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HomeMy WebLinkAbout08-19-09 15056051047 REV-1500 EX (O6-OS) OFFICIAL USE ONLY PA Depadment of Revenue County Code Year Ftle Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN = «>« *- t a *~ **= sbs =*~ ~, ~ 9 2 1 0 9 ~ ~7 0 ~; ~5 .1 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Soclal Security Number Date of Death Date of Blrth z ' z~ z ~~ ~ l ~ 3 ~ l~ j ~S~ ~ ~ ~~i~ 3 ( ~'r~~~~ 6 8 59 } an ~ ll ~l' iE a1 I x b aa M , ° 'd 3 b t . . : . atxvg# :> # s. > = Decedent s Last Name Suffix Decedent s First Name MI si H ( +. ' e 8i C " ~ k } A3 E § R y t ~a J~' A~3 C` K S 0 ~ ~ ~ + ~M.M m~`~ ~e d d6 S=? , . ,. } 1 K. ..' u$+++ on}aaa i.... t. ~ xo-0 *m~as eE U.a tl ~•bbia diava• 4 ~., ~ },e+~a=o aYV LS ~l S.d oa N.«rg~.*~A.=~.rb .b a OLRds (If Applicable) Enter Surviving Spouse's Information Below Suffix use s Last Name Sp o ame Spouse s First N MI *~~ gg * Ht~ ~ MJ ` f S ~ S ~ g ~ ~ +~ R ~ > ~ E ~ 8 ~ ~ 4 ~ ~ ~A~K ' E R,~ " I B3 p' E L> l B ,.. „. .„ >.. .. ..n ... : _s. ., .= Q Y. : , , , ; * a ,.< n5zb.a .., ... <x Spouse's Social Security Number Ra ¢ #~ t e..4~.<.R FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-B2) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) _ 8. Total Number of Safe Deposit Boxes O 10. Spousal Poverty Credit (date of death behween 12-31-91 and i-1-95) O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number y p ~: I ( i A D3R 9 ~ a t}a.iQ r: ! 5 Y f R ! ! y IS ' r i . r ..+ + + .er. )3 Gfne g, QxtlG § {j 4 t 4 = x [(~51~~ i i y y Q V .~ Y y 7 r~ 9 ?.da{ / y /~ Y ~ ~ ~~ ' $ ~ N : . E.>wR HY?+E,tEI~+;.~ ,;,t.~a .C.:r,. •a • / ~ ~ { U',I~~ 4+7n)a~<b56ek ..;,~s Ox ~yE. a$:.~, idFUn ~ ¢j ~ 1 S - FII}- xaa ra-.. r ~ ~ Flrm Name (f Applicable) .. , „r o-, a ...i a ' y ~ x ~ i. i REGISTER{O,F~~S US LY -' ~ ~ ij + 8 { ( + f y r ; i ~ . AxNyD R°E;Wt +Cy i3 H"Ey E+L+Y+ +A(Ti T; Ni Y; 'm ~ i' ii' a ... "4' '*°Yeixy*. [nir f.av.a a• v -. -i. R rv}..siv drf rf rtee4r ETVVaaavai ...'.y ~ -~; ~) ~ ~ )~ J First line of address ,.,... ~ } r -r,., k .}: . a.... a. > ~ ~, 7 C7 e- -ti ~, ~ ~') ~ ~-i b y k 9 1 2' 7 S 0 -0 b o- + + y U+ T~ H: M A R< K: Et T i y y d o-. ' SI T% R E ` Ea T B l l7-i~ ~. ,.t .,.,,,,=ya .. ...ata ~ . . 2. ,. t. . . ,.... .. +. s . t,,, ..a.,a. .... ` a ~ ' -' ~i Second line of address .T7 .i i. 1 ~ '~ a.air. ay.. a . . .... .vae F.+er+: a?s.rasaa r.v V..p.....a ,} is ,.,.. °.... r. r.w y (.~.~ 11 e i + ~ b ..»,.a ~a .. ~ ~ a...+ r..r....r . r,,,... .a, .. . . ..... ' DATE FILED Clty or Post Office -.. State ZIP Code r. , a v. M E C H 'A N y L' L S B U R C ' t ,. 0' 5 5 1'7 ' P A , y . °. ; ,i. ~ r~ .<. .?at.aa;.a :. l ,. ,, :+. .,.,:.,;a.„ . . r, .:, Correspondent'se-mail address: andreWC.sheely~VerlZOn.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the Desl of my knowledge and belief, it is true. wrrec[ and complete. Declaration of oreoarer other than the personal representative is based on all information of which preparer has anv knowledge. OF PERSON RESPON$IBKE FOR FILING ADDRESS Isabel ADDRESS Andrew C 15056051047 REPRESENTATIVE U 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15[]56051047 J ~1 -D REV-1500 EX 15056052048 Hammaker, ~ackaon R. Decedent's Social Security Number .. q-:..= ~. ... .. 1 ;8 ~z ; 23 226 88 )g :g RECAPITULATION { # 4 t 1. Real estate (Schedule A) . . .......... ........ ......... ......... i. • sei, ) .x<~gg§~88i~gag~gg;$g' 2. Stocks and Bonds (Schedule B) .... .. ......... ..... .... ......... 