HomeMy WebLinkAbout06-08-09 (3)--~ REV-1500 1505607120
EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box.2sosoi INHERITANCE TAX RETURN 2 1 0 9 0 11 9
Harrisburg, PA 17128-0601 - RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
180 03 7524 Ol 27 2009 10 09 1919
Decedent's Last Name Suffix Decedent's First Name
SCHUCKER MI
FRANCES M
(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 TH
E
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ^ 2. Supplemental Return ^
3. Remainder Return (date of death
^
4. Limited Estate
~
qa Future Interest Compromise prior to 12-13-82)
^
5
(date of death after 12-12-82) . Federal Estate Tax Return Required
g Decedent Died Testate
(Attach Copy of Will)
^ ~ Decedent Maintained a Living Trust
(Attach Copy of Tn,st)
8. Total Number of Safe Deposit Boxes
^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95) ~ 11.Electlon to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
CYNTHIA S . HUBLER Daytime Telephone Number
(717) 763 8927
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
First line of address
618 GRANDVIEW AVE
-, ~'
Second line of address
_~ w
r
`! ~ 4
City or Post Office State ZIP Code DATE FlL~ `"
CAMP HILL PA 17011 - -~ t="
--.,
Correspondent's a-mail address: --- ; --`i ..-
~nder penaiiies of perjury i aeclare that I havC exammea mis return Including accompanying schedules and statements, and to the best of m knowle
It Is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any know edge.
S ATURE OF ERSON SPON IB FO F ING TURN ggAA
CYNTHIA S. HUBLER /' /C~~ i.; i
_, ,
->
.;
--y
belief,
C18 GRANDVIEW AVE., CAMP HILL, PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
Side 1
1505607120
1505607120 J
~ 1
LAST i~VILL AND TESTAMENT
OF ~ O n `~
FRANCES M. SCHUCKER U--' u
1, FRANCES M. SCHUCKER, of East Pennsboro Township, Cumberland County,
Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking
and niai;ing void any and all former Vvills made by me.
ARTICLE I
I direct that all my legal debts and funeral expenses, including my grave marker and all
expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my
decease as a part of the expense of the administration of my estate.
ARTICLE II
I direct that all inheritance, transfer, estate and similar taxes (including interest and penalties)
assessed in consequence of my death, of whatever nature or by whatever jurisdiction imposed, shall
be paid out of my residuary estate as a part of the expense of the administration of my Estate. My
Executrix shall not require any beneficiary to reimburse my estate for taxes paid on property passing
under the terms of this Will or otherwise.
ARTICLE III
I bequeath my household goods and personal effects (not including cash and securities)
together with any existing insurance thereon, to my children, JANET F. HUBLER, CYNTHIA G.
HUBLER, CAROLS L. BREHONY and DOUGLAS W. SCHUCKER , to be divided among them by
my Executrix with due regard for their personal preferences in as nearly equal shares as practical.
,t
,, _ - _ -
_-
_ _. _ - - -
, ~ - - - = -
ARTICLE IV
If the two (2) Gold Coins are still in my possession at the time of my death, they can be
purchased by any one of my children, JANET F. HUBLER, CYNTHIA G. HUBLER, CAROLE L.
BREHONY and DOUGLAS W. SCHUCKER, at the appraised value. If a disagreement exists with
regard to the coins, they are to be disposed as a part of the residue of my estate.
ARTICLE V
I give, devise and bequeath alf the rest, residue and remainder of my estate of every nature
and wherever situate, as follows:
A. Twenty (20%) percent to my daughter, JANET F. HUBLER.
B. Twenty (20%) percent to my daughter, CYNTHIA G. HUBLER.
C. Twenty (20%) percent to my daughter, CAROLE L. BREHONY.
D. Twenty (20%) percent to my son, DOUGLAS W. SCHUCKER.
E. Twenty (20%) percent, in equal shares, to my grandchildren DANIEL S. BREHONY,
MELISSA J. HARBOLD, KATHLEEN M. YOUNG, KIMBERLY L. HAYNES, DANIEL D.
SCHUCKER AND THOMAS D. SCHUCKER.
