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HomeMy WebLinkAbout05-26-09 (2)1505607121 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number Po sox 28oso1 2 1 0 8 1 1 4 4 Hamsburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 7 1 5 6 6 6 5 1 0 3 1 2 0 0 8 0 8 1 3 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name MI W O L F E E L I Z A B E T H A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation 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 D A V I D H S T O N E E S Q U I R E 7 1 7 7 7 4 7 4 3 5 Firm Name (If Applicable) I-- - --- --- - --- S T O N E L A F A V E R S H E K L E T S K First line of address 4 1 4 B R I D G E S T R E E T Second line of address City or Post Office N E W C U M B E RL A N D State ZIP Code P A 1 7 0 7 0 ~:~ ~ -~ REGISTER OF WILLS USE ONLY I --~ i _.. - ,: __. 7 ~• _ r: ~ , _ _ ~ r'~ ,i c~ i -- DATA FILED 1 ~. , .: _ ~ _ '- - ~' y r~ Correspondent's a-mail address: D S T O N E a~ S T O N E L A W• N E T Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU 01PERSON f~ESPONSie~ FOR FILIN RETURN , D9TE , ~ ~ n S AMHERST /&RIViE THAN REPRESENTATIVE CAMP HILL PA 17011 Dl4TE , 414 BRIDGE STit~ET NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 15D5607121 1505607121 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: ELIZABETH A• WOLFE 1 8 7 1 5 6 6 6 5 RECAPITULATION ........................................ 1. Real estate (Schedule A) 1 ~ • .................................. 2. Stocks and Bonds (Schedule B) 2~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) . ~ • ~ ~ • • • ~ ~ • ~ • • ~ 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 11. Total Deductions (total Lines 9 ~ 10) ......... • • • • .. • ~ ~ ~ • . 11 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...... • • .. • • • .. • • • 14. 5 9 8 9 3. 3 6 1 0 8 8 7. 4 2 8 7 3 8 0. 5 4 1 5 8 1 6 1. 3 2 1 9 4 3 5. 6 8 4 7 3 9. 0 0 2 4 1 7 4. 6 8 1 3 3 9 8 6. 6 4 1 3 3 9 8 6. 6 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 D D D 15 (a)(1.2) X• 0 . 16. Amount of Line 14Dt4 5ble at lineal rate X _, 1 3 3 9 8 6 6 4 16. 17. Amount of Line 14 taxable D D D 17 at sibling rate X .12 . 18. Amount of Line 14 taxable D D D at collateral rate X .15 18. 19. Tax Due ........... ........................... .. ..... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505607221 Side 2 0. D 0 6 0 2 9. 4 0 0. D 0 0. D 0 6 0 2 9. 4 0 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 08 1144 DECEDENT'S NAME ELIZABETH A. WOLFE STREET ADDRESS 5225 WILSON LANE SUITE 225 CITY STATE it ZIP - _--- MECHANICSBURG ! PA I, 17055- Tax Payments and Credits: ~• Tax Due (Page 2 Line 19) 2, CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 6,029.40 7,000.00 368.42 Total Credits (A + B + C) (2) 7, 368.42 Total InteresUPenalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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 the tax due. 0.00 (4) 1, 339.02 (5) 0.00 (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 0.00 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 : ...................................................................... ^ Q b. retain the right to designate who shall use the property 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 receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 ^ 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 (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 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. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ELIZABETH A. WOLFE 21 08 1144 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. 