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HomeMy WebLinkAbout05-20-09J 15056051058 RSV-1500 EX cDa~S) PA Oepatrnsnt Of Revenue OFFICUIL USE ONLY Bureau of Indvidual Taxes County Cods Yea Fib Number Po soxzaosol INHERITANCE TAX RETURN Nameburg, PA 17129-0601 RESIDENT DECEDENT 21 08 0585 ENTER DECEDENT INFORMATION BELOW Social Severiy Number Date of DAM Date of Birth 203-10-6352 05/14/2008 12/24/1914 Decedents Last Name Suffix Decedent's First Name MI Long Fred R (N Applkable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Severity Number FlLL INAPPROPRIATE OVALS BELOW ':r. 1. Original Retum _ 2. Supplemental Relum :.._ 3. Remainder Relum (tla~ of death prior to 12-1382) •:: -, 4. Limited Esmfe <.,...::~, 4a. Future Interest Compromise (date of , .-_.., 5. Federal Estate Taz Retum R squired tleath after 12-12$2) '::::7 6. Decedent Died Testate (Attach Copy of WIII) <.": ".) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 0 S. Total Number of Safe Deposit Boxes ', 9. Litigation Proceeds Receivetl :~:~] 10. Spousal Poverty Cretlll (data of death _., 11. Electlon b fax under Sec, 9113(A) tx3NVeen 12-St-91 and 1-1-95) (Attach Sch. O) CORRESPONpENT - TidB SECTION MUST aE COMPLETEp. ALL CORRESPONDENCE AND CONFltNiNML TAX INtVRMATN)N SHOULD BE gRECTED T0 Name : Daytime Telephone Number W. Scott Staruch (717)975-0600 Firm Name (If Applicable) ,~ Laws, Staruch 8 Pisarci REGISTER OF BLS USE ONL>~ >O ,a First line of address 3 a 20 Erford Rd. iZCJ t ~ ~ rn Iv Sevend line of address ~:; ~ cr, ~ ~ Suite 305 ? J '_~ ~ ~-. - Cdy or Post Ofice State ZIP Coda : .DATE FJ~B-t Lemoyne PA 17043 D o Correspondent's e-mail address: LSPIaw(d1801.com e Is true,, caned ar~complele Decleratlon o1 examined this realm, indudrg accompmying schedules and etatemams, end m lira bear of my Wnwled9a erM bNiaf, preparer odor then the paraonal rapresenta9ve is ba9ed on all infomurtion of whirur prepaer has arty knowledge. SfGNgTUR/E,pF PERSON RESPONSI~BL/E~FOR/F/ILnING RE~TU~R~N q DATE ~/ /\ /.l.! PAn Q 1C ,."~"f~i ~'/y=-`C GF r '~f~ , ~ n~ 561 Dogwood Dr~Mechar ie Fp~~rg, Pq 17055 O Laws, Staruch & Pisarcik, 20 Erford Rd., Ste 305, Lemoyne, PA 17043 ~ ~ L 15056051058 Side 1 15056051058 J THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS j-'., ', .,,. C; ;~ ': ~. r. .~. "~ r-7 _~ '; ri ~p~ ~b ~ b \"~ ~a~ ~~~~ ~° ~ ~~ ~ ~, ~ ~ 15056052059 REV-1500 EX Decedent's Social Security Number l)~,n': Name: - Fred R. Long _ _. 203-10-6352 RECAPRULATN)N -.... - - .. - _... 1. Real estate (Schedule A) ......................................... .... 1. 0.00 2. Stocks and Bonds (Schedule e) ................................... .... 2. 1,045,663.07 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0.00 5. Cash, Benk Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 233,373.55 6. Jointly Owned Property (Schedule F) r:":.; Separate Billing Requested .... ... 6. 0 00 7. Inter-Vlvas Transfers & Miscellaneous Non-Probate Property . (Schedule G) c:..r Separate Billing Requested..... ... 7. 0.00 6. Total Gross,Asssb (total Lmes 1 7).... ..... ... -. ... e. . _ _ _.. ~ 1.278,036.62 9. Funeral F_xpen5es & Administrative Costs (Schedule H) ......... g 103,630.27 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .. 10 ........... ... . 7,249.36 11. Total Dsductlons (total LMes 9 8 10) ................................ ... it. 110,879.83 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 1,168 156 99 13. Charitable and Govemmenfal BequestslSec 9113 Trusts for whkJr , . an election to tax has rwt been made (Schedule J) ...................... .. 13. 350,447.10 14. Net Valus Subject to Tax (Line 12 minus Llne 13) ... . .. ... .. 