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HomeMy WebLinkAbout05-20-08 15056041158 J REV-1500 EX (os-05> PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box zaosot INHERITANCE TAX RETURN 21 0 8 0 2 7 4 Harrisburg, PA 17128-0501 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 205-09-6337 12252007 02151915 Decedent's Last Name RADOS Suffix Decedent's First Name BARBARA MI K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4 i ^ 4 I i d f F C ^ 5 F . Lim ted Estate a. uture nterest omprom se ( ate o . ederal Estate Tax Return Required death after 12-12-82) a 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9 i ^ 10 S l P C di d t f d h ^ 11 El i . Litigation Proceeds Rece ved . pousa overty re a e o eat t ( . ect on to tax under Sec. 9113(A) between 12-31-91 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 JOHN R• ZONARICH, ESQ• 717-233-1000 r,,~ --, Firm Name (If Applicable) SKARLATOS & ZONARICH LLP First line of address 17 S• 2ND ST•, 6TH FLOOR Second line of address City or Post Office HARRISBURG c , REGISTER bFlNjL1S USE O i -~, it - c~ =- ~.~ r . ~, ~ _. ...~ ' -1 _--' .. 1 J ~_„~ DATE FILED CX~ State ZIP Code PA 17050 Side 1 15056041158 6M46473.000 15056041158 J Correspondent'se-mail address: JRZu1SKARLATOSZONARICH • COM 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 repr is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE~6 G RETURN ~ ~\ ~ D~TE~ ~ / ~~ CHERYL L• DEATON 15056042159 REV-1500 EX Decedent's Social Security Number iRADOC 205-09-6337 Decedent's Name B A R B A R A K RECAPITULATION 1 . Real estate (Schedule A) 1. D.oo 2 . Stocks and Bonds (Schedule B) . 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3 . 0.00 4. Mortgages & Notes Receivable (Schedule D). 4 . 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5. 433.00 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6 7. . Inter-Vivos Transfers & Miscellaneous Non-Probate Property 8 4 7 9 9 •0 0 (Schedule G) ~ Separate Billing Requested 7 . 0.00 8. Total Gross Assets (total Lines 1-7). 8. 85 32.00 9. Funeral Expenses & Administrative Costs (Schedule H) . g . 13520.OD 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 1p . 295.OD 11. Total Deductions (total Lines 9 & 10) . 1 1. 13815.00 12. Net Value of Estate (Line 8 minus Line 11) 12 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 71417 • D 0 an election to tax has not been made (Schedule J) . 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 71417.0 0 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .o1L 16. O .O D 15. Amount of Line 14 taxable 0 •0 0 at lineal rate X .04~ 71417.0 0 1 s. 17. Amount of Line 14 taxable 3214 • DD at sibling rate X .12 D . D D 17. 18. Amount of Line 14 taxable D ' D D at collateral rate X .15 D • D D 18. o.oo 19. TAX DUE 19. 3214.00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 15056042159 15056042159 J 6M4646 2.000 REV-1500 EX Page 3 Decedent's Complete Address: File Number 0274 DECEDENTS NAME RA 0 BARBARA K STREET ADDRESS UMBERLAND CITY MEHANICSBURG STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit D • D D B. Prior Payments 2 8 5 D• D D C. Discount 15 D • D D 3. Interest/Penalty if applicable D. Interest D • D 0 E. Penalty _ D • D D (1) 3214 •00 Total Credits (A + B+ C) (2> 3 0 0 0. 0 0 Total InterestlPenalty (D + E) (3) D D D 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) D , D D 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 214 • 0 D A. Enter the interest on the tax due. (5A) 0 . 