HomeMy WebLinkAbout05-23-08 (2)15056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Poaox2aosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 07 0808
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
174-20-3391 08/26/2007 05/22/1928
Decedent's Last Name Suffix Decedent's First Names MI
Keane Richard ! H
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Keane Freda
Spouse's Social Security Number
177-24-5790 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
+:fi':, 1. Original Retum ~ 2. Supplemental Retum era ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~,~";~? 4a. Future Interest Compromise (date of ~'..~s 5. Federal Estate Tax Return Required
death after 12-12-82)
'~:; 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0_. 8. Total Number of Safe Deposit Boxes
(Attach Copy of Wilt) (Attach Copy of Trust)
::.~ 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death ~.e.;~ 11. Election 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 CONFIDENTU\L TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytircie Telephone Number
__ ___ _ .
Charles L. Sieck, Esquire ; (561) 395-555 ~'
Firm Name (If Applicable) - - ----~ -- - -
REGISTEROFiil~ILLS USE~NLY ;
--~} -~:
~._
First line of address _ __ ~, ~~ ,
~' GJ -
Suite 203 -~ --~
-, •
__
Second line of address -
1700 South Dixie Highway
City or Post Office State ZIP Code DATE FILED L'T,,,,
_... __ _
Boca Raton
__ . ' FL 33432
Correspondent's a-mail address: CSI@Ck@COmpUSBfVe.COm
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, amd 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.
SIG A RE OF PERSON RESP IBLE R FILING RETURN ~jDAT~
-~ - _.. - 4~cr~usl-G--~
Bar a A~ieck, 3817 Pamay Dri e, Mechanicsburg, PA 17050-7675
NATURE OF E A N PRESENTATIVE p Z/
A
Charles L. Sieck, Esquire, Suite 203, 1700 South Dixie Highway, Boca Raton, FL 3ci432
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Richard H Keane ' 174-20-3391
RECAPITULATION
_.
1. Real estate (Schedule A) . ............................................ L 0.00
2. Stocks and Bonds (Schedule B) ....................................... 2.
_ __ 108,794.42
._ _ _ _
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00
4. Mort a es 8 Notes Receivable Schedule D
9 9 ( ) ............................. 4. 0.00
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 249,922.34
6. Jointly Owned Property (Schedu-e F) C:J Separate Billing Requested ....... 6. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c~ Separate Billing Requested........ 7. 83,840.00
8. Total Gross Assets (total Lines 1-7) .................................... 6. ', 442,556.76
9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 19,213.71
10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ............. ... 10. 1,503.11
11. Total Deductions (total Lines 9 ~ 10) ................................ ... 11. 20,716.82
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ' 421,839.94
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
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. '
_~~ -______. 421,839.94 !:
^~ ~~~
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
..
transfers under Sec. 9116 __
(a)(1.2) x .0 00 36,424.64 15. ' 0.00
16. Amount of Line 14 taxable
at lineal rate X .045 385,415.30 16, ' 17,343.69
17. Amount of Line 14 taxable
0
00
:
0
00
.
at sibling rate X .12
_..._ .._. .._._ _ ,,,...,. _... _....__ __.._~..
___ .._ . _ 17.
.r __~.,,..._ .
_.._..._. _,_. _..~.. ____ ._...~ _ _ ___
18. ,
_
Amount of Line 14 taxable
0
00 .
0
00
.
at collateral rate X .15 18 .
19. TAX DUE ...................................................... ...19. 17,343.69
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
15056052059
REV-1500 EX Page 3
1'lnrnrlnn4~c rAm~'1t0+G Aflf'IPACC'
_ File_N.umbef .. ___ __ .__....3
21 ~,, 0 10808 I
DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER
H Keane ,174-20-3391 _
Richard
_
STREET ADDRESS
108 November Drive, Apt. 3 __ _ _ __
---
CITY ---
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit __-
B. Prior Payments
C. Discount
16, 300.
