Loading...
HomeMy WebLinkAbout09-08-0815056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau of Individual Taxes tY Po Box 2aosol INHERITANCE TAX RETURN _ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ ~ ~ ~ ~ f ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth / 7 6 /0 9 z y~ z oz ~2~,00 7 ©/ z7 /9/ S Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N /~ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return L3 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 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) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CN~~e c~S ~' ~S,y/ EL DS i i / 7 i 7 7~~ ozo 9 Firm Name (If Applicable) ti' / /`F First line of address Second line of address City or Post Office State ~'I ~ eN~N/ cs~ uRG ~~4 ZIP Code REGISTER OF WILLS USE ONLY n -- ti ~, : _8~ ~:;:, ~ -: ` J ~ r ^ =,[Fl Wis. { ay . ~ +~ , + l _ ~ 1 'j /~y .~ E FILED _~ ~~ .~_ .A. ~- - r Ti -;, Correspondent's a-mail address: _ ~ ~J ~ ~ ~~dS ~ ®C DaW CLLS f 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 preparer other than the person sentative is based on all information of which preparer has any knowledge. SIGNATURE OF PER ESPON~SI FOR FI RETUR DATE ~ ~ 9~~ ADDRESS',p/} ~. LONG `f Nol/y +ar~ ye, ~(/u,~ C~~ ~r/a.~ra; PA' ~ 70 70 SZNATU PR ARERj~THER fN REPR SENTATIVE DATE/'/e~ ~o Gol.(Se~- mod, ^f11P~l~tnics~ur4, Pi9~~ /7asS PLE/N5E USE ORIGINAL FORM ONLY Side 1 15056051047 15056051D47 J 15056052048 REV-1500 EX er b cedent's Social Security Num De • ~ L ~/~G v£~~ ~' ' l l / ` ~ ~ / D ~ a 7 / s Name: Decedent RECAPITULATION 1. Real estate (Schedule A) . ........................................... . 1. ~ 2. Stocks and Bonds (Schedule B) ...................................... . 2. 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. . D 0 4. Mortgages & Notes Receivable (Schedule D) ............................ 4 . DO; 5. p P Y( ) ....... Cash, Bank De osits & Miscellaneous Personal Pro ert Schedule E 5. . I y ?j ~ O . D O 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 6. ~ O ` 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ested R Billi t 7 ~ ~ i p S ~ O • ~ 1 ...... equ ng e (Schedule G) O Separa . .. 8. _ r.. Total Gross Assets (total Lines 1-7) .................................. .. 8. I 8' S 9 O O 1 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~ ~ ~ ~ ~ s 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. ~ ~ d ~ ~ ~ D 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. ~ g S ~ .~ .~ S 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. - / ~ 6 / / J p 3 p g -s~7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~ E an election to tax has not been made (Schedule J) ...................... .. 13. • 13 14 ~ ~ 7 I p c-~ L ~ o g • J ~7 14. ) ...................... Net Value Subject to Tax (Line 12 minus Line .. . 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 D Q ~ 15. D O 16. Amount of Line 14 taxable / ~/ at lineal rate X .0~ ~ t0 7 3 ~ g • 5 T 16. ~ g S 3 ~ • j{ 17. Amount of Line 14 taxable D D 17 D ~ • at sibling rate X .12 . 18 . Amount of Line 14 taxable • ~ 0 18 ~ ~ at collateral rate X .15 . 19. TAX DUE ........................._ ............... ................ 19. 2CI. