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HomeMy WebLinkAbout09-17-08J lsos~osioss REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ fNHERITANCE TAX RETURN PO BOX 260601 Harrisburg, PA 17128-0601 ,. RESIDENT DECEDENT 2I 08 0?~L( ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ) ~ ~ September 21, 2007 October 19, 1946 Decedent's Last Name Suffix Decedent's First Name MI _ _ _ (1f Appllc~able) Enter Survlving $pouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Lichtel !Beverly G Spouse's Social Security Number TH1S RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL 1N APPROPRIATE QVALS BELOW "~~ 1. Qriginal Return ~' '^ 2. Supplemental Return , ., W, 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ ;';;:, 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Tokal Number of Safe Deposit Boxes {Attach Copy of Will} {Attach Copy of Trust) 9. Litigation Proceeds Received ~`~;":"'r 10. Spousal Poverty Credit {date of death ;;;":""~~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) {Attach 5ch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0; Name Daytime Telephone Number Andrew C. Sheely, Esquire 717-697-7050 Firm Name (If Applicable 1 - _ _ 1 REG#STFR t~r~tl~fILLS USE UI~ .Andrew C. Sheely, Attorney at La w ~O ~ -_ c =; ~ `,.Z First lint; of address t~ ~ i ? 127 South Market Street ~ ~ w ._._ - <~ ; "'t Second line of address _ ~ ~-~ ~ ~ . r ~~ `n P.O. Elox 95 ~+: ~ -' ~i ~ UA~T~~~..EU City or Lost Office _ Skate ZIP Code Mechanicsburg CJt PA 17055 Correspondent's a-ma+I address: andreWC.Sheely (werizon.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and t nowledge 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 knowledge. SIGN URE OF PERSON RE= PO SIB F/~OR~FILING RETURN c~ /^TF A ,S Beverly G. Lic t i, Administratrix, 118 North 26th Street, Camp Hill, PA 17011 SIG RE OF PREPAR ~ H HAN REPRESENTATIVE fIATF p F~:c Andrew C. Sheely;'€squire, 127 South Market St., P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLX Side 1 15056051058 1505605t058 r c,~~ 15056052(}S9 REV-1°.i00 EX ~~~~. RECAPITULATION 39, 326.00 i. Real estate (Schedule A} ..................................... . ....... 1. _ 2. Stocks and Bonds (Schedule B) ..................................... . . 2. 3. Closely Neld Corporation, Partnership or Sole-Proprietorship (Schedule C) , .... 3. 4. INortgages & Notes Receivable {Schedule D) .... . ........................ 4. 5. Cash, Bank peposits & Miscellaneous Personal Property (Schedule E} ....... , 5. ~'20Q"00 6. Jointly Owned Property (Schedule F) C'M.:~ Separate Billing Requested ...... . 6. ', 7. Inter-Vivos Transfers & Miscellaneous Nan-Probate Property (Schedule G) ~:;`~'~ Separate Billing Requested....... . 7. 8. Total Gross Assets (total tines 1-7} ...................... . ............ ~ . 8. 40,526.00 9. sts (Schedule H} .................... ~ Funeral Expenses & Administrative Co . 9. ! 13,429.50 10. ......... C~ebts of pecedent, Mortgage Liabilities, & Liens (Schedule l) ...... . 10. '. 628,00 11. Total Deductions (total Lines 9 & 10) .... . ....................... . ..... . 11. ! 14,057,50 12. Net Value of Estate (Line 8 minus Line 11} ............................. . 12. 26,468.50 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made {Schedule J) ............... . ....... . 13. 14. N~2t Value Sub'ect to Tax Line 12 minus Line 13 .............. . 14. , 26,468.50 TAX COMPUTATION -SEE. INSTRUCTIONS FOR APPLICABLE RATES 15. Arnount of Line 14 taxable at the spousal tax rate, or transfers unc'a~ cec. 9116 26,468.50 (al(1~.2} X .OO 15. ' 0.00 _ 16. Arnount of Line 14 ~~~able ; at lineal rate X .0 16. 