Should any of my children or my grandchildren predecease me, I devise and bequeath his or
her share to his or her then-living issue, per stirpes. In the event that any of my said children or
grandchildren shall predecease me and shall not be survived by issue, I devise his or her share to my
surviving children, grandchildren, or their then-living issue, per stirpes, as applicable.
ARTICLE VI
Should any of my issue entitled to a share of my estate not have attained the age of eighteen
(18) years of age at the time of distribution to him or her, I devise and bequeath the share of each
such issue to my daughter, CYNTHIA G. HUBLER, IN SEPARATE TRUST, to hold, manage, invest
and reinvest the share so received, and the accumulation of income thereon, and to use and apply
the income and principal, or so much thereof as, in Trustee's sole and absolute discretion; may be
necessary or appropriate for each issue's education (including trade school and college education,
both graduate and undergraduate) without regard for his or her parent's ability to provide for such
education, or to make payments for these purposes, without further responsibility, to such issue or to
such issue's parent or to any person taking care of such issue. Any principal or income not so used
or applied shall be distributed to such issue absolutely when he or she attains the age of eighteen
(18) years. If he or she dies before attaining the age of eighteen (18) years, the Trust shall terminate
and such share shall be distributed to his or her personal representative. In the event that my j`
daughter, CYNTHIA G. HUBLER, shall fail to qualify or cease to act as Trustee, I appoint my j
daughter, JANET F. HUBLER, as successor Trustee.
ARTICLE VII
I nominate and appoint my daughter, CYNTHIA G. HUBLER, Executrix of this my Last Will
and Testament. Should my daughter, CYNTHIA G. HUBLER, fail to qualify, or cease to act as
Executrix„ I nominate and appoint my daughter, JANET F. HUBLER, Executrix of this my Last Will
and Testament. Should my daughter, JANET F. HUBLER, fail to qualify or cease to act as Executrix,
I appoint my daughter, CAROLE L. BREHONY, Executrix of this, my Last Will. Should my daughter,
CAROLE L. BREHONY, fail to qualify or cease to act as Executrix, I appoint my son, DOUGLAS W.
SCHUCKER, Executor of this, my Last Will.
ARTICLE VIII
I direct that my Executrix and Trustee, or their successors, shall not be required to post bond
for the faithful performance of their duties in any jurisdiction.
^ II I SIN WITNESS 'OIVHEREOF, I hereunto set my -hand and seal. this ;') day of
~1 l~ ~-~- .2008.
/Y_~fz-~9',y+-r,~J~- ~~n J.~'~~~~.ui~..~..-~~-- (SEAL)
` FRANCES M. SCHUCKER
q3
Signed, sealed, published and declared by the above-named Testatrix as and for her Last
Will and Testament in the presence of us, who, at her request, in her presence and in the presence
of each other have hereunto subscribed our names as witnesses.
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
I, FRANCES M. SCHUCKER, Testatrix, whose name is signed to the foregoing instrument,
having been duly 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.
FRANCES M. SCI-~'UCKER
Sworn or affirmed to and acknowledged before me, by FRANCES M. SCHUCKER, the
Testatrix, this ~~~" day of ~,~.i~ , 2008.
C®IYIMOfVwEALYFi OF P~IVNSYLVAtdIA
Notarxa! Seal
l~na L Wyman, t~o~ry Publ~
Lemoyne eoro, Cumberland aunty
~ ~ommisslon Ezpires Nov. 15, 2UQS
~.~~~~~~
-~' Notary Public '
lUlOmbar, Psnnoylvania ~ssooiation Of No4aries
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
:ss:
We, ~~`N1 ~. ~-~'{~2~I~n~~ and ~~r l~"`i~~~~~~~ ~~~'~`j the
witnesses whose names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing
instrument as her Last Will and Testament; that she signed willingly and that she executed it as her
free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of
the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at
that time at least 18 years of age, of sound mind and under no constraint or undue influence.
• / V
f.:
Sworn to or affirmed to and subscribe to before me by
~~ ~ , ( an ~ ~ ~ witnesses, this
~~ day of ~ ~,t,l.i~.~ U , 2008.