1a. 817,709.89 TAX COMPUTATION SEE INSTRUCTIONS FOR APPLICABLE RATES '~-_-°- - ___..__.. . ._ ..___,._~_,._,_.,, 15. Amount of Lure 14 taxable at the spousal fez raN, or transfers under Sec. 9118 (ax1.2) X .0_ 15. 16. Amount of Una 14 taxable at lineal rate X .0 _ 16. 17. Amount of Una 14 taxable at sibling rate X .12 350,447.10 17 42,053.65 1 B. Amount of Une 14 taxable at collateral rate x .15 467,262.79 18 70,089.42 19. TAX DUE ....................................................... .. 19. 112,143.07 20. FlLL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L_ 15056052059 Side2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 08 0585 DECEDENTS NAME DECEDENTS SOCIAL SECURffY NUMBER Fred R. Long 203-10-6352 STREETADDRESS 561 Dogwood Dr. crrv Mechanicsburg STATE Zlp PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Cred9s/Paymenls A. Spousal Poveny Credd B. Pdor PaymeMS 106,000.00 C. Discount 5,000.00 Total CrediLS (A+ g + C ) 3. ImeresbPenatty'rf applicable D. Interest E. PenaNy Total IMereStlPenally (D + E ) 4. If Lina 2 is greater than Life 1 + Line 3, enter the di9~erlce. This is the OVERPAYMENT. FII In oval on Page 2, Lino 20 ro request a rahnd. (i) 112,143.07 (2) 111,000.00 (3) (4) 5. IF Line 1 + Line 3s greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,143.07 A. Enter the interest on the tax due. (5A) 16.44 B. Enter the total of Line 5 + 5A This is the BALANCE WE (5B) 1,159.51 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRWTE BLOCKS 1. Did decedent make a hansfer and: Yes No a. retain the uae a income of the property trans(erred :......................................................................................... . ^ b. retain the dght to designate who shah use the Properly transferred or its income :........................................... . ^ c. retain a reversbnary irdareat; or ......................................................................................................................... . ^ d. receive the prardse for life of either paymerds, benefits or cereT ..................................................................... . ^ 2. h death ocalrred after December 12, 1992, did decedent transfer propedy within orle year of death withax receiving adequate mnsideretbn7 ..................................................... 3. Did decedent own an'in trust for" or payable upon death bank account or secudty at his or her d~thT ............. . ^ 4. Did decedent avn an Individual Retrremem Account, annuity. or otltarnon-Probate property which contains a beneficiary designafionT ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. For dates of death on ar 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 ar for the use of fire surviving spouse is zero (O) 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 disdosure of assets and filing a tax velum are sfill applicable even N the surviving spouse is the only benefidary. 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 ar for the use of a natural parent, an adop9ve 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 decedents lineal benefidaries 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 172 P.S. §9116(a)(1.3)]. Asibling is defined, under Sedion 9102, as an individual who has at least one parent in common with the decedent, whether by flood or adoptron. REV-1503 EX+(g-g8) scNEOU~E s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fred R. Long 21-08-0585 All property folMlybwrled with rtpht or wrvNOnhip must be dlselowd on SchetluN F. ITEM NUMBER DESCRIPTION - VALUE AT DATE OF DEATH t 4784 shares AT&T Incorporated -DOD Value 190,164.00 2. 325 shares Comcast Corp. New Class A -DOD Value 7,276.75 3. 37 shares FairpoiM Communications -DOD Value 359.64 4. 100 shares Idearc Incorporated -DOD Value 463.50 5. 2008 shares Verizon Communications -DOD Value 77 820 04 6. 13435.549 shares Delaware Tax Free Inrwrrle PA -DOD Value 105,603.41 7. 6796.624 shares Dreyfus Premier PA Municipal -DOD Value 106,910.89 8. 10073.943 shares Lord Abbott Affiliated Fund -DOD Value 133,882.70 9. 5307.74 shares Lord Abbott PA Tax Free Fund -DOD Value 26,857.16 10. 15414.676 shares Dryden Government Income Fund -DOD Value 135,803.29 11. 7873.093 shares Dryden National Municipal Fund -DOD Value 114,789.69 12. 74 Series EE U.S. Savings Bonds - as enumberated on the attached Exhibit A 145,732.00 _ TOTAL (Also enter on line 2, Recapitulation) I S 1,045,663.07 (If more space Is needed, imen addhbnal sheers of the same size) REV-1508 EX+ (g-ge) SCNEpULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Fred R. Long 21-08-0585 Indude Me proceeds of INigatlon end the date the proceeds were received by the eatek. All preperry Jointlybwared wAM dght of auMwnhip must he diedoted on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Checking Account No. 0771024029 -Sovereign Bank, PO Box 841005 Boston MA 02284 , , 24,150.07 2. Interest accrued to date of death for checking account no. 0771024029 6.20 3. Money Market Account No. 1051079096 -Sovereign Bank, PO Box 841005 Boston MA 02284 , , 11, 080.06 4. Interest accrued to date of death for Money Market Akxxxtnt N0.1051079098 0.40 5. Capital One Bank, N.A. Certificate of DeposB plus akx;rued interest to DOD- due 9/19/08 25,138.08 6. First Gulf Bank Certificate of Deposit plus interest accrued to DOD -due 7/30/08 25,258.90 7. First Bank PR Certificate of Deposit plus interest accrued to DOD -due 11/14/08 25,063.56 8. Indymac Bank FSB Certifikxte of Deposit plus interest accrued to DOD -due 5/30/08 25,110.45 9. Indymac Bank FSB Certificate of Deposit plus interest accrued to DOD - due 8/15108 25, 097.19 10. GMAC Bank Certificate of Deposit plus interest accnted to DOD -due 6/13/08 25,144.14 11. South Bay Bank Certificate of Deposit plus interest accrued to DOD -due 5121/08 26,241.74 12. Money Market Fund Acct # 53444056 WY 38, Wachovia Securtties, LLC, 3 Lemoyne, Dr., Lemoyne, PA 15 864 71 13. Office of Federal Empbyees' Group Life Ins. (FEGLI) No. 2008 0700361 plus accrued interest 1,504.44 14. Dept. of Treasury - Internal Revenue Service - 2008 Economic Stimulus Payment 300.00 15. Cash on Hand 277.00 16. United States, Office of Personnel Managmeent -Death Benefits under Civil Service Retirement System 414.61 17. Dept of Treasury, Internal Revenue Service -Refund of 2008 Income Tax Payments 1,744.00 18. PA Dept. of Revenue -Refund of 2008 Income Tax Payments 978.00 TOTAL (Also enter on line 5, Recapitulation) f ~ 233,373.55 pt more space is needed, insert additlanal sheets of Ne same size) REV-1511 EX+(12-99) SC11EpULE M COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FlLE NUMBER Fred R. Long 21-08-0585 Dells d deeedenl must bs reported on Schedule L A. I FUNERAL EXPENSES: t' Prepaid 6. ADMINISTRATIVE COSTS: 1. Personal Repreaentathe's Commissims Named Persanel Representative(s) Karen J. Kapp 51,161.46 Saul SeaeNy Number(syE1N Number d Personal Represerltetlve(s) 176347732 street Address 561 Dogwood Dr. Gry Mechanicsburg state PA Zp 17055 Year(s) Caanissbn Paid: 2008, 2009 2. ANaney Fees 51,161.46 3. Fatuity Exemption: (N decedent's address is not tiro same as daimenYS, attach ezplenation) Claimant Sheet Address ~Y State .Zry Reletla~ship d Geiment to Decedent 4. Probate Fees 835.00 5. Acwuntant's Fees 