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HomeMy WebLinkAbout07-10-081505604114? REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 21 0 7 113 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 264 88 3196 11 29 2007 12 22 1946 Decedent's Last Name Suffix Decedent's First Name MI PALENZ DONNA L (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 L~ 2. Supplemental Return I ~ 3. Remainder Return (date of death prior to 12-13-82) I ~i 4. Limited Estate ] 4a. Future Interest Compromise ` ~ 5. Federal Estate Tax Return Required ~--- (date of death after 12-12-82) -~ g Decedent Died Testate !~ ~ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes ^ I (Attach Copy of Will) (Attach Copy of Trust) ~~ 9. Liti ation Proceeds Received J 10. Spousal Poverty Credit (date of deam ~ 11, Election to tax under Sec. 9113(A) ~~ g L between 12-31-91 and t-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 EDMUND G. MYERS (717) 761 4540 Firm Name (If Applicable) JOHNSON DUFFIE First line of address 301 MARKET STREET Second line of address PO BOX 109 City or Post Office LEMOYNE Correspondent's a-mail address: State ZIP Code PA 17043 i` REGISTER', WILLS ~ ONLY: . --~-, c: r~ I- _l ~~ ~ ._ -~~ Q ~ - _: C~ -~ ~; ~ ~ ,; c .1:7 N - , DATE FILES 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. ADDRESS Charles R Palenz 49 Gale Road, Camp Hill, PA 17011 SIGNATU F PREPARE T R THAN REPRESENTATIVE DAT EDMUND G. MYERS ,~ ~ ~~ ~U ADDRESS V ' 301 MARKET STREET, LEMOYNE, PA 17043 Side 1 15056041147 15056041147 e ~ 15056042148 REV-1500 EX Decedent's Social Security Number Decedenc~s name: D o n n a L P a l e n z 2 6 4 8 8 319 6 RECAPITULATION 143,900.00 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. 3 9 , 5 4 8 . 5 7 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............ . 6. 8 5 2 0 4 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............ . 7. 3 , 7 7 1 9 5 8. Total Gross Assets (total Lines 1-7) .................................................................. ..... 8. 1 8 8, 0 7 2$ 6 9. ............................ Funeral Expenses & Administrative Costs (Schedule H)......... .... 9. 1 4 , 3 6 0 . 9 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ .... 10. 1 2 7 , 313.16 11. Total Deductions (total Lines 9 & 10) ................................................................. .....11. 1 4 1 , 6 7 4.11 12• Net Value of Estate (Line 8 minus Line 11) ........................................................ .....12. 4 6 , 3 9 8 . 4 5 13. Charitable and Governmental BequestslSec 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. 4 6 , 3 9 8 . 4 5 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 3 2, 719.91 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate x .045 12 , 8 2 6. 5 0 16. 5 7 7.19 17. Amount of Line 14 taxable at sibling rate X .12 8 5 2. 0 4 17. 1 0 2 2 4 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 1 g. 0 . 0 0 19. Tax Due .............................................................................................................. .....19. 6 7 9. 4 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 15056042148 15056042148 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-07-1134 DECEDENT'S NAME Donna L Palenz STREET ADDRESS 49 Gale Road CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 679.43 2. Credits/Payments A. Spousal Poverty Credit g. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 0.0 0 3. Interest/Penalty if applicable 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) 679.43 A, Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 6 7 9.43 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 a. retain the use or income of the property transferred :............................................................................... ..