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HomeMy WebLinkAbout06-29-09J REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 8 1 0 2 8 PO 80X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09292008 11271914 Decedent's Last Name Suffix Decedent's First Name MI LANDIS J. STANLEY (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 ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) 0 ^ g Decedent Died Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 1 D Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes ^ 11. Election 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 Daytime Telephone Number HAMILTON C DAVIS 7175325713 Firm Name (If Applicable) ZULLINGER DAVIS, PC First line of address 20 EAST BURD STREET, SUITE 6 Second line of address City or Post Office SHIPPENSBURG State ZIP Code PA 17257 Correspondent'se-mail address: HCD@hamiltondavislaw.COm na ea REGISTER O..S USE QNLY ikl ~ ~ ~ ~~ ~ m n.~ J " . ~ V I. ~~ :A 'r3 -t .. DATE FILED ,,.... _,.~ r_i f.,,.~ -.- / ~~ 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~~;_. ~t~'~: \~~~~;1,~_~i~E` ~~ ,t-~tA MINKASARACINA ~i~2_S I ~A ADDRESS 15 CHURCH ROAD, APT. A, CARLISLE, PA 17013 SIGNATURE PREPA~E~/OTHER THAN REPRESENTATIVE A ~i //~i DATE /~,~,,~tf/~L.n„ ~' / Hamilton C Davis G~z~•~~, ADDRES Tr 20 East Burd Street, Suite 6, Shippensburg, PA 17257 Side 1 1505607120 1505607120 1505607220 REV-1500 EX Decedent's Social Security Number oecedenrsNeme: LANDIS, J. STANLEY 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. 17,053.67 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property S h S 3 1 7 9 0 9 9 0 ( c edule G) ^ eparate Billing Requested ............ . 7, , 8. Total Gross Assets (total Lines 1-7) ...................................................................... . g. 3 3 4, 9 6 3. 5 7 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... .. 9. 12,572.15 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. .. 10. 53.50 11. Total Deductions (total Lines 9& 10) .................................................................... .. 11. 1 2, 6 2 5. 6 5 12• Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12, 3 2 2 , 3 3 7 . 9 2 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. 3 2 2 , 3 3 7 9 2 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 15. 16. Amount of Line 14 taxable 3 2 2, 3 3 7 9 2 at lineal rate X .045 16. 14 , 5 0 5 . 2 1 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due .................................................................................................................... . 19. 14 , 5 0 5 . 2 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 08 - 1028 DECEDENT' NAME LANDIS, J. STANLEY STREET ADDRESS 15 CHURCH ROAD, APT. 1 CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable p. Interest E. Penalty Total Credits (A + B + C) Total InteresUPenalty (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. (1) 14,505.21 (2) 0.00 (3) 0.00 (4) (5) 14,505.21 (5A) (56) 14,505.21 Make Check Payable to: REGISTER OF WILLS, AGENT 'a~'i~<'~3':rPai'~~if{r'`rw yP. ~r ~~ .. r c- ;. ~. , ~ - PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................. ^ b. retain the right to designate who shall use the property transferred or its income :.................................... ^ c. retain a reversionary interest; or .................................................................................................................. ^ ^x 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? ....................................................................................................................... ^ ^x 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 a beneficiary designation? ...................................................................................................................... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ..- _ .. _ __ ~ - --: ~, ~, e - Fordates 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 exemot 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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF LANDIS, J. STANLEY 21 - 08 -1028 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 ORRSTOWN BANK CHECKING ACCOUNT NO. 404497 1,805.89 2 ORRSTOWN BANK SAVINGS ACCOUNT NO. 706000091 3,173.87 3 ACCRUED INTEREST ON ITEM 2 3.95 4 HOSPITALERS RELIEF 1,023.75 5 CONSECO INSRUANCE PREMIUM REFUND 247.21 6 2008 INCOME TAX REFUND 10,799.00 TOTAL (Also enter on Line 5, Recapitulation) I 17,053.67 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF LANDIS, J. STANLEY FILE NUMBER 21 - 08 - 1028 This schedule must be completed and filed if the answer to any of questions 1 through 4 on oaae 2 is ves_ ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 SCUDDER DESTINATIONS VARIABLE ANNUITY, 275,909.90 100% 275,909.90 CONTRACT NO. KL11011719, PAYABLE TO , CHILDREN AS NAMED BENEFICIARIES 2 GIFT TO DAUGHTER, MINKA A. SARACINA, MADE 17,000.00 3,000.00 14,000.00 WITHIN ONE YEAR OF DEATH i 3 GIFT TO DAUGHTER, RANDI L. TRUNER, MADE 17,000.00 3,000.00 14,000.00 WITHIN ONE YEAR OF DEATH 4 GIFT TO SON, TIMOTHY L. LANDIS, MADE WITHIN 17,000.00 3,000.00 14,000.00 ONE YEAR OF DEATH I I TOTAL (Also enter on line 7, Recapitulation) 317,909.90 COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H /~FU~N~E~RcA~LpEXPEfVVSES & /'YJIY111~7 1 rW I IYG W~7~ ESTATE OF LANDIS, J. STANLEY FILE NUMBER 21 - 08 - 1028 Debts of decedent must be reported on Schedule L ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 2. 3. City State Zip Year(s) Commission paid Attorney's Fees HAMILTON C. DAVIS, ESQUIRE Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5. 6. 7. 1 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS Accountant's Fees Tax Return Preparer's Fees HAMILTON C. DAVIS, ESQUIRE Other Administrative Costs THE NEWS CHRONICLE -LEGAL ADVERTISING 12,100.00 100.00 75.00 113.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral Expenses & Adminishative Costs continued FILE NUMBER ESTATE OF LANDIS, J. STANLEY 21 - 08 - 1028 CUMBERLAND COUNTY LEGAL JOURNAL -LEGAL ADVERTISING 3 I ORRSTOWN BANK -CHECK ORDER FEE 4 ~ STOTT AND STOTT FINANCIAL SERVICE FEE 75.00 9.15 100.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COM NHERITANCEOTAX RETURLN ANIA LIABILITIES, & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF LANDIS, J. STANLEY 21 - 08 -1028 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 SHIPPENSBURG HEALTH CARE CENTER 12.00 2 I CUMBERLAND GOODWILL FIRE AND RESCUE ~ 11.50 3 I STOKEN OPHTHALMOLOGY ~ 10.00 4 I BAXTER DREW WELLMON, DO ~ 20.00 TOTAL (Also enter on Line 10, Recapitulation) I 53.50 REV-1513 EX+ (9-00) ,~ ~ s SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LANDIS, J. STANLEY FILE NUMBER 21 - 08 - 1028 NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I, TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 MINKA SARACINA DAUGHTER 1/3 OF RESIDUE 102,610.90 15 CHURCH ROAD, APT. A CARLISLE, PA 17015 2 RANDI TURNER DAUGHTER 1/3 OF RESIDUE 102,610.90 110 RICHARDSON STREET OXFORD, MD 21654 3 TIMOTHY LANDIS SON 1/3 OF RESIDUE 102,610.90 429 WEST MAIN STREET WALNUT BOTTOM, PA 17266 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover 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 SHEETI O.OO HAMILTON C. DAVIS Attorney at Law Newville & Shippensburg Penna. .~ ..,w.»-....... LAST WILL AND TESTAMENT I, J. STANLEY LANDIS, (sometimes known as Jacob S. Landis), of Penn Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including r~ ~~ ~~ t \.. `~:_ u (`~ ~~ ~ ~. _~. •~. • .