0 D B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 214 • 0 0 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No i th i f th f t t d a. re n e use or ncome o e property a rans erre ; r i b th i ht t i ll th t d t h h rt f it t d i ^ . n e r g o es gna e w o s e a a use e prope y rans erre ncome; or s c. retain a reversionary interest; or ^ 0 d. receive the promise for life of either payments, benefits or care? ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death i ith i d ? ng a . w out rece v equate consideration 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §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)]. 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 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. X9116(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. >39116(a)(1.3)j. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 6M4671 1.000 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY FILE NUMBER Barbara K. Rados 21 08 0274 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH Loyalton of Creekview Refund of nursing care pre-payment 433 TOTAL Also enter on line 5 Reca itulation $ 433 swasgo i.ooo (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERffANCETAX RETURN RESIDENT DE(,EDEPlT SCHEDULEF JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Barbara K. Rados 21 08 0274 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVNINGJOINTTBVANT(S)NAME I ADDRESS RELATIONSHIP TO DECEDENT A Deaton, Cheryl L 6332 Pennsboro Dr., Mechanicsburg, PA 17050 Daughter JOINTLY-0WNED PROPERTY: ~~ LETTER DATE DESCRIFfION OF PROPERTY NUMBER FOR JOIN TENANT MADE JDINT INCLUDE NAME OF FINANCIALINSTITUTION AND HANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR DATE OF DEATH % OF DC-CD'S DA TE OF DEATH VALUE OF JOINTLY-HELD REAL ESTATE. VALUEOFASSET INTEREST DECEDBVTS INTEREST 1 A 11/22/1989 M&T Bank Account #70161283 Barbara K. Rados & Cheyl L. Deaton 10,873 50.0000 5,436 2 A 11/22/1989 PSECU Regular Share Account SO1 Barbara K. Rados & Cheryl L. Deaton 382 50.0000 191 3 A 11/22/1989 PSECU Money Handler Account S04 Barbara K. Rados & Cheryl L. Deaton 1 0 0 4 A 11/22/1989 PSECU Money Handler Account S07 Barbara K. Rados & Cheryl L. Deaton 157,910 50.0000 78 955 Interest accrued to , 12/25/2007 434 50.0000 217 i R i i 84,799 (If more space is needed, insert additional sheets of the same size) 3W46AE 1.000 REV-1511 EX+(10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Barbara K. Rados 21 08 0274 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Wiedeman Funeral Home funeral services 5,002 B. 1 Total from continuation schedules . ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address 773 City Year(s) Commission Paid: State Zip 2. 3. Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Cheryl L . Deaton 3,470 3,500 Street Address 6332 Pennsboro Drive City Mechanicsburg State PA Zip 17050 Relationship of Claimant to Decedent DAUGHTER 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Skarlatos & Zonarich 2007 1040 Return for decedent 550 2 Skarlatos & Zonarich 2008 1041 return for estate 225 TOTAL (Also enter on line 9, Recapitulation) $ 13 520 ~wasnc 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Barbara K. Rados Schedule H Part 1 (Page 2) Item No. Description 2 Gilligan's Bar & grill funeral luncheon 205-09-6337 Amount 773 Total (Carry forward to main schedule) 773 REV-1512 EX + (12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHRESIDENTDECEDENfRN MORTGAGE LIABILITIES, Hs LIENS ESTATE OF FILE NUMBER Barbara K Rados 21 08 0274 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1~ PBGC - Bethlehem Steel Corp, pension plan Refund pension payment not due decedent 88 2 PSERS Repayment of December pension benefit not due decedent 48 3 Omnicare Pharmacy Services Rx services 159 TOTAL (Also enter on line 10, Recapitulation) $ 295 3wasnH z.ooo (If more space is needed, insert additional sheets of the same size) RED/-1513 EX+ fg_00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT =STATE OF Barbara K. Rados FILE NUMBER 21 08 0274 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Cheryl L. Deaton 6332 Pennsboro Dr. Mechanicsburg, PA 17050 All of Residue: 71,417 (Daughter I 71,417 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) ^ nuls.xus ke:v loom LOCAL REGISTRAR'S CERTIFICATION OF DEATH 1JVARNING: It is illegal to duplicate this copy by photostat or photograph,~~ Fee for this certificate, ~6.0(l Certificati(m Number X1105-1u REV I V1pD8 I TVPEi PRWTW PERMANENT t BUCK WK 1 7 This is (o certify that the information here giver i~ correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vitai Records Office for permanent filing- a Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instruetlons and examples on reverse) ~,,,~ ~„ ~ ,,, ,,,ems, I. Narr a Dec dare (Frt, md7e, lan. wlrnl z. S•. 3. Sopr SecpnY NuniMr ~. ow d Dean IMOnm. aaY, Y•+0 BARBARA KOSTELAC RADOS Female 205 - 09 - 6337 c 'ZS moo s. Age Itau BumhY) larder I Yer Urqu i by 6. Dale a Bum IManm. h . ru) T Binlplape lC~ry era wu a br mae 1 !u. Pnp a Dom ICrai oro) 92 "°"" °'" "°"' '"""' Feb 15, 1915 Steelton, PA "~D~'' ° Mwc ca ~~ Yrs. ^ hgaferu ^ ER / Oulpahr ^ DDA y~y M.sirq Y1aro ^ Reuhrce ^IXrr - 9gdY: m. Cowtly d Deem &. CM• Boro. Twp. d Daam BA. FaaYly Name (If rid uraufon, qw slnrt and nunberl 9. Wss Deceauq d IisParea Orgl7 ®No ^ Vr 10. Rrs: Amulun fiDUl BWa, Whn, eb. Cumberland Hampden 'Iw?p. Loyalton of Creelcview I~PUerbR~ran,.b~ f~M 11. DeteauPS Useti Oa Kbd d aw ear moll d ~ da, oo rrol stw !sires 12. Wss Decehnl war m yr 13. Decehre'a Educaam (Speary orM nryru gfadl mmpetea) i!. Nuaal Stann: Mora, Newr Married. 1S. Swv'+nY Syare (y rh, gw nsaHn rH~lr) %rddarrr,/waeay Schoo~" Leacher Education U.S. ArmW Faar? ENmanury l~at:«mryco-lz) cotla0. (IJ ar s.) ts~t 6 ^Yr (gNa 1L Widowed 1e. oenaerda Maiinp Aaarere Isyeer. w! wan, ,nos. aP meal oeaWMa pA oa oearen 6332 Pennsboro Dr. 1TC.~Yr,oeworeureb Hampden Tp. "~"°' °a~ Mechanicsbur PA 17050 ~ ,>e. r•«~r ~~ Yf17}YPY~ aY'Mj 1tl ^ ~"a"a° "°'" , , CM r Boo Il. Femr'e Harr (Feri ntidse. WC ulfn) Michael Kost l 19. Alolnr's Nurr IFust. nWale, maWn sumrr( e ac Julia Galinez 20a hepmuyY Nang ITrw! PM) Cher l L Deaton 20y. idomiurYS Mae+W Asper ISbrl ply /ban, slw, aP sale) y . 6332 Pennsboro Dr. Mechanicsbur PA•17050 21a. Neuaa d orpoanbn i QCrenrion ^ Dorrion 21 e. Dw a Dapmiom (MpW, hy, yea0 21c. 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You Q _ ~ L ~s / / //L /!