The URL can be used to link to this page

Home My WebLink About02-04-09-J REV-1500 Lsos6o7120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Cate Vear Fila Number PO 60X.280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 5 7 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 183124592 05192008 10251907 Decedent's Last Name Suffix Decedent's First Name MI WALKER LOUISE g (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 INAPPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-a2) ^ 4. Limited Estate ^ qa, wture toterest compromise 5. Federal Estate Tax Return Re wired (tlate of Oeath after 12-12-82J ® Q ® g Decetlent Dietl Tastale (Attach copy o1 Will) ^ 7 Decetlent Maintained a Living Trust (Attach Copy or TmsQ __ _ a. Total Number of Sate Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1D. petween P2veny Cretlit (date of death 11. EleQion to tax under Sec. 9113 A 31-91 and 1-1-95) ^ ( ) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA7( INFORMATION SHOULD BE DIRECTED TO: ame FRANCIS A ZULLI Daytime Telephone Number 7172321488 Firm Name (If Applicable) WION, ZULLI AND SEIBERT First line of address 109 LOCUST STREET Second line of adtlress City or Post Office State HARRISBURG pA ZIP Code 17101 WILLS US~NLY v = - , m ,_ ~ ~? W = . ' . .11 : ~~ Tr r r_ ~ _.. ~- ~ILED !V O 0 Correspondent's a-mail address: WZS ~In IndSprln9.COt11 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, antl to the best of my knowledge and belief, it is true, correct antl complete. Declaration of preparer other than the personal representative le based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FIyNG RETURN DATE ~/ ~~-t f ~r-u-^-~-~--. C-~o~--t-.E-.-~- Mary Louise Walker 3 ~0 9 142 Hawk Lane, Ephrata, PA 17522 Francis A Zulli PA 17101 ~ Side 1 1505607120 1505607120 J ~~ ~~~ ~ ~ ~~~~ ~~ ~- .~ 1505607220 REV-1500 EX Decedent's Social Security Number oeceaem~s NSme WALKER, LOUISE E. 183124592 RECAPITULATION ___ __ _. __. __ _.. _-. -.. __. _. __. __-.. ___ 1. Real Estate (Schedule A) ....................................................................................... ... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. .. 2, 2, 4 8 0, 0 1 5. 1 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ .. 3. 4. Mongages & Notes Receivable (Schedule D) ....................................................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) .............. .. 5. 5 5 , 2 3 2 . 2 1 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ........... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ........... .. 7, 2 1 , 0 0 0 . 0 0 8. Total Gross Assets (total Lines 1-7) ..................................................................... _ _ _ _ .. g. 2, 5 5 6, 2 4 7. 3 7 9. Funeral Expenses & Administrative Costs (Schedule H) ........ -_ s. ___ 3 4 , 1 9 7 . 5 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..........:................... .. 10. 3 , 3 4 5 . 4 3 11. Total Deductions (total Lines 9& 10) .................................................................... .. 11, 3 7, 5 4 2 9 9 12~ Net Value of Estate (Line t3 minus Line 11) ........................................................... .. 12. 2 , 5 1 8 , 7 0 4 3 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................ . 13. 2 5 , 0 0 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ................................................ . 14. 2 . 4 9 3 , '] 0 4 . 3 8 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 2, 4 9 3, 7 0 4. 3 8 at lineal rate X .045 16. 1 12 , 2 1 6. 7 0 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due .................................................................................................................... . 19. 