HomeMy WebLinkAbout10-09-08--~ REV-7 500 15056041147
EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO 60X.280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-06D1 RESIDENT DECEDENT 21 0 8 0 0 4 8 4
ENTER DECEDENT INFORMATION BELOW
04272008 09271919
Decedent's Last Name Suffix Decedent's First Name
MI
VALENTEEN MATILDA R
(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
® 1. Original Return ^ 2. Supplemental Return ^ 3, Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ qa. Future Interest Compromise
(date of death after 12-12-82) ^ 5. Federal Estate 1-ax Retum Required
® g, Decedent Died Testate ~ Decedent Maintained a Living Trust
(Attach Copy of Will) ^ (Attach Copy of Trust) 0 8. Total Number of Safe Deposit Boxes
^ 9. Litigation Proceeds Received ^ 1 p, Spousal Poverty Credit (date of death 11. EleCtiOn t0 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:
ame
Daytime Telephone Number
THOMAS A. CAPPER 7172328731
Firm Name (If Applicable)
BALL, MURREN
First line of address
2303 MARKET
Second line of address
City or Post Office
CAMP HILL
State ZIP Code
PA 17011
REGISTER OF WILLS U31:,'ONLY
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DATEFILED :..3
Correspondent'se-mail address: capper@bmC-IaW.net
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 Ihas any knowledge.
SIGNATUREldiF PERSON RESPONSIBLE FO ING RETURN
~ 1 ~}- DATE
C ~~~'~'( ~~ ~G-~°i~~-cam Jill Ann Lancaster 1 ~'/` ~~jj
ADDRES~~P~ / ~ ~~)Y'9
2408 Brandemere Drive, Germantown, TN 38139
SIGNATU ~ PREPARER OTHE HAN ESENTATIVE
Thomas A. Capper
ADDRESS
2303 Market Street, Camp Hill, PA 17011
I_ Side 1
15056041147
& CONNELL
STREET
I
15056041147
TE
J ~(o~
15056042148
REV-1500 EX
RECAPITULATION - - -
1. Real Estate (Schedule A) .......................................................................................... 1. 1. 0 4, 8 7 0. 2 8
2. Stocks and Bonds (Schedule B) ............................................................................... 2. 9 7, 4 4 6. 2 6
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4 . Mortgages & Notes Receivable (Schedule D) ...................................................... .... 4.
5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............. ... 5. 8 , 0 8 9 . 6 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .......... ... ti.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .......... ... 7.
8. Total Gross Assets (total Lines 1-7) ...... ..............................................
_ _. -- ... g. 2 1 0 4 0 6. 1 4
9. -
Funeral Expenses & Administrative Costs (Schedule H) .......................... .... ---
... 9.
1 2 , $ 2 0 . 8 1
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 1 , 5 5 5 . 4 6
11. Total Deductions (total Lines 9 & 10) ................................................................... ... 11. 1 4 , 3 7 6 . 2 7
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12. 1 9 6 , 0 2 9 . 8 7
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. 1.9 6 , 0 2 9 . 8 7
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 .00 15.
16. Amount of Line 14 taxable
at lineal rate x .045 19 6, 0 2 9. 8 7 16. 8, 8 21.3 4
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
1s. Tax Due .................................................................................................................... . 19. 8 , 8 21.3 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
X
Side 2
15056042148
15056042148 J
REV-1500 EX Page 3
Decedent's Complete Address:
Valenteen, Matilda R
STREET ADDRESS - - -
126 West Portland Street, Apt
CITY-. _--------
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
6
--8,383.00-
441.07
Fiie Number 21 - 08 - 00484
'-STATE -- - -
- ---- - i PA zIP
17055
Total Credits (A + B + C)
(1) 8,821.34
(2> 8,824.07
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund (4) - __- 2.73
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
q. Enter the interest on the tax due. (5)
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. _- ----- -
(56> ~ . 0 0
~- Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
Yes No
a. retain the use or income of the property transferred :.................... L j ~- ;
b. retain the right to designate who shall use the property transferred or its income :.................................... - LXJ
c. retain a reversionary interest; or ...................... ~ x]
. .......................................................................................... i I ~ J
d. receive the promise for life of either payments, benefits or care? ......................... `JI ~
................................... .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without XJ
receiving adequate consideration? .......................................................................................................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... L I LXJ
r ~ i`x J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
IF THE ANSWER TO ANY OF THEIABOVE QUtESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART f x j
~k - ~- ;:,, _. ;.~ _ . _ - _ E RETURN.
_ _ -- - - _
_ ~._ t
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax r ~ TH -rcZ ~F
ate 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)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA '~
REAL ESTATE
INHERRANCE TAX RETURN ~'
RESIDENT DECEDENT i
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-- _ _- - ---1 --
- --
---- - _
-__
- ---
--:
_-
-- _ _--
ESTATE OF Valenteen, Matilda R FILE NUMBER
--- 121 - 08 - 00484
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 wilting seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM -- --_- - _ _-___
- - --
NUMBER DESCRIPTION
1 126 West Portland Street, Unit #6, Mechanicsburg, PA 17055
Mechanicsburg Borough, Cumberland County
Tax Parcel # 19-22-0519-057-U126-6
(See HUD-1 Settlement Statement, dated 9-8-2008, attached)
VALUE AT DATE OF
DEATH
104, 870.28
__ - -
-- ____
--
TOTAL (Also enter on Line 1, Recapitulation) 104,870.28
Schrock and Linsenbach
Law Offices
~ mnNiu wr vvuwuwsr
124 W. Harrisburg Street " P.O. Box 310 B• TYPE OF LOAN
Dillsburg, PA 17019 ~ 1. FHA ^ 2, FMHA
^ 4. VA ^ 5. CONY, INS.
Phone (717} q32-8733 Fax (717} 432-1053 6945 E NUMBER: 7. LOAN Ni
MORT. INS. CASE NO.:
C. NOTE: This lorm is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(p.o.c.)"were paid outside the dosing; they are shown here for information purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER:
PAUL E. DeBUIGNE JILL ANN LANCASTER EXECUTOR OF THE F. NAME AND ADDRESS OF LEI
ESTATE OF
7 W. RIDGE ROAD MATILDA R. VALENTEEN, DECEASED
DILLSBURG, PA 17019
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: SCHRACK 8 LINSENBACH
126 W. PORTLAND STREET, UNIT #6 I. SET t LtM
MECHANICSBURG, PA 17055 Sep 08 20D8
Mechanicsburg Boro.Curnberland County PLACE OF SETTLEMENT: Monday
T.Ai PARCEL N19-22-0519-057-U126-6 124 WEST HARRISBURG STREET 02:00 PM
DILLSBURG. PA 17019
J. SUMMARY OF BORROWER'S TRANSACTION
00. Gross Amount Due From Borrower K SUMMARY OF SELLER'S TRANSACTION
01. Contract sties price 400. Gross Amount Due to Seller
105,000.00 401. Contract sales price
02. Personal Property
03. Settlement Charges (line 1400) 402. Personal Property
2.577.00 403.
04.
05. 404.
Adjustments for items paid in advance by seller(s)
106. City/Town tax Adjustments for items paid in advance by seller(s)
107. County/Cilytnx 9/8/2006 to 12/31/2008
108. Assessments
125.74 406. Qty/1-owntax
407. County/Ciytax 9/8/2008 to 12/31/2008
109. School Tex 9/8/2006 l0 6/30/2009 408. Assessments
10.
716.14
409. School Tax 9/8/2008 to 6/30/2009
11. Sewer/crash 9/8/2006 to 9/30/2008
12. Condo Fee 9/8/2008 to 9/30/2006
15.71 410
411. Sewer/Trnsh 9/8/2008 to 9/30/2006
60.69 412. Condo Fee 9
/8/2008 to 9/30/2000
20. Gross Amount Due from Borrower
108,497.28 420. Grass Amount Due to Seller
00. Amounts Paid By Or In Behalf Of Borrower
Dl. Deposit or earnest money 500. Reductions In Amount Due To Seller
)2. Prindpal Amount of new loan(s) 5,000.00 501. Excess deposit (see instructions)
13. Existing loan(s) taken subject to 502. Settlement charges to seller (line 1400)
)4. 503. 6tisting loan(s) taken subject to
504. Payoff of First Mortgage Loan
15.
505. Peyoft of Second Mortgage Lonn
~D7.
Zoe. sD7.
508.
?09.
509.
Adjustments for items unpaid by seller
Adjustments for items unpaid by seller
?10. City/Town tax
510. Ci
?71. County/Ciytax ty/1-owntax
511. CountyJCityteuc
!12. Assessments
?13. School Tex 512. Assessments
!14. 513. School Tex
514
'15.
.
1 s.
515.
17.
516.
517
18.
.
518
19.
.
519.