17. Amount of Line 14 taxable at sibling rate X .1? _. 17• 18. Arnount of Line 14 taxable at collateral rate X .15 18. a.oo 19. TAX DUE ....... .................................................19.` _ 20. FILL 1N THE OV MENT 15056052059 Side 2 t SOSfiOS2059 REV-1500 EX Page 3 Decedent's Complete Address: STREET ADDRESS 118 Narth :?6th Street ~,-v Camp Hiii Tax Payments and Credits: 1, Tax Due (Page 2 Line 19) 2. CreditslPaynients A. Spousal Poverty Credit B. Pnor Paynnents C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty ~I G File~gNu"'m~berQ DECE-DEyN;T'S SOCIAL SECURIT~Y(/NU~MBE~R/ STATE PA (1) Total Credits (A + B + C) (2) - Total interestlPenaity (D + E } (3} ~. 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. (5) A. Enter the innterest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable #0: 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 usr or income of the property transferred :.......................................................................................... ^ 0 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. )f death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent owm an "Intrust for" or payable upon death bank account or security at his or her death? .............. _ 1_i 4. Did decedent awn an lndividua! Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ 0 o-oa o.aa 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 far the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates ofi deatPl 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 R.S. §9116 (a) (1.1) (ii)j. 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 impo:>ed 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) percenk [72 P.S. §9116(a)(1.2)]. The tax rata impo:>ed an 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 imposf,d on fha net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least ane parent in common with the decedent, whether by blood or adoption. ZIP 17011 REV-1502 E}:+ (6-98) ,, SCHEDULE CA COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Richard VV. Lichtel FILE NUMBER 21-08-0794 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 reasonabie knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Decedent died on September 21, 2007. Decedent owned an undivided one-third (1!3) interest in the following oronerties as of his date of death. Values have been determined by using each applicable county's assessed value multiplied by the aoolicable common level ration. reduced by decedent's interest therein. Copies of the deeds are attached. 11 Furnace Lane, Hartley Township, Union County, PA .434 Acres Parcel No. 005-108-204-00000-21. Assessed value $53.000 X CLR 1.13 = $59.890 -- --_ 19,964.00 138 E. Chestnut St., Shamokin, Northumberland County, PA I 10,295.66 Parce! No. 1-2-202. Assessed value $6.700 X CLR 4.61 = $30.887 3. ~ 136 E. Chestnut St., Shamokin, Northumberland County, PA ~ 9,066.34 Parcel No. 1-2-203. Assessed value $5.900.00 X CLR 4.61 = $27.199 TOTAL (Also enter on line 1, Recapitulation) I $ 39,326.QI0 (If more space is needed, insert additional sheets of the same size) aaarr~neo nr GWVM7: ~ MNRk'F* U+ \IU7M6\NCN\ON6p[\ I.:tClNrkt.Y . DLP oa-a~-~ i4:Yat:t.~x a esb~~ 1VIADE thn 7th day of August IJpii7 TRX l~D. SO RFFOFp HDllS y11. Sll itt the year of our Lord two thousnrul (2000) CTY REC FEE 91.110 R£C FEE S1.ili1 RECO1tQ FEl; f14.5YJ i3TTW~FN I ZSL.iE WARY~,LS`~17'~S and ICA'CRItYN ET,i7.ARF..TTi L.IGHTEL., husband and wife, of Shamokin, Nortl-umbtrlsmd County, Pennsylvania, Clrnntors and parties of the 19rst part, AND ' ~ , of Elysburg, Northumberland County. Pent-sylvania, W. ATFCF. T,i["=WTP'T ., of Mechontcsburg, Cumberland County, Pcnnsytvanla, and RI~~-~~i }~. T I~.