1 12 , 2 1 6. 7 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 06 - 0575 Walker, Louise E. _- - - __ STREET ADDRESS -- 210 Big Spring Road __ clrY __. __ Newville _ _ ___ _- __ ~. STATE ZIP ~ PA 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresVPenalty if applicable p. Interest E. Penalty Total Credits (A + B + C) Total InteresVPenalty (D + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (2> 105,263.16 (3) 0.00 (4) _ _ - - (5) 6,953.54 _.-. __ _ (5A) (se> 6,953.54 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 :.............................................._................................. I I b. retain the right to designate who shall use the property transferred or its income :.................................... [__ ~'~ ~ xJ c. retain a reversionary interest; or .................................................................................................................. ~ 1 X. d. receive the promise for life o(either payments, benefits or care? ......................... i__~ I x ..................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................_..... I _1 IX~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... x~ ;_~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which _ contains a beneficiary designation? ................................................................................................................._... ~' ~' x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ... . .....::: . ,.... i... ,y,,i For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (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)j. The tax rate imposed on the net value of transfers to or for the use o(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)j. 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. (1) 112,216.70 700,000.00 5,263.16 COMMONWEALTH OF PENNSTLVNNIA INHERITANCE TIU(RETURN RESIDENT pECEOENT j _. _..._. ESTATE OF Walker, Louise E. __ SCHEDULE B STOCKS & BONDS FILE NUMBER 21 - 08 - 0575 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER II DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH errill Lynch Assets and Cusip Nos.as follows: I Account No. 87242188 1 ~ 350 Shares of American InYI Group, Inc. @ $39.13 per share 026874107 13,697.25 2 i, 306 Shares of Anadarko Pete Corp @ $77.985 per share 032511107 23,863.41 3 2750 Shares of Analog Devices Inc. @ $35.915 per share 032654105 98,766.25 4 400 Shares of Bank of America Corp. @ $36.185 per share 060505104 14,474.00 5 .1000 Shares of Baxter InPI Inc @ $61.27 per share 071813109 61,270.00 6 800 Shares of H&R Block @ $23.585 per share 093671105 18,868.00 7 186 Shares of Cardinal Health, Inc @ $55.865 per share 141494108 10,390.89 8 1800 Shares of Carpenter Technology Corp @ $60.955 144285103 48,764.00 Accrued dividend 144.00 9. 1618 Shares of Chevron Corp New @ $101.61 per share 166764100 164,404.98 Accrued dividend 1,051.70 10 252 Shares of CVS Caremark Corp @ $43.305 per share 126650100 10,912.86 11 442 Shares of Devon Energy Corp New @ $122.77 per share 25179M103 54,264.34 12 1 1800 Shares of DuPont E I De Nemours @ $49.605 per share 263534109 i 89,289.00 _. __ _ -- -- _I - _ TOTAL (Also enter on line 2, Recapitulation) 2,480,015.16 COMMONWEALTH OF PENNSYLVANIA ~I INHERITANCE TA%RETURN RESIDENT DECEDENT i -- - ____ I ESTATE OF Walker, Louise E. SCHEDULE B STOCKS 8r BONDS continued All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM._...I - - - -__-- ----_. --.._.. ___.