471 shares PNC Financial Services Group Inc stock @ $65.060 each 30,643.26 2 ~ 45.049 shares PNC Inv-Artisan Fds Inc Midcap Value Inv @ $13.050 each 3 ~ 262.663 shares PNC Inv-Eaton Vance Spl Invt Tr Large Cap Val A @ $15.350 each 4 ~ 110.246 shares PNC Inv-Euro Pac Growth Fd CI F-1 @ $29.730 each 5 ~ 164.789 shares PNC Inv-Federated Equity Fds Kauffman CIA @ $3.810 each 6 ~ 20.35 shares PNC Inv-Federated Equity Fds Kauffman Sm Cap A @ $15.190 each 7 ~ 1581.942 shares PNC Inv-Federated Total Return Sers Total Ret Bd A @ $9.800 each 8 ~ 10.066 shares PNC Inv-Franklin Value Invs Tr Sm Cap Value A @ $28.580 each 9 ~ 209.372 shares PNC Inv-Growth Fd Amer Inc CI F-1 @ $22.090 each NOTE: The safe deposit box inventory showed 475 shares PNC Financial Services Group Inc but there is only 471 shs. See copy of stock cert attached. 587.89 4,031.88 3,277.61 627.85 309.12 15, 503.03 287.69 4,625.03 TOTAL (Also enter on line 2, Recapitulation) I $ 59,893.36 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MSC. IN RESI DENTEDECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER ELIZABETH A. WOLFE 21 08 1144 Include 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. Cash on hand 56.75 cash $19.00, coins $37.75 2 Mens ring w/3 diamonds-ring w/birthstone-diamond 100.00 engagement ring-mens wedding band-cocktail ring 3 PNC Bank NA-Checking Acct #5140070193 10,717.71 Princ. $10,717.71, Int. $1.43 4 PNC Bank NA-Checking Acct #5140070193 -Accrued Interest 1.43 5 PNC Bank NA-Savings Acct #5004335791 8.01 6 PNC Inv-MM Fund 3.52 NOTE: As per safe deposit box inventory, there were 4 PNC Bank (CCNB Bank) certificate of deposits mentioned. Each of them were cashed in prior to death. The original certificates were not necessary at time of redemption. TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER ELIZABETH A. WOLFE 21 08 1144 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIRREIATIDNSHIPTODECEDENTAND THE DATE OF TRANSFER. ATTACHACDPVOFTHEDEEDFDRREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. PNC Invstmts-MetLife Invs USA Ins Fixed Annuity 41,416.24 100. 41,416.24 Contract #9200686744 beneficiaries Patricia D Tepsic and Deborah S Wolfe 2 PNC Invstmts-MetLife Invs USA Ins Fixed Annuity 45,964.30 100. 45,964.30 Contract #9200661259 beneficiaries Patricia D Tepsic and Deborah S Wolfe TOTAL (Also enter on line 7 Recapitulation) I $ 87 380.54 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ELIZABETH A. WOLFE 21 08 1144 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Stone & Murray Funeral Home-funeral expenses 8,627.00 2. Rolling Green Cemetery-grave marker 1,668.00 B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: 2 Attorney Fees DAVID H STONE, ESQUIRE 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 7,500.00 Street Address City State _ Relationship of Claimant to Decedent Probate Fees Register of Wills, Cumberland Co. 5. I Accountant's Fees 6. I Tax Retum Preparers Fees 314.00 ~. Interest withholding 0.44 2 Checks written by prior to death by decedent 880.00 3 Cumberland Law Journal-advertising grant of letters 75.00 4 The Patriot News Co-advertising grant of letters 141.24 5 Register of Wills-filing Inheritance tax return and Inventory 30.00 6 Reserve for closing expenses 200.00 TOTAL (Also enter on line 9, Recapitulation) $ 19.435.68 State Zip Zip (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER ELIZABETH A. WOLFE 21 08 1144 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Bethany Village-services rendered 4,739.00 