857.87
(1)
Total Credits (A + B + t;) (2)
3. InteresUPenalty if applicable
D. Interest _
E. Penalty
Total InteresUPenalty (D + E: )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval 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.
(3)
(4)
(5)
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
17,343.69
17,157.87
0.00
185.82
0.00
185.82
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 :.......................................................................................... ^ ~
b. retain the right to designate who shall use the property Vansferred or its income : ............................................ ^ 0
c. retain a reversionary interest; or .......................................................................................................................... ^
^
d. receive the promise for life of either payments, benefds or care? ......................................................................
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideratbn? .............................................................................................................. ^
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 designationl ........................................................................................................................ ^x ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE I, AND FILE IT AS PART OF THE RETURN.
_., ~_ -
_ k,
For dates of death an or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of Iransfers 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 lax 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 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)(1j].
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.
REV•1503 EX+ (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Richard H. Keane 21-07-0808
Alt property jointlyowned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Richard H. Keane
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-07-0808
InGude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Sovereign Bank, certificate of deposit, no. 0355002544 40,135.91
2 Sovereign Bank, checking account, no. 2291036696 4,104.40
3 M&T Bank, money market account, no. 98206346 187, 599.91
4 M&T Bank, select account, no. 50359053 286.74
5 PA Central Federal Credit Union, no. 90063-015 1,428.53
6 Comcast -cable TV refund 20.85
7 Property insurance refund 23.00
8 Federal income tax refund 513.00
9 2005 Chevrolet Impala (Per Keliy Blue Book) 13,810.00
10 Clothing, furniture, furnishings and other tangible personal property 2,000.00
TOTAL (Also enter on line 5, Recapitulation) s I 249,922.34
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Richard H. Keane 21-07-0808
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBS DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A CDPY OF THE OEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET 'k OF DECD'S
INTEREST EXCLUSION
IF APPLICABLE TAXABLE
VALUE
t• PPL Savings Plan, Account No. OP007452 36,424.64 100 0.00 36,424.64
Beneficiary: Freda Keane
2 M&T Bank, IRA, Account No, 35004200714168 47,415.36 100 0.00 47,415.36
Beneficiary: Barbara A. Sieck
TOTAL (Also enter on line 7 Recapitulation) 5 I 83,840.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NIJMBER
Richard H. Keane 21-07-0808
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Gilbert L. Dailey Funeral Home Inc. 9,512.41
2 Catholic Cemeteries -headstone 150.00
3 Four Points Sheraton -get together after funeral 1,576.02
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City ,State
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation)
Claimant
Street Address
City .State
Relationship or Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Register ofWills -fees
a. Patriot News & Cumberland Law Journal -advertising Letters Testamentary
s. Erie Insurance -premium on bond re lost stock certificate
Zip
Zip
6,000.00
270.00
460.00
410.28
835.00
TOTAL (Also enter on line E, Recapitulation) + S 19,213.71
(If more space is needed, inseA additional sheets of the same size)
REV-1512 EX~ (12-03)
SCHEDULE 1
DEBTS OF DECEDENT,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Richard H. Keane 21-07-0808
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~• Camp Hill Plaza Apartments -rent 777.37
2 West Shore EMS -transportation services 225.95
3 Orthopedic Institute of PA -medical 5.67
4 Pathology Associates of PA -medical 27.63
5 Verizon -telephone 22.84
6 Jackson Sieglbaum -medical 46.12
7 Quantum Imaging -medical 10.89
8 Central PA MRI -medical 114.44
9 PPL -electricity 12.40
10 Quantum Imaging -radiology 47.89
11 OSP Physical Therapy - physical therapy 77.91
12 PA Dept. of Revenue -final income tax 134.00
TOTAL (Also enter on line 10, Recapitulation) S I 1,503.11
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9.00) ~
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Richard H. Keane 21-07-0808
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
1 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Freda Keane, 560 Poplar Church Road, Camp Hill, PA 17011 Wife 36,424.64
2 Richard P. Keane, 55 Sandhurst Lane, Elkton, MD 21921 Son 128,471.77
3 Barbara A. Sieck, 3817 Pamay Drive, Mechanicsburg, PA 17050 Daughter 128,471.76
Steven M. Keane, 37 Brookside Avenue, Hershey, PA 17033 Son 128,471.77
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
11 NON-TAXABLE DISTRIBUTIONS: ~~~
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING f<dADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 0.00
(II more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
RICHARD H. KEANE
I, RICHARD H. KEANE, a resident of Dauphin County,
Pennsylvania, being of sound and disposing mind and memory, do
make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils by me at any time
previously made.
