HomeMy WebLinkAbout05-20-08
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15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 8
0009
Date of Birth
197 05 7127
12 10 2007
12 26 1907
Decedent's Last Name
Suffix
Decedent's First Name
MI
ESHELMAN
MYRTLE
M
(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 OVALS BELOW
[!] 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of death
priorto 12-13-82)
0 4. Limited Estate 0 4a. Future Interest Compromise 0 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
[K] 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10 Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
. between 12-31-91 and 1-1-95) (Attach Sch. 0)
Name
JAMES D. BOGAR
CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
SHIREMANSTOWN
State
FA
ZIP Code
17011
Daytime Telephone Number
717 737 8761
C) "'.;)
REGISTER Qi:;'~LS USE ~L Y
"':1 ~
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:02'-~ ~~
DATE FILED a
Firm Name (If Applicable)
BOGAR & HIPP LAW OFFICES
First line of address
ONE WEST MAIN STREET
Second line of address
City or Post Office
Correspondent's e-mail address:
Donald E. Smith
os 0% O)ooE>
17050
James D. Bogar
anstown, PA 17011
Side 1
L
15056041147
15056041147
-..J
~
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Eshelman, Myrtle M. 21-08-0009
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 #2
a;~d-ce. ~
.
Name
Address1
Address2
City, State, Zip
Violet E. Smith
2 Red Fox Lane
Mechanicsburg, PA 17050
Date
c...)-joJ !.;;)OOt'.
I I
--.J
15056042148
REV-1500 EX
Decedent's Neme Myrtle M. Es h e I m'a n
Decedent's Social Security Number
197 05 7127
RECAPITULATION
1, Real Estate (Schedule A),.""""""".".""""""""""".."""",.""""".""""""""...""" 1.
2, Stocks and Bonds (Schedule B)""""..."""""."""""".".""...""".""".""""".""..", 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).""""' 3,
4. Mortgages & Notes Receivable (Schedule D)."""."""""".""."""."".".""""""."" 4.
5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)."""""..". 5,
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested..."."."" 6,
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested""""..". 7,
8, Total Gross Assets (total lines 1-7)".".".""..."".."""""""".""""""."""".""...." 8,
9, Funeral Expenses & Administrative Costs (Schedule H)""""."."".".".."".."""."" 9.
10, Debts of Decedent, Mortgage liabilities, & Liens (Schedule I)..""".".".""..""..."" 10,
11, Total Deductions (total Lines 9 & 10)...""""...""...".""""....."..."...""..""....."...... 11,
12, Net Value of Estate (Line 8 minus Line 11)....................""..............".........""........ 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)..."......"".."".".........."""......... 13,
14, Net Value Subject to Tax (Line 12 minus Line 13)"..."........."........""................".
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under See, 9116
(a)(1 ,2) X ~ 0 . 0 0
14.
15,
16, Amount of Line 14 taxable
at lineal rate X ,045
17, Amount of Line 14 taxable
at sibling rate X ,12
18, Amount of Line 14 taxable
at collateral rate X .15
16,
40,608.86
0.00
17,
0.00
18,
19, Tax Due".,..",,,,,,,,.,,,,,,,,,,..,,,,,....,,,,,,...,,....,,,,,,...,,....,,,,,.,,..,,........,,,,,,,,,,,,, .."""""..., 19,
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
61,986.91
2,582.60
64,569.51
7,781.00
16,179.65
23,960.65
40,608.86
40,608.86
0.00
1,827.40
0.00
0.00
1,827.40
o
15056042148
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-0009
DECEDENT'S NAME
Myrtle M. Eshelman
STREET ADDRESS
1700 Market Street
CITY I STATE IZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
1,735.72
91.35
Total Credits (A + B + C)
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
4. If line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT.
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 the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
1,827.40
1,827.07
(3)
(4)
(5) 0.33
(5A)
(58) 0.33
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
[!J
!Xl
[!J
[!J
[!J
[!J
o [!J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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
LJ
o
[J
o
o
o
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000: . .
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 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. S9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1508 EX+ (6-98)
.~
~
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Eshelman, Myrtle M.
fFILE NUMBER
21-08-0009
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with the right of sUNivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Capitol Blue Cross - Refund of unearned premimium
VALUE AT DATE
OF DEATH
97.20
2 Holy Spirit Hospital - Refund of overpayment of medical bill
31.00
3 Sovereign Bank - Checking Account Number 1681790440; Date of Death Value
$61,712.04; Accrued Interest from date of death $146.67
61.858.71
TOTAL (Also enter on Line 5, Recapitulation)
61.986.91
(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)
~w~ Sovere.
