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Home My WebLink About03-30-09J 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau Of Individual Taxes County Cotle Vear File Number Po Box.2aosol INHERITANCE TAX RETURN Harrisburg, Pq 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 0 4 0 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 199 52 3511 03 20 2008 10 30 1957 Decedent's Last Name FREY Suffix Decedent's First Name S. (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW X', 1. Original Return ~__~ 4. Limited Estate L_ .X.i g Decedent Died Testate r'. (Attach Copy o(Wilg Spouse's First Name MI K MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return LJ 3. Remainder Retum (date of death prior to 12-13-82) qa, Fuwre Interest Compromise r 5. Federel Estate Tax Return R wired (date of death after 12-72.82) __ ag ~ Decedent Maintained a Living Trust O 8. Total Number of Safe De osit Boxes (Attach Copy of Trosq p 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit ((tlate of tlealh between 12-31-97 antl f-0-95) C. 11. Election t0 tax Under Sac. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD aE DIRECTED 70: Name Daytime Telephone Number BRIAN C. LINSENBACH 717 432_9733 n, Firm Name (If Applicable) -- SCHRACK & LINSENBACH PC REGISTER OFWI4LSUSE~ILY ;' ('~ :~ First line of address ~-? ~,~ _ ~ 124 W. HARRISBURG ST. "i ~ - Second line of address '-v P.O. HOX 310 ~ " clt City or Post Office State ZIP Code DATE FILED N ' DILLSBURG PA 17019-0310 Correspondent's e-mail address: blinsenbaCh@COmCdst.net tf Isdtrueecortrect endecomple[e~Derecla2ation of preeparer other thanutheloersolnal ronrPCwniaa°: 1e best of my preparer has belief, ~-' 1 lRk,(,ut rl._. Maureen Shoaff 1 / `~~ U ADDRESS ~ _132 Spring Road, Dillsburg PA 17019 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE /~~`. ~~ Brian C. Linsenbach ~ ~; ~ ~g~~ 124 W. Harrisburg St., Dillsburg, PA 17019.0310 Side 1 15056041147 15056041147 J J 15056042148 REV-1500 EX Decedent's Social Security Number oe~aem~:Name: S. Karin Frey 199 52 3511 _. __ _ _ __ _ _.. __ ECAPITULATION -- - --- - - --- -- 1. Real Estate (Schedule A) ...................................................................................... 1. 1 1 0, 0 0 0. 0 0 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. 1 , 7 9 6 . 2 8 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ........ ..... 6. 8 6 6 . 9 9 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) r~ Sepaate Billing Requested ......... .... 7, 8. Total Gross Assets (total Lines 1-7) ............................._.............................. _ _ .... 8. 11 2 , 6 6 3 . 2 7 9. Funeral Expenses & Administrative Costs (Schedule H) .................................. - .... 9. __ - ___ 7 7 , 4 9 S . 15 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule p ......................... ....... 10. 4 9 , 2 3 9 . 3 2 11. Total Deductions (total Lines 9& 10) ............................... 11 1 2 6, 7 3 7. 4 7 12. Net Value of Estate (Line 8 minus Line 11) ............................._.......................... 12. - 1 4 , 0 7 4 . 2 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. 13, 14. Net Value Subject to Tax (Line 12 minus Line 13) ............ _ ................................ .. 14. - 1 4 , 0 7 4 . 2 0 -. _ 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 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0. 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 19. Tax Due ............................