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Home My WebLink About03-24-09 (2)Lsos6o7120 REV-1500 EX,GG.BS, PA Depadment of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes p, cower cra~a vu,- r,i~ u,,,¢,n, PO 80X 2BOG01 NC,N~,~ INHERITANCE TAX RETURN Harrisburg, PA 17128-OGGt "' RESIDENT DECEDENT 2 1 O B 0 9 7 7 ENTER DECEDENT INFORMATION BELOW O1 20 2008 10 06 1941 Decedents Last Name Sulfix Deretlent's Frsl Name Mf OUTRIGHT JEAN p (I} Appgcable) Enter Surviving Spouso'a Inlormalion Below Spouses Last Name Sull:x Spouse's Rrst Name PAI Spouse's 5ocral Security Number FILL IN APPROPRIATE OVALS BELOW X t Or:g~nal RaNrn 4 Lumlad Estate X G c„ 9 l yauoa Procee]s Racervetl THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2 Supplemental Return ] Rema,ndor Retum hate oY acam pear to iD I a~811 <a rmuclmumn cM„rxam~,a 5 Fadarnr Estate Tax Retum Requn. r %e:.emm Ua.ea,.,n a 1~.,-p -.,,;, 1 .... ~. -~.r mT~_y,, B Total Number o' Safe Depose Goxos 10 sw=sx r~mene ew.a n:.m er tles:-. nz;.,ec»ia-J+sl sm it-3s, It Election to tax uvaar 6ac 9nhkr f~ttacb Sch OI CORRESPONDENT -THIS SECTION MUST DE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA% INFORMATION SHOULD BE DIRECTED TO: Noma Daytime Telephone Number NEIL E. HENDERSHOT ESQ. 717 234 9121 firm Namo (11 Applicablcl TUCKER ARENS BERGr p, C. REGISTER OF WILLS USE ONLY First lino of address ~~ cN~ 111 NORTH FRONT ST. `.=n ~ .,T- ,~ ~_ -- Second lim of address ~~ ~ ~ - A P.O. SOX 889 ;_ ;' fV - t City or Post OtOCO Slate ZIP Codo DATE FILED ~- HARRISBURG PA 17108-899 - -" ' n -1 W T+ cormspondent's a~man addmss: Nyandors hot@tuelCO{Ia W.CORI r Under penaRws of penury, I dcclara that I bave eaemmed Ihrs slum. incWdmg ocmmpnnyinq sGratlulas untl statements. old to Inc best of my Anowladge and belie' it is true, correct and complete Dadnration of preparcr other Than trm personal representative is Oased on ell information of whirtt preparer has nny knawredye ~96~NA~tfUNt C~ nInSCN HGSnUYS'mF f pR sII ING RLilr(n y /~ /> CFTE /~~j~-f AO ~~ // v ~ ja^YrF~y'~ Meredith A Outright ~ j~~ :~ ~7~~ 7012 Ohlo River Boulov d, Roar House, Pi[tsbur h, PA 15202 S.iitld t,JHf ~eEPRHI:,II),rn lr .I RC'PnESFtlfn(iVl fni6 Neil E. Hendershot Esq. rcne-s~ 111 North Front Street, Harrisburg, PA 17106-899 Side 1 1505607120 150560712^ J ~~ v_ ,- ~~ ~~~ ~= i ~ ~~'`' ~? ~ ~- ~~ ,~ J 1505607220 REV-1500 EX RECAPITULATION -- -- -_- -- -- --- 1. Real Estate (Schedule A) ..................................................................................... 1. 2 3 9, 0 0 0. 0 0 2. Stocks and Bands (Schedule B) .......................................................................... 2. 9, 9 6 2. 9 8 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. 8 2 , 2 2 $ . 1 2 6. Jointly Owned Property (Schedule F) _ -i Separate Billing Requested......... ... 6. 7. Inter-Vivos T ansfers & Miscellaneous N Probate Pro n- erl ' ` p y (Schedule G Separate Billing Requested......... ... 7. 9 5 2 , 0 7 7 . 7 0 8. Total Gross Assets (total Lines 1-7) ............................................................... .... 8. 7 $ 3 , 2 6 8 . 8 0 9. Funeral Expenses & Administrative Costs (Schedule H) ......... g. 9 0 , 9 9 7 . $ 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .......................... .... 10. 1 0 3 , 2 6 2 . 0 6 11. Total Deductions (total Lines 9& 10) .............................................................. .... 11. 1 4 4, 2 5 9. 8 8 12. Net Value of Estate (Line 8 minus Line 11) ...................................................... ... 12. 6 3 9 , 0 0 8 . 9 2 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. 6 3 9 , 0 0 8 . 9 2 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 .o0 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at linealrateX .045 639,008.92 16. 2$,755.40 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 16. 0. 0 0 19. Tax Due ........................................................................................... 1s. 28,755.40 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAY MENT. ^ Side 2 1505007220 1505607220 J REV-1500 EX Page3 File Number 21-08-0477 Decedent's Complete Address: Jean A. Outright STREET ADDRESS --. _ __ _-_ _.