___ NUMBER DESCRIPTION Accrued dividend 13 i 150 Shares of Lilly Eli & Co @ $49.275 per share 532457108 Accrued dividend 14 1280 Shares of Exxon Mobil Corp @ $ 93.545 per share 302316102 Accrued dividend 15 11 Shares of Fairpoint Communications Inc. @ $8.745 per share 305560104 16 II 331 Shares of Firstenergy Corp @ $77.555 per share 337932107 Accrued dividends 17 14265 Shares of Forest Labs, Inc. @ $34.90 per share 345838106 18 900 Shares of Gannett Inc @ $29.955 per share 364730101 19 1877.4630 Shares of General Electric Co. @ $32.35 per share 369604103 20 ~ 4800 Shares of Hershey Co. @ $37.62 per share 427866108 21 30 Shares of Idearc Inc @ $4.645 per share 451663108 22 ~ 400 Shares of Johnson & Johnson @ $ 66.525 per share 478160104 23 500 Shares of Kellogg Co. @ $51.005 per share 487836108 24 3200 Shares of Microsoft Corp @ $29.60 per share 594918104 ~_ FILENUMBER 21 - 08 - 0575 I UNIT VALUE I VALUE AT DATE OF DEATH 738.00 7,391.25 70.50 119,737.60 512.00 96.20 25,670.71 182.05 148,848.50 26, 959.50 28,385.93 180, 576.00 139.35 26,610.00 25,502.50 94, 720.00 Page 2 of Schedule B SCHEDULE B I STOCKS & BONDS COMMONWEFLTH OF PENNSYLVANIF INHERITANCE TA%RETURN I continued RESIDENT DECEDENT ESTATE OF Walker, LOUISe E. FILE NUMBER 21 - 08 - 0575 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM 'I. DESCRIPTION NUMBER VALUE AT DATEOF UNIT VALUE Accrued dividend DEATH _ - --- 352.00 25 790 Monsanto Co. New @ $123.16 per share 61166W101 97,296.40 26 2772 Shares of Pfizer Inc @ $20.115 per share 717081103 ~ 55,758.78 i Accrued dividend 887.04 27 396 Shares of Solutia Inc @ $0.00 per share 0.00 28 2 Shares of Solutia Inc. New @ $13.52 per share 834376501 27.04 29 800 Sharesof Travelers Companies Inc @ $50.845 per share 89417E109 40,676.00 30 1400 Shares of Union Pac Corp @ $156.10 per share 907818108 62,440.00 31 112 Shares of Ventas Inc @ $48.25 per share 92276F100 5,404.00 32 600 Shares of Verizon Communications @ $38.801 per share 9234V104 23,280.60 33 400 Shares of Wachovia Corp @ $27.595 per share 929903102 11,038.00 34 1012 Shares of Weis Mkts Inc. @ $34.225 per share 948849104 34,635.70 35 i 16 Shares of Solutia Inc @ $0.90 per share 834376147 14.40 36 2390 0 00 Shares of Davis NY Venture Fd Inc @ $38.13 per share I 46,961.44 37 10447.8890 Shares of Franklin Tax Free PA @ $10.35 per share 354723447 ~' 108,135.65 Page 3 of Schedule B ~, SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RFTURN RE continued SIDENT DECE°ENT ESTATE OF Walker, LOUISe E. _ _ = _ _ _ _ FILE NUMBER 21 - 08 - 0575 All property jointly-owned with right of survivorsh ip must be disclosed on Schedule F. ITEM --- __._ __- __. __-_. --- -- NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 39.6747.180 Shares of Natixis FDS Tr @ $10.24 per share 638728889 CIDPX 69,091.22 j Central Dauphin School District Bond Cusip No. 153300KR8 dT 10-01-1998 40,201.20 4.750% 10-15-2014 $40,000.00 100.503 I I Accrued interest 676.00 40 Ephrata PA Area School District Bond Cusip No. 294223JS2 DT 10-01-1998 10,067.80 4.750% 10-15-2014 1 $ 0,000.00 100.678 Accrued interest 46.18 41 Lebanon County PA Bond Cusip No. 522426KQ7 40,340.00 Dt 03-15-2003 3.80% 10-15-2014 $40,000.00 100.85 Accrued interest 147 78 42 Moshannon Vy School District Bond Cusip No. 61958FR7 Dt 08-01-2003 9,809.10 3.60% 12-01-2015 $10,000.00 98.091 Accrued interest 169.00 43 Pennsylvania St Bond Cusip No. 709141DS1 9,923.00 Dt 06-10-2003 3.500% 07-01-2016 $10,000.00 99.23 Accrued interest 135.14 44 Pennsylvania St. Bond Cusip No. 709141 WJO ' 10,799.90 ~ Dt 05-O1-2002 5.00% 05-01-2020 $10,000.00 107.999 Accrued interest ~ 26.39 I Page 4 of Schedule B LOMMONWEgLTH OF PENNSYLVANIA INHERITANCE Tp%ftETURN RESIDENT OELEOENT 'i ESTATE OF Walker. Louise E. SCHEDULE B STOCKS 8L BONDS continued FILE NUMBER 21 - 08 - 0575 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION NUMBER 45 Pennsylvania St Bond Cusip No. 709141ZR9 i Dt 01-01-2003 4.750% 01-01-2023 $10,000.00 102.279 Accrued interest End of Merrill Lynch Assets 46.483 Shares of Pfizer @ $20.12 per share 717081103 Accued Dividend UNIT VALUE ~ VALUE AT DATE OF DEATH 10,227.90 183.40 9,717.96 154.56 47 i 1296.252 Shares of Wellington Fund @ $30.31 per share 949535306 ~ 39,289.40 48 1800 Shares of British Petroleum @ $71.98 per share 055622104 57,584.00 49 1286 Shares of Nationwide @ $49.84 per share 063861210 14,254.24 50 U.S. Series H Bond No. D12098084H Issued 06-79 500.00 51 U.S. Series H Bond No. M17787074H Issued 06-79 1,000.00 52 U. S. Series H Bond No. M17787075H Issued 06-79 1,000. 