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 15056042148 0.00 REV-1500 EX Page 3 File Number 21-08-00408 Decedent's Complete Address: S. Karin Frey STREET ADDRESS - - _ - - -~ _ 1076-5 Lancaster Boulevard __ __ _. __.. _. _.. - __..- _ _._ - _-_ _-.STATE _-. rZIP-. __. -__....- Mechanicsburg PA II 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments --- -- - - - A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 3. InteresVPenalty if applicable Total Credits (A + g + C) (2) 0.00 D. Interest E. Penalty Total InteresVPenalty (D+E) (3) 4. me 2 is greater than Line 1 + Line 3, enter the difference. This is theDVERPAYMENT. (q) Check box on Page 2 Line 20 to request arefund -- - --- ---- 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5) 0.00 _._ __._ q, nter t e interest on the tax due. (SA) B. nter the total of Line 5 + SA. This is theBALANCE DUE (5B) 0. ~ 0 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................. . . J [x_i b. retain the right to designate who shall use the property transferred or its income :.............................._ L_. rx c. retain a reversionary interest; or ..............................................................................................._........... ~~ -% d. receive the promise for life of either payments, benefits or care? .......................................................... [_ [x 2. If death occurred after 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" or payable upon death bank account or security at his or her death?......... I x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............................. --- _- .................................................................................. L . IF$$THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exemota 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 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 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. ~~# ~ C`~.esext~ OF S• KARIN FREY a/k/a STELLA KARIN FREY BE IT REMEMBERED, that I, S. KARIN FREY, a1k/a Stella Karin Frey, presently of 1076-5 Lancaster Bouleeazd; Mechanicsburg, Cumberland County, Pennsylvania 17055, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that my hereinafter named Executrix pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Executrix to expend for my funeral expenses and interment such amounts as she may consider necessary and proper, without regazd to any limit that maybe prescribed by a court of law. ITEM 2: I direct my Executrix to pay all inheritance, estate, succession, and legacy taxes of whatsoever nature and kind, to which my estate, or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes against my residuary estate. It is my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal taw now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 3: I give and bequeath my Armoire to EVERETT SHOAFF. ITEM 4: I give and bequeath my Roll Top Desk to my sister, MAUREEN SHOAFF. ITEM 5: I give and bequeath the amount ofTHREE THOUSAND DOLLARS ($3,000.00) to Helping Hearts-and -Hands, Sertoma Club (attention: Mary Lank, President, of 1155 Dry Powder Circle, Mechanicsburg, PA 17050). Rev-1502 F~(« (g-9g) SCHEDULE A REAL ESTATE cOMMONWEALTN OF PENNSYLVgNIa INHERITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF S. Karin ILE NUMBER 21-08-00406 All real property owned aoley or as a tenant In common must be reported at fair market value. Fair market value is tlefnetl es the price