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HomeMy WebLinkAbout08-21-08 REV-~50~ 15056041158 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 07 1115 Harrisburg, PA 1 7 1 28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1,80-26-5284 11232007 ],201,1,933 Decedent's Last Name HAMSHER Suffix Decedent's First Name DORIS (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First N<tme Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF~ WILLS MI B MI FILL iN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ~~ 3. Remainder Return (date of death prior to 12-13-82) ^ 4 it Li d E t t I ^ 4 F I t t t C i d f ~~ 5 . m e s a e a. I ure n eres u omprom se ( ate o . Federal Estate Tax Return Required 6. Decedent Died Testate ^ 7. death after 12-12-82) Decedent Maintained a Living Trust Il- 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 ~~ 1 1. 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 TO: Name Daytime Telephone Number RICHARD C• SNELBAKER, ESQU IRE 717-697-8528 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY SNELBAKER & BRENNEMAN, P•C• First line of address P•0• BOX 31,8 Second line of address 44 WEST f1AIN STREET ~ City or Post Office State ZIP Code DATE FILED ' : - r7 MECHANICSBURG PA 1,7055 1 ' c-~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and :>tatements, and to the best of my knowledge and beliaf, 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS :ECUTRIX 1107 BALDWI:N STREET, f1ECHANICSBURG, THAN REPRESENTATIVE DATE RICHARD C• SNELBAKER, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG, PLEASE USE ORIGINAL FORM ONLY Side 1 15056041158 6M46473.000 15056041158 I t J~.. ; _I 15056042159 REV-1500 EX Decedent's Social Security Number 180-26-5284 Decedent's Name:H A M S H E R D O R I S B RECAPITULATION 1. Real estate (Schedule A) 1. ], 3 8 0 0 0• 0 0 2. Stocks and Bonds (Schedule B) . 2. 0 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) • 3. 0 . 0 0 4. Mortgages & Notes Receivable (Schedule D). 4. 0 , 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E). 5. 676130 • 56 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8 9 8 6 9 - ~ 4 8. Total Gross Assets (total Lines 1-7). 8. 9 O 4 0 D O. 3 0 9. Funeral Expenses & Administrative Costs (Schedule H) . 9. 3 ], 2 6 9 , 2 4 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 10. 4 615 • 50 1 1. Total Deductions (total Lines 9& 10) . 11. 3 5 8 8 4. 7 4 12. Net Value of Estate (Line 8 minus Line 11) 12. 868115 • 56 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . 13. 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 8 6 8115 • 5 6 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~ 0, 0 0 15. O• O O 16. Amount of Line 14 taxable at lineal ratex.o4~ 868115.56 16. 39065.20 17. Amount of Line 14 taxable at sibling rate X .12 0, 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0, 0 0 18. 0, 0 0 19. TAX DUE 19. 39065 • 20 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042159 6M46482.000 15056042159 REV-1500 EX Page 3 Decedent's Complete Address: File Number 1115 DECEDENTS NAME HAMSHER DORIS B ___ STREET ADDRESS 4 AST COOVER STREET, CUMBERLAND COUNTY CITY STATE ZIP MECHANICSBURG - Tax Payments and Credits: 1 . Tax Due (Page 2 Line 19) 2 CreditsiPayments A. Spousal Poverty Credit 0 • 0 0 B. Prior Payments 3 0 0 0 0. 0 0 C. Discount 15 0 0 • 0 0 3. Interest/Penalty if applicable D. Interest 0 • 0 0 E. Penalty 0 • 0 0 (1) 39065.20 Total Credits (A + g + C) (2) 315 0 0 0 0 Total InterestlPenalty (D + E) (3) 0 . 