BanK
Court Ordered Processing \ Decedents - MAI-MB3-02-10 - P. O. Box 841005 - Boston, MA 02284
March 5, 2008
James D. Bogar
Attorney at Law
1 West Main St.
Shiremanstown, PA 17011
RE: Estate of Myrtle M Eshelman
Date of Death: 197-05-7127
Dear James D. Bogar:
Per your request, enclosed please find the account information as of the date of death
for the above-named decedent. For your information, accrued interest is not included in
the date of death balance.
Please feel free to contact me if I can be of any further assistance.
Very,~~ruly yours,
/1
/. / --
, ,/" ;",. ,i -l ,.../J ~:.-,/.., ~1. / _,,~ (__ '"-i!-::.':~
{f;cit:>C///t..-L .' '~1J.,(h'-'-t.4''<..J / "-'<- ,,--
Laurie DiGiantJ.bmenico
Team Leader
617-533-1789
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Myrtle M. Eshelman
197-05-7127
December 10, 2007
Account #: 1681790440 Type: Checking
In the name of: Myrtle M. Eshelman (Donald E. Smith POA)
Date of Death Balance: ..00
Int.(YTD) from 1/112007
Accrued interest to date of death:
Other Info: Closed 117/08
Open date: 10/30/2006
to
12/10/2007
$0.00
$0.00
Account #: 1684068266 Type: Money Market
In the name of: Myrtle M. Eshelman (Donald E. Smith POA)
Date of Death Balance: $61,712.04
Int.(YTD) from 1/1/2007 to 11/22/2007
Accrued interest to date of death: $146.67
Other Info: Closed 1/4/08
Open date: 10/30/2006
$4,180.88
Page 1 of 1
Rev-1509 EX... (6-98)
SCHEDULE F
JOINTL V-OWNED PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eshelman, Myrtle M.
FILE NUMBER
21-08-0009
If an asset was made joint within one year of the decedenfs date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Donald E. Smith
ADDRESS
RELATIONSHIP TO DECEDENT
Son
2 Red Fox Lane
Mechanicsburg, PA 17050
B.
C.
JOINTLY OWNED PROPERTY:
DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
LETTER
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENTS INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 1 0/19/1998 M& T Bank - Checking Account Number 5.165.20 50.000% 2.582.60
3740575877; Date of Death Balance
$5,165.20; Accrued Interest $0.00
TOTAL (Also enter on Line 6, Recapitulation) 2.582.60
(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)
l!M&fBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
January 11,2008
James D Bogar
Attorney At Law
One West Main Street
Shiremanstown, Pennsylvania 17011
Re: Estate or Mvrtle M Eshelman
Social Securitv: 197-05-7127
Date of Death: December 10, 2007
Dear Sir or Madam:
Per your inquiry dated January 04, 2008, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
I.
Type of Account
Checking Account
Account Number
3740575877
Ownership (Names oj)
Myrtle M Eshelman *
Donald E Smith *
Opening Date
10/19/98 Closed 01/10/08
Balance on Date of Death
$5,165.20
Accrued Interest
$ 0.00
Total
$5,165.20
Please be advised, there was no safe deposit box fmUlct for the above decedent.
*Ifyou feel that any additional accounts should exist, please provide us with an account number and/or the name of
any possible joint account holder. For further account information, regarding ownership, closures and/or
reimbursement of funds, etc., please call the Trindle Road Office # 717-737-2308.
Sincerely,
.. /1 ' //-:.:~;:.., ~ "f;I
'~f }/1'-''1/1,,,",,,/ /" 1_-,t'V'!.r~-,/~ ,
./ /1r {Fr.:' /;<""~~:;- .;1
Nancy Clagett
Records Management
REV-1151 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eshelman, Myrtle M.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-08-0009
ITEM .
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,215.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Bogar & Hipp Law Offices 4,100.00
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
4. Probate Fees 185.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,281.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 7,781.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-15Q2 ex.. (6-98)
,~.u .
~
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eshelman, Myrtle M.
FILE NUMBER
21-08-0009
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Gingrich Memorials - Purchase of headstone
2.215.00
Subtotal
2.215.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT OECEOENT
ESTATE OF
Eshelman, Myrtle M.
FILE NUMBER
21-08-0009
ITEM
NUMBER
1
DESCRIPTION
Holy Spirit Hospital - Payment of medical bill
AMOUNT
31.00
2
RESERVES - Cost to conclude administration of Estate including filing of Pa.
Inheritance Tax Return and Inventory and fiduciary income tax returns
1.250.00
Subtotal
1.281.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-B? (Rev. 6-98)
Rev-1512 EX+ (6-9B)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Eshelman, Myrtle M.