20. Total Paid By/For Borrower 5,000.00 520. Total Reduction Amount Due Seller
D0. CASH AT SETTLEMENT From/To BORROWER 600. CASH ATSETTLEMENT To/From SELLER
Dl. Gross Amt. due from borrower (line 120) 106.497.28 601. Gross Amount due Seller (line 420)
D2. Less Aml paid byJfor borrower (line 220) 5,000.00 602. Less reduction in Amtdue Seller (line 520)
)3. Cash ®FROM ^ TO Borrower 103,497.28 603
Cash ®TO ^ FROM
.
Seller
1
buyer w eorrowefs Signature
DATE:
1
718.1
15.7
1
3. CONV.UNINS.
HUD4
L. SETTLEMENT CHARGES Case 9 1945
700. Total Sales Commission based an Price: E %
Division of Commission al: $ Total
701.
702. Paid From
Borrower's
Funds At
Settlement Paid From
Seller's
Funds At
Settlement
703.
704. Commission paid at Settlement
800. Items Payable in Connection With Loan
801. Loan Origination Fee
802. Loan Discount
803. Appraisal Fee to
804. CreditReportto
805. Inspection Fee to
806. Mortgage Insurance to
807. Assumption Fee to
808.
809.
010.
811.
900. Items Required By Lender To Be Paid In Advance
901. Interest from 0.0000 /Day
902. Mortgage Ins. Premium 0 Months to
903. Hazard Ins. Premium 0 Years to
904• 0 Years to
905. 0 Years to
1000. Reserves Deposited With Lender For
1001. Hazard Insurance 0 Months @ S /Month
1002. Mortgage Insurance 0 Months @ E /Month
1003. Ciy/1-own Taxes 0 Months @ $ /Month
1004. County Taxes 0 Months @ E /Month
1005. Assessments 0 Months @ E /Month
1006. School Taxes 0 Months @ E /Month
1007. 0 Months @ S /Month
1008. 0 Months @ $ JMonth
1100. Title Charges
1101. Settlement or closing tee
1102. Abstract or title search
1103. Title Examination
1104. Title Insurance Binder
1105. Document preparation
1106. Notary fees JANET S. GORE 5.00
1107. Attorney's fees SIB-{RACK 8 UNSENBACH 594.75
(includes above items No.:)
1108. Ti0e Insurance FIRSTAMERICAN TITLE 883.75
(ncludes above items No.:) NO ENDS, NO CPL
1109. Lender's coverage $
1110. Owner's coverage $ 105,000.00
1111.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Recording Fees :Deed $ 38.50 Mortgage S Relaase S 38.50
1202. City/County tax/stamps : Deed E 1,050.00 Mortgage S 1,050.00
1203. State tax/stamps : Deed E 1.050.00 Modgage $ 1,050.00
1204. Recorder of Deeds
1205.
1300. Additional Settlement Charges
1301. TAX CERTIFICATION to BARRYLHECKARD,TAXCOLLECTOR 5.00
1302. RESALE CERTIFICATION to MANAGEMENT COMPANY $50.00 P.O.C.
1303.
1304.
1305.
1400. Total Settlement Charges (enter on lines 103 S 502. Sections J 8 K) 2.577.00 1,050.00
Parties agree that no liability is assumed by Settlement Ageni for the accuracy of Information furnished by others as shown on the HUD-1 Settlement Statement.
HUD CERTIFICATION OF BUYERS AND SELLERS
1 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 by me in this transaction. I further cedi(y that I have received a copy of the HUD-1 Settlement Statement.
uyer or Borrower's Signature g
Buyers Address 8 Phon Seller's New Address & Phone:
The HUD-1 Settlement S tam ch 1 ve prepared is a We antl accurate account of Nis ~ ~ec~n. 1 have caused or will cause the funds to be disbursed in accortlance with tnis
statement. i//~~
"Settlement Agent Date
WARNING:' It Is a crime to knowingly make false statements to the United States on this or any slmllar form. Penalties upon conviction can include a fine and imprisonment. For details
i
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Valenteen, Matilda R
SCHEDULE B i
STOCKS & BONDS
- ..
FILE NUMBER
21 - 08 - 00484
----------
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
--
ITEM i __
NUMBER DESCRIPTION
--- -.
