HomeMy WebLinkAbout08-05-0815056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box 28osa1 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 0435
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
184-05-0512 03/26/2008 02/16/1915
Decedent's Last Name Suffix Decedent's First Name MI
Peiffer Kathryn E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
N/A
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 2. Supplemental Return 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
• 6. Decedent Died Testate 7. Decedent Maintained a Living Trust _0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 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 Daytime Telephone Number
James D. Cameron, Esq. (717) 236-37ta~
~
=
Firm Name (If Applicable) _
f= ~? ~-'
REGISTER OFLS USE (`MtLY
L ~ ~'• c;
-. r--
First line of address E :~ i I
CJ`t
1325 North Front Street ~~ ~~~ - `~
- -a
Second line of address -t '°`
City Or POSt Office State ZIP Code DATE FILED .C-
Harrisburg PA 17102
Correspondent's a-mail address
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.
SIGNATU E OF PERSON~RE~PON~IBL FOR FILING BURN ATE
ADDRES-S ~-
5506 Union Deposit R _ d, Harrisburg, PA 1711.1 _ _ _ __
_ _
SIGNATURE OF(~EPA OT R THAN REPRESENTATIVE DATE
ADD ESS ~ _- ~~~ ~/ /~
1325 orth Front Street, Harrisburg, PA 17102
PLEASE USE
FORM ONLY
Side 1
15056051058 15056051058
J
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's rvame~ Kathryn E Pelffer 184-05-0512
RECAPITULATION
1.
..........................................
Real estate (Schedule A). 11.
.. 0.00
2. Stocks and Bonds (Schedule B) ..................................... .. 2. 1,904.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. ;l. 0.00
4. Mort a es & Notes Receivable Schedule D
9 9 ( ) ........................... 4.
.. 0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. Ei. 64,479.09
6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. Ei. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested...... .. T. 186,641.92
8. Total Gross Assets (total Lines 1-7) .................................. .. Es. 253,025.01
9. Funeral Expenses &Administrative Costs (Schedule H) ................... .. fl. 7,137.16
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 1CI. 2,048.74
11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 9,185.90
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 243,839.11
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... .. 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 243,839.11
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable
at lineal rate X .0 45 243,839.11 16. 10,972.76
17. Amount of Line 14 taxable
at sibling rate X .12 17'.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
10,972.76
15056052059 Side 2
15056052059
REV-1500 EX Page 3
Ilennrlnnf°c rnmrfln+p ~flflr'P_SC'
File Number
21 08 -0435
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
_Kathryn ____ E Peiffer _ _ __ _ 184-05-0512
STREET ADDRESS
36 West Factory Street _ _
CITY ~ STATE ZIP
Mechanicsburg PA , 17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 10,972.76
2. Credits/Payments
A. Spousal Poverty Credit __
B. Prior Payments 10,000.00
C. Discount 526.30
Total Credits (A+ B + C) (2) 10,526.30
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total InteresUPenalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, (5) 446.46
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 446.46
Make Check Payable fo: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "K" 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? .................................................................................................................. ...... 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.
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 exe_pt 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 blond or adoption.
_. . ..~_.;~ ~.,. , . ,cam ~_ ~:_?s..w a: r4_a .c, di:h_~.~ ~ ,,. .a _.~r .h,n~ ,....__r~. ~ ~ ~.~ ~ ~.._.
LAST WILL AND T EST,4N~ENT
OF
KA TIIR YN E. PEI FFL'R
1, KATHRYN E. PEIFFEK, of the Borough oI'Mfechanicsburg, County of
Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this my Last ~~'Vill and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can be conveniently done.
2.
I give and bequeath the sum of One "Thousand ($1,000.00) Dollars apiece, to
cash of my following named grandchildren, to wit, KIMBERLY HARPSTER, JOHN
STOUFFER, TONY SPENCER, NOEL SPENCER and WILLIAM SAUVE, and direct
that the inheritance tax on these bequest be paid out of my residuary estate.
3.
I give, devise and bequeath all the rest, residue and remainder of my estate, real,
personal and mixed, whatsoever and wheresoever the same may be situate, to my three (3)
daughters, to wit, SANDRA K. STOUFFER, VICKY L. VALCIS and DOROTHY A.
SIMMERS, share and share alike.