~ __...
Notary Public
C®MfiAOhlt,N~s~LTi-l Oi= F~~N~ISYLVd4{098~
Notarial SSai
Darla L wi~nan, Naiad Pty
Lemoyne @oro. CumB~e9artd CourP~fi
My Commission F,x~ires Nov.1~,
Member, Pennsylvania ~ssoalation Of tdo4ari®s
_ s ~.
REV-1500 EX
1505607220
~eoeeenc~sName: FRANCES M. SCHUCKER
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.
Decedent's Social Security Number
138,500.00
175,576.65
314,076.65
17,511.88
2,091.39
19,603.27
294,473.38
294,473.38
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 0 0 0 15.
16. Amount of Line 14 taxable 2 9 4
4 7 3 3 8 16
at lineal rate X .045 , .
17. Amount of Line 14 taxable 0 0 0
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due ..................................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
0.00
13,251.30
0.00
0.00
13,251.30
Side 2
1505607220 1505607220
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-0119
DECEDENT'S NAME
FRANCES M. SCHUCKER
STREET ADDRESS
54 BURD DRIVE
CITY
CAMP HILL STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
10,500.00
552.63
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
p. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
(1> 13,251.30
11,052.63
2,198.67
2,198.67
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 :.................................................................................. ^ O
b. retain the right to designate who shall use the property transferred or its income :.................................... ^
c. retain a reversionary interest; or .................................................................................................................. ^ ^x
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? ....................................................................................................................... ^ ^x
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 Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................................................................... ^ x^
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)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1502 EX+(8.98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SCHUCKER, FRANCES M. 21-09-0119
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.
Real property which is jointly-owned with right of aurvivorehip must be disclosed on schedule F.
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98)
(If more space is needed, additional pages of the same size)
A. vmu ~w. cavrucoo
B. TYPE OF LOAN: ~
U.S. DEPARTMENT OF HOUSING 8~ URBAN DEVELOPMENT 1.QFHA 2.~FmHA 3. ~X CONV. UNINS. 4. QVA 5. ~CONV. INS.
SETTLEMENT STATEMENT 6. FILE NUMBER:
- 1 7. LOAN NUMBER:
21
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked '[POCJ" were yard outside the cbsing; they are shown here for informational purposes and are not rncluded in the totals.
1.0 3l`J8 (030678.PFDrD9-061826)
D. NAME AND ADDRESS OF BORROWER:
Robert R. Slaybaugh
5A Richland Lane, Apt T1
Camp Hill, PA 17011 E. NAME AND ADDRESS OF SELLER:
Cynthia S. Hubler, Executrix and
of the Will of Frances M. Schucker
618 Grandview Avenue
Camp Hill, PA 17011 F. NAME AND ADDRF~:~ LENDER:
RBS Citizens, N.A.
One Citizens Plaza / ~~ )
Providence, RI 02903
G. PROPERTY LOCATION:
54 Burd Drive
Camp Hill, PA 17011 H. SETTLEMENT AGENT: 23-2850082
White Rose Settlement Services, Inc./09-0618 I. SETTLEMENT DATE:
J
1
2009
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
1441 East Market Street
York, Pennsylvania 17403 une
,
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRA NSACTION
101. Contract Sales Price 138,500.00 401. Contract Sales Price 138,500.00
102. Personal Pro a 402. Personal Pro r
103. Settlement Char es to Borrower Line 1400 5,661.12 403.
104. 404.
105. 405.
Ad Lstmen s rltems Paid B ellerrn a vane Ad ustment Forltems Pa 8 ellerm a vance
106. Ci frown Taxes 06/01/09 to 01/01/10 80.97 406. Ci frown Taxes 06/01/09 to 01/01/10 80.97
107. Coun Taxes 06/01/09 to 01/01/10 175.49 407. Coun Taxes 06/01/09 to 01/01/10 175.49
108. School Taxes 06/01/09 to 07/01/09 112.49 408. School Taxes 06/01/09 to 07/01/09 112.49
109. 2nd Qt. Sewer/Refuse 06/01/09 to 07!01/09 37.91 409. 2nd Qt. Sewer/Refuse 06/01/09 to 07/01/09 37
91
110. 410. .