TOTAL (Also enter on line 10, Recapitulation) I S 4 739 00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ELIZABETH A. WOLFE 21 08 1144 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)j 1 Patricia D Tepsic Lineal 66,993.32 10 Amherst Drive Camp Hill PA 17011- 2 Deborah Sue Wolfe Lineal 66,993.32 140 Van Cortlandt Avenue, West Apt. 5C Bronx NY 10463- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ (If more space is needed, insert additional sheets of the same size) ~% Vv317 THIRD STREET •• ~~' NEW CU1`4BERLAND, PENNSYLVANIA 17070 LAST WILL AND TESTAP~IENT OF ELIZABETH A. WOLFE also known as BETTY A. WOLFE ! I, ELIZABETH A. WOLFE, also known as BETTY A. WOLFE, of the Borough ~f New Cumberland, Cumberland County, Pennsylvania, being of sound mind, memory ind understanding, do hereby make, publish and declare this as and for my Last Jill and Testament hereby revoking and making void any and all other wills by m. at any time heretofore made. I. I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease II. Lww orrlccs JON F. LAFAVER J17 TN111D lTRELT NLW CUM~LIILAND. PA. ~ All the rest, residue and remainder of my estate, whether real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my husband, EARL J. GJOLFE, if he survives me by a period of thirty (30) days. If my said husband does not survive me by a period of thirty (30) days, then this gift to him shall be divested and I then give, devise and bequeath my! entire estate as follows: A. One-half (1/2) unto my daughter, PATRICIA DAWN TEPSIC. B. One-half (1/2) unto my daughter, DEBORAH SUE WOLFE. i~ I III. I hereby nominate, constitute and appoint my husband, EARL J. WOLFE~ ~s Executor of this, my Last Will and Testament. If the said Earl J. Wolfe ! E should predecease me, fail to qualify or cease to act as such, then I hereby nominate, constitute and appoint my daughter, PATRICIA DAWN TEPSIC, as Executri~. Page one of two Pages r IV. !~ No fiduciary acting under this Will shall be required to post bond ?~ '~~ in this jurisdiction or in any jurisdiction in which he may act. IN WITNESS WHEREOF, I, ELIZABETH A. WOLFE, also known as BETTY A. WOLFE, the Testatrix, have unto this, my Last Will and Testament, set my hand y t~ and seal this `"' day of Cti A. D., 1980. ~~ w ~~ ( SEAL El~zabet Wolfe, als known as Betty A. Wolfe SIGNED, SEALED, PUBLISHED and DECLARED by ELIZABETH A. WOLFE, also ~~ known as BETTY A. WOLFE, the above-named Testatrix, as and for her Last Will and Testament, in the presence of us who have hereunto subscribed our names as witnesses at her request, in the presence of the said Testatrix and of each other. LAW O/FICE! t 1N F. LAFAVER ~~ THIRD STRE[T i Page two Of two Pages N CUM[[RLAMD. VA. (, STONE LAFAVEI3 &SHEKLETSKI ATTORNEYS AT LAW 4}4 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E OF COUNSEL GERALD J. SHEKLETSKI NEW CUMBERLAND. PA 17070 CHARLES H. STONE ELIZABETH B. STONE www,stonelaw.net JON F. LAFAVER TELEPHONE (717) 774-7433 FACSIMILE (717) 774-3869 December 22, 2008 Department of Revenue Inheritance Tax Division Dept. 280601 Harrisburg, PA 17128-0601 Re: Estate of Elizabeth A. Wolfe a/k/a Betty A. Wolfe Date of Death: October 31, 2008 Social Security No. 187-16-6653 Estate No. 21-08-1144 Greetings: Please find enclosed an original Safe Deposit Box Inventory for Box No. 243. Thank you for your attention in this matter. Should you have any questions, please feel free to contact me. Very truly yours, DHS/jam Enclosure cc: Patricia D. Tepsic, Executrix (w/enclosure) PNC Bank (w/out enclosure) STONE LaF ER &SHEKLETSKI vi ne, Esquire J REV-485 EX (1-07) 48500041046 SAFE DEPOSIT BOX INVENTORY PA Department of Revenue Social Security or Death Certificate Number Date of Death PLEASE USE ORIGINAL FORM ONLY County Code Year File Number ~118~p~ ~~ . 