___~;..,;, of Catnp HiII, Cumberltmd County, hennsylvania, as tennnts in common, Geantees and parties of the second par[, W~'NESSETH, that the stud parties of the first part, for aad in consideration of the Run- of Qne pellet ($t.00), lawtUt money of the Unitccl States of America, well and truly paid by the said parties of the second part to the said parties of the first part at and before the scaling a~ delivery of these prcacnts, the receip[ whereof is hereby actrnowledged, huvc granted, bargained, sold, aliened, enfeoffed, released, conveyed and conflrtned, and by thew presart~ do grant, bargain, sell, alien, enfeoff. release, convey and confirm unto said partlea of the second part, tltelr hens and assigns forever, os tcnnnts in common. AI.L TI~rA7 C;1rfiTATN lot or piece of ground situate. being and Iying in the C[ty of Shamokin, County of Northumberland and Commonwealth of Pennsylvania, known and designated on the general ilthographrd plot or plan of said City as tits eastern one-half of Lot Numbcr'I'en (10} in Block Numbered ']'wo Hundred Slx (206), whereon is erected one-half of a threesstory double frame dwciting house. ANA AL50 AT.L the southern fifty (SO) Poet In deptl[ by twelve and ot-o•half (lZ 112) feet in width of tl-e western half oC AY.I. that certain part lot or piece of ground altuate, being and lying in ilia City of Shatttokin, County of NotKhutnborland and Commonwealth of Pcttttsylvania, known and deslgttated on the general tithographcd plot or plan of said Clty of Shamokin as Lot Numbered Ten (10), Block Numbered Twn Hundred Six (2U6), tilt said piece or parcel of ground being bounded on the North by the noru~ern one hundred (100) feet of a,9id Lot Numbered Ten (10); on the West by the southern portion of Lot Numbtred r1-2008(MON) 10:34 P. 003!010 Nine (93; on the Stwth by High Strut soul on the East by the souutarn portion of the eastern one-half of said Lot Numbered Ten (10) in 13iock Numbered Two Hundred Six (20b~. BEING THE SAME pretstiacs which Harry I•l. Reese and ivy B. Reese, his wife, by their deed data] September 19, 15b7, recorded Septtxnber 21,19b7, In thrr Office of'the Recorder of Deeds in and for Northumberland County. PctulSylvania, iri Dead Boole 469, ut Page 638, granted and conveyed unto Leslie Ward Liclztel and Kathryn F,(izabeth T.ichtcl, his wife, Gti-ntors herein. Tax Assessment Map No. 1-2-20Z. AND AL30 ALC. the northern one hundred (100) feet by twelve atui ono-half (12 l!2) feet in with of ALL THAT CERTAIN ]ot or piece of gtound situate, heitig and fyiag in the City (Cormerly borough) aP Shtmakin, County of Northumberland and Couunonwz:aith of Petatsylvatua. known and designated on the getw•ra] lithographed plot or plan of the said City (fwtuerly Borough) of Shamokin as Lot 1Vtuttber Ten (I~ in 1'Ilock Nutttbeted Two Hundred Six (106), ttte so(d part lot havirtg a width or frontage of twdvc and ono-half (12 112) feet on Chestnut Street and extending of that width in depth one hundred (lam) feet, the eastern boundary line of said parcel herein conveyed, rotating through the center partition wall of. a double titttie-story, frau-e dwelling erected on said Lot Nutnbercd Ten (10) dividing sa[d double dwelling East and wit. BBINGr THLr SAl1;~ promises which John D. Reese and Agnes R. Raase, husband acrd wife, by their deed doted January 15, 1942, recorded January 15. 1942, in tha OfSee of the Raeorclcr of Deeds id and for NorlhutnberUtttd County. Pennsylvania, in Deets 8aak 283, at Gage 460. granted and ¢anveyed uata Leslie Ward Lichtd and .Kathryn E. Lichtel, husband and wife, Grnntars herein. ,\.