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HomeMy WebLinkAbout06-12-0815056041147 REV-1500 Ex (os-05) OFFICIAL USE ONLY PA Department of Revenue county code veer File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 1712s-0601 RESIDENT DECEDENT 21 0 8 0 0 8 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 135 50 3308 11 06 2007 07 19 1969 Decedent's Last Name Suffix Decedent's First Name MI ANDERSON II JAMES J (N Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Return ^ 4. Limited Estate ^ ^ g. Decedent Died Testate ^ (Attach Copy of Ywl) MI THIS RETURN MUST BE FILED IN DUPLJCATE WITH THE REGISTER OF WILLS 2. Supplemental Return ^ 3. Remainder Return (date of death priorfA 12-13-82) 4a. Future Interest compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-1282) 7_ Decedent Maintained a Irving Tnut (Attach Capy of Trust) Q 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. Spousal Povenv Credd (dace ~ death 11. Election to tax under Sec. 9113(A) between 121- 1 and i-1-g5) ^ (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES D. BOGAR 717 737 8761 Finn Name (If Applicable) BOGAR & HIPP LAW OFFICES First line of address ONE WEST MAIN STREET Second Ilne of address City or Post Office State ZIP Code SHIREMANSTOWN PA 17011 REGISTER OF WILLS U9C~NLY C? ' ~ .-~ ~: _'~TI t"J '' F . --. c') -t1 ~ v t" ~_ 7 c •~ :, i _ry [j ~' ~` ~! .r `r'rr ~~ C~~ --r 1 Correspondents e-mail address: Under penalties of perjury, I deGare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, con-ect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS JoAnne L Anderson 4908 Shasta Way, Mechanicsburg, PA 17050 SIGNATURE OF~REpARER 0TH REPRESENTATNE James D. Boger ADDRESS ~ One West Main Stree , hiremanstown, PA 17011 Side 1 15056041147 15056041147 J J REV-1500 EX oeceaeni•s Name: J a m e s J A n d e rs o n RECAPITULATION 15056042148 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) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ 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/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. 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. 16. Amount of Line 14 taxable at lineal rate X .045 0 , 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 135 50 3308 29,014.61 31.61 29,046.22 9,836.65 49,446.72 59,283.37 -30,237.15 -30,237.15 0.00 0.00 0.00 0.00 0.00 Side 2 15056042148 15056D42148 J REV-1500 EX Page 3 Decedent's Complete Address: Fite Number 21-08-0089 DECEDENT'S NAME James J Anderson 11 STREET ADDRESS 5169 E. Trindie Road, Lot #21 CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19} (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 3. Total Credits (A + B + C) Interest/Penalty if applicable (2) 0.00 p. Interest E. Penalty Total Interest/Penalty (D + E} (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (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 the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5B) ~ . 0 0 Make Check Payable t~o: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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 fife 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? ...................................................................................................................... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .. ~3`w !t, i ;;c r r .:~' %~. L.:z ~.:~ex.~us ."'- .... 4,, , ~,. ~: a s, ~"~ ,,. :-. 9.-: 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)J. 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 (O) percent (72 P.S. §9116 (a) {1.1) (ii)J. 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 j72 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) j72 P.S. §9116 (a) (1)J. 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)J. 