111• 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 144,567.98 420. GROSS AMOUNT DUE TO SELLER 138,906.86
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. De osit oreamest move 3,500.00 501. Excess De osit See Instructions
202. Prince al Amount of New Loans 110,800.00 502. Settlement Char es to Seller Line 1400 4,165.00
203. Exisfrn bans taken sub'ect to 503. Existin loans taken sub'ect to
204. Gift Funds 6,500.00 504. Payoff of first Mortgage
205. 2nd Mt .Proceeds 23,466.00 505. Pa off of second Mort a e
206. ~,
207• 507. De ositdisb.as roceeds
208. 508.
209. 509.
Ad ustments Forltems n atd eller Ad ustrnents rltems n a B eller
210. Ci /Town Taxes to 510. Ci frown Taxes to
211. Coun Taxes to 511. Coun Taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217- 517. Refuse
218. 518. Sewer
219. 519.
220. TOTAL PAID BY/FOR BORROWER 144,266.00 520. TOTAL REDUC770N AMOUNT DUE SELLER 4,165.00
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENTTOIFROM SELLER:
301. Gross Amount Due From Borrower Line 120 144,567.98 601. Gross Amount Due To Seller Line 420 138,906.86
302. Less Amount Paid BylFor Borrower (Line 220) ( 144,266.00) 602. Less Reductions Due Seller (Line 520) ( 4,165.00
303. CASH(X FROM) ( TO) BORROWER 301.98 603. CASH(X TO) ( FROM) SELLER 134,741.86
r ne unaersgnea nereoy acxnowieage recei t of a compieteD copy of pages itS1 of th~S statement ~ a attachments ref ed to erein.
Borrower ~~„-~ ~, -,~. Seller // ~ ~~~"~
Robert R. Slaybaugh ^~ C is S. Hubler, Executrix
of the Will of Frances M.
HUD-1 (3-86) RES PP, HB4305.2
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price 1 2. ° 2 77 PAID FROM PAID FROM
Division of Commission (line 700 as Follows: eoRROwER's SELLER'S
701. $ 2,770.00 to Hardys Auction Services FUNC6 AT FUNDS AT
702.$ t0 SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. to 2,770.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Or• ination Fee 0.2500 % to RBS Citizens, N.A. 277 00
802. Loan Discount % to
803. Appraisal Fee to Wenzler Real Estate POC:L400.00
804. Credit Report to Kroll Factual Data POC:L16.82
805. Application Fee to RBS Citizens, N.A. 350.00
806. Tax Service Fee to 1st American R.E. Tax Svcs
807. Flood Cert~cation Fee to 1st American Flood Data Svcs 67.00
7 ~
808. Processing Fee to RBS Citizens, N:A. 3~ ~
809. AU Underwriting Fee to FNMA POC:L18.00
810. Undernrriting Fee to RBS Citizens, N.A. 125
00
811. .
900. ITEMS RE UIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 06/01/09 to 06/01/09 @ $ /day ( days 5.2500%)
902. Mort a e Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 ears to State Farm 371.00
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months $ 30.92 er month 92.76
1002. Mort a e Insurance months $ er month
1003. Ci /Town Taxes 5.000 months $ 11.51 er month 57.55
1004. Coun Taxes 5.000 months $ 24.87 er month 124.35
1005. School Taxes 12.000 months @ $ 114.06 per month
1006. months $ er month 1,368.72
1007. months er month
1008. A re ateAccountin Ad•ustmt months $ er month -274.76
1100. TITLE CHARGES
1101. Settlement or Closin Fee to
1102. Abstract orTdle Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Pre aration to
1106. Nota Fees to Shonna S. Cardello 25.00 10.00
1107. Attorneys Fees to
indudes above item numbers:
1108. Title Insurance to White Rose Settlement Services Inc. Basic 1 203.75
indudes above item numbers)102, 1103, 1104, 1111
1109. Lender's Coverage $ 110,800.00 9
1110. Owner's Coverage $ 138,500.00 1,203.75
1111. Ends PA100/300/8.1 to White Rose Settlement Services Incl w/1108 $150
1112. Closing Service Letter to Old Republic National Title Insurance Co. Ins. Letter 35.00
1113. Doc. Prep. Fee to White Rose Settlement Services 15.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 42.00; Mortgage $ 70.00; Releases $ 112.D0
1202. Ci /Coun Tax/Stam s: Deed 1,385.00• Mort a e 1,385.00
1203. State Tax/Stam s: TransferTax ; Mort a e 1,385.00 1,385.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve to
1302. Pest Ins ection to
1303. Tax Certification
1304. Overni ht/Delive Fee to White Rose Settlement Serv/FedEx Pk 9.75
1305. Wire Fee to White Rose SSJCommerce Bank Incg 10.00
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 5,661.12 4,165.00
ay siynniy page I or rnls s1a[emen[, me sgnarones aacnowleage receipt or a comp(eteo~o y of page 2 of t is two age statement.