6~ ~r~,`.. ( ~~j~Zb~bl~8 ~~i~: 2 ~ ( ~~~' s 1 ~ ~ ~ Decedent s Last Name ., s.. ~ .WO LF~E ~ ~ ~ ,.,. Suffix .N n ~ ~~' ~ ~ . First Name _, ~EL ~,.y .. . ,(~ 4 4 . MI ,,., ,.. ~B ~ ~ , . :.., ~.,.~. ._.. ~,-.. ~_ , I E ZA T H A © ADDRESS OF DECEDENT STREET: CITY: . . . ...:. STATE: ZIP CODE: NAME AND ADDRE33 OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME: STREETAD~RES~-~~--~AFit3T--ESf~li~-~'~------ ----- -------------- - CITY: STATE: ZIP CODE: 414 Brid a Street N w Cumb rl n P • NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. rvf+nne: RELATIONSHIP: Patti_ci~_II~ Tepsi~-------- --------- p~~,~, ~1~ ~ ' STREET ADDRESS: - CITY: -----~--- - STATE: ------- ZIP CODE: ,' 1 Q_Amhers-t_Ilriti~------ - --- ----- -----.Camp. Hill -_ PA ~II1 1 b. NAME: RELATIONSHIP: - -__- i STREET ADDRESS: CITY: STATE: ZIP CODE: - --- c. NAME: RELATIONSHIP: ------- ------ --- STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRE33 OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: -- PNC_-Ha11~L~_.CeC~ar --C'1-if ~-_Mal~--____- __ ____ __ -- -- STREET ADDRESS: CITY: _------- -----~--- STATE:-- ----ZIP CODE: i NAME OF PERSON MAKING LAST ENTRY DATE OF CONTRACT TO RENt 80X ~ NUMBER OF BOX . ~-19-2004 a4a NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX nATF awn Tiuc nF iJ\ST ENTRY TITLE UNDER WHICH BOX IS REGISTERED Elizabeth Wolfe & Patricia a. NAME: E1laahetl~ 1~~ - Wo-~f e- _ -- --__ - --- ----- _ _ STREET ADDRESS: 1-0_ Amh~rst__ Driv~_ _-____ _-_-_- _-- _------ -- CITY: STATE: ZIP CODE: b. NAME: _P~tricsl_.~~._Tep~i~------- -- -- STREETADDRESS: --1-~Amhers t _ Dsist~--. _ _ - -- --- -------- --- CITY: STATE: ZIP CODE: Ca mn Hill PA 1 Z-01.1-;i NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY D v WAS A WILL IN THE BOX7 ~ YES ^ NO If yes, a. Dat. of well: 4 _ g _ 1 9 8 0 ~ _ removed _ f rom_ _b.ox__ b. Nams and address of personal representative, If named in the will --- - I NAME: on 1 1-6-2008 Patricia-~._Tepai~ __ i STREET ADDRESS: CITY: STATE: ZIP CODE: 1 0_ -Amherst Drive - _ CaWp-. Hi11- _. _- FA__ i?QLL_ _-- c. Name and address of attorney, H any NAME: .- STREETADDRESS: _ - - - --- CITY: STATE: ZIP CODE: L, 48500041046 48500041046 ~4 REV-485 EX SAFE DEPOSIT BOX INVENTORY Page °f t~tATl1t ^ATtA~tw IIV.7 1 RVtr I IVIV.7 (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of Indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 ITEM NO. ITEM DESCRIPTION _ 1 ___ _miscellaneous cash -_- _~1~, 00 total ------------- 2 ---------------------------- -- miscellaneous coins - $37.75 total 3 _ CD'_~__-P-~T~__B_a13_k_H~g~__#1-51041----$~tQ00;-QIl------------------ - --- #827.55_- $10, 000.00 #82756 - $10,000.00 - __4___ _ __ ----------- 475_ shares__of__PNC _Bank_N.A,. stock_-_. certificate X69347510-_ - --- . 5_. IIeetL__t.o.._cemeter.~-_lo-ts--lr-2r-~r-4~- ~-&_ 8-r-14t--1-~-9--~l-ss)s~--~--e-~----- --- Rolling Green Cemetery, Camp Hill, Pennsylvania ------- _6_- - ---- Insurance__ polc.