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. Yes No ^ x ^ x ^ x ^ x ^ a Rev-1508 EX+ (6.88) COWM1AONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Anderson, James J II 21-08-0089 Include the proceeds of Idigatbn and the date the proceeds were received by the estate. All properly JoinOy~owned with the right of survivorship must be dtsdosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Comcast -Refund 21.55 2 Commonwealth of Pennsylvania - 2007 Personal Income Tax Refund 1.00 3 Davis Country Living - Final paycheck 376.91 4 Heritage Medical Group -Refund 20.00 5 Kingsbury Associates -Return of deposit 100.00 6 Merrill Lynch/Pierce, Fenner ~ Smith, Inc. -Retirement Account No. 5HP 21442 - 638.14 date of death balance per attached statement 7 Safe Auto -Refund of unearned insurance premium 891.00 8 U. S. Treasury - 2007 Personal Income Tax Refund 3,918.00 9 Verizon Wireless -Refund 48.01 10 2006 Saturn Vue -VIN #SGZCZ63436S838877 -per attached appraisal 11.000.00 11 2006 Toyota Corolla -VIN #2T1 BR32E16C677856 -per attached appraisal 10.000.00 12 Mobile Home -VIN #CJ9636A; Sold at private sale 2,000.00 TOTAL (Also enter on Line 5, Recapitulation) I 29,014.61 (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) Merrill Lynch Statement of Pierce, Fenner & Smith Inc.. Retirement Account Member, Securities Investor Protection Corporation (SIPC) ACCOUNT # F/A# PAGE # 5HP 21442 1010 1 STATEMENT PERIOD 09/29/07 TO 12/31/07 CONTACT THE FINANCIAL ACCOUNT ADVISORY CENTER AT TYPE 1-888-ML-INVEST SEP PLAN OFFICE SERVING YOUR ACCOUNT: PO BOX 1528 PENNINGTON NJ 08534-1528 ST350R02 07365 519789 0000723 MLPF& 5 CUST FPO KERRYS LAWN & GARDEN INC SEP FBO JAMES ANDERSON =-- 5169 E TRINDLE RD LOT 21 MECHANICSBURG PA 17050-3658 ***** ACCOUNT SUMMARY **~*** PRICED PORTFOLIO DIVIDEND/INTEREST AS OF 12/31/07. 589.76 THI5 STATEMENT........ $$1.30CR AS OF 09/28/07. 638.46 THIS YEAR ........... $7.11CR 1 ***** CONTRIBUTION INFORMATION ***** TAX YEAR 2006 TAX YEAR 2007 EMPLOYER CONTRIBUTIONS $341.2 $.00 ***** DISTRIBUTION INFORMATION ***** TAX YEAR 2006 TAX YEAR 2007 $.00 ~ $.00 ***** MONEY ACCOUNT QUARTERLY DIVIDEND/INTEREST RECAP ***** CURRENT MONTH'S MONEY ACCOUNT OCTOBER NOVEMBER DECEMBER YIELD aJ, ML BANK USA RASP $.61 $.36 $.33 .69 ***** DAILY ACCOUNT ACTIVITY ***** DATE TRANSACTION DESCRIPTION PRICE AMOUNT 09 29 OPENING BALANCE $.32CR 12 05 Received 50 ML BANK USA RASP 12 OS Redeemed 50 ML BANK USA RASP $50.000R 12 05 Journal Entry ANNUAL ACCOUNT FEE $50.00 010107-123107 $ 50.00 12 31 CLOSING BALANCE $.32CR ***** CURRENT PORTFOLIO **+-** MONEY ACCOUNT OPENING BALANCE CLOSING BALANCE DIVIDENDS/INTEREST AS OF 09/29 AS OF 12/31 THIS STMT. YEAR TO DATE ML BANK USA RASP $638.14 $589.44 $1.30 $7.11 FOR PURPOSES OF CALCULATING REQUIRED MINIMUM DISTRIBUTIONS OR COMPLETING IRS FORM 8606, YOU ARE REQUIRED TO USE THE VALUE OF YOUR ACCOUNT AS OF 12/31/07. THIS VALUE SHOULD INCLUDE YOUR PRICED PORTFOLIO TOTAL AND THE VALUE OF CERTAIN LIMITED PARTNERSHIPS AND OTHER DIRECT INVESTMENTS AS WELL AS ANY SECURITIES THAT WE ARE UNABLE TO PRICE - MARKED "UNAVAILABLE". THE "YEAR-END PLAN VALUE" SHOWN CONSISTS OF YOUR PRICED PORTFOLIO TOTAL PLUS THE ESTIMATED VALUE OF LIMITED PARTNERSHIPS OR OTHER DIREC INVESTMENTS REPORTED ON YOUR YEAR-END STATEMENT. YEAR-END PLAN VALUE AS OF 12/31/07: $589.76 -aooooiaa5 DECEMBER, 2007 Please advise your Fnancial Advisor immediately of any discrepancies on your statement or 'rf ycu ^ contemplate changing your address. When making inquiries, please, mention your account number and Merrill Lynch address all correspondence to the oKce servicing your account. Please retain this statement for your tax records. See reverse side for explanation of key terms. CODE 5029R (R10-0~ Merrill Lynch Statement of Pierce, Fenner & Smith Inc, Retirement Account Member, Securities Investor Protection Corporation (SIPC) MLPF& S COST FPO .