Loading...
HomeMy WebLinkAbout07-10-09 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes "~. ~ INHERITANCE TAX RETURN Count Code Year y File Number PO BOX 280601 ~ Q~ ©~~~ Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT + ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 193-14-1910 ' 03/30/2009 :08/05/1922 Decedent's Last Name Suffix Decedent's First Name MI O'Hara 'Dora E (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 (date of _~ ,_ 5. Federal Estate Tax Return Required death after 12-12-82) •: 6. Lecedent Died Testate ~ 7. Decedent Maintained a Living Trust 0. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death e 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 8E DIRECTED TO: Name _. Daytime Telephone Number Mary Ellen Mundorf (717) 991-6125 Firm Name (If Applicable) __ _ N -- -- ---- o - _ ~ REGISTER VYtLLS USE 0~' Y'} t J ~~ ~ , 'l First line of address I.1 C'' -._C7 t- ~. t- ~ '_'i ~ r't"F r , 5256 Meadowbrook Drive „~, r;; o Second line of address r~ =~ ~ 'Z7 ` - ; -; v _~, _ City or Post Office D~ F ED Cai State ZIP Code '~ ~ Mechanicsburg ' PA ' ' 17050 Correspondent's a-mail address: DemMem@comcast.net 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 P RSON RESPONSIBLE FOR FILING RETURN DATE ~~,~, ~~-„- °~~Cc,~,,,Lez.~ _ 06/25/09 ADDRESS ~ ~` 5256 Meadowbrook Drive Mechanicsburg, PA 17055 IGNATURE F P~RER OTHER TH REPRESENTATIVE (~ ~ DATE _l, ~-. ,.~. - ~.~ f thsa - ,.- _ __~~L __~ ~ r 1f, ~ ~ ~ ~ ~. -~ ~~ 06/25/09 601 East Simpson Street Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ___1 15056052059 REV-1500 EX Decedent's Name' DOra E O'Hara RECAPITULATION _"~`~'~ ~''_' Real estate (Schedule A) ............................................. 2. Stocks and Bonds (Schedule B) ...................................... . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 4. Mortgages & Notes Receivable (Schedule D) ........ . .................... 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . 6. Jointly Owned Property (Schedule F) Separate Billing Requested ...... . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ., ..~ Separate Billing Requested....... . Decedent's Social Security Number 193-14-1910 1. 0.00 2. 0.00 3. ' 0.00 a. ' 0.00 5. " 40,578.29 s. 0.00 7~ ! 126,973.38 8 Total Gross Assets (total Lines 1 7) . . _.. .._ ......_.,,. .. $. 167,551.67 9. Funeral Expenses & Administrative Costs (Schedule H) ' ... '~' ""~ "~~ 9. 1,617.75 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......... 10 .... ... . 881.30 11. Total Deductions (total Lines 9 & 10) ..... ........................... ... 11. 2,499.05 12. Net Value of Estate (Line 8 minus Line 11) . 13. ........ . ................. Charitable and Governmental Bequests/Sec 9113 Trusts for which ... 12. 165,052.62 an election to tax has not been made (Schedule J) .................. 