~,~ ;
a~:'
[[~ ;
xAe x~
!F~}.
'~
;:~~ s~rxYs::-,
(a) In the event that my daughter, SANDRA K. STOUFFER,
should predecease me, then in such event, I give and bequeath her share in
my estate to her husband, ROBERT L. STOUFF1h;R.
LASTLY, 1 nominate, constitute and appoint my daughter, V[CKY L. VALCIS,
Executrix of this my Last Will and Testament, and in the event that my said daughter should
predecease me, or should she be unable or unwilling to serve in such capacity for any
reason, then in such event, I nominate, constitute and appoint my son-in-law, ROBERT L.
STOUFFER, Executor of this my Last Will and Testament, ir- her place and stead, and in
all instances, I direct that my said personal representatives be excused from posting bond or
other security for the faithful performance of their duties, in any jurisdiction.
IN WITNESS WHEREOF, 1 have hereunto set my Land and seal this ~~iday of
November, A. D. 1999.
f
(SEAL)
Katy ryn E. Peiffer
Signed, sealed, published and declared by the above-named, KATHRYN E.
PEIFFER, as and for her Last Will and Testament, in the presence of us, who, at her
request and in her presence, and in the pr~c~each other, have hereunto subscribed ow
names as witnesses. ~ /
~~ U~
~.
-2-
_ ;~.
COMMONWEALTH OF PENNSYLVANIA )
SS
COUN'T'Y OF CUMBERLAND )
I, KATHRYN E. PEIFFER, the testatrix, whose name is signed to the attached or
foregoing instrt.ttnent, having been duly qualif ed according to law, do hereby acknowledge
that I signed and executed the same instrument as my Last Will and Testament; that I signed
it willingly, and that I signed it as my free and voluntary act and deed, for the purposes
therein expre~,s~ 1.
~ ~--ti (SEAL)
ath n L. Pei er
Sworn anscribed to before
me this Y , day of November, 1999.
c ~~ ~ ~~
Not Public
COMMONWEALTH OF PENNSYLVANIA )
SS
Notarial Seat
Marilyn E. Williams, Notary Pyblic
McChanlcsburg Boro, Cumberland County
My Commission Expires Nov. 6, 2001
iulomf~r, ptlnntylvania Association of Notaries
COUNTY OF CUMBERLAND )
We, the undersigned, J. ROBERT STAUFFER and SUSAN A. McCOY, the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the testatrix,
KATHRYN E. PEIFFER, sign and execute the instrument as her Last Will and
Testament; that the said testatrix executed it as her free and voluntary act for the purposes
therein expressed; that each of us, in the hearing and sight of the testatrix, signed the Will as
witnesses; and that, to the best of our kno dge, the testatrix was, at the time, eighteen (18)
or more years of age, of sound mind, d u er~,,e'onstrajnt, dt~re~s or undue influence.
Jam' ~~/G
CL ~
Sworn andscribed to before
me this ~" ~ day of November, 1999.
~~~~ ~~~~
Notary Public
Notui~ ary pupNc
Marilyn ErWigoamCumber~nd County - 3 -
Mechan~csbu 9, TO' res Nov 6, 2~t
My Commission ExW
Member, Pennsylvania Association of Notar'~s
REV-1503 EX+ (6-98)
c:
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kathryn E. Peiffer, deceased 21-08-0435
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(It more space is needed, insert additional sheets of the same size)
Investor Relations -Prudential Financial
Historical Price Lookup
Stock Quote ~ Stuck Chart ~ Historical Price Lookup ~ Investment Calculator
Symbol
PRU (Common Stock)
Lookup Date
March 26 2008
look Up
Results
Date Requested 03/26/08
Closing Price $76.220
Volume 2,904,694
Split Adjustment Factor 1.0000:1
Open $76.200
Day's High $77.060
Day's Low $75.260
http: //www. investor.prudential. com/phoenix. zhtml?c=12969.5 &p=irol-stock.
