B47 To ~1RS Y `JUNE Gi~EEN CCU 1 36t~7' CNESTkUT ST~;EET i° GASP 1il;ll PENNA 1711 'ISSUE DATE WHICH iS THE FIRST DAY OF OZ~i~S DEG l~i't7 ,~~i15U .,Y a~$g~INS~,l4~aTg Y OATUdO 6TAMP ~. ~ ~ Y I: Ago; Cat. HR LYN~f iC GREEN H6~.` PA. ; - Yxli aelmsnaDCe IIyDM UrtlgxrtYa eetm AR AS AraacD.Nnasa- J6f.OlxFRnxfMpLDxDIT1011$S~41{D r.R1MILL![VMIOGxtYlr~~arlx- INDEPENDENCE'W-LL scxlDm ule DAr.o.wicurcll[Dn MFmrw rwwr nlFnvee. ~, SERIES E ,` tt° "Ni -: ;~. tt.~~ ~~ 0 6 2 2 3 9 2 6 6 0 A~ E Rev-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Green, V. June 21-' If an asset was made J°Int within one year of the decedent's date of death, It must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Thomas H. Green 30 Williams Street Son Halifax, PA 17032 B C -IOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 8/28/1964 M & T Bank Checking Account 1,232.65 50.000% 616.33 #38538318 TOTAL {Also enter on Line 6, Recapitulation) I 616.33 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Q M&TBank 499 Mitchell Street, Millsboro, DE 19966 January 22, 2008 Etzweiler and Associates Attorneys At Law 105 North Front Street Harrisburg, PA 17101-1436 RE: Estate of V. June Green Date of Death: December 16, 2007 Social Security Number: 086-20-4847 Dear Mr. Etzweiler: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. Account Type ........................... Checking Account Account Number ....................... 38538318 Ownership jNames oj~ .............. V. June Green, T.H. Green Opening Date ...........................08/ 28/ 64 (account closed 12 / 31 / 07) Balance on Date of Death.........$1,232.65 Accrued Interest $ 0.00 Total .......................................$1,232.65 The above named decedent did not have a safe deposit box. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please contact our West Shore Plaza Branch at 1200 Market Street, Lemoyne, PA 17043, or # 717-255- 2271. Sincerely, .~ Charlene Warrington, Records Management 1-888-502-4349 Rev-1508 EX+ J6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Green, V. June 21-- 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. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV•1151 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ~ FILE NUMBER Green, V. June 21-- Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Thomas H. Green Social Security Number(s) ! EIN Number of Personal Representative(s): Street Address 30 Williams Street City Halifax State PA Zip 17032 Year(s) Commission paid 2. Attorney's Fees Earl Richard Etzweiler 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 222.42 500.00 500.00 4. Probate Fees 40.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 482.28 See continuation schedule(s) attached TOTAL (Also enter on line 8, Recapitulation) 1,744.70 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev1502 EX+ (6-98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Green, V. June 21-- Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Green, V. June 21-_ ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal, advertise Letters Testamentary 75.00 2 Etzweiler & Associates, postage, photocopies, notary fees, etc. 75.00 3 Patriot News, advertise Letters Testamentary 263.28 4 Register of Wills, 1 Short Certificate 5.00 5 Register of Wills, additional probate fee 14.00 6 Register of Wills, file Inheritance Tax Return and Inventory 30.00 7 Register of Wills, take Oath 20.00 Subtotal 482.28 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-981 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE f DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF (FILE NUMBER Green, V. June 21-- Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Carlisle Regional Medical Center, outstanding medical bill 144.92 2 PA Department of Public Welfare, Class 3 claim 24,431.04 3 PA Department of Public Welfare, Class 6 claim 123,623.52 4 United Church of Christ Homes, outstanding nursing home bill 1,251.25 70TAL (Also enter on Line 10, Recapitulation) I 149,450.73 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) ~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG. PA 17105-8486 January 15, 2008 ETZWEILER AND ASSOCIATES EARL RICHARD ETZWEILER ESQUIRE 105 NORTH FRONT ST HARRISBURG PA 17101 Re: VIRGINIA CiREEN CIS #: 080174932 SSN: 086-20-4847 Date of Death: 12/1612007 Dear Mr Etzweiler: Please be advised that the Department of Public Welfare maintains a claim in the amount of $148,054.56 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective Auaust 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $24,431.04, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim., namely $123,623.52, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may :be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, r . ~' /, ~ r Kelly I. Wells TPL Program Investigator 717-214-1870 717-7`72-6553 FAX Enclosure REV•1513 EX+ (9.00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Green, V. June 21-- NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee s I~ TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Linda J. Bunn Daughter 708 North Seventh Street Macclenny, FL 32063 Katheryn J. Green Chapman Daughter 3607 Chestnut Street Camp Hill, PA 17011 Thomas H. Green Son 30 Williams Street Halifax, PA 17032 Total Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cov er sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) ~~•a . ~~j,~ #~'~ 'y~~ ~=r Is": :J ~~. ~;' A ,~ ,.r~'~ i ~ t '~ ~- ~ ~ '~'` ~t ~ ~C~: 4: U Ss j U e~ Q` Ss U t~Q~ i ._ LL r.,,,~ ., ~ ~~: { y ~L,~,~~~~EG ~r CL~C'K ~ ;, Q~~ `~~;~~ ~ ~ Ir ~ ~ (~~ ;1{~11 ~~ W ~- o Q ~ T U ~~ ._ p ~T N~~~ ~ya - o 'G7~~T to Cn e( ~''~o.. ~ ~ ~ ~ ~ ~ ~ ~ ,,,, o L W Z = O H T W ,t N 0 U ~`' '~ !"