__
Merrill Lynch Account # 872-55596
(See attached Merrill Lynch account report)
UNIT VALUE VALUE AT DATE OF
DEATH
97,446.26
~'
- -
--_ _ _ i
TOTAL (Also enter on line 2, Recapitulation) 97 446.26
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA ~ PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
_-.. _. _. ._ - _ _ _ _~_L
__ _
ESTATE OF Valenteen, Matilda R 1 FILE NUMBER
----- j 21 - 08 - 00484
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
NUMBER DESCRIPTION
-- __ _-
_. _ --- --
1 1991 Buick LeSabre
2 Miscellaneous clothing and personal property
3 Merrill Lynch -Bank Deposit Program
Account # 872-55886
(See attached Merrill Lynch account report)
VALUE AT DATE OF
DEATH
_.
800.00
1, 000.00
6,289.60
____ _-
_- _ __
TOTAL (Also enter on Line 5, Recapitulation) 8,089.60
~ i 9q
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SCF~DULE H
COMMONWEALTH OF PENNSYLVANIA ~~vY ~+~W~
INHERITANCE TAX RETURN /~ ~y w~A n~ w
RESIDENT DECEDENT r\LArY1 rh7 1 f W~ ~~
ESTATE OF Valenteen, Matilda R
-___
----- __
--
ebts of decedent must be reported on Schedule L
- T _ _ _ ._ -- -- -- _ - -
ITEM - ---
NUMBER DESCRIPTION
FUNERAL EXPENSES:
A. 1 Malpezzi Funeral Home
2 Greenwood Cemetery Association
(Grave Marker)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Jill Ann Lancaster
5.
6.
7
1
FILE NUMBER
21 - 08 - 00484
_-
-- --
AMOUNT
__
835.02
770.00
aoclal ~ecurlry Number(s) / EIN Number of Personal Representative(s):
259-74-6237
street Address 2408 Brandemere Drive
City Germantown state TN zip 38139
Year(s) Commission paid 2008
2. j Attorney's Fees Ball, Murren & Connell (estimated fees and costs)
3. ~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
i City State zip
Relationship of Claimant to Decedent
4. Probate Fees (Estimated)
Accountant's Fees
Tax Return Preparer's Fees
i Other Administrative Costs
j Executor's Expenses and Postage
4,208.00
~ 4, 500.00
300.00
483.96
---___ _
_- - --
TOTAL (Also enter on line 9, Recapitulation) 12,820.81
C Schedule H
COMMONWEALTH OF PENNSYLVANIA i, Funeral ~'Y""' ^""' `+~
INHERITANCE TAX RETURN ~min:c.1...5.... /~....L ~.VI IYn~ II
RESIDENT DECEDENT J__ ~~7a~u CQIYYYtlCC ~~++~~AA1l~a
__ __
_... _.. _... _ -.-_ _-I----__-..
___.. --
.- -..
ESTATE OF Valenteen, Matilda R FILE NUMBER
121 - 08 - 00484
2 I RSR Appraisers & Analysts _ _ ___
(Real Estate Appraisal) ~ 350.00
3 Utilities for 126 West Portland Street, Apt. 6, Mechanicsburg, PA 17055
a. United Water (5-1-08, 7-3-08, 8-4-08 & 9-3-08) $ 55.69
b. PPL (5-2-08, 7-3-08, 6-2-08, 8-1-08, & 9-3-08) $ 347.91
c. Borough of Mechanicsburg -Trash/Sewer $ 114.29
(5-9-08, 7-1-08 to 9-8-08)
4 ,Portland Court Condominium Association Fees
~ (5-08; 6-08; 7-08; 8-08; 9-1 - 9-8-08)
5 ,School Tax and County Tax (7-08 to 9-8-08)
6 Merrill Lynch CMA -annual fee (6-4-08 & 8-5-08)
7 I Wendy Valenteen -Reimbursement for newspaper advertisements -sale of real
estate.
8 I Portland Court Condominium Association Re-Sale Certification Materials fee.
I
517.89
339.31
42.23
250.00
174.40
I
I 50.00
Page 2 of >chedule H
r
C06KdONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
__ -._-_
ESTATE OF Valenteen, Matilda R
Include unreimbursed medical expenses.
--r- -. _ -- - --
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE II
LIABILITIES, & LIENS
_.- -_-. - _-_-- -. J_
_- _ _ - - __
_- _
-- - _ -z .--__-.-
FILE NUMBER
_- _ ~ 21 - 08 - 00484
ITEM - _ --__
NUMBER DESCRIPTION
-.