- _.- _. __. __. _.. __. _ _- 805 Sharon Avenue _ __ _ _ CITY - __. _. __ _ --... -_._ __ _- _. _. -. _._ _ Mechanicsburg j sraTE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 28,755.40 - 0.00 720.55 Total Cretlits (A + B + C) (2) 0.00 Total InteresUPenalty (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 [he tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 720.55 (5) 29,475.95 (5A) (sB> 29,475.95 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: No a. retain the use or income of the property trans!erred :..................... .............._......................................_ es Ix_i b. retain the right to designate who shall use the property transferred or its income :................................_ ~, _x' c. retain a reversionary interest; or ................................ ~ i --, . .. ........................................................................ x d, receive the promise for life of either payments, benefts or care? ................. _ - . ........................................ ~ I I x 2. If death occurred after December 12, 1982, did tlecetlent transfer property within one year of death without receiving adequate consideration?........- - .......................................................................... ! x 1 3. Ditl decedent own an "in trust for" or payable upon death bank account or security at his or her death......... I j x_i 4. Ditl decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefciarydesignation?........-... ~ x I ........................................... . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. InllAll For tlates of death on or after July i, 1994 antl 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 tleath 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 172 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, antl the statutory requirements for disGOSUre of assets and filing a [ax 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 o(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 172 P.S. §9116 (a) (1.2)]. The tax rate imposetl on the net value of Vansfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1 )]. The tax rate imposetl on the net value of transfers to or far the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defned under Section 9102, as an individual who has a[ least one parent in common with the decedent, whether by blood or adoption. Rev-150] EX4 (fi-98) SCHEDULE A ~'~°' REAL ESTATE COMMONKFALTH OF CENNSYLVANIA INHERITANCE iA%RETURN RESIDFM DECEDENT ESTATE OF FILE NUMBER Outright, Jean A. 21-08-0477 All real properly ownetl solely or as a tenant in common must be repertetl el lair market value. Fair market value Is defined as fM1e pace at which properly would be exchanged belwean a willing buyer and a willing seller, neither being dompelletl to buy or sell, bdM1 M1aving reasonable knowledge of IM1e relevant lads. Real properly which is jointly-ownetl with right or aurvivorahip must be tllaplovetl on achetlule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Residence -House & lot located at 606 Sharon Avenue, Mechanicsburg, PA 17055, 239,000.00 valued at gross sale price to third party buyer, settled on 10/01/08 (per Settlement Sheet attached to PIT Return filed with PA DOR) TOTAL (Also enter on Line 1, Recapitulation) I 239 000 00 Qf more space Is neatletl, adtl OlOnal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule A (Rev. 6-98) Rev45W E%~ (6-98) SCHEDULE B .~••..° STOCKS & BONDS COM'AONWEALTH OF FENNSTLVANW INHERITANCE TPX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Outright, Jean A. 21-08-0477 All property fointlygwnetl with nqM of aurvivonMp must ba tlisclosetl on Schetlula F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 107.0015 shares of ExxonMobil Corp. -Common stock 83.765 8 962 98 (42 in certificate, remainder in book entry) valued as , . median price (83.765) calculated by averaging Fri Jan 18th closing price (85.08) and Tue Jan 22 (after holiday) closing price (82.45) 2 U.S. Savings Bonds -Two $500 Series H U.S. Savings 1 000 00 Bonds, both issued Feb 1977, valued at face amount , . TOTAL (Also enter