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HomeMy WebLinkAbout08-28-08 (2)15056041046 REV-1500 EX (05-04) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Dept. 280601 RESIDENT DECEDENT ~ ~ Q ~ ~ ~ ~ `~ Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~~ 07~~26~~ oq©'l f~ t5 Suffix Decedents First Name MI D~_~:dents Last Name ~'r'3 ~ N ~ /-~ ~ ~ S C I L ~. ~ G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) ation Proceeds Received O Liti O 9 (Attach Copy of Trust) under Sec. 9113(A) ax 10. Spousal Poverty Credit (date of death O 11 ~ g . O Attach Sch between 12-31-91 and 1-1-95) ( ) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number Name ~} ~ ~I" ~ ~' ~ t~ ~~ ~ ~~ '7 J 7 ~ 1 % c~ ~ ~ 3 Firm Name (If Applicable) First line of address ___.~ ~ ~ Rork ~ u~ ~~ ~~.~ r Second line of address ZIP Code REGISTER OF WILLS USE ONLY r-_ ~ ~' ~ ,: _, -, ~. _'`? _ r ,> DATE-FILED ~- City or Post Office State ,-~ _ ~ _ti °~ 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 knowledrg~e.t~` SIGNAT.jjRE OF PER~S_ODN,RESPONSIBLE FOR FILING RE_ J RN ~ l~v U ADDRES~n ~ ~ ~~~ ~ c~~~i-- -,A. SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE G DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 15056041046 Side 1 15056041046 15056042047 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~ ~ ~ ~~ - ~ '~ RECAPITULATION 1. Real estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. ~ ~ ~~ J ~ , 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. r ~ ~; ~ J ~ fJ C.~ J J~ ~ 6. Jointly Owned Property (Schedule F) G Separate Billing Requested ..... .. 6. c ~ r ~ ! 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. ~-7 , ~ ~ ~ ! g f ~ ?`? ~ . 8. Total Gross Assets (total Lines 1-7) ....................... ........... .. s. ~ ~ ~ ~ l ~ ~ ~ m 7 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~ ~ `#- 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. ~ ,11. Total Deductions (total Lines 9 & 10) ............................., ... .. 11. ~ ~ ~ ~ ~ 3 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 7 ~ j C=- ~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........... ~ ~ £~ .............14. ~ ~ . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ~ ~ ~ ~ ,/ ~r ~ ~ ~ ~ ~ J + ~j 16. Amount of Line 14,t~,x~ble ~ --r ? l ~^ ,f at lineal rate X .0 ~ J~~ ~ . T--^- 16. ~--~'- 17. Amount of Line 14 taxable • at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE .........................................................19. ~ ~ d d~ ~. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p C/~~ 15056042047 Side 2 15056042047 REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ 1 `--' ~ Q - ~ ~ ~ g per s~,c c_~.~~ ~ ~2~~J~ _ _______ _.- - _ __ _ _ - _ _ _ ---_ __-- _ - STREET ADDRESS ~~ ~~ f _ _ __ _ - __ - -_ _ _ T _ - - CITY fin ~~ ~"~c~~0 ~ I ~.S ~t~ /~ t~ __ - i ST`~~~1~s~'~ tf~r~i~~P ~~QSS -- ~~S Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A, Spousal Poverty Credit _ - _ _ _ _ _ _ _ _ B. Prior Payments _ _ _ C. Discount j ~ CI ~_'~~~, T- - - Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest _ __ 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. Make Check Payable to: REGISTER OF WILLS, AGENT s'z, dSg.~ ~z t,~c`~_Lj2 (5A) (5B) PLEASE ANSJVER 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? ....... ....... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................. ....... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98) - SCFIEDIJLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. U ~ S . how ccc,~ b , ~-~ce.¢ Ff tl : ~/~ ooc ~ (, ~ p c ,-- (rJC-i ~ ~ r Sc~o ,-- to c~~ 3 ®~ coo ~~~~ ~ ~ , ~ , U. S . SaU ~ ~io'z~ , yLfav, r,~ l ~~ / a `~ ?. ~Q`~/ . ~za~ ~ y33-~° ~,Q ! ~ 4 5 sow ~ ~` l~~s ~t 3 3~ ~ e I ~, ~p (~r ..- TOTAL (Also enter on line 2, Recapitulation) I $ ~ Sg ~ ~ ~` ~ / (If more space is needed, insert additional sheets of the same size) REV-7508 EX+ (7-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY_ ESTAT OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~ _; - G~ ~.~`~' z ~,~. ,. I~ C ~ c~a,e-~C ~22.y,~,~,-vn ~ ~ ~ ~ ~n ~ ~~ ~~~~~ ~~zY ~, ~~~~~~ ~~ L ~ . ~~ ~~~ ~ ~ ~ ~~ TOTAL (Also enter on line 5, Recapitulation) I $ ~~ ! ! ~~ ~ ~~ (If more space is needed, insert additional sheets of the same size) ~ g Y J ~.~. /^'_" ~~C~'~"^~ ~-- ~ t ~. ( __~ ~ 1. ~:~~c.~~_~. rat - ;; C'u~lru~C~, l L~ ', .; ~~-~1,r~ _ _ _ -~ ~ ,. - i ~ ~ _. ~~~ f __ - - / ~ ~ t ;, _ ~ ~~lrC~t7.G~l Z(~!/~r _ ~y~ _ ~ .-. _~ _ U _ __ ..O .. _.. _ i ~ ' a "_ S_naG~ ~"v _, ~_F-eLl j _ _ _ ~` ^ ,; -_ ~ _. ,, u , ',' ,, -~ __ ~ __ _. lS~,- it ~ _ _ _ ___ __ ~~ _. ~~ ~~ _ - G_ - ~a_-, _ t~ i -~ ~~',- ~~ ~~- .- i ~%t-~ - _ _ _ _ _ _ _ _. ~~, }} __ E ~~~-+ - _ ~~ ~, f ~ ~ __ _ ~~ _ ~e .- - - ~ i _. ~~o I# ~~ {! ~' j __ _ ____ __ .. _ _ _ i I I ~~} ~~,p ,`~`, /~yy~n~ /J ~~P ~~ i 3~ _ , -- Q, S ~- ~/!/G~hL.. Grp ' ;, ,~~ G __ ,: 2_ _ u,~1~u t~~c-ece~. c - ~ / f _. ~ V .i ,,i ~ ~ - ~_ . i - _ _._ _ ~ ~! r ,, ;; _ __ -__ _ r 2_- -. S7~ .~ i ~fy~,~ .^-~- '~ S~3 ~', _ _ _ _ __ _ _ ; : __ __ _ .. _ _ -_ ___ _ _ -_ _S~-_ _ _~ _---, _ _~ _. // Y 1 ' ,~f/A/` ~~j t ~/~///yy ~ M 1 _. _.. 9 t j_- I! _ __ -_ _ . ~ -~_~t .~c ~~ ~' _ _ __ _ - ao , j _ ~_ (2 Gc..c~-ec _ _ _ _ -- - ~G _ ~ ~ ~7 ,~ ~-- i _ __- _ _ _ _ _ _ _. _ Q z ;~ _- _ _ __ _ '; _ f, II -.- i~l° Eet~-~L~ - ~1:IF~E~7 c1-~ ,~ ~ ~ 14 _ _. __ ____ __ __ _ . _ __ - - ' l r ~~_.~l~-C!.Q~l ~~~ _ a ~u~ ~1 3D 0 _~ _ - {. ~ I ~~ ~{ ~.~ j~ 1• t, i~ I ~~ ~i ~~ +j ~~ 1 I ;1 j y{ i ~.~ f ~~ )^ ~C'~~' ~~ t r ~~` / i ~...,, REV-485 EX (1-07) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue X77: ~ -,z 4850004],046 PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number bale of Death County Code Year File Number < r~x ~ ~ ~ Decedent's Last Name Suffix First Name MI ' ~ ~ 1ni ~,'~ .r..".. AD,~~D{{~~R''E~~SS OF DECEDENT STREET: ~+ ` CITY: ~~Cis.1r7J ~ .:~~'~. ~ c~c^~•. 1~.``Ict mss'` .^.t (' t't.~.'S~: v '~, ~, '~"'t•~a, STATE: ZIP CODE: t~ ~~`,}~ `.. ... NAME AND ADDRE$~ OF PERSON, REQUESYING THE OPENING OF THE SAFE DEPOSIT BOX NAME: - _ STREETADDRES~S CITY: STATE: CAt3'E: NAME, ADDRESS AND RELATIONS P (IF ANY) TO DECEDENT, OF PERSON(Sj PRESENT AT THE BOX OPENING a. NAME: RELATIO SHIP: STREET ADDRESS: ,. CITY: ---., ,. STATE:. _ ZIP CODE: mac-'.--~'- --- b. NAME _ RELATIO SHIP: STREET ADDRESS: ~ \ ~ CITY j STA ZIP CODE: c. NAME: RELATIONSHIP: STREETADDRESS: -~ __ -CITY _ ~ STATE: ZIP CODE NAME AND ADDRESS OF FINANCIAL iNST1TUT10N WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: 'i~ STREET ADDRESS: CITY: , `. STATE: ZIP CODE: NAME OF PERSON iNAKfNG EAST ENVY DATE AND TIME OF LAST ENTRY ~ DATE OF CON RAC'f' TO RENT BOX NUMBECR OF 80X 1 TITLE UNDER`W,HICH BOX IS REGISTERED NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. ME: b. NAME: STREETADDR€$,S:, C-~ ~~ STREFi"ADDRESS: _ _ _._____.. -__.