13 ... ... . 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ._ . ,w_.~W ,,_.. .~._.. .._~~,~.. ' " ' ~ ' d . -~... ~ ~-.„ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14 ~ e__.~ ~ ~ .~ ~ 165,052.62 ~ .~ °'". 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 - - - - (a)(1.2) X .0_ 16. Amount of Line 14 taxable -- - 15. at lineal rate X .0 45 165,052.62 '' 16. 7 427 37 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. '' 7,427.37 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Dora E O'Hara DECEDENT'S SOCIAL S ECURITY NUMBER STREET ADDRESS 193-14-1910 5225 Wilson Lane CITY Mechanicsburg STATE ~ ZIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments (1) 7,427.37 A. Spousal Poverty Credit B. Prior Payments 1, 598.24 C. Discount 371.37 3. InterestlPenalty if applicable Total Credits (A + B + C) (2) 1, 969.61 D. Interest E. Penalty Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 0.00 Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5,457.76 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 5,457.76 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 :.................................................................................... ...... ^ 0 b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "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. 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)j. 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)j. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT c.a~n,r= yr ITEM ~ C , U ~ ~~ /a(> A InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship muat be disclosed on Schedule f. VALUE AT DATE T /-~ .5~}-)~C ~ ~ t J'~ L~ o~~~ "~ C.~ C~, ; r (~,, ~ ! o r+ ~ i {, ~ 3 ~j~ ~j G.~ ~ , L..~ L i A-~COLe.,'77 ~ ~~Da / y' /D ~7.~ JrJz>ii~ G~ l~~c o u. ~ -' C~. ~r-~ ~//~vi~e~e r~~~~( S~~Te ~1)ri~LDG/CGS ~r~Gg~ t' LL,1~or},/2 looft~ " ~fb~3,6~j ~ ~na~c^s +'ar ~ 1 ue f ~, b . ~ C`~. ~ ~ D l ~ ,'~+7~a'-,2 t y C; ~2..s+ G 1~-1 r1 / `) ! b /~ -7 D J~ ~"-_ r~(~!'LCyl7 `~" 6~~~ r+~afv ` ,,j ~~~+"1l't'(C'/'~'i~ r`7~'Cl?lt,'~; ad i. ~~' X (l~~c~ J ~s`r ~, i 7 ~ ¢^ {, fi, f ,.~ r r fi .. r fi ~ ~ r., / A I I c1 Pc ecQ c~~-4 'S (~ C'~A{)~i3Cfir1: ~~~at~; ;: 1 -, ~uv,cQ~ ~t~ L~.~~ FILE NUMBER TOTAL (Also enter on line 5, Recapitulation) S I~Ot 5 ~ >~ ~~ Q~8 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF -~ FILE NUMBER `~ a ~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE IAANSFEREE, THEIR RELATIONSHIP TO DECEDENiAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE GATE OF TRANSFER. ATTACH ACOPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPIICABIE) VALUE ~ . -_t, ,i.vf~~~ r% f i.