HomeMy WebLinkAbout07-15-08REV-1500 EX f (B-00)
COMMONWEALTH OF REV-1500 OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
FILE NUMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 5 9
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
H
IZ Edwards Charles H. 1 5 4- 0 1- 9 9 9 2
~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WRH THE
V 10/13/2007 04/25/1916 REGISTER OF WILLS
IJ.I (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
N/A _ _
OX 1.Original Return ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death
rior to 12-13.82)
p
Y ~ Y ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of Beam after tztz-e2) ~ 5
Federal Estate Tax Retum Required
.
~ a ~ QX 6. Decedent Died Testate (Anach copy or will) ~ 7. Decedent Maintained a Living Trust (attacn copy of Trust) 0 8. Total Number of Safe Deposit Boxes
~ ~ 9. Litigation Proceeds Received ~ 10. SpoUS81 POVerty Cfedit (date of death behveen 12-31-91 and 1.1-95) ~ 11. Election to tax under Sec. 9113(A) (Anach sch o)
o NAME COMPLETE MAILING ADDRESS
c Melvin E. Newcomer Es uire P. O. Box 539
y FIRM NAME (If Applicable)
KLUXEN & NEWCOMER 339 North Duke Street
p TELEPHONE NUMBER
717 393-7885 Lancaster P 17602
1. Real Estate (Schedule A) (1) OFFICIA~iC-SE O t «ti ~,I
158,807.40 '~
-
2. Stocks and Bonds (Schedule B) (2) ,
~ O c_ ~ -,, ;~ _-~
I
4,207.20 ~' ~ ~ n ~ E ~~ ~
3
Closel
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ti
P
h I
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7
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.
y
e
orpora
on,
artners
ip or Sole-Proprietorship (3) I .'- ;
t-
~ _~
-
~~ [..
4. Mortgages 8 Notes Receivable (Schedule D) (4)
i~~t \ ~
~~~C.. "~ ~ ~-t ~ ~ I
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~ ~~
`~- r•j
379,016.70 ' '.~ ~ ~~~= f-n
(Schedule E) --~
,~-, ~-
Z
~
6. Jointly Owned Property (Schedule F) (6) ~
~
ry
~
Separate Billing Requested
~ 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (7) l
H (Schedule G or L) - -- _- - --
a
~ 8. Total Gross Asssts (total Lines 1-7) (6) 542,031.30
~ 9. Funeral Expenses 8 Administrative Costs (Schedule H) (9) 23,135.72
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 9,803.99
11. Total Dsductlona (total Lines 9 & 10) (11) 32,939.71
12. Net Value of Estate (Line 8 minus Line 11) (12) 509,091.59
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Taz (Line 12 minus Line 13) (14) 509,091.59
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z
~ 15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X (15) 0.00
16. Amount of Line 14 taxable at lineal rate 509,091.59 X .045 (16) 22.909.12
la 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00
V 18. Amount of Line t4 taxable at collateral rate 0.00 X .15 (18) 0.00
19. Tax Due (19) 22,909.12
H
20.
uecedent's Gom lete Address:
STREET ADDRESS
1824 Walnut Street ~+
clrr
Camp Hill srnrE ziP
PA. 17011
Tax Payments and Credits:
t • Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 17.000 00
C. Discount 894 74
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) _ _ 22,909.12
Total Credits (A + B + C) (2) 17.894.74
Total InteresUPenatty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Ltne 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3)
0.00
{4) 0.00
(5) 5,014.38
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) t 5,014.38
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 : ...................................... .. ^ Q
c. retain a reversionary interest; or .....................................
............................................................... ^
.. ^
X
d. receive the promise for life of either payments, benefits or care? .....................
......................................
.. ^
a
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? ............... .. ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..................................................................................................... .. ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of m kno
Declaration of preparer otner than the personal representative a based o 'formation of which preparer has any knowledge. y wledge and belief, ft is true, correct and complete.