-____-- tlCITY: ,~ .,~` S TATE: ZIP CODE: CITY: STATE: ZIP CODE '~ NAME AND TITLE OF EMP~O,~YEE KING THE INVE RY {' ~ `~ WAS A WILL IN THE BOX? ^ YES ENO If yes, a. Date of will: b. Name and address of personal representative, if named in the will _ NAME: STREETADDRESS~ i CITY: i STATE: ZIP CODE: c. Name and address of attorney, if any NAME: STREETADDRESS: i CITY: STATE: ZIP CODE: 48500041046 48500041,046 REV-485 EX SN~C ~.JG~°®S~ ® B®X ~N ~i EI~I~~RY Page of INSTRUCTIONS (1) Cash: Report total only. (2} Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) Alf other contents. (9} Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 ITEM ITEM DESCRIPTION .~ ~~ ``~,_`l~ `tel.`\~Cs'~`~ _ ~~~~_ _' _ ~~~'°~ ~ _ " `~ ~ c,. '~ • ~ ., v - -- P :~ e Y ` ,~ .~'e 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS CORRECT AND COMPLETE TO THE $E MY KNOWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: 5d NATUR `\ ~ ~ f` ~~ _F~-_ d $.. W. SIGNATURE ., y y PR~T-NAME `~, ~ -' ~~a'iYt.'~"t-(-;~ ~~.ti .J'~~^`ti4ti ~ ~, PRINT NAME AND CHECK APPROPRIATE BOX BELOW: ~~ L'l~ ~ 4. ~~ ~!~ IV I~.r Nt , PRINT TITLE DATE CHECK APPROPRIATE BOX' . 7 Executor(trix) ~ Administrator(trix) ~ ~ ~ Estate Representative ~ Joint owner of safe deposit box NOTE: Attach additional 8'/2" x 11" sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. §405 (e)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. ~ Sovereign Bank Sovereign Bank 7-28-2008 798 E. Simpson St. Mechanicsburg Pa 17055 717-697-8279 To Whom it may concern, ---_~ The balance on account number 1684000845 on July 18 2008 was $3,262.63. The account is in the name of Priscilla MannTTEE and Hunter Mann III Beneficiary. Susan K Crossland `~~ f~ Community Banking Assistant Manager A~~: E-~ -~ PNCBANK To Whom It May Concern July 31, 2008 To Whom It May Concern, This letter is to inform you of the date of death balance for PNC Bank checking and savings for Priscilla G Mann (Deceased) SS # 229-42-3452 DOD 07/18/2008 Account Number DOD Balance Interest Accrued DDA 5140041405 $ 4,924.29 + $ 0.92 = $4,926.13 SVG 5000734699 $ 9,708.98 + $2.06 Any questions, feel free to contact me at the number below. Carrie DeHark Financial Sales Consultant Windsor Park (717) 697-3015 _ $9,711.04 A member of the PNC Financial Services Group 5288 Simpson Ferry Rd Mechanicsburg PA 17050 www.pncbank.com ---~_, ~ M&T Banlc 3805Trindle Road, Camp Hill, PA 17011 717 737 2308 Fax 717 737 2303 August 25, 2008 To Whom It May Concern, This Letter is to inform you the date of death balance for Priscilla Mann's Account # 15004216706802 as of July 18`h 2008 was $91,339.81. If you have any questions please feel free to call me at 717-737-2308. Sincerely, -...~' -' i , ~.~~ ._~_ -:~ ` ~ Silvia L Foley ~, Assistant Branch Manager Trindle Road Office Unrealized Gain/Loss Unrealized Gain/Loss Page 1 of 3 ~~ ~- _~-"_' Gain/Loss Summary Realized Gain/Loss ~ Unrealized Gain/Loss Show: AAA 410 056580 `. AAA/410 056580 HUNTER MANN EXECUTOR Total Market Value Total Cost Adjusted ; Gain/Loss Cost All Assets 441,425.22 454,020.75 454,020 75 -12,595 53 Certificates of Deposit (f~2 z Date ' Market ' Unit . Adjusted .Name Quantity Acquired Value Cost Totat Cost Cost GaiNLoss Period 1,000.000 ' 7/18/08 j 980.02 100.53 1,005.25 1,005.25 -25.23 ; Long CAPMARK BK CD 5.000 9- _ _ ._. _........ _._. 12-14 1,000.000. 980.02 ! 100.53. 