..
t l
Certified to be a true copy. ite Rose Settlement Se 'ces, Inc.
Settlement Agen t
( 09-0618 / 09-0618 / 26 )
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SCHUCKER, FRANCES M. 21-09-0119
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cash in decedent's possession. 311.99
2 Alcoa Retirement -final pension check. 347.72
3 Citizens Bank -Certificate of Deposit No. 6241-083134 -Date of -death balance, 47,665.32
plus accrued interest.
4 Citizens Bank -Certificate of Deposit No. 6244-045284 -Date of death -balance, 60,354.20
plus accrued interest.
5 Citizens Bank -Certificate of Deposit No. 6245-257633 -Date of death -balance, 12,221.31
plus accrued interest.
6 Citizens Bank -Checking Account No. 610078-544-0 -Date of death -balance, plus 3,951.99
accrued interest.
7 Comcast -refund -cable service. 20.50
8 M&T Bank -Certificate of Deposit No. 31003917269035 -Date of death balance, plus 49,465.61
accrued interest.
9 M8T Bank -Checking Account No. 9846286376 -Date of death balance. 25.01
10 1883 - $5.00 US Gold Coin -appraised value. 225.00
11 1903 - $2 1/2 Dollar US Gold Coin -appraised value. 190.00
12 Household Goods -appraised value. 798.00
TOTAL (Also enter on Line 5, Recapitulation) I 175,576.65
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (12.99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
SCHUCKER, FRANCES M. 21-09-0119
Debts of decedent must be reported on Schedule L
ITEM DESCRIPTION AMOUNT
NUMBER
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 State Zip
Year(s) Commission paid
2. ~ Attorney's Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip _
Relationship of Claimant to Decedent
4. ~ Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
10,424.04
372.00
7. Other Administrative Costs 6,715.84
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 17,511.88
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
SCHUCKER, FRANCES M. 21-09-0119
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Musselman Funeral Home, Inc. -Funeral expenses 8,241.50
2 Rudy's Italian Restaurant -Funeral Lunch 337.54
3 Schuylkill Memorial Park, LLC. -Chapel Rental 485.00
4 Schuylkill Memorial Park, LLC. -Interment Charges. 1,360.00
H-A Subtotal 10,424.04
Other Administrative Costs
5 D8~S Lawn Services -lawn maintenance - 54 Burd Drive 210.00
6 Debbie Lupold, Tax Collector - County/Township Real Estate Taxes - 54 Burd Drive. 428.68
7 East Pennsboro Township - Sewer/Trash - 54 Burd Drive. 115.00
8 Haar's Auction Service - 2% Commission -sale of 54 Burd Drive. 2,770.00
9 Hardy's Auction Services -Advertising charges - 54 Burd Drive 339.40
10 Home Paramount -yearly charge - re Contract requirements. 140.98
11 Keystone Oil -Oil deliveries -1/31/09 - $409.71; 3/31/09 - $299.88. 709.59
12 PA American Water Co., -water service -March, April, May 8~ final 2009 108.74
13 PP8~L -electricity service -March, April, May 8~ final 2009 190.08
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
SCHUCKER, FRANCES M. 21-09-0119
ITEM
NUMBER DESCRIPTION AMOUNT
14 Recorder of Deeds - 1% Transfer Tax - 54 Burd Drive. 1,385.00
15 Register of Wills -file Inventory 8~ Inheritance Tax Return 30.00
16 S. Brian Magaro, Auctioneer -appraisal of household goods. 125.00
17 U.S. Postal Service -Postage/Certified Mail 31.86
18 UPS -charges -return of Medical Alarm System 17.55
19 Verizon -telephone service -March, April, May 8< final 2009 103.96