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 7 : 3~-~`0 Side 2 15056052048 15056052048 O REV-1500 EX Page 3 Decedent's Complete Address: File Number ~/- (/7-~~~~'' DECEDENT'S NAME ~~p,~ z. ~o~G _ _ -- - - - STREETADDRESS -._ _ _ _. rhE~/may ~//L[f1GE too ter, ~LL~~ ~~~dE CITY - _ ___ - _ _ 'STATE 'ZIP - - - - -_ /yIECf/i¢/1//C~-s'B ll/2G ' /~i~ / 70 S~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit ~ B. Prior Payments C. Discount p - 3. InteresUPeinalty if applicable (1) ~7, S3 ~, y8 Total Credits (A + g + C) (2) O D. Interest ~ _- - - _ E. Penalt O Y _- - - Total InteresUPenalty (D + E) (3) g 7,S~z.Y 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) O 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ']~ S ~ ~, y~ A. Enter the: interest on the tax due. (5A) ~ 3 q, ~ $ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ,~ 7Te1 T /. 7(e Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ (~] c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death wilhout receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ~ ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) j1.1) (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.;?) [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-1509 EX + (L97) SCHEDULE E p ~+~~++ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $ M~$1r. INHRESIDENT DECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER L oNG, ~~~ Z 2 i- o ~- /8~ 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. Sffi-F DEPoS ~7' ~X /Nf EN Taffy of /~l~.~GH ~9, zoo ~ ._ ~, ~. S~NGtE IY~4/rE At'rCT: C I T I ZENcS 4~4NK ~) ~, ooo. °o 3, ~ OLD -r'v "70. ~ y.~ OLD CH/F/Rs ~ ~mo.d0 ~ INFO /VOTES : bEC~~u7' M.ovED IN~o /lt~'SS~~H iN zooy „ef..T WH/GH 7>~tE sN~ .scxo oK Gvf[/E ~u~~ y o ~~ i~hrs of PERSp~yiO,CTy ,~4ND 4NP.F' s~IIE' htOr~D <NTo /ytE'sS/NN ~S~/E' /YA-D /-'~ NOD ?o CAS y ©R K6~ G4d~,/. 6. flies phrmvG ~ s. oD ~ k- ,InAS ©~'coR~4-T/opts ~` io , o~ ~'. 7'va,K.F~T sTcc Ff ~"-~2p//tgi 7'R.t~ X30 • °o TOTAL (Also enter on line 5, Recapitulation) I $ ~ ~{~ .3 e'IQ. ° ~ (If more space is needed, insert additional sheets of the same size) RED!-15t0 £%+ (1-97) COMMGNWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER L oNG, vEI~A I. ~ /- 0 7- /~~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-150Q COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE7RANSFEREE,THEIRRELATIONSHIPTODECEDENTANDTHEDATEOFTRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET °lo OF DECD'S INTEREST EXCLUSION IFAPPLICABLE TAXABLE VALUE ~ • AMEX ~ pR1sF FiM~~uCI~L Qi~nrCE1p,4GE .¢CG'auil'T.t' .A~+VlJ RELATED lTE7r1S: ~,4.) ~ ~cT iY4. Doo a ADD ia98 0~ 9z ~ Ao2 Ti4X- EX ~iYIJ ~J -.4 l~, 58S.1y/ sh• N~~ 3.80 .~ S~, z9P d 5~ /000 - o - ~ S,~,.z9~' 6 y T•P.~.HSFE~ ort~ D64Tiy /TES To ..smv, Q~rro I. l~~ilG, .¢wi0 t0i4~GllHT~~', /QLt7:y ,¢,v~ ~P.lE3E, /N~ ~EIP~lASG ~Y~i~•~ ~/3~ ~,~vva/TY moo. 9300 ~GB~ a9/ ~ ooyC ~3~ /9z. ~ ~ /ooSo -o - ~~4; /~z. ~ ~ ~C •) /f,n/~Ykl7'y MD. 9300 (o~2`f ~oz 9 00~ f2b, ~s~ 38 /oQ~ -Q - fez4, v37_:38 ~o~ .~Nrl/!•f/Ti4 ,f~i¢Y.~/.3[E' ~rl/ ,~Gti~L cSr~i~ ~5 to S.~/D Soar/ ~{iC/~ ?JffU'Gf/TE,~ ~1~~) REA•t .~s7A,T~ /NV~S/ifJ~iltT T.e~lST ~~o, c~ao.oo /oo f, -o ' ~/p ooo. o0 ~ l~CCT. ~/D• ood o ©eoo 65/2 380y o 02 / CMY HoTEZ$ ~ /ZE /~A~Y~tT/,F sac~ZY ?v s'~`/~ Loaf' (7"~,I/5 ~S SuN/~oS~D 7~ fr.