1,005.25 1,005.25 -25.23 2,000.000 7/18/08 2,001.94 ; 100.00 2,000.00 2,000.00 1.94 Long CITIZENS BANK FID 5.000 _.. _ _~_.._. _ _ 12-23-11 2,000.000 2,001.94 100.00 2,000.00: 2,000.00 '; 1.94 100,000.000 7/18/08 . 96,904.00 ! 100.00 ' 100,000.00 100,000.00 -3096.00 Long COUNTRYWIDE SK NA .-.. _- _.. _ .~ .~ ~._ ..._ ....~... 6.000 11-30-28 100,000.000 96,904.00 100.00 100,000.00 100,000.00 -3,096.00 13,000.000. 7/18/08. 12,828.14. 100.00. 13,000.00 13,000.00' -171.86 ' Long DISCOVER BANK FID 5 1/2 _.... .._ _ 3-05-18 13,000.000 i 12,828.14 100.00 13,000.00 ' 13,000.00 • -171.86 ' 2,000.000 , 7/18/08 1,983.86 ; 100.00 ! _ .. .. - 2,000.00 .... ... 2,000.00 ' .. _ ....._ ~ . -16 14 . ~n ... Long FIRSTBANK PR FID 5.000 _.._~. .-......: ~ . __ _ _. _ _..._.., . , ._. . 12-30-13 2,000.000 ' 1,983.86 ;' 100.00: 2,000.00 2,000.00 -16.14 81,000.000 ' 7/18/08 ; 79,720.20 100.00 !. 81,000.00 81,000.00 - -1279.80 ' Long LEHMAN BROS BK CD 5 ~. _.. _ ,.., , . ? .. . .......... 1/2 12-20-18 81,000.000 ' 79,720.20. 100.00 81,000.00: 81,000.00 -1,279.80 9,000.000 7/18/08 8,754.57 i 00.00 9,000.00 ` 9,000.00 -245.43 Long LEHMAN BROS COML _ _ _ _ _. _ _ _ 5.00011-13-i5 9,000.000 8,754.57 100.00 9,000.00 9,000.00 -245.43: 43,000.000 , 7/18/08 41,672.59 100.00 ' 43,000.00 43,000.00 -1327.41. Long LEHMAN EROS COML _ __ _ _ _ _ 6.000 12-20-28 43,000.000 41,672.59 ' 100.00 43,000.00 43,000.00 -1,327.41 100,000.000 7/i 8/08: 96,827.00 100.01 100,005.25 100,00525 -3178.25 Long MIBKFSBCD51/211- _... _ ... ._ __. _ .. _ .___ 30-23 100,000.000 96,827.00 f00.01 100,005.25 100,005.25 -3,178.25 3,000.000 7/18/08 2,925.90: 100.17 3,005.00. 3,005.00 -79.10. Long MIDFIRST BANK FID 5.000 _... _... . . _ , .. _..~.. ~. .._. _ ... „• -, _____~.._„4„~,,,,,,,,;o„*~q,.~,,,~,,,,icP,,,,,.P~~tr~;n QCAccnur,tSummarv/GainAndLossNi.. . S/12/2~08 Unrealized Gain/Loss Page 2 of 3 6-15-15 3,000.000 2,925.90 100.17 3,005.00 ! 3,005.00 :; -79.10 100,000.000 ', 7/18/08 i 96,827.00 100.01 100,005.25 100,005.25 -3178.25 ' Long SOUTHWEST BK CD 5 1/2 ,°....r ... _ _...,__..,. ~ ,-_ _-.. ~ . _ ..~.._ .. _~.... -... -,.... , , . .._. _-_ ,.. _ . _ ..~..__.- , .._..,..... _.__-. ., 11-30-23 100,000.000 !, 96,827.00 '. 100.01 ! 100,005.25 100,005.25 ' -3,178.25 Sub-total, Certificates of Deposit 441,425.22 ' ': 454,020.75 ! 454,020.75 -12,595.53 ' Total Market Value Total Cost ', Adjusted Gain/Loss . ', Cost i All Assets 441,425.22, 454,020.75 :454,020.75 i -12,595.53 ' w _ :: r Current prices are available for Stocks and Options only. All other current pricing reflects the most recently available price for that security. For example, Mutual Fund current prices are the most recent business day's Net Asset Value. The Estimated Gain and Loss information is provided for informational purposes only and may not be relied upon in making any tax, accounting or regulatory filing or report. We recommend that you contact your tax advisor to determine the appropriate information to be used in the preparation ofi your tax return. This Estimated Gain and Loss Summary is not a substitute '1099 form (or any other appropriate tax form) and should not be filed with your taxes. The Total Cost, Unit Cost and Proceeds of eligible equity and options transactions with Choice SelectSM pricing do not include commissions paid on your purchases or sales and therefore may not equal the acquisition price or principal amount of the sale. Cost basis adjustments for Choice Select Eligible Trades will be