~ from. Pruden~ia_1__In-s~~a~~~ _C~~~___ pQli~y. # PZ~~4283 - - face amount of policy $500.00 '7_- _ mens r_:inq _wth_ 3 _damonds ____ ___ _ __ _ - ------------ -~ -------- ring-- with-hir_ths-ton-~-------- - --------- --- ----------------------- ----- -- --- __ 9_ - - - -- __damc~nd._enga~~m~nt_ rng___ __________-- 10 -- - - mens wedding band 11 cocktail rind _ ______ I CERTIFY UNDER PENALTY OF E JURY T AT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT A HE ES MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: SIGN SIGNATURE PRINT NAME ~ r a (~` ~V ~~ ^ V \ v~~, PRINT NAME AND CHECK APPROPRIATE BOX BELOW: PRINT TITL E DATE CHECK APPROPRIATE BOX Executcrltnx} ~ Adm~n~strytortlnx) ~ J~ ~ ~ ~ ' ~ Estate Representative ~ domt o,nnei .~t safe d•,p~;;,t oox NOTE: Attach additional 8'l:" x 11" sheet(s) if necessary or use duplicates of this page of form. I The Department s authorized by law, 42 U.S.C. X405 (c)(2;(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department ~:es fhe i Social Security number to dentify the decedent and personal representatives of the estate. The Commonwealth may also use the ,nformahon ~n exchange of'ax ~nrc~Tat+on agreemen(s ~ _odh Fpteral .and !a:al'ax~ng 3uthonties- The state law proh!bds the Commomvealth~s personnel'rom dlsclos~ng confdential tax ~nformatlon except `cr o`fiual p~~:coses PNC Financial Services Group Inc (PNC) -Stock chart, Index chart -MSN Money Page 1 of 1 Quota, Chart, News SnaGShOt S~mpanx R~i2~rt Qugf,~~ ~har~ HS~Qri~al Real-T_ irng_ Intraday Key ~gy€i9~gntS .'~ R ce~nLNgyr;z Research SEC Filin A vi _FYI SA_P_~ 6tock5couter Earnings Estimates Arm Ratings Finan4i~l Re~piS,s Insider Trading wnersh4 Message Board Guided Research Research Wizard Find Stocks Stac~reener St~C_P4w~r "searches igp-RateQ ~tpCk~ Related Links QLQt€ WW~[S-hlist Fx~r# Pick E-mail_¢ Alert IP4._~eLt€f Mg~~_~ard~ ~ap~~, ~~s~ >L ~ $9.f3~ trades. FREE TRADE5 ' Na aurMrisRS. -~.~..5 Add To Watchlist A! Add to MSN List ~ Print report 30.16 unch L+arn i,aw ro ,,,~ Open: unch High: unch Low: unch StOCk Previous Close: 30.16 Volume: 14,274 ChattS After Hours: 29.50 -0.66 (-2.19% Vol. 13,724 Eastern Time Draw chart for::,PNC ~,~ Download the MSN Money [nvesfirent Toolbox advertisement PNC Financial Services Group Inc ~ i Gate Nigh Low ppen Close Volume 11/3/2008 68.8000 65.7000 66.8000 68.3700 3 565,700 10/31/2008 66,9600 63.1500 64.2100 66.6700 5,365 100 10/30/2008 66.1800 63.1600 65.7900 64.4700 5,330,000 10/29/2008 66.7700 61.5300 64.6100 62,8200 7 172 200 10/28/2008 65.4900 58.2700 60.5700 65.4400 7 226 600 10/27/2008 61.8400 57.4100 58.6000 58.6300 9,079,600 Oata providers Copyright p 2009 Thomson Reuters. Click for Restrictions. Quotes supplied by interactive Data. Stock price data provided by Nomura Research Instltute, Ltd. Quotes delayed 20 minutes. Page generated 1/22/2009 9:28 AM Eastem Time hrbre `-~~ - No account minimum required ~q~ No inactivity fees ~3~iS ~3v,~ 3 ~~ ~ ~ ~ S.O~ ~ ~. ~~ ~ 1 :~ ~ 30, ~H3.~1~ http://monevicentral.msn.com/investor/charts/chartdl asnx?PT=7Rrcmm~cvt„c=,~Tla-1,~r~ i /~~/~nno o` c o~ ~h a W ~ ~ w a W 0 Z F 2 x U F N ' W \`~ a ~. .~ w N ~ ~ O~ a yW ~ ~~ N ~. cU u ~~ ~W ~U `~ g ~u m ¢,~ PNC INVESTMENTS Member FINRA and SIPC January 16, 2009 David H. Stone Stone LaFaver & Shekletski Attorneys At Law 414 Bridge Street New Cumberland, PA 17070 ~~ ~" ~~ ~.% \~, ~ ~ ~~ // RE: Elizabeth A. Wolfe Date of Death Values as of 10/31/2008 PNC Investments Accounts 8933-4937 & 3950-6777 Dear Attorney Stone: As requested, attached is the date of death values on the above referenced PNC Investments accounts for Elizabeth A. Wolfe. Also enclosed is the October 2008 statement for Account 8933-4937 and the September 2008 statement for Account 3950-6777 (since there was no activity in October 2008 there was no statement for that month), along with the letters from MetLife showing the date of death values. If you have any other questions, please do not hesitate to contact me. Sincerely, C J`~ Todd Perry Senior Financial Consultant TP/ho Enclosures PNC Investments LLC Member of The PNC Financial Services Group 4242 Carlisle Pike Camp Hill Pennsylvania 17011 www p~c.com ' - (l.v (~ ~LZ~ •--___~ _~ _ ~~~~, ~~ ~ tE ^a_., _ - L~. ~ ~.