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HomeMy WebLinkAbout10-14-08 (2)i ~ --~ REV-1500 15056041147 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Po Box.2sosot County Code Year File Number INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 &I 0 0 1 6 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 195076601 0119 2008 11051915 Decedent's Last Name Suffix Decedent's First Name MI LUTZE ANTHONY J {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 12-13-8:2) ^ 4. Limited Estate ^ ya Future Interest Compromise ^ (date of death after 12-12-82) 5. Federal Estate Tax Return Required ® g. Decedent Died Testate ^ ~ Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) 1 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and i-1-95) ^ 11.Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name DEBRA K . WALLET Daytime Telephone Number 7177371300 Firm Name (If Applicable) LAW OFFICES OF DEBRA K. WALLET First line of address 24 NORTH 32ND STREET Second line of address City or Post Office CAMP HILL State ZIP Code PA 17011 REGISTER OF~nlllSLS USE ~1LY ~~, 1_ ~ lr f__- . ~I ~~ DD~'E FILED •• Correspondent's e-mail address: W a I l e t d e b c~ a O I. C O m Under penal ' 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, cct and complete. Decla~tic~of parer other than the personal representative is based on all Information of which preparer has any knowledge. ~~~~ r,~ ° ~r PERSON RE ~E ~1~18'I'E3 F I N ETURN '1 Leonard C. Morris, Jr. ~'©` ~~Q~ 694A Julie Court, Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~~ ~ 1~~ DATE lJ Debra K. Wallet / D -5 - OS~ ADDRESS 24 North 32nd Street, Camp Hill, PA 17011 Side 1 15056041147 15056041144 J ~~ 15056042148 REV-1500 EX 1. Real Estate (Schedule A) ........................................................................................... 1. 2. Stocks and Bonds (Schedule B) ................................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .............. 3. 4. Mortgages & Notes Receivable (Schedule D) ............................................................ 4 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .................... 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested .............. 7. 8. Total Gross Assets (total Lines 1-7) ........................................................................ g, 9. Funeral Expenses & Administrative Costs (Schedule H) ............................................ 9. 7 , 7 6 2 1 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................... 10. 2 3 4 . 5 6 11. Total Deductions (total Lines 9 & 10} ....................................................................... t 1. 7 , 9 9 6.71 12. Net Value of Estate (Line 8 minus Line 11) .............................................................. 12. 2 2 8 , 3 3 4 . 0 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................................................... 13. 5 0 0 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ................................................... 14. 2 2 7 , 8 3 4 0 5 ~ fan a,vmru ~ q I IDN -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 16. 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 2 2 7, 8 3 4. 0 5 18. 19. Tax Due .................................................................................................................... . 