~ IILTON C. DAVI5 \T TCIRNEY AT LAW ILLE & uNIPPEN SOURu PENNA. Amy gravemarker 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 administration of my estate. ITEM II: I bequeath those articles of my household furniture and furnishings and those articles of my personal effects and personal property as set forth in a separate memorandum, which I shall place with my will or deposit with my attorney, to the persons therein designated. ITEM III: I devise and bequeath the residue of my estate of every nature and wherever situate to my wife, MARION R. LANDIS, providing she shall survive me by thirty days. ITEM IV: Should my wife, MARION R. LANDIS, predecease me or die on or before the thirtieth day following my death, I devise and bequeath all of the residue of my estate of every nature and wherever situate to my issue, per ~stirpes, living on the thirty-first day following my death. ITEM V: I appoint hi_s or her respective parent or parents, guardian of any property which passes outright either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall rot supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including secondary, college education, both graduate and undergraduate, professional and other education) without regard to his or her parent`s ability to provide for such support and education, or to make payment for these purposes, without further responsibility to the minor or to the minor's parent or to any person taking care of the minor. ITEM VI: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. ITEM VII: I appoint my daughters, RANDI TURNER, presently of Beverly, ~INew Jersey, and MINKA SARACINA, presently of Mechanicsburg, Pennsylvania, executrices of this my last will. Should both of my said daughters, RANDI TURNER and MINKA SARACINA, fail to qualify or cease to act as executrices, I appoint my son, JEFFRY S. LANDIS, executor of this my last will. ITEM VIII: I direct that my executrices or guardian or their successors LTON C. OAVIS fGRNEY AT LAW .E S SHIPFEN.'.d IIRG PEN l1 A. shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on three (3) sheets of paper, dated this h ~ da of Y S '~~~tM~4.~ , 1984. J. Staple andis ~i~ The preceding instrument, consisting of this and. two (2) other typewritten pages, each identified by the signature of the testator, was on the day and date thereof signed, published and declared by the testator therein named, as and for his Last Will, in the presence of us, who, at his request, in his presence, and in the presence of each other have subscribed our names as witnesses hereto. r ~-7 ~ ~ ~ / ~ - -~' ~ '' G~-C~r" residing at ~'~ ~ 3 e ~ ~ ~ residing at ---~~~f d. t° G , 2 f t a t IILTON C. DAVIS 1TTORNEY AT LAW LLE 6 SNI PPEN99U RG PENNA. COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, J. STANLEY LANDIS, the testator whose name is signed to the attached instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~ J. Stanley, d~fs Sworn or affirmed to and acknow/~ edgS d '~ before me, by ~ - T N rl~ the tator, this c, day of ~~ 1984. t ~~ ~ otary Pub t?fi~FTt! ~. ~~- s;~'~l;sY ,~3'C11C 1 TEST Pi?tr~i <:,~ ,'s~;~„ r; ~° cFaL~:'t7 CCElWTY ~' ~" ;1.afT,,, t~Y ee~:f~:~:iw~=~' ~;~T=:~e5 SE'~T. ??, 1587 , ~' H 11 SI3 ~s~^ec~A~:pan o9 Pbata~ies COMMONWEALTH OF P i~'t`i~'~lw~'~~A ss. COUNTY OF CUMBERLAND We , ~K.ic~ /P L~ say Ej, S and ~~~.LT..d C7~~:~5 the witnesses whose names are signed to the attached instrument, being duly qualified according to law, do depose and say that we were preser_t and saw the testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the Will as witnesses; and that to the best of our knowledge the testator was at that time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. r ./ ~ ,' Sworn or affirmed to and subscribed before,, me by i~'i2~ ,~. ~w a%i.5 and ~,yyyLT,~L' ,a v, S , .witnesses , this ~~ft. day of 1954. ,~ II / otary Public E i~?7cTii ~. E~Zf~, ~~Tt1~Y N~iv ~j?