00 53 U. S. Series H Bond No. M17788625H Issued 06-79 1,000. 00 54 U. S. Series H Bond No. M17813026H Issued 09-79 1,000. 00 55 'i U. S. Series H Bond No. M17813027H Issued 09-79 1,000. 00 56 U. S. Series H Bond No. M17813028H Issued 09-79 1,000. 00 Page 5 of Schedule B COMMONWFNLTH OF PENNSVLVANIq INHERITgNCE TA%RETURN RESIDENT DECEDENT ESTATE OF Walker, Louise E. SCHEDULE B STOCKS & BONDS continued -- -_ 1- -_ __ - - _. ~ FILE NUMBER i 21 - 08 - 0575 All property jointly-owned with right of survivorship must be disclosed on Schedule F. _.. - __. ITEM ---. _ _ -__. -. __.- -- NUMBER ~ DESCRIPTION UNIT VALUE VALUE AT DATE OF i. ___ __.. DEATH _._. -. _.. __ ---- _.. __ _._ I 57 U.S. Series H Bond No. V5348530H Issued 09-79 5,000.00 Morgan Stanley Assets and Cusip Nos. as follows: ~ Account No. 410 015320 084 58 602.27 Shares of American Cap World GR& Inc A @ $44.14 per share 26,584.20 1140543109 59 2925.77 Shares of Goldman Sachs @ $9.75per share 38142Y625 60 300 Shares of Citigroup Inc @ $23.20 per share 172967101 61 1700 Shares of Eaton Vance Tax MGD Div Fd @ $17.39 per share 27829F108 62 200 Shares of Marathon Oil Co. @ $54.46 per share 565849106 63 13007 Shares of Van Kampen PA Mun Inc @ $13.08 per share 921127108 64 Central Dauphin PA Sch Dist NTS REF Cusip No. 1533000E1 4.500% 02-01-27 $30,000.00 98.466 65 ~, Cumberland Cnty PA Mun Auth Messiah College Cusip No. 23061 NBV8 5.125% 10-O1-15 $5,000.00 100.295 66 I Dallas PA Sch Dist Cusip No. 235177LH3 4.250% 04-01-24 $10,000.00 93.831 67 !Garnet Vy PA Sch Dist Cusip No. 366268GK0 5.00% 02-15-21 $10,000.00 107.119 28,526.26 6,960.00 29,563.00 10,892.00 39, 331.56 29,539.80 5,014.75 9,383.10 10, 711.90 Page 6 of Schedule B COMMONWEgLTH OF GENNSTLVANIA I, INHERITgNCE TA% RETURN RESIDENT OECEOENT ESTATE OF Walker, Louise E. SCHEDULE B STOCKS 8L BONDS continued All property jointly-owned with right of survivorship must be disclosed on Schedule F. 'FILE NUMBER 21 - OS - 0575 ___- __ __ NUMBER DESCRIPTION UNIT VALUE I VALUE AT DATE OF DEATH 68 'Jeannette PA Sch Dist REF SER C Cusip No. 472286GV9 4.70°/D 06-15-28 20,099.60 $20,000.00 100.498 I 69 'I Mars PA Area Sch Dist UnLTD Tax Cusip No. 571720GT2 5.00% 09-01-18 $20,000.00 100.853 70 i North Penn Sch Dist SER-A Cusip No. 661517RL8 4.033% 03-01-20 $5,000.00 100.85 71 'North Hills PA Sch Dist RFDG UnLTD Tax Cusip No. 659868JV6 4.75% 10-15-17 $5,000.00 101.134 72 Penn St Edu Facs Au HLTH Svcs Rev C Cusip No. 709172ER7 5.70% 11-15-10 $20,000.00 100.504 73 Pittsburgh PA Aud Auth Cusip No. 72478PAP1 5.00% 02-01-29 $20,000.00 101.884 74 Reading PA Sch Dist Cusip No. 755638SK0 14.625% 01-15-32 $20,000.00 98.231 75 'Warwick Twp PA Gen Cusip No. 936692CK6 4.60% 11-15-24 $20,000.00 101.224 76 William Penn PA Sch Dist Cusip No. 969255GR3 4.30% 03-01-21 $20,000.00 101.351 77 Butler Co PA Hosp Au Cusip No. 366268GK0 5.250°/D 07-01-12 $15,000.00 100.316 20,170.60 5,042.50 5,056.70 20, 001.80 20,376.80 19,646.20 20,244.80 20,270.20 15,047.40 Page 7 of Schedule B SCHEDULE E CASH, BANK DEPOSITS, & MISC. CDMMDNWEgLTN DE FENNSYLVhNIA ~NHEF~TgNLETA%RETUFN PERSONAL PROPERTY RESIDENT DECEDENT -- ESTATE OF -_ -.- _---- _ - Walker LOUISe E J--. -__ FILE NUMBER , . 