reflected in the account shortly after the calendar quarter end. The figures should be independently verified. Estimated Gain and Loss information does not take into account a taxpayer's particular circumstances such as the existence of hedging transactions, constructive sales or marked-to-market pricing adjustments on certain options held at year-end. Please note that although Morgan Stanley & Co. Incorporated makes every effort to adjust the cost basis for such securities' capital changes, it does not adjust the cost basis for all events, including amortization of non-municipal bond premiums; exercise of unlisted stock options; securities deemed to have been sold and simultaneously repurchased; receipt of cash in lieu of fractional shares; or the net effect of wash sales and/or short sales against the box. For securities not purchased through Morgan Stanley & Co. Incorporated, for example, securities purchased elsewhere and later transferred to it, any data included in the Estimated Gain and Loss information has been provided either by you or another financial institution. Whether provided by you, another financial institution or Morgan Stanley & Co. Incorporated, it is your responsibility to ensure the accuracy of all of the Estimated Gain and Loss information. Please contact your Financial Advisor with any questions or to correct any information. For Managed Futures and alternative investments, there are likely to be restrictions on redemptions, please see applicable offering document. With respect to estimated gains and losses for listed equity options, Morgan Stanley has taken into account option premiums paid or received and, in respect to multiple purchases and/or sales, calculated cost using an average unit price for all like positions. Morgan Stanley has made calculations using what appear to be off-setting positions; no assurance can be given that these positions are intended to off-set each other or that they are not intended to off-set other securities positions, in which case the analysis may be different. 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Incorporated Financial Statement. https://internal.morgan stanleyclientserv.com/Secure/HoldingsAccountSummary/GainAndLoss/Vi... 8/ 12/2008 Realized Gairt/Loss Page 1 of 2 Realized Gain/Loss Gain/Loss Summary ~ Realized Gain/Loss Unrealized Gain/Loss Show: AAA 410 056580 ~ Tuesday, August 12, 2008 __.. .. Long-Term Gain/Loss Date i Name Quantity f Acquired ~ Date Sold 3,000.000 ~`: 7/18/07 NEW SOUTH FSB CD 6.000 - - -- - 2-02-15 3,000.000 ii Sub-total, Long-Term Total Total Cost Adj. Cost Proceeds GainlLoss ; j Tuesday, August 12, 2008 3,000.00 3,000.00 ; 3,000.00 ! 0.00 The Estimated Gain and Loss information is provided for in#ormational purposes only and may not be relied upon in making any tax, accounting or regulatory filing or report. We recommend that you contact your tax advisor to determine the appropriate information to be used in the preparation of your tax return. This Estimated Gain and Loss Summary is not a substitute 1099 form {or any other appropriate tax form) and should not be filed with your taxes. The Total Cost, Unit Cost and Proceeds of eligible equity and options transactions with Choice SelectSM pricing do not include commissions paid on your purchases or sales and therefore may not equal the acquisition price or principal amount of the sale. Cost basis adjustments for Choice