//C~/< < ' ~7/~r / DaPOUfarr Perm) No. W /y /y~ A1VC?CLV Jiiliq(LA1Va JOHN R. ZONARICH ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF BARBARA K. RADO5 I, BARBARA K. RADOS, of Susquehanna Township, Dauphin County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking and making void all Wills, Codicils, or writings in the nature thereof by me at any time heretofore made. ITEM I: I direct that the expenses of my last illness and funeral shall be paid from my Estate as an Administration expense. ITEM II: I give all of my property, real and personal, to my Husband, MARTIN M. RADOS, provided that if he dies before the Thirtieth (30) day following the day of my death, this gift shall lapse or be divested and I give such property to my issue, CHERYL LEE DEATON, living at the death of the survivor of my Husband and myself. If my daughter, Cheryl, does not survive me, then I give such property to my grandson, Aaron L. Deaton, and any other grandchildren surviving at my death, in equal shares, with the exception of adopted children. ITEM III: In the event there are minor children receiving assets under my Will, I appoint my sister, Margaret Goulet, of 611 Southgate Road, Aberdeen, Maryland, 21001, as Guardian of those assets with power (1) to hold for minors all property payable by law to a Guardian appointed by my Will; (2) after considering the minor's wishes, to retain tangible personal property or deliver it to the person standing in the place of a minor's parent, without bond; (3) to invest the balance of the minor's property and all accumulated income without restriction to investments authorized for fiduciaries; and (4) to use the income and the PACxE ONE OF FIVE PAGES F~ ~ ~m principal for the minor's maintenance and education, either directly or by payment to any person selected to disburse it whose receipt shall be a complete acquittance therefor. All unexpended principal and income shall be paid to the minor at age Twenty-one (21). My Guardian may, in discharge of all duty hereunder pay any minor's share deemed impractical of administration to the person standing in place of the minor's parent or deposit it in an interest-bearing account in the minor's name. --- ITEM IV : No interest of any beneficiary under this Will or any Codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. ITEM V ; In addition to owers iven them b _-' p g y law, my Executor and his successor and any Guardian acting hereunder shall have the following powers, applicable to all property held by them, effective without Court Order and until actual distribution. (A) To retain any property received by him (including the stock of any corporate fiduciary acting hereunder) ; (B) To sell real estate for any purpose, publicly or privately, for such prices and on such terms as he deems proper, without liability on the purchaser to see to application of the purchase moneys; s (C) To compromise controversies; and (D) To distribute in cash or kind or both at such valuations as he may fix. PAGE TWO OF FIVE PAGES ~~,, ITEM VI: All taxes, interest, and penalties thereon payable by reason of my death with respect to property comprising my gross taxable Estate, whether or not passing under this Will, shall be paid from the principal of my residuary Estate. ITEM VTI: I appoint my Husband, Martin M. Rados, Executor of this Will. If he does not act or continue to act, I appoint my daughter, Cheryl Lee Deaton, Executrix in his place with the same powers and duties. No fiduciary acting hereunder shall be required to post bond or enter security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will and Testament, consisting of five typewritten pages, including this attestation clause, to be executed, declared.. and published this ~~ day of ~ ,pti.,*~~~ 1981, at ~ l~/~/r_~~~ Pennsylvania. BARBARA K. RADOS Residing at ~ ~{~~ ~~ ~~~GCG~ a_~ / ~a ~5 Residing at ~~~ ~~~:ry(f,~ U Residing at ~~~ ~~,~~ /~_.