FILE NUMBER
21-08-0009
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Department of Public Welfare - Claim for restitution for medical assistance per
attached letter
VALUE AT DATE
OF DEATH
16.179.65
TOTAL (Also enter on Line 10, Recapitulation)
16,179.65
(If more space is needed, additional pages of the same size)
Copyright (cl 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
COMMONWEIIL TH OF PENNSYLVANIA
DEPARTMENT OF pueuc WEI.FAAE
DUR5AU OF FINANCIAL OPERATIONS
DIVISION Or: THIRD PARlY LV\!lILlTY
ESTATE RECOV~Y PROGRAM
FO BOX B4B6
HARRIGBUM. PA 1710S~86
Jan1.1ary 11, 2008
JAMES lJ BOGAR AT'l'ORNBY AT LAW'
ONE WEST MAIN ST
SH:Z;RE~fANSTOWN FA 17011
Re; MYRTLE ESHELMAN
CIS *: 200182176
SSN: 197-05-7127
Date of Death: 12/10/2007
Dear Mr Bogar:
Please be advised that the Department of ?ublic Welfare maintains a
claim in the amount of 516,l79.65 against the abo~e-mentioned estate. This
claim is for restitution or 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 August 15, 1994, as
amenclea by Act 20-95, effective June 3D, 1995. ~nclosed is the Depar~~ent's
itemized statement of claim.
A portion of this medical expense, namely S.OO, 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 $16,179.65, is to be
entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is completer please provide a copy. If the estate contains
~eal estate, please provide copies of the deed, the latest tax BS$eS6ment,
and Q current app~aisal, ix available.
Sincerely,
~J
Kelly I. Wells
TPL Program In~estigator
717-214-1870
717-772-6553 FA-X
p ff1"
tf I,.,; ( 11
rV~
Enclosure
COMMONWE:/U.T;( OF FENNSYLVANIA
OEPARTM5NT Or PU8LIC WELFARE
BUReAU OF FINANCIAL OPERATIONS
TPL SECTION - CASUAI.TY UNIT
PO BOX 04ee
MARRISBtJRG PA 1710S.B41l5
January 11, 2008
STATEMENT OF CLAIM SUMMARY
Estat5 of ESHELMAN, MYRTLE
200182176
INPATJENT
OUTPATIENT
LDNG TERM CARE
DRUG
.00
.00
.Oll
.00
.O!)
.00
16,171.21
11.44
.00
16,171.21
8.44
.00
.00
1 &,119 .65
16,179.65
January 11, 2008
STATEMENT OF CLAIM
ESHELMAN, MYRT1..E
200182176
MANORCARE HI.TH SVCS CAMP HILL
1100 MARKeT ST
07118106 . 07/31/00 04/1 fi/07 55071014121560001 55071014121560001 2,096.50 1,61.9.86
DIAGNOSIS 1; 8208 rX NfCK OF FEMUR NOSoCL
DIAGNOSIS 2: 4019 HYPER.TeNSIO~ NOS
PP.OC CODE: 000000
08/01/06 . 08131/06 04/16/07 55071014121570001 ~50i1014121570001 4,$42.26 4,418.74
DJAGNOSIS 1: &208 FX NECK OF FeMU~ NOS.CI.
DIAGNOSIS 2: 4019 HYPERTENSION NOS
PROC CODE: 000000
09/01/06 - 09/30106 04/16/01 55071014121580001 56071014121580001 4.452.50 4,;J.S4.1Q
DIAGNOSIS 1 : 8208 FX NeCK OF FEMUR NOS.CL
DIAGNOSIS 2: 4019 HYPEf{TENSION NOS
F'ROC CODe; 000000
10/01/06 - 10131/06 04/23/07 55071084042820001 55071 DS40l2!20001 4,642.25 4,466.19
DIAGNOSIS 1 : 820S FX NECK OF FEMUR NOS-C!.
DIAGNOSIS 2; 4019 HYPERTENSION NOS
PROC CODE; 000000
11/0'/106 . 11/13/06 04/2'3/07 55071084042330001 55011084042330001 '1,946.15 1.412.32
DIAGNOSIS 1 : 820& FX NECK OF FEMUR. NOS-Cl.
DIAGNOSIS 2: 4019 HYPERTENS!ON NOS
PR.OC CODE: 000000
rJANORCA~.E HLTH svcs CAM~ HILL 11,8~O.25 113,171.21
03 000747669 0001
January 11, 2008
STATEMENT OF CLAIM
ESHEl.MAN, MYRTU:
200182176
HEARiL.AND PHARMACY PA L.LC
7010 SNOWDRIfT RD
11/08106 . 11/08/06
OIAGNOSIS 1: 0
01/22/07
2506$626499350001
25063625499350001
3B.05
8.44
NDC CODE: 00186109039
rOPRO!. XL 50 MG TABLET SA - OTHER CARDIOVASCULAR PR.EPS
HEARTI..AND PHARMACY PA LLC
24 101710695 0001
32.05
8.44
.
