The URL can be used to link to this page

Home My WebLink About06-19-09 (4) 1505607120 REV 1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2sosol 2 1 0 9 0 0 3 8 8 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 189 07 0025 04 10 2009 04 18 1918 Decedent's Last Name Suffix Decedent's First Name MI BLETTNER ESTHER 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 THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) ~~ 4. Limited Estate ~_~ qa. Future Interest Compromise L. J 5. Federal Estate Tax Retum Required (date of death after 12-12-82) f3 Decedent Died Testate ~, Decedent Maintained a Living Tnist 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) -- (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 1 p, 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 DAVID J . LENCJX 717 432 9666 Firm Name (If Applicable) THE WILEY GRGUP,~PC First line of address 130 W. CHURCH STREET Second line of address City or Post Office DILLSBURG State ZIP Code PA 17019 ~~; REGISTWILLS U~ ONLY. ...,~~ ~ _ t, ~. ; ~ ~ t,sC7 =~ ~ ~ c`~ ~,.~.. .~{µ C~TE FILED * ~ ' ~ ' rv Correspondent's a-mail address: d a v e l e n o x~ c o m c a s t. n e t Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and ce ete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. RE OF.PE O R SPONSIBLE F FILING RETURN DATE Marie E. Boyer - ADDR SS 688 L nes Road, Dillsbur , PA 17019 SlrifQ1~TURE OFl~ftER 0 R THAN REPRESE ATIVE DATE David J. Lenox, Esquire 130 W. Church Street, Dillsburg, PA 17019 d Side 1 L 1505607120 L 15056U7120 J J REV-1500 EX oec~enes Nerve: Esther M. B l e tt n e r Decedent's Social Security Number 189 07 0025 RECAPITULATION 1 3 5 2 4 0 0 1 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 8~ Miscellaneous Personal Property (Schedule E) ................ 5. 5 5 9 6 8 1 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 1 9 1 3 0 7 0 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) [~ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 1 5 9, 9 6 7 5 2 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 1 6 0 9 1 0 7 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................................ 10. 3 8 6 3 9 11. Total Deductions (total Lines 9~ 10) ...................................................................... 11 • 1 6 4 7 7 4 6 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 1 4 3 4 9 0 0 6 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. 14. 1 ( ) ................................................. Net Value Sub ect to Tax Line 12 minus Line 13 14. 1 4 3 4 9 0 0 6 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 16 at lineal rate X .045 1 4 3, 4 9 0 0 6 . 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 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 6,457.05 0.00 0.00 6,457.05 0 Side 2 L 1505607220 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-00388 DECEDENT'S NAME Esther M. Blettner _ STREET ADDRESS 1046 York Road -------- CITY ---- - STATE ZIP Dillsburg PA 17019 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty ----3 2 2.8 5 Total Credits (A + B + C) (1) 6,457.05 (2) 322.85 Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (3) (4) (5) 6,134.20 (5A) (5B> 6,134.20 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 :.................................................................................. ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................... ^ ^x c. retain a reversionary interest; or .................