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J 15056051058
REV-1500 ~ (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN J
_ Hartisburg,PA17128-0601 RESIDENT DECEDENT ~, ~ 08" gay
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
195-16-7831 08/03/2008 06/16/1923
Decedent's Last Name Suffix Decedent's First Name MI
Kegris Winifred J
__
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
~~ 1. Original Retum ,~_,,, 2. Supplemental Retum ~,_. 3. Remainder Retum (date of death
prior to 12-13-82)
`"' 4. Limited Estate " ~ 4a. Future Interest Compromise (date of 5. Federal Estate Tax Retum Required
death after 12-12-82)
~' 6. Decedent Died Testate "~..? 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
~'~ 9. Litigabon Proceeds Received ~.~.-: 10. Spousal Poverty Credit (date of death ,.--: 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Anthony J. Nestico, Esq (717) 533-5406
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
7'J
First line of address ~ ~ _
840 E. Chocolate Avenue ~'_~~ o ? ~-', `
Second line of address ' t-r ,~ mac) _' _
'T. _ ~ i
City or Post Office State ZIP Code DATE~EbI -
_ ~.~~- _
~~
Hershey PA 17033 --o --+ ~ ~ ~ ' ' '~'
N -'-'
i
Correspondent's a-mail address: tnestico@hersheypalaw.com
Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, co and complete. DeGaretion reparer of er than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU OF PERSON RESPON B OR F RETURN DATE
- -- -1-- .
-~ --- --_- ~ a
-- --- -
ADDRES _ --
112 N. iddTe a Aisle, PA 17013
- -
--- -- - - -
-_ -
- -- - - -_
---
P P E R RESENTATIVE D~E ~ Q
-- --- - -- -- - --- r _ _
ADD - - - - -- ~--
840 E. Choco a Avenue, Hershey, PA 17033
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedents Name: Winifred J Kegris 195-16-7831
_ ._
RECAPITULATION ~~a ~ __. _.~~ _.
__.__ _ __ _ _._.._ __~,
1. Real estate (Schedule A) . ........................................ .... 1. 97,000.00
2. Stocks and Bonds (Schedule B) ................................... .... 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 0.00
4.
Mortgages r~ Notes Receivable (Schedule D) .........................
.... 4. ..
0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... .... 5. 16,534.94
6.
Jointly Owned Property (Schedule F) ~~ Separate Billing Requested ...
.... 6. ......... .
0.00
7. Inter-V'roos Transfers 8 Miscellaneous Non-Probate Property _ -- - ---
(Schedule G) .°"`~ Separate Billing Requested.... .... 7. 0.00
8. Total Gross Assets (total Lines 1-7) .............................. .... 8. 113,534.94
9. Funeral Expenses & AdminisVative Costs (Schedule H) ................. .... 9. 16,790.37
10.
Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............
.... 10. . _ --__ -
0.00
11. Total Deductions (total Lines 9 & 10) ............................... .... 11. 16,790.37
12. Net Value of Estate (Line 8 minus Line 11) ..... . .................... .... 12. 96
744.57
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ,
- - - - - -
an election to tax has not been made (Schedule J) .................... .... 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Lme 13) ..................... ... 14. 96,744.57
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 .0_ 0.00 15. 0.00
16. Amount of Line 14 taxable - - - - - -
___. _ _-.
at lineal rate x .0 45 96,744.57 16. 4,353.51
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 17 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0.00 18 0.00
19. TAX DUE ...................................................... ... 19. _ _ ....4,353.51
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
Flle Number
Winifred J Kegris
STREET ADDRESS
2 Locust Road
clrY ---- ---- .
Camp Hill
STATE -- 'ZIP
PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 4
353.51
2. CreditslPayments ,
A. Spousal Poverty Credit ___
- --- 0.00
__
B. Prior Payments 0.00
___ _
C. Discount 0.00
3. _
Interest/Penalty if appligble - Total Credits (A + g + C) (2) 0.00
D. Interest 0.00
E. Penalty - -- - --
- -0.00
4. __
- -- Total InteresUPenalty (D + E)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 0.00
Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,353.51
A. Enter the interest on the tax due. (5A) 0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 4,353.51
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 :.......................................................................................... ^
b. retain the right to designate who shall use the properly transferred or its income :............................................ ^
c. retain a reversionary interest; or .......................................................................
d. receive the promise for life of either payments, benefits or care? ....................... „ ^
.............................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without recenring adequate consideration? ..................................................................................... .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^
4. Did decedent own an Individual Retirement Acx;ount, annuity, or 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.
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 statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) 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)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
DECEDENTS SOCIAL SECURITY NUMBER
195-16-7831
REV-1502 EX+'1t-0@)
°. Pennsylvania SCHEDULE A
+~ DEPARTMENT OF REVENUE
INHERITANCE TAx RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Winifred J. Kegris
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
lr more space is needetl, Insert additional sheets of the same size.