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
February 27, 2008
JAMES D BOGAR ATTORNEY AT LAW
ONE WEST MAIN ST
SHIREMANSTOWN PA 17011
Re: MYRTLE ESHELMAN
CIS #: 200182176
SSN: 197-05-7127
Date of Death: 12/10/2007
Dear Mr Bogar:
This is to acknowledge receipt of payment in the amount of $16,179.65
regarding the above-referenced estate. The Estate Recovery Program's claim
is satisfied.
Your cooperation in resolving this matter is appreciated.
~JW~
Kelly I. Wells
TPL Program Investigator
717-214-1870
717-772-6553 FAX
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Eshelman, Myrtle M.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-08-0009
RELATIONSHIP TO
DECEDENT
Do Not List Trusteels)
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
Donald E. Smith
2 Red Fox Lane
Mechanicsburg, PA 17050
Son
One Hundred
Percent of
Rest, Residue
and Remainder
Total
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lac~ner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
1lI&~t lnIill ClnD Qlrstcrml?ttt
OF
MYBTIE ESHEr.MAl.'T
I, MYRTI.E ESHEINAN, of Hampden Township, Cumberland County, Pennsylvania
make, publish and declare this as and for my Last Will and Testament, hereby re-
voking all other Wills and Codicils heretofore lffide by me.
FIRST: I direct the payrrent of all my just debts and funeral expenses,
including my grave marker and all expenses of my last illness, shall be paid from
my residuary estate as soon as practical after my decease as a part of the 8..'{-
penses of the administration of my estate.
SECOND: I devise and bequeath all the rest, residue and remainder of my
estate of whatever nature and wherever situate, together with any insurance
policies thereon, unto my son, OONAID E. SMITH.
THIRD: Should my son, llinald E. Smith, predecease me, I devise and
bequeath all the rest, residue and remainder of my estate of whatever nature and
wherever situate, together" with any insurance policies thereon, as follows:
A. One-third (1/3) thereof unto my daughter-in-law, VIOlET E. SMITH .
B. One-third (1/3) thereof unto my grandson, DAVID E. SMITH.
C. One-third (1/3) thereof unto my granddaughter, LONNA J. GROUP.
FOURTH: In addition to all powers granted to them by law and by other
provisions of this Will, I give the fiduciaries acting hereunder the following
powers, applicable to all property, exercisable without court approval and effec-
tive until actual distribution of all property:
(A) To sell at public or private sale, or to lease, for any period of
any real or personal property and to give options for sales, exchanges or
for such prices and upon such terms or conditions as are deemed proper.
(B) To partition, subdivide, or improve real estate and to enter into
agreements concerning the partition, subdivision, improvement, zoning or II'anagemen
of real estate and to impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to abandon any property
which is of little or no value.
(D) To invest in all forms of property, including stocks, corrnxm trust
funds and rrortgage investrrent ftmds, without restriction to investments authorized.
for Pennsylvania fiduciaries, as are deemed proper, without regard to any principl
of diversification, risk or productivity.
(E) To exercise any option, right or privilege granted in insurance
policies or in other investments.
(F) To e.'ffircise any election or privilege given by the Federal and
other tax laws, including, but not necessarily being limited to, personal incorre,
gift and estate or inheritance tax laws.
(G) To make distributions to my herein named beneficiaries in cash or .
kind or partly in each.
FIF!'H: I direct that all inheritance, estate, transfer, succession
and death taxes, of any kind whatsoever, which TIE.Y be payable by reason of my
death, whether or not with respect to property passing under this Will, shall be
paid out of the principal of my residuary estate.
SDITH: All interests hereunder, whether principal or income, while
undistributed and in the possession of the fiduciaries acting heretmder, even
though vested or distributable, shall not be subject to attachnent, execution or
sequestration for any debt, contract, obligation or liability of any beneficiary,
and furtherrrore, shall not be subject to pledge, assigrnr:ent, conveyance or anti-
cipation.
SEVENTH: I nominate and appoint DONALD E. SMITH and VIOLET E. SMITH,
or the survivor thereof, Co-Executors of this, my Last Will and Testament. I
hereby relieve my Co-Execut0t"S from the necessity of posting security in cormectio
with their duties as such in any jurisdiction in which they may be called upon to
act insofar as I am able by law to do so.
IN WITNESS WHEREOF, I have heretmto set my hand and seal to this, my
"-
Last \-Jill and Testarrent, this.3 L\ day of r>1,;va-'
, 1985.
(SEAL)
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Signed, sealed, published and declared by the above naIIl2d TestatrL"'{ as
and for her Last Will and Testament in our presence, who, at her request, in her
presence and in the presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
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Address
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