on Line 2, Recapitulation) 9,962.98 _ =N=~ ~e ~~ecaeu, aamnonal pages o11ne same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA•1500 Schetlule B (Rev. 6-98) Rev-1508 E%+t6-90) ~ SCHEDULE E ~"~ CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF GENNSYLVgNN INNEAITgNCE Tq% RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Outright, Jean A. 21-08-0477 Inclutle file proceetls of litigation entl the Cale the proceetls ware re[eivetl by the estate. All properlyjoinlly~ownetl with [ha right o/survivorship must be tlisclosatl on achetlule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Citizens Bank Chk -Checking Account No. 620020-xxx-7, valued per bank's 84 40 statement dated 02/13/08 . 2 Commerce Bank Chk -Checking Account No. 0536741 xxx, valued per bank's 18 492 97 statement dated 02/11/08 , . 3 PNC Bank CD -Certificate of Deposit Account No. 31600270xxx, valued per bank's 5 443 25 statement dated 01/29/08 , . 4 PNC Bank Chk -Checking Account No. 51-4019-Sxxx, valued per bank's statement 1 588 25 dated 01/29/08 for balance as of 01/22/08 , . 5 PNC Bank MMA -Money market Account No. 50-0074-Oxxx, valued per bank's 43 300 33 statement dated 01/29/08 for balance , . 6 Contents -Household furnishings sold at auction by Brickers Auction on 09/06/08 3 325 25 , valued per gross proceeds , . 7 Ring -14 kt. gold setting, 3/4 carat diamond ring in fair condition 800.00 8 Vehicle - 2002 Toyota Solara coupe, in fair condition, valued per Blue Book online 8 996 26 and actual sale for cash , . 9 Real Estate Tax Refund -Prorated refund of prepaid county-borough real estate 197 41 taxes received upon sale of residence on 10/01/08 . TOTAL (Also enter on Line 5, Recapitulation) I 82,228.12 (Ii more space is neetletl, atltliticnal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule E (Rev. 6-98) Rav-1518 E%~ 16-8a1 ~ I SCHEDULE G ~'~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY LOMMCNNFJLLTH OF PpJNSYLVPNIA INHERITpNLE iq%RETDRN RESIDENT OECEOENT ESTATE OF Jean A. LE NUMBER 21-OS-0477 Tnis scneeula must Oe completetl one tiletl if the answer to any of questions 1 through 4 on the reverse sitle of the REV-1580 COVER SHEET is yes. ITEM NUMBER utSDRIPTION OF PROPE INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT ANO THE DATEOFTRANSFER. ATTACHACOPVOFTHE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET v of oecD~s INTEREST EXCLUSION (IFAPPLICAELE TAXABLE 7 VALUE 1 Allstate Annuity -Annuity Contract No. 33,926.60 100.000 33 926 60 GA16873xxx issued by Allstate Life Insurance , . Co. to Decedent, which named her two children as successor beneficiaries 2 200 shares of American Capital Ltd. -Common 5,740.00 100.000 5,740.00 stock held in Decedent's individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 3 150 shares of Arch Caal, Inc. -Common stock 5,343.00 100.000 5 343 00 held in Decedent's individual retirement account , . at FMA Advisory, Inc., valued per its statement dated 01/18/08 4 227.583 units of Artisan International Fund - 6,142.47 100.000 6 142 47 Equity mutual fund held in Decedent's individual , . retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 5 $25,000 Bear Sterns Co., Inc. - 7.625% corporate 25,838.25 100.000 25 838 25 bond due 12/07/09, held in Decedent's individual , . retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 6 $15,000 Credit Suisse FB USA - 6.125% 15,899.85 100.000 15 899 85 corporate bond due 11/15/11, held in Decedent's , . individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 Total of Continuation Schedules See attached pages TOTAL (Also enter on Line 7, Recapitulation) 452,077.70 (I( more space is neetled, atltlitional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Revd510 E%+(6981 ~ SCHEDULE G ~~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEPLTH OF PENNSYLVgNN INHEAITNNCE Tq%RETIIftN continued RESI°ENr DECEDENT ESTATE OF FILE NUMBER Outright, Jean A. 21-08-0477 ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPV OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET ~ of DecD~s INTEREST EXCLUSION (IF APPLICABLE TAXABLE ) VALUE 7 994.695 units of DFA International Core -Equity 12,393.90 100.000 