ITEM I: All inheritance, estate and
similar taxes becoming due by reason of my death. ("Death
Taxes"}, whether such Death Taxes shall be payable by my estate
or by any recipient of any property, shall be paid by my
Executor first out of the property passing under ITEM IV of this
Will as an expense and cost of administration of my estate. My
Executor shall have no duty or obligation to obtain
reimbursement for any Death Taxes paid by my Executor, even
though paid with respect to proceeds of insurance or other
property not passing under this Will.
ITEM II: I hereby exercise all powers of
appointment which I may have at the time of my death in favor of
my Executor, and all property subject to all such powers of
appointment shall be included in my estate and ~>e governed by
the provisions of this Wi11.
ITEM III: I give and bequeath all of my
household furniture and furnishings, automobiles>, books,
pictures, jewelry, china, crystal, appliances, ~;ilverware,
wearing apparel and all other like articles of Household or
personal use or adornment to my living children in as nearly
equal shares as they shall select under the supervision of my
Executor. Any conflicting choices shall be resolved by drawing
lots. Any such articles not so selected or whi~~h cannot be
fairly divided or distributed in kind in the opinion of my
Executor shall be sold or otherwise disposed of and the proceeds
thereof shall pass as a part of my residuary estate.
ITEM IV: I give, devise and bequeath all of
the rest, residue and remainder of my property, real, personal
and mixed, wherever situate, not disposed of in the preceding
portions of this Will, to my living issue, per :stirpes.
ITEM V: No interest in in~~ome or principal
of my estate shall be subject to attachment, le~~y or seizure by
any creditor, spouse, assignee or trustee or receiver in
bankruptcy of any beneficiary of my estate prior to the
beneficiary's actual receipt thereof. My Execui~or shall pay
over the net income and the principal to the beneficiaries
herein designated, as their interests may appear, without regard
to any attempted anticipation (except as may be specifically
provided herein), pledging or assignment by any beneficiary of
my estate and without regard to any claim therei:o or attempted
levy, attachment, seizure or other process against said
beneficiary.
ITEM VI: Any person who shall have died at
the same time as I or under such circumstances ghat it is
difficult or impossible to determine who shall Have died first
shall be deemed to have predeceased me.
ITEM VII: In the settlement of my estate, my
Executor shall possess, in addition to those powers conferred by
law, the following powers to be exercised, without authority
from any court, for the best interests of the beneficiaries:
(a) To retain any investments I may Piave at my death
so long as my Executor may deem it advisab7_e to my estate
or trust so to do.
Page 2 of 5 pages
(b} To vary investments, when deemed desirable by my
Executor, and to invest in such bonds, stocks, notes, real
estate mortgages or other securities or in such other real
or personal property as my Executor shall deem wise,
without being restricted to so called "legal investments."
(c) In order to effect a division of the principal of
my estate or for any other purpose, including any final
distribution of my estate, my Executor is authorized to
make said divisions or distributions of thE: personalty and
realty partly or wholly in kind. If such division or
distribution is made in kind, said assets :hall be divided
or distributed at their respective values on the date or
dates of their division or distribution. ]:n making any
division or distribution in kind, my Execut:or shall divide
or distribute said assets in a manner which will fairly
allocate any unrealized appreciation or de~>reciation among
the beneficiaries.
