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HomeMy WebLinkAbout07-14-08REV-1500 EX ( 6-05, PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0801 15056051058 OFFICIAL USE ONLY County Code Year File Number INHRESIDENTE E EDENTRN Social Security Number Date of Death Date of Birth ~ OCTOBER 14, 2006 APRIL 14, 1926 Decedent's Last Name Suffix Decedent's First Name MI O'CONNOR D PAUL J^ (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 11 1. Original Retum c~ 4. Limited Estate c~ 6. Decedent Died Testate (Attach Copy of Will) c~ 2. Supplemental Retum c~ 3. Remainder Retum (date of death prior to 12-13-82) c~ 4a. Future Interest Compromise (date c~ 5. Federal Estate Tax Retum Required of death after 12-12-82) c~ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 0 8. Total Number of Safe Deposit Boxes c~ 9. Litigation Proceeds Received c~ 10. Spousal Poverty Credit (date of death c~ 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name HARRY L. BRICKER, JR. Firm Name (If Applicable) HARRY L. BRICKER, JR., ATTORNEY AT LAW First line of address 407 NORTH FRONT STREET Second line of address Daytime Telephone Number (717) 233-2555 City or Post Office St t ZIP C d REGISTER~F WILLS USfr:~NLY _ ;? ~ - ~- i :~ i~ -~ -. ! __ - l ~- m. ~, F- :~,,~ c..- t -~ --~ c _. C7 `+7 a ©A71rE- ILED - - ae o e ,l HARRISBURG PA 17101 ~ t7(3 Correspondent's a-mail address: HLBLAW@VERIZON.NET _~ j i ~~ ,`~.-~ :..~ ,,. ,, ,,_i c `: C:.:~ r~l`'1 _, . ~7 --~; t 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 preperer other than the personal representative i7s based on all information of which preparer has any knowledge. SIG ATURE~ON~ESP,~IBLE FOR FILING RETURN / ~ - DATE ~ .~ 825 ALTAVISTA AVENUE, HARRISBURG, PA 17111 / 456 NORTH NYES ROAD, HARRISBURG, PA 17112 _ ~~ OF PR)=PARER OTHER THAN REPRESENTATIVE 407 NOR•~F+-FRCINT STREET, HARRISBURG, PA 1 15056051058 PLEASE USE ORIGINAL FORM ONLY Side 1 DATE --L -- .. - c,~ 15056051058 Decedent's Social Security Number RECAPITULATION - 1. Real estate (Schedule A) 1. $0.00 2. Stocks and Bonds (Schedule B) 2. $0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. $0.00 4. Mortgages 8 Notes Receivable (Schedule D) 4. $0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. $43,835.84 6. Jointly Owned Property (Schedule F) c~ Separate Billing Requested 6. $0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 $0.00 (Schedule G) c~ Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 8. $43,835.84 9. Funeral Expenses ~ Administrative Costs (Schedule H) 9. $20,916.52 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. $0.00 11. Total Deductions (total Lines 9 & 10) 11. $20,916.52 12. Net Value of Estate (Line 8 minus Line 11) 12. $22,919.32 Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 $0.00 13 an election to tax has not been made (Schedule J) - 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. $22,919.32 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 $0.00 (a)(1.2) X 0. 15. - 16. Amount of Line 14 taxable $22 919 32 $1,031.37 at lineal rate X 0.045 16 17. Amount of Line 14 taxable $0.00 at sibling rate X .12 17. 18. Amount of Line 14 taxable $0.00 at collateral rate X .15 18. 