Select Eligible Trades will be reflected in the account shortly after the calendar quarter end. The figures should be independently verified. Estimated Gain and Loss information does not take into account a taxpayer's particular circumstances such as the existence of hedging transactions, constructive sales or marked-to-market pricing adjustments an certain options held at year-end. Please note that although Morgan Stanley & Co. Incorporated makes every effort to adjust the cost basis for such securities' capital changes, it does not adjust the cost basis for all events, including amortization of non-municipal bond premiums; exercise of unlisted stock options; securities deemed to have been sold and simultaneously repurchased; receipt of cash in lieu of fractional shares; or the net effect of wash sales and/or short sales against the box. For securities not purchased through Morgan Stanley & Co. Incorporated, for example, securities purchased elsewhere and later transferred to it, any data included in the Estimated Gain and Loss information has been provided either by you or another financial institution. Whether provided by you, another financial institution or Morgan Stanley & Co. Incorporated, it is your responsibility to ensure the accuracy of all of the Estimated Gain and Loss information. Please contact your Financial Advisor with any questions or to correct any information. For Managed Futures and alternative investments, there are likely to be restrictions on redemptions, please see applicable offering document. With respect to estimated gains and losses for listed equity options, Morgan Stanley has taken into account option premiums paid or received and, in respect to multiple purchases and/or sales, calculated cost using an average unit price for all like positions. Morgan ---- ,.,..,,~ePCnre/HoldingsAccountSummaty/GainAndLoss/Re... 8/12/200 REV-1509 EX ~ (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE 0~ FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT B. C. JOINTLY-OWNED PROPERTY: ITEM NUMt3ER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying numt~er. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 1 ~ 1 ~.3 ~' ~ltYj..t, c-~-~. ~. ~.s: ~ 5T ~`-e c~-e,~c~ C~ ~~c.,4~' t ~ 1 f ~ _ ~ ~- ~o ~5~ ~ `7 ~, ; ~'-lG~ -ern. C~.~f- *~ ~ ~~ ~ c-~ >~, J, S j ` ~~`~' ~ ~-~-G L2~'l'~ ~ yj 9f ~ l ~ 1 ~ ,~~ -t...l. ~ ' s ~ ~ ~-x ~,(.e.~c~,~ C~c-~' 3a, 7 1g , s ~ j ~J I ~ :~ j ~ : ~ t R '" ~i/e.a,x-vru.v~" ~ cc~L ~,ctiC~i ~,e,C~-a7ic.~ TOTAL (Also enter on line 6, Recapitulation} $ ~ ~, ~ ~`~` ~ ~ ,~ (If more space is needed, insert additional sheets of the same size) St O MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix 6824-00 Date Account Established 11/18/1963 Principal Balance at Date of Death $3,113.79 Accrued Interest to Date of Death $1.55 Total Principal and Accrued Interest $3,115.34 Name of Joint Owner Hunter Mann III Date Joint Ownership Established 10/03/1975 INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 6824-05 Date Account Established 02/15/1992 Principal Balance at Date of Death $30,778.65 Accrued Interest to Date of Death $19.93 Total Principal and Accrued Interest $30,798.58 Name of Joint Owner Hunter Mann III Date Joint Ownership Established 02/15/1992 ~~~ ~i E BERS 1ST FED RAL REDII,ToUNION Danielle A. Kline Insurance Services Specialist August 1, 2008 Estate of: PRISCILLA MANN Date of Death: July 18, 2008 Social Security Number: 229-42-3452 5000 Louise Drive PO. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 www.memberslst.org Reassure America Life Insurance Company PO Box 9584, Coppell, TX 75019-9084 Phone 800-792-4368 Fax 803-333-7833 August 14, 2008 HUNTER MANN III 606 ROBERT ST MECHANICSBURG PA 17055-3458 Annuitant: PRISCILLA MANN Contract Number: 0006588750 Correspondence Number: 08471806 Dear Hunter Mann: Thank you for contacting Reassure America Life Insurance Company. Listed below are the values of the annuity contract as of July 18, 2008: Status: Active Type of Contract: Annuity Accumulation Value: $ 103,781.00 Surrender Value: $ 103,781.00 Current Interest Rate: 4% If you have any questions, please call the Client Service Center at 800-792-4368, Monday through Friday from 7:30 AM to 4:30 PM Central Standard Time. Sincerely, Client Sei vices REV-1511 EX+ (10-06) SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE 0 FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ' 3 S, - m~ - afGcen C'11G,cc~f~~ ~_~ tv~/tP~ e. Gnu aC~e _~y~---2 G~~../~.~c~->~` ~`~~~~~''~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip 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 Zip Relationship of Claimant to Decedent 4. Probate Fees (~C(~j,~y~, , ~ f ~~ ~ IA~I ~~ ~ s. , c~P T~ ~~~ S3 ~ a ~- u ~ s, 1~,:~~CZiZ2i .~.e.7~~1.oc =e < UGQ~ 5. Accountant's Fees /Su ~~-(' ~'{ _2) 6. Tax Return Preparer's Fees l // ~. ~ c'6 l<<u,~~ ~ ~cc~~.c.e (Pa~~uc~-Z~' ~~f ~ ~ ~ ~ , ~~ ~~ L~~ 3~C, y 3 S~ 0 4 ,~. ~;~-t~ ~ .~ ,ice ~~~~` ~~~ ~C~ ~-t~` ~- ~ ~ 3, ~ s r 1. ~~~~ ~ ' Cqc~-mac ~ zs ~L~.~.r ct.~ Sa • s ~ _ ~ 3, ~ 3 ~ `~ ~ ~ I TOTAL (Also enter on line 9, Recapitulation) $ ? ~ [ J (If more space is needed, insert additional sheets of the same size) ~~EMORIAL ~° ~ ~~~ ~ S ~~~ N SERA ~' ~ ~' / AVER MEMORIAL HOME nvv CREMATION SERVICES, INC. 4100 Jonestown Road • Harrisburg, PA 17109 • 1-800-720-8221 • Fax 717-541-9943 • Shawn E. Carper, Supervisor 3 2 :I QYIAH:~ fl3M ~[oofl ~ta13 c psSt 28®693 MC5 abx6~ lstxomeM abYB~ uoY ~Insr14' epsxoa4 a,>naYdmarasH Jul 18, 2008 19~I~6J ~O,C£~ r1-lU ottzsl9 Yxovl X Yon t b.rno:J rro 1 1am9x~ .i IusV i s ~ xuEi nxU Mx. Hunter Mann III sasJ ~s['1 2nax91sV 606 Robert Street YS~[7sM tstxomaM\evs-t~ Mechanicsburg, PA 17055 N01 . ~' f T ~~;''. Ll61f~HJS#3M .tflri.'t.j'1' Priscilla Qainey Diann - Deceased ~:M:~'rr. ~ ~:~ ~~avua N~~ a,, pninagU ~vsxJ SPECIAL CHARt3ES inenaq iup3 v.,i~rean9:.a X D1 reef Crsmat ion apxsri~ ~,-, i v@is39ssrO. Forwarding Remains a~Y~+gaq~swe~! ~tlc! yang Remains ~y\ES\~ tsuJoA\Jot's.lsq pxt.rds r xisH x 33 ii•te Burial ypxaiJ Iiationrride C~arantee Program Jztoto2~~acnBp-r~r~.rlaiuriJ Worldwide Travel Protection 2xewot'~ TOTAL SPECIAL CHAiIC;ES apzsri~ yao f BatsY:3 $1, 395.00 PRO $~iVIQ~tggA not 1ameY~ YsnoYO~ ylnuo~ bns i xsda[tr:J x C~ao23tJ7e~ riJa9o 3o astno7 ba[3t1xsJ ?; :~ erv ces o! Funeral Director & Sta!! c ~ . r t ~ z Emba imi ng 2M3Ti CI~~MAVUA H2A`} SaTci'1' Other Preparation o! the Body Facilities & Stet! !or Viewing ($20®/hour) Facilities & Sts!! !or Funsra i Service 23aAAH~ ~c} Y ~IAMM~12 Facilities & Stal~Bl~gllq~orial ServiceaepxsriJ ~stoec('r. Sta!! & Equipment~p~ZViswing ($2~q~}~~ tsnorza43oY~ Arrange/Deliver R~i~s To A Natior~b~~ge~vcsoaroJcra Sta!! Q Equipment 0~?~ mortal Service satbnsrf~Y9M Private Family Vi~i.~g~{itnesaing Cfjigp,onsvbA rtas:~ Witnessing the Cre~t~ ~ j~ ,igri~crr nun Packaging And Forwarding Created Remains Persona 1 De 11 very ~ .