~ w O OU alcn cn p,~o ~ ~ ~ ~ H ~ ~ ~ U ~ ~ o a o as ~ cd .~ ~ a~~ ~~ ~ ~ ~-~ •rl O rl bD U ~+ pl., V.~U O H INVENTORY REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } Thomas H. Green CUMBERLAND COUNTY, PENNSYLVANIA ____ r' , File Number 21-- (~,+ . C' Personal Representative(s) of the Estate of V. June Green deceased, depose(s) and say(s), that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate In the Commonwealth of Pennsylvania of saki Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I verify that the statements made in this Inven- ~ .~~~iy~'' 1...~. ~~.~--- tory are true and correct. I understand that false state- ~- ~''' - ments herein are made subject to the penalties of Thomas H. Green 18 Pa.C.S. § 4904 relating to unsworn falsification to } _. ~ :'~ authorities. ~_.~ ~ _ -_.~ ~.~ Attorney -- (Name) Earl Richard Etrweiler (Supreme Cour,~tlZ-lvo.) ~ 06398<.-> (Firm) Etzweiler and Associates ._n ~ _. ~,_., - (Address) 105 North Front Street, Harrisburg, PA 17101 ~-~,. ~~ ~y (Telephone) __ - _ _ -- (717) 234-5600 0 . , DATE OF DEATH IAST RESIDENCE 3607 Chestnut Street DECEDENT'S SOC. SEC. NO . 12/16/2007 Camp Hill, PA 17011 086-20-4847 Personal Propert FIGURES MUST BE TOTALED Cash ............................................................................................... Personal Property ......................................................................... Stocks/Listed ................................................................................. Stocks/Closely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property ......................................... Total Real Property ................................................ 370.00 2,200.02 2,570.02 Total Personal and Real Property ......................... 2,570.02 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b)) Foam RW-09 Rey. Dais-zoos REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } DATE OF DEATH LAST RESIDENCE 3607 Chestnut Street DECEDENTS SOC. SEC. NO. 12/1612007 Camp Hill, PA 17011 086-20-4847 Cash Internal Revenue Service, refund of 2007 income tax 370.00 Total Cash 370.00 Bond Series E $25.00 U.S. Savings Bond #Q6150078431E owned by Decedent and 138.04 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6161231452E owned by Decedent and 138.04 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6177595343E owned by Decedent and 138.04 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6177595343E owned by Decedent and 139.40 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6184826610E owned by Decedent and 139.70 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6191285690E owned by Decedent and 139.67 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6203237618E owned by Decedent and 139.67 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6210976440E owned by Decedent and 139.67 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6223926604E owned by Decedent and 128.45 her husband, Lynn K. Green, who died January 15, 1979 INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA File Number 21-- (Attach additional sheets if necessary) Total Personal Property and Real Estate 2,570.02 REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } DATE OF DEATH LAST RESIDENCE 3607 Chestnut Street DECEDENT'S SOC. SEC. NO. 12/1612007 Camp Hill, PA 17011 086-20-4847 Series E $25.00 U.S. Savings Bond #Q6223931876E owned by Decedent and 125.93 her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6232513541 E owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6246559054E owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6254344850E owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6277296346E owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6286422111E owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6292313932E owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6292498044E owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Series E $25.00 U.S. Savings Bond #Q6302564233E owned by Decedent and her husband, Lynn K. Green, who died January 15, 1979 Total Bond INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA File Number 21-- 106.27 106.27 104.58 102.81 102.81 103.79 102.81 104.07 2,200.02 -2- ETZWEILER AND ASSOCIATES ATTORNEYS-AT-LAW 105 NORTH FRONT STREET HARRISBURG, PA 17101-1436 Office hours: Mon.-Fri. 8:00 a.m.-5:00 p.m. (717)234-5600 Earl Richard Etzweiler, Esquire ----- Christian S. Daghir, Esquire HALIFAX LINE (717)896-3737 225 Market Street Fax Line: (717) 234-5610 2 West Main Street Millersburg, PA 17061 Email Address: retzweiler(F~comcast.net Elizabethville. PA 17023 (717)692-2519 (717)362-8395 Offtee hours: Tues. ai:d Fri. 4:00 p. m.-8:00 p. m. Office hours: Thurs. 7:00 p.m.-9:00 p.m. Sat. ]0:00 a.m.-12:00 noon May 13, 2008 Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 ~-~~ `~ -- -~ -~ :> _J -~ {~ --G 7 Re: Estate of V. June Green ~ F, ~; __., Dear Madam: ~ -%f~ ~ y '~ ~ _J Please find enclosed the original and one copy of the Inheritance Tax Re~rn and ~" Inventory together with a check in the amount of $30.00 to file the same. Please time stamp the copies and return them to our office in the enclosed envelope. Sincerely yours, r~ ~2_ Earl Richard Etzweiler ERE:kIp Enclosure G:l WPIDOCIESTATE-D1R~ESTATE1Grcd~-VhmcVdtcrs.npd