19. TAX DUE 19 $1,031.37 15056052059 REV-1500 EX Decedent's Name: PAUL O'CONNOR 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 0 15056052059 REV-1500 EX Page 3 Flle Number nor_ndpnt'g Cemnlete Address: DECEDENT'S SOCIAL SECURITY NUMBER DECEDENT'S NAME 209-14-9582 PAUL O'CONNOR STREET ADDRESS 3609 KOHLER PLACE STATE ZIP CITY PA 17011 CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $1,031.37 Total Credits (A + B + C) (2) $0.00 3. InteresUPenalty if applicable D. interest $77.40 E. Penalty Total InteresUPenalty (D + E) (3) $77.40 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII in oval on Page 2, Line 20 to request a refund. (4) $0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $1,108.77 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $1,108.77 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; ^ b. retain the right to designate who shall use the property transferred or its income; ^ c. retain a reversionary interest; or ^ d. receive the promise for life of either payments, benefits or care? ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one ^ year of death without receiving adequate consideration? ^ 3. Did decedent own an "intrust 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. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (I)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for 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)(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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (g-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF PAUL O'CONNOR FILE NUMBER 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. 2001 FORD TAURUS STATION WAGON (KELLY BLUE BOOK VALUE) $5,345.00 2. MEMBERS 1ST FEDERAL CREDIT UNION: A. REGULAR SAVINGS ACCOUNT NO. - 182438-00 $893.74 B. CHECKING ACCOUNT NO. - 182438-11 $20,473.90 3. PSECU -ACCOUNT NO. - 0209149582: A. SAVINGS ACCOUNT (S1) B. CHECKING ACCOUNT (S4) 4. BELCO COMMUNITY CREDIT UNION -ACCOUNT NO. - 852360: A. REGULAR SAVINGS ACCOUNT B. CHECKING ACCOUNT 5. COMCAST CABLE -REFUND 6. PPL ELECTRIC UTILITIES CORP. -REFUND 7. AIR BASE CARPET MART -REFUND FOR OVERPAYMENT 8. THE PATRIOT-NEWS -SUBSCRIBER REFUND 9. ALLSTATE LIFE INSURANCE COMPANY -CERTIFICATE NO. - 1111996944860 - REFUND OF UNEARNED PREMIUM 10. AAA -PRO RATA REFUND OF UNEARNED PREMIUM FOR AAA MEMBER -YEARS INSURANCE PLAN FOR 10/15/06 - 02!01/07 11. TV GUIDE -CANCELLATION ADJUSTMENT 12. UNITED AMERICAN INSURANCE COMPANY -POLICY NO. - 02625073 -UNEARNED PREMIUM - LIFE BASIC POLICY FACE AMOUNT $397.65 $2,415.48 $515.10 $12,021.23 $17.73 $306.34 $66.45 $76.30 $63.60 $20.02 $53.30 $1,170.00 TOTAL (Also enter on line 5, Recapitulation) ~ $43,835.84 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10.06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES b ADMINISTRATNE COSTS ESTATE OF PAUL O'CONNOR FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. NEILL FUNERAL HOME, INC. - ALDERWOODS GROUP, CUSTOMER FINANCE FOR FUNERAL EXPENSES $2,966.40 2. WEST SHORE ELKS -LUNCHEON FOLLOWING FUNERAL $978.72 B 1 2. 3. 4. 5. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees HARRY L. BRICKER, JR., ESQ. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees PROBATE FEE -CUMBERLAND COUNTY Accountant's Fees 6. Tax Return Preparer's Fees 7. THE CUMBERLAND LAW JOURNAL -ADVERTISE ESTATE 8. THE CARLISLE SENTINEL -ADVERTISE ESTATE 9. MEMBERS 15T FEDERAL CREDIT UNION -USED VEHICLE LOAN ACCOUNT NO. - 182438-01 (LOAN PAID OFF ON 05/16/2007) 10. PSECU -ACCOUNT NO. - 0209149582 -VISA LOAN (L9) 11. PP&L UTILITIES -ELECTRIC SERVICE (2 PAYMENTS) 12. VITAL RECORDS - 10 DEATH CERTIFICATES 13. WILLIAM JOHNSON, ACCOUNTANT -PREPARATION AND COMPLETION OF 2006 FEDERAL AND STATE INCOME TAX RETURNS 14. DIANE BAKER, ESQ. -PROFESSIONAL SERVICES AMOUNT OF CONTINUATION PAGE FOR SCHEDULE H $2,191.79 $144.00 $75.00 $206.50 $1, 581.42 $351.58 $315.15 $97.00 $35.00 $350.00 $11,623.96 TOTAL (Also enter on line 9, Recapitulation) I $20,916.52 (If more space is needed, insert additional sheets of the same size) CONTINUATION PAGE COMMONWEALTH OF PENNSYLVANIA SCHEDULE H INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PAUL O'CONNOR FILE NUMBER ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. THANK YOU NOTES, POSTAGE AND INK CARTRIDGE RE: ESTATE MATTERS $52.92 2. U-HAUL -RENTAL FEE $62.00 3. VETERINARIAN BILL FOR DECEDENT'S CAT $152.00 4. CAREMARK -DEBIT MEMO # 840207811 $20.00 5. COLLECTION AGENCY -PHILLIPS & COHEN ASSOCIATES, LTD. -ACCOUNT NO. - 5828557 CLIENT -CITIBANK (CREDIT CARD) -ACCOUNT N0. - 5491 1303 8746 2252 $4,535.93 6. COLLECTION AGENCY - OMINIUM WORLDWIDE, INC. -ACCOUNT NO. - 140371974 CLIENT - HSBC BANK (CREDIT CARD) -ACCOUNT NO. - 5437 0306 8347 8076 $150.45 7. SAM'S CLUB -ACCOUNT N0. - 771 4 11 0427345525 $77.79 8. COLLECTION AGENCY - BALOGH BECKER, LTD. -REFERENCE NO. - 3618264 CLIENT -CITIBANK (SOUTH DAKOTA) N.A. SEARS ROEBUCK 8 CO. (CREDIT CARD) $6,158.13 9. SHELL (CREDIT CARD) -ACCOUNT NO. - 73-046-2865-9 $6.95 10. WEST SHORE PATHOLOGY -MEDICAL SERVICES -ACCOUNT NO. - 26"2619089 $20.67 -ACCOUNT NO. - 26"2619610 $25.10 -ACCOUNT NO. - 26"28484798 $19.77 11 DELUXE CHECKS -ESTATE ACCOUNT CHECKS $17.25 12. SELIGMAN, FRIEDMAN 8 COMPANY, P.C. - RE: IRS MATTER $295.00 13. REGISTER OF WILLS -FILING FEE FOR PENNSYLVANIA INHERITANCE TAX RETURN AND INVENTORY $30.00 TOTAL $11,623.96 REV-1513 EX + (9-00)) SCHEDULE J CDMMNHERITnNCE TAX RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF PAUL O'CONNOR FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. SONDRA C. PETRASIC DAUGHTER ONE-HALF ('/~) OF 825 ALTAVISTA AVENUE ESTATE OR HARRISBURG, PA 17111 $11,459.66 2. JANICE G. GARRISON DAUGHTER ONE-HALF ('/:) OF 456 NORTH NYES ROAD ESTATE OR HARRISBURG, PA 17112 $11,459.66 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV- 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00 (Ir more space is needed, insert additional sheets of the same size) 'Kelley Blue Book -Private Party Pricing Report -Ford, Taurus -Official Kelley Blue Bo... Page 1 of 2 Kelley Blue Bak THE TRUSTED RESOURCE advertisement Home New Cars Used Cars Research rk Explore News & Reviews Classlfleds Auto Loans & Insurance Find a Dealer Used Car Values Classifieds I Certified Pre-Owned Compare Vehicles I Perfect Car Finder I Most Researched Used Vehicles I CARFAX Vehicle History Walooma bade I MyK68 Recently Viewed You Might Also Like Free Dealer Price Quote home > Used Cars > YVr~90ni > );yg y > Taurus > 2001 > sE Wagon 4D Print ..' 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FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix 182438-00 Date Account Established 03/09/1999 Principal Balance at Date of Death $893:42 Accrued Interest to Date of Death $.32 Total Principal and Accrued Interest $893.74 Name of Joint Owner None CHECKING ACCOUNT: Account Number/Suffix 182438-11 Date Account Established 06/04/1999 Principal Balance at Date of Death $20,472.04 Accrued Interest to Date of Death $1.86 Total Principal and Accrued Interest $20,473.90 Name of Joint Owner None USED VEHICLE LOAN: Account Number/Suffix 182438-01* Date Loan Established 12/22/2004 Principal Balance at Date of Death $1,581.42 Interest Rate 5.69% Name of Co-Borrower None Collateral Securing Loan 2001 Ford Taurus/Contractual Pledge of Shares *Loan did not have Credit Life Insurance. Loan paid off on 05/16/07. BERS 1ST FEDE L Cr/R~'~IT UNION I~...X.