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0 • 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAx DUE. (5) 7565 • 20 A. Enter the interest on the tax due. (5A) 0 • 0 0 B Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 7 5 6 5 • 2 0 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: 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? Yes ^^ ^ ^ No X^ 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? X^ ^ 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. X9116 (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 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)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 6M4671 1 000 RE~_,5°zEX'`"ge, SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris B. Hamsher 21 07 1115 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 DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. Real Estate known and numbered as 405 East Coover Street, Mechanicsburg Borough, Cumberland County, PA, sale value (see attached settlement sheet) 138,000.00 TOTAL (Also enter on line 1, Recapitulation) I $ 138 , 000.00 swasss r o00 (If rnore space is needed, insert additional sheets of the same size) ~~x>testoga ~'iile Insurance Co. Settlement Statement U.S. Department of Labor and Urban Development FAX. 71'1-295-7155 OMB No. 2502-0265 A. HUD-7 UNIFORM SETTLEMENT STATEMENT B. Type of Loan 1. [ ]FHA 2. [ ] FmHA 3. [ ]Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4. [ ] VA 5. [ ]Conv. Ins. _ C. NOTE: This form furnishes a statement of settlement costs. Amouts paid to and by the settlement agent are shown. Items marked "(p.o.c)" were paid outside the closing; they are shown for informational purposes and are not included in the totals. D. Name & Address of Borrower: E. Name, Address and TIN of Seller: F. Name & Address of Lender: Tyler John Miller Estate of Doris B. Hamsher, Deceased John C. Crowe 1122 Granada Lane Gail H. True, Executrix, 1107 Baldwin Street 521 Brentwater Road Mechanicsburg, PA 17055 Mechanicsburg, PA 17055 Camp Hill, PA 17011 TIN of Seller: G. Property Location: 405 East Coover Street Borough of Mechanicsburg, lvania 17055 Penns t d C b l Place of Settlement: 44 West Main Street Mechanicsburg, Pennsylvania 17055 Phone: (717) 697-8528; FAX: (717) 697-7681 H. Settlement Agent: Keith O. Brenneman y oun y, Cum er an Date of Settlement: June 30, 2008 J. Summary of Borrower's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract sales price $138,000.00 401. Contract sales price $138,000.00 102. Personal property 402. Personal property 103. Borrower's settlement charges (line 1400) $4,214.75 403 104. Mortgage Payoff 404 105 405 Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106. City/town taxes 06/30/08 to 12/31/08 $151.79 406. City/town taxes 06/30/08 to 12!31/08 $151.79 107. County taxes 06/30/08 to 12/31/08 $124.73 407. County taxes 06/30/08 to 12/31/08 $124.73 108. Assessments to 408. Assessments to 109. School Taxes to 409. School Taxes to 110 410 111 411 112 412 113 413 120. Gross Amount Due From Borrower $142,491.27 420. Gross Amount Due to Seller $138,276.52 200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due to Seller 2D1. Deposits or earnest money $10,000.00 501. Excess deposit (see in:,tructions) $10,000.00 202. Principal amount of new loan(s): $128,000.00 502. Settlement charges to seller (line 1400) $1,385.00 203 503. Existing loan(s) taken subject to 204 504. Payoff of first mortgage_ 205 505. Payoff of second mortgage 206 506 $0.00 207 507 208 508 209 509 Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210. City/town taxes to 510. City/town taxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213 to 513 to 214 514 215 515 216 516 217 517 218 519 220. Total Paid Bylfor Borrower $138,000.00 520. Total Reduction of Amount Due to Seller $11,385.00 300. Cash at Settlement Frorn/to Borrower 600. Cash at Settlement Talfrom Seller 301. Gross amount due from borrower (line 1'L0) $142,491.27 601. Gross amount due to seller (line 420) $138,276.52 302. Less amounts paid bylfor borrower (line 220) $138,000.00 602. Less reductions in amount due seller (line 520) $11,385.00 303. Cash [ ]from [ ] to Borrower $4,491.27 603. Cash [ ] to [ ]from Seller $126,891.52 Substitute Form 1099 Seller Statement The information in Blocks E, G, H, I & line 401 (or if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is required to be reported and the IRS determines chat it has not been reported. If this real estate is your principal residence, file FOF;M 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable; parts of Form 4797, Form 6252 and/or Schedule D (Form 1040). You are required to provide the Settlement Agent (named above) with your taxpayer identification number. If you do not provide the Settlement Agent with your taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. ] 23 Fast Ding Si:reet, Lancaster PA 1.7602 Phone 1-800-73?.