at which properly woultl be exchangetl between a willing buyer antl a willing seller, neither being compelled to buy or sell, bath having reasonable knowletlge of the relevant facts. Real properly which Is Jolntlyowned with right o/survivorship moat be disclosed on schedule F. ITEM NUMBER DESCRIPTION LUE AT DATE OF DEATH Condominum unit at 1076 Lancaster Boulevard, Mechanicsburg, Upper Allen 110,000.00 Township, Cumberland County, Pennsylvania (contract sale price -see HUD1 attached) TOTAL (Also enter on Line 1, Recapitulation) I 110 000 00 (It more space Is needed, addltlonal pages of the same slze) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleA (Rev. 6-98) a. Settlement Statement ,~,,,,n~ 1 ~ ~a.w~,..we,. SUroBaSTpITnUTE FORM IOW SELLER STATEMEM: TpInlNnialbn mnlelnetl pNtlnbhpplgnl la5lnlprtullpeaMbpelry/VmNpM bllq lnlemal RCrenw $eMCe, lly an repuketl bNee nbm. Nrro 101 ep dal tlhnm Ne GmaP ~sdMla pamS~ryplNla llpnbreµlyM to Ee npxlW enO Ne lqS tlelgm'w lryal ll Iles nd pem r<Opletl. iln Cmincl gab6 Pale tlgglyeE qi ^w ere mqulnetl py lewlo poNOe Ne mNemml epenl ~Fep. Ta110 Na: ~~ ~ mpEar.Y mry Ee aVplaCl to yNlMpylYnalpMaltlee lnyKKatl pYlpw cVM peng~~ry~~v edl°CaW IEenIM®Ibn nu~er.ttycu eo ml puWM pur Wnetl layyyylEenlMwWn 1 cMllyryul Vro nVnOarYlwm g10y5 Slelpnpll IB mY Ou+411a@eyb Mm0tltatlan aYnlCa'. TIN:_._. 1_ __ SELLERIS)SWNANRE(S~: SELLER(5)NEW NAILING PDppESS: ( SELLER(S) PRONE NIIMSERS: (RI ^ (am HUO-1 (31B811e1 HendGVk <3052 Prcmaue eesiana eye odwlele PAGE 2 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 08.01-6.06503 ,.. ce«lome„1 c.elem PHntM OAI19I2008 at 11:08 LM SETILtMtIVL sLAltmtrvr ~„~~,., .,w ................._ _._. ____. PAID FROM PAID FROM L. SETTLEMENT CHARGES TOTAL SALES/BROKER'S COMMISSION based on rice 8110000.00=4650.00 700 BORROWER'S SELLER'S . FUNDS AT FUNDS AT Division of commission Ilse 700 as fdlows'. EMENT SETTLEMENT 00 to HOWARD HANNA REAL ESTATE 2 725 SETTL . 701, 7pp. 2125.00 to For Sale b Owner Plus 4 850.00 703. Commission aid al Settlement 195 00 704. Administrafion Fee to HOWARD HANNA REAL ESTATE . 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % LR 1 080 33 602. Loan Discount 1.000 %PNC Mort a e LLC LR . 400.00 803. A sisal Fee to RELS Valuation LR 16.00 804. Credit Re n to RELS Re ortin C P O 00 B er LR 310 . . . 805. Home and Pest Ins ion Fee fo Ins ection Canter . LR 19.00 806. Flood Life of Loan Fee to WF Insurance Inc. O C P 00 Bu er LR 200 200.00 . . . 807. Processin Fee to PNC Mort a e LLC . LR 00 100 806. Undenvritin Fee to PNC Mort a e LLC LR . 1 333.00 809. U front MIP to FHA 810. 611. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 900 . Interest From 0811912008 to 0910112006 19.2400 Ida 901 13 Da s LR 250.75 . 902. Mort a elnsurance Premium for to 903. Hazard Insurance Premium for to 160 00 904. Homeowner Contents Insurance to Howard Hanna Insurance Services . 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Nazard Insurance mo. Imo 1002. Mon a e Insurance mo. .Ofi Imo 1003. Cit Pro d Tax mo. Imo 29.90 Imo 8 mo LR 239.20 . 1004. Coun Pro h Tax 95.37 Imo 4 mo LR 381.48 . 1005. School taxes 1009. A re ate Anal sls Ad'ustment to PNC Mort a e LLC LR -244.85 0.00 1100. TITLE CHARGES 45 00 FJedronic Da Transmittal Fee to Barristers Land Abstract Genersl•Hb 1101 . . Ovemi ht Fee 2 k sl to Barristers Land Abstract Poste e • Hb 1102 26.00 13.00 . 1103. Wre Fee 2loans to Barristers Land Abstract Wira-Hb 22.00 1104. Title insurance binder - 75 90 1105. Deed Pre aration to Schrock & Linsenbach Law Offices . 