REV-1508 EX+ (6-98)
S~NEDULE E
COMMONWEALTH OF PENNSYLVANIA p
~.I~SH~ BANK DEPOSITS, $c M~S~.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Winifred J. Kegris
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Commerce Bank, account #0538029992
9,189.02
2 Highmark insurance refund
146.90
3 Comcast Cable refund
18.17
4 2001 Mercury Sable, VIN 1MEHM59591A648200
5,200.00
5 Travelers insurance refund
35.40
6 American water refund
17.94
7 Travelers insurance
water damage
, 1,720.01
8 Jack Gaughen Realtor, ERA
sewer repair refund
, 207.50
TOTAL (Also enter on line 5, Recapitulation) s I 16,534.94
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE N
FUNERAL EXPENSES ~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Winifred J. Kearis
Debts of decederst must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t' Neill Funeral Homes, Inc., 3401 Market Street, Camp Hill, PA 17011
2,437.00
B. ~ ADMINISTRATIVE COSTS
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Settlement costs for sale of real property at 2 Locust Road, Camp Hill, PA
e. Jonny Geznett, lawn care and snow removal
s. PPBL, electric
10. American Water Company, water
> > ~ Comcast, cable
12• From second page of Schedule H
Zip
Zip
TOTAL (Also enter on line 9, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
880.00
217.66
9,793.29
125.00
135.09
164.30
9.71
3,028.32
16,790.37
CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 5.6(a)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: Winifred J. Ke~ris
Date of Death: August 3, 2008 File Number: 2008 - 00825
Date Letters Granted: August 8, 2008
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
(CONTINUED)
AAA $ 70.00
UGI, gas $ 370.96
Commonwealth of Pennsylvania, vehicle $ 58.50
transfer
Travelers Insurance, homeowners' insurance $ 222.51
U-Haul $ 82.44
Allstate Insurance, car insurance $ 76.40
Lower Allen Township, sewer and refuse $ 177.50
Gelco, water extraction $1,970.01
TOTAL $3,028.32
REV-151; EX+ !11-OS)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE
BENEFICIARIES
CJIAIC Ur
Winifred J. Kegris
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 2116 (a) (1.2).)
1. Bruce J. Reinhold, 112 N. Middlesex Road, Carlisle, PA 17013
RELATIONSHIP TO DECEDENT
Do Not List Trustee(sl
Son
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
FILENUMBER
AMOUNT OR SHARE
OF ESTATE
100%
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I$
If more space is needed, insert additional sheets of the same size.
Previous editions are obsolete
r '- n
A. Settlement Statement
B. T vpe of Loan
form HUD-1 (3186) ref Handbook 4305.2
U.S. Department of Housing and Urban Development
C)MR Annrnval Nn ~~r»_r»a~ lo,.,,l~e~ ~ ~ nni~nno~
^FHA 2. ^FmHA 3. ~IConv. Unins.
4. ^VA 5. ^Conv.lns.
6. File Number
09022 - ----- -~----
7. Loan Number
5542464161 ---- 9 9-- ....,..._...,..
8. Mort a e Insurance Case Number
is orm is umis e o give you a s a amen o ac ua 'se amen cos s. moun s poi o an y e se amen agen are s own.
C. Note: Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals.
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon
conviction can include a fine and im risonment. For details see: Title ifi U. S. Code Section ~ooi and Section 1oio.
TItIeEXpreSS Settlement System
Pflnted 02/13/2009 of 13:09 CH
D. NAME OF BORROWER: Daniel Houseknecht
ADDRESS: 103 S 36th Street Cam Hill PA 17011
E. NAME OF SELLER: Winifred J. Reinhold Estate
ADDRESS: 2 Locust Road Cam Hill PA 17011
F. NAME OF LENDER: Stonewater Mortgage Corporation
ADDRESS:
G. PROPERTY ADDRESS: 2 Locust Road, Camp Hill, PA 17011
Lower Allen Townshi
H. SETTLEMENT AGENT: 1st Advantage Settlement Services Inc., Telephone: 7'17.591-7755 Fax: 717-591.7756
PLACE OF SETTLEMENT: 6375 Mercu Drive Suite 102 Mechanicsbur PA 17050
I. SETTLEMENT DATE: 0 211 312 0 0 9
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rice 97 000.00 401. Contract sales rice 97 000.00
102. Personal Pro art 402. Personal Pro art
103. Settlement char es to borrower line 1400 4 501.18 403.
104. 404.
105. 405.
Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance
106. Cit !town taxes 406. Cit /town taxes
107. Count taxes 407. Count taxes
108. School taxes 02113109 to 06/30/09 330.65 408. School taxes 02113109 to 06130!09 330.65
109. Sewer/Trash 02113109 to 03/31/09 48.56 409. SewerfTrash 02113109 to 03131109 48.56
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 101 880.39 420. GROSS AMOUNT DUE TO SELLER 97 379.21
200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or earnest mone 500.00 501. Excess De osit see instructions
202. Princi al amount of new loans 77 600.00 502. Settlement char es to seller line 1400 10120.00
203. Existin loans taken sub'ect to 503. Existin loan s taken sub'ect to
204. 504. Pa off of First Mort a e Loan
205. 505.