21 - 08 - 0575 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on schedule F. ITEM - -. _. __- -_. ___. __. ___. __.. - --_.. _. _ --- -- NUMBER DESCRIPTION VALUE AT DATE OF _... -__-. -_ _-.. __ DEATH T Bank Checking Account No. 88409619 _. __ __ 27,646.54 2 Merrill Lynch Ready Assets Trust 2,464.00 3 Morgan Stanley Deposit Account 23,197.65 4 Refund from Highmark 186.18 5 Refund from Carlisle Regional MC 121.58 6 Refund from Kinetic Imaging 9.51 7 Refund from Highmark 35.94 8 Economic Stimulus Check 600.00 9 Refund from HMA Physicians Mgm 11.58 10 Refund from Presbyterian Homes 959.23 - __ - - TOTAL (Also enter on Line 5, Recapitulation) 55,232.21 COMMONWEALTH OF PENNSYLVANIA ~ SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RBSIDENr DeceDENT MISC. NON-PROBATE PROPERTY -- _ _ -- ESTATE OF Walker, Louise E. i FILE NUMBER 21 - 08 - 0575 - - - -- --- - - - - This schedule must be completed and fded if the answer to any of questions 1 through 4 on page 2 is yes. - ~. _ i_ _--- _. __ ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF InGUtle the name o/the transferee, their relationship m tlece0anl EXCLUSION NUMBER i vnwE OF ASSET DecDS TAXABLE VALUE and [he date of Vansfar. Attach a spy of the tleetl far real estate INTEREST (IF APPLICABLE) 1 U.S. Series HH Bond No. D4069896HH Issued 03-96, 500.00 500.00 POD Mary Louise Walker, her daughter 2 I U.S. Series HH Bond No. D4069897HH Issued 03-96, 500.00 500.00 I POD Mary Louise Walker 3 I U.S. Series HH Bond No. X779587HH Issued 03-96, 10,000.00 I 10 000.00 POD Mary Louise Walker I ' 4 ' U.S. Series HH Bond No. X779588HH Issued 03-96, 10,000.00 10,000.00 POD Mary Louise Walker ii I __ __ _ I _ _ __ _ _ _ __ TOTAL (Also enter on line 7, Recapitulation) 21,000.00 SC F E DI A_ E H ~''rw1 ~ A 1 ~ p p ~ ~ (~~ r4.I1 ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RENRN ArMII\IIQT~ATII IG IYICT~ I~LII~~r~N r /Y\ r rYG NV~7 r J RESIDENT OECEOENT ESTATE OF Walker Louise E. _ _ FILE NUMBER , 21 - 08 - 05 75 Debts of decedent must be reported on Sc . hedule I. ITEM NUMBER I FUNERAL EXPENSES: ____.. _ ------- DESCRIPTION AMOUNT I _____. ___.. A. 1 Kimmel Funeral Home -Funeral III, __.. - -.. ____. ___ ~' 11,687.00 B. ADMINISTRATIVE COSTS: i. Personal Representative's Commissions I' Social Security Number(s) / EIN Number of Personal Representative(s): I~. Street Address I City State Zip Year(s) Commission paid 2. Attorney's Fees Wion, Zulli & Seibert 20,000.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant a. 5. '' Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Short Certificates Reserve for Additional Probate fee Accountant's Fees JBCk NeCe, CPA 6. l Tax Return Preparer's Fees 7, Other Administrative Costs 1 I Cumberland Law Journal -Advertising -___ I __ ___ TOTAL (Also enter on line 9, Recapitulation) 287.00 16.00 1, 500.00 400.00 75.00 34,197.56 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN '. RESIDENT DECEDENT ESTATE OF Walker, Louise E. 2 j The Sentinel -Advertising Schedule H Funeral 8~ Adrrtinistrative Casts continued ___. __. _ ____... _ L. FILE NUMBER i 21 - 08 - 0575 3 Reserve for Postage, Certified Mail, Etc. 50.00 182.56 Page 2 of Schedule H COMMONWEALTH OF GENNSTLVANIA INHERITgNCE TAX RETURN RESIDENT pECEOENT ESTATE OF Walker, Louise E. Include unreimbursed medical expenses. SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS _ _. __ __ __ FILE NUMBER 21 - 08 - 0575 __ ___ ITEM -- NUMBER DESCRIPTION _.. 