~ ^x b. retain the right to designate who shall use the property transferred or its income :................................... . ~ x^ c. retain a reversionary interest; or .............................................................................................................. .^ d. receive the promise for life of either payments, benefits or care? ............................................................ ..~ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................... ..~ ^x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ ^x 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. 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 exemog 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;l (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ,Rev-1502 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Palenz, Donna L 21-07-1134 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointlyowned with right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Palenz, Donna L 21-07-1134 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Comerce Bank -Certificate of Deposit Account 4,000.00 2 Country Wide Home Loans 1,246.03 3 HDH Health Plan Premium Refund 179.68 4 Homeowners Insurance Refund 405.00 5 Members First Checking Account 2,630.04 6 Real Estate -Property owned at 271 North 72nd Street, Steelton, Swatara Township, 681.05 Dauphin County, PA -Reimbursement of Taxes 7 Wachovia Checking Account 606.77 8 1997 Toyota Avalon 4,000.00 9 Heirloom Ring 1,800.00 10 Jewelry 24,000.00 TOTAL (Also enter on Line 5, Recapitulation) I 39,548.57 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6-98) . SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Palenz, Donna L 21-07-1134 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. James E. Collins 737 Hayden Hill Road Brother Hinesburg, VT 05461 B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A Wachovia Savings Account 1,704.08 50.000% 852.04 TOTAL (Also enter on Line 6, Recapitulation) I 852.04 (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) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Palenz, Donna L 21-07-1134 This schedule must be completed and filed rf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER D I TI N P TY 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 1 401 K Retirement Account -Beneficiary: Charles 3,256.18 3,256.18 Palenz 2 ESOP Retirement Account -Beneficiary: Charles 515.77 515.77 Palenz TOTAL (Also enter on Line 7, Recapitulation) I 3,771.95 (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) REV-1151 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Palenz, Donna L 21-07-1134 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 1,248.00 2. Attorney's Fees JOHNSON DUFFIE 8,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Charles Palenz Street Address 49 Gale Road City Camp Hill State PA Zip 17011 Relationship of Claimant to Decedent SpOUSe 4. Probate Fees 298.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 814.95 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 14,360.95 Cogvright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+~6-98) . SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Palenz, Donna L 21-07-1134 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 E~(+(6-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Palenz, Donna L 21-07-1134 ITEM NUMBER DESCRIPTION AMOUNT 1 Appraisal for Decedent's Jewelry 515.00 2 Cumberland County Register of Wills Office -Additional Short Certificates 8.00 3 Cumberland County Register of Wills Office -Filing Fees for Disclaimers 10.00 4 Members First Federal Credit Union -Cost of Estate Checks 10.99 5 The Cumberland Law Journal -Notice of Estate Administration 75.00 6 