Page 1 of 1
07/28/08
REV-1508 EX+ (6-98)
SCHEDI~ILE Ep
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kathryn E. Peiffer, deceased 21-08-0435
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Miscellaneous tangible personal property (appraised value--please see attached) 72.00
2. Miscellaneous tangible personal property (net proceeds of sale) 1,360.86
3. Members 1st Federal Credit Union savings account number 110181-00 84.96
4. Accrued interest, Members 1st Federal Credit Union savings account number 110181-00 0.06
5. Members 1st Federal Credit Union checking account number 110181-11 292 87
6. PNC Bank checking account number 5030121359 1,480.83
7. Accrued interest, PNC Bank checking account number 5030121359 0.10
8. PNC Bank money market account number 5030121332 59,468.98
9. Accrued interest, PNC Bank money market account number 5030121332 80.21
10. Highmark Blue Shield (refund--health insurance premium) 182.17
11. United States Treasury (2007 federal income tax refund) 1,132.00
12. United States Treasury (economic stimulus payment) 300.00
13. Verizon (refund on account) 5.10
14. Comcast (refund on account) 18.95
TOTAL (Also enter on Pine 5, Recapitulation) $ 64,479.09
(If more space is needed, insert additional sheets of the sarrie size)
s 1~ 1~- ~ i ~~ ------------______.-----___
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MEMBERS 15~
FF.DERALCRF.DI"f UNION
REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix 110181-00
Date Account Established 08/11/1989
Principal Balance at Date of Death $84.96
Accrued Interest to Date of Death $.06
Total Principal and Accrued Interest $85.02
Name of Joint Owner None
CHECKING ACCOUNT:
Account Number/ Suffix 110181-11
Date Account Established 08/11/1989
Principal Balance at Date of Death $292.87
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest $292.87
Name of Joint Owner None
VISA:
Account Number/Suffix
Date Account Established
Balance at Date of Death
Name of Joint Cardholder
Estate of: KATHRYN E. PEIFFER
Date of Death: March 26, 2008
Social Security Number: 184-05-0512
4121449991101812
08/25/1989
$.00
None
'l~r
~rnV (~ 'N ~~il'~ t
~ ° ..
BERS 1ST FEDER CRE T USN, IOI`N
'~ ~ 1~-~--..
Ida ielle A. ine
Insurance Services Specialist
April 30, 2008
INSURANCE DEPARTMENT
5000 Louise Drive
P. O. Box 40
Mechanicsburg, PA 17055
1-800-283-2328 or (717) 697-1161
~in~~l I uui,e I~ri~~r l'.C). 131) ~~U Mecllanicshur~;, 1'eunsylvani.) 171155 (tiU(I~ ?~;~~?.;?;~ www.n)euiberel~torg
~~.
Tht ThkRlnq OeRieed The Mvn~
r-~er :3. xaoa
t~aes ~ C.a~euran
Attorney at iaw
?32S N FrnntSt
kiarrisriur~. ~A ~?412
FtE: K.aihryn 1E Pi+effer
SSN: 164-0S.OSt2
AO~: 03.2f,-2408
Data Mr. ~usraema:
]n res~sanae to yam nquc~rt far Die of Y~aath haisncns Ear tits c:ustarx~cr aotaci aborc~, rout
rokorde sikiw the followuig:
Ckeckta= Account
Account ~' 543012! 3S4 F..s~iibiish~+d Ik-~S~ f483
kATHR'YN ~ E'~'[FFEii.
GUt- betance: $ ],480.83 +0..14 uccruad interest
~it~a Accoont
Au:aunt# Sp30]21332 ~stabiialacci 04-25•]4$3
~za~~~x ~ ~r--.~~
1~D bttlence: S 59,415$.98 + 80.2 ] awan~cd intomst
X?;.c decedem tnsintoimcd [nvtstrt-ent Aoeount # ti'1219'3S~ Fnr fturt~e~r info~atiAr, yn+~
1~Y coataet tl+e E~t+okerage I3ep~rtrnenR At i -$OQ-74?.-Fs i 1 ] .
Axge ~ of 2
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Kathryn E. Peiffer, deceased 21-08-0435
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE 1RANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
~ Allstate annuity contract number GA277201, held in PNC Investments 186,641.92 100 186,641.92
account number 67219357 (please see attached)
Beneficiaries: Dorothy A. Simmers (daughter); Sandra K. Stouffer (daughter);
and Vicky L. Valcis (daughter)
TOTAL (Also enter on line 7 Recapitulation) $ I 186,641.92
(If more space is needed, insert additional sheets of the same size)
Allstate Life [nsurance Company
I'.O. I3ux 94212
['alatine, IL (10094-4212
clephune: (877) 499-6418
facsimile: (8(16) 635-4523
tilay 5, 2008
Inmes Cameron
1325 N. Front Street
I larrishur~, I',~~ 17102
Rc: Kathryn I'eiffer
~on(ract Nu: GA277201
Dear ]~~lr. Cameron:
A I I state :~,
You`re in good hands.