SIGN RSON RESP ISLE F RET RN DATE
ADDRESS ~ 7/11 /2008
1824 W nut Street
C H~ PA. 17011
51GNAT EPA T~~{{ER THAN REPR NTATIVE DATE
A .. IIJ.1 w_
39, 339'North Duke Street
7/11 /2
PA. 17608-0539
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 3%
[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 0% [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 0% [72 P.S. §9116(a)(1.2)j.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, 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 12% [72 P.S. §9116(a)(1.3)j. Asibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX + (6-98)
^ SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OF
FILE
Edwards. Charles H. 07 00 ~
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 whk:h is 1olnUy-owned with right of;urvhrorehip must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Date of death value of decedent's property located at 1824 Walnut Street 158,807.40
Borough of Camp Hill, County of Cumberland, Commonwealth of Pennsylvania
Value based on assessment ($130,170) times common level ratio (1.22) in effect
for Cumberland County at the time of decedent's death
TOTAL (Also enter on line 1,
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (6-98)
^ SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Edwards. Charles H. 07 OOA59
All property jointry-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Date of death value of 60 units of MetLife Policyholder Trust (ID No.806721509691) 4,207.20
(Copy of statement showing number of shares is attached) at $70.12/share
TOTAL (Also enter on line 2, Recapitulation) I s 4
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
^
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE
SCHEDULE E
CASH, BANK DEPOSITS, 8~ MISC.
PERSONAL PROPERTY
FILE NUMBER
Edwards. Charles H. 07 00
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntlyowned wltlr rlpht of sunrhrorshlp must M disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1. Proceeds received from sale of 2000 Impala Chevrolet Sedan Automobile, 3,500.00
titled in decedent's name alone (Title No. 53855687301ED),
2• Date of death balance held in decedent's Checking Account (Account No. 6101192451) held with 108,776.89
Citizens Bank, Pittsburgh, PA., held in decedent's name alone, said account established April 9, 2002
3. Date of death balance held in decedent's Checking Account (Account No. 2008209) held with 63,340.89
Harleysville National Bank/East Penn Bank, said account being established April 22, 2003
4. Accrued interest earned in decedent's Checking Account (Account No. 2008209) held with Harleysville 119.15
National BanklEast Penn Bank, Harleysville, Pennsylvania
5. Date of death balance held in decedent's Money Market Account (Account No. 1000752376) held with 202,965.37
Harleysville National Bank/East Penn Bank, said account being established September 21, 2007
6. Accrued interest earned in decedent's Money Market Account (Account No. 1000752376) held with 314.40
Harleysville National Bank/East Penn Bank, Harleysville, Pennsylvania
TOTAL (Also enter on line 5, Recapitulation) ~ :
3
016.70
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
. ^ SCHEDULE 1
,, COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
iN R Si DAE TEDECEDENTRN MORTGAGE LIABILITIES 8 LIENS
ESTATE OF FILE NUMBER
Edwards. Charles H. 07 00 A
Include unrefmbursed medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1. Scaringi &Scaringi, P.C. -payment of professional services rendered for preparation 190.00
of 2007 Federal and State Income Tax Returns
2. West Shore EMS -payment of emergency medical services 169.33
3. Penn State-UMS PFFS -payment of medical services 50.00
4. ENPS Bridgeport Family Practice -payment of medical services 20.00
5. Holy Spirit Hospital -payment of hospital expenses 62.00
6. Contract Pharmacy Services -payment of medical services 5.79
7. Meadowood Nursing Home -final nursing home expenses 3,599.48
8. Family Practice of Jeffersonville -payment of medical services 20.00
9. Mercy Suburban Hospital -payment of hospital services 100.17
10. Philadelphia Inquirer -payment of newspaper services 24.57
11. MCHS Camp Hill -payment of medical services for room and board for decedent 2,732.40
12. BLS Medical Transport -payment of medical services 699.00
13. Foremost Insurance Company -payment of insurance premium 799.00
(Check dated 10/12/07 from decedent's personal account but not negotiated until
after date of decedent's death)
14. Steven G. Edwards- reimbursement for advance payment of miscellaneous expenses 917.25
15. PA Dept of Revenue- payment of 2007 state income tax 415.00
TOTAL (Also enter on line 10, Recapitulation) S 9 803.99
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX +
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
- INHERITANCE TAX RETURN
RESIDENT DECEDENT
Frlui~rrle f h~rlne 4.1
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Lfst Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal disUibutions, and transfers under
Sec. 9116 (a) (1.2)]
1. Steven G. Edwards Lineal 158,807.40
1824 Walnut Street, Camp Hill, PA., 17011
2. Margaret Edwards Lineal 82,067.46
130-K East Longview Street, Chapel Hill, North Carolina
3. Charles W. Edwards Lineal 82,067.46
1875 Bridgman Road, Apt. No. I, Vernon, Vermont
4. Barbara Florence Edwards Sheer Lineal 82,067.46
4217 Sundown Road, Laytownsville, MD., 20882
5. Richard C. Edwards Lineal 82,067.46
432 Narrow Gauge Road, Reidsville, North Carolina
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET s
(it more space is needed, insert additional sheets of the same size)
April 1, 2008
MELVIN E NEWCOMER Esq
339 N DUKE ST
PO BOX 539
LANCASTER PA 17608-0539
Estate of CHARLES H EDWARDS
Date of Death: October 13, 2007
SSN: 154-01-9992
Dear Sir/Madam:
525 William Penn Place
Suite 153-2618
Pittsburgh, PA 15219
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his date of death.