19. oe~ede~rsName: LUTZE, ANTHONY J. Decedent's Social Security Number 195076601 27,705.14 208,625.62 2'36, 330.76 34,175.11 :34 , 175.11 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15056042148 Side 2 15056042148 J REV-1500 EX Page 3 Decedent's Complete Address: Lutze, Anthony J. STREET ADDRESS 3614 Kohler Place CITY File Number 21 - 08 - 00166 Camp Hill I STATE Zlp PA ~ 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 34,175.11 A. Spousal Poverty Credit B. Prior Payments 30,000.00 C. Discount 1,578.95 3. Interest/Penalty if applicable Total Credits (A + g + C) (2) 31, 578.95 D. Interest - E. Penalty 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) __ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2,596.16 A. Enter the interest on the tax due. __ (SA) _ B. Enter the total of Line 5 + SA. This is the BALANCE DUE. '' (5B> 2,596.16 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 a. retain the use or income of the property transferred :............................................................................ Yes No b. retain the right to designate who shall use the property transferred or its income :......................................... c. retain a reversionary interest; or ..................................................................................................................... x 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 Nrithout x 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? .............. ................................ . 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 ............::::.::..:.:;:.::;:<.:.::<.::<;.:::::;:::>:::;::::::;;:::~::::::::::<~::::z::>:;;::•::•:::~::.s:x::::•:..:..::::•.;:.>•.~:.~::::::::.;•::::::.: ~::,. 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~•useJof •the~ surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1} (i)J. 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)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 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.`.i) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1 )]. sibling is definedounder Sectiont9102, astan nd vidual whothas at least one padrent in oolmmon wt th the(decedent nwhe her by'olood oa)ado tion. p a i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~. ESTATE OF Lutze, Anthony J. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 45 Savings Bonds (see attached redemption receipts) FILE NUMBER 21 - 08 - 00166 UNIT VALUE VALUE AT DATE OF DEATH 27,705.14 TOTAL (Also enter on line 2, Recapitulation) 27,705.14 SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LutZe, Anthony J. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 - 08 - 00166 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 Sovereign Bank Checking Account #2291029053 2 Sovereign Bank Savings Account #2294016510 3 Sovereign Bank CD #2295250118 4 M&T CD #31003914376619 5 M&T CD #31003914376643 6 Coins (830 pennies; 10 dimes; 5 quarters; 1 dollar; 1 1963 Italian 10 centesimi coin) 7 Cash in possession of Decedent 8 1993 Chevrolet Corsica LT Sedan (poor condition) based on proceeds from sale 9 Comcast refund 10 Refund from Neumyer Funeral Home (overpayment of son's funeral expenses) TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 1, 362.88 22,426.65 131,108.20 37,670.92 12,577.64 12.00 27.00 500.00 29.29 2,911.04 208,625.62 i ~ SSE H ~7 COMMONWEALTH OF PENNSYLVANIA _• ~'~' ~ /V y R7~. V INHERITANCE TAX RETURN AMA ~ RESIDENT DECEDENT /'Y.JIrY ~. ~ ESTATE OF LutZe, Anthony J. FILE NUMBER Debts of decedent must be reported on Schedule I. 21 -08-00166 ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Neumyer Funeral Home, Inc. (in excess of pre-paids) 552.00 2 ,Duke's (funeral luncheon) 910.51 3 Father John Acri 500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Leonard C. Morris, Jr. Social Security Number(s) / EIN Number of Personal Representative(s): 2,000.00 202-20-3457 Street Address 694A Julie Court City Mechanicsburg state PA zip 17055 Year(s) Commission paid 2008 2. Attorney's Fees Debra K. Wallet, Esq. 3,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 410.00 5. Accountant's Fees 6. ' Tax Return Preparer's Fees 7. Other Administrative Costs 1 ,Photocopies, postage, mileage, etc. 50.00 TOTAL (Also enter on line 9, Recapitulation) 7,762.15 l 1 Schhedure H COMMONWEALTH OF PENNSYLVANIA "'"""~" ~1E119ES ~( INHERITANCE TAX RETURN A.,L.,,;.