00 10 1106. Note Fees to Jo ce Ehrich 35.00 . 1107. Atlome 's fees includes above items No: 817 88 1108. Title Insurance to Barristers Land Abstract Com an . includes above items No'. re-issue rate 1109. Lendels Pollc 108 033.00 1110. Owner's Polic 110 000.00 •817.88 150 00 End 100 End 300 End 900 to Barristers Land Abstact Com an 1111 . . End 810 Loan to Barristers Land Abstract Com an 1112 50.00 . 1113. Closin SvcLV to Barristers Land Abstract Com an 35.00 GOVERNMENT RECORDING AND TRANSFER CHARGES 1200 . 1201. Relxxdln Fees Deed 38.50 'Mon 54.50 ~ Release 93.00 1 100.00 1202. Cit (Count taxlstam s Deed 1100.00 ~ Mort a e 1 100 00 State Taz/stam s Daed 1 100.00 ~ Mon e 1203 . . Record 2nd Mod a to Cumbarand Coun Recorder of Deeds 40.50 POC b Lender 1204 . 1205. Assi nmentd Mon to Cumberland Coun Recorder of Deeds 27.00 ADDITIONAL SETTLEMENT CHARGES 1300 . 1301. Resale Cert to PMI Pro a Mana ement Inc. 150.00 1 144 46 1303. 2008109 Scheol Taxes to Marlin A. Yohn Sr. Tax Collector . 106 00 1304. Au ust HOA Fee to Horst Pro a Mana errant . 00 5 Tax Ced to Barristers Land Abstract General - Hb 1305 . . 1306. Sewer-3b Otr. tDU er Allen Townshl Autho' 112.00 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Sedbn J and 502 Section K 6 530.91 7 565.46 HUO CERTIFICATION OF BUYERANU OeLLen Ia~vTe gteluy~Ipwsq~M tl,elH~et ~~m Slemenl elmpyd1 eX00L 16e AemeanlS l~°'^elba4ue ene ecorele alelemenl al ell lacNpts anEdlsEUrsamenls mademmy ecwnl /0fy /'M1 ~ ~ ~OP, m, WARNING:IT ISACRIME TOIWOWINGLY M4(E FALSE eTATEMENTS TO THE Tae HU615el0enan15plenmh MIO6s2 pepertdlse WeeM ecEUnle ecrounlMNb UNREO STATESONlH150RANY e1MILAR FORM. PENALTIEe UPON CONVICTION IrensaNm. Iluve is use Na ands bE IeEUSeElneccarden WNNis ale nl. CAN INCLUDE A FINE AND IMPRISONMENT. FOR CETAl13 SEE TITLE 10: y7 U.S. CODE SECTION 1001 AND SECTION 1010. GI] SETILEMENTA T' OATS Rev-7508 EXi (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE Tq%RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Frey, S. Karin FILE NUMBER 7V V Indutle the proceetls of litigalicn antl the Gate the proceetls were received by the estate. All property lolntlyrownetl with the right of survlvorshlp must be tllsclosetl on schatlule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Pennsylvania Housing Finance Agency - S 0064 1998 SFM ISSUE 064 BONDS 1,114.50 2 Final pay check received 87.78 3 Government stimulus check received 600.00 TOTAL (Also enter on Line 5, Recapitulation) I 1 796 28 (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 E (Rev. 6-98) Pennsylvania Housing Finance Agency DATE 9 / 1z /zoo s PR0.7ECT INVOICE DETAIL AMOUNT S 0064 1998 SFM ISSUE 064 BONDS 0000817544 FREY 1,114.50 ~'~ ~~.~ ~_-~°~~ '~ CHECK TOTAL: 1,114,50 2T1 North Front Street r one ~7i2r~~rd, ~;; YF ,''~~C wmi i',~ 769232 DATE r, i '4~w h`~d~a mhiw, ir~ii r,.W'. dwti°~r mrN iqi idm a?d mr 9V.r ~ v ,~.~~ yrr, ~~4i w : wr ~ wr + ~` r~ i ~ ~' ~~~ wm~"'~~~~~ ~ oN ~~r~~wnu~r r u~ud ~' N WP i i i u4 d+ ~i i ~ In w~d4 ~r d' n, ~ N yl 41 i~V I iPi~ wtl iw ~i li 4 uY ~6 lµ r ~~~~ ~ w~ A~i~ it p rd~i ~~: ~r~ ~' "~ a A ~ ~p~~l r ~, ii 4i~j~ ~~t„ u h ~ ~' ir,~,,. y4d 4h ~.,~,~~~ m~olii w:w tl nYu m ~y~iX ld 'Pi J,r tl,~'~' ~$~~ph ~f~uµ utltlifAMl)R. ~6v,ym~ i !i ne ~ui,ro ~YI'~dUi ******1,114.50* lr~d~ -` ~ {_ - 4_ -~ __ ._~-4 =-~.o hil dill u",i pM '~1ii'r~ 1 ~~~ 411 tltl ""'W,~~ ~ ~^i ~ Ny^ ~, ~~I W... Y tl Wtl ~ x ^ii. + Vr w6 "1mn ^+~,a'1 mN dr ~~~~' n tl nwNm mud w0o~~`~ iw yn~dw "+ioRi aw A "n ' ~'iµ~ ~~~i mY~tl ~Ytl~ '~hmi~wy ~~w .