~ Tax Assessment Map PIo. 1 Z-?A3. THIS DOCUMENT 170LS NOT SELL. CONVEX, TRANSFER, lNCI.UD$ OR 1N5UFtL'1'FlE TITLE TO TEIE COAL AND RIGHT OF SUPPORT UNDERNEATH THE SURFACfi LAND ALSGRIBEU ORREFSFLRED TO HERLOri, ADiU TFiB OWN>rR, Olt OWNP.IIS OF SUCH COAL, l•IAVE THE COMPZETE LBGAIG RIGHT TO REMOVE ALL OF SUCH COAL AND. IN THAT CONNBG'1'iON, DAMAtI:E MAY 1tL'SUI-T TO THE SURFACE OF THFS LANA AND ANY HOUSE. DUT~LUING OR OTHER STRUCTURE ON OR IN 5UCII LANA. 'FI•]E 1NC1.USION O>P THIS NO'CiCIi DOF«S NOT F1YI,ARGE. RESTRICT OR MODIFY ANY LFQAL RIGHTS OR ESTATE OTHERWISE CREATED, TRANSFT1tR~A. E7fCEP''1€'ED OR ItI?SLfiVED BY THIS INSTRUMENT. This decd eat7eets the description Cotuaiued in a prior decd Crow cite Grantors to We C)tatttees dtttctl July ZZ, 2000. rcco*ded the same day in Record Book 1299, at Papa 028. which erroneously omitted rho northern one humlred (100) feec of the western one-half (1(2) of Lot Tar (10) ]n BlacTt Numixred Two Hundred Six (`l06). The omitted pared is Included in this eort:ectcd conveyance whereby the complete title W Lac'I'cn (IO) Block Two Hundred Six f7.Oti) Is vested in the Grantus. TH15 IS A CORRECTED CONVEYANCE BY PARENTS TO THEIR SONS ANi) IS A 1T2ANSACTION EXCLUDED 1t~OM THE 1MP051TION OF REALTY TRANSFER TAXES. Apt ~.3C+tt P~ss7 - Ca~`~ `~ ~a 2`_~~ , ~G q~ "J~" '~ ti~ ~~~ Yh is 1 r~cl~r~~ru ~e MAbL• the ~~~ day of in the year of our Lord one Thousand nine hundred and September e~.ghty-nine (I9 t3EfW~EN LESLIE WARA LICI.ITI~L and KATHRXN LICI~TEL, his w~.fe, of Shamokin, L~:SLIE l:llW:LIJLIC 1`'~L and SUS N k,. L ~C TEL, his wide, of L•'lysburg, a-~,KATIi1.,E11~! 1'lAG ~, '1' , wi ow, o S amo in, ail of the County of No-rt um er an' an GomntronweRlth of Pennsylvania, grantors and parties o~ the first part:, AND L. E~w~, T•i'cxT1rL of EJ.ysburg, Northumberland Gounty, '?ercnsyl-ranxa, -'q. REESL LICHTLL, of PSeGhanicsUurg, and RZGHAP.D W. LICHTEL, p£ ~atnp'"'ETY ~ ; of of the County of Gumberlan an Gottunonwea th of Pennsylvania, a one-L'hird interesL• each as tenants in common and not as joint t~:nants with.ri~trt oL survivorship, grantees and parties of the second part wll'NCSSETH, rh,~t the said part ies of the first part, far and in consideration of ihesumnf Cna (1.40) Dollars, lawful money of tl-e United Srares of America, well and truly pail t;y the said part ies of the second part to tlZe'said part iES of the first pirr, at and before the sealing and delivery of these presents. the receipt whereat is hereby a<knvwlcdged have f;rantcd, barl;ained, sold, aliened, cn- ~feoffed, released conveyed and confirmed, and by These presents do grant, bargain, sell, alien, en- feoft, release., convey and confirm unto said part ies of the second part Chair ;heirs and assigns forever. ALL the surface of ALL THUSE TWO (2) CF.RTAl1V parcels, lots or pieces of land, Bart of the Furnace Tract, situate, lying anal being in the town of Clan Iron., kiartlev Township, T.Tni.o:- ;runty in Mlle .Gotnmoztweal'Ch of peYtnsylvania, bounded a.rtd described as follows, to wit: FAhG~L 1 J3eginning at a pin on the north side of the Church road; thence in axt• easterly cirection along the NorL-h side at Church road a distartee of 50 feet to an iron pin; thence in a northerly direction a distanca of J.35 feet morn or lass a).ong a lina bounded an the East by Parcel No. 2 hereinafter described, to a poin-G; thence in a westerly direction a distance a:~ 50 feet more or less along a Line bounded on the North by land now or formerly of the John T. Church Estate, to a pin; thence ~.n a soutl~ierly direction a distance of 235 feet along a line bounded on t:he West by land now or formerly of John and Jacobs Horn, to a point, the place of beginning. ~' M`~ ~d.