-l ~--~ Danielle .. Kli Insurance Services Specialist May 23, 2008 Estate of: PAUL J. O'CONNOR Date of Death: October 14, 2006 Social Security Number: 209-14-9582, 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org PSEC~k May 20,.2008 Harry L. Bricker Jr. Attorney at Law 407 North Front Street Harrisburg, PA 17101-1296 Re: Paul J. O'Connor, Deceased. PSECU Account # 0209149582 Deaz Mr. Bricker: The account was opened on June 1, 1999. The Shaze accounts were held solely by Paul J. O'Connor. The Personal Service and Visa loans were held solely by Mr. O'Connor. The following are the Date of Death Balances for Mr. O'Connor's account with PSECU: Account Date of Death Balances Interest Savings (S1) $ 397.65 $ 3.34 Checking (S4) $ 2,415.48 $ 3.14 Loans: Personal Service (L1) $ 0.00 Visa Loan (L9) $ 351.58 Enclosed is a check, i>i the amount of $ 1,789.96, the last remaining funds in Mr. Paul 3. O'Connor's accc~,znt. T'he account is closed. If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237-7328, then press 6, extension 3120. S' erely, it 1..~(.I._.y~r.~ ~.G Roxann Myers Service Advisor PSECU Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Place, Harrisburg, PA 1 71 1 0-2990 • 717.234.8484 • 800.237.7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 1 71 06-701 3 • 717.777.2100 (TDD) • 800.472.1967 (TDD) psecu.com This credit union is federally insured by the National Credit Union Administration. Equal Opportunity Lender BELCO COMMUNITY CREDIT UNION DECEDENT ESTATE INFORMATION 1. Name(s) in which the account was held: PAUL J O'CONNOR 2. Account number: 852360 3. Balance as of date of death: 10/14/2006 Balance Accrued Dividends YTD Dividends For 10/14!2006 5/31/2008 Regular Savings: $ $515.10 $3.83 $7.87 Christmas Club: $ $ $ IRA Acct $ $ $ Checking: $ $12,021.23 $33.86 $ $58.85 Money Market: $ $ Certificates: Balance Accrued Dividends YTD Dividends Certificate Number For $ $ $ $ $ $ $ $ $ 4. Date the account was initiated: 10/13/2005 5. Name(s) in which Safe Deposit Box was held: N/A 6. Date the box was initially rented: 7. Branch address at which the box is located: 8. Loan Information: A. VISA LOAN B. Secured Loans C. Mortgage Loans: Balance Accrued Interest Per Diem Int $ $ $ $ $ $ $ $ $ $ $ $ $ Miscellaneous: COMCAST CABLE COMMUNICATIONS oaocH~T-ooooo~asss 4008 N. DUPONT HIGHWAY ATTN: SUPPORT SERVICES NEW CASTLE, DE 19720 33889 PAUL OCONNOR 825 ALVISTA AVE HARRISBURG, PA 17111 Dear Paul Oconnor, Comcast The attached check represents a subscriber refund for account number 09547-196883 in the amount of $17.73. I. you have any questions or concerns regarding the refund check you can write us at the address above or call Comcast's toll free customer service number at 1-888-COMCAST. Check Date: 02/03/2007 I~ Check Number: 158224453 I~ III DETACH AND RETAIN THIS STATEMENT 7HE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED ABOVE. IF NOT CORRECT, PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED. -PAUL J OCONNER 3609 KOHLER PL APT 18 CAMP HILL PA 17011 306.34 I Message Code Key PPL Electric Utilities Corp. Allentown PA 18101 Date 03N2l2007 Vendor Code 0000257238 Check No. 0010880289 Print No. 58110000265 Total =""""`"308.34 -- > > - Invoice i - - Invoice -- -- --~- --- Message --~-- Net I 03J07/2007 203752804800 !. ,~ ~~ .Q C3? F- ~ z ~"~ Z O U 2 O H U to D H Z O Q ~~ 'U ~ O . ~ " O ~ > ~ __ :.