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Home My WebLink About08-03-09 (2)15D5607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN PO BOX 280601 2 1 0 8 0 1 1 1 3 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 2 0 3 6 9 2 8 4 1 1 D 4 2 0 0 8 0 4 2 6 1 9 1 0 Decedent's Last Name Suffix Decedent's First Name MI D A V I S M A R T H A L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 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 ~ 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 CONFID ENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number I V O V O T T O I I I "r' 1 7 2 4 3 3 3 4 1 Firm Name (If Applicable) M A R T S O N First line of address 1 0 E A S T Second line of address City or Post Office C A R L I S L E State ZIP Code REGISTER OF WILLS USE ONLY t~.~ n .~ :_, ~~ ~ ~_rs ..rt-.-~ c'7 -` j-. f ~rn ~ c s ~~ is _~-ti i -' ) _.: i _: a C~.) i ,=- +~ r't ~' C..) ~' ' t_ P A 1 7 0 1 3 Iv `r' Correspondent's a-mail address: I O T T O a~ M A R T S O N L A W• C O M 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. SIGNAT 0~~~~~ O~ES NSIBLE FQR~LING RETURN 7 p~~ E~ y 1 WEST H GH STRE"ET SIGNATURE OF PR PAI~EF2~Q H THAN 13EPRESENTATIVE 10 EAST HIGH STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J L A W O F F I C E S H I G H S T R E E T 1505607221 REV-1500 EX ~ecedenYs Name: MARTHA L• D A V I S Decedent's Social Security Number 2 2 0 3 6 9 2 8 4 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1 • ' 2 1 2 2 3 6 0 7. 7 8 2. .................................. Stocks and Bonds (Schedule B) . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 1 1 8 4 5 7 0 . 4 6 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 2 4 0 8 1 7 8. 2 4 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9• 1 3 0 8 0 6 • 0 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . 10. 2 8 8 9 . 5 1 11. Total Deductions (total Lines 9& 10) ........................... 11. 1 3 3 6 9 5. 5 6 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 2 2 7 4 4 8 2 . 6 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 1 7 0 3 9 5 4 6 8 an election to tax has not been made (Schedule J) .................. 13. . 14. Net Value Subject to Tax (Line 12 minus Line 13) ......... .. ..... .. 14. 5 7 0 5 2 8 . 0 0 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.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable 7 6 7 1 7 5 0 3 4 5 2 2 9 at lineal rate X .045 . 16. . 17. Amount of Line 14 taxable 0 0 0 0 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable 4 2 9 3 2 7 5 0 6 4 3 9 9 1 3 at collateral rate X .15 18. . 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 6 7 8 5 1. 4 2 Side 2 1505607221 1505607221 REV-1500 EX Page 3 I~pr_Pdpnt's Cemnlete Address: File Number 21 08 01113 DECEDENT'S NAME MARTHA L. DAVIS STREET ADDRESS 47 BULLOCK CIRCLE CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ (1) 67,851.42 B. Prior Payments 64,000.00 C. Discount 3,368.32 Total Credits (A + B + C) (2) 67,368.32 3. Interest/Penalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 483.10 483.10 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 : ...................................................................... ^ ^X 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? ....................................................... ^ 0 2. If death occurred after December 12,1962, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 0 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ......... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ 0 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 i:o 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 ar 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.;i. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN oGCinFNT nFCFI'fFNT ESTATE OF FILE NUMBER MARTHA L. DAVIS 21 08 01113 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 10800 sh American Express Co. (CUSIP 025816109) @29.435 317,898.00 2 Accrued dividend, No. 1 1,944.00 3 2160 sh Ameriprise Financial (CUSIP 030760106) @22.835 49,323.60 4 219 sh Arvinmeritor, Inc. (CUSIP 0433530101) @5.815 1,273.49 5 1000 sh Energizer Holdings Inc. (CUSIP 292668108) @50.345 50,345.00 6 275 sh Fulton Financial Corp. (CUSIP 360271100) @10.35 2,846.25 7 260 sh General Mills, Inc. (CUSIP 370334104) @68.065 17,696.90 8 300 sh Hawaiian Elec Indus (CUSIP 419870100) @26.885 8,065.50 9 300 sh H J Heinz Co (CUSIP 423074103) @45.265 13,579.50 10 1200 sh Hershey Co (CUSIP 427866108) @38.195 45,834.00 11 300 sh Johnson & Johnson Co. (CUSIP 478160104) @61.74 18,522.00 12 800 sh Koninklijke Ahold NV (CUSIP 500467402) @10.84 8,672.00 13 4160 sh Lehman Bros Holdings (CUSIP 524908100) @.0628 261.04 14 400 sh Lowes Companies (CUSIP 548661107) @21.115 ~ 8,446.00 I S 400 sh Microsoft Corp (CUSIP 594918104) @23.265 9,306.00 16 464 sh PPL Corp (CUSIP 693517106) @28.91 13,414.24 TOTAL (Also enter on line 2, Recapitulation) I $ 1,223,607.78 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARTHA L. DAVIS 21 08 01113 Decedent's Name Page 1 File Number Schedule B -Stocks 8~ Bonds ITEM NUMBER DESCRIPTION 17 880 sh Rockwell Automation Inc (CUSIP 773903109) @29.615 18 880 sh Rockwell Collins Inc (CUSIP 774341101) @38.625 19 390 sh Susquehanna Bancshares, Inc. (CUSIP 869099101) @16.2349 20 Accrued dividend, No. 19 21 300 sh Weis Markets Inc (CUSIP 948849104) @33.045 22 Accrued dividend, No. 21 23 50000 par Central Dauphin ASD 5% (CUSIP 153300JA7) @105.041 due 11/15/24 24 Accrued Interest, No. 23 25 25000 par Bloomsburg ASD 5% (CUSIP 095011DD1) @105.915 due 09/01/19 26 Accrued Interest, No. 25 27 20000 par PA State GO 4.5% (CUSIP 709141690) @94.258 due 2/01/22 28 Accrued Interest, No. 27 29 20000 par Blairsville-Saltsburg SC 4.5% (CUSIP 093151FJ2) @92.527 due 3/15124 30 Accrued Interest, No. 29 31 10000 par Reading SD 4.375% (CUSIP 755638UE1) @91.903 due 3/01/25 SUBTOTAL SCHEDULE B VALUE AT DATE OF DEATH 203,778.64 Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARTHA L. DAVIS 21 08 01113 Decedent's Name Page 2 File Number Schedule B -Stocks 8 Bonds ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 32 Accrued Interest, No. 31 96.01 33 20000 par Allegheny Co IDA 5% (CUSIP 01730GAU3) @100.058 20,011.60 due 12/ 1 /27 34 Accrued Interest, No. 33 425.00 35 15000 par GMAC 6% due 3/15/19 (CUSIP 3704AOHS4) @30.8093 4,621.40 36 Accrued Interest, No. 35 122.50 37 25000 par Federal Home Ln Mtg Corp (CUSIP 3133FOU123) @94.1227 23,530.68 4% due 6/15/16 38 Accrued Interest, No. 37 52.78 39 800 sh GMC (CUSIP 370442725) @5.65 4,520.00 40 Accrued Dividend, No. 39 368.74 41 400 sh Indiana Michigan Power Co, @23.6525 9,461.00 Sr NT D 6% PFD 42 1000 sh NPB Capital Trust II (CUSIP 629358209) @20.995 20,994.95 43 5000 sh Lord Abbett Municipal Income Tr (CUSIP 543912208) @4.53 22,650.00 44 2000 sh Nuveen Municipal Value Fd (CUSIP 670928100) @8.875 17,750.00 45 2101 sh Nuveen PA Premium Income (CUSIP 67061F101) @9.49 19,938.49 46 1971 sh Nuveen PA Investment Quality (CUSIP 670972108) @10.465 20,626.52 SUBTOTAL SCHEDULE B 165,169.67 Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARTHA L. DAVIS rlnrnrlcnt'c Alamo Page 3 21 08 01113 File Number Schedule B - Stocks ~ Bonds ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 47 1211 sh Delaware Group Equity Fd (CUSIP 246093108) @13.74 16,639.14 48 1700 sh Nuveen Quality PFD Income Fd (CUSIP 67071S101) @5.375 9,137.50 49 7500 sh USAATax-Exempt Long-Term (CUSIP 903289106) @11.61 87,075.00 Fd 50 25000 par US Treasury Notes (CUSIP 912828FZ8) @100.3437 25,085.94 4.625% due 11/30/08 51 Accured Interest, No. 50 495.99 52 25000 par US Treasury Notes (CUSIP 912828GJ3) @101.3125 25,328.13 4.75% due 2/28/09 53 Accrued Interest, No. 52 213.23 54 US Series H Savings Bonds 111,000.00 55 300 sh HSBC Holdings PLC (CUSIP 404280604) @18.075 5,422.50 ADR 6.2% PFD 56 300 sh Royal Bank of Scotland (CUSIP 780097762) @10.2951 3,088.52 ADR 6.25% PFD 57 200 sh BGE Capital Trust II 6.2% PFD (CUSIP 05541Q206) @18.73 3,746.00 SUBTOTAL SCHEDULE B 287,231.95 GRAND TOTAL SCHEDULE B $ 1,223,607.78 REV-1508 EX + (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARTHA L. DAVIS 21 08 01113 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Janney Montgomery Scott Money Market #2593-3144 3,454.76 2 M&T Bank CD #445727 20,000.00 3 Accrued Interest, No. 2 2.85 4 Sovereign Bank, Checking #1691027383 476.46 5 Sovereign Bank, CD #2895390231 26,549.14 6 Accrued Interest, No. 5 13.93 7 Sovereign Bank, CD #3385019611 41,301.58 8 Accrued Interest, No. 7 21.68 9 Sovereign Bank, CD #3385047133 34,417.58 10 Accrued Interest, No. 9 18.06 11 Sovereign Bank, CD #3385171065 67,789.67 12 Accrued Interest, No. 11 35.58 13 Sovereign Bank, CD #3385171073 64,399.26 14 Accrued Interest, No. 13 ~ 33.79 15 Sovereign Bank, CD #3385058106 33,074.91 16 Accrued Interest, No. 15 14.72 TOTAL (Also enter on line 5, Recapitulation) I $ 1,184,570.46 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARTHA L. DAVIS 21 08 01113 Decedent's Name Page 4 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH _ 17 Sovereign Bank, CD #3385058114 33,114.28 18 Accrued Interest, No. 17 16.70 19 Members 1st FCU, Savings #53491-00 1,238.11 20 Accrued Interest, No. 19 0.10 21 Members 1st FCU, CD #53491-42 43,320.42 22 Accrued Interest, No. 21 19.12 23 Members 1st FCU, CD #53491-46 36,546.69 24 Accrued Interest, No. 23 9.19 25 Members 1st FCU, CD #53491-43 44,162.78 26 Accrued Interest, No. 25 19.49 27 Members 1st FCU, CD #53491-48 35,154.79 28 Accrued Interest, No. 27 9.54 29 Members 1st FCU, CD #53491-69 59,570.23 30 Accrued Interest, No. 29 18.07 31 Members 1st FCU, CD #53491-70 53,494.03 SUBTOTAL SCHEDULE E ~ 306,693.54 Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARTHA L. DAVIS 21 08 01113 Decedent's Name