~f'~ .~ STifc3LE dfFL GC E dF '~O~ BOD~OD /~~ ~/sCysS/~ ~/3%~ w/TN sT~CEY tie.~.uK o~ A-~~I- ~~~ ~S~'F t!!~-L6l~Tlp,~ SHF'E~S ~i'¢.o~D' ~. '~ wse .~.dder ~ S hor~ 1~u.lra.•4~+ o n t~l>~.s - ~'ien~- S ~' •O 3~f q )obl l A~ No. 9475 ,ooo. o --o- ,ooa•oo 3j P~tY~ble fiti Sw:d Seh a,~.l ~~u 3. - /V~'onw;a/~ J4-~nti~~ 3, 600• ~OO~ - o - 3 b~.o~ __ II AA ~~IC ~D SQ4.~ S6V1 ~.v+~ ~4,1.(s~~ , y. y '~ Z~5~~~7 It`(aar15^,I~MCt'i[a ~rq~ts *7, dS 2, I'D IDDIO '- O" Z7~ DSZ./O ~ dod value p ~ ~ b~ ~~ ~ ~ TOTAL (Also enter on line 7, Recapitulation) I $ l7 /, $~ ~ • 7 /If mnro mono is noorlerl {nn...1 .,.L.O+:......~ ..ti....a_ .t a~_ --'-- -'--~ Amer~prise ~~ Financial Ameriprise Financial 5521 Carlisle Pike Mechanicsburg, Pa 17050 Phone: 717-591-1800 Fax: 717-591-1811 fax ?o: ~ From: Doris Srytz Fax: ~ ~ ~ - ~ ~ ~ 7 `7 ~ 3 Phone: 717-591-1800 X202 Date: 3 ~ ~ ~ ~ ~ Pages: ^ Urgent Per Youc Request ^ For Review ^ Please Reply Comments: U ~-e, ~ ro k~ Q C Caur~-' ~ 010 a f~~ f-~ ~ -~- ~ 5 C~ lV~ Gum.- c~.nC~ -~r~ec.~-2~ /d 1Z - ~-`". ~t vt ~ U.te~ ~a; d -}~ ~ ~~ ~ I~O.~ ~~ w~ ~ i~ q ~-~ficsrs . 1 J ~~ This communigtion and all attachments are confidential and may be legally privileged, It you are not the intended recipient, (i) please do not read or disGose any content to others, (ii) please notify the sender by reply {e-mail or fax) immediately, and (lit) please destroy this document. Failure to follow this process may be unlawful and subject to prosecution. Thank you fvr your cooperation. Advisor Connect: TAX-EX BOND FD - A Page Z of ] Ameriprise. _ ONLINE SERVICE & TRANSACTIONS TAX-EX BOND FD - A Close Window Ownershi Information ccount #: 0000 0010 1298 0692 2 002 Ownershi EDA I LONG TOD Value As of 02/12/20t}7 Shares NAV Principal Value 14585.141 3.860 $56,298.64 View Corporate Entities andd Important Disciosure~, Web Site Rules and Regulations, Privacy Statement and About E-mail Fraud. Copyright ©2005 Ameriprise Financial, All Rights Reserved, Users of this site agree to be bound by tale terms of the Ameriprise Web Site Rules and Regulations. ~o /3E D/l~/D ~D fit/ ~~Pa~fL vh'i~~ i8~~'~~> ~iri ~ D•¢G~lh'T~ . /~~ /~/~ll6L 30, ZoQ~ dlsCussr~~ u~f r~ ST,~tC'~"y ~rr.~yc~, o.~" ,¢,,~,l~P,e/s€: C~~ hops://wwwg.in.is.ameriprise.com/Ost/Secure/AccounfProfi le/AccountProfileFundAsOfV ... 3/14/2007 f 'k 'r ;~ , }i=" Suzanhe Wnemann ~,. .~,-:70: Qoris E Brytz/i=ieldM/H/AEFA®AMPF yyyyggss~~ it F~ ' t -_ Sul '~F'"'~ { A * ~ (.ti: ~; ~ ~ `^~ ~; • r X11 ~/2~0(I~ b3.~0 PM ?~r~ _~ r bcc: M, ~ {* ~ ' F } es ~ ' s ~ ~F';Y `""~ ^.., Subject: Date of Death values for Veda Long -client ~ ~ . , ~ ~;- :;: . ~.~__~ `. :. ~ ~ • 18949149 Thank you for your recent inquiry regarding VEDA I LONG's accounts. These are the values of the accounts as of 02/12!2007. Account Information Annuities -Post 1985 Account Number Ownership 93006687091 4 004 Individual 93006724802 9 004 Individual Annuities -Post 1985 Account Number Total Value # of shares Asset Value Per Share 93006687091 4 004 $34192.67 93006724802 9 004 $26437.38 $e'7Jy/ 'TD ,t5~- IJIy/AE,~ /i{/ E'C~ll~f-L .TNA~t'E$ t~~'TltJEEA/ sd/U ~D ,D/S~ICGNTEJ~,' ~~ dISCLfSS/G/!J w/ TH STffCE1' FR.~ti~ ,/~A?E~?