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ^ ^x 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 "in trust for" or payable upon death bank account or security at his or her death?......... ^ x^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which -- contains abeneficiary 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 benel'tciaries 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. ~~~k rll tttt~ t~estttrrtertt OF ESTRER M. BLETTNER BE IT REMEMBERED, that I, ESTRER M. BLETTNER, of 1046 York Road, Dillsburg, i~4onroe Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath as follows: 1. One-third (1/3) thereof to my daughter, LINDA L. GREEK. 2. One-third (1/3) thereof to my daughter, MARIE E. BOYER. 3. One-sixth (1/6) thereof to my daughter, JOYCE E. FICRETT. 4. The remaining one-sixth (1/6) thereof to my granddaughter, JES3IC~_ L. iiABECRER. ITEM 3: I direct my hereinafter named Co-Executrixes to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the NESS: -tC~ ~ 6~C ESTRER M. BLETTNER -1- transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforese?d taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ZTEM 4: I appoint my three daughters, LINDA L. GREER, MARIE E. BOYER and JOYCE E. FICRETT, as Co-Executrixes of this my Last Will and Testament. ITEM 5: I direct that my Co-Executrixes shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNEBB WHEREOF, I have hereunto set my hand and seal this ~? 7~ day of /4~~ ~ ~ , 1999. W ESS: ~v~I~..~ ,/~1 F/~ 1~:~(~- ( SEAL ESTHER M. BLETTNER -2- COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF YORK We, ESTHER M. BL,?:'I'TZiER, JAN M. WILEY, ESQUIRE and JANICE E. YOCUM, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last Will and Testament as witness and that to the best of their knowledge the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ESTHER M. LETTNER l~h W ESS ITNESS ' Sworn to and subscribed before me this 2 ?.~ day of ,~l 1999. /~1 NOTARY PUBLIC MY COMMISSION EXPIRES: No[arial Seal , _,nc S pawn G~adlelter, Not'' pillsburg Boro. YDrk C : i ~res';~~,., 200t My ; ommiss~on Exp Member, cnnsylvania Associa~."~~'~ of Notaries Rev-1602 EX+ (8-88) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blettner, Esther M. 21-09-00388 All real propeRy owned solety 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 survivorehlp must be dlaclosed on schedule F. (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 A (Rev. 6-98) OMB Approval No. 2502-0265 ~~r ~~~t~1R ~ A. Settlement Statement (HI~TI)~1) 1. ~ FHA 2. ~ KHS 3. ®Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Inswance Case Number: 4. ^ VA 5. ^ Cenv. Ins. 3146750 C. NOTE: This fonn is furnished to give you a statement of actual settlement costs. Amounts paid to and by the sett]ement agent are shovm. Items marked "(p.o.e.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name & Address of Borrower(s): E. Name & Address of Seller(s): David A. Taylor (Mort. Signer Only) Kelly S. Taylor Estate of Esther M. Blettner Marie E. Boyer 309 Hempt Drive 309 Hempt Drive c/o Atty David J. Lenox Executrix Mechanicsbwg, PA 17050 Mechanicsbwg, PA 17050 130 W. Chruch Street, Suite 101 llillsbwg, PA 17019 F. Name & Address of Lender: G. Property Location: Home Loan Center, Inc., dba I:ending Tree Loans 1046 York Road 163 Technology Drive Dillsbwg (Monroe Township, Crunberland County), Pennsylvania 170] 9 