Page 5 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM NUMBER DESCRIPTION 32 Accrued Interest, No. 31 33 Orrstown Bank, Checking #03438 34 Orrstown Bank, CD 35 Orrstown Bank, CD 36 Orrstown Bank, CD 37 Orrstown Bank, CD 38 Citizens Bank, Checking #6100728455 39 Citizens Bank, Checking #6208347932 40 Citizens Bank, Checking #6221890954 41 Citizens Bank, CD #6140728150 42 Accrued Interest, No. 41 43 Citizens Bank, CD #6140730058 44 Accrued Interest, No. 43 45 Citizens Bank, CD #6247704661 46 Accrued Interest, No. 45 VALUE AT DATE OF DEATH 16.22 182.42 16,407.13 20,235.45 36,417.02 21,240.53 12,676.88 147.06 186,508.54 44,769.50 38.09 28,639.76 13.57 22,911.72 4.66 SUBTOTAL SCHEDULE E ~ 390,208.55 Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARTHA L. DAVIS 21 08 01113 Decedent's Name Page 6 File Number Schedule E -Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 47 Citizens Bank, CD #6252142442 20,266.19 48 Accrued Interest, No. 47 8.73 49 Citizens Bank, CD #6252143988 65,809.11 50 Accrued Interest, No. 49 97.98 51 Citizens Bank, CD #6254357446 50,000.00 52 Accrued Interest, No. 51 145.36 53 Proceeds of Sale of Right of Occupancy, Cumberland Crossings 48,028.75 Retirement Center 54 U.S. Treasury, refund, 2008 Form 1040 2,592.00 55 Personal Property as appraised (Rials/Chirgotis 3,755.00 families) 56 Personal Property as appraised (Davis family) 2,290.00 57 1993 Buick Skylark Custom, proceeds of sale 3,071.28 SUBTOTAL SCHEDULE E 196,064.40 GRAND TOTAL SCHEDILE E $ 1,184,570.46 REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN o CCIf1CA1T f'1Cf CIICNT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARTHA L. DAMS 21 08 01113 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. Auer Cremation Services of PA, balance due 894.31 2 St Paul Lutheran Church, services 200.00 3 Fort Indiantown Gap, services 120.21 4 Georges' Flowers, funeral flowers 130.38 5 Cumberland Crossings Retirement Center, funeral luncheon 622.75 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) M&T Bank (16-0538020) Street Address 1 West High Street City Carlisle State PA Zip 17013 Year(s) Commission Paid: 2009 62,600.00 p. Attorney Fees Manson Law Offices 59,750.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip _ Relationship of Claimant to Decedent 4. Probate Fees 1,153.00 5 Accountant's Fees 2,500.00 6. Tax Return Preparer's Fees 450.00 7. Cumberland Law Journal, advertising Letters Testamentary 75.00 4 The Sentinel, advertising Letters Testamentary 166.60 5 Carl Ocker, appraisal of personal property 150.00 6 Shipping charges, personal property 1,981.80 7 Register of Wills, Short Certificates 12.00 TOTAL (Also enter on line 9, Recapitulation) I $ 13 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARTHA L. DAVIS 21 08 01113 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Joan Kuntz, balance due for care 90.00 2 Cumberland Crossings Retirement Center, balance due, 1,463.16 monthly maintenance fee 3 Visiting Angels, balance due for care 306.25 4 Embarq, balance due, phone service 47.16 5 UGI Utilities, balance due for service 408.94 6 Met-Ed, balance due for service 112.52 7 USAA, balance due, insurance premium 262.48 8 PA Dept. of Revenue, balance 2008 income tax 199.00 TOTAL (Also enter online 10, Recapitulation) I $ 2 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF MARTHA L. DAVIS NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS (include outri ht spousal distributions, and transfers under Sec. 9116 (aj (1.2)) 1. Phyllis I. Chirgotis Meredith L. Rials Thelma C. Davis II. 1. Kathy D. Hammond Gary D. Davis Thomas E. Davis FILE NUMBER 2l 08 0111: RELATIONSHIP TO DECEDENT Do Not List'frustee(s) Collateral Collateral Collateral Lineal Lineal Lineal AMOUNT OR SHARE OF ESTATE 201,877.50 201,877.50 25,572.50 25,572.50 25,572.50 25,572.50 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. MOAA Scholarship Fund 10,000.00 201 North Washington Street Alexandria, VA 22314 2 Snyder County Historical Society 20,000.00 P.O. Box 276 Middleburg, PA 17842 3 Susquehanna University - Laudenslager Fund for Education 1,673,954.68 514 University Avenue Selinsgrove, PA 17870 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 1.703.954.68 (If more space is needed, insert additional sheets of the same size) ~,~ ~iti~ens Bank° January 16, 2009 M & T EXECUTOR ESTATE OF MARTHA L DAVIS 1 WEST STREET CARLISLE PA 17013 Estate of MARTHA L DAVIS Date of Death: Nov 04, 2008 SSN: 220-36-9284 Dear Sir/Madam: 525 William Penn Place Suite 153-2618 Pittsburgh,PA 15219 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, Cheryl El-Walker Operations Services Citizens Bank... Account Number 6100728455 Account Title MARTHA L DAVIS Date Opened 8/26/1976 Account Tye Checkin Principal Balance as of DOD $12676.88 Interest from Last Postin to DOD $ •00 _ Account Balance as of DOD $12676.88 YTD Interest