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HomeMy WebLinkAbout08-13-08 (2)15056051047 REV-1500 EX (06-05) PA Department of Revenue ~ ~ - ~ "" Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 7 0 0 6 4 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 29 4 14 362'0 0'~ 25 2007 05 10 1917 Decedent's Last Name Suffix Decedent's First Name MI K R O E G E R M I L D R E D M (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 INAPPROPRIATE OVALS BELOW ~;: 1. Original Return ~ 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. limited Estate C ::J 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) :,.~r 9. Litigation Proceeds Received 3 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 8E DIRECTED T0: Name Daytime Telephone Number r-% KEITH .0. BRE NNE MAN ES DIRE Q `~~ `~ 7 1 7 f~ ~.? 7 8-~5 2 '8 ` Firm Name (If Applicable) ~ -- - ° _ - - - - ~ REGISTER 0!" yt+li=~ C1SlSt:2R7LY SNELBAKER & BR ENNEMAN PC _ ~~ '. < <~, First line of address _ ~ ~ _ -~ 44 WEST MAIN ST REET -'-" -~` - , c,a Second line of address - =°=1 -,~ ~ a ' N City or Post Office State ZIP Code ----- -- - - M E C H A N I C S B U R G P A 1 7 0 5 5 Correspondent's a-mail address Under pens s of perjury, I declare that I have examined this return, including accompan ' schedules and statements, and to the best of my knowledge and belief, it is true, rect and complete. Declaration eparer other than the personal repres t 've is based o II information of which preparer has any knowledge. SIGN OF PER N ESP OR FILING RETURN DATE gimme ~' Ca2,,2,%Executrix: `~ - ._~x.~~~~ _.._Aug~s~-12, 2008 tersburg Road, Carlisle, PA 1701 SIGN ~TIJE~'EJ Q REPARER OTHER THAN REPRESENTATIVE C~/Z vi TE ADDRESS l!~/ G T 44 W. Main Street. MechanicsburQ_ PA 1755 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J 15056052048 REV-1500 EX Decedent's Name: Mildred M. Kroeger Decedent's Social Security Number 2 9 4 1 4 3 6 2 0 RECAPITULATION 1. Reai estate (Schedule A) ........................................... .. 1. 1 6 5, 0 0 0. 0 0 2. Stocks and Bonds(Schedute 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 7 5 7 ' 4 S 6. Jointly Owned Property (Schedule F} O Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. '7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 1 6 8, 7 5 7. 4 5 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9• 2 ~ , 1 8 8 •0 0 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............. ... 10. 1 3 3 6 4 4 ' 9 7 11. Total Deductions (total Lines 9 8 10) ................................ ... 111. 1 6 0, 8 3 2 • 9 7 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 7 , 9 2 4 •4 8 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 3 s 0 0 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 4 9 2 4 • 4 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ . 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 . 17. 18. Amount of Line 14 taxable at collateral rate X .15 4, 9 2 4 •4 8 18. 7 3 8 •6 7 19. TAX DUE ...................................................... ...19. • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 L 15056052048 15056052048 REV-7500 EX Page 3 File Number Decedent's Complete Address: 21-07-00644 DECEDENT'S NAME Mildred M. Kroeger STREET ADDRESS 191 Easy Road ciTV - -----_ ---- --_- -- STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit ___ B. Prior Payments _ _ C. Discount (1) 738.67 ---_- -_- __ ___ Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest _ - _ 20 ._99_____ _ __ 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. 