(d) To sell either at public or private sale and upon
such terms and conditions as my Executor may deem
advantageous to my estate, any or all real or personal
property or interest therein owned by my e:~tate severally
or in conjunction with other persons, and t:o consummate
said sale or sales by sufficient deeds or other instruments
to the purchaser or purchasers, conveying a fee simple
title, free and clear of all trust and witYiout obligation
or liability of the purchaser or purchaser: to see to the
application of the purchase money or to ma~:e inquiry into
the validity of said sale or sales; also, t:o make, execute,
acknowledge and deliver any and all deeds, assignments,
options or other writings which may be necessary or
desirable in carrying out any of the power~> conferred upon
my Executor in this paragraph or elsewhere in this Will.
(e) To mortgage or pledge real or personal property
owned by my estate and to make leases of real or personal
property for any term.
(f) To borrow money from any party, including my
Executor, to pay indebtedness of mine or of` my estate,
expenses of administration, Death Taxes, other taxes or for
any other purpose.
(g) To pay all costs, Death Taxes, other taxes,
legally enforceable debts, expenses and ch~~rges in
connection with the administration of my e~>tate, the
expenses of my last illness and my funeral expenses.
Page 3 of 5 pages
(h) To vote any shares of stock which form a part of
my estate and to otherwise exercise all the powers incident
to the ownership of such stock and to hold and actively
manage and operate any unincorporated business, including
any sole proprietorship, joint venture and partnership,
with all the rights and powers of any owner thereof.
(i) In the discretion of my Executor,. to unite with
other owners of similar property in carrying out any plans
for the reorganization of any corporation or company whose
securities form a part of my estate.
(j) To assign to and hold in my estate an undivided
portion of any asset.
(k) To hold investments in the name of a nominee.
(1) To abandon, compromise, settle, arbitrate, pay or
otherwise deal with claims in favor of or against my
estate.
(m) To select, employ and compensate any person, firm
or corporation engaged in rendering investment counsel
advice to advise my Executor in making investments,
managing securities or making decisions concerning the
purchase, retention, sale or other disposition of any part
of my estate; and to select, employ and compensate any
attorney, accountant, broker or other specialist or firm
thereof to render services to my Executor with respect to
my estate.
ITEM VIII: In the settlement of my estate My
Executor shall not be personally liable for any loss to my
estate or to any beneficiary of my estate resulting from any
decision or election made by my Executor in goocl faith; nor, as
a result of any such decision or election, shal]_ any
compensating adjustments be made.
ITEM IX: I hereby nominate my daughter,
BARBARA A. SIECK, to be the Executor of my estate. If for any
reason she should fail or cease to act, I nominate my son,
RICHARD P. KEANE, to be my Executor. If for an~~ reason he
should fail or cease to act, I nominate my son, STEVEN M. KEANE,
Page 4 of 5 pages
to be my Executor. All references in this Will. to my "Executor"
shall also refer to any Executrix and to any successor Executor.
ITEM X: Any Executor shall qualify and
serve without the duty or obligation of filing any bond or other
security. Any Executor shall not be surcharged or otherwise
held liable under any prudent investor statute or otherwise
except for gross negligence or intentional wrongdoing.
ITEM XI: In the event that for any reason
on the date of any distribution of income or principal from my
estate there is not a beneficiary thereof, then such
distribution shall be made to such persons, and in such
proportions, as would be entitled to my estate ]zad I then died
intestate, a resident of the Commonwealth of Pennsylvania.
IN WITNESS WHEREOF, I have hereunto sE:t my hand and
seal and do hereby declare this instrument to bes my Last Will
and Testament, thi s ~ day of ~ ~~~'~ , 2005.
,~- - j ~-~'~-~. c SEAL
Richard H. Keane
We, the undersigned, do hereby certify that the
foregoing instrument was signed, sealed, published and declared
by RICHARD H. KEANE, the Testator, to be his Last Will and
Testament, in our presence.