to DOD $145.44 Citizens Bank Account Number 6208347932 Account Title MARTHA L DAVIS Date O ened 3/14/2005 Account Tye Checking Principal Balance as of DOD Interest from Last Posting to DOD $147.06 $ .00 Account Balance as of DOD $147.06 YTD Interest to DOD $1059.49 ~~ +Citizens Bank Account Number 6221890954 Account Title MARTHA L DA.VIS Date O ened 10/9/2008 Account Tye Checkin Principal Balance as of DOD $186508.54 Interest from Last Postin to DOll $ .00 Account Balance as of DOD $186508.54 YTD Interest to DOD $665.30 ~~ Citizens Bank. Account Number 6140728150 Account Title MARTHA L DAVIS Date O ened 5/27/1998 Account Tye Time De osits Principal Balance as of DOD $44769.50 Interest from Last Posting to DOD $38.09 Account Balance as of DOD $44807.59 YTD Interest to DOD $1664.88 ~,~ Citizens Bank Account Number 6140730058 Account Title MARTHA L DAVIS Date O ened 7/2/1998 Account Tye Time De osits Principal Balance as of DOD $28639.76 Interest from Last Postir~ to DOD $13.57 Account Balance as of DOD $28653.33 YTD Interest to DOD $866.11 ~~ titizerrs Bank Account Number 6247704661 Account Title MARTHA L DAMS Date O ened 9/6/2005 Account Tye Time De osits Principal Balance as of DOD $22911.72 Interest from Last Postin to DOD $4.66 Account Balance as of DOD $22916.38 YTD Interest to DOD $694.36 Citizens Bank Account Number 6252142442 Account Title MARTHA L DAVIS Date O ened 7/1/2008 Account Tye Time De osits Principal Balance as of DOD $20266.19 Interest from Last Postin to DOD $8.73 Account Balance as of DOD $20274.92 YTD Interest to DOD $266.19 ~~ Citizens 8ank:° Account Number 6252143988 Account Title MARTHA L DA.VIS Date O ened 4/14/2008 Account Tye Time De osil;s Principal Balance as of DOD Interest from Las± Postin to DOD $65809.11 $97.98 Account Balance as of DOD $65907.09 YTD Interest to DOD $809.11 ~~ citizens Bank Account Number 6254357446 _ Account Title MARTHA L DAMS Date O ened 10/9/2008 Account Tye Time De osits Principal Balance as of DOD $50000.00 Interest from Last Posting to DOD $145.36 Account Balance as of DOD $50145.36 YTD Interest to DOD $ .00 St MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 53491-00 Date Account Established 10/10/1978 Principal Balance at Date of Death $1,238.11 Accrued Interest to Date of Death $.10 Total Principal and Accrued Interest $1,238.21 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 53491-42 5349'1-43 Date Certificate Established 10/04/2006' 10/04/2006" Principal Balance at Date of Death $43,320.42 $44,162.78 Accrued Interest to Date of Death $19.12 $19.49 Total Principal and Accrued Interest $43,339.54 $44,182.27 Name of Joint Owner None None 'Rollover from certificate 53491-71, originally established on 10/0412004. '*Rollover from certificate 53941-72 , originally established on 1010412004. CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 53491-46 05/05/2008 $36,546.69 $9.19 $36,555.88 None 'Rollover from certificate 53491-44, originally established on 04/03!2007. CERTIFICATES OF DEPOSIT: Account Number/Suffix ~~~`' 53491-48 Date Certificate Established 07/03/2008" Principal Balance at Date of Death $35,154.79 Accrued Interest to Date of Death $9.54 Total Principal and Accrued Interest $35,164.33 Name of Joint Owner None 'Rollover from certificate 53491-45, originally established on 04!03/2007. CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 53491-70 02101 /2004 $53,494.03 $16.22 $53,510.25 None 5349'1-47 07/03/2008' $35,154.79 $9.54 $35,164.33 None 53491-69 02/01 /2004 $59,570.23 $18.07 $59,.'188.30 None EM ER~S 1QsT FEDE LC~~gIT UNION Ile A. line Insurance Services Specialist December 5, 2008 Estate of: MARTHA L. DAVIS Date of Death: 11/04/2008 Social Security Number: 220-36-9284 :~'~ ~; 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org November 24, 2008 Estate of Martha L. Davis M&T Bank, Executor 1 West High Street Carlisle, Pa 17013 RE: Martha L. Davis SS: 220-36-9284 Gentleman: 77 East King Street P.O. Box 250 Shippensburg, PA 17257 Martha L. Davis has five deposit accounts with Orrstown Bank. The; dollar amounts below indicate the balance on or before November 4, 2008. Some accounts do have a higher balance at this. time. • 50+ Checking - $182.42 • 15 Month CD - $16,407.13 • 15 Month CD - $20,235.45 • 15 Month CD - $36,417.02 • 15 Month CD - $21,240.53 Should you have any questions, please do not hesitate to call me at 7' 17-241-2010. Thank you, Orrstown Bank ~'Vl~ci~~-~i1~~~ Nichole R. Clouser Assistant Branch Manager ORRST0~ITN B~ A Tradition of Excellence Sri ~ ~, `~ _ ~~ Sovereign Bank ESTATE OF Martha L Davis SOCIAL SECURITY #: 220-36-9284 _ DATE OF DEATH: November 4, 2008 _ Account #: 1691027383 Type: Checking Open date: 4/5/1995 In the name of: Martha L Davis Date of Death Balance: _ $476.46 Int,(YTD) from Ill/2008 to 10/28/2008 _ $0.40 Accrued interest to date of death: $0.00 Other Info: Account #: 2895390231 Type: CD _Open date: 4!711997 In the name of: Martha L Davis Date of Death Balance; $26,549.14 Int.