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. {5) (5A) 20.99 (56) 759.66 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 "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 exemot 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 isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether bV blood or adoption. REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT pECEDENT ESTATE OF SCHEDULE A REAL ESTATE FILE NUMBER Mildred M. Kroeger 21-07-00644 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 jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION nr n~eTu All that certain parcel of land improved with a single-family residential dwelling, located in North Middleton Township, Cumberland County, Pennsylvania, identified as Tax Parcel No. 29-05-0425-099, commonly known as 191 Easy Road, Carlisle, Pennsylvania (sale value); $165,000.00 TOTAL (Also enter on line 1, Recapitulation) ~ S 165 , 000.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOS{TS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Mildred M. KroeQer 21-07-00644 Indude the proceeds of litigation and the date the proceeds were received by the estate. Afl property jointly-owned with right of survivorship must be disclosed on Schedule F. REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mildred M. Kroeger 21-07-00644 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Ronan Funeral Home, funeral expenses $2,962.40 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Geraldine Ronan and Lynn Ronan 5 , 000.00 Street Address 759 Petersburg Road/729 Petersburg Road city Carlisle State PA _Z;p 17015 Year(s) Commission Paid: 2008 ($2 , 500 to each) 2. AttomeyFees to Snelbaker & Brenneman, P. C. 5,000.00 3. 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 4. Probate Fees to Register of Wills ($204.00) ; additional probate 329.00 fee due ($125.00) s. Accountant's Fees to Grennawalt & Company P. C. 395.00 s. Tax Return Preparers Fees , reserve and miscellaneous f ilingj 1, 500.00 administration expenses ~ Advertise grant of Letters Testamentary: a. Cumberland Law Journal: $ 75.00 b. The Sentinel: 166.60 241.60 g. Transfer tax upon sale of realty 1,650.00 g. Commission to realtor (Ebener & Associates) for sale of realty: . 9,600.00 10. Repair of septic system to Decedent's property 510.00 TOTAL (Also enter on line 9, Recapitulation) $ 27 , 188.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN scNEC-u~ ~ DEBTS C-E DECEDENT, MORTGAGE UABfUTIES, & UENS ESTATE OF FILE NUMBER Mildred M Kroeger 71-ny-nntii,i, 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 _ ____ nccrc~o~rinu OF DEATH ~. Financial Freedom Funding Corporation, conversion mortgage 300054397, balance due as of date of death 2. PPL Electric Utilities, payment on account of e]_ectric service 3. Embarq, payment due for telephone service 4. Sarah A. Todd Memorial Home, balance due for services provided 5. Capital Tax Claim Bureau, real estate taxes due on account 6. 2006 IRS tax liability $124,035.26 59.59 95.10 7,439.04 1,499.98 516.00 TOTAL (Also enter on line 10, Recapitulation) S ~ 133 , 644.97 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mildred M. Kroe er 21-07-00644 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Kathy Snyder None $5,000.00 360 North Middleton Road Carlisle, PA 17013 2. Shirly Morrison None 500.00 201 Easy Road Carlisle PA 17013 3. Barbara Turner None 5,000.00 89 Walnutdale Road Shippensburg, PA 17257 4. Geraldine Ronan None Various items of 759 Petersburg Road personal property Carlisle, PA 17015 5. Lynn Ronan None Personal papers 729 Petersburg Road Carlisle, PA 17015 (Continued) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON RE V-1500 COVER SHEET It NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1• Salvation Army, 20 East Pomfret Street, Carlisle, PA 17013 $1,000.00 2• WITF TV, 4801 Lindle Road, Harrisburg, PA 17111 1,000.00 