~ ~ ,`~. ~~- ~ 41'ivi. y I°` Importantlnvestorlnformation: Securities and brokerage services are provided by PNC Investments CLC, member FINRA an7 SIPC. 1ol3ank(u rnute`~ Annuities and other insurance products are offered by PNC insurance Services LLC, a licen;e!1 ~rsurance agency. -^^• i v• t v v i L V I ~ in No. 0385 P. 2 ESTATE OF BETTX A. WOLFE (DOD VALUATION 31 OCTOBER 2008) The information provided in this report is believed to be reliable, but its accuracy cannot be guaranteed. A mean price is calculated as an average of the high and low on the valuation date when available. if these prices are not available, such as on weekends or holidays, the mean price is the inversely weighted average of the high and low on the nearest trading dates before and after, when these prices are available within one week of the valuation date. If actual trades are not available, the nearest bid and ask prices are substituted. Note that securities traded on the Toronto Exchange are in Canadian dollars. If an equity is ex-dividend for a cash distribution on or before the valuation date but is of record after the valuation date, the dividend is included in the valuation report and is added to the security's value. This is reported as an adjusted value on the report. If the date of death is on or after the record date and the dividend is payable after that date, the accrued dividend is listed separately on the report and added to the portfolio's total value, Prices for which daily updates are not available are priced according to a Corporate Pricing Cycle, These pricing dates occur on the last business day of the week, and the last business day of the month, unless the end of the week update falls within three business days or less, of the end-of--month update. Prepared: 16 January 2009 + ~~ • I u, L V V/ L V f l III Date of Death: 10/31/2008 Valuation Date: 30/31/x008 Processing Date: 01/16/2009 Betate Valuation shales security or Par Description 11 45.099 ARTIBAN PDS INC (093146709) MIDCP VALU INV Mutual Fund (as quoted by NAS~IiQ) 10/31/1008 1) 261.663 BATpN VANCg $PL IW1n ~ (287905808) LGGu' VAt.UB A Mutual E1xnd (as quoted by NASDAQ) 10/31/9001 3) 110.246 Bp'HO pAC gQp11'TN PD (298706409) CL F-1 Mutual 4vnd (as quoted by NASDAQ) 10/31/2001 4) 20.35 FBD®iATSD HQUY?Y PDS (314172636) KAUFMN S CAP A Mutual Pond (ae quoted by NAgDIAQ) 10/31/1008 5) 16!.789 FBD@RAT@D EQUITY PDS (314172677) KAOPMANN CL A Mutual FLnd (ae quoted by NASDAQ) 10/31/2001 6) 1511,9!1 FRDSRATBb TOTAL R.B'111Rli' gg~ (314a8Q820) TO7L 1t$1' Bb A Mutual Purtd (as quoted by NASDAQ) to/31/aooe 7) 10.066 FRANKLIN VALUE INVS TR (355148305) SML CAP VAL A Mutual Fund (as quoted by NASDAQ) 10/31/x008 ej 209.372 ORONTH FD AM@R INC (399874903) CG F-1 Mutual Fund (ae quoted by NASDAQ) 10/31/2006 W ~ 9) 96969.3 MSTLIPS INV3 USA YNS (591567701) ~ ANNDAL RBN@NABLH BPDA W PIl(SD ANNUITY V,! 