206. 506.
207• 507.
1st Advanta a Settlement Servi
208. 508.
209. 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller
210. Cit !town taxes 510. Cit /town taxes
211. Count taxes 01101109to02113109 52.50 511. Count taxes 01101l09to02113109 52.50
212. School taxes 512. School taxes
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 78152.50 520. TOTAL REDUCTION AMOUNT DUE SELLER 10172.50
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 101 880.39 601. Gross amount due to seller line 420 97 379.21
302. Less amounts aid b /for borrower line 220 78152.50 602. Less reduction amount due seller line 520 10172.50
303. CASH FROM BORROWER 23 727.89 603. CASH TO SELLER 87 206.71
Previous editions are obsolete
U.~6. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
form HUD-1 (3/66) ref Handbook 4305.2
File Number: 09022 PAGE 2
TitleExnress Settlement Svstem Printed 02/13!2009 at 1309 CH
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on rice $97 000.00 = 5 640.00 BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
701. $ 2 795.00 to ReiMax 1st Advanta a SETTLEMENT SETTLEMENT
702. 2 845.00 to Jack Gau hen Realtor ERA
703. Commission aid at Settlement 5 640.00
704. Transaction Fee to Re1Max 1st Advanta a 250.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori ination Fee
802. Loan Discount 2.082 %Stonewater Mort a e Cor oration LR 1 615.63
803. A raise! Fee to Stonewater Mort a e Cor oration P.O.C. 350.00 Bu er LR
804. Credit Re ort
805. Processin Fee to Guardian An el Mort a e Services 695.00
806. Mort a e Broker Fee to Guardian An el Mort a e Services 595.00
807. Tax Service Fee to Stonewater Mort a e Cor oration LR 75.00
808. Administration Fee to Stonewater Mort a e Cor oration LR 300.63 249.37
809. Flood Certification to Stonewater Mort a e Cor oration LR 15.00
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 0211312009 to 0310112009 $ 11.5860 Ida 16 Da s LR 185.38
902. Mort a e Insurance Premium for to
903. Hazard Insurance Premium for 1 YEAR to Erie Insurance Exchan a P.O.C. 364.00 Bu er
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 2 mo. 30.33 Imo LR 60.66
1002. Mort a e Insurance mo. Imo
1003. Cit Pro ert Tax mo. Imo
1004. Count Pro ert Tax 2 mo. $ 36.46 Imo LR 72.92
1005. School taxes 9 mo. $ 71.42 !mo LR 642.78
1009. A re ate Anal sis Ad'ustment to Stonewater Mort a e Cor oration LR -333.94 0.00
1100. TITLE CHARGES
1101. Settlement or closin fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Pre oration
1106. Note Fees to Carol A.Hinman 35.00 10.00
1107. Attorne 's fees
includes above items No:
1108. Title Insurance to 1st Advanta a Settlement Services Inc. 840.75
includes above items No: 1101 -1104
1109. Lender's Polic 106277576-PASL 77 600.00 -
1110. Owner's Polic -1068709411 97 000.00 -840.75
1111. End 100 End 300 End 900 to 1st Advanta a Settlement Services Inc. 150.00
1112.
1113. Closin SvcLtr to 1st Advanta a Settlement Services Inc. 35.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed 50.50 • Mort a e 76.50 • Release 127.00
1202. Cit /Count tax/stems Deed 970.00 • Mort a e $ 970.00
1203. State Tax/stam s Deed 970.00 • Mort a e 970.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Transaction Fee to Jack Gau hen Realtor ERA 165.00
1302. Re lace Sewer Pie to Herman Plumbin 415.00
1303. Wire In Fee to 1st Advanta a Settlement Services Inc. 10.00
1304. Tax Cert Fee to 1st Advanta a Settlement Services Inc. 10.00 10.00
1305. Overni ht Delive Fee-Pk to 1st Advanta a Settlement Services Inc. 25.00
1306. Email Pk !Doc Co Fee to 1st Advanta a Settlement Services Inc. 35.00
1307. 2009 Count /Tw RE Taxes to Bonnie Miller 750.00
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 4 501.18 10120.00
HUD CERTIFICATION OF BUYER AND SELLER
I have carefu y reviewed th UD-1 Se lament stem nt a to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account
or by m in th tra tion. furth ce ify t t eve ceiv d a copy of the HUD-1 Settlement Statement.
erne /ou
4C /
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U. S. CODE SECTION 1001 AND SECTION 1010.
The HUD-1 Settlement Statement which I have prepared is a Vue and accurate account of this
transaction. I have caused or will cause the funds to be disbursed in accordance with this statement.
SETTLEMENT AGENT: DATE: