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HomeMy WebLinkAbout07-13-0915056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes `~ j; ~ INHERITANCE TAX RETURN ~ ~ r C~ PO Box zsosol ~~~;~ RESIDENT DECEDENT a' ~ ~ 8 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death 1 ~9 I S 1 `f 6s ~I 3D~.oos oa-I3 19 ~2 MI Decedent's Last Name Suffix Decedent's First Name LE"'NM/~~ Su~1E Z (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name MI Spouse's Last Name N/~ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 2. Supplemental Return O 3. Remainder Return (date of death 1. Original Return prior to 12-13-82) R ed O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return equir O 4. Limited Estate death after 12-12-82) Total Number of Safe Deposit Boxes D 8 ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) . (Attach Copy of Will) Spousal Poverty Credit (date of death O 10 nder Sec. 9113(A) O 11 a O 9. Litigation Proceeds Received . betveen 12-31-91 and 1-1-95) O) Attach Sch ( E DIRECTED T0: ALL CORRESPONDENCE AND CONFIDENTIAL UST BE COMPLETED H F CORRESPONDENT -THIS SECTION . M Numbe e Telephone Dayt m Name ! j 7 ~o O.O 9 ~~ S US ~ LY REGISTER OF'-ytIIL~L Firm Name (If Applicable) ~ ~~ ~ ~ _~ First line of address ' "'~ ~ -' (~ ~ L D u '_.~ ,..., Second line of address - '" ~ _ ,i . i N / ~ ~ _ DATE FILED State ZIP Code City or Post Office PA I~ osSy73~ ~E~y~N~ Cs BukG : d ' ~~ S ~ ~ ~~~5 v ~m~"a~~~~e~ ress s e-mail ad nt Correspon~e rdsogal representati e Is basted on a It ntfo mat on of which preparernhas any kdgowledge lie , nd h u e a a l e t ati Decla completec irueecor rect a d i e pe n t other tha of prepare on DATE SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS V ~kF/~ S. ~ gE~ H'N'~ ~ ~ /~d ~ T OSS ~X nStQ~L /Cd, //'11.°C SIC L~h~l, r!/ - DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE X ADDRESS n h/~~~,ca E, ~N~~~ s a r4s ~A ~7~ SS ~/P_--~' PLEASE USA ORIO,INAL FORM ONLY Side 1 1505605],047 15056051047 REV-1500 EX 15056052048 Decedent's Name: ~~N~° ~• `G "~~~ RECAPITULATION 1. 1. Real estate (Schedule A) . ........................................... . 2. 2. Stocks and Bonds (Schedule B) ......... Decedent's Social Security Number 7 9 / S / 46S 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. /]o pD0.0o .DD .~~ .D~ .... 4. Mortgages & Notes Receivable (Schedule D) ..................... . 4. 5 1 7 ~ S d, 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . . 73 ~o I / . 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... s. . O O 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property O Separate Billing Requested.... .. . 7. ~ (Schedule G) 8 / TJ ~ ' `y 3 g 8. Total Gross Assets (total Lines 1-7) ................................... . . So .Z7 z. a 9 ............ Funeral Expenses & Administrative Costs (Schedule H)...... . 9 . 9. . X30.28 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . ............ 10 10. . . . 11. So S'o a . 3 7 Total Deductions (total Lines 9 & 10) ................................. 11 .. . 12 ~ 37 ~S I .~`f ............. 12. Net Value of Estate (Line 8 minus Line 11) ............. . . .. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 13 ~ O O . ... ... an election to tax has not been made (Schedule J) ............ . . .. 14 J 3? 6S 1 . ~ ~ ..... ... . 14. Net Value Subject to Tax (Line 12 minus Line 13) .......... . . .. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ~ D 15 ,: O O ~ (a)(1.2) X .0~ , 16. Amount of Line 14 taxable t ~ ~ ~ Jr ' Sl ~ at lineal rate X .0 ~S 16. • ~ I ~ ' 3 17. Amount of Line 14 taxable ~ ~ Q 17 • O O at sibling rate X .12 O 18. Amount of Line 14 taxable ~ Q 18. at collateral rate X .15 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052048 Side 2 b l q`f.3 i 15056052048 O REV-1500 EX Page 3 Decedent's Complete Address: File Number ~/. p8 _ ~~~ DECEDENT'S NAME J'uNE 2_ LENivJq~~1 STREET ADDRESS y 8 sT,~~ ,p o.~ ~ CITY h'I EC~f,/~g~/I CSB U/?C~ STATE ^,,,g ZIP / ~ n ss- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments (1) A. Spousal Poverty Credit O i 19 ~. 31 B. Prior Payments 0 - C. Discount 0 3. Interest/Penalty if applicable Total Credits (A + g + C) (2) ~ D. Interest p ~_ E. Penalty --- 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENTotal Interest/Penalty (D + E) {3) 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. {4) O A. Enter the interest on the tax due. {5) - ~G' ~ 4 y `~~ (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 3 y ~ 3 - - (5B) / (~ y2 ~ ~ ~{ Make Check Payable to: REGISTER OF WILLS, AGENT _ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" I N THE APP 1. Did decedent make a transfer and: ROPRIA T E BLOCKS a. retain the use or income of the property transferred :............... . .... b retain th i ht Yes ^ No . e r g to designate who shall use the property transferred or its income : .................................. c retain a i ^ ........ . revers onary 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? ............................................ ............................... . . ................................. " Did decedent own an intrust for" or payable upon death bank account or security at his or her death? .............. ^ ~C] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ =THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN 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 free (3) percent [72 P.S. §9116 (a) (1.1) (i)]. 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 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 q a tax return are still applicable even if the surviving spouse is the only beneficiary. dates of death on or after July 1, 2000: 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 otive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. 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 '.S. §91161.2) X72 P.S. §9116(a)~1~~. ~~`~'~~'~~~~~1~OSed4~~ne~etValueo~t~anslecsto or aoe~~e~ eommonwth~he ae~ ae g Whether by1b~ od o~ dopto~. §9116(a)(1.3)] Asibling is defined, under . ~ a ~~ ~~ ~n'~n~~~~dual whohas atleast ore p REV-1502 EX+ (6-98) r SCHE~46LE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF L ['H Jy~~~ .7G//I~tc ~ FILE NUMBER a/-o8-/~l 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 self, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. /~GL 7N.¢T CE72Tif /A/ T2 /1•G'7` OF GKvk Nl~ .4 .OwELLl~1lG yo4sE ~NsT,r'ucrEd o~ ,~,~i~ ~~ ~N~r /V Gc /19 t3 F? EZ~ ~f(n S7it~TE ,~d~f-D , I7?E'Cy/t/!