/piC/SE ~fi°R/L 3o~ZbG~ (~"~ The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. Please note that the values indicated for any Life Insurance product(s) reflect the gross death benefit at date of death, not the cash value. Values for any proprietary mutual fitnds include accrued dividends as applicable. Values provided for brokerage products are manually calculated, and should be used as estimates only. The prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a service to its clients. Actual values used in preparation of tax returns or for planning purposes should be verified by your legal and accounting advisors. We appreciate the opportunity to be of service to you. Please contact us if you have any questions. > > > > > > > > Suzanne Luncmann ~ Sr. Claims Analyst F..state Sert]ements Client Account Administration Ameriprise Financial Services 70100 Ameriprise Financial Center ~ Minneapolis, iYiN 55474 Offsce: 1-800-862-7919, Option 5, 1 ~ Fax: 612-671-4538 amerintise.com Suzanne.Lunemann~c,)ampf.com SAO Forxns tool can reduce errors and simplify preparation'for meetings. Find the link here. Advisor Connect: Account Profile Page 1 of 2 Att~exi rise ~ ONLLNE SIJR~LCE & TRANSACTI ONS 1=financial _. ~_ _.::. _.,..-._~.:~_._...~_~-~._-~:..,. ~-_~._...:.._ ..._ ;. _._,._..,_.n..... Account Profile - AMERIPRISE BROKERAGE Close window Account Profile ~ Activit ~ Checks Issued ~ Arranaemen~s Transac#ion Wizards Move Money Move Money ~ New M y In Systematic Out of Account) Wlthln Account Move Money First Account Next Account Ownership Information Account #: 0000 0000 6512 3804 0 021 °LB Account Status: ACTIVE Opened Date: 05/08/2006 Ownership: VEDA I LONG TOD Pian Type: NON-QUALIFIED Associated TiN: 176-10-9242 Taxpayer's Current Age: Deceased Associated Group IDs - Select Group Account List Group ID Group Type 0872 1636 2 001 HOUSEHOLD Associated Client lDs - Select Client Profile Client ID Client Name Role Beneficia fnformation PRIMARY BENEFICIARY DAVID LONG SON 100.00% Value Cash Value: $0.00 Margin Value: $0.00 Total Securities Value: $10,000.00 Valuation Date: 03/13/2007 Total Account Value: $10,000.00 https://www 8. in. is. ameriprise. com/Ost/Secure/AccountProfil e/Acco untProfi le. asp?a1KeyV ... 3/I 4/2007 Advisor Connect: Account Profile Page 2 of 2 Positions Held Ticker Quantity Price Estimated Description Symbo! Held Price Date Market Value CNL HOTELS & CNLHDI 500 $20.00 3/13/2007 $10 000.00" RE , Address Address: C/O DAVID LONG 4 HOLLY DRIVE NEW CUMBERLND, PA 17070-2304 Notes: There are no active arrangements for this account. . +The valuation of non-traded REIT and limited partnership investments is either the initial offering price or an estimated value (both provided by the issuer). This information is not intended to reflect the value you may realize if the issuer liquidates the security or if you sell your interests. fn addition, this estimated value is reflected in the total value of your account. . If you hold a Limited Partnership (LP} or Real Estate Investment Trust (REIT} in a non-IRA account or have designated a beneficiary on the LP or REIT or have registered the LP or REIT as a Transfer on Death account, these ownership and beneficiary records are . maintained at the transfer agent and not at Ameriprise Financial Services, Inc. I# you have questions