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REV-1500 OFFICIAL USE GN!y --
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INHERITANCE TAX RETURN FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
280601
PT
RESIDENT DECEDENT
21 2007 1013
.
DE
HARRISBURG, PA 1712&0601 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) _ SOCIAL SECURITY NUMBER
ANDROSHICK, ROBERT F. 179-30-7700
w DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
W 10/28/2007 04/09/1938 REGISTER OF WILLS
~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
® 1. Original Return ^ 2. Supplemental Return ^ 3, Remainder Return (date of death prior to 12-1 3-82)
w
a v~
Y
^ 4. Limited Estate ^ qa, Future Interest Compromise (date of deatn after
^ 5. Federal Estate Tax Return, Required
~ Y
_ ~ ~
~ 12-12-82)
® 6. Decedent Died Testate (Attach copy ^ 7, Decedent Maintained a Living Trust (Attach
0 8. Total Number of Safe Deposit Boxes
a'n
a
a of Will) copy of Trust)
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death between
11. Election to tax under Sec. 9113(A) (attach Sch o)
.~_~1-at and ~-~-051 _. _. - - _.- .- _
THIS SEGTION'MUST BE COMPLETED. ALL CORRESPONDENCE AND~ONFID ENTIAL TAX IN FORMATION SHOULD BE DIRECTED Tfl:
AME COMPLETE MAILING ADDRESS
Lisa Marie Coyne
z c IRM NAME (If applicable) 3901 Market Street
o a Coyne & Coyne, P.C. Camp Hil PA 17011-4227
l
ELEPHONE NUMBER ,
717/737-0464
1. Real Estate (Schedule A) (1) 199,000.00 o=FLr.IAL t13~NLY -,~-~
~ ~
~
~
2. Stocks and Bonds (Schedule B) (2) None Q tf3
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P
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ors
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3. Closely Held Corporation, Partnership or So one t~.1 fir-- t
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4. Mortgages & Notes Receivable (Schedule D) (4) None ~y ~ C7
Q
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 7,889.00 ~j
~ ~~ ~;-`
`
'
=~`
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) 3 81, 855.95 ~
--~
~ ~ ~ . r
C
L.,'S C
_
° ^ Separate Billing Requested ~ ~"`
(7)
~ In4nr_~~ivn¢ Transfarc R Miscellaneous Non-Probate Prooerty 44,744.61 W
(Schedule G or L)
a 8. Total Gross Assets (total Lines 1-7) (8) 633,489.56
~ 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 36,057.72
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I} (10) 24,815.40
11. Total Deductions (total Lines 9 & 10) (11) 60,873.12
12. Net Value of Estate (Line 8 minus Line 11) (12) 572,616.44
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13}
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 5 72, 616.44
SEE INSTRUCTIONS ON .REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x ,00 (15)
or transfers under Sec. 9116(a)(1.2}
16.Amount of Line 14 taxable at lineal rate. 572,616.44 x .045 (16) 25,767.74
r
Q
17.Amount of Line 14 taxable at sibling rate x ,~2 (17)
0
U
F 18. Amount of Line 14 taxable at collateral rate x ,~ 5 (18)
19. Tax Due (19) 25,767.74
20. ~ - . • - - ~ ~ - .. . - - .
» BE SURE TO ANSWER ALL QUESTIONS DN REVERSE SIDE AND RECHECK MATH -- -
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
1
Decedent's Complete Address:
STREET ADDRESS
911 Cocklin Street.
CITY Mechanicsburg STATE PA zrn 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
24,100.00
1,288.39
(1)
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 theOVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(5A)
(5B)
25,767.74
25,388.39
0.00
379.35
379.35
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? ...........................................................
1982, did decedent transfer property within one year of death without
If death occurred after December 12
2
^
,
.
receiving adequate consideration? .................................................................................................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
4
.
contains a beneficiary designation? ..............................._................................................................................ ® ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE tT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration
preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIB OR FILI RETURN ADDRESS DATE
rbar . Chilco 33 Teaberry Drive
~ a~ ~~
~ Carlisle, PA 17015
, nov nr vocn~r C 11 I _ FTI IRN Ahr1RFRS DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE
Lisa Marie Coyne 3901 Market Street
Camp Hill, PA 17011-4227
.~~ - - -- ... _. .. , w ,_.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exemota 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.