{ml~P~^ ~Iwa uw loi ~w1~wd i71rar~. r ,~ „ e ~, tl" '~ ~w ' ~y '' ,,y~,y "'ui who ~~ ~~+ i9 r,~d a°~m W+ ,, ~~~ '~~~ it kph tl~~1 uodd~ d ' h ~,'' tl23L~ i"i' S '~R hw"rr~, N 4 i~ ., ~ d iil~i 7' i! :.dM i '~dyr' pQN ~~~rry7ti rd,4uWuduif r PA 170554491 /1 - ~ .~Y ~ J n ii'000 769 2 3 2~i' ~:03ii00225~:20 799 500 24 5 76n• Rev-1508 E%+ (6.98) SCHEDULE F DDNNDNwEALTR Dr RENNSVLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF S. Karin Han asset was matlajolnt wlihln one SURVIVING JOINT TENANT(S) NAME A. Maureen Shoaff B. C. JOINTLY OWNED PROPERTY: ADDRESS 132 Spring Road Dillsburg, PA 17019 FILE NUMBER 21-08.00406 reportetl on achetlule G. RELATIONSHIP TO DECEDENT Sistel 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-MELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET s~O L)F DECD'S INTEREST DATE OF DEATH DECEDENT'S INTEREST 1 A 3/1/1990 Members 1st Federal Credit Union - 1,733.98 50.000% 866 99 checking account #113239-11 . TOTAL (Also enter on Line 6, Recapitulation) I 866.99 (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 F (Rev. 6-98) COMMONWEALTH OF PENNSY LVAN DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA I]128-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE sfv-ucs sx err <as-oa> FILE N0. 21 ACN 08116361 DATE 04-16-2008 TYPE OF ACCOUNT EST. OF S K FREY ^ sgvlmcs S.S. N0. 199-52-3511 ® CHECKING DATE OF DEATH 03-20-2008 ^ rausT COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: MAUREEN SHOAFF REGISTEk OF WILLS 132 SPRING ROAD CUMBERLAND CO COURT HOUSE DILLSB G -- - -- -- MEMBERS 1ST FCU has provided the Departaent with the infornation listed below which has been usetl in calculating the potential tax due. Their records indicate that ak thv death of the above decedent, You were a joint owner/beneficiary of this account. If You feel this inf oraation is incorrect, please obtain written correction froa the financial institutipn, akkech a copy tp this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of 4he Coanonwaalth of Pennsylvania. questions wav be en swa rod by anl]ing. (71]) 787-832]. COMPLETE PART 1 BELOW ^ ~ ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Aceo unt No. 113239-11 -Date 03-01-1990 To insure proper cradiY to your account, two E5 ta61f Shed (2) copies of this notice oust accoaparry your Account Balanea 1,733.98 pevnant to the Register of Wills. Make check payable to. ''Register of Wills, Aaent". Percent Taxable X 50.000 Amount Subject to Tax 866.99 NOTE, If tax oavnents era wade within three (3) aonths of the decedent's tlate of tleath. Tax Rate x . 0 45 you aay detluct a 5x discount of the kax due. Potential Tax Due 39 B 1 Any inheritance kax due will bacons delinouent nine (9) aonths of tar the data of death. PARr TAXPAYER RESPONSE v i4'=3.;'' Ali i'rY v .i y+ n $y+~/~ay~ ~y]y~ a~,;y+~Y~h~,~j ayfp~ iti~~~. I~ ~i ~ 9,:5. ~' ~ ~~ ~ S~: i¢ ~ ~i r£Aigtli!i4.~4j ~f `'v.n. i~:ry!F.L$'iF'2if:i i;:_: +iill'Gdi~~l .... v ... .... .:. ~:.ia:3v A. ~ The above inf ornation and fax due is ca tract. 