~ /~~ ~~ RESIDENT DECEDENT /'ka ~ ®~ ~+~JOL.7 ESTATE OF Lutze, Anthony J. FILE NUMBER 21 - 08 - 00166 2 Penndot (vehicle title needed to sell automobile) 22.50 3 Mileage of Executor (628 miles x $0.505/mile) 317.14 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LutZe, Anthony J. SCHEDULEI i DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS I FILE NUMBER 21 - 08 - 00166 Include unreimbursed medical expenses. ITEM NUMBER 1 Neurology Center, P.C. 2 AT&T 3 Heritage Medical Group 4 Heistands Garage (vehicle inspection) 5 Penndot (vehicle registration) DESCRIPTION AMOUNT 51.55 14.68 57.33 75.00 36.00 TOTAL (Also enter on Line 10, Recapitulation) ~ 234.56 1 1 REV-1573 EX+ (9-0O) i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lutze, Anthony J. SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) _ RECEIVING PROPERTY I, 'TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Shirley Wolfe ~ 1305 Well Drive Camp Hill, PA 17011 2 Anthony Wolfe, Jr. 6 Indiana Circle Lemoyne, PA 17043 3 Marilyn Mackavage 603 River Stix i Mechanicsburg, PA 17055 II. ~ 21 - 08 - 00166 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) (~) Do Not List Trustee(s) -- ~ Sister-in-Law Nephew Niece =nter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet Ivviv-IAXAt3LE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 Holy Family Roman Catholic Church 25th and Berryhill Streets B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 1,000.00 1,000.00 1,000.00 500.00 500.00 REV-1513 EX+(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lutze, Anthony J. SCHEDULE) BENEFICIARIES continued FILE NUMBER NUMBER -- - ~- ~ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 21 - O8 - 00 SHARE OF ES')-AT E (Words) I ~b OM UA NT OF ESTATE (~) I, (TAXABLE DISTRIBUTIONS[include outright spousal distnbutlons, and transfers i under Sec. 9116 (a) (1.2)] 4 Donna Brady i 326 Arbys Road Niece 1/4 of residua(y Harrisburg, PA 17109 i Estate 5 Dorothy M. Morris 694A Julie Court Sister-in-Law 1/2 of residuary Mechanicsburg, PA 17055 Estate 6 Leonar d C. Morris, Jr. Brother-in-Law 1/4 of residuary 694A Julie Court E t t Mechanicsburg, PA 17055 s a e I Page 2 of Schedule J ~~ ~~~~~~ ~o ~~~~~ I, ANTHONY J. LUTZE, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby make, publish, and declare this to be my Last Will and Testament and hereby revoke all other Wills and Codicils, if any, that I have made. FIRST: I give and bequeath: A. The sum of One Thousand ($1,000.00) Dollars to my sister-in-law, SHIRLEY WOLFE, of Camp Hill, Pennsylvania, so long as she shall survive me by thirty (30) days; B. The sum of One Thousand ($1,000.00) Dollars to my nephew, ~~nthony Wolfe, Jr. , of Enola, Pennsylvania, so long as he shall survive me by thirty (30) days:; C. The sum of One Thousand ($1,000.00) Dollars to my niece, MARILYN MACKAVAGE, of Camp Hill, Pennsylvania, so long as she shall survive me by thirty (30) days; D. The sum of Five Hundred ($500.00) Dollars to HOLY FAMILY' ROMAN CATHOLIC CHURCH, in Harrisburg, Pennsylvania. SECOND: I give, devise, and bequeath all the rest, residue, and remainder of my Estate, of whatever nature and wherever situate, in two equal shares, to the following individuals who shall survive me by thirty (30) days: A. One share to my niece, DONNA BRADY, of Harrisburg, Per,~nsylvania. Should my niece fail to survive me