//CS.BLI /ZG~ S/~ vet SPR!/t!' T u~i°., C ~~t ,~3~7?16¢N/J Co c~/v 7Y~ ,o~N,~¢ TiQ-x .o•~Re~ ~Yo ~g z3-ds~/_o~g ~ wN/cN /s /rtorlE ~~aT~ cu ~~R~ y ~E-sc,~2/~Ev /u Tw~T C~~iti ~~~ Fiedm ~c'~,KL m. tin ~cK~-n, w~~ew, ; ~,~T~-x~ ~~. zd, I4~B To YElZE S. LE~///I/~N '~'~ Jt>!NE i, LEf//11~N, ~//S w/FE ~E"Co~2D~ vN T~YE o~i~ Dom' ?1;~E !~Z'D~ d~ /7~~5' /N .¢rvo .Fo2 Cu/hD~21~-iv.D CouNTj~ it/ DEAD /COOL' c~ ,~ !/OL • ~ 7~ ,PifiGE ~ 3 7, ~B,E/NG Fi~RTiS/E,~ R~ Co~DED /N s~~D 2ECa~Oc71s o~FicE ifs .~ C~art,(~- Cc ~ivE aE~D /N ~E~ ~K `~S' ~ Yp/, 27 Pi~E 9ss %~lE ~REI~'I /.SE3 7h~E~2E//U ~E.~/BiE7~ lvE,~2E ~E-Du~ 03Y ~ s~~3sf 4'[l ~'+~' 3k,~D/v~s~oa N~v~ ~Dr~25~' C'.~~tlr/Ey- //NCE To OECtDt7VTs ~SoN~ ~/E)2E S . L EH/j1~N, ..7~ ~ ~ilip ~~u~MrE~2 -/N-~~¢sd, pE~~y v, c~hriN.~N, ~~t-t~ /~llG; /8~ /94S /¢N1J R.fCD~DE~ /^J 7Xf S~t~ 02FCO~b~2s OFf/CF /N !~~ ,fro/< la(o~ ~~~E 1156. T~lE SAID //~2E S. LEH~I~it; /h~4g !/ERF' S. LE!/ly~,¢,,~~ St'.~ ,PRE D FC~~S~D ~h~E s ~ /1) ,TYNE r. L EyIYJi¢N` N/S G~ /FE Ti>/E 17~C"~Di k"1V T ~I~'~'E/N, WNFi~ZE'61P0/t~ aSyE i3EL~/~/yIE' ?1,~~ ,SCE ~D /~-~5ol,.uT~ owNE~ c~=' 7XF- S.,¢~,D ,i°~eEn~ isE3 ~y V/ R % U mac' p~- T~F' L~GVS OF iy/S C~lyl/Y1 D/!/ll~ccgLT// /NC /,o~--T T T~y~NC~E,s ,8Y T~/E ~i~~ ~~F T~Es VALUE AT DATE OF DEATH ~~ l~i~LGf,/t%lo~ -SEA b` F i TC~/y!~'/YT .SiYE~"T ~vl~ i~`c- R` spy Of= UE~ ~ ,,gty~S /~ ~i¢C~Y~ / 7 f>~ p pO , o0 (If more space is needed, insert additional sheets of the same si~a~ TOTAL (Also enter on line 1, Recapitulation) I ~ r ~~ DO0- oa A OMB NO. 2502-0265 B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT 1• XOFHA 2.QFmHA 3.^CONV. UNINS. 4.QVA 5.QCONV INS. SETTLEMENT STATEMENT 6 09276 UMBER: 7. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: 0072084072 441-9216882-703 C. NOTE: This form is furnished to give you a statement of actual setNement costs. Amounts paid to and by fhe settlement agent are shown. Items medred (POCJ" were paid outside the closing; they are shown here for informational purposes and ere not included in the totals. D. NAME AND ADDRESS OF BORROWER: to awe tosnsrosz7srq E. NAME AND ADDRESS OF SELLER: F, NAME AND ADDRESS OF LENDER: Stephen D. Brink and June I. Lehman Estate Susan A. Marrow MetLife Home Loans, A Division Fieldcrest Drive of MetLife Bank N.A. Mechanicsburg, Pa. 17055 4000 Horizon Way Irving, TX 75063 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1878915 46 State Road Mechanicsburg, PA 17050 Keystone Land Transfer, Ltd. Cumberland County, Pennsylvania PLACE OF SETTLEMENT 3421 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION ~--~~~ 100. GROSS nnnni ruT r,~ ~~ ~~,... ____ _ t k TO to 109. - -- 110. 111. 112. 120. GROSS AMOUNT DUE FROM BORROWER to to to 216 217 218 219 220. TOTAL PAID BY/FOR BORROWER 179,147.18 420. GROSS AMOUNT DUE to 1 14. 15. 16. n~ ~emance I axes to Ke stone Land Tr 519. 156,677.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 600 CAS to I. SETTLEMENT DATE: June 24, 2009 170,310. 75. 