^-(~,~' %_ri(ir., _ ', it - _ 1, 0 Z. ~~i~,Gz,l :~L(,z`"i'l /))!c^r,~~~',` ~frc.r/'lr;- )-'_ '4`-. . , I~ ;li ~ 'r' i - - -- .r 63y;~~llg~ ~c~CjV,I ~~ i ~ , TOTAL (Also enter on line 7 Recapitulation) S I ~ ~, ~ ~ ~3 3 ~ 0:~@ (If mare space is needed, insert additional sheets of the same size) REV-1517 EX+ (12-99) SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER _. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FU NERAL EXPENSES: r _. _. ~ i _. ~ - ~..' , ._~ _ .~_ b ~ ~ ,~ i_"_ C. ~`.. ,_ `-, J ~j .? l /'J ! j "i it i`` l v) ! ; („ ~ i B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)lEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney 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 Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) I $ (! ' f , ~? (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) ji1 pennsylvania SCHEDULE I ~ DEPARTMEN70FREVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS REStDENT DECEDENT ESTATE OF ~ FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid ar rha daro „t ae,+ti :__~..~:__ . ~~ ~~~~~_ ~Na~= ~~ ~~Cr~c~, uiseri aoaiaonai sneers or the same size. REV-1513 EX +- (ll-08j Pennsylvania SCHEDULE OEPARiMENi OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER ., ~ ~. ~ ^ K i-. { NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT CR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J _. ~ , I_ ~1 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, insert additional sheets of the same size. LAST WILL AND TESTAMENT OF DORA E . O' ~iARA "v.w I, DORA E. O'HARA, of Lower Allen Township, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, unto my husband, FRANK o'HARA, provided he survives me by sixty (60) days. SECOND: Should my husband, FRANK O'HARA, predecease me or die on or_ before the sixty-first (61st) day following my death, I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, as follows: (A) I give and bequeath the sum of Five Thousand and No/100 ($5,000.00) Dollars to each of my grandchildren who shall survive me. My grandchildren are JOHN W. CAMERON, FRANK F. SPEICHER, IV, PAMELA A. SCHRIFT and SANDRA OLSON. (B) I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, in equal shares, to my daughters, MARY ELLEN MUNDORF and DORA F. GIERLACK, provided that should any of my children predecease me, I give and bequeath such child's share unto her issue per stirpes by representation, and if there be a failure of same, then I give and bequeath such deceased child's share to my surviving child as provided herein. THIRD: Should my husband predecease me and, further, should I have no surviving children or deceased children with issue, I devise and bequeath all the rest, residue and remainder diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. .