~~' ~,~' ~~c,~ ~-11-2008(NON? 10:35 CA1L~lilw Jr 2 P. DD7/O10 ll j! Begitixza.ng aL an a.rori, pint ,ot~, the Norcl~t side of tyre. Chuxch xoad, ;~ being the Soutl-xeast CarneT . of tl~i.s 1'arcul No. ~ l~eitt~; h~:rel~y ;+ conveyed; thence ~,n aweste.rly dir4c~iox1 along, CIYC~ Nurtll side aL ~~ Cl~.urch road a distancr~ o~ 90 ft;GL' ~t:o ate iron p:f.x7; `tlirr:nc~ in a, I; nartrhexly direction ,a dist~.ncr~ . of 13S ~eoC a~.c,ng a line bounded an ~~ tlac~ West by. 1'arcel..Na,_ :1 ,described i~rrreiaia.bove, to a piiY; thence i,n art easter~.y direction a .clis~artce of t)U. feet: a~.ong a line ~bvunded ,ari { tYxe Norct~ lay land now or., farmer.ly o:f the Church >rstate., to a pin; ,, thence in, a southerly ciirectiari a distance of 135 feet; along a litre bcaundecl on the rest by .and now or forniexl.y of Matt'rer, to an iron • p:z.n, the glace U~ beginn:i~ng.. SUBJECT, hawever; a~. a1T Lhe "excepL-ions, reservations, l' provisions, coczd~:t~ions; cav~itants, anc3 a~•Leements canta~.ned in ,: etie pria;~ .deeds , itt the chain of. ~C~,t.le , . R ' i ~. B'~IIdG "i'H~ SAl~IL pxemises which 7,.c.~l~.e irJaic's .Liclitel,, ct al. , ~,- ~i by thea.x di;'ed dated, P4ay-:3,1., 1.96~.,.,xccprcle.cl August" $,, 19G2, .in the • :. ,j ~i~~ice .of, ~.he l;ecazder o~.natrcls in and' fgr Union County, t. Fennsylvacia,. lit 17eeii Iio:Qlc ,105, at~~ Pa~c 55`3, ~'ranLed~~ and cc~rtveyed ...: '~! . onto Leslie ~[dard ~l~icl~trcl.-~and~:lCal;}ia:.yrt, lxis wi.i~:,: ,Les1.i.,e Edwin . . ;! L,ichtel artd Rathle:e'n Magrix:l,~.a;:, ~.al.l bei,nS. the.. same p~r.;ox2s wlZa, l t:a~ettter with Sus~tnn E'. • Liclztel, Spouse of Lc_;;i1ie :Edwin Lichti?1, ~~ are the grai1>"Qr.~ ltere,in. ,~ .. .. , ~~ • . • ~a ;~ ~i~ ji • !~ , I. _ . i :.. •- ti 7QG~THCR with all and singular the tenements; her,cclu;irrrutts and.appurtenances t+~ the came Liefonging; ar , .in any wise appertaining; aid rhrr reversion and rcversloi~s, rCin.iindcr and remaindcrti, rents, issitcs ,ind'proFits ~1 thereof; and also all the estzte; rilihr, title„irtterest, nr,ohitrty, clJirr+s and dirrit:+~+:Is whatsoever, Both in law ~~iri ~~ . ec{uity,,of.the said part . . of the lirsi 1~an, of,,irt, to or out af' the said pr+~rrxiscs and every part.anJ l . ~ ,, xes '~ Parcel tfierof. .. .. • I~ ~ I ~~ i . TQ HAVE AN© Tta ha_ULL]. the said premises, with a!I arrd sing~rlar the. appurtenances tanro thN said ~ ~ thcar heirs and assi nti, to :end (or{hc Dill to~~cr ust ariil beliaof of"the said . part..i~s of the second part, E Y p , f _. .. ~ • ~` part ias of the second parr, ~he~~,heirs and assigns iut.evrr. ,i and t1,e.said .part-ies o~ ;the:. First .parer,; t;ttea.r ! _ `' . ~ • I; '• ,, • '.. • i ~~ ~l ~~ ~ ~ .. ~ . ~ COMMONWEALtH OF PENNSYLVANIA INFIFHITANCE TAX RETURN RESIDENT UK;EDENT SCHEDULE E CA5H, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE ~OF ~'~`~ Richard W. Lichtel Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21-08-0794 REV-1511 EX+ (12-99) ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE IOF FILE NUMBER Richard W. Lichtel 21-08-0794 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I. Myers-Harner Funeral Home, Inc. X7,025.00 2 Gingrich Memorials -headstone 2,400.04 B. ADMINISTRATIVE COSTS: 1. Persona{ Representative's Commissions Name of Personal Representative(s) Beverly G. LlChtel Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 118 North 26th Street City Camp