20 White Rose Settlement Services -Notary fees 10.00
H-B7 subtotal 6,715.84
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev1512 EX+ (6-98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SCHUCKER, FRANCES M. 21-09-0119
Include unrelmbursed medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 AT&T -long distance service - 54 Burd Drive -final charges. 24,87
2 Camp Hill Emergency Physicians -balance not covered by insurance. 63.94
3 Center for Kidney Disease 8~ Hypertension -balance not covered by -insurance. 169.99
4 Central PA Pulmonary Associates -balance not covered by insurance. 192.28
5 Charles R. Inners, MD -balance not covered by insurance. 77.39
6 Comcast Cable - 54 Burd Drive -final cable charges. 57.24
7 Connect America -Medical Alarm -balance due. 89.85
8 Debbie Lupold, Treasurer - 2009 Personal Taxes -billed prior to death. 4.90
9 Internists of Central PA -balance not covered by insurance. 498.09
10 Kantor 8 Tkatch Assoc., P.C. -balance not covered by insurance. 91.77
11 Keystone Oil - 54 Burd Drive -repair hot water mixer 248,72
12 Moffitt Heart 8~ Vascular Group -balance not covered by insurance. 61.99
13 PA Department of Revenue -tax due -decedent's final PA 40. 20.00
14 Pennsylvania American Water - 54 Burd Drive -decedent's account. 30.69
15 Physicians of Rehabilitation, P.C. -balance not covered by insurance. 336.61
16 PPL -electricity charges - 54 Burd Drive -decedent's account 55.85
17 Smith Radiology -balance not covered by insurance. 7.12
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 10, Recapitulation) 2,091.39
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1 (Rev. 6-98)
Rev1512 EX+ (6-98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN continued
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SCHUCKER, FRANCES M. 21-09-0119
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9.00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
~~.nu~.n~r[, rrwlv~.~a m. 21-09-01 19
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
Do Not Llst Trustees
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)I
1 Carole S. Brehony Daughter 1/4th Tangible
306 Dwight Street Personalty;
West Lawn, PA 19609 1/5th Residue
2 Daniel S. Brehony Grandson 1/30th Residue
3319 E. University Dr. #455
Mesa, AZ 85213
3 Melissa J. Harbold Granddaughter 1/30th Residue
630 Belfry Dr.
Blue Bell, PA 19422
4 Kimberly L. Haynes Granddaughter 1/30th Residue
1794 Ridge Road
Westminster, MD 21157
5 Cynthia S. Hubler Daughter 1/4th Tangible
618 Grandview Avenue Personalty;
Camp Hill, PA 17011 1/5th Residue
See continuation schedule attached Continuation
Total
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
SCHEDULE J
The BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
FRANCES M. SCHUCKER 01/27/2009
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Daniel D. Schucker Grandson 1/30th Residue
4940 E. Beverly Road
Phoenix, AZ 85044
7 Douglas W. Schucker Son 1/4 Tangible
4940 E. Beverly Road Personalty; 1/5th
Phoenix, AZ 85044 Residue
8 Thomas D. Schucker Grandson 1/30th Residue
4940 E. Beverly Road
Phoenix, AZ 85044
9 Kathleen M. Young Granddaughter 1/30th Residue
1617 Lowell Lane
New Cumberland, PA 17070
10 Janet F. Hubler Daughter 1l4 Tangible
603 Grandview Ave. Personalty; 1/5
Camp Hill, PA 17011 Residue
Total
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