~ ~, V ~'V (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. FIFTH: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. SISTH: I nominate and appoint my husband, FRANK O'HARA, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said FRANK O'HARA, I nominate and appoint MARY ELLEN MUNDORF and DORA F. GIERLACK; Co-Executrixes of this, my Last Will and Testament. If either MARY ELLEN ML7NDORF or DORA F. GIERLACK is unwilling or unable to so serve for any reason, the other shall serve as sole Executrix. I direct that my Executrix or Co-Executrixes, as the case may be, and their successors, shall not be required to post security or a 3 '/t~RN9t~JG: It is zlln~a! t~ Diu; !i.~-ate tx?is c;~?;j tfy ~t;c,iosi'~; ~~f S~ht~toT.~!~3~;i. ee for this certificate. yfiOU ~. ., .__ Certification tiunih~r Ir ' ;i~~ ~~I'~ CF p~ .' vy - ~' y 1 .a ` ca < ;A •1 z. *yC:, Lr~rge~ *: \ `F~.. ~C,,`~ A' ~ ~i~~?'° „ (C% ~:1'_~I': liiaY (~iC 1111r'r(I]1:IIJ1?'l 11~CC _Rtil: L:lrrr~(Ir, ll,~,,c~-1 !~;I,m an .,ri~in:l? C'crl.~i~.it~ of i~c;t CIU~V ~'~Cy't ':'.} i'. lli;,' ~l.-; ~_lr~1i1 ~~C ~1:ir:1f. 1~1C 1111L~!Il 11~I.fi i ;~ill~ hr 1yl~t,lr,l,°ll to t'„ tii,ll~ VII ~ _:lyliYl tri(~i,•'~ in; ~l~Itlllll'lli ii~lll~r """ I'~nty ° =~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE PRIIlT IN Pe,"ncK°Ir`,~li~ CERTIFICATE OF DEATH (See instructions and examples on reverse) S 7A I E F IL L r~11 r.1D[R I Name W De:eOenl IF:rsr m:G1le. la>t suG:r) 2 5 r 7 Suciol $atinly Nwnber . pan of Daaln Iblcrdn tlay year] Dora E. O'Hara Faemale 193 _ 14 - 1910 March 30, 2009 5 Aye ILasl BrGl,cl y) UnUer 1 y¢ar IIncL.r 10.rY 6 Odle cl drnlc IM~rnln tlay year) 7 B:nnylac¢ Icily anU slab G Iaer n unhyl Be Plase of DeaIN ICn¢ck only cnel 86 M:::u, rw~,. ....a co Hcsyrur Diner y ~ M August 5, 1922 Erie, Pennsylvania ~~( ^Inyal,orrl ^ ER' Ouq:aDenl L~ UDA I(~ Na,cng Il.rn¢ ^ i1a~,iJ¢r,:e C~Olfe, ~ $,;e:ay dD CuunlY W Dealn Bc Crly eae, iwy of poaln BU FacJ,ly Nan':e Ill nw .nsulurcn. yr,a slreel arW numcerl 9. Was D¢ceUaW ul H,>pan,c Ong~.ns ~ No ^ Yri 10 Pate ;,r ,.n IrW,y'. Bad ':. - Cumberland Lower Allen Twp. Bethany Village III r¢: speLGYC°La^, s rerK r,:,. rl s Meaca n, Punlu R,can. cl,) `v` ry) White D~.cadenl: Uwal 0.vary,l,:n rRmU oI wvN Un na Junn I a wcrser hie Dz nol >laln reoraUl t~s 12 Waa pecetlznl ever m Ina q Daatluni s EUucal cn Isyuoly auy 6uflasl grate mmp Wl¢GI la IA u1 l Slel Al xuxG of Wak A:ri~ I Bna. ! Intl,.avy ~ U 5 Arm¢U Furces? Elementary I $¢COnGarY ID-121 Culle ¢ I I ~a or 5 ,. a us anwU Necar ManwJ. W:tloweG DrvcrceU I $ve: ~fy1 Ii $urvrnng Spouse pl unit yr:a ma.Ieo name, Homemaker bwri Home ^y¢, L,g,;n y e) 3 Widowed IE D¢c¢G¢nrSMa:la:gArlGraae,9reaL aly:luwn sL,la. rw=wa De<Yaer,ra PA DxID¢co aanl 5225 Wilson Lane AppalRef„krri IIa $r,la Lower Allen l,eama Ile 1i4raa Da¢,kWL„Wm Mechanicsburg PA 17055 Iro cJ a ,,.