The Patriot News -Notice of Estate Administration 168.96 7 Vital Records -Death Certificate 27.00 Subtotal 814.95 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-95) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Palenz, Donna L 21-07-1134 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1997 Toyota Avalon -Lien against Automobile 9,800.00 2 Country Wide Home Loans 450.00 3 Ewing Gutter Repair to Townhouse 85.00 4 Hampden Ambulance 380.00 5 Lance Hildew DO 42.62 6 McCusick Health Care 40.00 7 Moffett Cardiology Diagnostics 40.30 8 Pa Department of Transportation 5.00 9 Pinnacle Hospital 884.48 10 PPS~L - Townshouse 97.21 11 Pulmonary CC 52.50 12 Quantum Imaging 34.56 13 Real Estate -Property owned at 271 North 72nd Street, Steelton, Swatara Township, 12,627.56 Dauphin County, PA -Settlement Costs 14 Real Estate -Property owned at 271 North 72nd Street, Steelton, Swatara Township, 101,313.20 Dauphin County, PA -Mortgage Payoff to Country Wide Home Loans 15 Riverside Anesthesia 115.50 16 SafeCo Auto Insurance 383.60 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 127,313.16 (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) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Palenz, Donna L 21-07-1134 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1519 EX+(9-00) r " - SCHEDULE J ANIA COM R ~ RT ~ BENEFICIARIES N E ANCE AXRETU N RESIDENT DECEDENT ESTATE OF FILE NUMBER Palenz, Donna L 21-07-1134 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Tnastee(s) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2}] 1 Holly A Anderson 110 Pavers Lane Ephrata, PA 17522 2 Charles R Palenz 49 Gale Road Camp Hill, PA 17011 II. Daughter Spouse * In accordance with 20 Pa.C.S.A. X3541, the foregoing are the only specific bequests which could be funded with the net value of the Es ate. Subject to tax (P.2, Line 14)* $25,000,00. I$ 12,826.50 (Art. III(A)) 'I~ngible Pers. $ 3 2 , 719.91 Party (Azt. ) E9~.' and 401K (Sd~a]_e G) I I Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet 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 SHEE 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98} ESTATE OF DONNA L. PALENZ SCHEDULE OF EXHIBITS EXHIBIT A Last Will & Testament for Donna L. Palenz signed and dated November 21, 2007 EXHIBIT B Settlement Sheet from the Sale of Decedent's Property located at 271 North 72"d Street, Steelton, Swatarcz Township, PA 338088 Last Will and Testament OF DONNA L. PALENZ `~~ I, DONNA L. P A>i FNZ, of Camp Hill, Cumberland County; Pennsylvania; being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS it I direct the payment of my just and legal debts as promptly and conveniently as may be practical. ARTICLE II TANGIBLE PERSONAL PROPERTY I give and bequeath my motor vehicles(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my husband, CHARLES R. PALENZ, provided he survives me. 1 ARTICLE III SPECIFIC BEQUESTS I make the following specific bequests: A. I give and bequeath the sum of TWENTY-FIVE THOUSAND ($25,000.00) DOLLARS unto my daughter, HOLLY A. ANDERSON, 110 Pavers Lane, Ephrata, PA 17522, or her then-living issue, per stirpes, should she predecease me; B. I give and bequeath the sum of FIFTEEN THOUSAND ($15,000.00) DOLLARS unto my grandson, LIAM ANDERSON, 110 Pavers Lane, Ephrata, PA 17522, provided he survives me; C. I give and bequeath the sum of FIV>H: THOUSAND ($5,000.00) DOLLARS unto my brother, JAMES E. COLLINS, 737 Hayden Hill Road West, Hinesburg, VT 05461, provided he survives me; D. I give and bequeath the sum of FIV>H; THOUSAND ($5,000.00) DOLLARS unto my brother, MARK COLLINS, 4 Hudson Road, Gloucester, MA 01930, provided he survives me; E. I give and bequeath the sum of FIVE; THOUSAND ($5,000.00) DOLLARS unto my sister, LINDA