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Home My WebLink About02-20-09 (3)J 1505007120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Intlividual Taxes County Code Year File Number PO 60X.280601 '~' INHERITANCE TAX RETURN Hardsburg, PA t7tz8-DSOs "`- RESIDENT DECEDENT 2 1 O B 0 6 0 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 205 09 9289 OS 19 2008 09 25 1920 Decedent's Last Name Suffix Decedent's First Name MI SHELLY JANET K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Secudy Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW X^ 1. Original Return ^ 2. Supplemental Retum ^ 3. Remainder Return (date of tleafh prior to 12-13-92) ^ 4. Limited Estate ^ qa, FNUre Interest Compromise ^ 5. Federal Estate Tax Return Re aired (tlate of death eflar 12-12-92) 9 X^ S Decadent Diatl Testate IAtlech Copy of Will) ^ ~ Decadent Maintained a LiNng Trost (Attach Copy of TmsQ 0 8. Total Number W Safe Deposl BOxe$ ^ 9. Litigation Proceeds Received ^ 10. Spousal POlerty CreElt((tlate of deeN 7tElacaon to taxunder San 9173A between 1231-91 antl 7-1&5) ^ (gttech Sch. O) ( ) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number NEIL E. HENDERSHOT 717 234 4161 Firm Name (If Applicable) GOLDBERG KATZMAN, P. C. First Ilne of adtlress 320 MARKET ST. Second Ilne of address P.O. BOX 1268 City or Post Office State ZIP Code HARRISBURG PA 17108 N REGISTER~~e LLS US~JLY - *t -l7 ~j rTl ; --r' C7 f'w7 i ~: .r-i fV 0 t ~ `~ b - - r i ~ ,:. u '-" _ DAT~FTLED U7 !:' i Correspondent's a-mall address: Under penalties of perjury, I declare that I haw examined this return, including accompanying schedules end statements, end to the best o(my knowledge and belief, it is true, correct and complete. Declaration of preperer otherihan the personal representative is based on ell in(ormetion a(which preparer has any knowledge. 91GNATU E OF PERSON RESPONS LE FOR FILING RETURN DATE .~~ Sandra L. Renninster ~ h o/n o 1107 S. York Neil E. Hendershot 320 Market St., Harrisburg, PA 17108 Side 1 L 1505607120 1505607120 J Y U 1505607220 REV-1500 EX Decedent's Social Secudty Number oacaaam~s Hama: Janet Kitzmiller Shelly 205 09 9289 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 8 Notes Receivable (Schedule D) ............................................................ 4. 5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .................... 5. 6. Jointly Ownetl Property (Schedule F) ~ Separate Billing Requestetl .............. 6. 7. Inter-Viws Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested .............. 7, 8. Total Gross Assets (total Lines 1-7) ........................................................................ g. 575,000.00 2,492,867.92 301,539.17 236,568.59 3,605,975.68 9. Funeral Expenses 8 Administrative Costs (Schedule H) ............................................ g. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................... 10. 11. Total Detluctions (total Lines 9 & 10) ....................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................................................. 12. 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 lax (Line 12 minus Line 13) ................................................ . 14 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable al [he spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate x oa5 3 , 4 7 9 , 717.7 0 is. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ........................................................................................................._.._._... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 92,114.11 34,143.87 126,257.98 3,479,717.70 3,479,717.70 0.00 156,587.30 0.00 0.00 156,587.30 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: FIIe Number 21-08-0604 DECEDENT'S NAME Janet Kitzmiiler Shelly STREET ADDRESS 1115 South York Street CITY Mechanicsburg STATE ZIP PA 17055 Tax Payments and Credits: 1. TaxDUe(PagelLinel9) (1) 156,587.30 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 139,904.06 C. Discount 7,383.37 3. InteresUPenal fa licable Total Credits (A+B+C) tyi pp (2) 147,287.43 D. Interest E. Penalty Total lnteresVPenalty (D+E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Llne 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 9,319.87 A. Enter the interest on the taz due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 9, 319.8 7 ..yy~~~~''ii Make Check Payable to: REGISTER OF WILLS, AGENT Y 1~x'~i.w~S:TC'^kg.1i 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 transferretl :..................................................................................... ^ O b. retain the right to designate who shall use the property transferred or its income :......................................... c. retain a reversionary interest or..........._ ................................................... . ~ r ~ n r- I . ................................................... d. receive the promise for life of either payments, benefits «care? ...................................................... L J L xJ x 2. If death occurretl aRer December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................................................... ^ ^x 3. Did decedent own an "in trust for" «payable upon death bank account or security at his or her death? ............... ^ ^ 4. Did decedent own an Individual Retirement Account, annuity, « other non-probate property which contains a beneficiary designation? ........................................................................................................................ ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. F« tlates of tleath on or affer 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)]. For dates of death on «after January 1, 1995, the tax rate imposed on the net value of transfers to or f« 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 tlisclosure of assets and filing a taz 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 imposetl 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 benefciaries 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 taz 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 atloption. Rev-15111E%~ (fi-9a) SCHEDULE A :„~••.. ° REAL ESTATE LOMMONHEgLTX OF PENASVLVAMA IWERIiANLE iqX gEil1RN RESIpEM OELEOEM ESTATE OF FILE NUMBER Shelly, Janet Kitzmiller 21-08-0604 All real property ownetl solely or as a tenant In cornrron must be reportetl at /air market value. Fair market value Is tledned as Me pace at which properly woub be eschangetl petween a willing buyer antl a willing seller, neither being compelled to buy or sell, poth hating reasonable knowletlga of iha relevant leas. Real property which Is Jolndybwnetl with right of aurvivorehlp must be tllaclosetl on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Residence 8 Farm -Decedent's residence, outbuildings, and land located at 1115 575,000.00 South York Street, Mechanicsburg (Upper Allen Twp., Cumberland Co.), PA 17055, valued by RSR Appraisers in Reports TOTAL (Also enter on Line 1, Recapitulation) I 575 000.00 (H more space ns needed, eddltnonal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) ftev-1803 E%~ (6-98) ~ SCHEDULE B ~~ STOCKS & BONDS COMMONAFA~TM OF pEWJ6V~VPNIA INIEPITPNCE TAC 0.ETLRN FE610EM OECECENI ESTATE OF FILE NUMBER __ Shelly, Janet Kitzmiller 21-08-0604 All propertyJolntlyawned vAN right of survivorship must he disclosetl on Schetlule F ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 018802108 1,140 shares of Alliant -Common stock, valued per 37.595 42,856.30 EstateVal report 2 olszzaaa2 9,246 shares of Allied Irish Banks P L C - Spon Adr Ord, 43.125 398,733.75 valued per EstateVal report 3 025537101 300 shares of American Electric Power Inc -Common 43.390 13,017.00 stock, valued per EstateVal report Accrued dividend on Item 3 through date of death 123.00 4 25746U109 1,600 shares of Dominion Resources Inc Va New - 46.160 73,856.00 Common stock, valued per EstateVal report 5 2nsos53z 