O For dates of death on or after July 1, 2000:
~ The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
~ parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116
1.2) [72 P.S. §9116 (a) (1 )].
~} The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)J. A sibling is defined,
\' der Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
/~
~~G~
~. Sej;~lement Statement
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESfDEN7 DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF ANDROSHICK, ROBERT F.
FILE NUMBER
21 - 2007 - 1013
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 compel{ed 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 OF
NUMBER DEATH
911 Cocklin Street, Mechanicsburg, Cumberland County, Pennsylvania-- Per Attached Settlement Sheet
U.S. Department of Housing OMB Approval No. 2502-0265
and Urban Development (expires tt/30/2009)
199,000.00
TOTAL (Also enter on Line 1, Recapitulation) I 199,000.00
.,rt Charges
.total SaleslBroker's Commission based on price $ 5199, 000.00 @ 2. 5 ^/,_ $4, 975, 00 paid From paid From
Division of Commission (line 700) as follows: Borrowers Selleis
~pi,$ $4, 975. 00 tp Re/Max Realty Associates, inc. Funds at Funds al
Settiemenl Settlement
'02. $ to
`03. Commission paid at Settlement S4, 975.00
04.
:nn uo...~ Pev~hln t., c,,..co~rtcn with t ~
01. Loan Origination Fee % AmeziChoice Federal <
02. Loan Discount / AmeriChoice Federal
03. Appraisal Fee to AmeriChoice Federal t $325. 00
D
4. Credit Repod. to Americhoice Federal c ~' Sla. o0
_
05. Lender's Inspection Fee Americhoice Federal credit union
O6. Mortgage Insurance Application Fee to Americhoice Federal credit union
07. Assumption Fee AmerlChoice Federal Credit Union
pg, Processing Fee to AmeriChoice Federal Credit Union $250. 00
Og, Underwriting Fee to AmeriChoice Federal Credit Union $550. 00
10, Flood Cert Fee (x 2) to AmeriChoice Federal Credit Union $50. 00
11.
12.
13. - - -
14.
15.
16.
17.
18.
19
20.
;01. Interest from 08/08/2008 (0 09/01/2008 ep $ $39. 06 (day $937.50
)02. Mortgage Insurance Premium for months to
103. Hazard Insurance Premium for years to
104, years to
105.
nnn txe~e~,e~ nen~ttrnd wur, t endor
001. Hazard insurance months @$ per month
002. Mortgage insurance months @$ per month
003. City property taxes months @$ per month
004. County property taxes months @$ per month
005. Annual assessments months @$ per month
006. months @$ per month
007. months @$ per month
008. months @$ per month
009. Aggregate Acceunting Escrow Adjustment So. oo So. 00
ann nee rno.~oe
101. Settlement or closing fee to LAW OFFICE OF DARRELL C. DETRLEFS
102. Abstract Or title Search to Hringdown Fee - Law Ofc DCD $35.00
103. Title examination to
104. Title insurance binder to
105. Document preparation to
I06.Notaryfees t0 Michael J. Pykosh, Esquire $20.00
107. Attorney's fees to
(includes above items numbers )
100. Title insurance IO Security Title/Law Office of Darrell C. Dethle5 $1,808.75
(In Chides above items numbers: Basic - 4 End. )
09. Lender's coverage $ S25o, ooo. oo ( S25o, ooo. oo )
10. Owner's coverage $ 5199, 000, 00 ( 5394, 000, 00 )
it. Closing Service Letter £ee to Security Title $35.00
12.
13.
n r_,...e.......,..~ oe.....ar..., ~..d r.~..~re, eti~.,,ee
)1. Recording fees: Deed $ S3a. 50 ;Mortgage $ 570.50 ;Releases $ S1o9. 00
)2. City/county tax/stamps: Deed $ Sl, 990.00 ; portgage $ $1, 990.00
)3. State taxlstamps: Deed $ Sl, 990.00 ;Mortgage $ SI, 990.00
)4.