~!3~d Remains r~~ 1 ct;~;~:; Scattering o! Cremated Remains Msd i ca 1 Document s /C~t{~i~ Fee .I a`t <,~t~ TOTAL PROFESSIONAL SERVICES $0.00 AUTOMO'PIVE EQUIPMENT Removal Vehicle c C . t' t ?, Casket Coach Flower Car Le:d Car/Clergy Car Service Vehicle Family Car ToT~~«P~i~ T~3,I'~3A s~N6-S , ? 1 1 trt~ t~ IAA '!'NUtaMA ~1UU ;.9 `.?Vfa,J A TOE! YAM T(/13M3TaTi: c 4 s-!T $0.00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 MANN PRISCILLA GAINEY Estate File No.: 2008-00778 Paid By Remarks: HUNTER MANN III WZ ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 546 Total Received......... ~ ~ ~/ -~ z Receipt Date: 7/25/2008 Receipt Time: 09:51:32 Receipt No.: 1053496 Receipt Distribution ------ ------- -------- --- Payment Amount Payee Name 460.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 48.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- $538.00 $538.00 REMITTANCE ADDRESS ~ THE SENTINEL - LEGAL P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS 353559 10 PUBLIC NOTICES AD DESCRIPTION NOTICE LETTERS TESTAMENTARY FOR TH PUBLICATION INSET 3 THE SENTINEL - LEGAL TOTAL AD CHARGE 3 PROOF OF PUBLICATION PREVIOUSLY PAID DAYS RUN PURCHASE O1PRF PAY THIS AMOUNT 08/12/08 34 * 2 START DATE STOP DATE 07/29/08 08/12/08 NET AMOUNT GROSS AMOUNT 135.66 135.66 2.6 .00 I .00* MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 717-240-7176 Fax your legals to 717-243-3754 attention Tammy Shoemaker You can also EMAIL your legal to Classified ads: classifiedCcumberlink.com Please send a cover letter including your name and address as an attachment DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT THE SENTINEL -LEGAL r. n .~.~~~ win nnn~ ~c~ r nn ~~nnz ~ .v. vv.. .v.. AD NUMBER .. ., .. CLASSO START DATE STOP DATE 353559 PUBLIC NOTICES 07/29/08 08/12/08 AD DESCRIPTION BILLING DATE TELEPHONE NUMBER NOTICE LETTERS TESTAMENTARY FOR TH 08/12/08 717-697-9003 HUNTER MANN III 606 ROBERT ST. MECHANICSBURG, PA 17055 I~~~III~~~lll~~~~l~l~~l~l~~~l~ll RETAIN THIS PORTION FOR YOUR RECORDS R°t`t HUNTER MANN III N ~. robik 3 I LGL GROSS AMOUNT OF .~~ DUE AFTER 09!11!08 TOTAL AMOUNT DUE .00 ENTER AMOUNT ENCLOSED 20200000003535590000000000000000000000000000004 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 August 15, 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Hunter Mann, III Priscilla Gainey Mann Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: August 1, August 8 and August 15, 2008 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt1LE J BENEFICIARIES ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under ec. 9116 (a) (1.2)] S 1. 1/ j ~ Y ~~L.~Gt_ J Vii;-~ ~ ~tzr~ri~~t~cr~ ~? ~l ~~`~ 3 ~~ ~~ 51 ~~ S LL,S ~~-oz~.~y ~~itc,t,j ~,~ tX rti-d" ~Lr~r,,~ ~ ~ S L h ~ / l~ Cc~iis.~rc ~ L= ~- Y~r>~ ~ ~~ ~yL I ~'1 c~`~J~Z~ In ~ y ~~~~1~~ ~Gt~in-'~- l"i,1~ s:~C?-t _ c;twc~'CVt ~~1 ~,~, ~Cd- ~ o~ ~~ (j ~ ~~ ~~ ~.1~t.z2tx ,t 1 G~ GL ~ (jt,-~~z-~C q r~ O'~ ~R~otLA- ~ y /~Gt,~' ~wt,c~c~.~vl qq.~~ _ ~ S~ C~--c'>~-Z~ ~ ~ ~ ~ ~ ~~ `'~`M f ~ C ~! J _ l 1 c,Gu.~L ~~-e~a~,~_.~. f ~i~ l 7C ~~ - 3 ~~ ~-T v'ru~` -'~ ~ ~ ®~/~ Gc 2 ~ a DD - J cC r ~ c ~2 / ~ S ~Z i ~2, ~~ ~l-`LYt/r cr.~., ~ , c,~- - J 33 S ~mc {~~ z {/~, ~ a 13,1 ENTER DOLLAR AMOUNTS FOR D S I TRIBUTI S SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ $ 1~ (If more space is needed, insert additional sheets of the same size)