18,075.00 ---- • °~•~~~~. o nom comower Line 120 179,147.18 601. Gross Amount DuenTo Sel eOILROM SOELLER: 302. Less Amount Paid B lFor Borrower (Line 220) ( 156,677.00) 602. Less Reductions Due Seller (Line 520) 170,310.7( 303. CASH (X FROM) ( TO) BORROWER 22,470.18 603. CASH (X TO) ( FROM) SELLER ( 18,075.0[ The undersigned hereby acknowledge receip(t~of a completed copy of pages 182 of this statement & any attachments referred to herein. 152'235.70 Borrower ~i--L~" / I) ~~ SCtephen 15. Bnnk rl XX» Seller ~~~ ~ {\~,~ - }~}~ ~~~ _ ~ June I. Lehman Estate - ~~~dn r. rviarrow - Yf ~V\ ( 0927fi / 0927fi / 31 ) Kby~lone [and Transfer, Ltd. Certified to be a true copy:.:. Settlement Agent Tax Parcel Number: THIS INDENTURE MADE THE aV fY day of ~'kne two thousand and nine (2009). , in the year of our Lord BETWEEN VERE S. LEHMAN, JR, as Executor of the Estate of JUNE I. LEHMAN, deceased, late of Mechanicsburg Silver Spring Township, Cumberland County, Pennsylvania, Grantor, and STEPHEN D. BRINK, single man, and SUSAN A. MARROW, single woman, currently of 5022 East Trindle Road, Mechanicsburg Cumberland County, Pennsylvania, Grantees, as joint tenants with right of survivorship and not as tenants in common. WHEREAS, the said June L Lehman, was vested in her lifetime with title to the premises hereinafter described, in Silver Spring Township, County of Cumberland and Commonwealth of Pennsylvania; and WHEREAS, the said June I. Lehman, departed this earthly life, testate, on the 30th day of January, 2008, and Letters Testamentary were duly issued to the said Vere S. Lehman, Jr., by the Register of Wills of said Cumberland County, docketed to No. 21-08-0141; and WHEREAS, the lands herein-mentioned were not specifically devised: NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Vere S. Lehman, Jr., Executor, as aforesaid, for and in consideration of the sum of ONE HUNDRED SEVENTY THOUSAND and No/IOOths ($170,000.00) DOLLARS, and other good and valuable considerations, to him in hand paid by the said Grantees, at and before the ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released, and confirmed, and by these presents, by virtue of the power and authority in him vested by the Fiduciaries Act of the Commonwealth of Pennsylvania, does grant, bargain, sell, alien, release, and confirm unto the said Grantees, they to hold as joint tenants with right of survivorship and not as tenants in common, their respective heirs and assigns: ALL THAT CERTAIN piece or parcel of land situate in the Township of Silver Spring, County of Cumberland and Commonwealth of Pennsylvania, bounded and described as follows: BEGINNING at a point in the centerline of State Road, S. R. 20127, at the corner of lands of Vere S. Lehman, Jr. and Peggy D. Lehman, his wife, as shown on the hereinafter mentioned Plan; thence North 08 degrees 00 minutes 00 seconds West, a distance of 248.75 feet to an iron pin at the northeast corner of said Lehman lands and at the southern boundary line of lands now or formerly of Gary W. Karkliff and Karen W. Karkliff; thence along the said southern boundary line of said Karkliffs, North 82 degrees 00 minutes 00 seconds East, a distance of 120.93 feet to a pipe found at a westerly boundary line of said Karkliffs; thence along said westerly boundary line of said Karkliffs, South 08 degrees 00 minutes 00 seconds East, a distance of 248.75 feet to a point in the