J. DEAN, 23 School Street #4, Gloucester, MA 01930, provided she survives me; F. I give and bequeath the sum of FIVF: THOUSAND ($5,000.00) DOLLARS unto my brother, TIMOTHY B. COLLINS, 3333 Breamar Drive, Santa Barbara, CA 93109, provided he survives me; 2 ,. - _ ~__ .. z - -- - - -- - - -. _ _ - . ;- ,_ _ _:: , ,_ , G. I give and bequeath the sum of TEN THOUSAND ($10,000.00) DOLLARS unto THE FIRST CHURCH OF CHRIST, SCIENTIST, incorporated under the laws of the Commonwealth of Pennsylvania, 2147 North Front Street, Harrisburg, PA 17110, for its unrestricted uses and purposes; H. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS unto THE FIRST CHURCH OF CHRIST, SCIENTIST, incorporated under the laws of the State of Florida, 649 Central Avenue, Naples, FL 34102, for its unrestricted uses and purposes; and I. I give and bequeath the sum of TEN THOUSAND ($10,000.00) DOLLARS unto DAYSTAR, INC. (a Christian Science facility), 3800 S. Flamingo Road, Ft. Lauderdale (Davie), FL 33330. ARTICLE IV REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever situate, unto my husband, CHARLES R. PALENZ, provided he survives me. If my husband, CHARLES R. PALENZ, predeceases me, I give, devise and bequeath the same as follows: A. I give and bequeath the sum of TWENTY-FIVE THOUSAND ($25,000.00) DOLLARS unto my daughter, HOLLY A. ANDERSON, or her then- living issue, per stirpes, should she predecease me; B. I give and bequeath the sum of TEN THOUSAND ($10,000.00) DOLLARS unto my grandson, LIAM ANDERSON, provided he survives me; and 3 _i. _ ~-__. ,. ,._ _, _ - ., - - - _ _ - J _ ~ /: `"1 ~ ~~~1--~ 7 ' ! _ /-'.= ~ r _ y .'~ fit: ,_. a ~ C. I give, devise and bequeath the remainder unto THE MOTHER CHURCH, THE FIRST CHURCH OF CHRIST, SCIENTIST, 175 Huntington Avenue, Boston, MA 02115 for its unrestricted uses and purposes. ARTICLE V DISTRIBUTION TO BENEFICIARIES UNDER THE AGE OF 25 /INCAPACITATED PERSONS Whenever my Personal Representative is directed to distribute property to or for the benefit of any beneficiary who is under (a) twenty-five years of age, or (b) a legal disability or otherwise suffers from an illness or mental or physical disability that would make distribution directly to such beneficiary inappropriate (as determined in my Personal Representative's sole discretion exercised in good faith), my Personal Representative may distribute such property to the person who has custody of such beneficiary, may apply such property for the benefit of such beneficiary, may distribute such property to a custodian for such beneficiary, whether then serving or selected and appointed by my Personal Representative (including my Personal Representative), under any applicable Uniform Transfers to Minors Act - or Uniform Gifts to :Minors Act, or may distribute such property directly to such beneficiary without liability on the part of my Personal Representative to see to the application of such property. This provision shall not in any way operate to suspend such beneficiary's absolute ownership of such property or to prevent the absolute vesting thereof in such beneficiary. ARTICLE VI TAXES I direct that all estate, inheritance, transfer and other taxes of similar nature payable by reason of my death, together with any interest or penalties thereon, and imposed with respect to 4 . , ,. - --_ - - - T , _ _ _ ,,_ _- --- -- ~ - . - ;- '' M any property, whether or not disposed of by this Will, shall be paid out of the residue of my Estate. I further direct that any and all such taxes shall be paid from and be deducted from my residuary estate prior to the calculations of the shares of the residuary beneficiaries, so that each residuary beneficiary, charitable or not, shall bear a portion of the burden of such taxes. ARTICLE