6. Tax Rehm Preparer's Fees ~. Cumberland Law Journal -Estate Advertising 75.00 e. The Sentinel -Estate Advertising 70 64 s. U.S. Postal Service -Postage, Certified Mal 10.64 10. Sovereign bank-wire transfer fee 12.00 1 d. Federa Express - Overnight Mating 181.32 12. Westiaw Lega Research 122.75 TOTAL (Also enter on line 9, RecapNulation) S 103,630.27 (N more space is needed, insect additlmal sheets or the same size) REV-1512 EX+ (12-OB) FILE NUMBER Fred R. Long 21 08 0585 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, Including unrafmburaed medical expenses. ~ ` Pennsylvania SCHEDULE I DEPFgTMENT OF gEVENUE DEBTS OF DECEDENT, INNERRANCE TAX RETURN MORTGAGE LIABILITIES 8t LIENS RESIDENT DECEDENT ESTATE OF Alert Pharmacy Serv., Inc. - 219 N. Baltimore Ave., Mt. Holty Springs, PA 17065 206.44 2. Mobile X-Ray Imaging -Medical Billing 34.55 3. Messiah Village -May 2008 BiNing 7,008.37 TOTAL (IUso enter on Line 10, Recapitulation) ~; 7,249.36 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) „~i - Pennsylvania SCHEDULE 7 ~ OEPARTMENTOFREVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENr DECEDENT ESTATE OF FILE NUMBER Fred R. Long ,,, ,,, ~~°~ rvv-uava NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY REDOTNa List TryD~(a;NT AM00 ES ATE ARE I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and t2nsfers under Sec. 9116 (a) (1.2).j 1. Karen J. Kapp, 561 Dogwood Dr., Mechanicsburg, PA 17055 Niece 30% 2. Wayne T. Long, c% Cheryl Ashman, Administratdx, 664 W. Spring St., Fleetwood, PA 19522 Brother 30°h 3. Amber Leibig, 524 Third St., New Cumberland, PA 17070 Friend 100 ENTER DOLUR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECrION TO TAX IS NOT TAKEN 1. None. B. CHARITABLE AND GOVERNMENTAL D15iRIBUTI0N5 1. Trinity United Metlrodist Church, 421 Bridge St., New Cumberland, PA 17070 10% 2. The Salvation Army, 615 Slaters Ln., Alexandria VA 22313 , 10% 3. Bethesda Mission, 611 Reilly St., Hanisburg,PA 17102 10% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ ,~ nmre space is nee°eD, insert a(IDltlonal sheets of the same size. ~~Sovereign Bank SAVINGS BOND REDEMPTION FORM P PZ # PBR NAME/OPR # (Enter complete Sequence # from Presentment Item Window) (Enter your name and OPR pl CBO # 0057 CSR # 005 DATE REDEEMED 06/12/2ooB MM/ DD/ YYYY Transaction disbursement type: ^ Cash ^ Check ^ Sovereign Acct Credited (Attach one co Form PDF 3263) (Obtain Monetary figures from Customer Report created in Bond Calculation Window) NUMBER OF BONDS # 74 TOTAL REDEEMED $ 145, 732.00 TOTAL 1099 INTEREST TO BE REPORTED IS $ 90, 732.00 (Total Interest- Name of Registered Hokbr• - INo abbrevlational Street Address Ilnclude Street # and ST, RD, BLVD, etc.) City, State, and Zip Code State abbreviations acceptable. Ciry end Zip mandatory Taxpayer IdentHication Number ISSN or QN) of Registered Holder of Bonds•• Date of Birth Country of Citlzenahip I certify under penalties of perjury, that: (1) The number shown above as my Taxpayer Identification Number is my correct TIN; 12) 1 am not subject to backup withholding either beca I h use ave not been notified that I am subject to backup withholding as a result of a failure to report all imerest or dividends, or the Internal Revenue Service has notified h l me t am no at I onger subject to backup withholding; and 131 I am a U.S. person )including a U.S. resident alien). Certification instructions: You must cross out item 2 above if ou have b ifi d y een not e by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return . Important Reminder: If not a "U.S. Person," certify foreign status separately using appropriate Form W-B. lgttature o e stare er an Date Conservator, or9f the legal represemative is a corpo arts entity the fullscor or t u e' a p a name and signe s title such as Pres. etc.) .n.anarwu.e _ _ _ _ . -_ ..