12 393 90 mutual fund held in Decedent's individual , . retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 8 $15,000 FHLMC - 6.0% gov-insured bond due 15,134.25 100.000 15 134 25 06/05/17, held in Decedent's individual retiremen , . account at FMA Advisory, Inc., valued per its statement dated 01/18/08 9 659.87 units of Fidelity Cash Reserve Fund - 6,504.93 100.000 6 504 93 Cash investment fund held in Decedent's , . individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 10 659.87 units of Fidelity Convertible Securities - 16,965.26 100.000 16 965 26 Equity mutual fund held in Decedent's individual , . retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 11 2,393.792 units of Fidelity PA Mun Inc Fund - 26 116 27 Municipal bond fund held in Decedent's , . 26,116.27 individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 12 1,057.27 units of Fidelity Short-Term Bond Fund 9 145 39 - Bond fund held in Decedent's individual , . 9,145.39 retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Rev451° EX~ Ifi-881 ~ SCHEDULE G .~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANW INHERITgNCE TA%RETUftN continued FESIOENT DECEDENT ESTATE OF Jean A. LE NUMBER 21-08-0477 ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF RAONSFER.SgTTACHACOPV OF TtlE DEED FOR REAREESTATDE. DATE OF DEATH VALUE OF ASSET ~ of Decor INTEREST ExcLUSION (IF APPLICABLE) TAXABLE VALUE 13 219.892 units of Fidelity US Bond Index Fund - 2,427.61 2,427.61 Bond fund held in Decedent's individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 14 $25,000 FNMA-4.2%gov-insured bond due 25,062.50 100.000 25,062.50 06/16/08, held in Decedent's individual retiremen account at FMA Advisory, Inc., valued per its statement dated 01/18/08 15 $15,000 FNMA - 3.75% gov-insured bond due 15,046.95 100.000 15,046.95 09/15/08, held in Decedent's individual retiremen account at FMA Advisory, Inc., valued per its statement dated 01/18/08 16 $15,000 Ford Motor Co.-7.25% corporate bond 12,926.40 100.000 12,926.40 due 10/25/11, held in Decedent's individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 17 150 shares of France Telecom -Common stock 5,413.50 100.000 5,413.50 held in Decedent's individual retirement account at FMA Advisory, Inc. valued per its statement dated 01/18/08 18 $15,000 Goldman Sachs Group, Inc. - 6.60% 16,086.75 100.000 16 086.75 corporate bond due 01/15/12, held in Decedent's , individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schetlule G (Rev. 6-98) Rev-1510 E%~ (6-961 ~ SCHEDULE G ~''~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY coMmorvven~Lr~T~vq~sgNrww continued R6slo6rvr oEC6o6rvr ESTATE OF FILE NUMBER Outright, Jean A. 21-OS-0477 ITEM NUMBER DESCRIPTION OF PROPERTY THE DAOTE OF TRANS FERSATTACHACOPY OF THE DEEDTFOR REAL ESTANE. DATE OF DEATH VALUE OF ASSET v of Deco~s INTEREST ExcwsloN (IF APPLICABLE) TAXABLE VALUE 19 100 shares of Illinois Tool Works, Inc. -Common 4,715.00 100.000 4,715.00 stock held in Decedent's individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 20 $15,000 JP Morgan Chase & Co. - 6.00% 15,213.90 100.000 15,213.90 corporate bond due 02/15/09, held in Decedent's individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 21 100 shares of KB Financial Group, Inc. - 6,739.00 100.000 6 739 00 Common stock held in Decedent's individual , . retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 22 $20,000 Lehman Bros. Holdings - 8.50% 22,838.20 100.000 22,838.20 corporate bond due 08/01/15, held in Decedent's individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 23 150 shares of Pfizer, Inc. -Common stock held in 3,375.00 100.000 3 375.00 Decedent's individual retirement account at FMA , Advisory, Inc., valued per its statement dated 01/18/08 24 100 shares of Praxair, Inc. -Common stock held 7,901.00 100.000 7 901 00 in Decedent's individual retirement account at , . FMA Advisory, Inc., valued per its statement dated 01/18/08 Copyright (c) 2002 (arm software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-96) ftev-1510 E%a (6-ggl ~ SCHEDULE G ~~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSTLVRNW INHERITANCE TA%RETURN continued