VII POWERS OF PERSONAL REPRESENTATIVE AND TRUSTEE My Personal Representative shall have the following powers in addition to those vested in them by law and by other provisions of my Will applicable to all property, whether principal or income, including property held for minors, exercisable without court approval and effective until actual distribution of all property: A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as they may determine. B. To retain any or all of the assets of my Estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. C. To invest in all forms of property without restriction to i.westmer~ts authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification or risk. D. To sell at public or private sale, to exchange, or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. 5 , . ~ 1 :- ~._ ' "' , -. E. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. F. To compromise any claim or controversy. G. To make such elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift, generation skipping or other tax refunds and the payment of such taxes as my Personal Representative shall deem appropriate, without obligation to adjust the distributive share of any person thereby affected. ARTICLE VIII PERSONAL REPRESENTATIVE I name, constitute and appoint my husband, CHARLES It. PALENZ, Executor of this, my Last Will and Testament. Should my husband, CHARLES R. PALENZ, fail to qualify or cease to so act, I name, constitute and appoint my daughter, HOLLY A. ANDERSON, alternate Executrix to complete the administration of my Estate, and if she should also fail to qualify or case to so act, I name, constitute and appoint my brother, JAMES E. COLLINS, alternate Executor to complete the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~ is ~ day of November, 2007. ---r=- (SEAL) DONNA L. PALENZ 6 -- - _ a Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~~=-- :316409v3 7 _. _. .:. _, _ _ J ~ ~-, - f ~ ,. _ s __ -~----.- i~ > ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA . ss. COUNTY OF CUMBERLAND .~ We, DONNA L. PALENZ, , ~~7%~~-'~ ~~. ~~/~1~L%~~` .~ and ~` ?>f1? ~ fc.f ~'> ~' ~fi ~At::~,k"3-S ,the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to +.he undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. DONNA L. PALENZ Wi ss / t ~~ ~~~ Witness ~` s _. - - - - - - ,. _.. ~,, ~ i Subscribed, sworn to and acknowledged before me by DONNA L. PALENZ, Testatrix, and ) ~ r~ ~,~ k~ A.' f 1'J t', - 5 K 5+" and t'. )S n7 ~' R-`.?~ L~' .~ ;~`i ~,~witnesses, r- this -~ %r~ day of November, 2007. ,'.~ ~-' ~ Notary Public ~~ Cc'~MM0~+9`.NEAL~FEPIiaSYLVANIA Nataria! ~~~ Fubfic Margaret E. RufF, Lemcysi$ 5~ro, t;iamt~efiand ~~1 Phy Comrq~issic~n E~i~s May ~, 1~,4ie~ of t~l~at~!'laz Member, ~'enn'aYivairl~a ,~a.~cn 9 - _ _ i ' °~ _ ~ j / r-E.~ _- 'L 'J~ - `!"",--` , J - ~r _ ~~ll _i 6a ,i''4 xi 4 ~ A. Settlement Statement U.S. Department of Housing and Urban Development OMB Approval No. 2502-0265 B. Type of Loan 1. ( ]FHA 2. [ ] FmHA 3. [ ]Conv. Unins. 6. File Number 7. Loan Number. 8. Mortgage Insurance Case Number: 4. [ ] VA 5. [ X ]Conv. Ins. ~ 400701909-SK 0207314592 C. NOTE'. This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the selllelnent agent are shown. Items marked "(p.o.c.)'" were paid outside of the closing: they are shown here for informational purposes and are not included in the totals. D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender JENNIFER L. COUP CHARLES R. PALENZ, EXECUTOR OF SUNTRUST MORTGAGE, INC. ESTATE OF DONNA L. PALENZ. A/K/A 2651 CARNEGIE ROAD, DONNA LOUISE PALENZ F!K/A DONNA YORK, PA 17402 PA L. BRECKENRIDGE 271 NORTH 72ND STREET HARRISBURG, PA 17111 G. Property Location ~~~ AIrI~TIJ 77 xlfl CTDCFT H. Settlement Agent &Fr:l IRFI1 I ANtI TRANSFERS - MFC:HANI(:SfSI1R(', HARRISBURG. PA 17111 place of Settlement I. Settlement Date 01/1412006 COUNTY: DAUPHIN 4099 DERRY STREET Disbursement Date 01!14/2008 PARCEL ID: 63-084-003 HARRISBURG, PA 17111 TOWNSHIP: SWATARA TOWNSHIP J. SUMMARY OF BORROWER'S TRANSACTIONS K, SUMMARY OF SELLER'S TRANSACTIONS 100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller 101. Contract Sales Price $143,900.00 401. Contract Sales Price $143,900.