by thirty (30) days, but be represented by children then living, these children shall take, per stirpes, the share to which my niece would have° been entitled if then living. B. One share to my sister-in-law, DOROTHY M. MORRIS, of ~vf Y'` ~_J v Elizabethtown, Pennsylvania. Should my sister-in-law fail to survive me by thirty (30) days, I give her share to my brother-in-law, LEONARD C. MORRIS, JR. , of Elizabethtown, Pennsylvania. Should my brother-in-law fail to survive me by thirty (30) days, I give this share equally to my nephews, LEONARD C. MORRIS, III, of Mechanicsburg, Pennsylvania, and DOUGLAS S. MORRIS, of State College, Pennsylvania. THIRD: All interests of any beneficiary in the income or principal of this Estate, ~~ ~~ r ~; ~~., '~~1~ ~~ -- ~~ while undistributed and in the possession of my Executor, even though vested and distributable, shall not be subject to attachment, execution. or sequestration for any debt, contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to pledge, assignment, conveyance, or anticipation. FOURTH: All inheritance, estate, and succession taxes (including interest and any penalties thereon) payable by reason of my death shall be paid out of and be charged ;generally against the principal of my residuary estate, without apportionment or right reimbursement from any person. In the event that a substantial portion, as determined in the sole and absolute judgment and discretion of my Executor, of the non-probate assets such as an annuity or mutual funds are directed to be paid to a beneficiary or beneficiaries, so that the taxes referred to herein would be paid out of the probate residue passing to the beneficiary or beneficiaries of this will (whether or not the same as the beneficiary or beneficiaries under the non-probate assets), my Executor, in the Executor's sole and absolute judgment and discretion, shall have the right to allocate the full or partial payment of the taxes to the beneficiary or beneficiaries of the non-probate assets. FIFTH: In addition to all rights and powers conferred by law, I authorize and empower my Executor and his successors, in his absolute discretion and without necf:ssity of obtaining court approval: A. To buy investments at a premium or discount. ~~ B. To hold property unregistered or in the name of a nominee. ~~~ n \ C. To give proxies, both ministerial and discretionary. -. ~; ` ~ D. To compromise claims. E. To join any merger, consolidation, reorganization, voting trust plan, or any other concerted action of security holders and to dele ate discretionary ~~ ~' g ,~ daties with .~ ~ respect thereto. ~: ~ F. To lend to, and buy from, my estate. `~ \~ G. To borrow and to pledge real and personal property as security therefor. H. To sell at public or private sale for cash or credit or partly for each, to exchange, or to lease for any period of time, any real or personal property, and to givf: options for sales, exchanges, or leases. I. To exercise any option permitted by law which he believes to be advantageous from the viewpoint of overall tax reductions, including, without limitatic~n of the foregoing, power and authority to claim administration or other expenses either as income tax deductions or inheritance or estate tax deductions, without regard to whether they were paid from principal or income and without requiring adjustments between principal and income for any resulting effect on income or estate taxes, and a deduction of such expenses for income tax purposes shall be given effect in computing the respective shares of all persons interested in my estate set forth herein, even though the effect is to increase the share of one beneficiary or class of beneficiaries