~ KERRYS LAWN & GARDEN INC SEP FOR IRA, IRRA, SEP/IRA, SIMPLE/IRA, ROTH IRA AND COVERDELL ESA ACCOUNTS, THE YEAR-END PLAN VALUE REPRESENTS THE VALUATION WE MUST FURNISH TO YOU AND THE INTERNAL REVENUE SERVICE AS PART OF THE IRS FORM 5498 REPORTING REQUIREMENTS. wt ACCOUNT // F/A# PAGE ~ 5HP 21442 1010 2 _nnnnntcsc FNf] OF CTATFMFNT QEr`FMR-,,R, GR,r~n07 Please advise your Flnencial Advisor immediately of any discrepancies on your statement or'd you comemplate changing your address. When making inquiries, phase, mention your account number and Merrill 6ynch address all correspondence to the office servicing your aaount Phase retain this statement for your tax records. See reverse side for explanatbn of key terms. CODE 5029R (R70-0~ ~4 tf: 4P ~~~~~-.?RI7R'YTITLEI >TE f CC F ~~E~I-~1 C ~;uE ,~,.- I ~ - ~~ ~ ,~ rt I,u~ "~.,.. i~ts ~ ~ PFD e~ ~~ . , ~... ILE^,~' oo~~ P r , DATE PA TITLED I DATE OF ISSUE I UNLADEN WEIGHT I ~GVWR 1 GGWR { TITLE BRANDB ~~ T• ~ a r ~L"~ C ~ = U 9 3•fi e J r e' .r N y} ,, of r• ~ ~~" ~~ -'~ All -0- y..:. ..,,• .. .. r '~~' TAM RIFlE {~ ~{}'~~ t~ {{ +~ }^ { i ~ - BRAND R CISCLOSUnE i.t~CJ~~~~~ ~ LJ1 JL ~~Jt/~~ ~' 'i"~~ `~~^~}~~,. ~~~ 4~IXEMPT OM OCOM STE~IEfI O _~ ~ ,~ n'~ ' ICL ;,~ rtt ~ VE y~~~~~1 ~ ,/ ~ _ ''. ~ ~ IMF F OFD ~ +~'~' +nr ' w ._ W..,. ~_ ~ ~~iz _~e...r a. ~hrr, ~ L So L,. d B VERHLLIC ~ - r ~, t ''{{ @t£ ~ [rte ~L. +~ 7~ P ISNJAS A POLICE VEHICLE L IV~R.j3~Vna~ ~H `~ f U ~'Ip6. ~" `"% F PE^. UCTEO- """~, ~ ~'- i~N~~ ~~ +r I '. ~~ T n€ca E ~FII€c~ '! ~ ~, ~ ip ~,IpreY "^ "' ~i ~ . Ejf ~-~ aF ~ €awr><~ i ~ >~ ~-,.. ~ ~Hllpl II ~ ~ ~ v F"~cio ~F V `i. ~~ ~~ EOM, uAV.av ~S`f ;, .~ ~ FI NF P CF ~ ~ IE ~ ~,.. __ ~14. .. _.. ~ i", t .r ^Ka .. *x~ q' ~~" ~ °Ir a ~««,a rb rwaae _r ~oated A"L.' ~ ~ ~ Venn ~IGec mist Iolwerd m« lltl FI EI E„sr~x~ '~ s Y :~; ~ acP w~~ ro~ a~ BY SECONDUEN RELEASED - . ~ AUTHORIZED REPRESENTATIVE DATE MAILING ADDRESS ~ ~ - BY ~~~~~~ AUTHORIZED REPRESENTATIVE . -. a r .. .: 1 certlfy_as M the data of Issue; the. ofAclal records of the PennaylvenlaDepeMlent $~~~,~~~ ~ ,~~.~~~ - of Transportstion'reilact. That the peiaDn(sl ror company named nereln is iha"Yewlut owiter~- - - ----_ otlhesaid~vahlda. - .•:. - _.. , __ . , -, , _ 3ecratar~ of Ttsasporfatlon SUBSCRIBED AND SWORN It a CO-pUTCheSef Othef than your spouse le IfBted and y0U Want.the title 10- r FOR e ~ H ' A 3 be listed as ' 'nt Tenants With R ht of S arship' On dea one ,_ rvivi HF~ O. nvi wIi ss e t Y ~ ~IC . ~;~ - ran s m, ( 0 on o ne x d a~d er Ito his~heP hel or~"sTa at +~ r ~ ' ~ ~ ~ ` " ; ,•. N1F 9 s MYIBTER C ATH ~.,, nr ++ ~~~ y ~ ~ 's - _ - w, .,. .. "', . D., - I OUEN ~H £14 ~ ~ ~ - '".:5:~~;.,xv~. ~: ` .,y ~::~ 1ST ENHOLD - - ..` --~ _. -w r . ~ -. :.~ ~ 7 ;; 9Tf1E~ 9'.d :' - I iCIT{ STATE ' -21P - ~1 1 ~ ~ / ~ FINANCIAL {NSTITUTION NUMBER V 1 W _ °r ~ ~k : 2ND LIEN DATE: IF NO LIEN CHECK N nis .,~aer F.a I,.xaw ~« c.~olKU. a TN. m m. wnm. a. n .e .awr ~~o~, :o~..~~„r,..,~o~,.~.,, ~.~,~1~,~.. .«;ew - 2N0 UENHOLDER . M >; , ..: ; .. ~~ ~ - - W :: ... .. - ~ ~ ' STREET ~ - N SIa NATI RE OF gPPLICMfr OR AUTHORIZED SIGNEN 'r-~ .: -.. _ ~- -:-..~: CITY ,_ STA ~ Llr~ sIONATUnE ov w-.+RRUC.wrrtm,E OG AUTlgglgD SIGNER FNANCIAL INSTITUTION NUMBER Rw-1610 EX+ 16-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONVVEALTN OF PENNSYLVANIA MIHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Anderson, James J it 21-08-0089 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 NUMBER I N INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Members 1st -Savings Account No. 53841-00; 31.61 31.61 date of death balance $31.53; accrued interest $.08. 