38,755.048 units of Eaton Vance Special Investment 14.45 560,010.44 Trust -Utilities Fund CL A, valued per EstateVal report 6 3ooz3c7ss 5,486.352 units of Evergreen Equity Trust -Balanced 9.38 51,461.98 Fund C, valued per EstateVal report 7 300237278 6,450.43 units of Evergreen Funds -Growth Fund CL C, 11.76 75,857.06 valued per EstateVal report $ 30161N701 4,000 shares of Exelon Corp -Common stock, valued 85.835 343,340.00 per EstateVal report Accrued dividend on Item 8 through date of death 2,000.00 9 713291102 1,000 shares of Pepco Holdings Inc -Common stock, 26.56 26,560.00 valued per EstateVal report Total of Continuation Schedules See attached pages TOTAL (Also enter on Line 2, Recapitulation) 2,492,867.92 (It more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-150] EXi tfi-98) ~ SCHEDULE B ~~ STOCKS & BONDS continued COMMONNEnLTry OF PENNSYLVPNIP INREgIThNLE TpX RETIgN RESIOENr OECECEM ESTATE OF Janet Kitzmiller FILE NUMBER 21-OS_osnd ITEM NUMBER CUSIP NUMBER DESCRIPTION UNR VALUE VALUE AT DATE OF DEATH 10 693475105 1,240 shares of PNC Financial Services Group Inc - 68.01 84,332.40 Common stock, valued per EstateVal report 11 r6Trsataa 4,000 shares of Rite Aid Corp -Common stock, valued 2.395 9,580.00 per EstateVal report 12 s2nzr~oa 2,002 shares of Van Kamp AMR Cap PA Value Municipal 13.075 26,176.15 -Common stock, valued per EstateVal report Accrued dividend on Item 12 through date of death 123.12 13 929603102 900 shares of Wachovia Corp 2nd New -Common 27.595 24,835.50 stock, valued per EstateVal report 14 19765L850 $745,675.3 Columbia FDS SER TR I (Tax-exempt) - 13.31 99,249.38 Mutual fund, valued per EstateVal report 15 67061F101 300,700 units of Nuveen PA Premium Inc Mun Fund 2 - 12.44 37,407.08 Bond fund, valued per EstateVal report Accrued income on Item 15 through date of death 148.85 16 67062P708 $100,000 Nuveen Pertorm Plus Municipal Fund -Bond 13.54 13,540.00 fund, valued per EstateVal report Accrued income on Item 16 through date of death 57.50 17 67069F137 $15,000 Nuveen Tax Exempt UT TR INSD PA Ser 275 - 101.2 15,180.00 Bond fund, valued per EstateVal report Accrued income on Item 17 through date of death 42.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Farm PA-1600 Schetlule 8 (Rev. 6-98) Rev-150] EXi (6-9a) ~ I SCHEDULE B ~~° STOCKS 8L BONDS continued LOMMONhEPLTH OF PENNSYLVANIA INF£RITANLE TAC RETUiN RESIOENI OECECEM ESTATE OF FILE NUMBER Shelly, Janet Kitrmiller 21-08-0604 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1g sross4asa $9,800 Nuveen Tax Exempt UT TR INSD PA Ser 52 - 19.75 1,935.50 Bond fund, valued per EstateVal report Accrued income on Item 18 through date of death 13.72 19 67096Ja33 $55,300 Nuveen Tax Free UT TR INSD PA Ser 187 - 23.16 12,807.48 Bond fund, valued per EstateVal report Accrued income on Item 19 through date of death 66.36 20 67066E257 $20,000 Nuveen Tax Free UT TR INSD PA Ser 253 - 60.96 12,192.00 Bond fund, valued per EstateVal report Accrued income on Item 20 through date of death 34.00 21 70884F605 $1,500 Nuveen Tax Free UT TR INSD PA Ser 264 - 986.43 14,826.45 Bond fund, valued per EstateVal report Accrued income on Item 21 through date of death 55.65 Accrued income on Item 21 through date of death 22,20 22 67066E612 20,000 Nuveen Tax Free UT TR INSD PA Ser 265 - 101.35 20,270.00 Bond fund, valued per EstateVal report Accrued income on Item 22 through date of death 62.00 23 67066E703 $15,000 Nuveen Tax Free UT TR INSD PA Ser 268 - 91.84 13,776.00 Bond fund, valued per EstateVal report Accrued income on Item 23 through date of death 39.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-150] E%+ (6-98) .~ I SCHEDULE B .'