The decedent had 1 active account at the time of his death and he had no Safe Deposit Box.
For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 1-888-999-6884
Sincerely,
Phillip Lynch
Operations Services
`s-
•
Citizens Bank
Account Number 6101192451
Account Title CHARLES H EDWARDS
Date O ened 4/9/2002
Account T e Checkin
Princi al Balance as of DOD $108,776.89
Interest from Last Postin to DOD $ .00
Account Balance as of DOD $108,776.89
YTD Interest to DOD $1,589.43
n~.Qns Rc~r m~rn~r
-._ , ; LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 13859839
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
' ~--~%a4.~.~ r~~-~ QCT 1/I 2007
Local Registrar Date Issued
REV 11da06 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PRIM IN
';""I,~ CERTIFICATE OF DEATH
(Sceinstructlons and exarnales on reversal
1. Name d Deoedenl (Flrsl, mkldb, lest. suffix)
Charles H
Edwards 2. Sex 3. Sods) Seanry Number V .,.. ` .._` .. V,.• 4. Date d DeaU (MOnm, tlay, Year)
. M 154 - O1 - 9992 October13,2007
5. Age (tasl Simgay) Under 1 r Under 1 day 6. Date of DMth (MmU, da , r) 7. D aM ebb a I coon ) 8a Place of DeeU Check one)
Maww b•Ya Haun Mxaes
W; Other.
91 yro. 04 / 25 / 16 Waterbury ,Conn ^,,,,,,;,,,, ^ ER I aq>etbnt ^ DoA g1 Nuroklg HElme ^ Residence ^Dlher ~ Spedly
•
Bb. County d Death Bc. City. Boro, Twp. d DeaM 9d. FaalAy Name (n rid memutlon, ghe etreel and number) 9. Wns Decedent of Hlepenk Origin? No ^ vas 10. Race: American IMian, Black, While. ek.
(II yes, epedly Cuban,
Cumberland Camp Hill, Manor Care MexipagPpeQoRiegeta) White
11. DarodatYa l1suM tlon KA1d d wpk tlone most d ms. Do rid slab 12. Wee Deedenl aver h Ale 13. DeawlenCS Eduetlon (Spexmy any highed grade omgletedl 14. Medlel Sbhw: Mernetl, Nevi Marred, 15. Suruiuing Spouse (II wib, give marten name)
19rrd d Buakima I
11.5. Ambd Fareal EMrmntery l Searndary (o-12) Colbge (1-4 or 5+) Widowed. dvared (Spedly)
Grant 0 icer Hershe
Medt
y
r. Yea ^NO 4 Widowed
• 18. DeardaM'a Meirg Adders (Sheaf, dry /lows, able, zip aide) DecederiYs
b Pa I°J
1824 Walnut Street AcdWReeidenca n
sl
"I°e:°d"
a
a
w
„~.pyBB,~d,n,,;,,dro T~
Camp Hi11,Pa 17011 17b.Counry Cumberland T°w"~'0~ t7a(~ I
L
ivedwAtlan ~p Hill
o
f
~~,~~
18. FatlwYS Nerve IFksl, mitltlb, bsL sdax) 19. MaUera Noma (Fhsl, midde, rmNen aumamel
George Edwards
Florence Hinkel
20a. InksmeM'9 Name (type /Prim)
Steven Edwards 20b. InhmwnYS McAhg AdUeas (Street, dry / loyal, state, zp model
1824 Walnut Street' Hill, Pa 17011
• 21a. Metlgd d Dispodllori I ^ Crarmtpn ^ Danekon 21b. Dale d Diwomnm (MOdh, day. year) 21u Place d Dbpmitlpl INeme d amelery. crormtory a oUer place) 21d. Location (Clry /town, able. Up aide)
-
Bu
Removal fromSble
^ ~
O
' ~~ ^Yea^Aw October 18,2007 Indiantown Ga National Cemeter Annville,Pa
oral Service Licensee as such) 22b. Ilterae NuMer 22c. Name and Address d Faa91y
~
-
011654-L Myers-Horner Funeral Home Inc 1903 Market Street C Hi11,Pa 17011
Ibrra 23ac arty wMn cernlykg
physbbn b rat evalade M mne d dedh to 23e. To tie lbp d my knowledge, death at tie mra, dale and place Natetl. (SlpbNro and tltlel 23b. Ucerbe Number 23c. Date Signed (Monti, day, year)
army cause d a«m.