centerline of the aforesaid road; thence by the centerline of said road, South 82 degrees 00 minutes 00 seconds West, a distance of 120.93 feet to a point, the place of BEGINNING. BEING Lot 1-B on the Minor Resubdivision Plan for Vere S. and June I. Lehman, prepared by Hartman and Associates, Inc., Engineers and Surveyors, dated April 28, 1995, and being recorded in the Recorder's Office in and for Cumberland County, in Plan Book 70, Page 74. BEING a part of the same premises which Pearl M. Bricker, widow, by her deed dated February 20, 1978 and recorded in the Recorder of Deeds Office in Cumberland County in Deed Book "R", Volume 27, Page 337, and Deed Book "S", Volume 27, Page 955, granted and conveyed unto Vere S. Lehman and June I. Lehman, his wife. The said Vere S. Lehman predeceased his said wife whereupon full and absolute title to the said premises became vested in the said ,tune I. Lehman by virtue of the laws of this Commonwealth incident to tenancies by the entireties. Her estate is the Grantor herein. AND THE SAID GRANTOR, Executor, as aforesaid, his heirs and assigns do covenant, promise and agree to and with the said Grantee, his heirs and assigns, by these presents, that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or otherwise howsoever. IN WITNESS WHEREOF, the said Vere S. Lehman, Jr., Executor of the Estate of June I. Lehman, deceased, Grantor herein, has hereunto set his hand and seal the day and year first above written. Signed, Sealed and Delivered in the Presence of: 'I~zrlcS ,E. ~i%P,{c~s ~ S~I~G/'e -S `-~KHf~zYlif • (SEAL) VERE S. LEHMAN, JR., Executor of the Estate of June I. Lehman Deceased ~/y1,c~u~ T. .Track COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: On this, the day of , A.D. 2009, before me a notarv public. in and for the Commonwealth of Pennsylvania, personally appeared VERE S. LEHMAN, JR., known to me (or satisfactorily proven) to be the person whose name is subscribed as Executor of the Last Will and Testament of June L Lehman, and acknowledged that he executed the same in such capacity. IN WITNESS WHEREOF, I hereunto set my hand an official seal. Notary Public My commission expires: (SEAL) CERTIFICATE OF RESIDENCE I do hereby certify that the precise and exact post office address of the within Grantee is: Attorney for Grantee REV~1 W8 EX +,~ h97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH '. ~~{~~ 05'~/~ ~ ~rssort~d ~oerso~a /~'y ~y .Day Hershcy, fluch'o,yee~ ~. ~NC ~<F/~K, AJ.~.. 5'uvinys ~-cct. lVo_ Soo3 at7q X97 ~. ~ccr. -1-n~. fo' d. o. d. ~ S~ No.2 CSee PNC ~~~vK,N. ~. 1/a/ua~oh letfcr af~a~tlea ~e l wt.~urseMen7s oh se'H'le nn ent sleet a~ ~a-(c o~ t^ea~ ~ S ~a'Ce ~-. ~iAG 'x{07 - ~Jrora~io~l o~ ~nun~7 ~uxe~S ~. ~%ne 4~d8- rJrorafioH o~ SGstOJol ~5 CSGe Scf~/tminf S{itt,~ Off'GG~c~ ~O SC~ec% /•~) .5'- ~a~f;a~ ~P.~unal Keys{v~te Na~,'oha~ -~su,r. (f-foivtcowners J ~ • ,~Qr~~a l (l~~~w~-~( Penh I,Jaste 7. ~ I S C. CQS ~ aMCJ ~ I n a c~e ~~~ /. 00 ¢lo.s3 ~~ 83, 8g ad, ~~ ¢30, OD rt ~~.oo fG.~2 TOTAL (Also enter on line 5, Recapitulation) ~ ~ ~ 7~ / $a , ~~ f~~ar,1G~ 2009 11:~2AM PNC BANK 412-70~-2747 .._.