15.
wd~s.... ~: e~ree...e..r rr.~..,e~
1. purvey to
2. Pest inspection to
3, Overnight Fee to Law Office of Darrell C. Dethlefs (UPS) 519.00
q, Law Office of Darrell C, Dethlefs (email Doc Fee) $25.00
j. Law Office of Darrell 0. Dethlefs (Tax Cert Reimb) $5. 00
j. Harry Heckard, Tax Collector (2008-09 School Tax) 51,872. 39
Borough of Mechanicsburg (rioter/Sewer-3rd Quarter Balance Due) $17. 47
t. '{otal Settlement Charges (enter on lines 103, Section J and 502, Section Kj $11,147.25 $3, 885. 36
form HUD•1 (3/86)
ious editions are obsofefe Page 2 of 2 ref Handbook 4305.2
Certification
(continued from HUD-1)
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,
it is a true and accurate statement of all receipts 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 Settlement Statement.
~ nj Seller or
Borrower: ~ Date: . ~ Cr ~ Agent: ~ + ~ ate:R g i~~
Timoth . Yeag Barbara . Chilcote, xecutrix
~ -, Estate of Robert F. Androshick
Borrower. ~'' /~~y ~~ Date: C3>j • ~~~ 0 Seller or
Agent: Date:
Elenita B. Yeager ~/ ~%
Estate of Robert F. Androshick
The HUD-1 Settlement which I have prepared is a true and accurate account of this transaction. I have
caused. or will cause the funds to be disbursed in accordance with this statement.
Date: Settlement Agent: Date: ~ ~ Dg
ichael J P osh, Esquire
WARNING: It is a crime to knowingly make false statements to the United 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 1010.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ANDROSHICK, ROBERT F.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 - 2007 - 1013
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.
fTEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Misc. Personal Property and Automobile -- Per Attached Inventory ~ 7,889.00
TOTAL (Also enter on Line 5, Recapitulation) ~ 7,889.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910 = -
~_ ~ r • _,
2009 LINCOLN STREET CAMP HILL, PA 17011 ,_,_ _~ ` `~
717-737-0734
DEC ~ 2007
November 30, 2007
Appraisal far the Estate of Robert F. Androshick
911 Cocklin Street, Mechanicsburg, PA 17055
LIVING ROOM
Recliner 20.00
Round Maple table 25.00
Pair of Lenoir House -Broyhill end tables with Queen Anne legs 30.00
Pair of brass table lamps 10.00
4-Seat sofa 45.00
Small bench 10.00
Child's white rocking chair 12.00
Turtle stool 2.00
Misc. stuffed animals 15.00
Floor lamp/stand 12.00
Mauve colored chair 20.00
Large curio cabinet 250.00
5 Beam bottles 50.00
Misc. contents of curio cabinet 10.00
Misc. contents of living room 25.00
KITCHEN
Small cabinet 7.00
Trash can 1.00
GE No Frost refrigerator -old 40.00
Grilling machine 3.Q0
Electric can .opener 2.00
Blender 2.00
Coffee maker 2.00
GE mixer 12.00
Small coffee maker 2.00
4- Slice toaster 4.00
CLAl~QE C. W®LFE- & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET CAMP HELL, PA 17011
7i 7-737-0734
Androshick appraisal
Page 2 of 7
KITCHEN -continued
GE microwave 10.00
Kitchen table & 4 chairs 15.00
Zenith TV & stand -old 10.00
Zenith radio 1.00
Misc. everyday dishes 25.00
Cookware 20.00
Utensils 5.00
Flatware 5.00
Clock 2.00
Remington electric hair trimmer 3.00
Misc. contents of kitchen 20.00
DINING ROOM
TV trays 7.00
Curio cabinet 150.00
12 Beam bottles -vehicle motif 120.00
Table & 4 chairs 35.00
Knick knack shelves 15.00
Misc, knack knacks -bears 25.00
Corner cupboard 95.00
Misc. Pfaltzgraff dinnerware 35.00
Flatware 5.00
Misc. contents of dining room 15.00
FAMILY ROOM
Zenith TV 35.00
Zenith VCR 10.00
TV stand 15.00
Magnavox VCR/DVD player 25.00