(YTD) from 1/1/2008 to 10/31/2008 _ $765.90 Accrued interest to date of death: $13.93 Other Info: Account #: 3385019611 Type: In the name of: Martha L Davis CD Open date: 2/7/2000 Date of Death Balance: $41,301.58 Int.(YTD} from 1/1/2008 to 10/31/2008 $1,367.35 Accrued interest to date of death: $21.68 Othertnfo: Account #: 3385047133 Type: CD Open date: 2/7/2002 In the name of: Martha L Davis Date of Death Balance: $34,417.58 Int.{YTD) from 1/1/2008 to 10/31/2008 $1,139.45 Accrued interest to date of death: $18.06 Other Info: Account#: 3385171065 Type: CD Open date: 2/2/2006 In the name of: Martha L Davis Date of Death Balance: $67,789.67 Int.(YTD) from 1/1/2008 to 10/31/2008 $2,057.72 Accrued interest to date of death: $35.58 Other Info: Page 1 of 3 Sovereign Bank ESTATE OF Martha L Davis SOCIAL SECURITY #: 220-36-9284 DATE OF DEATH: November 4, 2008 Account #: 3385171073 Type: CD Open date: 2/2/2006 In the name of: Martha L Davis Date of Death Balance: $64,399.26 Int.(YTD) from 1/1/2008 to 10/31/2008 $1,954.85 Accrued interest to date of death: $33.79 Other Info: Account #: 3385058106 Type: CD Open date: 7/22/2002 In the name of: Martha L Davis Date of Death Balance: $33,074.91 Int.(YTD) from 1/1/2008 to 10/31/2008 $1,211.11 Accrued interest to date of death: $14.72 Otherlnfo: Account #: 3385058114 Type: In the name of: Martha L Davis Date of Death Balance: Int.(YTD) from 1/1/2008 Accrued interest to date of death: Other Info: CD $33,114.28 to 10/31/2008 $16.70 C-pen date: 7/22/2002 $1,250.48 Account #: Type: In the name of: Date of Death Balance: Int.(YTD) from to Accrued interest to date of death: Otherlnfo: Open date: Account #: Type: In the name of: Date of Death Balance: Int.(YTD) from Accrued interest to date of death: Other info: to Open date: Page 2 of 3 Credit Information: Account Numbers: For credit information please contact: Sovereign Bank Attn: Bruce McCauley RI1-WST-04-03 15 Westminster Street Providence, RI 02903 Page 3 of 3 ~ M&T Banlc 1 West High Street, Carlisle, PA 17013 November 26, 2008 David Gority M & T Investment Group 1 W High Street Carlisle PA 17013. RE: Martha L. Davis CD Acct # xxxxxxxx445727 Dave: Per your request, following is the date of death value as of November 4, 2008, for the above referenced certificate of deposit, including accrued interest: Principal amount: $ 20,000.00 Accrued Interest: $ 2.85 Total Value $ 20,002.85 Should you have any questions regarding this matter, please do not hesitate to contact me. Sincerely, E Kri ty J. Le man-Martson Assistant Branch Manager CARL E. OCKER AUCTIONEER 4401 Philadelphia Avenue Chambersburg, PA 17201 (717) 264-6578 Personal Property Appraisal for Martha L. Davis Estate 47 Bullock Circle Carlisle PA 17013 LiVTNG ROOM .40.00 4 FLOOR LAMPS ....................................................................................................... EST OF THREE INLAID MARQUETRY INLAID TABLES ................................. .................................... ...................,..................75.00 N MARQUETRY INLAID ROUND COFFEE TABLE ................................................ .......................................75.00 ICE WAGON ................................................................................... IRON BUGGY ....................................... 5.00 , SAWYER FINN FIGURE .......................................................................................... ......................................10.00 GLASS SIGNED BIRD .............................................................................................. ......................................20.00 RECLINER ................................................................................................................. ....................................... T AND WING CHATR ......................................10.00 ......................................50.00 ..................................... LOVE SEA CHANNEL BACK CHAIR ........................................................................................ ......................................20.00 LARGE GILT MIRROR ............................................................................................. ......................................35.00 ZENITH TV ................................................................................................................ ......................................10.00 CD PLAYER, PAPER SHREDDER .......................................................................... ......................................10.00 40 00 CANE SEAT ROCKER .............................................................................................. . ...................................... 