1. You nay choose ko resit Oayaent ko the Register of Wills with two copies of this notice to obtain CHECK -I a discount or avoid infarnst, or You nay check box '•A" and return this notice to the Resister of 0 NE J Wills and an official assessment will be issuatl by the PA Departnant of Revenua. BLOCK B. ~ The above asset has bean or will be raoorted and tax paid with th¢ Pennsylvania Inheritance Taz return ONL Y to be filed by kha deeedmt's repro sent ative. - C. ~ The above inf ore ati gn is incorrect and/or debts end deduct ions were paitl by you. Vou Host complete PART 2~ and/or PART 3^ below. PART If you indicate a tl3ffarent tax rake, please state your relationship to daeaden t: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS L1NE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3_ X 4. Amount Subject kc Tax 4 5. Debts and Detluetions 5 6, Amount Taxahle 6 ~ 7. Tax Rate 7 X 8. Tax Due a _ .._..._.-. ......~...-~..,. ,,~ :. -: axe.:,,:. PART DEBTS AND DEDUCTIONS CLAIMED GATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CE nter on Line 5 Under penalties of perjury, I d¢ela ra that the facts I have raps rted above are true, correct antl complete to the best of my knowledge and belief. .._.._ WORK C ) rnynnvrp crcunrnRr TFI FPNf)NF NIIMRFR TIATF REV-0151 Ex~ (13-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Frey, S. Karin 21 08 00406 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 See continuation schedule(s) attached I 5,821.65 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Maureen Shoaff Social Security Number(s) / EIN Number of Personal Representative(s): street Address 132 Spring Road city Dillsburg state PA Zip 17019 Year(s) Commission paid 2008 6,000.00 2. Attorney's Fees Schrack & Linsenbach PC 7,000.00 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 5. Accountant's Fees 6. Tax Retum Preparer's Fees 356.00 7. Other Administrative Costs 58,320.50 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 77,498.15 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1504 E%~ (fi-98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT DECEDENT ESTATE OF S. Karin LE NUMBER 21-08-00406 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Revd502 EX* (8-981 COMMONWEALTX OF PENNSYLVANIA INXERITANCE TA%RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued Frey, S. Karin LE NUMBER 21-08-00406 ITEM NUMBER DESCRIPTION AMOUNT 1 Check fee 11.00 2 Clerk of Orphans' Court -Release filing 5.00 3 Costs on sale of 1076-5 Lancaster Blvd., Mechanicsburg PA property (see HUD-1 attached) 49,094.41 4 Cumberland Law Journal -estate advertisement 75.00 5 Evening News (Metro West section) -estate advertisement 134.31 6 Maureen Shoaff -amount due for monies loaned to Estate during administration 5,525.00 7 Miscellaneous expense during administration (posta e co i t g , p es, e c.) 50.00 8 Pennsylvania Housing Finance Agency -payments on Loan #817544 1,676.00 9 Property Management, Inc. - Sunguild II Condo Asso. payments on Account #H0420 107605 424.00 10 Register of Wills -filing fee 15.00 11 Reserve for future administrative expense 900.00 12 Smart Clean -prepare residence for sale 180.00 13 Upper Allen Township -sewer bill 230.78 Subtotal I 58,320.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) A. Settlement Statement , SrUyg~$TpIT~UIE FORM f09d SELLER STATEMENT; TM Infunprypi m11aInM Iwyn Is Imryrlanl by IMarmayw yw b Mry hmbtla! m Ne Inlemal Revaxi¢ gaNCe. Mycua2 regvyel lp flb a 20m, Yne WlaMe mutlhlles the (' Prq~eeEfla My~pyq ~blbmknyuYeE to he lywlM aM INe IRS OaIemlNe Ne111 Ma rvA pevi iLpylai. TAe Cmbtl 9alea PNCe Ee~glpap pi Yw ere myul2]hylewmpgUe Ne aaltlenew py~I (Fetl Tev lD NO: wlyi wmhe., w~marmmgea maw namrrelo®+MUes mymm Mlew. Ulda ~F~ mfetl mmaraaanunmum ~~rehs-. rsW eo awl cre~ma wln Caen la~,va~m.