~hi ;~u0tp.~ ~~'~.. Ca3~4iER-fael~ ~©BMTY klY C~J?fltr.SS3C!t EXP;RES SEPT. 32, 1957 R+ienker. P'bnns~Exaiia r~saotiatien cf ~!u;ariss LocAL OBITUARIE ~ J. Stanley Landis Carlisle A Memorial service for J. Stanley Landis , 93 of Cazlisle, will be held October 4, 2008 at 11 a.m. in the Egger Funeral Home Inc. 15 Big Spring Ave. Newville with Bruce Reifstock officiating. He died Monday September 29, 2008 in Carlisle Regional Med- ical Center. He was born November 27, 1914 in Lancaster County, the son of the late Jacob Z. and Lidia Kreider Landis. He is preceded in death by his wife Marion R." Molly" Landis who died August 18, 2000. Mr. Landis was a graduate of Paradise High School, and Millersville University, and took graduate courses at Temple Uni- versity. He taught Industrial Arts for 37 yeazs in the Philadelphia area. He also taught apprenticeship courses during WWII at Baldwin- Hamilton-Lima Corp. in Eddystone PA and Ludwig Honel Corp in Folcroft PA. He retired to Cumberland County in 1975 and start- ed asecond cazeer remodeling homes and apartments, He was a member of 2nd Presbyterian Church in Carlisle, the Carlisle Historical Society and P.S.E.A.R. He is survived by two daughters Randi Turner of Oxford MD, and Mirka Saracina of Cazlisle, and two sons Jeffry S. Landis of Carlisle, and Timothy L. Landis of Walnut Bottom; one sister Lois Acker of Mechanicsburg, seven grandchildren, one step-grand- child, and 15 great-grandchildren. He is preceded in death by two sisters Kathleen Werner, and Vera Byle. Burial will be held at the convenience of the family. Orrstown donates $6,500 to charity Open hog Social Se LIFE (Living Indepen- serving reside Bence for the Elderly) Luther- County, make an Services is hosting an open eligible indivi house on Wednesday, October independent 8, 4:00 p.m.-7:00 p.m., for the communi~ anyone interested in learning possible, thrc more about this new ministry delivery of of Lutheran Social Services. array of he The open house will be held at services. Co the LIFE Center, 840 Fifth interdisciplin Avenue, Chambersburg, PA. ices are prim For directions or more infor- the LIFE Cf mation, please call LIFE Fifth Avenu Lutheran Services at (717) burg, and s 264-5433. in-home and LIFE Lutheran Services, All services GIANT food of Breast Ca This October, Giant Food women. Th. Stores across Pennsylvania grateful to 1 are going pink in support of for working National Breast Cancer effort." Awareness Month. According Giant al to an estimate by the Ameri- chain-wide can Cancer Society, more than features grc 200,000 new cases of breast chandise, 1 cancer were diagnosed in and floral 2007. Today Giant announced the pink ril that it will donate five cents of Giant will every reusable bag sold in area "paint Pennsylvania throughout the customers month of October to the Penn- products m Sylvania Breast Cancer Coali- of the prom tion (PBCC). The PBCC is a be donated statewide non-profit organiza- and Giant lion that represents, supports G. Komen and serves breast cancer Sur- ters across vivors and their families operating through educational program- $10,000 w ming, legislative advocacy and Pepperidg~ breast cancer research grants. $10,000 b "No woman with breast Komen for cancer should be denied treat- "Octobe ment -regardless of their Awareness income or insurance situa- " 80 percent said Pat Halpin-Mur tion, : women. w i PHOTO BY