• ..-...-. (' •L-.a. m J~ C1 i{ 2 1 G L ~ d_/ G. c-~
Item 2428 muss be completed by person 24. Time d DeU 25. Date Pronwrcad oeatl IMaah, day. y~ 28. Was Case Referred m Medal Eeaminer /Coroner kx a Reason OUer than Cremadon or Domlion?
~ whopmwuncw deU. ti M. 1Q' / 3, d ^Ves ~No
CAUSE OF DEATIi (Sea InahtACtlons end saemples) r Apgoximeb 4ltervel;
Item 27. Pan I: Ester the beef d events - dbesses, kiuries, ar ocnlplcatlon6 -Uat dkedhy caused the deeU. DO NOT enter temYnal everaa such es erdec arrest Pan Ii: Enter dher
~ 28. Dkl Tobacco Uae Contnbde to DeaU?
. Omd ro DmU
reBprarorY anesL or vedncdar Ahraatlan w1tlnlA showeg the eAology. Lbt arAy our cause on each Yw. M rid resubi m Iha cause
a~Yi'S given n Pan I.
n9
^ Yes ^ Pmhabiy
AYEpIATE CAUSE Fhwl deeeae or r
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c ^ ~ ^ lk~nown
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tlal rewlAng b
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y,~,c~: cCYA'-'~F ~`i
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.
Duero (« m e ax7sequence off: /
p r
Nd Prognanl wMF pBd year
~
eW~tl~y
9edrg b IFw aaalB Ibted~on Ana a b. ~tw' 1•~r*.-a.1...~~.~ ~1+~.y~ ti 9Ja•- r 7~,.4 A ,2,en~
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^ Pregiant et rime of tlealh
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Emx UN~~DpENlYIN6 CAUSE Due to (a as a wnee9uence d): i G~
~
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e
~m
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l
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~
^ Nd preganL but pregnant within bz days
. fj
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'-~, /
{,.. CG F.•,
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ies
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s9q in ~M Sr~ a ( of daeU
Due ro (or m a coneaquerKa dl: r ^ Nd pragwnl, bd pregnan143 days l0 1 year
/,Iy
d. ~ ~ ~ Y '"" ~" -i ~[I ^ U~Mcn%w~ pregmm wman me pall year
30e. Wes an ANapsy 3W. Were Adapsy Endings 37. Maurer d DeU 32a. Deb d Iryury (Monti. day, Year) 32b. Descdbe How Injury Oauned
Penomwd? Available Poor to Competlon 32c. Pbe d In' Home. Farm. Sired, Fed
Nry: ay,
d Cause d DeeU7 'cV Nalurel [] Haniade Olfie Iluidng. etc. lSoecfi')
^ yes ~i No ^ yes ^ No ^ Aaetlenl ^ PendMg Imestlgedon 32d. Time d Injury 32e. Injury at Work? 321. II Trensponetion Injury (SpedlyJ 32g. Lacanm of Inpxy (Strcel, city / lam, sbte)
^ Suidtle ^ GorAd Nd ba Debrtnmed ^ Yes ^ No ^ Omrer / Dpereror ^ Paaaenger ^Pedminen
M OUer - Sped7y:
33e. Cenifar (check onry am) 33D. Signanse art Tills of Cerlifbr
CartllyUg physlcW (Physician erafyvg reuse of tlaeU when arwtlwr phygden has lxorioiaiced daaM art completed Ilam 23) /'
To Ue heal d know
my ledge, death occumd due to tie cause(s) and rrunner u eteb6, _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~
• Pronouncing art cMirying physiclen (Ph
sidan both
ran
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Al ~ ~,~ ~~, ~wr.ry
- .rr.+w.c G._.--. ,
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ng