~,unnuaa oraa wnwr. ~~InM mr mlmee<mvaa an ws aMlamnlhmyaarafbwaraaeaunana, nme«. TIN: _._. )__ gELLERISI gIG.WTURE(g): gELLEgIg)NEW M9ILING TOOREgg: SELLERS) PHONE NUMBERg: .... loan Huo-1 (SIB6) rH neMMOk a90.5.1 ra„e~> aamona «a oe>aara File Number OBA1-6.06503 PAGE 2 I I S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT ea c.,~l~„ PrivrM ON192008 at 11:06 LM SETTLEMENT STATEMENT ""`° """""""""'" "'-' PAID FROM PAID FROM L. SETTLEMENT CHARGES rice$110000.00=4650.00 d eORROwER's sELLERs on 700. TOTAL SALES/BROKER'S COMMISSION base FUNDS AT FUNDS AT Division of oJmmie5io0 line 700 as follows: HOWARD HANNA REAL ESTATE 00 SETTLEMENT SETTLEMENT to 701 2725. 702 2125.00 tc For Saleb Owner Plus 4850.00 703. Commission aid at Senlement HOWARD HANNA REAL ESTATE t 795.00 o 704. Administration Fee 800. ITEMB PAYABLE IN CONNECTION WITH LOAN 801. Loan Od inatbn fee % LR 1 080.33 602. Loan Dlsmunt 1.000 %PNC Mort a e LLC LR 400.00 1103. A asset Fee to RELS Valuation LR 16.00 804. Credit Re n to RELS Re ortin C P O 310.00 B er LR . . . 805. Home and Pest Ins ion Fee to Ins action Center LR 19.00 806. Flood Life of Loan Fee to WF Insurance Inc. p C O 00 Bu er LR 200 200.00 , . . 807. Processin Fee to PNC Mort a e LLC . LR 100.00 808. Underwrltin Fee to PNC Mort a e LLC LR 1 333.00 809. U ont MlP to FHA 810. 811. ITEMS REQUIRED BY LENDERTO BE PAID IN ADVANCE 12 250 900. 19.2400 Ida 901. Interest From 0811912008 to 0 910112 0 0 8 13 Da s LR LR . 75 902. Mon a elnsumnce Premium for to 903. Hazard Insurance Premium for to 160.00 904. Homeowner Contents Insurance to Howard Hanna Insurance Services 905. 1000. RESERVES DEPOSITED WITH LENDER FOR Imo 1001. Hazard Insurance mo. O6 Imo Mon a e Insurance mo. . 1002 . Imo 10113. Cit Pro Tax mo. 29.90 Imo 8 mo LR 239.20 . 1004. Cant Pro n Tax 95.37 Imo 4 mo LR 381.48 . 1005. School taxes LR -244.85 0.00 1009. A re ate Anal sis Ad'ustment to PNC Mort a e LLC 1100. TITLE CHARGES 00 45 Electronic Doc Transminal Fee to Barristers Land Abstract General-Hb 1101 . 26.00 13.00 . Oveml ht Fee 2 k s/ 1o Barristers Land Abstract Poste e - Hb 1102 00 22 . 1103. Wire Fee 2loans to Barristers Land Abstract Wire - Hb , 1104. Title insurance finder k & Linsenbach Law Offices h S 75.00 c rac 1105. Deed Pre aration to - 35.00 10.00 1106. Notar Fees to Jo ce Ehrich 1107. Aname 's tees inGUdes above items No: Barristers Land Abstract Com an 817.88 1108. Title Insurance to Includes above items No: re-Issue rate 1109. Lender's Poli 100 033.00 - 1110. Ownel's Pol' 110 000.00 •817.88 00 150 End 100 End 300 End 900 to Barristers Land Abstract Com an 1111 . 00 50 . 1112. End 810 Loan 1o Banisters Land Abstract Com an . 35.00 Closin SvcLU to Barristers Land Ahsbact Com an 1113 . 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 93.00 1201. Recordin Fees Deed 38.50 'Mort 54.50 ~ Release 1 100.00 1202. Cit (Coun taxlslam s Deed 1 100.00 ~ Mon e $ 1 100.00 1203. State Taxlstam s Deed 1 100.00 'Mona a to Cumberland Coun Recorder of Deeds .50 POC b Lender 1204. Record 2nd Mon a 1205. Assi nment ofM a to Cumherland Coun Recorderot Deeds 27 00 1300. ADDITIONAL SETTLEMENT CHARGES 150.00 Resale Cen to PMI Pro a Mana ement Ina 1301 1144.46 . 1303. 2W8109 Scholl Taxes to Marlin A. Yohn Sr. Tax Collector 106.00 1304. AU ust HOA Fee to Horst Pro a Mana ement 5.00 1305. Tan Cen tD Barristers Land Abstract General - Hb 112.00 1306. Sewer-3rd ar, to U er Allen Townshl Authors _. ___..__...____ .___~.