Round end table 15.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET CAMP HILL, PA 17011
717-737-0734
Androshick appraisal
Page 3 of 7
FAMILY ROOM -continued
Wall clock 25.00
Glide rocker 30.00
Night stand 5.00
6-Car beam bottle train 60.00
Fox 5-646 electric wheel chair -approximately 7 years old 300.00
Floor lamp/stand 12.00
Sofa 30.00
Misc. contents of family room 25.00
BATH
Health aids 25.00
Linens 5.00
Trash can 1.00
ENCLOSED PORCH
9lPiece patio set 120.00
Wicker lamp 10.00
Blue colored recliner 10.00
Grill 25.00
Stool 1.00
Misc. contents of porch 10.00
SHED
Patio furniture 35.00
Hose & reel 6.00
Misc. contents of shed 15.00
CLAUDE C. WQlFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET CAMP HILL, PA 17011
717-737-0734
Androshick appraisal
Page 4 of 7
MASTER BEDROOM
Upright vacuum cleaner
2-Drawer file cabinet
Luggage
Dirt Devil vacuum cleaner
Bissel vacuum cleaner
33 1/3 Record albums
Electric hospital bed
Electric Mobility battery powered cart -old
Trash can
7-Piece bedroom suite
Misc. jewelry & box
Magnavox TV
Floor lamp
Hamper
Brass table lamp
Alarm clock
Electric lift chair
Over-the-bed tray
Ceiling lift
Misc. contents of bedroom
CORNER BEDROOM
3-Piece bedroom suite
Brass double bed
Brass table lamp
Hurricane table lamp
Brown chair
Linens
Hamper
Alarm clock/phone
Misc. contents of bedroom
12.00
10.00
15.00
5.00
10.00
5.00
25.00
65.00
1.00
195.00
15.00
20.00
8.00
1.00
4.00
2.00
10.00
8.00
50.00
25.00
150.00
70.00
5.00
20.00
10.00
5.00
1.00
2.00
5.00
CLAUDE C. WOLFS & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET CAMP HILL, PA 17011
717-737-0734
Androshick appraisal
Page 5 of 7
MIDDLE BEDROOM
Electric walking machine 10.00
Small desk 3.00
Twin bed 10.00
2 Hand sewn quilts 50.00
Plastic storage boxes 5.00
Shredder 5.00
Scale 4.00
Calculator 1.00
Humidifier 1.00
Desk & chair 5.00
Table lamp 2.00
Misc. contents of bedroom 10.00
RECREATION ROOM
5 Bar stools 5.00
Dehumidifier 25.00
Chest of drawers 30.00
Small desk 2.00
4 Small tables & chairs 10.00
Sewing machine -Blond stand 6.00
Bookshelf 5.00
Shuffleboard 3 5.00
Christmas ornaments 25.00
Lane Cedar chest 50.00
Green rocking chair 2A0
5 Table lamps 6.00
Zenith console TV -broken 1.00
Blue chair 2.00
Blond coffee & 2 end tables 15.00
CLAUDE C. VVOLFE ~ ASSOCIATES
AUCTIONEERS & APPRAISERS
Fr1MILY OWNED SINCE 1910
2009 LINCOLN STREET CAMP NILL, PA 17011
717-737-0734
Androshick appraisal
Page 6 of 7
RECREATION ROOM -continued
Old console TV with stereo -poor condition 1.00
Sofa -old 1.00
Day bed 10.00
Recliner 5.00
Bar supplies 5.00
122 Assorted Beam bottle collection 1,220.00
Misc. contents of rec room 25.00
BATH
Chest of drawers -broken 1.00
Wooden stool 3.00
BASEMENT
GE dryer 100.00
GE washer 150.00
Electric heater 6.00
Ironing board 1.00
Secretary chair 3.00
Green curio cabinet 10.00
Kirby vacuum cleaner -old 5.00
Clothes racks 5.00
Cooler 1.00
4 Chairs 4.00
2 Fold-away-beds 2.00
Ottoman 1.00
Glass top table 5.00
Misc. contents of basement 50.00
CLAUDE C. INOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
F~4MILY (7WNED SINCE 1910
2009 LINCOLN STREET CAMP HILL, PA 17011
717-737-0734
Androshick appraisal
Page 7 of 7
GARAGE
Shop vac
Yard chairs
Garden tools
Hose & reel
Misc. hand tools
Misc. contents of garage
1998 Dodge Grand Caravan, 35,024 miles -auto - V-6 good condition
5.00
2.00
5.00
5.00
75.00
25.00
3,000.00
APPRAISAL TOTAL $ 7,889.00
This Fair Market Value appraisal is true and correct to the best of my ability as an
auctioneer and appraiser with 35 years experience.