~ Cumberland Tew"''"`" vtl ^ N D , IB F„Ner s Name lFesl. m~a0.o. lass suh,al U y ~ ecaGe:a L,.eG w:lna, Aaaal lrmro a c.., B„o 19 Mann s Name Fnsl m GGl k Wilfred E. Blood , , e, ma,l I n summne) Florence Patasky 2Ua. Inlotmanl s Nama jT,pa; Pe,ntl Mary Ellen Mundorf f 2UD Inlamanl> MaAry Aalress ISlrael, cry' town, slate. ip cooa) 5256 Meadowbrook Orive Mechanicsburg, PA 17050 21a Me:noO of Dsposnrun ~ ^ G,.+nalam ^ Donation 210 Dele .:I Drs¢ma,al IM¢mrl. clap rear) 21c. F'bce of Orsppstlron Warne ul c¢melery, nemslGy a olnn p,cel 21G LOCa1H.u, ICuy' town stele zp cooel -Barv.t ^ aa,-. .a Iran Slaa i w.a Cremalmn or Donation wmarueG ^ DIL" Si%.'•`H i GyMeOhalEuminarljoroner7 ^ya,^Na A ril 3, P 2009 Rolling Green Memorial Park . . Camp Hill, Pa. 17011 Z2 alwe W Fur %9pr:: perspn agrny as sucnl L'D. lKanse N umber ?2c. Naha ant Abara ss ul FacAay ~C L J Fn.r11 ~FF~.I Mvc rc Frrnnral Hmm~ I..r 'x~ Cn..a eA ., ... c.___ Ccnlylae nrs ^.3a <G,ry wnen [erlrl)ing 27a is m4 LL m, snuwldtlge ~aN uccareJ al Va lucre Gale anU lace slamU ISiynalJre anU I:Ir¢) 2M lrcunsa N ncG r ' ' i/rl.wwrl is not e. aAaLk al lrnrt .I Jeall, lu ~ ' u a ,Bc Oale $g e U 1.4.nu: U year) cen,IY eenaa al team (,`(~? -, 2a li I D h / .£'i/ ~'N .J ~7 / / 6~~ L 3 3e "7 0 5' u¢nrs N 26 innsl Du tu,r U D yaile ypursur, mu L e:cl _ r 25 Dala Prurwcasod De G a IM~nIn . Gay. Yeah 2c. Was Casa RolerreG IL McUi:al EA•m,ner r Cacr.er la a Reason Gu,el ~nen Crendl.:n a L.,n au.~~. W yrGw„rxae dart, _ ,~. l/J M n ry [I~ ] /'~r'IK,/'/ .JU J~OC~ ^!os t~~„r CAUSE OF oFATIa ISww In.rr~ ~nenn. wnn ..o.....l..a ... ,. .. _ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 'cJq ~iv~7 Po BOX 280601 TAXPAYER RESPONSE ACN 09135979 HARRISBURG PA 17128-0601 DATE 06-15-2009 REV-1543 E% AFP (OB-OB) EST. OF PHYLLIS L PACKER SSN 203-20-9183 DATE OF DEATH 05-14-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: JERRY L PACKER REGISTER OF WILLS 143 PEACH LN CUMBERLAND CO COURT HOUSE CARLISLE PA 17015-7809 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PNC BANK NA provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of ^er~~~sv~.ar.ia. Please gall (717% 737-8327 with quastiar)s. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0000 05140151399 Date 12-28-1983 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 360.78 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NDTE: If tax payments are made within three Amount Subject to Tax $ 180 • 39 months of the decedent's date of death, X .045 deduct a 5 percent discount on the tax due. Tax Rate Any Inheritance Tax due will become delinquent Potential Tax DUe $ 8 • 12 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of C H E C K Wills and an official assessment will be issued by the PA Department of Revenue. ONE C B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax r~te , rilease state OFFICIAL U5E ONLY U AAF a relationship to decedent: ~ PA DEPARTMENT OF REVENUE TAX RE TURN - COMPUTATION OF O N TAX /TRUST ACCOUNTS JOINT PAD _ J ~ l ~j