hereunder at the expense of another; and to make such adjustments, if any, between beneficiaries with respect thereto as he shall deem appropriate in view o;F the nature of the transaction and the amounts involved. J. To distribute in cash or in kind or partly in each. The powers granted hereunder shall be exercisable with respect to all real and personal property, including, but not limited to, income and principal held for minors or disabled beneficiaries at any time, until the actual distribution of all property. All powers, authorities and discretion granted here shall be in addition to those granted by law and shall be ex.°rcisable without leave of court. However, nothing herein shall be interpreted or construed to encourage, authorize, empower, or permit the Executor to act or cause anyone to act in a manner contrary to or inconsistent with accepted standards of portfolio diversification and risk management. SIXTH: I nominate, constitute, and appoint my brother-in-law, LEONARD C. MORRIS, JR., as Executor of this, my Last Will and Testament. In the event of the renunciation, death, resignation, or inability of my brother-in-law to act for whatever r•°ason in this capacity, then I nominate, constitute, and appoint my nephew, LEONARD C. MORRIS, III, as Executor of this, my Last Will and Testament. I direct that no representative named above shall be required to post security for the faithful performance of his duties in any jurisdiction insofar as I am able by law to relieve him of such obligation. Any of my representatives shall be entitled to reasonable compensation for the performance of the duties set forth here. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~(;i~ day of ~Z{o ru,.,t~ , 2004, on this, the fifth of five typewritten pages. I have also signed the left-hand margin of the first four of these pages for purposes of identification only. --- _ _ _. ANTHONY J. I~JTZ SIGNED, PUBLISHED, and DECLARED by the Testator, ANTHONY J. LUTZE, as his Last Will and Testament, in the presence of us, who at his request, in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. 4kt~.l~....1~csL..~.. ~ :~+:-SS ACKNOWLEDGMENT Commonwealth of Pennsylvania County of Cumberland I, ANTHONY J. LUTZE, Testator, whose name is signed to the attached instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. E ~ 6 ~~ ANTHONY J. ~UTtLE Sworn or affirmed to and subscribed before me by ANTHONY J. LUTZE, tree Testator, this )G~~' day of ~r_,r ; ~~r~~ , 2004. Notary Pub~'ic COMMONWEALTH OF PENNSYLVANIA Notarial Seal Mary M. Loper. Notary Public Camp Hid Born. Cumberland Caunry My Commissiai Expires Od. 27, 2007 Member, Pennsylvania Association Of Notaries AFFIDAVIT Commonwealth of Pennsylvania County of Cumberland We, Debra K. Wallet and ,_~~ i ~ ,~,~, -,~ I~, ~~_ _ , i ,the witnesses whose names are signed to the attached instrument, being duly qualified according to law, depose ;and say that we were present and saw the Testator, ANTHONY J. LUTZE, sign and execute the instrument as his Last Will and Testament; that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that, to the best of our knowledge, the Testator was at that time 18 years of age or older, of sound mind, and under no constraint or undue influence. /~ ~ ~1~C~ Sworn or affirmed to and subscribed to before me by ~ ~,--rt ~ I ~ ~,n I ~ o I and ~~' ~ ~ ~ ~ ~ ~~ K ~~Y14 s, ; ( ,witnesses, this I(~,`'h day of ~ ~, ; ~ , ~__r- <<_,--~__, 2004. Notary Pub,~c COMMONWEALTH OF PENNSYLYAMA Notarial Seal ~Y M. Loper. Nohary Public Came Hitl Boro, Cumberland Courriy ~ Carnrr>ission Fires Oct 27, ZOQ7 Member, Pennsylvania Association Of Notaries T ~ar~~ /'~//L ~ ~~5' i~~ i~?