-- - _ _ ---
1 Delta Dental
2 Verizon Wireless
3 Verizon
4 Discover Card
5 VISA - USAA Savings Bank
6 Comcast
7 Car Insurance - USAA
8 St. Paul's United Church of Christ (remaining 2008 pledge)
__ - -
-- ___ _ _
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
27.78
18.99
162.43
79.98
178.84
53.29
59.15
975.00
1,555.46
REV-1515 EX+ (9.pp)
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
TATE OF ._ - -
___
Valenteen, Matilda R ' FILE NUMBER
j 21 - 08 - 00484
____
RELATIONSHIP TO SHARE OF ESTATE ~ AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words)
RECEIVING PROPERTY ($$$)
I. 'TAXABLE DISTRIBUTIONSulndebSec. 9116stran1 2rs
p Do Not Llst Trustee(s)
O ( )l
1 ,', Thomas W. Valenteen, Jr. Son
102 Boxwood Court
Kingsland, GA 31548
:
2 'Lynn Valenteen Marzoni ~ Daughter
11901 Volcano Drive
West Fork, AR 72724
3 ,Wendy Valenteen I Son
6988 Tippetts Drive
Mercersburg, PA 17236
II.
1/4 of residue
1/4 of residue
1/4 of residue
'Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
NVN-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
- TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ] 0.00
REV-7b13 EX+(8-00)
i ~
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
- - .- -. _.
STATE OF _ _ ___ _ ___- _
Valenteen, Matilda R ~ FILE NUMBER
- - 21 - 08 - 00484
NAME AND ADDRESS OF PERSON(S) RE DECEDENIT TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER RECEIVING PROPERTY l (Words) ($$$)
--__
distributions, and ransfers oo Nor uat trustee(s)
I~ ;TAXABLE DISTRIBUTIONS include outn ht spousal
under Sec. 9116 (a) (1.2)]
4 'Jill Ann Lancaster Daughter ' 1/4 of residue
2408 Brandemere Drive
Germantown, TN 38139
COPY
LAST WILL AND TESTAMENT
OF
MATILDA R. VALENTEEN
I, MATILDA R. VALENTEEN, a resident of the Commonwealth of Pennsylvania,
make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any
time heretofore made by me.
FIRST: I direct that the expenses of my last illness and funeral, the expenses of the
administration of my estate, and all estate, inheritance and similar taxes payable with respect to property
included in my estate, whether or not passing under this will, and any interest or penalties thereon, shall
be paid out of my residuary estate, without apportionment and with no right of reimbursement from any
recipient of any such property.
SECOND: It is my desire that, upon my death, my body be cremated!.
THIRD: I give all the rest, residue and remainder of my property ;rnd estate, both real
and personal, of whatever kind and wherever located, that I own or to which I shall be in any manner
entitled at the time of my death (collectively referred to as my "residuary estate"), as fi~llows:
(a) To those of my children (my daughter JILL ANN LANCASTER, my daughter
LYNN DELL MARZONI, my son THOMAS W. VALENTEEN and my daughter
WENDY S. VALENTEEN) who survive me and to the issue who survive me of those of
my children who shall not survive me, per st~ es.
(b) If no issue of mine survives me, I give my residuary estate to those who would take
from me as if I were then to die without a will, unmarried and the absolute owner of my
residuary estate, and a resident of the Commonwealth of Pennsylvania.
FOURTH: If any property of my estate vests in absolute owner;;hip in a minor or
incompetent, my Executor, at any time and without court authorization, may: distribute the whole or any
part of such property to the beneficiary; or use the whole or any part for the health, education,
maintenance and support of the beneficiary; or distribute the whole or any part to a guardian, committee
or other legal representative of the beneficiary, or to a custodian for the beneficiary under any gifts to
minors or transfers to minors act, or to the person or persons with whom the beneficiary resides.
Evidence of any such distribution or the receipt therefor executed by the person to whom the distribution
is made shall be a full discharge of my Executor from any liability with respect thereto, even though my
Executor may be such person. If such beneficiary is a minor, my Executor may defer the distribution of
the whole or any part of such property until the beneficiary attains the age of twenty-one (21) years, and
may hold the same as a separate fund for the beneficiary with all of the powers de;scribed in Article
SIXTH hereof. If the beneficiary dies before attaining said age, any balance shall be paid and distributed
to the estate of the beneficiary.
FIFTH: I appoint my daughter JILL ANN LANCASTER to be my Executor. If my
daughter JILL ANN LANCASTER shall fail to qualify for any reason as my Executor, or having
qualified shall die, resign or cease to act for any reason as my Executor, I appoint my daughter WENDY
S. VALENTEEN as my Executor. I direct that no Executor shall be required to file: or furnish any bond,
surety or other security in any jurisdiction.