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower $7,459.21 403. Adjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller in Advance 113. City/Town Taxes 413. CityfTown Taxes 114. County Taxes 414. County Taxes 115. School Taxes 1,322.12/yr 1!14/2008 l0 7/1/2008 $610.49 415. School Taxes 1,322.12lyr 1/14/200810 7/1/2008 $610.49 118. Assessments 416. Assessments 119. HOA 30.00lmo 1/14/2008 to 2(1/2008 $17.42 419. HOA 30.OOlmo 1 /1 412 0 0 8 to 2!1!2008 $17.42 121. Sewer 62.00/qtr for 1/14/2008 to 4!1/2008 $53.14 421. Sewer 62.00/qtr for 1114/2008 to 4/1/2008 $53.14 120. Gross Amount Due From Borrower I $152,040.261420. Gross Amount Due To Seller I $144,561.05 inn A..,o~~or~ Paid Rv Or In Behalf Oi Borrower 500. Reductions In Amount Due To Seller 201. Deposit or Earnest Money $1,000.00 501. Excess Deposits 202. Principal Loan Amount from Suntrusl Mortgage, Inc. $136,705.00 502, Settlement Charges fo Seller $10,595.00 203. Existing Loan(s) Taken Subject [o SD3. Existing Loan(s) Taken Subject to 204. 504. Payoff First Mortgage to Countrywide Home Loans $101,313.20 Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210. 510. 211. 511. 212. 512. 213. Cily(fown Taxes 513. City/Town Taxes 214. County Taxes 916.601yr 1/1/2008 l0 1/14/2008 $32.56 514. County Taxes 916.60/yr 1/1/2008 10 1/14/2008 $32.56 218. Assessments 518. Assessments 219. 519. 221. Seller Paid Closing Costs $2,000.00 521. Seller Paid Closing Costs $2,000.00 220. Buyer's Total Credits $139,737.56 520. Seller's Total Charges ~ $113,940.76 300. Cash At Settlement FromlTo Borrower 600. Cash At Settlement To/From Seller 301. Gross Amount Due From Borrower (line 120) $152,040.26 601. Gross Amount Due To Seller (line 420) $144,581.05 302. Less Amounts Paid By/For Borrower (line 220) $139,737.56 602. Less Deductions In Amt. Due To Seiler (line 520) $113,940.76 303. Cash [ X ]From [ ] To Borrower I $12,302.701603. Cash [ X ] To [ ]From Seller I $30,640.29 400701909 - SK Page L. Settlement Statement 700. Total Sale Commission 141900.00 @ 6 % = 8514.00 Division of Commission (line 700) As Follows: Paid From Borrowers Paid From Seller's 701. $4282.00 to Coldwell Banker Homesale Services Group Funds Al Settlement Funds AI Settlement 702, $4232.00 fo ERA-NRT, Inc. 703. Commission paid at settlement $8,514.0( 708. Transaction Fee to Coldwell Banker Homesale Services Group $195.0( 709, Broker Admin Fee to ERA-NRT, Inc, $165.00 800, Items Payable In Connection With Loan 801. Loan OdginalionFee % to Suntrust Mortgage, Inc. $1,367.05 802. Loan Discount Fee % to Suntrust Mortgage, Inc. $683.53 803. Appraisal Fee from TY Eby R.E. Appraisals (POC 350.00) 804. Credit Report to Kroll Factual Data $8,49 805. Lender Inspection Fee 811. Processing Fee to Suntrust Mortgage, Inc. $175.00 813. Tax Service to Valulree Real Eslale Serv $78.00 816. Document Review to Suntrust Mortgage, lnc. $295.00 826. LOL Flood Cert fo First American Flood Svcs $8.00 900. Items Required By Lender To 8e Paid In Advance 901 . Interest from 01li4/08 to 02/01/08 @23.41 /day $421.38 902 . Mortgage Insurance Premium 903 . Hazard Ins. Premium to Mutual Beneft Group (POC 380,00) 904 . Flood Ins. Premium 1000. Reserves Deposited With Lender 1001. Hazard Ins. Reserve 3.0000 mo @ 31.661 mo to Suntrust Mortgage, Inc. $94.98 1002. Mortgage Ins. Reserve 1003. City Property Taxes 1004. County Property Taxes 12.0000 mo @ 76.38 ! mo to Suntrust Mortgage, Inc. $916.56 1005. School Taxes 8.0000 mo @ 110.171 mo to Suntrust Mortgage, Inc. $881.36 1010. Aggregate Accounting Adjustment from Suntrust Mortgage, Inc. -$527.02 1100. Title Charges 1101. Settlemenl/Closing Fee 1102. Abstract or Title Search 1103. Title examination 1104. Title Insurance Binder 1105. Document preparation to Homesale Sellement Services $115.00 1106. Notary fee to Shirley Keys, Notary Public $20.00 $10.00 1107. Attorney Fee 1108. Title Ins. Total to Secured Land Transfers -Mechanicsburg $970.88 1109. Lenders Coverage $136705.00 ($) 1110, Owner's Coverage $143900.00 ($970.88)RI 1111. Endorsements-i0 0/3 0 0/9 0 018 2D ($200.00) Io Secured Land Transfers -Mechanicsburg $200.00 1116. Insured Closing Protection Letter to Genstar Title Insurance Company $35.00 1119. Wire Transfer Fee to Secured Land Transfers -Mechanicsburg $35.00 $35.00 1127. Electronic Delivery & Handling Fee to Secured Land Transfers -Mechanicsburg $50.00 1138. Processingfiax Cert. to Secured Land Transfers -Mechanicsburg $25.00 1140. Overnight Mail to Secured Land Transfers -Mechanicsburg $25.00 1200. Government Recording And Transfer Charges 1201. Recording Fees for Deed 41.50; Recording Fees for Mortgage 75.50 $117.00 1202, CitylCounty Tax/Stamps 1439.00 $1,439.00 1203. State Deed Tax 1439.00 $1,439.0[ 1300. Additional Settlement Charges 1302. Pest inspection to A'ns Company, Inc. (POC-B) 1305. HOA Dues for Jan 08 to Capital Ridge Homeowners Association $30.0[ 1306. HOA Resale Cert to Property Management, lnc. $150.0( 1307. Sewer for 1l2l3 to Swalara Township Sewer Authority $62.0( 1308. Home Inspection to A'ns Company, Inc. (POC-B) 1309. Reimbursement for Tax Cert to Roseann Annis $20.0( 1400. Total Settlement Charges $7,459.21 $10,595.0( I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief it is true and accurate statement of al! receipts and disbursements made on my account or by me in [his t ansaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. r /// ~~~ BUY /t/ / ~' SELLERS hY~i A..1 r Eslale of I a/ o Louise Palenz t/k/a Donna L. Jennifer L. Coup ` ~~ ~ ~ Breckenr g a By: Charles R. Palenz, Executor The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction, I have caused or wi set Tunds to he disbursed in accordan a with this statement. Set eme gent Date / ~1 ~-1 Dv1a/zDOa / SECURED LAND TR7~ISFERS - ME ANICSBURG INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS couNTY of Cumberland } Charles R Palenz File Number 21-07-1134 Personal Representative(s) of the Estate of Donna L Palenz 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 Bald Decedent, that the valuation placed ~osite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedert-awned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the en ~t~is invent{~y. ~ ~• I verify that the statements made in this Inven- ~ ~ T' ~-~ ~ ~ tory are true and correct. I understand that false state- ~ ~_ -- .i ments herein are made subject to the penalties of Charles R Palenz G J ~~ a ~ _ 18 Pa.C.S. § 4904 relating to unsworn falsification to --~ _ `~ authorities. ~ , ~~ ~'~' ~ ~~ ---~ O W Attorney -- (Name) (Firm) (Address) (Telephone) EDMUND G. MYERS JOHNSON DUFFIE (Supreme Court I.D. No.) 20558 301 MARKET STREET, LEMOYNE, PA 17043 (717) 761-4540 DATE OF DEATH LAST RESIDENCE 49 Gale Road DECEDENT'S SOC. SEC. NO. 11/29/2007 Camp Hill, PA 17011 264-88-3196 FIGURES MUST BE TOTALED Personal Propert Cash ............................................................................................... Personal Property ......................................................................... Stocks/Listed ................................................................................. StockslClosely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property ......................................... Total Real Property ............................................ Total Personal and Real Property ......................... 9,748.57 29,800.00 39,548.57 143,900.00 183,448.57 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the pf~rsonal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b)) Form RW-09 Rev. io-~s-loos INVENTORY REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA couNTY of Cumberland } ss File Number 21-07-1134 DATE OF DEATH LAST RESIDENCE 49 Gale Road DECEDENT'S SOC. SEC. No. 11/29/2007 Camp Hill, PA 17011 264-88-3196 Cash Personal Property 1997 Toyota Avalon Heirloom Ring Jewelry Real Estate Total Real Estate 4,000.00 1,246.03 179.68 405.00 2,630.04 681.05 606.77 9,748.57 4,000.00 1,800.00 24,000.00 29,800.00 143,900.00 143,900.00 Comerce Bank -Certificate of Deposit Account Country Wide Home Loans HDH Health Plan Premium Refund Homeowners Insurance Refund Members First Checking Account Real Estate -Property owned at 271 North 72nd Street, Steelton, Swatara Township, Dauphin County, PA -Reimbursement of Taxes Wachovia Checking Account CUMBERLAND COUNTY, PENNSYLVANIA Total Cash Total Personal Property Real Estate -Property owned at 271 North 72nd Street, Steelton, Swatara Township, Dauphin County, PA (Attach additional sheets if necessary) Total Personal Property and Real Estate 183,448.57 )i~ri~~ I: [)irF ir. Ricu,~rn ~t~. S~rr.~~~aR~r ('. Ro~~ 1t"t~.n~~r.r.. Ir. EI)yll 1I) G. 11FI:hS I),~~ n~ 11 I)r.Lccr. IUIIV 1 S"1~:1'fLER IL~ri~.rsu:~ 1. siiii~~i.,~ti ]li'FFNI{l L3. RICI"IlG KI[\ IS }~.. 05ROK~I' ~I ~i;~~ c. U~riir. l~~ii~~ K. ti~i~~~,sh~ 11i~~u~v~_i.I. G~ssm~ Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Dear Register: July 9, 2008 RE: Estate of Donna L. Palenz Date of Death: November 29, 2008 Your File No.. 21-2007-1134 Our File No. 15079-2 Enclosed for filing please find the following documents for the above referenced decedent: I~IIiLISS,-1 h17:L ~iRF[~.bl' Ruisi~.r r til. lt:v i~r.~~ ~~~,~ni: I~. ~t ~vi.i~:~ ELIZ.IIif:~ni D. S~~p~~F~:r IiELI.I~ 1,. E3Oti.1V:A~O OF COUNSEL F Lt:r, Sini>~i;~ i i ~,r, ~-?nn.;; 1. 2 Original PA Inheritance Tax Returns. There is tax due in the amount of $679.43. Estate Check No. 117 is attached to the Return. 2. Inventory 3. Two copies of Pages 1 of the Pa Inheritance tax return, which we ask that you time-stamp and return to us in the enclosed envelope. 4. Two copies of the of the Inventory to be time-stamped and returned to us in the enclosed self addressed envelope. 5. Check No.118 attached to this correspondence in the amount of $30.00 representing the filing fee for the Inheritance Tax Return and Inventory. Should you have any questions, please do not hesitate to contact our office. Thank you for you Enc. cc: Charles R. Palenz, Executor :338082 Very truly yours, ~ r-.a S , D F IE~ART &WEI ~ DNER ,-gyn.' - - ~ c=-- -- i , c ' ` ' r _ -' ~~ a an Estate Administration Paralegal `"" - _ ' < -p i ~...i =rt ,:-? ~ ~ - - _ ~ ^O V~ ` (V . o w ~Ol 49~RKE'r STREET P.U. [30X 109 LI:N10YV1~:, PI~,NNSY~I,4~A;ti~l/1 17043-0109 ~ti~~~'~t'.iDS11.C0~1 71%.161.4540 FAX:717.7613U13 11~aIL@JDS~ti'.CO'~~I JOHNSON j~UFFIE JOHNSON, DUFFIE, STEWART & WEIDNER, P.C. r~ ~ ~~, ,~. _- f~ f. ~.~ 3 I"~YIr r ,~ a r ~k. 9~~,f,,~,~~wq'~a »~ ic+ A' y ~. ~ ~y3. ~~~ ~ F ~• ~Y ~ u i ~ y~ ~~ ,~(~... \ L.. s~ O ~, ~~",.3 ,; ~- ~:. , ~? `-' r::, ~`' \.. n ~, `~_~. c . , '.? :~~ ~~ s 0 ,-~ P ©, ---- .r ~...- ~... ~~ ~• ..~• ~' V Y ~ ~~ ~~_::, ,w S , ~~7 (.~ ~~~ v~ ~' . ~~ ~~ I [-^ ~". ~~ ~" =~ ~ ~~- (Y:1 .i ~ -- =' j ~`' I ~~w ~"~~ ~I~~~ ~ :~~, ~~~ ---. d 0 a ~w UO~Q, O ~ ~ cnzwr ~o~° a ,~ o z ~ °" w w~oN ~~W4 V ~ ~