Member: Certified Appraisers Guild of America
CLAUDE C. WOLFE & ASSOCIATES
W. K. Dusty Chapman, CAGA
SCHEDULE F
COM NOHERITANCEOTAXRETURNANIA ; JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT ~
ESTATE OF
ANDROSHICK, ROBERT F.
FILE NUMBER
21 - 2007 - 1013
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
A Barbara A. Chilcote 33 Teaberry Drive Daughter
Carlisle, PA 17015
JOINTLY OWNED PROPERTY:
ITEM
NUMBE I LETTER ~ DATE
R IFORJOINT MADE
TENANT JOINT
--
1 -j- -
A
l
05/15/2002
2 ~ A ~ 05/15/2002
3 1
i A i
05/15/2002
I
4
! A I
105/15/2002
5 I
i A
~
105/15/2002
6 i
! A
102/28/2006
7
i
j A
I
I i
i
j 02/28/2006
i
r DESCRIPTION OF PROPERTY ~
Include name of financial institution and bank account number DATE OF DEATH % OF T
DATE of DEATH
or similar identifying number. Attach deed for jointly-held real
estate. VALUE OF ASSET DECD'S VALUE OF
INTEREST DECEDENT'S INTEREST
Members 1st FCU 688.16 50% 344.08
Savings Acct. No. 7746-00
Members 1st FCU 4,348.00 50% 2,174.00
Checking Acct. No. 7746-11
I
Members 1st FCU
180,786.49 50%
90,393.25
Investment Savings Acct. 7746-OS
!i Members 1st FCU 102,836.461 50% 51,418.23
i Certificate of Deposit No. 7746-40
Members 1st FCU 152,393.63 50% 76,196.82
Certificate of Deposit No. 7746-41
EDS Federal Credit Union 25.38 50% 12.64
Savings Acct. No. 16320036-D
EDS Federal Credit Union 322,633.75 50°l0 161,316.88
Certificate of Deposit No.
TOTAL (Also enter on line 6, Recapitulation} 381,855.95
St
MEMBERS 1St
FEDERAL CREDIT iJNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 7746-00
Date Account Established 02/16!1965
Principal Balance at Date of Death $687.65
Accrued Interest to Date of Death $.51
Total Principal and Accrued Interest to Date of Death $688.16
Name of Joint Owner Barbara Chilcote
Date Joint Ownership Established 05/15/2002
CHECKING ACCOUNT:
Account Number/Suffix 7746-11
Date Account Established 08/03/1977
Principal Balance at Date of Death $4,348.00
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest to Date of Death $4,348.00
Name of Joint Owner Barbara Chilcote
Date Joint Ownership Established 05/15/2002
INVESTMENT SAVINGS ACCOUNT
Account Number/Suffix 7746-05
Date Account Established 09/25/1985
Principal Balance at Date of Death $180,413.61
Accrued Interest to Date of Death $372.88
Total Principal and Accrued Interest to Date of Death $180,786.49
Name of Joint Owner Barbara Chilcote
Date Joint Ownership Established 05/15/2002
IRA CERTIFICATES OF DEPOSIT
Account Number/Suffix 7746-16 7746-17
Date Account Established 06/18/2007 07/16/2007
Principal Balance at Date of Death $35,298.15 $9,318.41
Accrued Interest to Date of Death : $92.69 $35.36
Total Principal and Accrued Interest to Date of Death $35,390.84 $9,353.77
Name of Beneficiary Barbara Chilcote Barbara Chilcote
CERTIFICATES OF DEPOSIT
Account Number/Suffix 7746-40 7746-41
Date Account Established 04/06/2007' 05/18/2007'
Principal Balance at Date of Death $102,458.26 $T51,994.49
Accrued Interest to Date of Death $378.20 $399.14
Total Principal and Accrued Interest to Date of Death $102,836.46 $152,393.63
Name of Joint Owner Barbara Androshick Barbara Chilcote
Date Joint Ownership Established 04/06/2007 05/18/2007
'Purchased by transr-of.funds from 7746-00.