CHRIS KELLY (Left to right) Sheryl Perkins, Shippensburg Orrstown Bank employee and United Way board member with Ken Shoemaker, Pr_ esident and CEO of Orrstown Bank, C3~sTO~w~ B~~ A Tradition of Excellence May 21, 2009 To: Hamilton C Davis 20 East Burd Street, Suite 6 Po Box 40 Shippensburg Pa 17257 From: Traci Yohe Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re: Estate of J Stanley Landis, Date of death September 29, 2008 ~~Au 2 6 ZQ~09 IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOLINTS WITH ORRSTOWN BANK: CHECKING ACCOUNT Account # Title of Account 404497 J Stanley Landis SAVINGS ACCOUNT Account # Title of Account 706000091 3 Stanley Landis CERTIFICATE OF DEPOSIT Account # Title of Account Date opened Principal Accrued Interest 01/04/95 1,805.89 0.05 Date opened Principal Accrued interest 0 i /04/95 3,173.87 3.95 Date Opened Principal Accrued Interest P.O. Box 250 • Shippensburg, PA 17257 • 717.530.3530 • 717.532.4143 fax uCT-20-2008 12:02P FROM:STOTT & STOTT Contract Values CONTe1/tt:T VALUES ;rudder Destinations 717-243-1748 T0: 101033317175305222 P.2 Page 1 of Owner: Landis,J. Stanley Contract Issue: 04/07/2000 Con : KI11011719 as of 9!30/2008' Contract Values Current Contract Value* $275,909.90 Death Benefit Value $275,909.90 CRIB Rider NO Charge on Surrender" $0.00 Surrender Value $275,909.90 Total Premiums Year to Date $0.00 Inception to Date Premiums $405.479.08 Free Withdrawal Amount $275,909.90 Pre-TEFRA Principal $0.00 Post•TEFRA Principal $280,000.00 Total Withdrawals Year to Date $-48,000.00 ~gfa4lo~ 'Values are as of the previous business day. etas are determined based on Central Standard Time. " A withdrawal charge may be assessed for early wllhdrewals. This charge Is computed by aublreding any applicable surrender charges from the curent contract value. withdrawals are subject to tax. Withdrawals prior to age 58 1/2 are subject to an additional 10% tax penalty. Please caH Annuity Contact Center 1-800-449-1)523 for further information. https://www.kemperinvestors.cotn/ContractValues.jsp 9/30/2008 LAW OFFICES OF ZULLINGER - DAMS PROFESSIONAL CORPORATION JOEL R. ZULLINGER 14 North Main Street Dale F. Shughart, Jr Suite 200 of counsel Chambersburg, PA 17201 717-264-6029 Fax:717-264-1884 zuln rg law~u,earthlink.net Register of Wills Cumberland Courthouse Room No. 102 One Courthouse Square Carlisle, PA 17013 RE: Estate of J. Stanley Landis Est. No. 21-08-1028 Dear Sir or Madam: June 26, 2009 a .a ~ ; . , ~- ;,' - r_ ~' , rr, ~ cv ~-; , _~y _ _. ~Q n ~~ .. .. o Enclosed herewith please find an inheritance tax return, filed in duplicate, and payment in the amount of Fourteen Thousand Five Hundred Five dollars and 21/100 ($14,505.21), as payment for the above estate. A check for filing fee in the amount of $15.00 is also enclosed. Please send a bill to our office for any additional costs due. If there are any questions or concerns, please contact me at the Shippensburg office. Thank you. Si cerely yours, Cam' H ilton C. Davis for Zullinger -Davis Professional Corporation HCD/njk Enclosures HAMILTON C. DAMS 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 717-532-5713 Fax:717-530-5222 hamiltondavislaw(a~ comcast. net Reply to: Hamilton C. Davis P.O. Box 40 Shippensburg, PA 17257 a .,, ~~'`~~~ CV ~~ ~- ~'~ s ~,~ c'~- 4 ''~ ~ ^'~ ~~ `.Y' o ~; a t ~, ~ _, ~. u~ ~, `'ii. v. r. ;~i W ~~11ldCl O ~ ~ ^~ ^~ ,a, ~ ~ '~ '~ :' -~ ; ;~., ~~ z~o~,~. ~, h =oQ ~=~~ I~l~, 'T ~" O a 8 E ~' N ._. ~ .~ a t. 1 ~ z ~,' w E- - _ ~ .~~ ~ <x. m T z w a a a 'i ~~•~ ~~~~,.; f ~ .;,;~ {ti ~~~- ~i•4 _ ... i ;~~m~:~ '' «,,. W tq O x W ~i Q,' M ~ D~ ~ o ao -~ U t/1 !~ ~ H CWJ~ ~ w oNoa oQox a ~~aw waoxa ~xzo~n ~ W UH Ha~~ a c~~owa w~oz~ C~ UG4OU ~~