regarding these accounts, please contact the transfer agent. If you have questions regarding the beneficiary of record of an IRA or other qualified brokerage account, please contact Ameriprise Financial customer service. View Corporate Entities and.. Important Disclosures, Web Site Rules and Regulations, Privacy Statement and About E-mail Fraud. Copyright ©2005 Ameriprise Financial. All Rights Reserved. Users of this sits agree to be bound by the terms of the Ameriprise Web Site Rules and Regulations. httns://www8.in.is.arxterinrise.com/Ost/Secure/AccountProfi le/AccountProfi le.asu?a1.KevV ... 3/ 14/2007 REV-1511 EX+ (12-99) ~~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER L o,~u~, v~A z : z / - 0 7- /~~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. P~RTHErvtoRE FuN,E32A-L HohtF 6~ NEW C6tM2Fa2L/MUD f~f,300.00 ~. ~k~~RA{ /1t~7~L ~? Nfly Cun~r3F~2t~it1D -~t/.viTy uN~rEp ~`175.oa M E7Nn ~is7' ,,~, G1~4R/MG F12dNKME~UT CEO, .off "7YRd.vE '~b oo . ~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) ~/f,V/~ ,~. LD/1/G ~ltr/V~ Social Security Number(s)/EIN Number of Personal Representative(s) Street Address ~ /l'/DCL ~ D/Z!{~E city _ /(/E!-t~ (i!l/j1dE~2G~4N.~ State Pi4 Zip /70 7D Year(s) Commission Paid: N/,ff 2. Attorney Fees CJu/g'/~La~ Lc 5H/ELKS' ~ ~QS~?'-h,, ~ 3, z Sb, o0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant NaNF NONE Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees ~yw,q~ D/'~19ii141 iSSKC p~ cf/7ePL cerh77GCtfCS ~ i! X0.00 5. Accountant's Fees 6. Tax Reiurn Preparer's Fees ~. Add: /ieaa~/ ~Oroba.~ ,~e -1b Red i s fcr o ~ /i/ ~~lls ~ 8' . F' ~/;~~ Fae -~ (~eg;s i~r o ~ t~ .'ll s 30. ~ 0 9• ,~du~%/ie/~a/ slzorf' UCtr/'i~{~CCt~S r 1$'.ep lo, /~da~;~onAl s~crf eer~i ~ica ~s ~1 ~, ao ~' ~ Re;Mbux~aernenfis fi, C . Ski eld5~ r fr d. ba yt ~iv Cos't's c~olnia.rt.c~ ~vr C~rf i fed /tita;I,ngs, Pos}t~, (~holvcop~es, ~. r Ccstin,•) 3 8.2 s TOTAL (Also enter on line 9, Recapitulation) $ ,~' S•/2,~5 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF `~~G,' y~I~ ?.. FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-151,3 EX+ (9-00) LE J SCHEDU COMMONWEALTH OF PENNSYLVANIA BENEFiC1ARfES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~,~ O 7r/~~ L oN~, V~a~ ?'. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under 1. Sec. 9116 (a) (1.2)] ~ uTN A~NAI lZIESF d~~+'~" / ~ 7Z S h't.o r,g an 'Zl an oLr Ar. Grass Vatl~e,~, cR 9S94S ~.. ~A~V t D !G. LONG Son ~/ y Heiry ~~-. ~ /IfP,cJ C ~M be--I mod, PA ~~ D ~ o ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II 1. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF VEDA 1. LONG I, VEDA I. LONG, of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to be divided as follows: a.) One-half (1/2) to my daughter, RUTH ANN RIESE, der stirpes. b.) One-half (1/2) to my son, DAVID A. LONG, Rer stirpes. 3. I nominate, constitute and appoint my son, DAVID A. LONG, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter, RUTH ANN RIESE , to be Executrix in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /Z ~ day of A.D. 1995. ~~..~.~~/ ~/ ~ ~+t-~--~ (SEAL) VEDA I. LONG Signed, sealed, published and declared by the above-named VEDA I. LONG as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. f ~~~