__._. _..__ ..__.~ .............. ,..u•u n one nine ar a corporeeon, ptamerohip, aaaodslkal, or other type of co rnetilutlon In its own fight must bs ached through Your aroa's FRB (Federal Rxerw Bankl• Bootle presented by An anomsy-In }act IPOAI m~uaet deo be pMd through the FFIB unlace the POA le oleo a Rsg4tarod Holder. Refer to Section 6.8 of the "SsvMga Bonds Rxoures Gulch" or, for eddkbnsl infomvdion cuetomero, non-eustomaro and Sovsroign teem members may contact the FsMrsl gaservs Bank tog {ree st 1-81x1-216.28G4. ••IMPORTANT REGARDING SSNIEIN : If bands Mhg rodesmed are to M roportad under more then one SSN/EIN, you moat sepaate the Savings bonds according to SSN/EIN end process a seperore tronsaedon for each SSN/EIN whleh vdg produce a separate Radempdon Form roquired for 1098 reporting. 1099 PROCESSING TEAM USE ONLY UTJ SBR001 REPORT DATE PZ 250 REPORT DATE t. Provide one copy to customer. 2. Forward one copy in the Vellow Savings Bontl/ESCheatment Envelope on the same processing day. 3. Retain original In PZp sequence for 2 calendar years. EXHIBIT A Reviaea de/oe I' ~'. D'D D.D D D D~D'D D D D D D=Z Z'Z~Z Z 2 Z~s .D D D•D D D Dj2 m':,m rn'm m m m;m m;m`m m m'm?m=m rn m rn m rn`n g ~,_ ~~,_ ^+' F+ F.. `f.. `+ t.. i.., : t., r~ ^t+. r~ f+ - t+, f+ : f+ t+: f+ t+ ~+ f. `f+ `f+ o°o o~0 0 0 00 oto 0 0 0~0~0 00-0 0 0 o~c o.0 0 0 0 0 0 0.0 0 0 0 0 0 0 oto 0 0 0 osc o'o 0 0 0 0 0 0 0 0 0 0 0'0:0 0'0 0 0 0 o c _ ~. .. O:O O,O O O f+;f+,f+ ~+:F+ r `+ F+!r f+'pa,~. 1+ F+ f..•N ;(fi:Ul VI:.N N VI F+;F+:F+ F+'F+ N H t+'.F+ ~+:f.; t+ -~ N f+'~-+ : \ `~ \ :\ \ \ \ \ \ \ ~ \ \ ~ i\ \ ;\ i\ \ \ :~ i\ :N.r r N N N N:r N'N`+ N F+:N:N V N H r N r.N '~:O tD;tO t0 ~D ''O itO ~D tp-~O t0 ~O ~Ot~D tO:~O aO tD t0'aD i~O j07 i0D OD•O O 00'W.O;W;O,W O O~O iO W;OD.W-OD W:G7iW ;f+.f+ r'r ~+ r_r'r r r~~+ r r f..:i-+ f.:r f.:t. r:f..:~... fN'N N.N N N.N;N N;N'.N N N`N!N NON NiN N N.N i0°O OHO O O,O iO O O.O O 0010 Oi0 O'O O O10 O ~O O~O O O~O?O Oi0 O O O~O;O O O O'O O'O i0 =0;0 O.O O, O,W:O W:O •:O O O.O:W O W W'O O'.O.O ~ a ~ , o , z zz m a D D;D fll y i mm m vi O ( ~ V o°1 H p ° o ~ an .w +n O O 0 ' o o o p V 0 0:0 0 3 ~ 0:0 ~ ~;~ 4+ I+:F' N ~:\;\ d N ~ a0 ~O t~O N i~:~ ~;N ~ ~ r+.F+ f+:f+ f+.~ r rr H.N Her r f+if+ r.t+'t+ ~N'N N-N N.N:N:N.N N-N'N N.N:N N:N'N'N.N :N •N:N:N `N i0 `O O:O O.0'O P.O °O i0 O'.O iOEO'O Oi0.O!O.O''O i0 `Oi0;0 €f+a+ ~.,~. -~-f+.f+it+'t+it+ t+!f+'-~if+if+ir+st+ t+:'f+ f+'t+if+:~+:~+ir ~~+ ur tw +n to an yrt aR +n ;~ in in in in'an ur Eu to in yr w stn sw %w 4n iUi;N W',~ GI UI to VI VI. VI VI!N'W-N <N tn.Vl ln!U7 W.N iU1'VI'tn'V7 ;o;o o:0 0 0:0:0 0:0 0:0 0 0;0 0 0;0 0;0:0;0;0;0;0 o'0 0 0 0.0,0:0 0'0 0 0 0 0:0 0.0 oio 0 0;0;0:0;0 o:o 0 0 0 0 0;0,0;0 0 0 ob:o o'o 0 0 0 00?0;0;0 o:o 0 0 0 0:0;0:0.0 0:0 0'0:0 0,0 0'0 0 0 0.0;0:0 ~N sN iR 'M iR iR iR iiR NN `iR ip R R iA ?fR `~:fR iA fR iR iA M Y! •iR HR i~O itO t0 O O ~O 10tt0 ~O `O OIN t0•bit0 t0 i~0 ~O-~D tp:O ~OiO bi0 iV1:(llVI. VI U1. V7:N EN,N jN N-N-N •N:N N:N N.N'N ~N'N;N (N ;N jN N N N N N.W iW W'W W-W W:W W W W W,W W'W W:W;W;W i0 O O O;O O~O~. O~ T;O~ O+. 