RESIDwT oecEOwr ESTATE OF FILE NUMBER Outright, Jean A. 21-08-0477 ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET roof Decor INTEREST ExcwsloN (IF APPLICABLE TAXABLE ) VALUE 25 Schwab Securities -Deposit account held in 392.91 392 91 Decedent's individual retirement account at FMA . Advisory, Inc., valued per its statement dated 01/18/08 26 374.177 units of Selected American Shares - 16,078.39 100.000 16 078 39 Series D equity mutual fund held in Decedent's , . individual retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 27 213.57 units of Third Avenue Value Fund -Equity 11,584.04 100.000 11 584.04 mutual fund held in Decedent's individual , retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 28 300 shares of United Technologies, Inc. - 20,415.00 100.000 20 415 00 Common stock held in Decedent's individual , . retirement account at FMA Advisory, Inc., valued per its statement dated 01/18/08 29 72 shares of DuPont -Common stock held in ' 3,072.60 100.000 3 072 60 Decedent s individual retirement account at , . Charles Schwab & Co., Inc., valued per its statement 30 909.6903 shares of ExxonMobil Corp. -Common 75,674.86 100.000 75 674 86 stock held in Decedent's individual retirement , . account at Charles Schwab & Co., Inc., valued per its statement Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Rev-1510 EX+ (6-96) ~ SCHEDULE G ~~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY commoNw>_nLrH ORPENNSVwANw INHERRANCE rAx aETUaN continued RESIDENT pECEDENT ESTATE OF FILE NUMBER Outright, Jean A. 21-08-0477 ITEM NUMBER DESCRIPTION OF PROPERTY THE D D E OF TRANSFER SATTACH AHCOPV OF TIHOE DEED POREREA EESTATE. DATE OF DEATH VALUE OF ASSET ~ of Decor INTEREST ExcwsioN (IF APPLICABLE TAXABLE ) VALUE 31 8 shares of General Motors Corp. -Common 185.92 100.000 185 92 stock held in Decedent's individual retirement . account at Charles Schwab 8 Co., Inc., valued per its statement 32 200 shares of Amerigroup Corp. -Common stock 7,778.00 7 778 00 held in Decedent's individual retirement account , . at FMA Advisory, Inc., valued per its statement dated 01/18/08 I v I AL (Also enter on Line 7, Recapitulation) 452,077.70 Copyright (c) 2002 form software only The Lackner Group, Inc. Farm PA-7500 Schetlule G (Rev. 6-98) REV-1151 EXa n2-991 k~ u! COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ESTATE OF FILE NUMBER Cutright,Jean A. 21-08-0477 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. ~ FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City Slate Zip Year(s) Commission paid 2. Attorneys Fees Tucker Arensberg, P.C. 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 12,465.47 7,500.00 4. Probate Fees 734.83 5. Accountant's Fees 1,000.00 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 19 297 52 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 40,997.82 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 FILE NUMBER Outright, Jean A. 21-OS-0477 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Catholic Cemeteries, Hbg Diocese -Gravestone 8: inscription 1,650.00 2 Catholic Cemeteries, Hbg Diocese - Interment at gravesite 860.00 3 Malpezzi Funeral Home -Funeral 8 memorial services 9,955.47 H-A Subtotal 12,465.47 Other Administrative Costs 4 Ace Hardware -Supplies to prepare house for sale 34.20 5 Ashcombe's -Mulch 8 weedkiller to prepare house for sale 267.85 6 Bricker's Auction -Auctioneer's commission & expenses for sale of household contents on 09/06/08 790.25 7 Cumberland Law Journal -Publication of Estate Notice 75.00 8 Duty's Locksmith - Rekeying locks at Decedent's residence 169.12 9 Federal Express -Express delivery re settlement of house 24.00 10 Hykes, Albert -Repairs to insulation in preparation of house for sale 35.00 11 Kennedy, Lesa - Groundskeeping S lawnmowing at house in preparation for sale 575.00 12 Patriot News -Publication of Estate Notice 218.15 13 Prudential Homestead Group -Settlement charges at settlement on house sale 200.00 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 FILE NUMBER Outright, Jean A. 21-08-0477 ITEM NUMBER DESCRIPTION AMOUNT 14 Prudential Homestead Group -Notary charge 10.00 15 Prudential Homestead