~- ~~ LEADING TIiE'WAY March 10, 2009 Charles E Shields III Attorney at Law 6 Clouser Rd Mechanicsburg, PA 17055 RE: Name: June I Lehman SSN: 179-18-1465 DOD: 01-30-2008 Dear Mr. Shields: ft'~c.9666 In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checlang Account Account # 5070083684 Established: 01-01-1979 JUNE I LEHMAN SUSAN I HOLTZINGER DOD balance: $1,991.46 + 0.12 accrued interest Savings Account Account # 5003209697 Established: 11-06-2000 JUNE I LEHMAN DOD balance: $15,888.43 + 10.53 accrued interest Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process aay fnancial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 1 REV-1509E%+ 1197) a' " SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~ ~N' ~A-N , .TUNE ?~, ~~ _ a ~ _ ~ ~/ If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. S U51~/11 T. HOLTZ/NGE-"~Z B C. JOINTLY-OWNED PROPERTY: ADDRESS ~/D CH2/S I-IOLTZ/n/GL-7Z 1 ~ 3 .Tiffin ~ per Dr. ~ C 1~-rs , P~ ~ ~ s ~ 9 RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identiiying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. ~ 1/79 %NC DANK, N,~. c~k, ny /~F-rct~. No. Sol 1 9 ~l ~l , . ~(o S'o ~o 00~368~ a. f1-. ~~ /~-Cer, fiyr~r I~ r~ a• ~ a~i 1 fCwi / . /Z .Sb~D sew -~a~l~ u hro~ ~ ~t~e-,~' o f ~N~ ~3ft-N/~, ~(J/~ t ~ 1, oo i . ~ 3 " ~ ~ Ct ~uG~tQU ~ .Sr%t'~L'CI E'"' J TOTAL (Also enter on line 6, Recapitulation) I $ / 00/, ~'3 REV-1511 EX+ (12-99) >x ~, S~HEDIJLE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF L ~N~~~ ~~~~ T FILE NUMBER o7/-D~ - I Sll Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~Q~~OCLZ/ / W~LI?2~ ~DN1e / O~ ~~/eC`1Q,iJ/ Cs 6 tt r~ / ~~ ~9~ ~ 6 9. 67 ,a, /vlecl~a,n~es~ur~ C11~,~~~, ©~ ~re~ren -~-^ Fu,Y-eral /Yle~,l dab©, o0 ~. ~oN9~jS~'he ~1~r~Gt~i~j ~~pp.ao B. I ADMINISTRATIVE COSTS 1. Personal Representative's Commissions Name of Personal Representative(s) Vt: CE J . ~c h M A.Y1 , J r Social Security Number(s)/EIN Numbernof Personal Representative(s) Street AddreMss ~~' oSfate V~ Deld nd City ~ a I~~1'1 t CS~ ~ ~j State Y~I Zip 170 SD Year(s) Co~mlmission Paid: c t,, 2. Attorney Fees L' ~ar~CS ~. 5 Yt~ ~~eas 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant ~~~~ _ - ~-~DLTZIn/6L-"~ Street Address (ar,~"' aP. o. ~.) `f(o ~fafie IRd ~ ,r~ City mC-C.,YI~lY1 tCSI~Kt"CI State t-~Pp Zip ~7D.SO Relationship of Claimant to Decedent U 0._kq~i~C/', /'lC~-t.tra,~ bowl/a,T Whp~G b100~ 4. Probate Fees ~(,trt[~ prj q ~ -~Q,) ~, 551.ie OT~ S~ot'I Ce~'~I hCQ7~S 5. Accountant's Fees ~(3'aeke..+On ~-~CW,~ ~ QttP ~~-~/. -~-zyc, C,e,~r»S 6. Tax Return Preparer's Fees > J4ne.~' B v'ackl„ II , H f~/Z l3>'oc.l< Jv~}I ~ P/} y.~ ~. ~ Cms n . T.,f ~Dc~>n Hers h ~. f~u~};oneElrS ~~ , ~-~nc~~oneer /~dverfs/~~ ~.~ ~'u~,d~rland ~~id Tarnal /~Gt~f~er~isiny :~ t~litlS/e ~'J9/Ii~G~ ~a . ~~ ~ ~n 9 FeC ~ ~~~.5/Er D ~ !~i %/S ~~'", ~SD, OD ~$, ~s0.oo ¢3, 500. o0 ¢~T~. ~ ~13~.00 X30 ~. 3S X75. oD ~//8. 7~ Q /,~ o 0 ~/70. 0O TOTAL (Also enter on line 9, Recapitulation) S ~ ~j ~ 70?, 0 (If more space is needed, insert additional sheets of the same size) ~•2 ~~. /.3_ / ~f, !~ /G. /7. /~ l r. 0~0„ z~. ~~ ~3. ~~ ~S. ~6. s~ a~ d~ .30, 3~, 3z 33. .