y f ~ 1 LINF 1. Date Established 1 ! / 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate ~ 8. Tax Due $ PART nerF Porn PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID / ~ - ~ ~ ~ ~hnFrat ' C ~ 5 1) ,~ l G r (,S Off' % -" m,~ r .p ~ ~O p m ~, 00 ~i5 ';~J IUIML lCflL ef' uri ~.inc wr•+~~•~~••- '7 ~~r!'S ~P , ~ Under penalties of perjury, I declare that the facts I have reported abr~ove are trlu~e, correct and is Mete,~t / bit my knowledge and belief. HOME C /~~ ) ~ / ~ ~~~ '`~,%/ C WORK C /~ ~77 ~ `" 3~ r~s nwrr ~~ ~~ .._ . ~. 5 ~~~~~~~ ~` i r~nr~,~F~ ~,` ~~a~ /~v/c=, y f;o~v' ;r - ____ rlti S ~ ~ ~`~ r~~ p~ , ~~ ~! .;~ ~« >~ ,~" ors __ii cc '~P l ~° ~ `'~ ~~1 ~ f/ ~j CL I'1 I~`~ ~'G~ ~~ ~~5~~ ~~ Coil ~ Czr,`~ ~ ~ 7 l l S L~ ~e r~ ~ `t--{'t`F CA. G ~ G ~~ tt ~ar~~ ~ ~c~~ w ~ (l (.~C~ t 0.~ f ~-1'l~ 1~ 1 n 5 ~' '~ ~ "''cam -~cc C~ ~~` , -~--~ ~ r c,, l--s ~ ~ s ~ ~ ~ n~ -~- SfeNeM• R. Neff Fu.,neraL Hovwe. 1,20 W. Mai..+~ St--eel Po- f3aw 437 Mi~U.h.F.~i.-w Pa 16854 100 May 18, 2009 .. Phyllis Packer (814) 349-5623 (814) 349-5884 ~:~ i ,n~e,ah~c r ~. i:.~,~ Jerry Packer 143 Peach Lane Carlisle Pa 17015 Date Type Invoice # Descripfion Amount Payment Balance 5/18/2009 Professional Services $2,320.00 $2,320.00 __ __ Facilities ___ .__ _. _ $275.00 . _ __-- , $2,595.00 _ _-__ _ _ __ - __ _ _.____ __ __ --_.__-- - __._-- - --~_.___ _ ___._. _ q _ _-- -.._.. Auto E uipment $215.00 $2,810.00 Merchandise Selected $945.00 $3,755.00 Special Charges $450.00 $4,205.00 Cash Advances .__ -_-_-_ _ $915.19 .___. ____ _ $5,120.19 _ . _....... __ __._.... _ . . m.. _ _.. _ _ - _-- _. _._ Total $5,120.19 6/17/2009 ck6319 Thank you payment received $3,120 19 $2,000.00 7/1/2009 ck6322 Thank you payment received $2,000.00 $ - Total ~ $ - REMITTANCE __ s,.~ €,=trvc: Jerry Packer _ ..._ .Phyllis Packer - 7 ; 100 May 18, 2009 . a•:. $ - ~~~ ~. 600/L;'L ...-aa~'P~'~?=suzn~az~,~alnia~an~S~ulzda~euzli~aj~_rasl~~uioa•and•~ut~u~gauiluo'opi-rnmhvi:sc~~t~ ~;,~ `~ ~p~! Fr~~ l ~'~^~ ~~,1 ~ ~I l • r~ ~' ~~ ~ A-'t o +r+Y~ F~a'1 ~ ~ T ~~ a ~~~ E. ~' "~ ~ ~ ; ~ r„i , , ~ , ~' ~'~ ~ rte r~ ; r~.~,. . ~-,~ ~ ~ its ,fit , ..n . ~ ,..,..~ °3 . ".'..~ ~ ~~ ..y. -~~. Y ~~.. _~ ~~'~" `,fti ... r~ ~-~ I~ :- i} ~ :~ °`; ;~`7 ~ F,, ,'~ ~~~ ~'_ _. 1~ ....-v.! Ti ~~ ~~~ 4 ; ~~' ~"~ 4':I abed ~ula~ C~ - ~' _ ~ n std ~ m" ~ ~~ ~ ., - 3.6~ .~. ~; ~ F q 3 ~1 '2 J yy~ f..i l ~ ~~ r~ i 1 -._ I ~~ _ s 4_ ~_~ ~ ' ~~^^'+»c LF ~~ y4C`~.. \~. r--, ~~ ~~~_~ ~-~~r~~ ~ ~ rte" ~_ ~. w ,~~ v' rt f ~ ~~ wt ~ l ~ v ~ J S1` " ~ ~7a ~ ~ Y ' ~ . _^ ~~~ ~, I ~ W a6eu3~ ones [l`,~[l, ~lt 4 ~u~~ •anl~e~uasa~da~ e o~ heads o~ (~aann e s~(ep uanas '~y6luplua o~ Wy g 'S9ZZ-Z9L-888-I) ~iNy9-~Nd -888-1 Ileo ~o a.zay ~1i~o /~~anllap a6ewl ~noge uolaew~o~ul avow god •wa~l sly 3o sn~e~s aye ~t~l~an o; suol;oesue~~ pa~sod ano% o} aa~ab •~a~ol~ ~Isodap ~o '~~ayo a~n~l~sgns '~oayo e ~o ~oeq pue ~uoa; aye ~o sa6ewl aae asayl ~d~a}~ ~ anopui~ aso1~ 9LE lZEL8 ='oN a~ua~a}a~ 00' lb$ :;unowiy 6002/LZ/SO :a;eQ E 6E9 :~{~a4~ 66E6S60~6S :;uno~~y ~o j a~~d ~uixu~g auiTUn :~~v'~ PNC Online Banl:in~ ~rra~e ~~e~Ee~ Account: Check: Date: Amount: Reference No. ~aasr= 5140151399 6314 05/2812009 $25.00 21874457 ~'totate This is an image of a check, substitute checi:, or deposit ticket. Refer to your posted transactions to verify the status of the item. For more information about image delivery cEick here or call 1-888-PNC-BANK (1- 888-762-2265, 6 AM to midnight, seven days a week) to speak to a representative. ttieu~ ~thet Sipe I~ai`, o° ~a~; Prim: o- Save hH ~41~i f 143 PtM~1~'31 L`~ .~ l CAFtLlSL~ F;+1 77t)l3 ~ r'Cl ~i~;~i5 l]~ae ~ 1 3 l-~~y -~ the ~ ~ /~ J ~ ;<' ~; L7td z z?9 ~ '~ YNc° 1 S.~nl, h h U4(1 Cul-t~pai ;v jA ~'7 __ f~ ~:fl ~ ~ ~ ~ ~'~ 33+~ 5 i4D 15 ~ 3~~1~1' 6 ~~ ,~'CJa~DQ~7 ~ 5C~~3~~' i~Aail or pax ' Print ctr Save © Copyright 2009. The PNC Financial Services Group, Inc. All Rights Reserved. Pa~,e 1 of 1 Cicse W~ndovk° ~ Neip=? hrr„~•/h:,.,~.~,_,-~i~ nr,linP}ianlrincr r~i~r rnm/alcan~lat/TrancartinnTnfnRPmtactCarvlPt?arr-nnntl~T '7 /'7!'~MQ 6001,:'!/L ...=a~~P~I~I=suin~a.z~,~alnia~an~S~uudaQ~uzl~~aln.zasj~/uio~•~tld•~LT~u~gautTuo'~p.i-h~.2~n~~,~:sd~~ti ,' +r. r.t°^x rn. ~~~~+r~ f 1 ~. . r~ t p~.,~~ _~.~ E' t ~ r~~1 ~' ~ ,~J '~f11 FE "^~_r ~:. :*tic- ~~~ ti ~'1T~v ~ ~ ~ j # ~ ~ ~ ~' ` ~ : ~-.+ r iT~,. i~ i I-- '~e rr I { -~ ,°- ~ i ~ ~~ ~~ , ~ .n i `I; ,,; ~' ~ } '~~ r ,1 _,,,, °^ .~. ir; 7~_, i:1 -,,= :~ -r. . 6' I a F„ 0~ ' J ~,~~ ~,,,yl-1 N 5~. 4 3 :"° !'° r°- ~~ ;"{ _'b.~ ~'~ ~;~~. rt ~ . ~s t r - ~~ ; '-r Gi ~/ ~ s ~ A t "".may r~'+. :~ yap ~,~ ~? ~ +~ _. ~ ~ ~ .. rrca s~ ~ ~ _. r ~~ .Y' ~~ r-^ ~ ~ R t~-f 4 .~: ~'~•. ~t, 1 ~~ I ~I }~ 4.Y (~L+.Irf~~ ~~. rr~e+ ,,1 €_~ i E 3 p V }(rLq,y°~-" 55 .+ ~ 1 ~x3 i~~ ~~ ~•~_ :: ;~~~ :~ V tt ~. ~+.~''*, ~t~' y3. L h.1 I~ dal _ ~: ~: is `;~ aBe~# ~ul~~ a6ewl aneg ~ae~ •anlTe~uasa~da~ e o; heads o~ (warn e s/~ep uanas '~y6luplw o~ wy 9 'S9ZZ-Z9L-888-I) ~iNtf9-~Nd -888-T Ileo ~o a.aay s~o~Eo /~~anpap a6ewl ~noge uol~ew~o~ul avow and •wa~l sly ~o sn~eTs aye l~~I~an o~ suolaoesue~~ pa~sod anon( o~ ~a~ab •~a~ol~ ~Isodap ao '~oay~ aTnTl~sgns '~oayo e ~o ~oeq pue Tua3 aye ~o sa6ewl aae asayl ~dia~ ~ nnopw~r, asc~l~ L9S6ZZ£8 :'oN aoua~a;aa 00•SZ$ :;unow~y 600Z/60/90 :a;ea 8 ~E9 :~loa4~ 66£6S60b6S :;unooob ~~'9Ll.S.l1 ~A~s a0 ~lii.~d ~.~o ~ a~~,~ ~cTt~[z~g auTluO J:~Id PNC Online Bai~l:in<~ Account: 5140151399 Check: 6320 Date: 06/19!2009 Amount: X15.00 Reference No.: 83369560 R ~' f~a ~k ~d~E i Of ~' dose Y~tinclow ~ 'riei[~ These are images of the front and back of a check, substitute check, or deposit ticket. Refer to your posted transactions to verify the status of this item. For more information about image delivery clici: here or call 1-888- PNC-BANK (1-888-762-2265, 6 AM to midnight, seven days a week! to speak to a representative. Save Image Prim Page ~~~ ~J ~$ w 4 y~y~^'ii {we r lJ ~`. C. I ~~; ~. ~ ~' ~ :wr -~ i ice; ~,~ z~ s ~~ ~• s _~ I /~ awl. A r~ ys~~ 3.i ~ i ^ ~+MM~ EM1"' 1°~'I !'