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ykrg to cause of deaU)
To the hest of my Mnowbdge, deU omnred et the time, date, end Place, and due to Ue ease(s) end mernrer as stated.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~, ~~ Nan
33tl. Dale Signetl (Monti, tlay, Yeer)
• Madkel Faaminer I Coroner ~ ~. { 2 ~ ~ ~.. ~<= ~' iG ~ G
On tM bees of axeminalion and I or Imestigatlon, In my opinion, delh occunetl at Nis tlme, date, and place, and due to the cause(s) end manner m ebted_ ^
3!. Name am Address of Person Who Compbled Cause d DeeU Illem 27) Type / Pnm
Regidrar's Dist ~ ~ ~ /I ~ / I ~ I De FAetl ( th, tlay. Yeer) ~ I ~ ~ y M O n/,D t. Ci ''{,a r' Dc : / "t-,D
a
/7 i 3 J
Dispmitbn Perms No. ~ ~ /Q y~-
317 THIRD 57 REST
1 ~~
~ ?V EVi,' CUMBERLAND, PENNSYLVANIA 17070
a
!I
'! LAST WILL AND 1I~SI~AMSr]T
ii
OF
(VARIES H. EDWARD6
I, Q~ARLES H. EDWARDS, of Camp Hill, G~mberland County, Permsylvania
of sotimd mind, memory and understanding, d4 hereby make, publish and
'e this as and for my Last Will and Testament hereby rewking and inking
any and all other wills by me at any time heretofore made.
I.
i
~i
I
~,
ii
~~
~~
'I I direct that my Executrix hereinafter named shall pay all my just
,debts and funeral expenses as soon as conveniently may be done after my decease.;
II.
f All the rest, residue and remainder of my estate, whether real,
personal or Bnxed, and wheresoever situate, I hereby give, devise and bequeath
unto my wife, RUTH D. EDWARD6, if she survives me by a period of thirty (30)
days.
III.
If my said wife, Ruth D. Edwards, does not survive me by a period of
thirty (30) days, then I give, devise and bequeath my house and lot of real
estate situate at 1824 Walnut Street, Camp Hill, Cumberland County, Pennsylvania;
.nzto my son, sTEVE<v G. EDwARDS. I also give and bequeath all of my furniture,
~hausehold equipment and the contents of the said house unto my son, STEVII~T G.
IV.
i If my said wife, Ruth D. Edwards, does not survive me by a period of
ii
;`thirty (30) days, then I give, devise and bequeath all the rest, residue and
;remainder of my estate, whether real, personal or mixed, and wheresoever situate,
LAW OPFIC ED ~,
JON F. LAFAVER ':j
;as follows:
317 TNIRD 7TIIEET iii
NEW CUMlE11LAND. PA. !I Page one of tW0 Pages
A. One-fourth (1/4) unto my daughter, MARGARET E. T~~INTf2AUB.
B. One-fourth (1/4) unto my san, c~~ART,ES W. EDWARDS.
C. One-fourth (1/4) unto my daughter, BARBARA FIARENCIE ELWARD6 SHEER.
;.
'' D. Otte-fourth (1/4) unto my son, RI(~IARD C. EDWARDS.
;;
ii V.
I hereby nominate, constitute and appoint AAUPHIlV LF:POSIT BANK AND
;;TRUST CCY"IPANY as Guardian of the estates of any minors who may take a share
,,
i;•under this Will.
;,
i' VI .
I
~~
I hereby nominate, constitute and appoint my wife, RUIIi D. EDWARDS,
~as Executrix of this, my Last Will and Testament. If the said Ruth D. Edwards
'ishould predecease me, fail to qualify or cease to act as such, then I nominate,
;~
-i
~~constitute and appoint my son, sTFvEN G. EDWARD6, as Executor.
i
i VII.