1 Outstanding Check No 6444 2 Outstanding Check no. 6445 3 05-30-08 Kinetic Imaging 4 05-30-08 Continuing Care RX 5 06-27-08 Stoken Ophthalmology 6 10-10-08 Repayment of Deposit to Mass Mutaul AMOUNT - _ __ 2, 861.00 48.14 11.52 173.07 22.00 229.70 __ TOTAL (Also enter on Line 70, Recapitulation) 3,345.43 REV-161] EX+19-00) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES ' INHERITANCE TA%RETURN RESIDENT pECEOENT __ ___ I ESTATE OF FILE NUMBER Walker, Louise E. _ _ 21 - 08 - 0575 NAME AND ADDRESS OF PERSONS RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER ~. O DECEDENT (Words) - ($$$) RECEIVING PROPERTY Do Not Llar Trua[ea(c) j, '(TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~ 1 Mary Louise Walker Daughter 100 % of Residue 142 Hawk Lane I Ehprata, PA 17522 (Enter dollar amounts for distributions shown above on lines 1~5 through 18, as appropriate, on Rev 1500 cover sheet II. iNON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 j Presbyterian Homes, Green Ridge Village Fund, Non-profit EIN 23-2941518 25,000.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET' 2S,OOO.OO _.. _-_ ____. _. _. __ I /~.< ' ~7 5 ~ciSY .~iII Citt~ LJP3Yet11tPttY ~, ~:~ - _~ _ ~__ J.+ OF i.:?ic~ < - IV - p LOUISE E. WALKER z I, LOUISE E. WALKER, of Newville, Cumberland County, Pennsylvania, Nang of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament hereby revoking all other Wills and Codicils by me at any time heretofore made. ITEM I: I direct that all of my just debts and currently due debts and funeral expenses shall be paid from my estate as soon as practicable aRer my decease as a part of [he expense of the administration of my estate. ITEM II: I give and bequeath the sum of Twenty-Five Thousand ($25,000.00) Dollars to OGLALA LAK07'A COLLEGE of Kyle, South Dakota. ITEM III: I give, devise and bequeath all of the rest, residue and remainder of my estate, whether real or personal, or wheresoever the same maybe situate or located, to my daughter, MARY LOUISE WALKER, only if she survives me. In the event that my daughter, MARY LOUISE WALKER, predeceases me, then I give, devise and bequeath all of the rest, residue and remainder of my estate, whether real or personal, or wheresoever the same may be situate or located, to the GREEN RIDGE VILLAGE FUND, of Newville, Pennsylvania. ITEM IV: 1 nominate, constitute and appoint my daughter, MARY LOUISE WALKER, as Executrix of this my Last Will and Testament. In the event that my daughter is unable or unwilling to serve in this capacity, then I appoint my attorney, FRANCIS A.LULLI, ESQUIRE, as Executor of this my Last Will. and Testament. ITEM V: It is hereby directed that my Executrix shall pay all inheritance, estate, succession and legacy taxes to which my estate for the transfer of any property hereunder maybe subject, and to charge such taxes as a part of the expense of the administration, payable out of my residuary estate. ~C ~ ~a/ W ar 01 y ~ O ogV LLt10~< Q ~.~ ~ O or~. vEE - m ~~; ~ c O ¢- 7 ~c cU m'o r O~ $U ITEM VI: I direct that no Execuhix or other fiduciary named, nominated or appointed in this my Last Will and Testament shall bc; required to post any bond or give any security of any type for any purpose whatsoever, any law or mle of the Court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ' o day of ~~w~ eL _ 2005. Louse E. Walker Signed, sealed, published and declared by the said Louise E. Walker, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence and in the presence of each other, all being present at the sa a ti ave hereunto subscribed our na/m/~es as witnesses hereto. ~ Residing //! Residing 7J~i~n.c11/~ i Commonwealth of Pennsylvania :SS County of CUn.