2 - : ~ "~ ,", '~ i •.1IICi a:#t}P55 49f3A tad tY#X~ ..{ ~.. .; s r .l. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3 { '. ', ; Sxs pAAAi{r$b6 E,irolx $k4 }Rfit$bu#a. 4 4. Mortgages 8 Notes Receivable (Schedule D) ....... ..... ..... ........ q _' ~ ; { ; , ` ` # #$$ Acts%#zb# #t$exdtrre 3 #A#rt$Y t 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... 5 5 Y ss ,Y i F„ 4; §A ;e. } §}*. . # +,. ..Y.. y., ..e..., ...r. ,,.. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... 6 J Y` s '. 7. Inter-Vivos Transfers 8 Miscellaneous (Schedule G) Non-Probate Property O Separate Billing Requested...... 7 Y{{Ab 0$~9§#}; Y3Y{YR tb} yk §d*tiY~ a t ~ }1 '~ e$ %i Yd$$0{¢9$kYd iS}}k Y8#i8AQ9id83$ {~ t - i i .. 8. Total Gross Assets (total Lines 1-7). .. ......... ......... 8 ;. ;6 ,'~ .'Q 1 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9.: ~ `: ;1 ,a ,+5 ,~7 z E;Bt e t ile;; .p .., } 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .... ......... 10. t i `-. ~ ~ ` , ', 11. Total Deductions (total Lines 9 & 10) ................................... 11. ~ ; ,", 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. f °a $ ° is%i $ts ~s ba>ada 13. Charitable and Governmental BequestslSec 9113 Trusts for which x f an election to tax has not been made (Schedule J) ........................ 13. ; .._~d__a_.%f:_ 14. Net Value Subject to Tax (Line 12 minus Line 13) ................... ..... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 ~ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~Q~~ 15056052048 Side 2 15056052048 1'. tar Bass{<+ 8Yi'+ 5~8 9; 9; g 7; !Fn ~+,~ ~: t,;e <_ dt 9. 2 O REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0759 Jackson R. Iiammaker _. STREET ADDRESS 15 Sharon Road - _ __ _. - CITY Enola sTAre PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit _-__ _ __ B. Prior Payments C. Discount Total Credits (A+ g + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT tatf}pata saxoe[es nay>tt figl.3 t. lobe 8apppfl3 t e$aa$$.ae~a~ pa °a ygD~af °st~q$`e ea g$99¢t p'a'jgt 3a ds9'6 # e5 E; S } 6;2p»$p ;;a....t3 F Rfp"d:: 3 &E Saa r ; a« irit PAttrktf tt itli PSkp iRne 3i s, ea~xrtxea8a°i'....$... m.f0( . 8d& W... P 9Sf.aY14P 4Xi@f}9ttf kDB# k 6 9#b Y 6 vt {i. 4txe 61i J i f s t PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property tmnsfened :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income :...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefts or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate propedy which contains a beneficiary designation? .................................................................................................................. ...... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~~ a~~4~~tttl~~I ~;~~Ig t1~a,sa;a~ ¢ai"1~I~€$ ~f ttl~gbE~n$s~s;3~1 gSi~ItS22~~tt$~~tt#li~f ti>B$~.3f3&$s~~i3~~i#it3e#~~ i~;t€~ttt~#~4~ E i! t~E~tt~Ft~titttltttt~t tai#t~; 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 exemR a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and f ling 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 -I" a natural parent, an adoptive parent, or a stepparent of the child is zero (O) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. 