___~,,, ~_..:,... I~nA ~v cwt„o K1 .6530.91 7565.46 1400. TOTAL SETTLEMtNI DnArcbtJ enter DII mma i~~ ~e~N~ • w~. _"- -----~~ MUD CERTIFIGPTK)N OF BUYERAND SELLER Ilwue ®r~¢~Nu~IIY PM1mU ~INMeI w~NtlllyN Slemenl e~ydtMNU0.Y 1P5alYareanltl blemetlnl.elrue sM euunk slalm~erM1 Ol all rtcdPlaaM tllsbursmmlarretle on my avwunl r - /.• LE WARNING: IT6ACRIME TO KNOWINGLY M4KE FALSE STATEMENTS TO THE STATES ON THIS OR ANY eIMIIFR FORM PENALTIES UPON CONVICTION Ttle MUQl Seilklren Statement I2nsazYOn.INVa ca Mlluvd pepareU lye W08nC acaRle e¢nunlINNu t uv Vie etlsbE IsEUrsMln vrmlE viN Nls stele ` ~ UNREO CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS eEETITLE 1B: Of 0 /.~/} ' ~Y . U5. CODE SECTION i W I AND SECTION t ( . SETTLEMEMAG T: ~'r M °• OAiE' Rav-181Y E%+IB-98) COMMONWEALTH OF PENNSVLVANIq INXERITgNCE Tq%RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF S. Karin Inclutla unrelmburaetl matllcal expanses. LE NUMBER 21-08-00408 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Accounts Recovery Bureau, Inc. for Pinnacle Health Emergency -Account 452.00 #080449828 (last illness) 2 Accounts Recovery Bureau, Inc. for Pinnacle Health Hospitals -Account #270322533 (last illness) 1,374.94 3 Cardiovascular Surgical Institute -Account #49135 (last illness) 180.00 4 Charles R. Inners, M.D. -Account #072797-00 (last illness) 410.00 5 Holy Spirit Hospital -Account #31409154 (last illness) 623.07 8 Holy Spirit Hospital -Account #31494828 (last illness) 854.05 7 Internists of Central PA -Account #48908 (last illness) 2,495.84 8 Jackson Siegelbaum Gastroenterology (last illness) 17.00 9 Oakwood Center Radiation Oncology -Account #2039 (last illness) 8.40 10 OSL DBA Orthopaedic Institute of Pennsylvania -Account # 091389 (last illness) 131.00 11 Pennsylvania Housing Finance Agency -Loan #817544 41,648.81 12 Pinnacle Health Hospital -Account #280145409 (last illness) 442.98 13 PPL -Account #52801-29012 390.86 14 Property Management, Inc. - Sunguild II Condo Asso. Account #H0420 707805 (debt of decedent) 395.80 15 Quantum Imaging & Therapeutic Associates -account #105422-QQITA (last illness) 9.80 Total of Continuation Schedule See attached page 70TAL (Also enter on Line 10, Recapitulation) 49,239.32 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule I (Rev. 6-98) Rav1812 E%t 18-88) SCFIEDULE 1 DEBTS OF DECEDENT, DDMMDNWEAITH DR RENN$VLVANLI MORTGAGE LIABILITIES, & LIENS INHERITNNCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF Frey, S. Karin FILE NUMBER 21-08-00408 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EXi (9-0a) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Frey, S. Karin FILE NUMBER _ NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright svousal dlstnbuhons and transfers under Sec. J116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee s <I-VO-V SHARE OF ESTATE (WOrdS) V4V0 AMOUNT OF ESTATE ($$$) Everett Shoaff Brother-in-Law See Item 3 of 132 Spring Road Last Will Dillsburg, PA 17019 Maureen Shoaff Sister See Items 4 132 Spring Road and 6 of Last Dillsburg, PA 17019 Will Dave W. Stout Brother See Item 8 of 1101 Lincolnshire Drive Last Will Champaign, IL 61821 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri Total ate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS _ TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O 00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) _.. ... r•"i f # e, ~~ ~.~.~ k~' S ~v[ fyy~R~ 'i~ ~~ ~i 3:kh ~~":~ J F~ WI C W ~\' 'J ~f. r l v ~ U u. o pM ~ ~j V.1 v ~ ~ ; ~ . ~ ~ ~ o ~- ~ o~ a o Vyi A J 'J p a \ ~ . I .'C Q ` Y ~J „' N ~ ^ V ~ //~~ V1 NNN