~• STOCKS & BONDS continued COMMONhFALTH OF PENNSVLVANIP IMERITANCE TM RETLPN RESIOENr DECEOEM ESTATE OF FILE NUMBER Shelly, Janet Kitrmilier 21-08-0604 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 2q 67066E760 $15,000 Nuveen Tax Free UT TR INSD PA Ser 270 - 101.47 15,220.50 Common stock, valued per EstateVal report Accrued income on Item 24 through date of death 45.00 25 67069F103 $15,000 Nuveen Tax Free UT TR INSD PA Ser 274 - 98.63 14,794.50 Bond fund, valued per EstateVal report Accrued income on Item 25 through date of death 42.00 2g 67096F167 $15,000 Nuveen Tax Free UT TR INSD PA Ser 276 - 101.330 15,199.50 Bond fund, valued per EstateVal report Accrued income on Item 26 through date of death 43.50 27 67ossF2z6 $15,000 Nuveen Tax Free UT TR INSD PA Ser 278 - 97.04 14,556.00 Bond fund, valued per EstateVal report Accrued income on Item 27 through date of death 39.00 2g 70884F622 $1,500 PA INSD MUNS INC TR - UT Series 260 -Bond 1014.41 15,216.15 fund, valued per EstateVal report Accrued income on Item 28 through date of death 55.50 Accrued income on Item 28 through date of death 24,Y0 2g 7oseaFSaa $1,500 PA INSD MUNS INC TR - UT Series 261 -Bond 1016.92 15,253.80 fund, valued per EstateVal report Accrued income on Item 29 through date of death 57.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schetlule B (Rev. 6-98) Rev-1507 EXt (fi-9fi) ,~. COMMONN'cI,LTM OF GENN6YLVANIq INf RITPNCE TAX RETLtl2N RE610EM OECECEM SCHEDULE B STOCKS & BONDS continued ESTATE OF FILE NUMBER Shelly, Janet Kitrmiller 21.08-0604 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH Accrued income on Item 29 through date of death 22.95 30 70864F563 $1,500 PA INSD MUNS INC TR - UT Series 252 -Bond 1007.79 15,116.85 fund, valued per EstateVal report Accrued income on Item 30 through date of death 57.00 Accrued income on Item 30 through date of death 22.95 31 70864F621 $1,500 PA INSD MUNS INC TR - UT Series 255 • Bond 993.07 14,895.05 fund, valued per EstateVal report Accrued income on Item 31 through date of death 55.95 Accrued income on Item 31 through date of death 22.20 32 70864F647 $1,500 PA INSD MUNS INC TR - UT Series 285 -Bond 954.81 14,472.15 fund, valued per EstateVal report Accrued income on Item 32 through date of death 53.70 Accrued income on Item 32 through date of death 21.45 33 70684F562 $1,500 PA INSD MUNS INC TR - UT Series 267 -Bond 932.82 13,992.30 fund, valued per EstateVal report Accrued income on Item 33 through date of death 51.30 Accrued income on Item 33 through date of death 20.40 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1603 E%+(6-98) ~ SCHEDULE B ~~° STOCKS & BONDS continued COMMONNEALTI OF iEMJ$YLVPNIq INIERITANGE TA%RENflN RERIDENI OECELfNt ESTATE OF FILE NUMBER Shelly, Janet Kitzmiller 21-08-0604 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 34 70884F746 $1,500 PA INSD MUNS INC TR - UT Series 271 -Bond 968.4 14,526.00 fund, valued per EstateVal report Accrued income on Item 34 through date of death 53.25 Accrued income on Item 34 through date of death 21.30 35 708846765 $2,000 PA INSD MUNS INCM TR - UT Series 280 -Bond 991.81 19,836.20 fund, valued per EstateVal report Accrued income on Item 35 through date of death 74.60 Accrued income on Item 35 through date of death 29.80 36 7oaaaG2o7 $2,000 PA INSD MUNS INCM TR - UT Series 282 -Bond 974.96 19,499.20 fund, valued per EstateVal report Accrued income on Item 36 through date of death 29.20 Accrued income on Item 36 through date of death 73.20 37 708846249 $1,500 PA INSD MUNS INCM TR - UT Series 284 -Bond 956.79 14,351.85 fund, valued per EstateVal report Accrued income on Item 37 through date of death 53.40 Accrued income on Item 37 through date of death 21.45 3g 7ossaczao $1,500 PA INSD MUNS INCM TR - UT Series 286 -Bond 925.47 13,882.05 fund, valued per EstateVal report Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev~150] EXt 16-98) ~ I SCHEDULE B ~~ STOCKS & BONDS continued LOMMOM1WEpyTH OF GENJ$YIVANIA IWIERITANCE TAX gETMN gE51DEM DELECEM ESTATE OF FILE NUMBER Shelly, Janet Kitzmiller 21-OS-060a ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH Accrued income on Item 38 through date of death 51.90 Accrued income on Item 38 through date of death 20.70 39 708846389 $2,000 PA INSD MUNS INCM TR - UT Series 291 -Bond 973.86 19,477.20 