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The following is provided to 'you so that you may list all of your bonds for your Savings Bond Performance ReportTM. Please contact us at ###-###-#### if you require assistance with this form. Series Face Value ($) Issue Date (MM/YYYY) Series Face Value (S) Issue Date (MM/Yyyy) EE 50 O1 / 1998 ~ QD~ oS / 87 ~~ DSO , l1 987 ~" DOO• - / 87 ~~ /OOC~. t ~ ~ OOD, 05 / 87 ~ - - 000, I 1 g~ ~ oon. o, /9s7 ~ ~ oo, I s, ~-~ aoo, o s / s ~ ~~ /ooo , 11 1 ~ ~ ~ /aoa, o s- / s ~ 6~ OoO, rl I S~ ~ 000, os / 87 ~ UoU. 1( rq8~ ~ ODO r~ /oor. r( r 87 . ODD as i987 ~ /DDO. It / g7 ~~ , ODD oS / 87 ~- aoo. 1 1 ~ g 7 ~ , ooo os / 87 ~~ 0lJD- Ir r 87 ~~ , a00 o s ~~ - 000. ll r987 - ~ • UOC7 03 / 8 ~~ OoO, rl 87 , as / 8> oao. 11 r4 ~ ~- 000, or /~g'7 ~= o o• (( /voo. os 8~ ~ O qQ 1 ~ ~ ono. Us / s~ t~ , OOC9 f i r,~R 7 E~ (JOC9 , o S / 87 , o c~ 11 987 - E_"1:- OD /o 9~7 , a~c~, 1I a r /~~7 ~ oon~ O©O /~ /9$7 F:~ OC)O, O5/ l 9 ~~ E7= , /nr», i~ i987 ~~i i-~a ~" "YOUR OFFICE NAME ADVISOR'S'NAME Financial Advice Avenue, Anytown, 11SA 12345 Phone: 800-555-1212 -Fax: 800-555-1213 www,ABCflnanclal3si^vlc@s earn Series -~L Face Value ($) /000 Zasue Date (MM/YYyy) /o geryea Face Value (S) Issue Date fyyyy) ) (~' "' , /9 87 ~C 000, /0 19 87 ~~ D4Q, /o /~qg~ a% 000. /p S~ Ooo, /o / / 87 ODs, /v 1987 ~ DDD. S/1988 CC DOD ~ ~r g g ~~~ D00. S l g 8 8 voo ~- / /993 ) ovo a /993 7, oyo ~ / 99,3 ooo. 1 l gg~ ~oo~ ~ 1987 ADO- ll 1 S7 X00, ll ~ 87 ADO, ~ g7 X00, ii 987 00, it 1 87 )~4• ~c 1987 ~~' ~! ~ S~ 00' i ~ ! q 87 '~O, ~1 /iqd~ r LAST WILL AND TESTAMENT OF FRED R. LONG I, FRED R. LONG, of 214 Eutaw Street, New Cumberland, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and deGare this to be my Last Will and Testament, hereby revoking all otherwills and codicils previously made by me. ITEM I: I direct that payment of all my just debts, expenses of my last illness, funeral expenses and the casts of administering my estate be made from my estate as soon after my death as conveniently may be done. ITEM II: I give, devise and bequeath all of the rest, residue and remainder of my estate, of every nature and wherever situate, together with all insurance policies thereon, as follows: A. I bequeath thirty percent (30%) of the said residue to KAREN KAPP, my niece, of 506 Mount Allen Drive, Mechanicsburg, Pennsylvania 17055; B. I bequeath thirty percent (30%) of the said residue to WAYNE LONG, my brother, of 927 Sixteenth Street, New Cumberland, Pennsylvania 17070; C. I bequeath ten percent (10%) of the said residue to AMBER LEIBIG, of 524 Third Street, New Cumberland, Pennsylvania 17070; D. I bequeath ten percent (10%) of the said residue to TRINITY UNITED METHODIST CHURCH, New Cumberland, Pennsylvania 17070; E. 1 bequeath ten percent (10%) of the said residue to the SALVATION ARMY; Page 1 of 5 F. I bequeath ten percent (10)% of the said residue to BETHESDA MISSION, Hanisburg, Pennsylvania. ITEM III: I direct that any and all taxes that may be assessed in consequence of my death, incuding all inheritance, estate and transfer taxes imposed upon my estate passing under my Will or otherwise, shall be paid out of the principal of my residuary estate as a part of the expense of the administration of my estate. ITEM IV: I authorize and empower my personal representative to compromise, adjust, release and discharge in such manner as my personal representative may deem proper, all debts and claims owed by or to me or my Estate; to sell, lease or exchange at public or private sale or in such manner, at such prices, and upon such terms of credit or otherwise, as my personal representative may deem proper, all or any part of my property, real or personal; to execute, acknowledge and deliver instruments of conveyance, including deeds in fee simple; to borrow money for the purpose of paying estate, inheritance or other taxes which are required to be paid and to secure any such loans by pledge or mortgage of all or any part of my property and to execute the