3• West Shore Humane Society, 7790 Grayson Road, Harrisburg, 1,000.00 PA 17111 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) Estate of Mildred M. Kroeger Schedule J, Beneficiaries (Continued) Name and Address of Beneficiary File No. 21-07-00644 Relationship Amount or Share to Decedent of Estate 6. Connie Lee 20 Trim Street Kirkwood, NY 13795 7. Lebanon VA Medical Center 1700 South Lincoln Avenue Lebanon, PA 17042 8. Judith Fenstermacher 4980 State Rt. 45 Bristolville, OH 44402 9. Judith Harkness 144 Hickory Flat Road Harrison, OH 45030 None Photographs and letters None Reader's Digest books None Various items of personalty and '/2 of residue of Estate None %2 residue of Estate ~t`~ ,.x, xis T ~v'i~~~`~':tir~5'`v. ~' m ~'w`~~. ~~''~-'~.,,~~r?l~j~~~."~Vl7tTm. .p~..+~~; :9TTOR'VEY AT LAW' 19 S. HANOVER STREET-'SUITE 101 _ E C~IRLISLE, PENNSYLVANIA 12013 (717} 245-2648 • FAX (71 Z) 245=029 WILL OF~ MILDRED M. KROEGER I, Mildred M. Kroeger, of Carlisle, Cumberland Country. ~ennsylv<~nia, declare this to be my last Wili :end hereby revoke all prior tivill~; and Codicils. 1. i direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after m,, death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: A. {leave $1,000.00 to the Salvation Army in Carlisle; B. I leave $1,000.00 to WITF TV; C. I leave $1,000.00 to West Shore Humane Society; D. I leave $5,000.00 to Kathy Snyder; E. I leave $500.00 to Shirley Morrison. F. The remainder of my estate shall be divided equally between Judith Fenstermaker and Judith Harkness. Should Judith Fenstermaker spredecease me, her share shall go to her heirs. Should Kathy Snyder, Shirley Morrison or Judith Harkness predecease me, their share shall lapse and go to Judith Fenstermaker. LAW OFFICES OF STEPH..EN J. NOGG l9 S. i-IANOVER STREET SUITE 101 4. I appoint Lynne Ronan and Geraldine Ronan, jointly, or the survivor of either, as Executrix of this my last Will. 5. The Executrix of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. CARLISL 7013 j ~ ~7,-, E, PA 1 ~ , ~ /~~ 1 ~'' ~ ~ ~. I direct that nQ Executrix acting under this Will shall be required to-enter bond in any jurisdiction. IN WlT '? HE EOF, I have hereunto set my hand this ~~~~ day of ~~'~ :,~',~/ , 2004. ~o ~;, ~~' ~~ Mildred M. Kroeger r LAW OFFICES OF STEPHEN 1. HOGG 19 S. HANOVER STREET SLFITE 101 CARLISLE, PA 17013 The preceding instrument consisting of this and two other pages was on the day and date hereof signed, published and declared by Mildred M. Kroeger, as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. LAW' OFFICES Of STEPHEN J. HOGG I9 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ~,. ! ~ ~ ~ / WITNE~S j/e ~ ` /t f///~~/ v WI,~'NESS ~ (~ ACKNOWLEDGMENT State of Pennsylvania County of Cumberland ss I, Mildred M. Kroeger, the testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that { signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ,. Mildred M. Kroeger --~' Sworn to or affirmed and acknowledge~f6e s~Sr e , y Mildred M. Kroeger, the testatrix, this ~`? 'day of ~~~~~~~j--- 2004. M07ARIAL SEAL ~ ~' C- r ~" Si'SPIirN J. i10GP, +VOtAtRY E'UP.1..li; ~ •. CARLISLE gORO, cutxe~Ia1~~.Ir ~~ ~,,~ Notary PubliclA MY COMM18SIpN rXPIRE& SCf~;rF.g4&~55 3, 2pf15 State of Pennsylvania County of Cumberland AFFIDAVIT ss We, ~ ~.~rdre.~ ~ ,(~c61„ns and::...~~~rs~rr~1~ ~7 ;~, ~~` ~'~the ~~ - LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for t he purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influen/ce,~.+/~~ ~t.,t('!l-~" ..~R~E~''''.~)LiO,~-!/.~'L'; ~ `rte / ~!r-l~ /f r'. ~I ',~ .~'~/ ~/ ~orn to or aff~i'rm, nd su,bscribed to before me by witnesses, this ~- ~ day of ,~~i'?,,,~'`~. ~ '~ , 2004. Notary Public/ NOtA ,~ STEPH R/AL SEAL CARLIS EM J. HOGG, -dOtel3y PU MY COMMI&SIOMRO' CUM$ERLgAttY $i1C ExnlRes s ~Q•, PA EPTEM$ER 3, x405 .