Nifi State PA Zip 17011 Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Beverly G. Lichtel Street Address 118 North 26th Street City Camp Hill State PA _ Zip 17011 Relationship of Claimant to Decedent SpOUSe 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Postage $~ Filing fees TOTAL (Also enter on line 9, Recapitulation), $ (If more space is needed, insert additional sheets of the same size) O.OC) 375.00 3.500.00 6.50 15.06 13,420.51% Lvtyers-Warner runeraL tiunae, •uc. 1903 MARKET STREET CAMP HILL, PENNSYLVANIA 17017 Robert H. Hamer, Supervisor Phone: (717)737-99fi1 STATEMENT OF FIJNERAL GOODS AND SERVICES SELECTED Uuges aze only [or [hose items [hat you selccmd or [hu uro rcquircd. 11 we mx rcyuired by law or by a cemetery or crematory m use any ircms, we will explain M writing below. Ityou selected a funeral [ha[ nr~y require embalming, sack as a iuncnl with viewing, you may have ro pay for embalming. You do no[ have co pay for tmbalming y'ou did no[ approve cltd unngemen[s such ns .I dirty cremuion or imntcdiue bural. if we chugtd for embalming, we will zplain why below. Fo. eGe Sa~..:ro r l ~r~~r. b~ /~T~f ~j w of Dea c~arge ro: ~' £-rrs~ f~t. Ti~_ //,Y ~a4 '~`T,-~_.9as/l/7i« ~ 7/// Name ~ ~ Address Coy Sari A. CIL4RGE FOR SERVICES SELECTED: Other clothing L PROFCSSIONAL SERVICES // g Stn~ices of Funeral Dircaor~ SnrT .... YruG 6 Embalming ..... ..... ... >~ wG Cremation urn ................... S Ocher propantion of body (Dcscripnonj ........... ........ .. ...... .. 5~~/li SL'H-TOTAC OF PAOEESSIONAL SERVICES...... ?. FAGLITIES ANll SERVICES Use of facili[ics and sm~ices for viewing (\'ui[arioniW'akt). ...... .. 5~~ UsC Ot f1clEliu and lCtVieC3 fOf fun<nl CCfCNUm' .......... S/,~'~ .. UsC U[ ClC11111CA az1d felVil'e5 101' 6fzmurial Servic< ............. .. S Ust of equipment and scrvi¢s fOr gr1Vt51dC )CIVICC ..... ...... ~~~~ .. iL'=v Ofher use of facih[ics OTHER S F_ Al 5 i / TOTAL MERCHANDISE SELECTED ... .. ...... ..... U ~j~ C. SPECIAL CHARGES: Parwuding of remains [o S (Funeral Homc} Receiving of mmains from _ 5 (Funeral Homc) Wmcdie[c Burial . ............ .. . 5 Dirc<[ Cremation ..... .......... . 5 5 SUB~TOTAC OP SPECIAL CHARGES . ........ ....... C i D. C.45H ADVANCED Lo[and Dccd .......... ...... .. Vwl[ Service Charge .... ....... .. 5 ........... ............. ... . .. 9 /f/i. SUB-70TA1 OE FAC111TIESIEQUIPMENT ........... A? ;. AUTOMOTIVE EQUIPAENT Vchide to transfer rcmaitu [o Funer al Homt Local ........................ ... ~~ House lCuker Cnaeh) Local ....................... ... f/~!i Limousine Local ....................... . ... 3 Funh)' car Local .. ........... .. ... ... i Flower cu or Moral duposi[ion Local ........................ ... S/!w Lead caz;clcrgy car Car for pallbtuers Local ........................ ... 3 t o[ [own [ratuporn[ion ...... Opening Grave .................. 5 E Ccmtrery Equipmem .............. 5 Newspaper Notices-Local ...... Newspaper Noticri-Ow-ot-[own.... f Telephone A Tzlegnms ........... S Airfare ...... ............... S ~ ClergyJMassrtif3Rtng .............. /~•~'eJ Pallbcuc[s ..... ............... 3 Certified C,opia of [ht Uearh ///~ CCf[dlCa[C ...... ............ 5 C •~~ Police Es vr[ ...... .. .......... S Flowzrs ........................ ~/i~ d(J ... 3 a SUH-TOTAL OF ADVANCES......... i SUH-T07AL OF AUTOMOTIVE EQUIPMENT'........ A3 5 IX"e charge you for our >crvices in obtaining: TOTAL OF PROFESS10N.41 SERVICES, (sPecflY cnsb uAVnnczr rbar are marked-up) FACILITIES AND AUTOMOTIVE EQUIPMENT ..... ........ .. ............. ...... A B. CHARGE F MERCHANDISE SELECTEDr fDtscrip[ion} f S s T f } .............. I , )'~. 