~~ t rr far ~!~~v'~~ +~n9y ~t ~ ~~~~~~~~'~~~~ I ~ r a 4t ± a l , ..rte. .+a..R.~..+.~.Ae w.......w~... i ~~ l I,< ~ I. C ~i~ ~ u. Gd i i i7C.!r . L~i~ v 13 ~"`xC I a ;, n , . ~I; ~A ,'~ ~! E ' I --<! ~~ '~RIR' -I- '^ ,, ii -'- ---u._._t_~-_1,:..,~....,, .,....-.~.,loo,~.lo+!T,,,.,.TPp,-;,,rc~,~Pc~,-,~lat`7rar!,,,,c-T~TR.rlat~- 7/'7!7(1(1Q PNC Online Banning Page i of PCtCt~ ~C u~~~ ~E"~~C~~ Ci~se Windov.~ ~ Ne1p? Account: 5140151399 These are images of the front and back of a check, substitute check, or Check: 6315 deposit ticket. Refer to your posted transactions to verify the status of this Date: 05/28/2009 item. For more information about image delivery c€i~i. here or call 1-888- PNC-BANK (1-888-762-2265, 6 AM to midnight, seven days a week) to speak Amount: X10.00 to a representative. Reference No.: 88192404 _.__. ____._.__._i3ack _ __.~.___Save Image ~rtnt =age i ., ~~ ~ ~- ~ ~- w ~ ~ ~r ~ o ~~ ~ ; ~~~ ~} ~ , ~~1 ~~r7,Y r'r- ~1r ta~~!! v~ ~'ir` tls~,.F P ~,:~~~ -° {'1c~ i~rl:~ r fir.: .~._ .. ,,r '~ ~~ .,,, - ; .r.. I art ,..~,~ ~' ~ , d ~~ ... ~'`~' ~ ~ r • ~ ~ ~ ~ w-~.a. a .. -----i_t___._.t,.~~T...,,,.~D.•.,,tC~.,PCP,-~,lrt`7ratn~7ic=NR~rlate= 7/7/7nn9 O ` ~ ~ ~ .,, ~, i ~ o. ~ ~ .. ~/~/ N.1 J ~~ ~ ~.~~ :vl' iM ~:. ~~ ~ , „. 0 ~ ~ O ~J` ~ ~~~~ F M co ~~~ - of n a ~ ` chLL ~~Tr t c f ~ i , ~ ~ Q F:~ t ~y`~~ ~ ~ t { ~ Y . .. ~ . ~ H O ~ ~ ~ ~ ~ i _,.q ~; P R^ _ ~ ~ n ~ W ~.~. 1 r ~- k I '- ~ 1Cr 1 ~ ~ t ~ :. + ! y l ~ ~ ^f'4 ~ E ~~ ~ ~ ( ~ .~ , ` I ~ ~ ~~ ~ I ,~1 Z ? ~+'+. r .^ f ,~~' 1 '. ~ ~ ~'~K ~, ~. _ ,r~+ x'=~ +. , ~T~ ~t ' ~ v~ ~ ~~ `~ ~ ~ ~' r .~ - :~ ~ ~~,e"t a4~ ~. X a ~ av ~' 4"~'' !M ~ X12 ~: 3~ ~r~ to rs { ~ ~ x~ f x ~ ~ i~ i tx+ry.}s ~ ' l ~'. S ~~ Y~ ~ tir ~ti- ~ '- } ~ ,X"E ~ ~~ $r~~ e ' A -ft1M ^ ~~~ ; ~ ~ ~ ~~1~ Et 3,~ L" 1 ~'~, ~ r ;" Yr `yr Y Y ': x ,~,-.i- E ,.; ,a,: ,~~ ;° '~, i 1 ^yt~ dry. . ~ ~~~~ ' ~ y ; , ;~ var .~. . r 3s,~3~31 ~ I ,.~+?, F tf ;{~"~ l~ n R.~^ I i~ • r:@~ 1, ~.) . ~~.; ;y. ~~ . sr + ~S ~ y L.q . ~~ t~5{._-_ Sm~ ~ L 7 ti + 3 . yM ~ J ~ ~ T ~ x. ~tiR F n • ( J F~, ~J~ I Ft 1 ~ .,ii.4.' ~ F rt ~ M?Y. R s" _ ~ ~, •• ,r x . PA'S r v, r r .. k. 1 + .. ) .. .. ~? Y i. x _ n ~': ~ Y . ~ ~~, ,~~`` ..~~ty~ S. ,e~f.*.S..rE~: Y J`4.'2ffi~in~u• y 1..: .dl«. _.. txy$. e ~ 4 Y2. ~, ~ . ~, = > .~` ~- s p *.i }~` rn jq AY~~ Wi't' h ~.! r.T'ij~' r ` Y 1 .r r 4 ~ , ~, 8 ^ ryry a Y S r~ ~ ~ F .F ` ~ ~ a ~ J }.. r .k~e k ~ti ~~ ~ ~~v~~~ ~ s ; c+~ ...p ~ , ~ ~C1 SAS: '~ N 1 ~ t ~T. r ~`'` ` ~ ~ ~` R^ 1 1 ~ ~ ;~ ~` ~i S ~ i a~ ~4' ~. -~ d ,