2 Members 1st -Checking Account No. 53841-11; 1,426.95 50.000% 3.000.00 0.00 date of death balance $1,426.95; accrued interest $0.00. •AN EXCLUSION IN THE AMOUNT OF $3,000.00 IS MADE IN ACCORDANCE WITH THE PROVISIONS OF THE INHERITANCE AND ESTATE ACT, BEING 72 P.S. SECTION 9108(c) and 72 P.S. SECTION 9108(c)(3). TOTAL (Also enter on Line 7, Recapitulation) I 31.61 (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 G (Rev. 6-98) St MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established PERSONAL SERVICE LOAN ACCOUNT: Account Number Date Loan Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Payoff at Date of Death Principal Balance as of 2/21/08 Accrued Interest as of 2/21/08 Total Payoff as of 2/21/08 Daily Interest Accrual Next Due Date Name of Co-Borrower Collateral Estate of: JAMES J. ANDERSON, II Date of Death: November 6, 2007 Social Security Number: 135-50-3308 53841 -00 04/16/1979 $31.53 $.08 $31.61 JoAnne L. Anderson, added 04/16/1979 Roxanne L. Fuller, added 12/7/2006 53841 -11 08/26/1999 $1,426.95 $.00 $1,426.95 Roxanne L. Fuller 12R/2006 53841 -01 08/12/2003 $4, 940.22 $31.51 $4,971.72 $4,606.01 $11.10 $4,617.11 $1.3881 03/31/2008 None Signature/ Contractual Pledge of Shares ME ~RS 1ST FEI~RAL CREDIT UNION Denise A. Wolfe ~/ Insurance Services Supervisor February 21, 2008 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 ~vwwmemberslst.org REV-1761 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Anderson, James J II 21-08-0089 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 Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2, Attorney's Fees Bogar 8s Hipp Law Offices 3, Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) Claimant Street Address City State Zip _ Relationship of Claimant to Decedent 2,973.60 2,747.00 4. Probate Fees 80.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 4,036.05 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 9,836.65 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rw-1502 IX+ (B-95) SCHEDULE H-A FUNERAL EXPENSES continued cor~noNVUeuTrl of PENNSVI.vANu INHERRANCE TAX RETURN RESDENT DECEDENT ESTATE OF (FILE NUMBER Anderson, James J II 21-08-0089 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rsv-'1502 EX+ ls-se) cor~oNwen~TH of PENNSV~vANw INHERRANCE TAX RETURN RESDENr DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Anderson, James J II 21-08-0089 ITEM NUMBER DESCRIPTION AMOUNT 1 1-800-GOT~IUNK -Trash hauling 464.00 2 Cumberland Law Journal -legal advertising 75.00 3 Frieda Pratt -Clean out of mobile home 300.00 4 Heritage Medical Group -Medical Bill 44.14 5 Journal Publications -legal advertising 103.00 6 Kingsbury Associates -Monthly Lot Rent 270.00 7 KingsburyAssociates -Monthly Lot Rent 270.00 8 KingsburyAssociates -Monthly Lot Rent 250.00 9 KingsburyAssociates -Monthly Lot Rent 260.00 10 Merrill Lynch/Pierce, Fenner Sz Smith, Inc. -Yearly service fee 50.00 11 PA American Water -Water bill 22.75 12 PA American Water -Water bill 13.48 13 PA American Water -Water bill 14.72 14 PA American Water -Water bill 14.04 15 PA American Water -Final water bill 13.36 16 PPL -Electric bill 173.00 17 PPL -Electric bill 172.88 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-67 (Rev. 6-98) Rsv-1502 EX+ (6.98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS coroanoNwEA~TH of PENNSn.vANw 6JHERRANCE TAX RETURN continued RESX)ENT DECEDENT ` ESTATE OF FILE NUMBER Anderson, James J II 21-08-0089 ITEM NUMBER DESCRIPTION AMOUNT 18 PPL -Electric bill 161.74 19 PPL -Electric bill 161.74 20 PPL -Final electric bill 273.15 21 Register of Wills -Filing fee for Pennsylvania Inheritance Tax Return 15.00 22 Safe Auto -Auto Insurance Premium 262.00 23 Safe Auto -Automobile Insurance Premium 260.00 24 Safe Auto -Automobile Insurance Premium 237.00 25 Verizon -Phone bill 155.05 Subtotal ~ 4,036.05 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule H-67 (Rev. 6-98) Rev-1b12 ©(+ (6~8) cotisnoNVUEA~TrI aF aENNSn_vANw INFiERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER Anderson, James J it 21-08-0089 Indude unrMmbursed medcal expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 American Car Care/GE Money Bank -Credit Card No. 6019-1800-67034724 733.32 2 Capital One Credit Card -Account No. 4791-2420-8450-1991 1.227.87 3 Capital One Credit Card -Account No. 4115-0719-0646-6607 340.18 4 Capital One Credit Card -Account No. 4121-7416-1395-1982 583.90 5 Capitol One Credit Card -Account No. 4388-6418-3237-9692 447.70 6 Lowes -Account No. 819-2339-178714-2 144.93 7 Lowes -Account No. 4305-9823-0668-1349 977.39 8 M8~T Credit Services, LLC Automobile Loan for 2006 Saturn Vue -Outstanding 22.386.09 obligation per M8T Credit Services, LLC Notice of Repossession and Sale of Merchandise dated February 8, 2008 (copy attached) 9 Members 1st -Personal Service Loan No. 53841-01; principal balance as of date of 4.971.11 death $4,940.22; accrued interest $31.51 10 Mystic Stamp Company 32.35 11 Wells Fargo Automobile Loan for 2006 Toyota Corolla -Outstanding obligation per 17.601.88 Creditor's Claim filed at Cumberland County Register of Wills Office (copy attached) TOTAL (Also enter on Line 10, Recapitulation) I 49,446.72 (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) ~ M&T Credit Services, LLC A Subsidiary of M&T Bank 1100 Wehrle Drive, 2nd Floor, Williamsville, NY 14221 ,o~~nee 800 724 2525 NOTICE OF REPOSSESSION AND SALE OF MERCHANDISE February 8, 2008 Estate of James Anderson 4908 Shasta Mechanicsburg, PA 17030 Name: James Anderson Storage Location: Chappell Waynesboro, PA _ Collateral: 2006 Saturn Vue Vin: SGZCZ634365838877 Account: 11079425100001 Dear Estate of James Anderson: This letter provides the following information: I. NOTICE OF PRIVATE SALE: We notify you that you are in default under the contract listed above. Because of your default, M&T Credit Services, LLC has repossessed the collateral and will sell it by private sale. You have 15 days from the date listed above to redeem this collateral. II. NOTICE OF RIGHT TO REDEEM: At any time before the sale, you have the right to redeem (get back) the collateral by paying certified funds to M&T Credit Services, LLC at the address listed below, for the full amount of all past due installment payments under your contract (including all late charges) and the costs of repossession, preparing, holding, and advertising the collateral for sale. That amount, as of the date of this letter, is: PAST DUE PAYMENTS ON YOUR ACCOUNT: $22,202.83 ACCRUED LATE CHARGES: $8.26 REPOSSESSION FEES: $175.00 TOTAL AMOUNT DUE: $22,386.09 This amount is subject to change as additional payments become due, or costs continue to accrue.. Any additional amount must be paid in order to redeem the collateral. Please note that peisoual property found in-the collateral vtill be-held and may be reclaimed for thirty (30) days. Thereafter, the property can be disposed using the same method as the collateral. Once the sale of the collateral has taken place, M&T Credit Services, LLC will deduct from the sales proceeds all amounts owed to it. If there is still money owing after this is done, you are responsible to pay M&T Credit Services, LLC this deficiency. If there is money left over, M&T Credit Services, LLC will pay you this surplus. If you have filed for relief under the United States Bankruptcy Code, please understand that this notice is given to you as a requirement of State Law and is not an attempt to collect a debt, including any deficiency after the sale. Further, if you are no longer the titled owner of the collateral, this