~,s~~li1 l~~i°~~/itii~ ~~T ~~4-T y ~ ~~ ~~~~~o r _ ~~ ~/~~e~~ ~~ { <~- /c ~,~~~~- ~~~ ~~ ~„~~s Tom-. -. ~~~ ~i~r i~~ ~i~e~.~7~/L ~~ ~i ' ~~ ~~r REV-res Ex + (a.oil) COMMO WEALTH OF PENNSYLVANIA DE RTMENT OF REVENUE INH RITANCE TAX DIVISION DEPT. 280601 HAR ISBURG, PA 17128-0601 SAFE DEPOSIT BOX INVENTORY Please Print or Type MUST BE COMF~LETED BY REPRESENTATIVE O ° FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY DE ' ~ILE NUMBER SOCIAL SECURITY (ReQUired) 0R DEATH CERTIFICATE NUMBER (only H SSN is unknown) DECFDENT AD~ S ' NAME (LAST, FIRST,I MIDDLE.) F DECEDENT (STRtL r) • ~ PI ~ DATE OF DEATH CITY) (STATE) {ZIP CODE) ~ ~ ~ -a~~. c~ NAME AN (NAME) (STREET ADDRESS OF ~P~ER~SO;N,R~E,QUE STI~NG/THE OPENING` OF THE SAFE D OSIT BOX ~'h q y~ ~r~., ~ c ~_~~-V~ ~Wi C.1 ~. I"l ~Y~1 SV ~. ~4~~ l.~ ~ . ~"~,t!.1.~ `W ~~CalY "~~ ~ I VJ~ ME) (CITY) (STATE) (ZIP CODE) NAME, AD DRESS AND RELATIONSHIP (IF ANY) TO DECEDE> , OF PERSON(S) PRESENT AT THE BOX OPENING a. (NA ~ ) ~ ~.o nG,r~- C ~ 1~ ~ r r ; .~ J r. (RELATIONSHIP) . t(3+ro~r - N ~L~.u~ dub (STR ET NAME) r' l r' n w. J V~/wC G~ ~ ~~ ~~ ) (ZIP CODE) ~nll...~.> ~ ~~(STATE I ~Ss b. (NA E) (RELATIONS (STR i ET NAME) (CITY) (STATE) (ZIP CODE) e. (NAME) (RELATIONSHIP) (STFi ET NAME) (CITY) (STATE) (ZIP CODE) ' NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSR BOX IS LOCATED (NAME) ~ ~ ~~ (STREET N ME)~ ~~ n~ + ~ (CITYZ n~(STATE) ~ „(ZII ODE) XI I~IL 1 NA OF PERSON MAKING LAST ENTRY _ ~eolnax-d. C. r~ J r ~CG~t,~htr DATE D TIME OF LAST ENTRY (72 ZC~ Og I:oo~PH .DATE OF CONTRACT TO RENT BOX NUMBEg~BOX ~~ ~5 ~ TITLE UNDER WHICH BOX IS REGUESTE ~.c,~, c.~r. NAME AND ADDRESS OF PERSON(S) HA VIN G A C CE SS TO BOX a. (N ) i r , ~ ~ p ~, ~ Wl.i~.~--~ b. (NAME) (STREET A~DgR i SS)h ~ x``''11 ~ l U ~ ~ ~ , ^ _ ' ~ ' , ( E (STREET ADDRESS) ~ ~~ ~ ~ (CI )) (S T AT ) (ZIP C D (CITY) (STATE) (ZIP CODE) NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY 1 C~,1~ (~-~l~a S S .~ ~ r. WAS A WILL IN THE BOX? Q YES [~ NO H yes, a. Date of will: b. Name and address of personal repreasrhatlve, H named in the will (NAIVi`E) (STFaEET NAME) I (CITY) (STATE) (ZIP CODE) c. Name and address of attorney, H any (N i E) (STiEET NAME) (CITY) (STATE) (ZIP CODE) SAFE DEPOSIT BOX INVENTORY Page- of ~\~AI~l~• ~A~~A~~w Iltlalll'CUl.1IVIV5 The C~epartment is authorized under federal law , 42 U.S.C. § 405(c), to use the decedent's Social Security number in administering this state tax law. The Department uses Social Security numbers to establish a decedent's identity and ensur~ proper credit for tax payments. (1) ~1ash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of cert~cate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) ~ank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (8} ~welry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) eeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. rrEM NO. REM DESCRIPTION ~ rr `` (uV~ ~~ll 2 i Q 1'~"~ CQ.~.~ -4 ~ ~~ ~QXI -P~( v~ S 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON MNG COPY OF CORRECT A COMPLETE TO THE BEST OF MY KNOYVLEDGE AND BELIEF. SAF DE BOX INVENTORY: SIGNA ~i~ S ~ PRINT NAM P NAME~CHECK APPROPRIATE B OW: ! • ~ , ~. ~~ L~aals~en C, /j?o~~r ~T.e.. PRINTnTIT-LE DA~T'E} CHECK APPROPRIATE BOX ~"~" ~~ ~~ (/tf IlN l ~ V~-'( ~ IP ~ (~ ~~~(~) ^ Administrator(trix) r ,~ ^ Estate Repreaentetlve ®Jdm owner W safe depot:it ppx NOTE: Attar_h ar1r114in.,~~ Q+r_~ ......, _~ ~_ ~ ~ ~ anve~s) ~T necessary or use duplicates of this page of fom7. ~~ ` ` y ` ~ ~ ~ V ~ ~ t ~ ~~ 0 LL ~ H 1 O2 ~~ Y m yZ V W C ~ ~ ~ = ' t~q y ~ ~ i H Z O U Z ~ m ~ ~ ~ T J ~ Z O 7 Z _ ~ _ ~ i ~ > 7 ~ ~ ~ y ~ ~ % ~ i F LL m V fq Q ~ N W LL ~ ~ / ~ ~ ~ ~ 1 _ U , ~ Yl ~ ~ , V t O ~ ~~_ m ~ W ~ ° W ~ ° O ~ ~.