-3555 to Lancaster 299-4805 Seller Seller L Settlement Charges 700. Total Sales/Broker's Commission: (based on Division of Commission (line 700) as follows: 702 703. Commission paid at Settlement 704 800. Items Payable in Connection with Loan 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee 804. Credit Report to 805. Lender's Inspection Fee 806. Mortgage Insurance Application Fee 807. Flood Certification Fee to 808. Lender's Attorney's Fee to Karl M. Ledebohm, Esquire 809. Document Preparation Fee 810. Plan Review to 811. Assumption Fee to 812 813 814 900. Items Required by Lender to Be Paid In Advance 901. Interest from to 902. Mortgage Insurance Premium for 903. Hazard Insurance Premium for Paid from Borrower's Funds at Settlement d 1,500.00 0.00 Paid Seller's Funds at Settlement 905 1000. Reserves Deposited with Lender 1001. Hazard Insurance months @ per month 1002. Mortgage Insurance months @ per month 1003. City property taxes months @ per month 1004. County property taxes months @ per month 1005. Annual assessments months @ per month 0.00 0.00 0.00 0.00 0.00 1006. School taxes months @ per month 0.00 1007 1008 1009. Aggregate Accounting Adjustment 1100. Title Charges 1101. Settlement closing fee 1102. Abstract/title fee 1103. Title examination 1104. Title insurance binder 1105. Document preparation 1106. Notary fees 1107 Attorney's fees to (includes above item numbers 1108. Title insurance to Keith O. Brenneman, Agent, Conestoga Title Insurance Company 1,048.75 (includes above item numbers 1101-1106) 1109. Lender's coverage:$128,000.00 1110 Owner's coverage:$138,000.00 1111. Insured Closing Letter -Conestoga Title Insurance Company 35.00 1112."Endorsements 100, 300, 8.1 150.00 1113 1200. Government Recording and Transfer Charges 1201. Recording Fees: Deed: $38.50 Mortgage: $62.50 M/L Stip: .,...~~.,.....,,. nAP~t R1 sRn nn RAnrfnane 101.00 1.380.00 1203. .,,. y, ...,.....r .,.,., .,._...r- ~ - - State tax/stamps Deed: $1,380.00 Mortgage: 1,380.00 1204 1205 1206 1300. Additional Settlement Charges 1301. Survey 1302. Pest Inspection _ 1303. Courier Fee to 1304. R/E Tax Certification to Barry L. lieckard, Mechanicsburg Borough 5.00 1305 _ 1306 1307 1308 1400. Total Settlement Charges (This number transfers to Lines 103 & 502 Above) 4,214.75 1,385.00 Certification have carefully reviewed the rlUU-1 ~etuemen[ a[aremenr ana [o me oesr or my rcnowieage ana ueuet, it rs a uue anu accurate statenront ur au reciepts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlerent Statement Estate of Doris B. Hamsher, Deceased Tyler John Miller By Seller Gail H. True, Executrix To the best of my knowledge the HUD-1 Settlement Statement which I have prepared is true and accurate account of ilie funds which were received and have been or will be disbursed by the undersigned as part of the settlement of this transaction,. Settlement Agent Date: June 30, 2008 Keith O. Brenneman WARNING: It is a crime to knowingly make false statements to the I.lnited States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1(110. REV-1508 EX + (6-58) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN o~cin~nR nF!`F nFNT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF Doris B. Hams ITEM NUMBER n~~ rvumo~r~ 21 07 1115 Include the proceeds of litigation and the date the proceeds were received by the estate. All orooerN jointly-owned with the right of survivorship must be disclosed on Schedule F. 1 2008 Economic Stimulus Payment 2 AAA subscriber refund 3 AARP refund 4 Erie Insurance refund unused premium 5 Fulton Financial Advisors distributions from Trust and IRA account 6 Fulton Financial Advisors Deed of Trust, account #41-F301-O1-8 7 Household goods sold at public auction 8 Internal Revenue Service refund on 2007 Final Individual Income Tax Return 9 