,~
ti No fiduciary acting under this Will shall be required to post bond
li
'in this jurisdiction or in any jurisdiction in which he may act.
i~
'' IN WITI~.SS WHEREOF, I , C~EiARLES H . EDWARB6 , the Testator, have unto
rthis, my Last Will and Testament, set my hand and seal this-~ ut ~ day of
.. Ir A. D. , 1981.
r
;;
SIGNID, SEATED, ~ PUBLISHED and I~CLARED by (~TARtES H. EDWARDS, the
iabov+e-named Testator, as and for his Last Will and Testament, in the presence
of us who have hereunto subscribed our names as witnesses at his request, in
,';the presence of the said Testator and of each other.
' ~~
,~ -
LAW O/FICE9
~~
JON F. LAFAYER J -i- ~`r~ _= ~!
317 TNIRD 7TREET
Page of Pages
NEW CUMlERLAND. PA.
CHARLES EDWARDS
Aooourtt Markst Valus
Stock Price as of
11 O6 2007 Total Market
Value
565.360 53,s2t.f3o
The aggregate amount paid to all
Trust Beneficiaries in this distribution
is $194,178,148.74.
Investor ID 8067 21 50 9691
2007 Dltfklsnd Summary
Record Date Total Trust
Interests Dividend per
Trust Interest Current
Distribution
t1/O6/2007 (30.0000 50.74 $44.40
P able Gate
~ Tax Withheld Net Distribution Prior Year
Distribution
12/14/2007 50.00 544.40 535.40
For inquiries about your account, you may visit 1,vww.bnymellon.coMshareowner/Isd, or call 1-800849-359<i.
Trttet Beneficiary IrAormation
You may purchase or sell shares of MetLife, Inc. common stock through
the MetLrfe Policyholder Trust (the 'Trust7, free of arty commissions or
other fees, under the MetLrfe Purchase and Sale Program, as amended. A
copy of the brochure describing the program is available on the Internet
at www.mettife.com by selecting Investor Relations and then the
Shareholder Services Information page, or by calling the number listed
above. You are .permitted to transfer your Trust Interests only in the
circumstances described in the brochure. You may also instruct that all
(but not less than all) of your shares of MetL3fe, Inc. common stock held
by the Trust be withdrawn from the Trust. Information regarding your
withdrawal rights may be found in the Purchase and Sale Brochure or by
calling the number listed above.
0170726
An annual shareholders' meeting to elect members of the Board of
Directors of MetLife, Inc. and for the transaction of other business is
expected to be held on April 22, 2008. The deadline for submitting
shareholder proposals for consideration at this meeting is November 27,
2007. A copy of MetLife, Int.'s annual report and proxy statement will be
available free of charge on or before March 31, 2008, along wfth other
MetLife, Inc. and Trust filings under federal securities laws. (i) on the
Internet at www.metlife.com by selecting About Us, Corporate
Governance, under Related Links, (ii) by writing to MetL'rfe, Inc., c% BNY
Melon Sharehwner Services, PO Box 358447, Pittsburgh, PA 15252-8447
or (iii) by calling the number listed above. These and other SEC filings by
MetLife and the Trust are alsd available on the Internet at www.sec.gov.
1
Please Note: Important 2007 Tax Information MetUfe
FORM 1099-DIV. U.S
TAX INFORMATION FOR 2007 OMB NO. 1545-0110
.
DIVIDENDS/DISTRIBUTIONS
COPY B FOR
REGPIENT
REGPIENT'S TOTAL ORDINARY
QUALIFlED DMDENDS
IDENTIFICATION NUMBER DMDENDS FED~tAL INOOME TAX WITHHELD
~ _
BOX lA BOX 18 BOX 4
154-019992 $~.~ ~ $~'~
PAYER'S NAME PAYER'S FEDERAL IDENTIFCATION NUMBER
BNY MEU_ON SHAREOWNER SERVICES AS
CUSTODIAN OF THE METUFE POLICYHOLDER TRUST 51516987
SECURITY DESCRIPTION TO WHOM PAID
TRUST INTERESTS ~ ~~0~
~~ REPORTED BY
~
LANSDALE PA 19448-5868 BNY MELLON
SHAREOWNER SERVICES
480 WASHINGTON
BOULEVARD
JERSEY CITY, NJ 07310
IMPORTANT 2007 TAX INFORMATION FOR INFORMATION REGARDING THE ABOVE, CALL 1-800(49-3593
ThIs Is important tax information and is being furnished to the Internal Revenue Service.