~ o 7 ~ ~° O ~ ~ o ` ~ r4' ~ ~ ~ K> ~ p ~ J ~ o ~' p° rye ~ p ~ ~ ~ ~ ~ Q - ~Q ~ ~ C) d p - po ~ ~ ~ ~ (y rrt- ~ ~ ~ ~ ~ lv ~ ~ '~ ~ ~ ~~ ~ ~~ I O o ~ o o ~ ~ ~ ~ ~ ~ ~ " ~ ~ ~ ~° ~ ~ ~ ~ ~ ~ ~ Z ~ m ~ ~' ~ ~' ov ~ ~ T S ~ ~ 9 ' ~• c~- ~ ~ - g ~ ~~ m~. ~ -~ ~ ~ ~ s 9 , ~ o g ~ o ~ ~ ~ ~ e iA W '~ ~ J J ...._] ~ J l 1f .__1 ~l ~1 V ~ 0 z y {p Q 2 s C ~ s z a S ~ O V 1 z S 3 ; t i Y .. Q Z /~ ~~I/ J\ J 7 W c y2 0 f ~ S ~ r s s i 5 ~ y T a i S Y f. ZW^N O~Na f' Z o m W y ~ ~ ~~ ~ ~ l ~ ~~ ~~ ~ < `~ ~-~-~ vJ Lv ~ iJ t.~ ~~ ~ ~ 3~ ~ za ~ a 5 v . ~~ _ U fn O ~ $ ~ O ~ ~ ~ (~~' ~ ~ v ~ V ~ ~ ~ ` ~ ~ Q O ~V Y I ~ ~ LL O . J ~ ~ ~ ~ Hl ~~ 6 Y O ~ V ~ ` ~ ` \ \ \ t ~ \ L ~ \ \ \ t \ S H T yN 3- V ~ w z U Z r W m ~ ~ Z ~ O 2 U ? ~ W It W ~ ~ ~ ~ ~ _` ~ ~' ,\ \_7~\ * ` jj~'~~ "\ ~ ` n ~7~~ n _\` l \ H W J LL ~ V\ `1 ' [ \ `~`1{`\ ~ to \ 0 ~ V1 ~i E Z ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~` ~ ~ ~` ~ ~ ~ O ~` ~ ~ O ~ ~ ~ ~ ~° `~ a ~pp~ N p c 1 ~ m r p O o v a ® ~ ~ O ~ ~ ~ p Q! o ~») D ~ iA W W " ~ ~ ~ v ~ ~ ~ \ ~ ~ ~. \ ~ ~ V Z F h W Q Z 2 a ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ . ~ ~ G v V a z NZ N Z W ~ O~ma F- N W W ~Za~ 3 ~ ° ~ q ~ ~ v U LJ U ~.~ ~~ ~ V ~ ~ 1 U l~ l~ ~l ~. U lJ l~ _ za ~ ~~ v O U n S N ~ < Z oz '~ ~ ~ ~ ~ 0 ` O ~ ~ ~ o ' o ~ o ~ O o _° ~ ` D \ 0 0 0 ~ - \ O ~ o \ D 0 -„ ~ i f., -!- ~ W W ~~ O LL ~ ~ ~ ~ ~ 0 J ' oz m ~ W ~ I ~ 1 YO yN O W 2 3 Z U 2 o V W m W ~ ~ ~ ~ ~ s Y ~ Z ; O U Z ~ ~ O W = U ~ O ~ h ~ N tq ~ I ~ ` t W F Z Q ~ W ~ I ( ~ I `/~V'\ W IL fn Q ~J Q '`J `J m y ~ z O ~ ~ ~ ~ '^ ul ~ l Z ~ W Q 9 ~ s J Z W ~ ~ Q ~ `~ O ~ ~ ff~~~ O to W CI ~ ~ V ~ Z h W G 2 2 a Se O U y Z W o ~/ ~ rj 2 O ZW^N dLLm~ OONa N it ~Wa~ 3~~m W ~ 5 ~ ~ ~ ~~ ~ ~~ ow ~ a ~~ x U rn W _ % C W F• O ~ ~ ~ ~ ~ ~ ~ V w ~ ~1 JJJ -U.S~.°S~a~~ngs Bo~icLRecfernption-~Recept ANTHONY J LUTZE 1460 SOUTH 13 ST HARRISBURG PA 17055- 266-23-7968 Redemption Date: Transaction Number 02/26/2008 Serial Number Series Denom Issue Date Issue Price Interest Earned Redemption Value 10046070221 E $50.00 08 / 1972 X37.50 $218.60 $256.10 1004670219 E $50.00 08 / 1972 $37.50 $218.60 $256.10 1004670222 E $50.00 08 / 1972 $37.50 $218.60 $256.10 1004670223 E $50.00 08 / 1972 $37.50 $218.60 $256.10 1004670225 E $50.00 08 / 1972 $37.50 $218.60 '' $256.10 1010776651 E $50.00 09 / 1972 I $37.50 $218.60 $256.10 1010776652 E $50.00 09 / 1972 $37.50 j $218.60 $256.10 1027796221 E $50.00 03 / 1973 $37.50 ? $222.28 $259.78 Total number of bonds redeemed: g Total Total Total Price Interest Value 4' $3017:00 = $1,752.48 - r$2r052.48' _ __ u,.~w s -~,:.,~ ~.;~~~ .~ ~ r~ .~ -~ Paxton Street Office 2775 Paxton Street Harrisburg, PA 17111 (717) 255-2240 U.S. Savings~~Ba-nd Redemption Receipt ANTHONY J LUTZ 266-23-7968 1460 SOUTH 13 ST HARRISBURG PA 17055- Redemption Date Transaction Number: 02/26/2008 6118057294 Serial Number Series Denom Issue Dat Issue Price Interest Earned Redemption e Value 1004670224 E $50.00 08 / 1972 ~:~7.50 $218.60 $256.10 164575542 E $25.00 06 / 1959 $18.75 $169.13 $187.88 1698291837 E $25.00 06 / 1959 $18.75 $169.13 $187.88 1700637170 E $25.00 08 / 1959 $18.75 $167.26 I $186.01 1847244322 E $25.00 09 / 1960 S i 8.75 $178.03 $196.78 Total number of bonds redeemed: 5 Total Total Total Price Interest Value ;; $112.50 $902.15 - $1,014.65 ~~~ Paxton Street Office 2775 Paxton Street Harrisburg, PA 17111 (717) 255-2240 ~ ` • .. f"fl '~v'E7% d1*S, 1 as .,• Y - ~'~~.,i .1~~`.~~rpsav~ngs,~on~:~~.ec[emption ~~Receipt ~:.~CA wey..V«,>:w...~.'~~i* ~r.....i z.4r~'.~1.5•~. .~~'.v.'A~=~.