We have been requested to complete IRS Form 712 with regard to the above referenced contract. The
purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its
proceeds as of a certain date (usually the owner's date of death or date oftransfer of the contract).
I~his contract is an annuity contract, which is not reportable on IRS Forms 712. `I-he following information is
provided for estate purposes only as of the date specified:
Date of Death:
Annuity Value* as of Date of Death:
Cost Basis:
Named Beneficiary:
March. 26, 2008
$ 186,641.92
$ 186,325.64
Dorothy Ann Simmers, Sandra K.
Stoufer and Vicky L. Valcis
*~I~he actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
('harges.
If y;~u have any questions, please contact me at 1-877-499-6418 Ext. 862:23.
Sincerely,
J
l C~///./
.lonathan "Tong
Sr. Claim Examiner
REV•1511 EX+ (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kathryn E. Peiffer, deceased 21-08-0435
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT __
A. FUNERAL EXPENSES:
1' Jeffery's Flowers and Home Accents (funeral flowers) 392.15
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City ,State
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
~. Cumberland Law Journal (legal advertising)
s. The Patriot-News (legal advertising)
s. Pig Penn Hauling (refuse removal)
10. PPL Electric Utilities (electric service)
11. United Water Pennsylvania (water service)
(please see attached continuation sheet)
Zip
6.000.00
Zip
181.00
75.00
141.24
242.00
34.42
13.92
TOTAL (Also entE;r on line 9, Recapitulation) I $ 7 , 1 3 7 . 1 6
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H (continued)
Estate of Kathryn E. Peiffer, deceased
No. 21-08-0435
12. PPL Electric Utilities (electric service) 24.00
13. United Water Pennsylvania (water service) 8.68
14. Register of Wills of Cumberland County (short certificate) 4.00
15. PPL Electric Utilities (electric service-final bill) 11.75
16. United Water Pennsylvania (water service-final bill) 9.00
REV-1512 EX+ (12-03)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kathryn E. Peiffer, deceased 21-08-0435
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~ Ohio Casualty Insurance Company (insurance premium) 113.00
2. PPL Electric Utilities (electric service) 40.06
3. United Water (water service) 28.01
4. Comcast Cable (cable service) 53.29
5. AT&T (final bill--long distance service) 16.62
6. Verizon (telephone service) 42.74
7. Borough of Mechanicsburg (sewer & refuse) 108.32
8. MCHS Camp Hill (medical expense not covered by insurance) 886.00
9. Leffler Energy (balance due--fuel oil) 760.70
TOTAL (Also enter on line 10, Recapitulation) $ 2,048.74
(If more space is needed, insert additional sheets of the same size)
• REV-1513 EX+ (9-00)
~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Kathryn E. Peiffer, deceased 21-08-0435
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1 TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1- Dorothy A. Simmers, 120 Kim Acres Drive, Mechanicsburg, PA 17055 child 1/3 Schedule G and
1/3 residue
2- Sandra K. Stouffer, 7005 Horizon Terrace, Derwood, MD 20855 child 1i3 Schedule G and
1/3 residue
3. Vicky L. Valcis, 5006 Union Deposit Road, Harrisburg, PA 17111 child 1/3 Schedule G and
1/3 residue
4
5.
6.