Member's First Federal Credit Union certificate of deposit, #253176-45 Interest accrued to 11/23/2007 10 Member's First Federal Credit Union certificate of deposit, #253176-42 Interest accrued to 11/23/2007 11 Member's First Federal Credit Union certificate of deposit, #253176-41 Interest accrued to 11/23/2007 12 Member's First Federal Credit Union certificate of deposit, #253176-40 Interest accrued to 11/23/2007 13 Member's First Federal Credit Union savings account, #253176-00 Interest accrued to 11/23/2007 Total from continuation schedules 5,000.00 14.89 10,000.00 29.78 20,000.00 58.95 10,000.00 25.13 303.77 0.18 210,397.04 3 W46AD 1.000 TOTAL (Also enter on line 5, Recapit (If more space is needed, insert additional sheets oithe same size) VALUE AT DATE OF DEATH 600.00 35.00 13.99 127.00 1,489.00 408,191.33 5,727.50 4,117.00 676,130.56 Estate of: Doris B. Hamsher 180-26-5284 Schedule E (Page 2) Value at Date Item No. Description of Death 649.00 14 PA Department of Revenue refund on 2007 Final Individual Income Tax Return 35.00 15 Patriot-News subscriber refund 10,000.00 16 Pennsylvania State Bank certificate of deposit, #9150012955 Interest accrued to 11/23/2007 36.55 17 Pennsylvania Treasury Department 346.54 pension payments due the decedent 1,620.94 18 PNC Bank, N.A. checking account, #5070080061 Interest accrued to 11/23/2007 0.25 19 RiverSource Life Insurance Co. 1,132.24 refund unused premium on long term care insurance 10,000.00 20 Sovereign Bank certificate of deposit, #1685505834 Interest accrued to 11/23/2007 29'70 6,000.00 21 Sovereign Bank certificate of deposit, #1685358630 Interest accrued to 11/23/2007 17'82 12,000.00 22 Sovereign Bank certificate of deposit, #1685312769 Interest accrued to 11/23/2007 39.29 38,943.66 23 Sovereign Bank money market account, #1684067030 Interest accrued to 11/23/2007 82'63 2,407.15 24 Sovereign Bank checking account, #1681710552 Interest accrued to 11/23/2007 0.11 25 Travelers checks 370.00 cash found in residence 26 Wachovia Securities, LLC 126,686.16 brokerage account,#4018-4486 Total (Carry forward to main schedule) 210,397.04 REV-1550 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURPJ RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY TATS OF oris B. Hamsher FILE NUMIitK 21 07 1115 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 NUMBS DESCRIPTION OF PROPERTY r~c~~oErrewNneoFrrerRnr~sFEReerHeiRREUrioNSwPro~~ECeoerrrnNO rrEOnrEOFrRansFERnrrncHncoavoFrHEOEEOFOrzRE~a~ESrnrE DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION pFAPFUCABLE TAXABLE VALUE 1 Fulton Financial Advisors 81,914.41 100.0000 0.00 81,914.41 IRA, account #90-F557-O1-2 2 Genworth Life and Annuity 955.33 7 100.0000 0.00 7,955.33 Insurance , annuity, account #3876338A TOTAL (Also enter on line 7, Recapitulation) $ gg , 869.74 (If more space is needed, insert additional sheets of the same size) 3W46AF ~ 000 __ RED-,5„•Ex."°-os, SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURPJ ADMINISTRATIVE COSTS aESmFnIT DFC;EDENT ESTATE OF FILE NUMBER Doris B. Hamsher 21 07 1115 Debts of decedent must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: 392.81 ~ Funeral luncheon and flowers Total from continuation schedules . 10,387.19 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 10 , 000.00 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach e~lanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 350.00 5. Accountant's Fees 280.00 6. Tax Return Preparer's Fees 7. 1 Blizzard Plumbing 111.27 plumbing repairs I I Total from continuation schedules 9,747.97 TOTAL (Also enter on line 9, Recapitulation) j $ 31 , 2 6 9 . 