necessary instruments to carry out such powers; to distribute my estate in kind or partly in money or partly in kind, and to determine the fair value at which any property so distributed in kind shall be received by the distributees; to conduct any business in which I have an interest at the time of my death, for such period as my personal representative may deem proper, power to borrow money and pledge assets of the business and the power to do all other acts that I, in my lifetime, could have done, to delegate such power to any partner, manager or employee without liability for any loss occurring therein and to organize a corporation to carryon said business as capital to such corporation and accept stock in the corporation in lieu thereof and hold such stock for the uses of this, my Will, and to vote said stock or sell the same as to my personal representative may seem best; to retain all stocks, assets, bonds and investments owned Page 2 of 5 to what is known as legal investments; to execute any options to purchase, to apply for stocks, bonds or other investments, to purchase or otherwise acquire real estate and to execute the same powers thereover as hereinbefore provided, to retain indefinitely any part of my assets, real or personal, which is or may become unproductive or to make sale thereof; to pay carrying charges and expenses of the property out of other principal or income ewR my estate; to invest and reinvest in alf forms of property without restriction to inve ~ff pr 2 .. authorized for Penns Ivania fiduciaries as m ''= Y y personal representative deems proper, without "t~. regard to the principle of diversification or risk; to exercise any law-given option to treat administrative expenses either as income tax or as estate deductions, without regard to whether the expenses were paid from principal or income. The powers herein conferred shall be to my named personal representative and all successors thereto and shall be in addition and not in limitation of other powers conferred on said fiduciary. Any and all payment or payments of any sum or sums, whether in cash or in kind and whetherfor principal or income payable to any beneficiary shall be made upon the sole receipt of the respective beneficiary to whom the payment is made and free from anticipation, alienation, assignment, attachment, and pledge and free from control by the creditors of any such beneficiary. ITEM V: All shares of principal and income hereby given shall be free from anticipation, assignment, pledge or obligation of the beneficiaries and any of them and shall not be subject to any execution or attachment, levy or sequestration or other Gaims of the creditors of said beneficiaries or any of them. ITEM VI: I nominate, constitute and appoint KENNETH E. BANKERT as the sole Executor of this, my Last Will and Testament, to serve without bond. In the event of the renunciation, death, resignation, refusal or inability to act for any reason whatsoever of the said Page 3 of 5 irri.- KENNETH E. BANKERT, I nominate, constitute and appoint KAREN KAPP, my niece, as the Executrix of this, my Last Will and Testament, to serve without bond. IN WITNESS WHEREOF, I, FRED R. LONG, have, to this, my Last Will and Testament, set my hand this ~L day of ~uNF__ , 2004. r (SEAL) FR D R. LONG, Te for On this 1'4~~ day of "T n~a _ , 2004, Fred R. Long deGared to us that this instrument was his Last Will and Testament, and we were requested to act as witnesses to that deGaration and to his signature. This will was then signed in our presence, all of us being present simultaneously. We now declare that he is, to the best of our knowledge, of sound mind and we subscribe our names as witnesses. Signatures: of of Addresses: /~B/ .