~ ~: ~- ~ ~ LL! ~-' J ~- ~ ... Z ~` ~ U_ t~ > - ~ ~ ~ !zt ~ Z _ ~ ~ ~ ~ ~~ 't r r V - ~ ~ ,~ ~ ".~ ~~ _. .-d Q ~' t~ 1)! ffi ~ ~ ~~ _~ n -.. ~ - t: ' w d ~ ~ - st _-Q ~ . - ~ Vp Z ~~ :. a _ - ~- ~ > : ;_m ;.$~ ~:: ~ :w ~: _ .~-: N ' - {~ a ' ~ ~ ~~ ~: ` o -_ s~ .. . O ° as -.s - ~ z.. .... tc..'. ~~ :~ . Q.` ~_ ~ O - .. ~; - ,~ : . a. - ~ - n - :.. _.- ~ _ _, . ~3 :. _. ~. - ' . X nt _ri ~ ~.~..~ . - _ _ i _ :~° ,.: ~ . i:,. ~ O ,~ .~ :~ ~ - .-n - - . ~~ a- :•~ ,~ _. ,L7 ~} ~ ~. ..O: _ ~ '`~ : _;~~r... :~zo ~ ~ _© ._ ~ ~- ~~ J -. - - F. f~ 4• F _: a.~ G ~l- : . ~Q~ d. _ : ? Z :. - - ~". - _ ~ y~~. Q _.~' F D__: 'Q Q a~°o; THE PATRIOT-NEWS PO Box 2265 Harrisburg, PA 17105 Check Date: 10/262006 Vendor Number: 9999999999 ~ Check No. 0900000988 invoice Number Invoice Date Voucher ID Gross Amount Discount Taken Paid Amount _ a2lozols ,2006-1o-Za. SUBSICRJBER REFUND Qaestierxs regarding this check contact the AP l)eept 717/153-8260 Cheek Number Date 0900000988 10262006 00002925 7630 Total Gross A~mouot 57630 0.00 Total Total Discounts Paid Amount ALLST/~TE L1~~ ~NSURANGE~ •GOMPANY . Admi~niatrator: American Health and Life Inaurance.Co~pany 1-800-736-2242 _ P.0. Box 901099 JUNE 08, 2007 Ft. Worth, TX,~ 76113-2099. - XYSR 0000762945 CERTIFICATES 11.11996944860 Paul.Oconnor • EXPLANATION: REFUND OF UNEARNED PREHIIII~t ,- _. _ N~e~er-1f~~~r® Rewarding Your Years of AAA Memhership~ Tuesday, March 13, 2007 Sondra Petrasic 825 Altavista Avenue Harrisburg, PA 17111 ReQardint~: AAA Member-Years Insurance Plan _--___--_ __ Policy Number: ADD-11078 Estate of Paul J. O'Connor Dear Ms. Petrasic: Thank you for contacting our office to notify us of the death of your father. We were saddened to hear of your loss and extend our deepest sympathy. We have closed our files for your father as of October 15, 2006. Under this Plan,, the insured is covered on the date of death. I have attached our check in the amount of $20.02, which is a pro rata refund of unearned premium for the period of October 15, 2006, to the date for which premium was paid - February 1, 2007. If you have a question, Ms. Petrasic, or if we maybe of further service to you, please call me. REMOVE DOCUMENT ALONG THIS PERFORATION ~~'0 25369~~' ~: 1 2 200066 1~: 1459634544~i' 40374542 UNITED 14MERICAN INSURANCE COMPANY P.O. BOX 2440 MCKINNEY, TEXAS 75070 (972) 529-5085 ESTATE OF 001 PAUL J O'CONNOR C/0 407 N FRONT ST HARRISBURG PA 17101 ATTACHED TO THIS CHECK IS A BREAKDOWN OF THE BENEFITS ON YOUR POLICY. AMOUNT CO POLICY CLATM INS~J`RED 1,170.00 57 1742385 02625073 PAUL O'CONNOR UNEARNED PREMIUM - LIFE FROM 10/14/06 TO 10/14/06 26.00 BASIC POLICY FACE AMOUNT FROM 10/14/06 TO 10/14/06 1,144.00 IF WE CAN HELP YOU IN ANY OTHER WAY, PLEASE TELL US. rr.n~~~~n~'2 r, DETACH THIS PORTION AT DOTTED LINE BEFORE DEPOSITING CHECK 01106520 i'1+C~1 tnsE~il: J E-u~nv r ~s Colleet .through 1 1 :~i JPHouston~as'ues enk i:.. :.: ..; .. ~`~ - ~~' ~~% '~ Texas Controllable-Diebursamenta - For