~. ;.. .. ~ ' ....... .... Y...S. ..... .... ANTHONY J LUTZE 266-23-7968 Redemption Date: 02/26/2008 1460 SOUTH 13H ST HARRISBURG PA 17104- Transaction Number: 6118057291 Serial Number Series Denom Issue Issue Price Interest Earned Redemption Date Value 1002420859 E $100.00 07 / 1972 $75.00 $436.08 $511.08 1003632801 E $100.00 07 / 1972 $75.00 $436.08 $511.08 1003632802 E $100.00 07 / 1972 $75.00 $436.08 $511.08 1003632803 E $100.00 07 / 1972 $75.00 $436.08 $511.08 1003632804 E $100.00 07 / 1972 $75.00 $436.08 $511.08 1003632805 E $100.00 07 / 1972 $75.00 + $436.08 I $511.08 1003632806 E $100.00 07 / 1972 $75.00 ~ $436.08 $511.08 1003632807 E $100.00 07 / 1972 $75.00 tl $436.08 i $511.08 1003632808 E $100.00 07 / 1972 I $75.00 ~ $436.08 $511.08 1003632809 E $100.00 07 / 1972 $75.00 ` $436.08 $511.08 201114852 E $500.00 02 / 1976 $375.00 i $2,320.20 $2,695.20 201114853 E $500.00 02 / 1976 $375.00 `. $2,320.20 $2,695.20 201114854 E $500.00 02 / 1976 i - - - $375.00 ~ $2,320.20 $2,695.20 201114855 E $500.00 02 / 1976 $375.00 $2,320.20 $2,695.20 201114857 E $500.00 02 / 1976 $375.00 $2,320.20 $2,695.20 2035329703 E $100.00 06 / 1977 $75.00 $483.80 E $558.80 Total number of bonds redeemed: 16 Total Total Total Price Interest Value $2,700,00, . -'~~`~1S 445 60 r _;,$1;9 '~_~5.6a__ :fit' T - ~- -.v,,,, _ =~ ;; ~ <x:~~.-`_~ o - - y ~ • ~ir~~s,.~Bonc~~.Redetmption Receipt ANTHONY J LUTZE 266-23-7968 Redemption Date: 02/26/2008 1460 SOUTH 13TH ST HARRISBURG PA 17057- Transaction Number: 6118057292 Serial Number Series Denom Issue Issue Price Interest Earned Redemption Date Value 01698950957 E $25.00 07 ! 1959 $18.7 $169.13 $187.88 1026194491 E $100.00 01 / 1974 $75.00 $438.92 $513.92 1058229616 E $50.00 01 / 1974 $37.50 $219.46 $256.96 1681365658 E $25.00 03 / 1959 $18.75 $172.78 $191.53 1685499200 E $25.00 04 / 1959 ,18.75 $172.78 $191.53 1685501007 E $25.00 04 / 1959 $18.75 ~ $172.78 $191.53 1689741928 E $25.00 05 / 1959 $18.75 $172.78 $191.53 1690445848 E $25.00 05 / 1959 $18.75 I $172.78 $191.53 201373896 E $75.00 02 / 1976 $56.25 V $348.03 $404.28 201373897 E $75.00 02 / 1976 $56.25 i $348.03 $404.28 201373902 E $75.00 04 / 1977 I $56.25 ; $357.87 $414.12 201373903 E $75.00 04 / 1977 $56.25 j $357.87 $414.12 201566334 E $75.00 04 / 1977 1 - - _ $56.25 ~ $357.87 $414.12 201566335 E $75.00 04 / 1977 $56.25 $357.87 f $414.12 2016201592 E $100.00 04 / 1977 $75.00. $477.16 $552.16 2035329704 E $100.00 06 / 1977 $75.00 ' $483.80 i $558.80 Total number of bonds redeemed: 16 Total Total Total Price Interest Value _ ~ $7 2.50 - ~~ $4,779 91 .' _. $5,492 4't _: ............. . ,, .I I, ~~ ~ ~~, ~~ ~~ . .~ ~~ x ,. a ro ~. . ;,;;a> s .~ ~~TF i~ 9 ^a.., ~. c c c ^ r i f - ., a W r o a~ ~ 7 .~ .. ( 4 w~ L~ -- ~,: :.. : M V ~ ~r~i N ,) r ~ r1 JZ ~ 3 d cn : ~ ,.., .~ tia~~= ~ ~ ~ i ~d - ~ a cv '. ~ ~ _ A i _ ~ ~ :. --~ : . a ,'I ,~ ~ ~. -~ U PHONE: (717) 737-1300 1-RW Vff(CE1 Of DEBRA K. WALLET 24 N. 32nd STREET CAMP HILL, PA 17011-2917 E mail: Walletdeb@aol.com October 10, 2008 Glenda F. Strasbaugh, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Dear Ms. Strasbaugh: FAX: (717) 761-5319 ~~> c_; ~_ _~-1 ~~ _...- ._ __ {-) "°^i 1 ~ ~: -~ T~, _= -- Anthony J. Lutze ~ Will No. 2008-00166 Enclosed are an original and one copy of the Pennsylvania Inheritance Tax Return, a check in the amount of $2,596.16 representing the remainder of the inheritance tar; due, one copy of an Inventory of the Estate, and one copy of a Status Report Under Rule 6.12 for filing in the above-captioned estate. I have also enclosed a check in the amount of $30.00 representing the filing fees for the tax return and the inventory. I have enclosed a copy of the first page of each to be stamped in and returned to me in the pre-addressed envelope provided. Thank you. Sincerely yours, 1.1.~c. K • t.Jc..~~-- Debra K. Wallet DKW/mml Enc. cc: Leonard C. Morris, Jr., Executor