- ~ /~,[~ //~ /703 loyt w ~i1u ~<<a ~/z.L~/6TeWw f>Tz ACKNOWLEDGMENT COMMONWEALTMOPpENNSYLVANIA NotaW Seal State of c],risune M. Chudb, Noery PuMlc //~~ : SS HempOenTwp.,Gxr~berlerdCaxMy County of \;tre e.,n ~~ ezpkes ~ ~ ~~ Member, Pennsylvania Aasodallon 01 Notaries I, Fred R. Long, Testator, whose name is signed to the foregoing instrument, having been tluly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Fred R. Long Page 4 of 5 Sworn to or affirmed to and acknowledged before me by Fred R. Long, the Testator, this IN ~ day of '=Cu,.~ , 2004. ~~ Notary Public AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA Nolaflal Seal Christlne M. Chubb. Nofsy PubNc State of inca„~s.~yr,Q~, H:rmOsnrwp.,CurnberomCwrxy n : ss tih' coa~exon Exgree oa. z, zoos County of ~ "t~y.~~ ~ Member, Pa~neylv~nN Aa~ooiNlun p(NdeASs We, ~ t ~aP and 7n1,., R_ Ct ,the witnesses whose names re signed to the foregoing instrument, being my qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will and Testament; that Fred R. Long signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testator, signed the Will as witnesses; and that, to the best of our knowledge, the Testator was at that time 18 or nwrs years of age, of sound mind and under no consVaint or undue inFluence. wlv~gasO Wit's - °/ Swom or affirmed to and subscribed to before me by ` and '~'d:.~ li Cr:~. ,witnesses, this -4"t-~day of '~n.p 20 4. t . ~ -`"y Notary Pu~l~ Page 5 of 5 E X GRANTED TEMPLATE Subj: Fred R Long Est Date: 1/30/2009 12:46:16 P.M. Eastern Standard Time From: RA-InheritanceTaxExt state.~a.us To: ISDIaw aol_com u e wing message rs eing sent from an unmonitored account. Please do not reply. Re: Estate of FRED R LONG File Number 2108-0585 Dear Sir or Madam: Page I of I This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penally for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 08/14/2009. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. We now offer you the option to request your extension request via a-mail. Please use the following e-mail address: RA-InheritenoaTaxExt®state pa us. Please contact me with any questions or concerns at 717-787-8327. Sincerely, Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division Please do not reply to this email. This mailtwx ix not monitored and you will not receive a response. For assistance, visit us on the web at www.revenue.state.pa.us or call us at 717-787-8327 and/or ormahon transmitted is intended only for the person or entity to whom it is addressed and may contain confidential privileged material. Any use of this information other than by the intended recipient is prohibited. If you receive this message in error, please send a reply e-mail to the sender and delete the material from any and all computers. Friday, January 30, 2009 America Online: LSPIaw haws, ~~aruc~a ~ ~isarca~ j 20 Erford Road, Suite 305, Lemoyne, PA 17043-1163 ~ (717) 975-0600 Fax (717) 975-3871 LSPIaw@aol.com May 19, 2009 Register of Wills Attn: Chris Cumberland County Courthouse One Courthouse Sq. Carlisle, PA 17013 Re: Estate of Fred R. Long No. 21-08-0585 Dear Chris: Pursuant to your recent phone message, I have enclosed a check in the amount $65.00 for the inheritance tax return filing fee and additional privy in the above- referenoed estate. Thank you. Sincerely, Mariann L. Stiely MLS N O Enclosure IO D `° ;; ~ na. , m rv S JC ~ i a , o o62saoosena2s ~~~~s IAN Wy~O> ~LL~~ 'W'^ v/ O ,~ T I.I. O U o M _ M J O ~ ~ ~ ~~o _= Ov_~ZOa H ~~~ m O ~ ~Zm~_I ~ ~ ~ ~QU~U ~~ ~ ~ ~ G4 a ~ -d ~ ~ w 8 o a