Group -Document preparation fee 16 Prudential Homestead Group -Realtor's commissions for sale of house, per Settlement Sheet [attached to PIT Return filed with PA DOR] 17 Recorder of Deeds of Cumberland Co., PA -Realty transfer tax paid on sale of house 18 Repairs to House -Required repairs/adjustments to sale price at settlement of house re rugs & garage door opener, per Settlement Sheet 19 Sheely, Carrie -House cleaning in preparation for sale of house 20 Sheely, Carrie -Final floor cleaning 8window-washing in preparation for sale of house H-B7 Subtotal 125.00 13,393.95 2,390.00 430.00 420.00 140.00 19,297.52 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512E%~ (6-90) SCHEDULE 1 ~ ,+~. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEPLTH OF PENNSYLVRNN INXERIUWCETP%FETORN RESIDENT DECEDENT ESTATE OF FILE NUMBER Outright Jean A. 21-08-0477 Inclutle unreimbunetl metlical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 ATBT Mobile -Telephone charges owed by Decedent 482.35 2 Bank of America -Credit card charges owed by Decedent 585.67 3 Berkheimer, Inc. - HVAC repairs incurred by Decedent 264.93 4 Broadmoor Landscaping Services, LLC -Lawn maintenance charge owed by 333.90 Decedent 5 Citizens Bank -Home equity loan No. 6050-24xxx, per bank's statement dated 92,324.94 02/13108 6 Greensward Turf Care -Lawn maintenance charge incurred by Decedent 54.70 7 Mechanicsburg Borough -Sewer 8 refuse charges owed by Decedent 108.32 8 Nationwide Insurance -Homeowner's premium owed by Decedent 919.00 9 Pinnacle Health Hospital -Medical bill owed for Decedent not covered by insurance 22.75 10 PPBL -Electricity bill owed by Decedent 329.95 11 Pulmonary 8 Critical Care Medicine Assocs., P.C. -Medical provider charge owed 135.00 by Decedent and not covered by insurance 12 Tax Collector -Barry L. Heckard, tax collector, for county & borough real estate 785.37 taxes owed by Decedent 13 U.S. Treasury - 2006 federal individual income tax due from Decedent, per return 2,137.00 filed post-mortem by Executrix 14 U.S. Treasury - 2006 penalties & interest due on late-filed federal individual income 651.66 tax due from Decedent Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 103,262.06 (H more space is needed, atlditional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1013 E%+I6-90) .~. LOMMONWEPLTH OF PENNSYLVANIA INHEPITPNCE TPX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued ESTATE OF FILE NUMBER Outright, Jean A. 21-08-0477 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 15 U.S. Treasury - 2007 federal individual income tax due from Decedent, per return 3,261.00 filed post-mortem by Executrix 16 U.S. Treasury - 2007 penalties & interest due on late-filed federal individual income tax due from Decedent 17 United Water -Water service charge owed by Decedent 18 Verizon -Telephone 8 Internet charges owed by Decedent 508.80 33.08 323.64 TOTAL (Also enter on Line 10, Recapitulation) I 103,262.06 Copyright (c) 2002 form software only The Lackner Group, Inc. Farm PA-1500 Schedule I (Rev. 6-98) ~~ SCHEDULE J COMMON ANIA E A BENEFICIARIES ANCETA%RETURN ERI T RESIpENT DECEDENT ESTATE OF FILE NUMBER Cutright, Jean A. 21-08-0477 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT Do Not Liat Truatx s (WOrtls) ($$$) ](. TAXABLE DISTRIBUTIONS [include outright sppousal tlistnbuhons, and Vansfers under Sec. 9116(a)(1.2)] Lawrence L. Cutright III Son 112 tangible 312,004.46 17 Sheffield Drive pers prop; 112 Dillsburg, PA 17019 net residue of Estate Meredith A. Cutright Daughter Pecuniary 327,004.46 7012 Ohio River Boulevard, Rear House bequest of Pittsburgh, PA 15202 $15,000;112 tangible pers Total 639,008.92 Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cove r 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 _.____ __. ._____..___..___ nnn TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 Uh Htv-i ouu ctivtr< ante i I _ Copyright (c) 2002 form sofhvare only The Lackner Group, Inc. Form PA-1500 Schetlule J (Rev. 6-96) I - .~.~ap ~~ I N p C ++ d d = E~ N = „ E ~ d O O W ~ ~ W ` ~ V d '°3m O c ~ 90 '. •d~ N d d X Q C d C r ? 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