Irvine, CA 92618 Place of Settlement: H. Name of Settlement Agent: The Wiley Group Richard A. Cairo, Attorney at Law l 30 W. Church Street, Suite ] O1 I. Closing Date: Disbursement Date: Dillsburg, PA 17019 6-12-2009 6-12-2009 .100. Gross Amount Due from .Borrower 101. Contract sales rice ]35 000.00 :' 102, Personal ro e T'103: Settlement char s to Borrower line 1400 7 363.73 :1:04. X105:` ~:Ad'nstments for items aid- ' seller in advance X106; C (town taxes 6-12-2009 io' .12-312009 185.30 ': 107 i' Couii .taxes to: _,., 108: Assessments to 1;09:,School Tax, 6/]22009 to 6/30/2009 54.71 110. ' ~hla , ,. -::x.12. 120:Gross Amount Due from Borrower 142 603.74 j '~OOs'Amoants Paiid ; `or in Behalf"of Borrower ` ~ 01 osit or. earnest none 10 000.00 ~Z'.' `PrinCi al amount of new Loans ` 107 500.00 ~^~2U3~ Fadstin -loans taken sub'ect to' , 204: Appraisal Credit 600.00 205_ .~ 306,. f2p~` ~~2U8. ,.,_... . 209: ~`:'1~d`iistments for items rin aid b seller 2~0; Ci /town taxes to X21.1: -Coon .taxes. to :'212.: Assessments.... to .: ,.: 213'_ . 214: °2"1'5., .216: •,217. Yy218. 2] 9. • >220: Total Paid b /for Borrower 118.100.00 `~<300..Casb at Settlement from/to Borrower ~3U1. Gross amount due from Borrower ' e 120 142,603.74 :302. Less amounts aid /for Borrower line 220 118 100.00 ° `303. Cash From To Borrower 24 503.74 The Public Reporting Bwden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured, this discloswe is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. Previous editions are obsolete Page 1 of 3 HUD-1 T ' ,s ,R _ ~2:' `3 „¢+F " 'x/ ~a, '7.F{.~;>~ h ~ ~~ .! ~ C ~ a A'. .D 1 d ~~~ ~ y-AY-.' ~ 1 $~~ ~*. y3h .~ t 4 -9i'•' r[ ~. . }~Y' ''F „P +ik.` j ~ , . ~.FYt~+-CWfJG1I' I` s ~ ~ h sy '~ Y..~ { ~ 3 .. T -~ k? 4 y bT. .i~ J -J ~ 4 T -psi~ki ~ Ir 1_, l ~` U't' ~Z~. s ~ '+ H ~ ° y ~~ S r +Y''{ 1 SH ~% J~ , e. - ~ ~ 4' r1 ^+ ~.. ?B,~y ku~'~ -. a ~ - ~. ` ~~ ` ~ ~ ' ~~~ r ,,tit 1,075.00 1. _ ss ~ ~~.~°~ - '.,, .ar r „a ~ 4 rr' , ter ~`~ 400 00 ` ~ e _ . ""' * ~~, , ;~~r ~ r 4• ~.-, _ '.b'~~ :~~ ~~ :~: ` ~ = f~ . 679.00 _ r '~" ~ ~~ s°,{ aFU + ~~~~~~Xx ,i ~~`~ ~`~" ~~ ~ s~~ der kf w- ~ ,^ ` A ~ { + L°°' ', ~ .<y . ~ ~ s. ~ %~ ~ ~ t ~ 9 Ta' ,yam ~ ~ ~ _.~P ~. ~- ~ .' a7A~i: ~ ~ `_, t . , ,~ ~ ,~ '! ~~~iR~^ `' x ~ . '~ Y hs ~ r _ c s ~ ' ~t $'~~v~ t~~ ';" "~a . f , ~ ~~^.Y~-+T # ' i ~~~' '~~~' ~v ~ ~ ~ q F ~ ,t~ .5 ~ . t .±n ~ ,ALLLL 3@, ~c' J~ q Y' ~"T a~ h 3` N ': yy+Y~~~~ t . ' -~~4'~ "1. Y .'Y~1 i F C ~'' S ~ S ~J.r~ ~i~ '~+S W y i F ,Y .~ xt } 9. F~~ti r i ~ E rz, ,< ~~}' S. S'~:: ~ ~" Y ~ ~ . . ~ iy, "'9r~ ~'u ~5, m ~ +~ ~ 3 _ . J ] L~ N $iy 1 i ~~ F ~~~.4 ( t~ ~ i ?~l~ rb- ~~ ) ~ L ~ ~ . Y_ .} ~.~' 6 -.~+ E 'sYiLrd~ _ I'r:zF ~7. _ F` t+y` 7,363.73 1,350:00 CERTIFICATION: I have carefully reviewed the HUD-1 Settlement Statement and to be best of my knowledge and belief, it is a true and accurate statement of alt receipts and disbursements made on my account or by me in this transaction. I further certify that I receive a copy of the HUD-1 Settlement Statement. ~~--1. ~ - ~.' _ Signat r of Borrower Sign e of Borrower C~ ~ ~ P~ Si afore of Seller Signature of Seller The HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds disbursed or to be disbursed by the undersigned as part of the settlement of this transaction. .e''~~ .'