inQalrlac Ca11;:800'457-7191 ~~' S 40 L L06 5 20ii' ~: L i L 300880: ii'06 3000 L 4 L8 3i~' LAST WILL AND TESTAMENT I, PAUL J. O'COriNOR, of 4639 Fritchey Street, Harrisburg, Pennsylvania, do hereby make my Last-Will and Testament and revoke all Wills by me at any time heretofore made. FIRST• I direct the payment out od my estate of the expenses of my last illne nd funeral. SECOND: I give, devise and bequeath all of my estate, real and personal, to my wife., Ann O'Connor, her heirs and assigns forever. THIRD: In the event my said wife, Ann O'Conn~te d Teal and survive me, then I give, devise and bequeath all of my personal, to my daughters, Sondra Petrasic and Janice Garrison, share and share alike, their heirs and assigns forever. FOURTH: I nominate, constitute and appoint my said wife, Ann O'Connor, Executrix of this my Will, and I direct that she shall not be required to enter security in any jurisdiction in which she may act. In the event my said wife, Ann O'Connor, does not survive me, then I nominate, constitute and appoint my daughters, Sondra Petrasic and 3anice Garrison, Executrices of this my Will, and I direct that they shall not be required to enter security in any jurisdiction in which they may act. IN WITNESS WHEREOF, daaof 0 tober,a1967 d seal to this my Last Will and Testament this Y '~ pa ,lJ. O' Conno r We, the undersigned witnesses,/in the presence of the above-nan Testator and in the presence of each other, did hear Paul J. O'Connor decl the foregoing to be his Last Will and Testament and did witness the signing of the same by him. ra ~~ ~~ ' "* r .. ~ ~ : 7 ~ ~J ..A_I _ ~..:~ ~ .. ~ ~ 1~ 1 ` ;.~ ~`~ -~..i ~ ~ _ i~ _ _ ~. ~{ ,^ ... ~.. J . ^ A '~ •-- - HARRY L. BRICKER, JR. ATTORNEY AT LAW 407 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA AREA CODE x7 17101-1296 233-2555 E-MAIL - HLBLAW@VERIZON.NET """"" FAX 233-5555 July 11, 2008 Register of Wills Office `~ Cumberland County Courthouse ~ ~ c_.. r One Courthouse Square "~c-~ ~ ~: Carlisle, PA 17013 = _; ~ ~ _; ,~.. r ~ ;- , ~ ~ ~ ~° 1. _. i Re: Estate of Paul J. O'Connor, Deceased --~ ~ ~~' Social Security No. - 209-14-9582 -, ~ ~ " ~ ~ - Date of Death -October 14, 2006 ~ ~ Estate No. - 2008-00345 Tax. I.D. No. - 74-6564625 Gentlemen: Enclosed are five (5) completed Inventories and five (5) completed Pennsylvania Inheritance Tax Returns concerning the above captioned estate. Enclosed also is a check payable to the Register of Wills, Agent in the amount of $1,108.77 which is for the payment of the inheritance tax as well as a check payable to the Register of Wills in the amount of $30.00 for the filing fee for the Inventory and Return. We will appreciate you clocking all ofthe documents in and returning three (3) Inventories and three (3) Returns to this office using the enclosed self-addressed, stamped envelope. Certainly, if you have any questions, please feel free to call. Very truly yours, HLB, Jr./bld Enclosures ~ ___. Har L. Bricker, Jr. cc: Mrs. Sondra C. Petrasic Mrs. Janice G. Garrison _~ _V N O 1 ~ a c C~o -- 000C-~ ~Z N (na~r JQ ~o • ¢ ~ ~¢~ M '~ o n ~~ ` a3 n ~~ n w ~~ ~4 ~~ ~ ,~'~1L~~~ ~ _ I^ ~~~8 JUL 14 F'~~I I~?~ 5~3 CLERK 'PHA~1'` t0 ~ JS.+ L r ~ d 7 ® ~ V 3 F- W ~ ~ ~ Q ~W/Q¢Z i J O Q O ccn e~ y ~ ~ r V Q Z J _ -~ N ti mW ~~ ~ .a Q r LL Z ~~W o~ea JOxa ~ i ~ o ~ ~ ~ ~ ~ as m ~~ ~ ~ L ~ = a Gs 7 C ea OCVOv O H \~ Q.:: '~ v,. 4 ~- ~.+ ~\ 4