~ --.
~ ~ . Residing at : ~ ~- ~ ~~ ~ ~ `'~ ~~ ~'~
Residing at • ~4. /~~ ~~
'~ ~
Page 5 of 5 pages
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
We, the Testator and the Witnesses, respectively,
whose names are signed to the foregoing instrument, having been
sworn, do hereby declare to the undersigned officer that the
Testator, in the presence of the Witnesses, signed said
instrument as his Last Will and Testament, that he signed
voluntarily, that each of the Witnesses, in the presence of the
Testator and of each other, signed said Will as a Witness and
that to the best of the knowledge of each Witness, the Testator
was at the time eighteen (18) or more years of age, of sound
mind and under no constraint or undue influence.
Richard H . Keane ~-
Subscribed and sworn to before me by RICHARD H. KEANE, the
Testator, and by ~ ~~~~ j-}ahtlLy! and CCIA~~~E S ~ • SiEc.,~
the Witnesses, on this ~ day of 2005.
COMMONWEALTH OF PENN8Y~V N ry Pu 1 c
Jeeetai ~ gw N e : ~ S).(`.~ L• I bS(/Y~ .
~ ~ (type, stamp or print)
~~~ ~b~,~~ My Commission Expires: ~~~ It~~~
IiA~bsr, P~nnsylvanl~ ~ o f NohrNs
(SEAL)
Continued on next page.
As to RICHARD H. KEANE:
Personally known or produced identification ~ (check one)
If produced identification, type of identification produced:
~~ ~~ti v~-~rS L~(:~.~-~~.
As t o S ~,i]~(,(.i1 ~ ~ ~Y1 ~I O Yl
Personally known ~ or produced identification (check one)
If produced identification, type of identification produced:
Personally known or produced identification ~ (check one)
If produced identification, type of identification produced:
~~.- ~ ~ y~r~ ~ c~e~~
s
INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY OF CUMBERLAND
I. Barbara A. Sieck.
COUNTY, PENNSYLVANIA
File Number 00808 of 2007
Personal Representative(s) of the Estate of Richard H. Keane
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 said Decedent, that the valual:ion 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 memora~tdum at the end of this inventory.
I verify that the statements made in this Inven- ~ ~
tory are true and correct. I understand that false state- X
ments herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name) Charles L. Sieck
(Supreme Court LD. No.) 22114
(Address) Suite 203, 1700 South Dixie Highway, Boca Raton, FL 33432
(Telephone) (561) 395-5595
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
8/26/2007 Apt. 3, 108 November Drive, Camp Hill, PA 17011 174-20-3391
FIGURES MUST BE TOTALED
See Attachment
358,716.76
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v1
(Attach additional sheets as needed)
'TOTAL: I 358,716.76
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the per;~onal 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. § 330/(b))
Form RW-09 rev. 10.13.06
Estate of Richard H. Keane
Attachment to Inventory
Real Estate
None 0.00
Total Real Estate 0.00
Stocks
2,243.184 common shares, PP&L Corporation 108,'194.42
Total Stocks 108.794.42
Cash
Sovereign Bank, certificate of deposit, no. 0355002544 40,'135.91
Sovereign Bank, checking account, no. 2291036696 4,104.40
M&T Bank, money market account, no. 98206346 187,599.91
M&T Bank, select account, no. 50359053 ;?86.74
PA Central Federal Credit Union, no. 90063-015 1,428.53
Total Cash 233.555.49
Tangible Personal Propert
2005 Chevrolet Impala (Per Kelly Blue Book) 13,810.00
Clothing, furniture, furnishings and other tangible
personal property 2,000.00
Total Tangible Personal Property 15,810.00
Miscellaneous
Various refunds :156.85
Total Miscellaneous 556.85
TOTAL INVENTORY
358,716.76
Memorandum: The decedent did not own any real estate outside of lrhe Commonwealth
of Pennsylvania.