2 4 (If more space is needed, insert additional sheets of the same size) ~wasAC ~ o00 Estate of: Doris B. Hamsher 180-26-5284 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Gingrich Memorials inscription on marker 270.00 3 Malpezzi Funeral Home, Inc. funeral services 10,117.19 Total (Carry forward to main schedule) 10,387.19 Estate of: Doris B. Hamsher Schedule H Part 7 (Page 2) 2 Brickers Auction commission and expenses on sale of household goods sold at public auction 3 Cumberland Law Journal advertising Executrix notice 4 Expenses incurred for preparation of auction 5 Fulton Financial Advisors fees paid on trust and IRA account 6 Jewelry appraisal fee (sold at public auction with household goods) 7 Patriot News advertising Executrix notice 8 PPL Electric electric service 9 Register of Wills filing fee for Inheritance Tax return 10 RSR Appraisers and Anaylsts real estate appraisal fee 11 Settlement costs on sale of real estate as follows: a. transfer tax - $1,380.00 b. tax certification - $5.00 12 U.S. Postal Service postage expenses 13 UGI gas service 14 United Water Pennsylvania water service 15 Wachovia Securities, LLC fee for obtaining date of death values Total (Carry forward to main schedule) 180-26-5284 2,710.50 75.00 50.00 3,194.35 55.00 149.30 224.78 15.00 350.00 1,385.00 27.67 406.75 79.62 25.00 8,747.97 180-26-5284 Estate of: Doris B. Hamsher Schedule H Part 7 (Page 3) 16 Reserve for filing fees, accountant fees, and other miscellaneous fees associated with the administration of the decedent's estate 1,000.00 Total (Carry forward to main schedule) 1,000.00 REV-512 EX +~,.',2-031 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris B. Hamsher 21 07 1115 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1_ Barry L. Heckard real estate taxes 553.03 2 Borough of Mechanicsburg sewer/refuse service 3 Chase Credit Card Services ,payoff credit card 4 Comcast cable TV service (9.44 less refund 2.56) 5 Pennsylvania Department of Revenue estimated tax payments 2007 PA-41 6 PNC Bank check number 2982 $25.00 and check number 2990 $50.00 written by the decedent October 31, 2007 and November 17, 2007 7 PPL Electric electric service 8 United States Treasury estimated tax payments 2007 1041 9 United Water Pennsylvania water service 10 Verizon phone service 11 Verizon Wireless cell phone service TOTAL (Also enter on line 10, (Recapitulation) $ 3wasnH 2 000 (If more space is needed, insert additional sheets of the same size) SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS 108.32 64.32 6.88 619.00 75.00 45.71 3,094.00 13.76 26.93 8.53 4,615.50 REV-, 5,3 EX+~9.°°' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF 21 07 1115 Doris B. Hamsher RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTUONder(Sec 9116t( )h(1s2j)usal distributions, and transfers 1 Gail H. True 1107 Baldwin Street Mechanicsburg, PA 17055 Fulton Financial Advisors Inventory Value: 40,957.20 Genworth Life and Annuity Insurance Inventory Value: 7,955.33 438 035.45 One Half of Residue: 389,122.91 Daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 EI, 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 I $ 0 . 0 0 (If more space is needed, insert additional sheets of the: same size) 3W46AI 1.000 Estate of: Doris B. Hamsher Schedule J Part 1 (Page 2) 180-26-5284 Item REalation Amount No. Description 2 Kristin Noel True Runyon 3105 Penbrook Avenue Harrisburg, PA 17109 Fulton Financial Advisors Inventory Value: 20,478.60 One Quarter of Residue: 194,561.45 Granddaughter 215,040.05 3 Philip Michael Hamsher True 1107 Baldwin Street Mechanicsburg, PA 17055 Fulton Financial Advisors Inventory Value: 20,478.60 One Quarter of Residue: 194,561.45 Grandson 215,040.05 I_,AST WILL ANU TESTAA~ENt~ 1, I~OR1S f3. l-IAMSHER, of the Borough of IVlechanicsburg, Count}~ of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, menu~ry and understanding, do make; publish and declare ibis as and for my Last Will and ~l'estament, hereby revoking and mal<ing void all former wills and codicils by me ~.ll anytime heretofore made. l~ IIZST. 1 order and direct that all my just debts and funeral expenses be paid by m}~ Executrix or L;xecutor, as the case may be, hereinafter named, as soon as conveniently may be done alder my decease SECONll. 