__. h~ . , ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN ~ ss: I, BARBARA K. RADOS, testatrix, whose name i s si ned t or foregoing instrument, having been dul g o the attached y qualified according to law, do hereby acknowledge that I i ~ s gned and executed the instrument as m y Last Will; that I signed it willingly and that I signed it as my free and voluntar Y act for the purposes therein expressed. ~~_ /I ~~ BARBARA K. RADOS Sworn or affirm d ~ e to and acknowledged before me the testatrix, this `~ E\ by BARBARA K. RADOS, ~_ da f ~= y o * p ~ ~1~' ~ ~`~ ~.. 1981. ~ ~ '` ' ~ ~. `` NO • ARY PU BIC A~.` ,;, My Commission Expires: ~', AFFIDAVIT ~ ~+'~~ ~~ ~'~~ y_ , ~~;~~,~,~ ~~s~ie ' O~i f tF~s. ~ 1 L`S; F4 :3 COMMONWEALTH OF PE ~~~~ NNSYLVANIA COUNTY OF D ~ ss: H N ~ We ';~ , ~ ~a .c . L , 6 ---° - the witnesses who se names are signed to the attached or foregoing instrum t en , being duly qualified according to law do depose and say that. we wer e present and saw BARBARA K. RADOS i s gn and execute the II PAGE FOUR OF FIVE PAGES ~~ `''9 rr. 'i :' k ~, . '~ instrument as her Last Will; that she signed willingly and th her free and at she executed it as voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as wi to the best of our tnesses, and that knowledge the testatrix was at the time Twenty-one (21) or more years of age, of sound mind and under no...~~„-, ,,~___~ Sworn or affirmed to and acknowled ged before me by ~~ . day of ~~~-~ the witnesses th ~~` 1981. ~_ ~ _ -, NO RY PUB ~ c~L- C My Commission xpire : . ~.. -. 1tr ,~,u,~ .~~a<,~ PAGE FIVE OF FIVE PAGES ~'Ballk 499 Mitchell Koad, Millsboro, DE 19966 Mail Code DE-MB-12 Cheryl L Deaton Estate of: Barbara K Rados 6332 Pennsboro Drive Mechancisburg, Pennsylvania 17050-2322 Re: Estate of• Barbara K Rados Account Number: 70161283 Date of Death: December 25 2007 February 4, 2008 Dear Sir or Madam: Per your inquiry dated January 24, 2008, please be advised at the time of death, the balance on the above referenced account was: 1 • Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Account 70161283 Cheryl L Deaton Barbara K Rados * 08/28/ 64 $10, 872.65 $ 0.02 _. $10, 872.67 _ _ * For further accouat information, regarding ownershi funds, etc., please contact the Hampden Office at # (717) 252293. and/or reimbursement of M & T Bank DOD Unit /Records Management February 1, 2008 Account # 0205XXXXXX CHERYL L. DEATON 6332 PENNSBORO DR MECHANICSBURG, PA 17050-2322 Dear MS. DEATON: The following is the status of BARBARA K. RADOS's account with PSECU as of the date of death. Joint Owner's Name CHERYL L. DEATON -SINCE 11.22.1989 -JOINT TENANT W/ROS Date of Death 12.25.07 Date of Birth 05.15.1915 Share Description Open date S O1 Regular Shares 11 22 1989 Balance Accrued Dividend S 04 MoneyHandler . . 11 22 1989 $ 381.85 $ 0.31 S 07 Money Market . . 01.23 2002 1.07 0.00 . 157,910.93 433.63 Loan Description Open Date L 01 PSL Loan 01 22 1990 Balance Accrued Interest L 09 VISA . . 01.22.1990 $ 0.00 $ 0.00 0.00 0.00 The dividend earned from January 1 , 2007 tlu-ough the date of d th boxes for our members. ea was $6,967.36. W e do not have safe deposit If you have any questions, please ca11234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, Meaci Fairfa Member Servi e Representative Finance Support Unit Main Address: 1 Credit Union Place, HarrisburrePA S~IV 0 29 0tpt71Emp4 4845 Credit Union ~ - Mailing Address P.O. Box 67013, Harrisburg, PA 17106-7013 717.777.2100 TDD 800.237.7328 This credit union is federally