fund, valued per EstateVal report Accrued income on Item 39 through date of death 73.80 Accrued income on Item 39 through date of death 29.40 40 7ossacas2 $2,000 PA INSD MUNS INCM TR - UT Series 295 -Bond 977.44 19.548.80 fund, valued per EstateVal report Accrued income on Item 40 through date of death 71.40 Accrued income on Item 40 through date of death 28.40 41 708646504 $2,000 PA INSD MUNS INCM TR - UT Series 297 -Bond 909.59 18,191.80 fund, valued per EstateVal report Accrued income on Item 41 through date of death 67.40 Accrued income on Item 41 through date of death 27.00 42 708846520 $1,000 PA INSD MUNS INCM TR - UT Series 298 -Bond 943.26 9,432.60 fund, valued per EstateVal report Accrued income on Item 42 through date of death 33.90 Accrued income on Item 42 through date of death 13.60 Copyright (c) 2002 fwm software only The Lackner Group, Inc. Form PA•7500 Schetlule B (Rev. 6-98) Rev-1603 E%~ (6-98) COMMOMNEALTX OF pENJSVLVANIA INfERITMCE Tq%gETLRN RESIDEM OECEOEM SCHEDULE B STOCKS & BONDS continued ESTATE OF FILE NUMBER Shelly, Janet Kitzmiiler 21-08-0604 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 43 706846546 $2,000 PA INSD MUNS INCM TR - UT Series 299 -Bond 916.7 18 334.00 fund, valued per EstateVal report , Accrued income an Item 43 through date of death 67.80 Accrued income on Item 43 through date of death 27.00 44 7oa6acsas $2,500 PA INSD MUNS INCM TR - UT Series 304 -Bond 934.39 23,359.75 fund, valued per EstateVal report Accrued income on Item 44 through date of death 87.25 Accrued income on Item 44 through date of death 35.00 45 708846686 $2,500 PA INSD MUNS INCM TR - UT Series 306 -Bond 923.3 23,082.50 fund, valued per EstateVal report Accrued income on Item 45 through date of death 35.00 Accrued income on Item 45 through date of death 87.25 46 706846702 $2,000 PA INSD MUNS INCM TR - UT Series 307 -Bond 918.06 18,361.20 fund, valued per EstateVal report Accrued income on Item 46 through date of death 27.40 Accrued income on Item 46 through date of death 68.40 q7 708846728 $2,500 PA INSD MUNS INCM TR - UT Series 308 -Bond 954.14 23,853.50 fund, valued per EstateVal report Copyright (c) 2002 (orm software only The Lackner Group, Inc. Form PA-1800 Schedule B (Rev. 6-98) Rev-1503 E%+)fi-9fi) ~ I SCHEDULE B ,~ STOCKS & BONDS continued COMMOMNEALTH OF PEMISYLVANIA IWIERITPNCE TPS REILNN RESIOEM ceCEOEM ESTATE OF FILE NUMBER Shelly, Janet Kitzmiller 21-08-0604 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH Accrued income on Item 47 through date of death 35.00 Accrued income on Item 47 through date of death 87.50 qg 708846744 $2,500 PA INSD MUNS INCM TR - UT Series 309 -Bond 941.77 23,542.75 fund, valued per EstateVal report Accrued income on Item 48 through date of death 87.00 Accrued income on Item 48 through date of death 35.00 49 708846769 $2,500 PA INSD MUNS INCM TR - UT Series 310 -Bond 923.07 23,076.75 fund, valued per EstateVal report Accrued income on Item 49 through date of death 85.75 Accrued income on Item 49 through date of death 34.25 50 708846786 $2,000 PA INSD MUNS INCM TR - UT Series 311 -Bond 920.08 18,401.60 fund, valued per EstateVal report Accrued income on Item 50 through date of death 26.40 Accrued income on Item 50 through date of death 66.40 51 To66a6sa3 $2,000 PA INSD MUNS INCM TR - UT Series 374 -Bond 934.72 18,694.40 fund, valued per EstateVal report Accrued income on Item 51 through date of death 28.00 Accrued income on Item 51 through date of death 70.00 Copyright (c) 2002 Corm software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1683 E%+t6-98) ~ I SCHEDULE B ~;"~` STOCKS & BONDS continued COMMOµh£gLTN OG pENN6YLVANIA INIEgITPNCE TAX ftET1I2N flE610EM OECECEM ESTATE OF FILE NUMBER Shelly, Janet Kitzmiller 21-08-0604 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 52 70684H106 $2,500 PA INSD MUNS INCM TR - UT Series 315 -Bond 917.08 22,927.00 fund, valued per EstateVal report Accrued income on Item 52 through date of death 34.00 Accrued income on Item 