` ~~ ~,~` ,~ G ~ ~G~-,..s~ ~ ~ . Signature of Settlement Agent Date WARNING: 1t is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisionment. For details see: Title 13 U.S. Code Section 1001 and Section I O10. Rev-1608 EX+ (8-88) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMiAONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blettner, Esther M. 21-09-00388 InGude the proceeds of litigation and the date the proceeds were n3ceived by the estate. All property Jolirtly-owned with the right of survivorship must t-e disclosed on schedule F. (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) :~^ .. -. ~ - - ; ~~~~~~~s ~~~~~~~ -~ buy & Sett ors Gornrnissiar~ -Complete sere service 9~ Texaco del., -~#e~l~anl~sbur~, ~~ i'~~5~ ~'~6-5~'8s ~-f8 ~~ ~, t)uptatarndi~sg Tatat fade ,~,(, Total ~ ~~d[s ~':f/ ,;. ~_:_-, _-- -, ;~ - ~~~ a ~t~tar ~ ~iarits ~ ,,~`~. ~~ ~~~ ~P~6 ~ ~ ,c ~B/ ~~ s~~s~ ~~ - ~~ ~ ~Q Q®~ao ~ ', i r • Rev-1609 [:X+ (8.88) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blettner, Esther M. 21-09-00388 Nan asset was made joint within one year of the decedent's date of death, it must be roported on schedWe G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Marie E. Boyer 688 Lynes Road Daughter Dillsburg, PA 17019 B. Joyce E. Cover 2558 Raintree Drive Daughter The Villages, FL 32162 C. Linda L. Greer 6106 Housatonic Court Daughter Fairfax Station, VA 22039 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALOE OF ASSET % OF DECD'S INTEREST DATE OF DEATH DECEDENTS NTEREST 1 ABC 2/14/2007 Members 1st FCU CD Number 50021-48: 10,972.70 0.250% 2,743.18 2 ABC 3/3/2008 Members 1st FCU CD Number 50021-50 11,241.34 0.250% 2,810.34 3 ABC 6/1.1/2007 Members 1st FCU CD Number 50021-57: 10,234.60 0.250% 2,558.65 4 ABC 6/12/2007 Members 1st FCU CD Number 50021-58: 10,232.38 0.250% 2,558.10 5 E 1/11/2004 Members 1st FCU CD Number 50021-59 1,925.36 0.500% 962.68 6 D 1/11/2004 Members 1st FCU CD Number 50021-60: 1.925.36 0.500% 962.68 7 F 1/11/2004 Members 1st FCU CD Number 50021-61: 1,925.36 0.500% 962.68 8 ABC 3/12/2008 Members 1st FCU CD Number 50021-62: 11,263.80 0.250% 2,815.95 9 G 10/28/1992 Members 1st FCU CD Number 50021-63 1,921.24 0.500% 960.62 10 ABC 11/1!2004 Members 1st FCU Investment Savings 2,273.42 0.250% 568.36 Account Number 50021-05 11 ABC 1/1/1980 Members 1st FCU Savings Account 75.79 0.250% 18.95 Number 50021-00: Total of Continuation Schedule ee attached page TOTAL (Also enter on Line 6, Recapitulation) I 19,130.70 (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 F (Rev. 6-98) Rev-1bo8 EX+ (8-88) SCHEDULE F COMMONWEALTH of PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Blattner, Esther M. 21-09-00388 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. JOINTLY OWNED PROPERTY ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 12 ABC 11/1/2004 Members 1st FCU Savings Account 4.834.05 0.250% 1.208.51 Number 50021-11 TOTAL (Also enter on Line 6, Recapitulation) 19.130.70 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Schedule F Jointly Owned Property (continued) Estate of Blettner, Esther M. -File Number: 21-09-003 88 Addition to Surviving Joint Tenants: D. Charles Greer 202 Fox Creek Drive Goode, VA 24556 (Grandson) E. Thomas Greer 14102 Betsy Ross Lane Centreville, VA 20121 (Grandson) F. Jessica Habecker 2319 Oriole Drive Durham, NC 27707 (Granddaughter) G. Larry Fickett 1411 Kuhn Road Boiling Springs, PA 17007 (Son-In-Law) 04/16/2009 THU 22:35 FAX ?177955178 ME.4il3EKS 1ST FCU INSURANC S~ MEMBERS 1~ FEDERAL CREDIT UNION FACStMiLE COVER SHEET To: Dave Lenox Date: 4/17/2009 Company: # Rages including cover: Frorn: Danielle A. Kline, Insurance Services Specialist (717} 795-5139 or {800} 283-2328 extension 5139 Fax: (717) 795-5178 klined _memberslst.org Re: Esther Blettner Attached are Date of Death values per your request for Ms. Bletiner. 