1 order and direct that all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situated, be converted into cash or ocher distributable form as soon as practicable after my death, which shall be distributed and disposed of as follows: A. 1 give and bequeath unto each of my great grand-children living at the time of my death, a sum of money equal to one (I) ~~er cerium of my net distrib~~ilable residuary estate. In the event that any such bencliciary is a minor at the time of my death, 1 authorize and empower my Executrix or executor, as the case may be, to accept a receipt and release fi~om the beneficiary's parents on behalf of the beneficiary, in Iieu of a formal guardianship or trust. B. t order and direct that the balance ofnry residuary estate be divided into [our (4) equal earls, which parts shall be distributed and disposed or as follows: (]) f give and bequeath t«~o (2) such parts of my resid>~ary estate unto my daughter, namely GAIL I 1. TRUE, absolutely, if she survives me. Ifiuy said daughter should predecease me, i order and direct that said bequest shall Iapse and tl,e sub;ect matter thereof shat] he a~Ide~i to and listributed in accordance.•~~ith LAW OFFICES SNELBAKER, BRENNEMAN & SPARE subparagraph (2) hereinbelow. (2) 1 give and bequeath one (1) such eq~.~al part unto each of my two (2) grandchildren, namely, KRIS"f~tN NOIa, Tf2UE aiui PHILiP NIiCIIAEL HAMSlIERT1ZITl:, absolutely. lfeitlterofmy said grandchildren should predecease me and Ieave issue to survive me., l order and direct that the share attributable to such deceased beneficiary sha~.ll be distributed auto his or her issue per stirpes by representation and not per capita. If any such alternative beneficiary has not attained the age of hventy-three (23) years at the time of distribution, I order, direct, authorize and empower my Execuh~ix or Executor. as the case may be, to pay-over and distribute any such distribi:-table amount to the surviving parent of the beneficiary in trust, nevertheless, to hold, invast, reinvest and acc~mlulate income for said beneficiary until said beneficiaryy attains the age of twenty-thee (23) years, at which time said trust shall. be terminated and the then balance thereof shall be paid over and delivered unto the beneficiary absolutely. LASTLY. T nominate, constitute and appoint my da~~.-ghter, namely, GAIL H. TRUE, to be the Executrix of this, my Lust Wi11 and Testament, but if for an}~ reason ray said daughter should Lail to qualify as such Executrix or cease so to serve, then and in that event. I nominate constitute and appoint my son-in-law, Tamely, MICH_AB( D. TRl)E, to be the Executor hereof: each and both to serve without bond or other security as a condition of qualitication hereunder. IN WITNESS WIlEREOF, I, DORIS I3. F[AMSI-LER, have hereunto set my hand and seal to this my Last Will and Testament, which consists ol~tvao (2) typewritten pages to each of which 1 have affixed my signature this 22°~ day of October, A.D., 7'wo Thousand One (2001). .~.~' DORIS ~ HAMSIIER LAW OFFICES SNELBAKER, BRENNEMAN & SPARE "fhe preceding instrument, consisting of this and one (l j other typewritten page each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by I~OP~IS B. HA1~~;I-IEI:, the l :;statri<~ therein na;~~ed, as and for leer Last ~,~'ill and "Testament, 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 heretc -~- CO~II~~IONWIALTH Oh' PENNSYLVANIA) AW OFFICES ~~NELBAKER. RENNEMAN & SPARE COUNTY i~F CUMBERLAND ) SS. We, DORIS B. IIAMSHEIZ, RiCH~123~ C. SNF,LI3AkER and JANE :I. ('OONEY, the Testatrih and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will. acid Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a «~itness and that to the hest of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue inth~ence. ~, /. ./,' '? ~/ ,' ~. , T -~ trtx -~4~ --- _ Fitt ss - ------ Wit~ss ----- Subscribed, sworn to and acknowledged before me by DORIS I3. HA>\-ISEIL:[Z, the Testatrix; and subscribed and s~>,~orn to before me by RICIIAIZD C. SNELBAKER and JANE J. GOONEY, the witnesses, this 22°`~ day of October, 2001. ,~ a ::.mil v~~'`. _ „ 1,, _ -~--- -_ _ ~~~. . Notary Publ~'c~~ t,, niota~tat seat susan t~ zv~, tvc~y Pubttc M1ec~t-anicsbwg 8oro, Glxnbertand Caur~y My Corrur~issFon Expdres t~v. 34, ~3 ember, raga AssoCiattoR of t~tarise