15 00 CHILDS ROSE CARVED CHAIR ............................................................................. . ....................................... MARQUETRY INLAID COFFEE TABLE ............................................................... ......................................75.00 2 STILL LIFE PRINTS .............................................................. 3 LATIN PRINTS ..........................................5.00 , SWIVEL CHAIR ....................................................................................................... .........................................5.00 WOOD DRUM .......................................................................................................... .......................................10.00 CARVED T,TON ......................................................................................................... .........................................5.00 DINING ROOM 5.00 BAROMETER ........................................................................................................... ......................................... 20 00 GERMAN STEIN ...................................................................................................... . ....................................... 75 00 4 CARVED IVORY PIECES ..................................................................................... . ....................................... PROOF COIN PAPER WEIGHT .............................................................................. .......................................15.00 11 BACCARAT GLASS PAPER WEIGHTS -BICENTENNIAL COLL OF CAMEOS IN CRYSTAL...1100.00 HOODED OAK CHINA CLOSET ............................................................................ .....................................500.00 HEINZ CLOCK ........................................................................................................ 5 PRESSED GLASS COMPOTES-BOWLS ............................................................ ...................,,......................5.00 ........................................10.00 3 KNIFE RESTS, SALT DIP, CHILDS MUG ......................................................... ........................................10.00 2 GERMAN CAKE PLATES ................................................................................... ........................................15.00 3 PRESSED BOWLS, 2 SUGAR BOWLS ............................................................... ........................................10.00 4 SELINSGROVE, PA PORTRAIT PLATES .......................................................... ........................................75.00 CHINA BOWLS ....................................................................................................... ..........................................5.00 LOT OF PRESS BOWLS, 2 NAPPIES .................................................................... ........................................15.00 1910 CALENDAR PLATES .................................................................................... ........................................10.00 CARNIVAL BOWL ACORN .................................................................................. ........................................20.00 PRESS COMPOTE ................................................................................................... ........................................10.00 CAKE STAND ......................................................................................................... ........................................15.00 CELERY VASE, PATTERN PITCHER .................................................................. ...................,......................15.00 6 CANE SEAT CHAIRS ......................................................................................... ...................,......................75.00 DROP LEAF EXT TABLE ...................................................................................... .........................................50.00 MARQUETRY INLAID TABLE ............................................................................ ......................................... 