K you are required to file a return, a negligence penally or other sanMlon may be
imposed on you H this income is taxable and the IRS determines that it has not been
reported.
Box to -Shows total ordinary (short-term) dividends that are taxable. Include this amount on
line 9a of Form 1040 or 1040A. Also, report it on Schedule 8 (Form 1040) or Schedule 1 (Form
1040A), if required. The amount shown may be a distribution from an employee stack owner-
ship plan (ESOP). Report it as a dividend on your income tax return, but treat it as a plan
distribution, not as investment income for any other purpose.
Box 1 B -Shows the portion of the amount in box 1A that may be eligible for the 15 % or 5 % capi-
tal gains rates. See the Form 1040l1040A instructions for how to determine this amount. Report
the eligible amount on line 9b, Form 1040 or 1040A.
Box 4 -Shows backup withholding. For example, a payer must backup withhold on certain pay-
ments at the applicable rate if you did not give your taxpayer identification number to the payer.
See form W-9, Request for Taxpayer Identification Number and Certification, for information on
backup withholding. Include this amount on your income tax return as tax withheld.
Nominees. If this form includes amounts belonging to another person, you are considered a
nominee recipient. You must file Form 1099-DIV with the IRS for each of the other owners to
show their share of the income, and you must furnish a Form 1099-DIV to each. A husband or
wife is not required to file a nominee return to show amounts owned by the other. See the 2007
General Instructions for Forms 1099, 1098, 5498, and W-2G.
Please Deposit the Enclosed Check Immediately
MET: Historical Prices for METLIFE INC -Yahoo! Finance
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Histot~ical Prices Get Historical Pricea for: ~W GO
SET DATE RANGE
is Daily
Stag Date: OCt ~ 13 2007 Eg. 3an 1, zoo3 C Weekly
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PRICES
Date Open High Low Close Volume Adj Close`
12-Oct-07 69.68 70.26 69.40 70.12 1,892,500 69.33
`Close price ad)usted for dividends and splits.
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httn://finance.vahnn_cnm/a/hn?s=MET&a=09&b=13&c=2007&d=09&e=13&2007&e=d 7/10/2008
r~
2006 REALTY TRANSFER TAX
COMMON LEVEL RATIO REAL ESTATE
VALUATION FACTORS
The following is a list by County of the Common Level Ratio Factors for use with
documents accepted from July 01, 2007 to June 30, 2008, except as indicated below:
County Factor County Factor County Factor
Adams 4.53 Elk 2.65 Montour 1.14
Allegheny 1.15 Erie 1.20 Northampton 3.44
Armstrong 2.79 Fayette 1.17 Northumberland 4.53
Beaver 3.41 Forest 5.21 Perry 1.36
Bedford 5.81 Franklin 10.20 Philadelphia 3.52
Berks 1.47 Fulton 2.99 Pike 6.17
Blair 12.20 Greene 1.16 Potter 2.80
Bradford 2.68 Huntingdon 7.87 Schuylkill 2.62
Bucks 10.99 Indiana 6.17 *Snyder 5.32
Butler 10.42 Jefferson 1.87 Somerset 2.91
Cambria 3.22 Juniata 6.25 Sullivan 1.40
Cameron 2.96 Lackawanna 7.09 Susquehanna 2.96
Carbon 3.12 Lancaster 1.31 Tioga 1.33
Centre 3.41 Lawrence 1.14 Union 1.13
Chester 1.93 Lebanon 7.35 Venango 1.13
Clarion 5.65 Lehigh 3.58 Warren 2.93
Clearfield 5.75 Luzerne 20.00 Washington 7.52
Clinton 4.46 Lycoming 1.16 Wayne 1.32
Columbia 3.55 McKean 1.11 Westmoreland 5.05
Crawford 3.04 Mercer 3.66 Wyoming 4.59
Cumberland 1.22 Mifflin 2.20 York 1.31
Dauphin 1.40 Monroe 7.81
Delaware 1.64 Montgomery 1.97
*Adjusted by the Department of Revenue to reflect assessment ratio change effective January 1, 2007.