3 5000 Louise Drive, PD Box 40, Mechanicsburg, PA 17055 www.members1 storg 04/16/2009 THU 22:35 FAX ?177955178 KEMBERS 1ST FCU INSIiRANC X002 SAVINGS ACC~U T: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account NumberlSuffix Date Account Established PrinGpal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established INVESTMENT SA~(INGS ACCOUNT: Aexount Number/Suffer Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Acxnred Interest Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established CERTIFICATES OF DEPOSIT: Account NumberlSuffa Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established s~ 1VIEMBERS 1St FEDERALCREDri' UNIO[V 50021-00 12/05/1972 $75.78 $.01 $75.79 Joyce Cover 01/01/1980 Marie Boyer 01/01!1980 t_inda Greer 11!01/2004 50021-11 01121/1981 $4,$33.87 $.18 $4,834.05 Joyce Cover 01/21 /1981 Marie Boyer 05/0111984 Linda Greer 11!0112004 50021-05 10/2811992 $2, 273.34 $.08 $2,273.42 Joyce Cover 01/01/2002 Marge Boyer 01 /01/2002 Linda Greer 11 /01/2004 50021-48 01113/2009` $10,963.64 $9.06 $10,972.70 Joyce Cover Marie Boyer Linda Greer 0 1 11 312 0 09 "Rollover from certificate 50021-40, originally established 02/14!2007. '"'Rollover from cert~cate 50021-51, originally established 0310312008_ 50021-50 01 /3112009" $91,232.34 $9.00 $11,241.34 Joyce Cover Marie Boyer Linda Greer 01 /31/2009 5000 Louise L7rive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 w~,vwmemberslst_arg 04/16/2009 THU 22:35 FAX 71.77955178 YiEHBERS 1ST FCi1 INSURANC [~j003 CERTIFICATES OF DEQOSIT; Account Number/Suffuc Date Account Established Principal 8atance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 50021-5T 09~0912oos~ $10,224.57 $10.03 $10,234.80 Joyce ~'iOVer Marle Boyer Linda Greer 09/09/2008 50021-58 09/11 /2008*' $10,222.35 $10.03 $10,232.38 Joyce Cover Marie Boyer Linda Greer 09/11/2008 'Rollover from certificate 50021-41, originally established 06/11/2007. "Rollover from certificate 50021-42, originally established 06/12/2007. CERTIFICATES OF pEPOSIT: Account Number/Suffix 50021-59 50021-60 Date Account Established 01109/2009" 0110912009" Principal Balance at Date of Death $1,923.77 $1.923.77 Accrued Interest to Date of Death $1.59 $1.59 Total Principal and Accrued Interest $1,925.36 $1,925.36 Name of Joint Owner Thomas Greer Charles Greer Date Joint Ownership Established 01109/2009 01/09/2009 'Rollover from certificate 50021-43, originally established 0111112004. "'Rollover from certificate 50021-44, originally established 0111112004. CERTIFICATES OF DEPOSIT: Account Number/Sulfa 50021-61 30021-62 Date Account Established 01/0912009' 0210912009" Principal Balance at Date of Death $1,923.77 $11.254.78 Accrued Interest to Date of Death $1.59 $9.02 Total Principal and Accrued Interest $1,925.36 $11,263.80 Name of Joint Owner Jessica Habecker Joyce Cover Marie Boyer Linda Greer Date Joint Ownership Established 01/09/2009 02/0912009 'Rollover from certificate 50021-44, originally es#ablished 01/11/2004. "Rollover from certificate 50021-55, originalty established 03/1212008 . CERTIFICATES OF DEPOSIT: Account NumbedSuffix 30021-63 Date Account Established 03/27/2009" Principal