~y, 3S. 5c~~ h!, c~,ytd s T a ~ L EN/t~~-n~ , ~T u ~u F ,L~ F~~ ~vo . z ~• o~ /y~l G/eha'a Gt1e~i~ny7~ti ~r T~/P A~s1~r~ac~- , ~/3S o0 ~/ t~2inr durse~c~f 1~ ~1a~/s ~: ~Sh,e~ds 71l ~r ~~s~DCopicS, ~ 5S,7S' ~Q~ra ~~..se/jo~ ~/. e sf ~ L.:ic4r~ %. ~i~a~trf ~~es 536. / 2. ~d~ ~Se/ta~r ~1ie.5~ sC~i. ~a.xes. !, 3 97. ~/ 1Jone9a / ~lafxa/ ~s-rsur. , o~ ~l~~~ ~S~Z.oo L ~~~~/1Q /y~m/Xt~ ~y1S6lr: , ~SQ$ NCi~ ~al~Gy 6sl ~IdAye ~ ~ P (O ~ /, DO ~1~trk F /~ ~~rrL ~So ~S i ~~.n2, Sa~ Dr rloll f e f- lot ~..35~. 60 ~e:~rdurS~nc`u` ~ Sasa~ ~o% `zin~ee ,~r ~D~n~r~~ o~'o~% 6.%/ 'Faoo.ao ` L~s~ti' ~jJ. ~rd., ~ltG ~~' J~[G/ of / f~7 . do `!~ ~s/G- ~i, ~-r~ ~. ~~ ,~~~ o,r ~ab~ o0 Gfn,~~GJaf r '" /9. i3 ~, .. « <. ,~ .. ~. ~• ~~ ~, ., ., t~ ~~ /~P L ~, .~ ~c~~ lr~asf, mac. ~r ~~ ~,r Gar ~~ //~c ~irse ~~ .. f ~; 68 ~`. G8 ~: 6&' a~, ~9 7.07 s o9 ~/ 7, 68 f~ ~~. ~~ 3z , 27 ~ 7. 97 ~ ~~.7/ ~4t~ f 3~ ~3 ~~, 37. 3&. 3p ~{o, ~~. ~z, y3 ~5~ `~S yd. ~7 Y~'- ~9, moo. J', S~, 53. ~~ ~s CST ~ ~E7y~1/~iU~ ~LlN~ .Z_ F/G E /1lD, .Z /-08 /~/ mere -S'. ~~l~ntan C,~ lYlow:n s ~ ~ ~h 9 ,~ ~~/~crrl~Pala.nce /80,00 /Zo , Do ~, c, a ~. R/ ,~ D. 00 ~' " ~~ " t ~zo,eo ~r ~~ t, r, ,~CC /D.eo f~ r~ cr « R- / 20 .OD ~q O , Op f~' en //I~~IIGr~ ,ni~ovisia/? ~ ~s~4''t~ ho%~ ~~ /leLu [~UO~, rlc., i/7 /Jfe~araho~r ~r sale ~ ~jause. a, ~©D.°D E~ ,/~anc~I; ~'ePu%r c~ ~Q~n7~tance e f J~rna~e X120. o0 ~~9y Liman, ~er:'se c%jlin~, d,J'i~~t~%ry, e~' !ter ,~r~j~. ~br Sa /G ~~ 7Q aD rr 1~ !/ L,,~a~Q Gue,bu, `' /l/eui ~racfc ~vo,r o~oP~cr Gh p~ne~,• r~r 5Q/e. ~~.5lbAt /l~a.~mita/ ..1 n s Nr. ~ /4re/11 c Les~r !/. ~r6, ~ o. ~ tic/ o~ I~ ii .. r~ ~~ 'cSb. DD ~/ 9'd, ao 079,3. od r30 P. OD ~3 S8, SD ~.~`f 3, s~ Gfi~~ ~~ ~/~/tr '`a~, ~z p~~ x.30, ad /~I i°L ~~6.7/ Loss ~ Lhr~~Os ~,/l yr a.~ sc~cmeir~ myr ~s~/c df ' hca /<s~ ~. `, nc 703 ~.r.`i~vrs~0`llliylissioh ~~; y,5~, vv ~• Line //0 6 tio~r~ F:°es fit s, oa C'. Late lt~,~ 7.yc ~e~f~~a,~b~ ~~.~`a'~ io, a-o ~~ ~ s c~,r~v ,y, ~ ~! ~ ~ or- L~~~r/, ,.7~.UE s, fi«-~v~. ~r-o~ ~s~~ ~. L.~'nE ~a~03 ~edl-Fy 7Yausfer Tu.X ~ 70p. eo sb, Ka/s,f~~-c Na~ dyisur. , ~t~o~ocvner3 p3o~, o0 .`~ ~'. ~~w~ `va~1" X~S~ 7~ SYj. O~~L X30. 0 6 (o o, /LPG f~G, 7/ ~2. APL .77 3s" 63 , Gt~ea~ 1/a~ ~ Sz 6 ~, ,~a-~r / a ~ ~~ 3s Gs /~~%lcr_ ~ , ~a•r Q~/~/aye ~a~/ ~ ~ ~ ~v.~S.c~vQ//~ 6 ~o.~v G11~ ~ r 5..~• Gy1 ~ 6. GGl~~le~ ~/a~ - y, o~ 7/. ,%L 7~ /~2,~ ~/asr ~y ,%~~ s s~~. SZ ~o, eo .ZD. OD .5~. ~/ ~ao'eo ~Y~ 3 s'' pao. 07 REV-1512 EX+ (12-03) r3yk' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IE®U~E 1 DEBTS C)F DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF L ~~~~N/ ~~yF z' FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. REV-1513 EX+ (9-00) ^, l ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCEIE®dIL' E J BENEFICIARIES ESTATE ~ NUMBER I 1 a. 3, F ~ FNS/IA"lll~ ~GfI~F ~. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)j V ~'72~ s . L FHm~¢N, J~? y8 ~5'fafie ~c%, /IIeL>Ll~rlics~ur~, ,off / 7asa F~iNEST ~GlGEn/E' LEi~/11,i¢/~ `13S ~{},~ Sf. , La kcru ooc/ ~ ,NT D~ 70 / L7oN~1~ ~Q~.4D[Ey LEH/a1~N /1'lo u.