10/31/2008 i 10) 41916.29 M@TLIPS INVS USA INS (591567708) w ANNUAL RSNBHABL@ S2DA ti FIl((Bti ANNUITY 10/31/2008 11} 3.52 MONBY MARKET FUND (SVPO1) 10/31/2008 Total Value: Total Accrual: Total: $117,639.16 High/Ask Low/Bid No.0385 P. 3 estate of: B@TTY A. NOLPB Account: 3950-6777 & 8933-4937 Report Type; Date of Death Number o! Securities: 11 Pile ID; 91pLFH,mB1TY Mean sad/or Div and int security Adjustmante Accruals Value 13.05000 Mct 13.050000 SB7.89 15.35000 Mkt 15.350000 9,031.88 29.73000 Mkt 29.730000 3,177.61 15.19000 Mkt ls_19oo00 3o9.1a 3.81000 Mkt 3.110000 627.85 9,80000 Mkt 9.000000 15,503.03 28.58000 Mkt 28.580000 287.69 za.o9ooo Mkt aa.o9oo00 4,6as.o3 1.00000 1.00000 1.00000 1.00000 1.00000 1,00000 1.000000 46,964.30 1.000000 41,416.24 1.000000 3.52 5117,634.16 50.00 Page 1 This report was produced with HetateV81, a pXOduCt of Betate V81uat1on& & Pricing Syateos, Inc. If ypu have queatioree, gleaae contact XVP System6 at (818) 313-6300 or ww.evpays.com. (Revision x,0,4) ~~~~ ~~ cvvu ic. ic~iri riot, ar~iVn 41L-lU7-L/4/ A~VC LEAIli~l6 THEYlIAX December 5, 2008 David H Stone Stone, Lafaver & Shekletski 414 Bridge St PO Box E New Cumberland, PA 17070 1ZE: Betty A Wolfe SSN: 187-16-6653 DOD: 10-31-2008 Dear Mr. Stone: No, 4728 P, 1 In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Chocking Account Account # S 140470193 Established: O1-OI-1978 BETTY A WOLFE DOD balance: $10,717.71 + 1.43 accrued interest Interest paid 01-01-2008 tl~ru 10-31-2008 $9.06 YTD Savings Account Account # 5004335791 ~ Established: 09-21-2004 BETTY A WOLFE DOD balance: $ 8.01 + 0.00 accrued interest Interest paid O 1-01-2008 thru 10-31-200$ $OAO YTD Investment Account The decedent maintained Investment Account 34506777 and 89334937. For fiuther information, you may call the Brokerage Department at 1-800-762-6I 11. Ssfe Deposit Boa The decedent maintained safe deposit box 2431ocated at: Cedar Cliff Mall Branch 1104 Carlisle Camp Hill, PA 17011 (717) - 761-3180 Page 1 of 2 ~~~~ ~~ cvvv i[. I[iin flq~ DN14~ 4IL'IU7-L 14! No 4728 P 2 Please note that this office provides date o;F death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any Snancisl trs~nsactions or provide statements. If you need assistance with auy of these items, please call 1-888-PNC-BANK (1-888-762-2265) ar stoP by Your focal PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member )?DIC Page 2 of 2 MetLife P.O. Box 10366 Des Moines IA 50306-0366 MetLife January 8, 2009 PNC INVESTMENTS ATTH TODD PERRY 4242 CARLISLE PIKE CAMP HILL PA 17011 RE: METLIFE iN~iESTORS USA INSiiJRANCE COMPANY CONTRACT 92006136744 OWNER BETTY A WOLFE Dear Mr. Perry: Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the date of death and the account value on that date are: Date of Death: 10/31/2008 Account Value: $41,416.24 If you have any questions, please contact your representative or call our Customer Service Center at 1-800-255-9448 Monday through Friday between 8:30 a. m. and 6:30 p.m., ET. Sincerely, avid L Norton Sr. Annuity Representative -Post Issue Processing MetLife Annuity Operations and Services r t*..~;e,~e~lct~u l>±.S Ctrl ,~cr.Cu,cc.~. ~ ~ cps ~c z S~~~So MetLife P.O. Box 10366 Des Moines IA 50306-0366 MetLife January 8, 2009 PNC INVESTMENTS ATTN TODD PERRY 4242 CARLISLE PIKE CAMP HILL PA 17011 RE: METLIFE INVES T OF(S USA INSURANCE COMPANY CONTRACT 9200661259 OWNER BETTY A WOLFE Dear Mr. Perry: Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the date of death and the account value on that date are: Date of Death: 10/31!2008 Account Value: $46,964.30 If you have any questions, please contact your representative or cal! our Customer Service Center at 1-800-255-9448 Monday through Friday between 8:30 a.m. and 6:30 p. m., ET. Sincerely, David L Norton Sr. Annuity Representative -Post Issue Processing MetLife Annuity Operations and Services ~~~~ a~v~,~ C LLB,., sal so