50.00 4 WESTMORELAND MARY GREGORY PLATES ............................................. .........................................20.00 CHINA CUPS & SAUCERS ................................................................................... ......................................... ] 5.00 8 PENNSBURY POTTERY PLATES .............................................................................................................25.00 BRASS SKATERS LANTERN ....................................................................................................................... .35.00 GLASS BASKET, SALT & PEPPERS ........................................................................................................... .10.00 WINE GOBLETS, SALT DIPS ....................................................................................................................... .15.00 GOBEL BELL, FIGURES, STERLING CANDLESTICKS, BASKET .......................................................... .30.00 SUSQUEHANNA ON THE AVENUE RODNEY RILES ............................................................................. .20.00 HOWARD MILLER WALL CLOCK ............................................................................................................. .65.00 KITCHEN DINETTE TABLE ........................................................................................................................................... .10.00 2 PLANK CHAIRS .......................................................................................................................................... .15.00 REDWARE BUNDT MOLD ........................................................................................................................... .15.00 SMALL APPLIANCES ................................................................................................................................... .10.00 WESTMORELAND PTTCHER, SALT & PEPPERS, ETC, BUTTER DISiI ................................................. .20.00 FRTENDLY VILLAGES SET OF DiSHES ..................................................................................................... .50.00 GARAGE TAPERED LEG DROP LEAF TABLE ........................................................................................................... .75.00 BEDROOM ONE OAK CHEST & DRESSER, NIGHT STAND ................................................................................................ 100.00 2 SINGLE BEDS ............................................................................................................................................ ..20.00 FRANKLIN MINT TALL SHLPS 50 PCS SILVER ...................................................................................... 100.00 METAL BOOK SHELF ................................................................................................................................. ..20.00 WOOD RAM .................................................................................................................................................. ....5.00 BOOKS LOT .................................................................................................................................................. ..25.00 CAPTAIN CHAIR, BARREL BACK CHAIR ............................................................................................... ..20.00 DEN WING CHAIR ................................................................................................................................................ ..25.00 INLAID STATUE OF LIBERTY PLACQUES .............................................................................................. ....5.00 GLASS HORSE HEAD, SQUIRREL SIGNED LONF.TTi ............................................................................ ..35.00 BEVELED MIRROR ...................................................................................................................................... ..10.00 FLOOR LAMP, HANGING LAMP ............................................................................................................... .... 5.00 GLIDER ROCKER ......................................................................................................................................... ..20.00 INLAID STOOL ............................................................................................................................................. ....5.00 DUCK BOOKENDS ....................................................................................................................................... ....5.00 COMPUTER DESK & CHAIR ...................................................................................................................... ....5.00 WALNUT MARBLE TOP STAND ............................................................................................................... ..75.00 6 COLLECTOR PLATES ................................................................................................................................ ....5.00 14 RUNNEL COLLECTOR PLATES ........................................................................................................... ..25.00 6 STERLING COLLECTOR PLATES ............................................................................................,............... ..60.00 DUCK DECOY ................................................................................................................................,............... ..10.00 CARD TABLE ................................................................................................................................................. ..10.00 ORECK SWEEPER ...........................................................................................:.............................,............... ..50.00 FILE CABINET ............................................................................................................................................... ....5.00 KNEEHOLE DESK ........................................................................................................................,................ ..15.00 SOFA AED .................... ................................ ..20.00 17 FRANKLIN MINT BELLS ....................................................................................................................... ..25.00 TOTAL ............................................................................................................................................. $3,755.00 I, DO HEREBY CERTIFY that I have examined the tangible personal property of Martha L. Davis Estate, 47 Bullock Circle, Carlisle PA 17013 And do value and appraise the same at $3,755.00 as being fair market Value of said property on this date of November 12, 2008 Date i 4 ~ Carl E. Ocke ~J Appraiser CARL E. OCKER AUCTIONEER 4401 Philadelphia Avenue Chambersburg, PA 17201 (717) 264-6578 Personal Property Appraisal for Martha L. Davis Estate 47 Bullock Circle Carlisle PA 17013 2 IRON BULL DOG DOOR STOPS ....................................................................... .........................................75.00 CRYSTAL FISH SIGNED LONETTI ..................................................................... ...................................... 20.00 20 ANIMAL MEDALS, FRANKLIN lV(iNT .......................................................... .......................................100.00 7 CHILDREN OF THE WORLD ............................................................................ .........................................25.00 TOOLS LOT ............................................................................................................ .........................................10.00 12 PEWTER F.M. CARS ......................................................................................... .........................................75.00 14 IIUMMEL FIGURINES ..................................................................................... ....................................... 500.00 WALNUT VICTORIAN WRTCING DESK ............................................................ .......................................250.00 8 PEWTER ROARING 20'S FIGURINES IN CASE ............................................. .......................................150.00 40 ROYAL DOULTON TOBY MUGS ................................................................... ....................................... 500.00 13 PEWTER MEN & WOMEN FIGURES, WHO BUII.,T AMERICA, IN CASE . .......................................125.00 CHILDS CARVED ARM ROCKER ....................................................................... .........................................40.00 BOY & GIRL FIGURINE BOOKENDS ................................................................. ..........................................10.00 UNCLE HARRY GERMAN MUG ........................................................................ ......................................... 10.00 12 PEWTER FIGURINES PEOPLE OF AMERICA IN CASE ............................. .........................................120.00 LITTLE RED BENCH ............................................................................................ ..........................................10.00 FIESTA DISHES .................................................................................................... .......................................... 20.00 ARTIC FIGURINE BEAR ...................................................................................... ............................................5.00 20 GERMAN FIGURE WOOD CARVINGS ............. ;........................................... ........................................200.00 2 ST LOUIS GLASS PAPER WEIGHTS ............................................................... ..........................................15.00 CHILDS CARVED ROCKER NO ARMS ............................................................. .......................................... 35.00 TOTAL .............................................................................................................................................$2,290.00 I, DO HEREBY CERTIFY that I have examined the tangible personal property of Martha L. Davis Estate, 47 Bullock Circle, Carlisle PA 17013 And do value and appraise the same at $2,290.00 as being fair market Value of said property on this date of November 12, 2008 1 ! ~ Date ! ~ ~ D ~ Carl E. Ocker ~' ~ ~` Appraiser