_ M M ERS 1ST FEDERAL CREDIT~UNION
F ~ ~ \_ n
~ fad t ~,. ,~ ~ ~ Y~-
~~ ~ ~.
t`~"; ~'_ ~ ,~~~~ anielle A'. Kline
` -~~,. Insurance Services Specialist
-- _, `_ n""'mow ~~ .November 29, 2007
}
Estate of ROBERT F. ANDROSHICK ;
Date of Death: October 28, 2007 A''#°-~..,a
Social Security Number: 179-30-7700
5000 Louise Drive PO. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org
Checking Accounts•
Number:
Date Opened:
Balance at Date
of Death
Name of Joint
Owner, if any:
Savings Accounts•
Number: z
~3 ~- ~b~ ~ ~
Dato Opened: ~' ~ 8 ~' Oaf
Balance at Date ~~
of Death:
Name of Joint G~1~ ~~~~
(honer, if any: f
~etiificates of Deposit:
Number: ~u> ~ L `'
7J9
.W
Date Opened: ,~ ~7 ~
Name of Joint / '
Owner, if any: ~~G~p~~
Balance at Date „~
of Death:
Maturity Date:
Interest Rate: 7.~?
Interest Paid Quarterly,
Semi-Aruiual, etc. D/l~~ ~
Estate of: Robert F. Az~droshiek of
Date of Death: October 28, 2007 ~~ ~,~~~
Union
Union Official
SCHEDULE G
COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS &
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANDROSHICK, ROBERT F. ~ 21 - 2007 - 1013
__ _ This schedule must be com leted and filed if the answer to an of uestions 1 throu h 4 on a e 2 is es. _
ITEM I, DESCRIPTION OF PROPERTY % OF
Include the name of the transferee, their relationship to decedent and the date of transfer. DATE OF DEATH EXCLUSION
NUMBER ,, Attach a copy of the deed far real estate. VALUE OF ASSET DECD'S (IF APPLICABLE) TAXABLE VALUE
INTEREST
----~-- -
1 I Members 1st FCU ~ 35,390.84 35,390.84
IRA Certificate of Deposit 7746-16 ~
2 'Members 1st FCU i 9,353.77 i 9,353.77
IRA Certificate of Deposit 7746-17 ~
I
~~ ~ ~ ~
TOTAL (Also enter on line 7, Recapitulation) I 44,744.61
SCHEDULE H
FUNERALEXPENSES&
COMMONWEALTH OF PENNSYLVANIA ~~ !
INHERITANCE TAX RETURN "VC
RESIDENT DECEDENT
ESTATE OF ANDROSHICK, ROBERT F.
Debts of decedent must be reported on Schedule I.
ITEM ~ DESCRIPTION
NUMBER
A, ~ FUNERAL EXPENSES:
1 I Malpezzi Funeral Home
I
2 ~ Flowers
3 ~ Reception
4 Ilf Headstone Engraving
B.
1
2.
3.
4.
5.
6.
7.
1
2
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) ! EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
i
Attorney's Fees Coyne & Coyne, P.C.
I
Family Exemption: pf decedent's address is not the same as claimant's, attach explanation)
I
1 Claimant
~~ Street Address
j City State Zip
~i
~ Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Postage
Filing Fee -- Inheritance Tax Return
5,039.85
200.00
408.00
200.00
22,000.00
306.00
82.00
15.00
Total of Continuation Schedule(s)
7,806.87
TOTAL (Also enter on line 9, Recapitulation)
FILE NUMBER
21 - 2007 - 1013
AMOUNT
36,057.72
Schedule H
COMMONWEALTH OF PENNSYLVANIA Ft~ral
INHERITANCE TAX RETURN ~l'llll~Ve ~' '~ (;d'~J~
RESIDENT DECEDENT
ESTATE OF ANDROSHICK, ROBERT F.