52 through date of death 85.50 53 TosBaaz2a $2,000 PA INSD MUNS INCM TR - UT Series 89 -Bond 95 1,900.00 fund, valued per EstateVal report Accrued income on Item 53 through date of death 42.20 Accrued income on Item 53 through date of death 8.00 54 708848349 $2,000 PA INSD MUNS INCM TR - UT Series 95 -Bond 132.32 2,845.40 fund, valued per EstateVal report Accrued income on Item 54 through date of death 57.20 Accrued income on Item 54 through date of death 11.60 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule B (Rev. 6-98) Rev-1508 E%~ (698) ~ SCHEDULE E <~ CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONNFAITM OF PENNSYLVANIA INFERITPNLE Tq%RETLRN RESIOEM OECEOEM ESTATE OF FILE NUMBER Shelly, Janet Kitzmiller 21-08 0504 Include the proceeds of litigation and the tlate the preceatls were receivstl by the estate. All propertyJolntlyawned wtN the right of aurvlvoreblp must be dlacloaed on achetlule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash in JMS -Cash in securities account held by Decedent at Janney Montgomery 42,545.34 Scott, Inc. 2 M8T Bank CD -Principal balance in Certificate of Deposit No. 037003914551xxx titled) 105,000.00 in Decedent' sole name, valued per letter from bank Accrued interest on Item 2 through date of death 70.21 3 M8T Bank Checking Acct. -Principal balance in Checking Account No. 950280xxx 20,801.48 titled in Decedent' sole name, valued per letter from bank Accrued interest on hem 3 through date of death 0.48 4 Northwestern Mutual -Balance in Access Fund Account No. 80200510099xxx owned 107,570.40 by Decedent, valued per letter from issuer 5 Chrysler Van - 2005 Chrysler Town 8 County van in good condition with 25K miles, 9,680.00 valued per Kelly Blue Book (online) 8 Capital Blue Cross -Refund of medical insurance premium 141.27 7 Erie Insurance Group -Refund of automobile insurance policy premium 378:00 8 Met Life -Cash value of life insurance policy owned by Decedent on life of daughter, 2,557.30 Sandra L. Renninger, liquidated with proceeds paid post-death to Estate, valued per Form 712 per insurer 9 Prudential Life Ins Co -Cash surrender value of life insurance policy #M10403633 3,685.00 owned by Decedent on life of daughter, Sandra L. Renninger, valued per insurer's agent 10 Waggoner, Fruitiger & Daub, CPAs -Refund of accounting fees 1,500.00 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 301,539.17 (tl more space is neetled, additional pages o(tha same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule E (Rev. 6-98) Rev-1508 E%t (8-88) ~ SCHEDULE E ~~ CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMOMNFALTH OF PEMISVLVAMA INIERITANLE U%RETLRN continued RE610EM OECECENr ESTATE OF Janet Kitzmiller LE NUMBER 27-08-0804 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1909 EXa (6-99) ~: SCHEDULE F „ornnoN.xa~T„OERENNSYLVANIA I JOINTLY-OWNED PROPERTY INIERITISLE TRX RETUiN flE61CEM LECEnENi ESTATE OF (FILE NUMBER Shelly, Janet Kitzmiller 21-08-0604 I/an suet was matle loln[ witltln one year or Ne tlecetlenCa tla[e o/ tleam, It moat be npoRetl on achetlule G. SURVIVING JOINT TENANT(S) NAME B. C JOINTLY OWNED PROPERTY: RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET ~ OF DECD'S INTEREST DATE of DEATH VALUE OF DECEDENTS INTEREST 1 A 12/12/2007 PNC Bank Joint Acct. #1 -PNC Bank 31,141.46 100.000% 31,141.46 Account No. 50-7011-5xxx titled in joint names of Decedent and her daughter, Sandra L. Renninger, valued per bank's report to PA DOR as assessed in its Notice 2 A 4/21/2008 PNC Bank Joint Acct. #2 -Checking 29,505.84 100.000% 29,505.84 Account No. 51-4005-7xxx, titled in joint names of Decedent and her daughter, Sandra L. Renninger, valued per bank's report to PA DOR 8: assessed in its Notice 3 A 4/21/2008 PNC Bank Joint Acct. #3 -Money Market 68,607.34 100.000% 68,607.34 Savings Account No. 50-0311-2xxx, titled in joint names of Decedent and her daughter, Sandra L. Renninger, valued per bank's report to PA DOR & assessed in its Notice Total