~ We, Louise E. Walker Francis A Zulli ,and A~D~ S e Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby declare to the undersigned aurhority that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Wi11 as witnesses and that to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence, and I, the said Testatrix, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, [hat I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Subscribed, sworn to and acknowledged before me by Louise E Walker , the Testatrix, and subscribed and swo n to befor_ a rqe by ,AKCtS • ZK t~ and ~(~~ ~~ '~`A~rt n- 1- S7 r~ wttnesses, this L_day of S- c,.~f , 2005. > ~. Notary Public ' COMMONWEALTH OF PENNSYLVANIA NolaRl Seal Vk1u l Nu1an4 Ndery dr OouMY W Myeo~+sa~ E>@ys Jan. 5, 2009 Member Panneylwnla Aseadatiw 01 No:.'~" CODICIL TO fix, ~~~Y ~ii11 ~n~ (7~ P~Y~in~nY ~_. _ - OF ~ - ;, ~~ LOUISE E. WALKER ~ c' _.; ,. :r 1, LOUISE E. WALKER, of Newville, Cumberland County, Pennsylvania, be~ljg of sound and disposing mind, memory and understanding, do make:, publish and declare this to be a Codicil to my Last Will and Testament dated June ] 0, 2005. FIRST: I delete ITEM II set forth in my Last Will and Testament dated June 10, 2005, which was a bequest of "Twenty-Five Thousand and 00/] 00 Dollars ($25,000.00) to Oglala Lakota College of Kyle, South Dakota, and in its place substitute the following ITEM II: `YTEM I!.• I give and bequeath the sum of Twenty-Five Thousand and 00/100 Dollars (~Z5,000.00) to GREEN RIDGE VILLAGE FUND of Newville, Pennsylvania." SECOND: In all other respects, I ratify and confirm my Las[ Will and "Testament dated June ] 0, 2005. IN WITNESS WHEREOF, I, have hereunto set my hand and seal this '~` day of August, 2007. `1 ` LOUISE E. WALKER Signed, sealed, published and declazed by the above-named„ LOUISE E. WALKER, as and for a Codicil [o her Last Will and Testament, in our presence, who in his presence, and in the presence of each other, and at her request, have hereunto set our hands as subscrioing witnesses hereto. "~"Y-~'-'eiti 5~'PFP~s6-rc l`~t I_, COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN We, LOUISE E. WALKER, (~ /11 / SS Z `/ and the Testatrix and the wifiesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned officer that the Testatrix signed the instmment as a Codicil to her Last Will and that she signed voluntarily and that each of the witnesses in the presence of the Testatrix at her request, and in the presence of each other, signed the Codici] to her will as a witness and that to the best of the knowledge of each witness, [he Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ~J ~ ~r LOUISE E. WALKER Sworn to and subscribed before me by LOUISE E. WALKER, the Testatrix, and subscribed an~wom [o before me by ~-It 2 and Ll ICJ ~ Z.t /,the witnesses, on this ~t^'6 day of August, 2007. Z~ Notary public My Commission Expires: /_ ~~ _ ~ COMAtONWFALTH OF PENNSVLVMl1A NoCWISeg VitlJ L fkpkYa. No~y~ W esl Rear W uo Twp.. CuMeibq Coolly Nty CammYYm E+mYr Jn.15.2008 1AamEer, Panmylvanis Assoc~Hbn OI N0larles W~.~~ / ~> ,,~ PRESBYTERIAN ~~~~~, SENIOR LIVING December 29, 2008 Francis A. Zulli, Esq. Wion, Zulli & Seibert P. O. Box 1121 Harrisburg, PA 17108-1121 Dear Attorney Zulli: I am writing to you in response to you iefter of December 15 regarding the estate of Louise E. Walker. I visited Louise often and we miss her very much. We are most appreciative of her for remembering the Green Ridge Village Fund in her will. In response to your question, Green Ridge Village and the Green Ridge Village Fund would come under the Presbyterian Homes, Inc. umbrella of communities being exempt from payment of State and Federal death taxes with the non-profit Tax ID number of ~23~9459$. ~~ ~9 ~l,5'! If you have any further questions: please call or write. Sincerely, Le An erson Regional Director for Mission Support 717.502.8840 • i~. 717.502.8841 • mu o-.e 800.382.1385 •One Trinity Drive East • Suite 201 • Dillsburg, PA 77019-8522 • www.presbyterianseniorliving.org