insured by fhe National Credit Union Administration. E ual O ( ) 800.472.1967 (TDD) 4 pporfunity Lender www.psecu.com COMMONWEALTH OF PENNSYLVANIA ----= STATE EMPLOYEES' RETIREMENT SYSTEM ~' HARRISBURG REGIONAL COUNSELING CENTER 1 30 NORTH THIRD STREET, ROOM 319 HARRISBURG, PA ] 7101 TELEPHONE: (717) 783-9065 FAX: (717) 783-9599 TOLLFREE: 1-800-633-5461 www.sers.state.pa.us February 8, 2008 Estate of Barbara Rados C/O Cheryl Deaton 6332 Pennsboro Drive Mechanicsburg PA 17050-2322 Dear Ms. Deaton: SE RS Invoice # 18766 RE: Barbara Rados SS#: 205-09-6337 We have recently been informed of the death of Barbara Rados, a retired member of this System. We wish to extend our condolences to you at this time. Since Ms. Rados died 12/25107 and the December check was not returned to our office, this account has been overpaid in the amount of $48.44 for the period from 12!26/07 - 12f30l07. It will therefore be necessary for our office to be reimbursed for $48.44 to liquidate this overpayment. The reimbursement should be made payable to The State Employees' Retirement System, and mailed with the enclosed copy of this letter to the address shown above. Upon receipt of the reimbursement, this account will be closed. There are no further benefits to be paid from this System. Should you have any questions concerning this matter, please do not hesitate to contact me at the above address or by telephone at (717) 783-9065 or 1-800-633-5461. Thank you for your cooperation .~ ~~~ ~~~ ~-- ) Sincerely, ~f1 ~~~~ Linda Dolan, Administrative Assistant Harrisburg Regional Counseling Center Enclosure COMMONWEALTH OF PENNSYLVANIA PUBLIC SCIIOOL EMPLOYEES' RETIREMENT SYSTEM Mailing Address PO Box 125 Harrisburg, PA 17108-0125 Toll-Free - 1-888-773-7748 (1-888-PSERS4U) Local-717-787-8540 Web Address: www.psers.state.pa.us Building Location 5 North 5th Street Harrisburg, PA February 5, 2008 CHERYL L DEATON 6332 PENNSBORO DR MECHANICSBURG PA 17050-2322 RE: Barbara K. Rados S.S.# XXX-X.X.-5337 Dear Ms. Deaton: Thank you for your correspondence. A prorated payment of $771.82 for the period of December 1, through December 25, 2007, was due Barbara K. Rados, and is now payable to you, as the designated beneficiary. An additional amount of $100.00 is also due you. This payment is for the premium assistance that was scheduled to be paid to Barbara K. Rados for the month in which death occurred. The payment dated January 31, 2008 for $799.56 will be electronically transferred to M & T Bank, account #70161283. Since the. prorated payment due you is $871.82, and the net payment of $799.56 was electronically transferred, we will forward a check for $72.26. Enclosed is PSERS Health Options Program information sheet which applies to any surviving spouse or dependent(s) of the deceased member. A 1099-R will be sent which will report the deceased member's income. This form will be necessary for the preparation of the final income tax return. 1099-R's are generated and issued at the end of the calendar year. There will be no further benefits payable from this account. Please include the decedent's name and social security number with all correspondence. L ~1 ~- o Creekvi An Emeritus Arsiste~ Living a~ Special Care Community .iatruary i ~, 2UOa To Whomever It May Concern, Barbara Rados resided in our facility from October 2007, until her death in December. Please see attached copy of her Resident History showing all financial transactions during her stay. She paid pro-rated amounts of $261.00 and $2025.00 as well as a one time Choice Option Fee of $2500.00 upon admission. She paid November's total of $2525.00, and the same amount in December. She has a refund of $433.00 being processed as reimbursement for the last days in December that had been paid for, but fell after the family cleared and released her room. Sincerely, L.LIL~,L~?