~t Joy, p~' i7ss2 SuS,~N ?, L . ~lOL TZ/NG~7Z /6 3 .Tua~~er .1~i: , Ef1`er~, ~,~ /7,~/S FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) nF ESTATE ~n won ~h ~~`~ ~sw~rjtt,~' ~ ~d~~ of ~7, 9So, oo Y~ Y~ (s u,b~ct ~ a,d~~.t>4 ~' ;~/S, daa, oo~ ~~ ~S u b~c~ ,~' c~Yamt ~vf ~~~. ODa, moo) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 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-TAY,ABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ LAST WILL AND TESTAMENT OF .TUNE I. LEHMAN I, JUNE L LEHMAN, of the Township of Silver Spring, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. Al] the rest, residue, and remainder of my estate, real, personal, and mixed, whatsoever and wheresoever situate, I give, devise, and bequeath to my four children, to wit: VERE S. LEH1~I_~,N, JR.; ERNEST EUGENE LEHMAN; DONALD BRADLEY LEHMAN; and SUSAN ILENE LEHNI_~N HOLTZINGER, in equal shares, per stirpes, subject to the advancements and explanations made below. 3 Whereas, during my lifetime, I and my late husband made the following advancements against eventual shares of inheritances: A. My daughter, SUSAN LEHMAN, received an advance of Twenty-Four Thousand (52=1,000.001 Dollars. B. NIy son, DONALD LEHMAN, received an advance of Fifteen Thousand ($1 x,000.00) Dollars. C. My son, VERE S. LEHMAN, JR., has received two (2) separate gifts: I.) The sum of Seven Thousand Nine Hundred Fifty ($7,950.00) Dollars. This gift shall be counted as an advance to be counted against his eventual share in the estate upon the same terms and conditions as set forth above. ?.) The sum of Ten Thousand ($10,000.00) Dollars in association with the transfer of a lot which was subdivided off of my real estate property purchased from Pearl M. Bricker (Deed Book 27 R 337) and transfened to him in 1995 (Deed Book 126, Page 1 146). This gift is to be regarded, however, as an absolute and outright gift which shall not he counted against his eventual share in my estate. 4. I nominate, constitute and appoint my son, VERE S. LEHMAN, JR., to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my ``~~ ~ daughter, SUSAN ILENE LEHMAN HOLTZINGER, to be Executrix in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. //~~ IN WITNESS WHl;ItEOF, I have hereunto set my hand and seal this ~%1G., day of ~(,~. ~~-~ , A.D. 3000. % ~ -,~ ,~2`~- ~~ J~~~~,-o~.a~~-~ ~ (SEAL) JUNE .LEHMAN Signed; sealed, published and declared by the above-named JUNE I. LEHMAN as and for her Last Will and Testament, in the presence of us, who at her request and in her presence; and in the presence of each other, have hereunto subscribed our names~~a/s witnesses. L~~~~9 ~ ~~~~i ~` . ~~" CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) July 7, 2009 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of June I. Lehman No. 21-08-0141 Dear Register of Wills: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the June I. Lehman Estate as well as Check No. 152, in the amount of $15.00 for the filing fee, Check No. 1533, in the amount of $170.00 for additional Probate and Check No. 20867 in the amount of $6,428.94 for the Inheritance Tax due. Thank you for your kind attention to this matter. Very truly yours, ~~ C ~~1~~~1~{/~ ~ , Charles E. Shields, III Attorney-At-Law CES/mjj ,~ , Enclosures ~ , ~ o _ _ _ ~ ' am ~ c~ - - _ c ~> ~ ~ W _. 7 f) } .`T,i ~ . .~i~ ~ .~~ :~ ~n ~ ~FG.xY 3 111111 .i~, ;. _ R .~ h r~ ~ $ ~ ,. .~ ~ ~ f 'r.~ q Y { te ~~~ ~~~ 4i ~ :r ~ µ ~~ ~ F l C ., f .. Y r- t~~ ~.4,kf ~ ? 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