Balance at Date of Death $1,920.05 Accrued Interest to Oate of Death $1.19 Total Principal and Accrued Interest $1,921.24 Name of Joint Owner Larry Pickett Date Joint Ownership Established 03/27/2009 `Purchased by transfer of funds from 50021-05. VISA ACCOl1NT: Account Number/Suffix 4287590010500299 Date Account Established 03/18/1992 Balance at Date of Death $.00 Name of Joint Cardholder None ERS 1sT FEDE~~~DIT~U~NION Danielle .Kline Insurance Services Specialist April 17, 2009 Estate of: ESTHER M. BLETTNER Date of Death: 04/10/2009 Social Security Number. 159-07-0025 REV-1161 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Blattner, Esther M. 21-09-00388 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2,373.06 2. Attorney's Fees The Wiley Group, PC 8,403.98 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 332.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 4,982.03 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 16,091.07 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 Blattner, Esther M. 21-09-00388 ITEM DESCRIPTION AMOUNT NUMBER Funeral Expenses 1 Baughman Memorial: 1,840.00 2 Cocklin Funeral Home: 533.06 H-A Subtotal 2,373.06 Other Administrative Costs 3 Bank charge for checks: 11.95 4 Chuck Bricker, Auctioneer: 2,490.00 5 Closing costs from sale of real estate: 1,350.00 6 Crossroads Bible Church (auction parking): 50.00 7 Cumberland Law Journal (advertise estate): 75.00 8 D&D Septic: 85.30 9 Register of Wills (filing fee): 30.00 10 The Sentinel (advertise estate): 208.78 11 Thomas Spots Lawn Service: 180.00 12 Trash Dumpster: 486.00 13 Tri County Abstract (deed copy): 15.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Blattner, Esther M. 21-09-00388 ITEM NUMBER DESCRIPTION AMOUNT H-B7 Subtotal 4,982.03 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) .~ Rev-1512 EX~ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMNAONVJEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blattner, Esther M. 21-09-00388 Include unreimbursed medical expenses. (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 I (Rev. 6-98) ' REV•1613 EX;19-0o) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blattner. Esther M. 21-09-00388 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY t)o Not Llst Trust s (Words) ($$$) I • TAXABLE DISTRIBUTIONS [include outright spousal and transfers distributions , under Sec. 9116(a)(1.2)] 1 Marie E. Boyer Daughter 45,264.20 688 Lynes Road Dillsburg, PA 17019 2 Joyce E. Cover Daughter 22,631.22 2558 Raintree Drive The Villages, FL 32162 3 Larry Fickett Son-in-Law 1,921.24 1411 Kuhn Road Boiling Springs, PA 17007 4 Charles Greer Grandchild 1,925.36 202 Fox Creek Drive Goode, VA 24556 5 Linda L. Greer Daughter 45,263.79 6106 Housatonic Court Fairfax Station, VA 22039 See continuation schedule attached Continuation 26,481.94 Total 143,487.75 Enter dollar amounts for distributions shown above on lines 5 through 18, as appropri ate, on Rev 1500 cove r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ V.VV Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J The BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Esther M. Blattner 04/10/2009 189-07-0025 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) (~$$) 6 Thomas Greer Grandchild ~,9z5.3s 14102 Betsy Ross Lane Centreville, VA 20121 7 Jessica L. Habecker Grandchild 24.556.58 2319 Oriole Drive Durham, NC 27707 Total 26.481.94 1 ~~ ~v~2loo ~ic~ZtDo.Ot~ N~~~