00 SUMM.4HY OF CHARGES A. Professional Services, FaciBties and Equipment, and Awomotivc Equipmem ... T/o[T U'd6 B. Mcrchandisc......~~ ............ .. ~~ Other Recepnde ................. 5 C. Special Chugcs .................. f l l3 3 [~G h Adv nces 5 D C i De>crip[ion) - • ................. . . . u a - TOTAL OF ALL SECTIONS ........................ f Outer burial comainc ~Ls-~~pL. 3 •~!~ ~ PAID AT TIA[E OF OR PR10R TO (Description) / {~I(O(,gj~-~ ARR4NGEMENTS ........................ ... .... HAL4NCE DUE .................................. PJ7 Acknowledgement cods ........... ~[! L REASON FOR E3IRALMING Rtgis[cr book(s) .................. E~s ,~-,p,.i~ , r g /~-m Flemoq• toldtn .................. 3/ n~~ If any law, cemzreq', or crem ory mquiremrn[s have rcquircd rht purctu P d S o[ any of nc~ i[rms listed about [ht law or requirement H explained bclol y s • n}tt ~u .. ................... Tcmpo[a[)' gnVC marker ........... 8 d•~ ~A~ ~~ Burial clmhing ................... f 1 Agra [hu l havt examined [ht Teems of goods y1d strvims sclzc[cd nbovnnd found [hem to be correct and according ro the urangemcnti I have requested. l rcetipt of a ropy of [his Sta[emen[ of Funeral Goods Services Stleaed. I rzpresrn v I have sufficient funds available for paymtm of [ht cub price and servucs selected. 1 also agree tq a payment of b within days. 1 agree m be jointly and szverally Bible with an sagas belOw'. A Lt[t Chlfgc rat 5 per month amounting [0 5 per yor will be applied [o the unpaid 6alantt beginning ~( from [he dart of [hu agreement. 1 will also pay to [ht Funeral Director aB rnsonablc coati paid by the Funeral Director to codzcr amounts I owe order [h. Those mats mry include auomeyi tees, court co>ts and other cash. Any additional services or machan ~ ordatd or requzstzd afmr the date of dds a, bC cotuidemd put of this agreavem and [he cos[ [hereof will be rcFlcacd on [he final biB or s[ucme (Stal) (Purchaser) fD' fScalj ~.pf~~-~ ~~ u (Purchaser} lac «il Director IhC t } RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sgware Car]_isle, PA 17613 LICHTEL RICHARD W Estate File No.: 2008-00798 Paidl By Remarks: BEVERLY G LICHTEL AJW ------------------------ Receipt Distribution * DUPLICATE Receipt Date: 7/31j2008 Receipt Time: 09:33:15 Receipt No.: 1053546 Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 90.00 CUMBERLAND COUNTY GENERAL FU JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M. AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FU ---------------- Check# 265 $105.00 Total Received......... $105.00 REV-1512 E{+ i12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES4DENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FRT4TF nF Richard W. Lichtel FII F NIIMRFR 21-08-0794 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Final pharmacy bill to PharAmerica 62U t)ti TOTAL (Also enter on line 10, Recapitulation) $ C~28.(~~ '~ (If more space is needed, insert additional sheets of the same s¢e) :~..~~~ ~ ~' ~?EV?513 EX+ (9-OC; ;~ ~ COh9lv10NWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Richard W. Lichtel 21-08-0794 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 Sec. 9116 (a) (1.2)] 1. Beverly G. Lichtel, 118 North 26th Street, Camp Hill, PA 17011 Spouse $26,468.50 (Intestate share of surviving spouse is less than $30,000) 2. Jeffrey R. Lichtel, 13 Kower Court, Mechanicsburg, PA 17055 Son 0.00 3. Jason S. Lichtel, 2701 Lincoln Street, Camp Hill, PA 17011 Son 0.00 4. Megan E. Lichtel, 1710 Market Street, Apt. 21, Camp Hill, PA 17011 Daughter 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size)