of Continuation Schedule ee attached page TOTAL (Also enter on Line 6, Recapitulation) I 236,568.59 ADDRESS Mechanicsburg, PA 17055 (H more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-15°9 E%~ (699) , LOMMONNE4tX Oi PEMISYLVANIq INIERITAICE TPJ( RETLRN RESIDEM OECEDEM SCHEDULE F JOINTLY-OWNED PROPERTY continued ESTATE OF FILE NUMBER Shelly, Janet Kitrmiller 21-08-0604 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G JOINTLY OWNED PROPERTY NUM ER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INUMBER OR SEMIIARNDENTIFYNNG NUMIBER ATTACH DEEDOFOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE DECDFS T INTEREST OAVA~UE OETM DECEDENT'S INTEREST 4 A 4/21/2008 PNC Bank Joint CD #1 -PNC Certificate 55,147.65 100.000% 55 147 65 of Deposit No. 000031700114xxxtltled in , . joint names of Decedent and her daughter, Sandra L. Renninger, valued per bank's report to PA DOR 8 assessed in its Notice 5 A 4/21/2008 PNC Bank Joint CD #2 -PNC Certificate 52,166.30 100.000% 52 166 30 of Deposit No. 000021001025xxx titled in , . joint names of Decedent and her daughter, Sandra L. Renninger, valued per bank's report to PA DOR 8: assessed in its Notice 70TAL (Also enter on Line 6, Recapitulation) 236,568.59 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) REV-1161 E%t 113-99) u~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT pECEDENT SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER _ Shelly, Janet Kitzmiller 21 08 0604 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Rolling Green Cemetery -Interment charges 11,220.54 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees 66,367.70 See continuation schedule(s) attached 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. I Probate Fees 2,020.00 5. I Accountant's Fees I 3,500.00 6. I Tax Return Preparer's Fees 7. Other Administrative Costs 9,005.87 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 92,114.11 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Shelly, Janet Kitzmiller LE NUMBER 21-08-0604 NUMBER DESCRIPTION AMOUNT Attorney Fees 1 Fisher & Sauls, P.C.-Legal fees paid by Estate during administration to counsel in 1 826 38 Florida , . 2 Fisher & Sauls, P.C. -Legal fees paid by Estate during administration to counsel in 216 00 Florida . 3 Fisher 8: Sauls, P.C. -Legal fees paid by Estate during administration to counsel in 765 00 Florida . 4 Fisher & Sauis, P.C. -Legal fees paid by Estate during administration to counsel in 890 32 Florida . 5 Goldberg Katzman, P.C. -Legal fees paid by Estate during administration to counsel 5 625 00 in Pennsylvania , . 6 Goldberg Katzman, P.C. -Legal fees paid by Estate during administration to counsel 13,720.00 7 Goldberg Katzman, P.C. -Legal fees paid by Estate during administration to counsel 3 325 00 in Pennsylvania , . 8 Goldberg Katzman, P.C. -Reserve for additional counsel fees in administration of 15 000 00 Estate , . 9 Tucker Arensberg, P.C. -Reserve for additional counsel fees in administration of 25 000 00 Estate , . H-B2 Subtotal 66,367.70 Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn Pq-7500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Shelly, Janet Kitzmiller FILE NUMBER 21-OS-0604 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 10 Bricker, Chuck -Auctioneer's fee to appraise tangible personal property 80.00 11 Briggs, Sherrie -Fee to appraise contents of condominium in Florida 200.00 12 Carlisle Sentinal -Fee for publication of estate notice in local newspaper 190.54 13 Cumberland Law Journal -Fee for publication of estate notice in legal journal 75.00 14 Gehres 8 Assocs. Appraisers -Fee to appraise condominium in St. Petersburg, FL as of alternative valuation date 250.00 15 Gehres 8 Assocs. Appraisers -Fee to appraise condominium in St. Petersburg, FL as 300.00 off date of death 16 Goldberg Katzman, P.C. -Photocopy charges 40.00 17 Lyons Surveying LLC -Fee to survey farmland in conjunction with real estate 3,838.83 appraisal & Estate's corrective deed to beneficiary 18 PennDOT -Fee charged by PA Department of Transportation to transfer van 28.50 19 RSR Appraisers -Fee to search & obtain recorded real estate documents 200.00 20 RSR Appraisers -Fee to appraise residence & farmland in Mechanicsburg, PA as of 1,500.00 alternate valuation date 21 RSR Appraisers -Fee to appraise residence & farmland in Mechanicsburg, PA as of 2,250.00 date of death 22 VitalCheck - Fee to obtain five death certificates 53.