Notice is only for your information, as the rights referred to above may only be held by the new owner. Your right to redeem continues until the collateral is sold. If you wish to redeem the collateral, or if you have any questions regarding this notice, please contact us immediately at the number, below or in writing to the address listed below. Sincerely ' Mr. Fox~~/" Repossession Specialist, 1-800-639-8784 St MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix 53841 -00 Date Account Established 04/16/1979 Principal Balance at Date of Death $31.53 Accrued Interest to Date of Death $.08 Total Principal and Accrued Interest $31.61 Name of Joint Owner JoAnne L. Anderson, added 04/16/1979 Roxanne L. Fuller, added 12/7/2006 CHECKING ACCOUNT: Account Number/Suffix 53841 -11 Date Account Established 08/26/1999 Principal Balance at Date of Death $1,426.95 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $1,426.95 Name of Joint Owner Roxanne L. Fuller Date Joint Ownership Established 12/7/2006 PERSONAL SERVICE LOAN ACCOUNT: Account Number 53841 -01 Date Loan Established 08/12/2003 Principal Balance at Date of Death $4,940.22 Accrued Interest to Date of Death $31.51 Total Payoff at Date of Death $4,971.72 Principal Balance as of 2/21/08 $4,606.01 Accrued Interest as of 2/21/08 $11.10 Total Payoff as of 2121108 $4,617.11 Daily Interest Accrual $1.3881 Next Due Date 03/31/2008 Name of Co-Borrower None Collateral Signature/ Contractual Pledge of Shares MEMBERS 1ST FEDERAL CREDIT UNION Denise A. Wolfe ~/ Insurance Services Supervisor February 21, 2008 Estate of: JAMES J. ANDERSON, II Date of Death: November 6, 2007 Social Security Number: 135-50-3308 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org IN TKE Superror• Court of the State of Pennsylvania INAND FOR THE COUNTY OF Cunrber/and _ )n the Matter of the Estate of James Anderson CASE N0.2008-00089 CREDITOR S CL,4IM WELLS FARGO BANK CREDITOR Wells Fargo & Co AMOUNT $17,601.88 STATE OF Arizona ,~ COUNTY OF Maricopa ~ The undersigned Kindred Arvizu being a Creditor of the deceased for (or the authorized Agent far the firm of Wells Fargo & Co. who is a Creditor of the deceased) hereby files the Claim against the Estate ofthe-above named Deceased, together with the necessary voucher for approval, to wit: _ DATE OF CLAIM January 29.2005 NATURE OF CLAIM Secured Auto Installment Loan AMOUNT 17 601.88 We elect to have this claim approved as a tnatured secured claim to be pain in due coure of adtninistration. Vin # 2T1BR32E16C677856 06, TOYOTA. COROLLA That said debt is justly and truly owed and all payments, set-off and/or ctrdits have been applied thereto. January 29, 2005 j,, \ . L ~ ct _ _ ~ WELLS FARGO BANK > ! ~ ,E 1 `~ ~ ~ ~ Creditor .. _ ~ ;.d; Authorized Agent SUBSCRIBED AND SWORN TO before me this r~ ~ day of ~}L~ . (~,e~~ f ~ ~ ; ~ MY COMMISSION EXPIRE ~t_ ~ ~~- , ~~x ;L,~ ~ ~~/~~~ t ,/ u to Public The within claim was presented to the underigned Peronal Representative this day of of and is (check one) Approved Not approved for the sum of $ Peronal Representative The court having considered the within claim and the same is (check one) Approved Not approved For the sum of S RE1/-1613 ex+ (g.pp) SCHEDULE J COMM NANIA ~ H N R A BENEFICIARIES ANCE AX RETUR N E RESIDENT DECEDENT ESTATE OF FILE NUMBER Anderson, James J II 21-08-00 89 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Noe u>ae T : I • TAXABLE DISTRIBUTIONS [include outright spousal and transfers distributions , under Sec. 9116(a)(1.2)] James J Anderson III Son Rest, Residue RD 1, Box 1238 and Remainder Hop Bottom, PA 18824 Total Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r 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 I 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)