** COMPLIMENTS OF **
Old Republic National Tltle Insurance Company
Three Glenhardie Corporate Center Calder Square 125 Technology Drive, Suite 101
1265 Drummers Lane, Suite 220 P.O. Box 10326 Canonsburg, PA 15317
Wayne, PA 19087-1571 State College, PA 16805 866/364-2777 or 724/746-2777
610/687-8020 or 800/842-2080 814/238-3600 724/746-5434 -fax
610/687-6056 -fax 814/238-3604 -fax
=TAXES ARE IN ESCROW FORWARD TO MORTAGE COMPANY
:ASH ONLY AFTER 7?/52008
1
AYABLE
TO.'
JANET L. MILLER, TAX COLLECTOR
• 1939 WAWUT STREET
CAMP HILL PA 17011
Esc: ASSESS.NO-01001032
MAP NO: 01-21-0269-189
1824 WALNUT STREET
ACRES .250
LOT 20
Residential Building
RESIDENTIAL
TAx C/~ STEVS~N G EDWARDSRUTH
AVER
18 4 WALNUT STREET
CAMP HILL PA 17011
FFICE WED 10-2 AND 4-6 JULY-OCTOBER
ouRS: SPECIAL HOURS:
AUG 19,26 4-6 AUG 21,28 12-2
PHONE (717) 763-0177
Bill No: 751
2008 Statement of Real Estate Taxes
Control No- 001 - 001032 Rill n~ra- vine ~onnn
Assessed Land
Values 50,470
Homestead Exclusion Improvement
79,700 Mineral
0
130,170
CAMP HILL S.D. Discount Face Pe
Rates .01422000
SCHOOL R/E 717.68 .01422000
1 133.33 2 $
1 813.99
1 851.01 10 ~
2 036.11
Homestead Credit 111.97-
TAX AMOUNT DUE -> 51,704.26 x1,739.04 51,912.94
If Paid On. or ]-fter
If Paid Oa or Sefore 7 O1 2008
8 31 2008 9 Ol 2008
10 31 2008 11 O1 2008
RETURN BILL WITH PAYM . FOR A RECEIPT ENCLO SE
SELFADDRESSED STAMPED ENVELOPE AND 2 COPIES OF BILL
IF NOT PAID BY 12/13/2008 THIS BILL WILL BE RETURNED TO TAX
CLAIM FOR COLLECTION AND FlLING A LIEN AGAOdST YOUR PROPERTY
NOTICE OF PROPERTY TAX RELIEF
Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead
property. As an eligible homestead and/or farmstead property owner, you have received
tax relief through a homestead and/or farmstead exclusion which has been provided
under the Pennsylvania Taxpayer Relief Act, a law passed by the Pennsylvania General
Assembly designed to reduce your property taxes.
KLUXEN & NEWCOMER
ATTORNEYS AT LAW
339 North Duke Street
P. O. Box 539
Lancaster, Pennsylvania 17608-0539
Melvin E. Newcomer
Telephone No.
(717) 393-7885
David S. Kluxen, Jr. July 14, 2008 Fax No.
(1977 - 1993) (717) 393-0382
E-Mail Address
melvinnCa~epix.net
REGISTER OF WILLS OFFICE OF CUI~ERLAND COUNTY
One Courthouse Square
Carlisle, PA 17013 n
~-o
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Attention: Angie s c~
.;:~,- r
-- ~ u
,_-,
~
~ ~ to _~ i
Re : Estate of Charles H . Edwards .~ ~~ ~ ,. ~
No. 07-00959 -;i~-n ~
~ x:
~_~ ~--.
~
--~
~ -
--~,
--
Dear Angie: ~ ~
00
Pursuant to your telephone conversation with Pat of my
office, I am enclosing a $30.00 check made payable to the
Register of Wills in order to process the Inherita nce Tax
Return for the Edwards Estate.
Thank you for your help in this matter. If you need
any additional information, please do not hesitate to
contact tee.
Ver
MEL
MEN:pam
Enclosure - check
Thus pouch is reseelable. ,
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