1I
ton R. Stouffer, 2733 S.E. Taylor Street, Portland, OR 97212 grandchild $1,000.00
4imberly A. Harpster, 11451 Bethesda Church Rd., Damascus, MD 20872 grandchild $1,000.00
Noel W. Spencer, III, 2191 Canterbury Drive, Mechanicsburg, PA 17055 grandchild $1,000.00
(please see attached continuation sheet)
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 WHIGH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TATA1 ~~ MwnT 11 ~~ITCn TnTAI AInAI Tn VAI']I C I~1 G+T~'t1~11T1l1AIC l~AI I IAIC AZ /1C CC\/ ~Cl1l1 !`(1\/CD CLJCCT I Q
(If more space is needed, insert additional sheets of the same size)
SCHEDULE J (continued)
Estate of Kathryn E. Peiffer, deceased
No. 21-08-0435
7. Antoinette L. Spencer
1656 Columbia Avenue, Lancaster, PA 17603
grandchild
$1,000.00
8. William L. Sauve, Jr.
32 West Factory Street, Mechanicsburg, PA 17055 grandchild $1,000.00
i
i---
Reset Form
~,
INVENTORY `' ~ `
REGISTER OF WII_,LS OF CUMBERLAND
COMMONWEALTH OF t'fiNNSYI,VANIA 1 SS
COUNTY OF DAUPHIN /
Vicky L. Valcis
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COUNTY, PENN~~I~ANIIA
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file Number__ 21-08=04~~ ,~i -
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Personal Representative(s) ofthe Estate of Kathryn E. Peiffer
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and al] of the real estate in the Commomvealth of Pennsylvania of said Decedent, that: the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven-
tory are true and correct. 1 understand that false state-
ments herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name)
James D. Cameron
Vicky L. Va_Lcis, Execu rix
(Supreme Court 1. U. No.) 58998
(Address) 1325 North Front Street, Harrisburg, PA 17102
(Telephone) (717) 236-3755
DATE OF DEATH LAST RESIDENCE DECEDENTS SOC SEC NO
March 26, 2008 36 West Factory Street, Mechanicsburg, PA 17055 184-05-0512
FIGURES MUST BE TOTALED)
Miscellaneous tangible personal property (appraised value) 72.()0
Miscellaneous tangible personal property (net proceeds of sale) 1,360 ti6
Members 1st Federal Credit Union savings account number 110181-00 84.96
Accrued interest, Members 1st Federal Credit Union savings account number 110181-00 0.(~6
Members 1st Federal Credit Union checking account number 110181-11 282.87
PNC Bank checking account number 5030121359 1,480.83
Accrued interest, PNC Bank checking account number 5030121359 0.10
PNC Bank money market account number 5030121332 59,468.98
Accrued interest, PNC Bank money market account number 5030121332 80.21
25 shares common stock, Prudential Financial 1,904.00
American General Life and Accident Insurance Company (life insurance proceeds) 256.00
Prudential Financial (life insurance proceeds) 3 892 48
Highmark Blue Shield (refund health insurance premium) 182.17
United States Treasury (2007 federal income tax refund) 1,132.00
(please see attached for continuation)
(Atl«ch «dditiona/ s/reefs «s Weer/er/)
'I'OT'A ~,: ~ $ 7 0, 5 31.5 7
NOTE: "rhe Memorandum or real estate outside [he Commonwealth of Pennsylvania may, at the election of the personal ~eprescntanve include the ~aluc of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa C.S. ~' 3311! (b))
Form RW-09 rev. /OJ3.Of,
INVENTORY (page 2)
Estate of Kathryn E. Peiffer
No. 21-08-0512
United States Treasury (economic stimulus payment) 300.00
Verizon (refund on account)
5.10
Comcast (refund on account) 18.95
JAMES DURYEA CAMERON
ATTORNEY- AT-LAW
1325 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102
LICENSED IN BOTH PENNSYLVANIA
AND MARYLAND
TELEPHONE: (717) 236-3755
FACSIMILE: (717) 236-3655
Office of the Register of Wills
CUMBERLAND COUNTY COURTHOUSE
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Kathryn E. Peiffer, deceased
No. 21-08-0435
To Whom It May Concern:
August 4, 2008
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You will find enclosed the original and one copy of ari Inventory and the original
and two copies of a Pennsylvania Inheritance Tax Return for the above-referenced Estate.
Also enclosed are the Estate's checks, number 134, payable to "Register of Wills,
Agent", in the amount of $446.46, in payment of Pennsylvania Inheritance Tax due; and
number 136, payable to "Register of Wills", in the amount of $30.00, which represents
the filing fees for the enclosed.
Kindly file the original documents and return the time-stamped copies to me in
the envelope provided. Please contact my office if you have any questions. Thank you.
Sincerely,
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James .Cameron
JDC/sg
Enclosures
cc: Vicky L . Valcis, Executrix