~~{ ~-,~~,C ~~ ~--, ~~~,~ ~~~ ~ Page 1 of 2 ,~" LIST OF PERSONAL ITEMS AND APPROXIMATE AGE CREATED IN 1995 UPDATED OCTOBER 24, 2005 To: Judy Fenstermaker and Family; Bristolville, OH; (330)889-2203 Contents of dinette including table, chairs, and 2 leaves Mini-lemonade set (pressed glass) Pressed glass bowl with artificial fruit Green tablecloth Hummel-like figurines Steins and glassware in original boxes (1954) Books: Heidi, Little Women; Little Men; and Jo's Boys To: Gerry Ronan; Carlisle, PA; (717)258-6760 Musical brass bell (Wanamakers' 1949) Musical Santa Claus face (Wanainakers' 1949) Curling iron (1920s) Nutcracker and pies 2 amber bowls candlesticks (80 years old) cake dishes (80 years old) Nippon vase Doilies and dresser scarf (90 years old) Snifters Bundt calve pan Rolling pin (Mom's) (80 years old) Wooden breadboard {Ritter's 1973) Gibson art cup and saucer Women's Home Companion, 1946 edition BH&G complete set cookbooks Pyrex mixing bowl {approx 1930) Miscellaneous Christmas items Living room furniture, loveseat-recliner, stationary recliner• To: Lynn Ronan, Executor; Carlisle, PA; (717)258-9863 Personal papers in safe Page 2 of 2 To: Claremont Nursing Home or Lebanon VA Hospital Condensed Reader's Digest Books since 1950 ~ 'r To: Co;!mie Lee, 20 Trim Street, Kirkwood, Binghamton, NY Navy photos - Hall Lee-Peter Crofts Letters and snapshots dating back to 190 To: Barb Turner; Newburg, PA; (717)530-2047 $5000.00. Stove, refrigerator, washer, dryer, draperies and curtains stay with the house. Se11 any other items -Gerry Ronan has first choice before the sale. SALE: Any unsold items -hold for two years then sell or give away. S ~ 4 ~\ 1 { 2 r~ ' ~ =-~-4_: 4~ 1~~,~j ~\C~yr ~.._ ~;ti k'~~"``a ~..~ 1. ~ ~L2~J`~-~Ce' 1 ~~'C'_ C~ ''~~"r - i_ 3 ~~., `c ~' ~ ~ ~ -~~,~ ~.~-,~.; Y--, ~ r~(~ ~ _~ ~: r;~.~ rte: ~ >c~~ , .,_, e c-- j ~,C~ m.i~r~1CCt"a v.`f~c:~~~~ CAF '~E'rlri`~,.~~,~Lri. n ~~f~Mh ~ ,~F"1 ~~.~~ ~' ~' ~ ~ CC7MMONWEALTH OF PENNSYLVANIA `,~ l Notarial Seal f~enise L Ham1an, Notary Public North Middleton Twp., Curnberland County My Commission Expires Mar. 3, 2Q09 iViember, Pennsylvania Association of Notaries INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTI-I OF PENNSYLVANIA 1 SS 21-07-00644 COUNTY OF CUMBERLAND f File Number Geraldine Ronan and L nn Ronan Personal Representatives} of the Estate of Mildred M Kroeger - 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 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 merporandum at the end of this inventory. ~~ I verify that the statements made in this Inven- tory are true and correct. I understand that false state- er a ine ments herein are made subject to the penalties of 18 Pa.C.S. § 4904 xelating to unsworn falsification to authorities. Attorney -- (Name) Keith 0. Brenneman ynn xonan (Supreme Court LD. No.) 47077 (Address), 44 W Main Street, Mechanicsburg, PA 17055 _ (Telephone) (717) 697-8528 GATE OF DEATH LAST RES{DENCE DECEDENTS SOC. SEC. N0. June 25, 2007 191 Easy Road, Carlisle 294-14-3620 REAL ESTATE FIGURES MUST BE TOTALED Property and residence at 191 Easy Road, Carlisle, PA PERSONALTY 1. Miscellaneous furniture, furnishings and personal property 2. Members 1st Federal Credit Union: a. savings account 00: $1,403.67 b. money management 05: 783.93 3. Survivor annuity payment, Office of Personnel Management 4. t„~007 Property tax rebate o ~~. ,- -. c%: !_ _ ~ ,--~ --- ,~7 c > - , .~ ~-~ (Attach additia~l sheets weeded) $165,000.00 671.50 2,187.60 398.35 500.00 TOTAL: ~ $168,757.45 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See ZO Pa. C.S. ~' 3301(6))