SIXTH: I grant to my Executor all powers conferred on executors under the
Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and all powers
conferred upon executors wherever my Executor may act. I also grant to my Executor power to retain,
sell at public or private sale, exchange, grant options on, invest and reinvest, and otherwise deal with any
kind of property, real or personal, for cash or on credit; to borrow money and encumber or pledge any
property to secure loans; to exercise all powers of an absolute owner of property; to compromise and
release claims with or without consideration; and to employ attorneys, accountants and other persons for
services or advice. The term "Executor" wherever used herein shall mean the executors, executor,
executrix or administrator in office from time to time.
SEVENTH: I direct that for purposes of this will a beneficiary shall be deemed to
predecease me unless such beneficiary survives me by more than thirty days.
This document was prepared under the authority of 10 U.S.C. §1044 and implementing
military regulations and instructions, by Captain Joseph Krill, United States Army, who is licensed to
practice law in the State of Pennsylvania.
IN WITNESS WHEREOF, I, MATILDA R. V~LENTEEN,,s~ign~iy name and publish
and declare this instrument as my last will and testament this ~ day of ~~y~=~~- 2006.
MATILDA R. VALENTEEN
The foregoing instrument was signed, published and declared by MATILDA R.
VALENTEEN, the above-named Testatrix, to be her last will and testament in our presence, all being
present at the same time, and we, at her request and in her presence and in the presence of each other,
have subscribed our names as witnesses on the date above written.
-~+_ ~~~
having an address at
1 7d ~~;
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having an address at
~ 7Q ./7'-
2
ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA, COUNTY OF CUMBERLAND, ss.
We, the Testatrix and the witnesses, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix,
MATII..DA R. VALENTEEN, signed and executed said instrument as her last will and testament in the
presence and hearing of the witnesses, and that she had signed willingly, and that she executed it as her
free and voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the
request of the Testatrix, in the presence and hearing of the Testatrix and each other, signed the will as
witness, and that to the best of his or her knowledge the Testatrix was at the time at lf:ast eighteen years of
age or emancipated, of sound mind and under no constraint, duress, fraud or undue influence.
MATILDA R. VALENTEEN
Testatrix
.4 ~2
print: !=S i~ 6~'a Ls
Witness
~-
print: O~~ /~ D/2T!
Witness
Subscribed, sworn to and acknowledged before me by the said MATILDA R.
V NTEEN, estatri ,and subscribed and sworn to before me by the above-named witnesses, this
day of , 2006.
ary Public
My commission expires on ~~~j„ ~~09
COMMONWEALTH OF PENNSYLVANIA _ ~"
Notarial Seal
Betty S. lGstler, Notary Public
Carlisle Boro, Cumberland County
My Commission E~ires May 14, 2ppg
Member, Pennsylvania Association of Notaries
LAW OFFICES
BBL, MURREN & CONNELL
2303 MARKET STREET
CAMP HILL, PENNSYLVAN~ j']O j j
PHILIP ,1. MURREN
RICHARD E. CONNELL (~ 17) 232-8731
TERESA R. McCORMACK FACSIMILE (717
THOMAS A. CAPPER 1 232-2142
WILLIAM BENTLEY BALL
MAILING (1916-1999)
ADDRESS:
P.O. BOX 1108
HARRISBURG, PENNSYLVANIA j7jO$-j108
October 8, 2008
Glenda Fanner Strasbaugh
Register of Wills -Cumberland County
Cumberland Co '"
N }
unty Courthouse
One Courthouse Square Q ~:cs
``~' °
Carlisle, PA 17013 - -`
~: Estate of Matilda R. Valenteen (deceased
Date of Death: 4-27_Og ) - I
- u~
~~"
--1
Will No. 2008-0484 ~~,
== ~~
Our File No. 2860 .n
Dear Ms. Fanner Strasbaugh:
Enclosed please find, in duplicate, the Inheritance Tax Return with
Will attached) for Matilda R. Valenteen.
( copies of decedent's
Also enclosed are the Estate Inventory and a check in the amount of
the Inheritance Tax Return and the Inventory.
$30 for the filing of
Kindly date-stamp the additional copies of the Inheritance Tax Retu
in the self-addressed, stamped envelope provided.
rn and Inventory to me
Very truly yours,
TAC/hmp
Enclosures
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Thomas A. Ca
pper
cc: Mrs. Jill Ann Lancaster (w/out enclosure)
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