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-96) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Janet Kitzmiller LE NUMBER 21-08-0804 NUMBER DESCRIPTION AMOUNT H-a7 subtotal 9,005.87 Copyright (c) 2002 form software only The Lackner Group, Inc. Eorm PA-1500 Schedule H (Rev. 6-98) Rev-1612 E%~ (9.99) ~ SCHEDULE 1 ~~ DEBTS OF DECEDENT, DDMMDNJVH.LTH OF pENNSVIVgNIq MORTGAGE LIABILITIES, & LIENS IN1E0.1Tg1CE Tqx RETURN RESIpEM DEGEOEM ESTATE OF Janet Kitzmiller Inclutle unrelmbunetl metllcal expenses LE NUMBER 21-08-0604 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Boca Ciega Condominium -Monthly condominium fee assessed to Decedent 378.56 pre-death and paid post-death by Estate 2 Dilisburg Excavating & Septic -Charge for septic tank cleaning B recharge services 215.60 required by township regulations, incurred pre-death and paid post-death by Estate 3 Farm Buildings & Sanitation, Inc. -Cleaning 8 painting of fencing pertormed 279,gq pre-death and paid post-death by Estate 4 I Goldberg Katzman, P.C. -Legal fees incurred by Decedent pre-death 8 paid by I 2,150.00 Estate 5 Hematology & Oncology Consultants of PA, P.C. - Unreimbursed medical charge paid) 45.31 post-death by Estate 6 Internal Revenue Service -Tax, interest 8: penalty assessed to Decedent re 2007 12,674.00 individual income tax, paid post-death by Estate 7 PA Department of Revenue -Tax 8 interest assessed to Decedent re 2007 individual 28.50 income tax, paid post-death by Estate 8 PA Department of Revenue -Payment due 06/16/08 for Decedent's individual income 1,150.00 taxes 9 PPBL -Electric bill for Residence owed by Decedent and paid post-death by Estate 40.63 10 Pro Fence, LLC -Fence installation ordered by Decedent under pre-death contract 11,684.40 and paid post-death by Estate 11 Progress Electric -Electric bill for Condo owed by Decedent and paid post-death by g,24 Estate 12 U.S. Treasury -Payment due 06/15/08 for Decedent's individual income taxes 5,400.00 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 70, Recapitulation) 34,143.87 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1b13 E%t (6.98) ~ SCHEDULE 1 ~~ DEBTS OF DECEDENT, COMMOMMcALiN OE REM1sYLVl~NiA MORTGAGE LIABILITIES, & LIENS INER~TPIJLE iAY RETURR continued RESDEM OECECEM E57ATE OF FILE NUMBER Shelly, Janet Kitrmiller 21-08-0604 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 73 United Water -Water bill for Residence owed by Decedent and paid post-death by g,gg Estate 14 Upper Allen Township -Fee charged by township for home sewage system 30.00 inspection incurred pre-death and paid post-death by Estate 15 Verizon -Telephone bill for Condo owed by Decedent and paid post-death by Estate 26.70 16 Verizon -Telephone bill for Residence owed by Decedent and paid post-death by 23.41 Estate TOTAL (Also enter on Line 10, Recapitulation) I 34,143.87 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-151a EX~t9-00) p ~ ~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Shelly, Janet Kitzmiller 27-08-0604 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE Do NW List Trvetee s (Words) ($$$) I• TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Sandra L. Renninger (Decedent's daughter) -- Entire Net Estate Total 3,479,717.70 Enter tlollar amounts for distributions shown above on lines 15 t hrough 18, as appropriate , on Rev 1500 cover she et II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS _ TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0 00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-96)