/~ZQ. L~~.C~ Corinne Welsh Business Office Director 1100 Grandon Way .Mechanicsburg, PA 17050 rxorrE 717.730.4033 . F.sx 717.730.4036 . www.emeritus.com ~,/~iedeman FUN Dennis 1. Wiedeman, f.D.-Supervisor James W. Tayan, F.D. WilNam A. Sibert, F.D. Lisa M. Wiedeman-Krosnar, F.D. January 11, 2008 Mrs. Cheryl L. Deaton 6332 Pennsboro Drive Mechanicsburg, PA 17050 ERAL HOME STATEMENT O F A C C O U N T 357 South Second Street Steelton. PA. 17113 Phone: 717.939.2344 Fax: 717.939.1999 email: wiedemanfh@comcast.net www.wiedemanfuneralhome.com The Funeral Service of: Mrs. Barbara Rados f;. Ci~~;i2GE F~vR SERVICES ~EI.I:CTEI3: 1. PROFESSIONAL SERVICES $ 2990.00 2. FACILITIES/SERVICESlEQUIPMENT:$ -0- 3. AUTOMOTIVE EQUIPMENT: $ -0- (A) TOTAL OF PROFESSIONAL SERVICES, $ 2980,00 FACILITIES AND AUTOMOTIVE B. CHARGE FOR MERCHANDISE SELECTED: Casket ............................... $ -0- (Description) OuterReceptacie••••••••••••••••••••••$ -0- (Description) Outer burial container••••••••••.•••••••. $ -0- (Description) Acknowledgement Cards ............... $ -0- Register Book(s) ....................... $ -0- Memory Folders ....................... $ _0_ Prayer Cards .... ..................... $ -0- Temporary grave marker ................ $ -0- Burial Clothing ....................... . $ -0- Other Clothing ......................... $ _0_ Custom Grapi~~ic Design a~ rnntiny ........ $ _p_ Flowers Vase of Flowers,±Tax• • • , • • . , • • . $ 106.00 lyreath +Tax $ 132.50 $ -0- Cremation UrnSolid Gast bronze Ufa........ $ 795.00 Interior & Exterior Crucifixes ............. $ _p_ Refrigeration .......................... $ 90.00 (B) TOTAL MERCHANDISE SELECTED $ 1123.50 y C SPEC'tA! CHaRGFS• Forwarding of remains to $ -0- (Funeral Home) Receiving of remains from $ -0- (Funeral Home) Immediate Burial $ _0_ Direct Cremation $ _p_ $ -o- SUB-TOTAL OF SPECIAL CHARGES ...... .... C $ D. CASH ADVANCES: - Opening Grave ................... .' $ -0- Cemetery Equipment .............. :. $ _p_ Newspaper Notices -Local ......... . $ 367.53 Newspaper Notices -Out-of-town .... $ _p_ Telephone & Telegrams ........... .. $ _p_ Airfare ......................... . $ -0- Clergy Honorarium ............... • . $ 100.00 Pallbearers ..................... .. $ -0- Certified Copies of Death Certificate .. . $ 96.00 Crematory Charges ................ . $ 225.00 Organist ........................ . g 100.00 Coic.s:. ........................ ..$ 75 30 Other Coroner Cremation Authorization $ 25.00 Other $ _0_ Other $ _0_ -0- SUB-TOTAL OF CASH ADVANCES • . • .. , , • D $ 98$•53 TOTAL OF ALL SELECTIONS ................ . $ 5102.03 LESS PAYMENTS.RECEIVEII ................. $ 0.00 BALANCE DUE ............................. $ 5102.03 SUMMARY OF CHARGES: A. Professional Services, Facilities and Equipment and Automotive Equipment ....................... $ 2990.00 B. Merchandise ..................... $ 1123.50 C. Special Charges..,......•........... $ -0- D. Cash Advances......, .. • ........ $ 988.53 Family Owned and Operated....We Care GILLIGAN'S BAR & GRILL - EISENH OWER Address (000)000-0000 Date: 12%29/2007 Time: 1:26;47 PM Status: Approved Card Type; Visa Card Number: XXXXXXXXXXXX1961 Expiratiorr Date; 10/31;2010 Card Oarner: DEATON/ CHERYL L Swipe/Manual: Swipe Server ID: 40 Server Name; Itaren Check Number: 293515 Table Number': 14 Dining Area: Dining Room Number Of Covers; 1 _ Guest #: 1 AMOUNT 660.23 GRATUITY 112,81 TIP _ TOTAL ~~~ ' ~~ • Approval: 013292 I AGREE TO COMPLY WITH THE CARDHOLDER AGREEMENT X CUB TOMER .CORD'--_ _- i ~~~~1~ OMNICARE PHARMACY SERVICES OF EASTERN PA ~~~ ALLENTOWN, PAI18 O6 AD, 1ST FLOOR /„` ~J' Yr ~ ~ RETURN S ERVICE REQUESTED 3oso5-ua4s otot PHONE: 888-565-6708 I~~~III~~~Iil~~~~l~l~ll~~~~~l~l~~ll,~~I~I~~I,i~~ll~~~l~l~~ll~l BARBARA RADAS C!0 CHERYL DEATON 6332 PENNSBORO DR MECHANICSBURG, PA 17050-2322 KEEP TOP PORTION FOR YOUR RECORDS -RETURN BOTTOM STUB WITH PAYMENT STATEMENT OF ACCOUNT PAGE: 1 of 1 ACCOUNT NO: 1039.237 INVOICE NO: PN242207 Dx No: INVOICE DATE: FACILITY: PATIENT NO: PATIENT NAME: AMOUNT DUE: TAX: OPEDX 12!31 J07 1039 LOYALTON OF CREEKVIEW 237 RADAS, BARBARA 158.55 o.oo DUE DATE: 01/30/2008 AMOUNT DUE: 15 8 . 5 5 30905-U846`T9POAKDBM002736 29POAVKGC:1.1 I NNNI N ~ N~ ~I~ INI IINI NNN NI IIIN IIN NN alli NN NI RADAS, BARBARA 1039 LOYALTON OF CREEKVIEW ,. 1039.237 12/31 /07 DATE RX NO. TRANS DESCRIPTION PHYSICIAN NDC N0. QUANT AMOUNT TYPE 12f18f07 4735 LOCK PAYMENT -THANK YOU - Lockbox 20071218081507 0003 -187.10 11f20f07 R8267658 CHARGE LOPERAMIDE HCL 2MG CAPSULE SCHREIBER 00378-2100-05 30 20.94 RX 11f27f07 R8199114 CHARGE DIGITEK 0.125MG TABLET SCHREIBER 62794-0145-10 30 7.92 RX 11f27f07 R8199113 •CHARGE METOPROLOL TARTRATE 100MG TABLET SCHREIBER 57664-0167-18 60 39.97 RX 11/30/07 R8282921 CHARGE KLOR-CON M20 ER 20MEQ TABLET SCHREIBER 00245-0058-15 60 28.81 RX 12fO6f07 R8241555 CHARGE MIRTA2APINE (SUB FOR REMERON)'7.5MG TABLET SCHREIBER 57664-0510-83 30 64. b4 RX 12f10f07 R8251760 CHARGE FUROSEMIDE 20MG TABLET SCHREIBER 00172-2908-80 60 10.62 RX 12f27/07 R8282921 RETURN KLOR-CON M20 ER 20MEQ TABLET SCHREIBER 00245-0058-15 -30 -4.41 RX 12f27f07 R8199113 RETURN METOPROLOL TARTRATE 100MG TABLET '` SCHREIBER 57664-0167-18 -30 -9.99 RX Messages For Billing Inquiries please call 1-888-565-6708 Monday through FINANCE CHARGES are calculated at a MONTHLY PERIODIC RATE OF Friday B:OOam to 4:30pm Thank You 1.50°~ (ANNUAL RATE OF 18.00°h~) based upon an unpaid balance outstanding 30 days or more. Y IttV 1VW tlHLHIVIt LF1HKbtJ r11VNIVLC I.rINKbt ~UINL I.rINKbtJ YN TPICIVIJ & LKtV11J HI'IVUIVf VUt 187.10 158.55 0.00 345.65 -187.10 158.55 ~~~~~~~~~ ~ ~~~~ I~ ATTORNEYS AT LAW SKARLATOS & ZONARICH BUILDING 17 SOUTH SECOND STREET, 6'" FLOOR HARRISBURG, PENNSYLVANIA 1 7 1 01-2039 (717)233-1000 TELEFAX (717)233-6740 W W W.SKAR LATOSZO NAR ICH.COM -,~ i-~ ""_) May 19, 2008 ~ `~ -- ~ _- ' J_ - ` i ~`.) 1 Cumberland County Register of Wills -? c~ One Courthouse Square _ ~ _~ - -~ Carlisle PA 17013 -'~ `' - ` = - c~ ~,_I RE: Barbara K. Rados, Deceased 1' c~ No. 21-08-0274 Gentlemen; Enclosed please find two copies of the PA Inheritance Tax Return for the above- mentioned decedent. Please file these returns and return one date-stamped signature page to me in the self-addressed, stamped envelope enclosed. A filing fee of $20.00 and a payment of the balance of tax due in the amount of $214.00 is also enclosed Please do not hesitate to call me if you have any questions. Sincerely; Sharon M. Garcia Estate Administrator Enclosures Cc: Cheryl L. Deaton A MEMBER OF LAW PACT'^' - AN INTERNATIONAL ASSOCIATION OF INDEPENDENT BUSINESS LAW FIRMS