3 Reserves
4 i Rey Woof-- Real Estate Appraiser
I
5 ! Claude Wolfe & San, Appraiser
6 I Ron Morgan, CPA
7 Ij West Shore EMS
I
8 ~ Auqua Specialists-- Repairs to Pump and Pool Required for Sale
I
9 ~ Gene Lakin-- Drywall Repairs
I
LO Erie Insurance (Home and Vehicle)
11 '~ Zimmerman Electric-- Repairs to Water Heater for Sale
12 j Cleaning and Clearing Trash Hauling from House for Sale
13 ~~ Mileage for Executrix @$.505lmile
I
14 i Toll Calls for Executrix
15 i Cumberland Law Journal
I
16 I Patriot News
FILE NUMBER
21 - 2007 - 1013
2,000.00
300.00
295.00
300.00
45.45
1,50?.40
350.00
1,021.00
454.00
300.00
1,000.00
38.00
75.00
121.02
Page 2 of Schedule H
No . 2007- 01013 PA No . 21- 07- 1013
Estate Of : ROBERT F ANDROSH/CK
(First Middle, Last)
Late Df : MECHANICSBURG BOROUGH
CUMBERLAND COUNTY
Deceased
Social Securi ty~ No : 179-30-7700
`_h day of November 2007 an instrument dated
March 25th 1986 was admitted to probate as the Zast will of
ROBERT F ANDROSH/CK
(First, Middle, Lastl
late of MECHAN/CSBURG BOROUGH, CUMBERLAND County,
who died on the 28th day of October 2007 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
BARBARA A CH/L COTE
who has duly qualified as EXECUTOR(R/X)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARL/SLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 8th day of November 2007.
Register o Wills f
Deputy
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
LAST WILL ,
,, -.
OF
ROBERT F. ANDROSHICK 4
I, ROBERT F. ANDROSHLCK, of the Borough of Mechanicsburg,
;.~
CumTaerland County, Pennsylvania, declare this. to be my Last Will
and revoke any Wi11 previously made by me.
Ltem ~~1: I devise.-and bequeath all of my estate of every
nature and wheresoever situate, together with the. insurance
thereon, to my wife, MARY J. ANDROSHICK, providing she shall
survive me by thirty (3Q} days..
Ltem ~~2: Should my wife, MARX J. ANDROSHICK., predecease
me or die on or before the thirtieth (30th.} day following my
death, I devise and bequeath. all of my estate of every nature
and wheresoever situate, togethex with the insurance thereon, to
my daughter, BARBARA. ANN ROBINSON.
Item ~3: I direct that all my just debts and funeral
expenses sh.a11 be paid from the assets: of my estate as soon as
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practicable after my decease.
Ltem ~~4: I direct that I be buried in the National Cemetery
Fort Indi.antown Gap, Lebanon County, Pennsylvania.
Item ~~5: I direct th.at.all taxes Chat may be assessed in
consequence of my death., of whatever nature and by whatever
jurisdiction imposed, sha11 be paid from my residuary estate as
apart of the administration of my estate.
Item ~~6: I appoint my wife, MARY J. ANDROSHLCK, Executrix
lof this my Last Will. Should my wife, MARY J. ANDROSHICK, fail
to qualify or cease to act as: Executrix, I appoint my daughter,.
BARBARA ANN ROBINSON, Executrix of this my Last Will.
Item ~~7: I direct that my personal representative or
~, their successors, shall not be required to give hon d for the
(faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this .:n .S
day of ~'?C~r~..-c..~-~ 19 ~~~~..
Ro ert F. An ros ick
The preceding ins.trumerit, consisting of this and one (1)
other typewritten page, each identified by the signature of the
Testator, ROBERT F. ANDROSAI:CK, was on the day and date thereof
signed, published and declared by ROBERT F. ANDROSHICK, the
Testator named therein, as and for his Last Wi11, in the presenc
of us, who at his request, in his presence; in the presence of
each other, have subscribed their names as witnesse~`s~ here~t/off.
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