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-1503 EX+ (6-96) SCNEp11LE B COMMONWEALTH OF PENNSYLVANIA STOCKS Sc BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT FRTATF AF FILE NUMBER PART Jackson Ray Hammaker 21-09-0759 t.;alcutate the value ofYourPaper Savi~s Ho3d(s) TreasuryDirett 2S j9gry4d1 ~ Took ~ Cakulate Me Value of YOUr Fawr Sanngs Band(s) Calculate the Value of Your Paper Savings Bond(s) v.r4 .1 a:a wNN i, u`_ne ii N.m MrrN Dnowk:ofiw: eoKd fern N4NMr. LeNa Dab: EE 90IM8 75 Calculator Results for Redemption Date 06/2009 Ta8811riw Tob1V1W Tob11at1reR 15,400.00 8ilr,M3:9F 51],093.36 ~.?733Y/ tir.6/5_ 160 lmp://www.treasmydirecdgovBGSBCPrice 3nnructl9n tl9a1n Us9.Ihe51vD9s mne c9s9Nwc N91os Oescryton NI Na[bauM x2 xa lytlM3 hr wvme:rc f! I:KWaa 3 monM mt.rpt O.naEY ffA MllOnd aM wt wmin9 r,rmt YTD I3N1nK 5435.% K39988955lE !f f)5 08/1983 08/1009 W/201J f3).5D 1132./) 3.93% 814fAT .M8N3918]EE EF fJ5 01/1988 W/2009 01/30!8 f3>,SV f]l,{B 4,00% 8118A0 3bfiM16}EE- EE ..-.f%-- "OS/f9N- .. 0]/3009.. OU1819 "q):40 f)3.4D MWN-. . ~100,ED K931A959EE EE S]5 01/1990 10/3009 01/2020 53).50 163.09 4.00% 8100A1 K93458093EE H 1]5 03/19% 08/3009 02/Z020 53).50 (83.09 1.00% 8100.25 K9]155923EE EE 3]5 01/1990 0)/2009 01/2030 13).50 163.09 1.00% 8100.85 K91]J6ZJIEE EE 515 12/1989 12/2009 13/1019 13).50 565.10 1.00% µ03A0 K91)N%3EE EE f>5 11/1989 112009 11/3019 13).50 165.30 1.00% 8103A0 K94J31%3EE EE f)5 10/3989 10/2009 10/1019 l3 J.50 565.10 4.00% 8102.80 N90g5138EE EE f>5 09/1989 09/3009 W/2019 fJ>.$B 165.10 1.0044 8101.80 K906)2M6EE @ f)5 OE/1989 08/3009 00/2019' 53).50 (65.10 q.00% 8101./0 KBBZ3)%8EE EE f]3 0)/1989 0)/3009 O>/2019 53).50 S65.f0 L00% 8302A0 NBµ11361EE EE S)5 06/1989 12/2009 06!3019 53).50 56].1] 1.00% 8104A) K%20885)EE EE f>5 OS/1989 11/2009 05/2019 SJZ50 56).1] 1.00% 8f04A) 1®03%3gEE ~ 1)5 01/1989 10/3009 01/3019 53).50. fq.1> 1.00% 8314A) K%16]%6EE EE f)5 03/1989 09/3009 03/2019 53).58 f6J.1] 1.00% 8104.8) If8U01239EE EE SJS 02/1989 08/3009 02/2039 53).50 %).1] 1.00% µ04,q 1031301%JEE EE f)5 01/1989 OJ/2009 01/2019 S3J.50 fb>.1) 1.00% 8104.8) K812)155]EE EE f>5 1L1980 13/2009 13/201(1 13].50 169.3) 1.00% 8108.)] K81269010EE EE f>5 11/3988 11/2009 11/3018 13).50 ffi9.2] 1.00% 8108.]) K81231388EE ~ f)5 10/3988 10/2009 10/3018 f3). SO 569.2] 1.00% 8100.1) K812318]9EE EE f)5 09/1988 09/3009 09/3018 13).50 569.1] 1.00% 8108.)) I®131812]EE EE f)5 08/1908 OBR009 %/2038 53).50 969.3] 4.00% 8108.)] K81315113EE EE f)5 0)/3988 0)/3009 q/3018 13].50 569.3) 1.00% 8100.)) K8013I406EE EE f)5 0)/1980 OJ/Z009 O)/2018 13).50 569.3) 1.00% 8306.)1 1f~03N51EE EE f]3 06/1908 13/3009 06/2ou8 13).50 1]340 4.0094 8108.90 I®039319)EE H f>5 05/1908 11/2009 B$/ZDIe 53).50 SJl./0 1.00% 8101A0 K~392%IEE EE f>5 01/1900 30/2009 01/3018 53).50 f]1AO 0.00% •lOt10 10l0368838EE EE f)5 0]/1908 09/Z009 03/3018 13).50 5]3.10 LOOK 8101.10 1®0366%]EE EE f)5 03/1988 08/2009 02/3018 53).50 5)1.10 1.00% µ01.f0 KB33361)BEE EE fJ3 12/19q 11/3009 12/IOV S3>.30 5)3.56 1.00% 81f1A1 K00309384EE EE f)3 11/190] 11/3009 11/201) 13].30 1)3.56 1.00% 8111.08 KBpI%4J9EE EE f>3 10/198] 10/2009 10/301) 93).50 S]3.36 1.00% 8111.00 K)58fi155)EE EE f>5 09/198] 09/3009 09/301] 53).50 5)3.56 1.00% 8113.08 KJSBSBgSEE EE f)5 OB/19q 08/2009 OB/301) 1]].50 f)J.56 1.00% 8111A8 K]3055830EE EE f]5 00/19q 08/Z009 %/301) 13].50 5)3.56 LOMB 8111A6 KJI326692EE EE 1)5 W/19q W/2009 q/203) 53).50 i)3.% 4.00% µ11A5 KJ39%660FE EE fJ5 06/198] 13/2009 06/301) 33).60 1)5.)8 1.00% 8132.St K)]9q>30EE EE f)5 OS/19q 11/3009 05/301) 1)).50 5)5.78 LOOK 8111.38 KJZJ92390EE FE f]5 01/198) 10/3009 M/301) fJ].50 5)5.]8 1.00% µ13.S( g3620115EE ~ f)5 02/198) 08/2009 03/301) 13].50 5)3.)1 {.00% 811].21 K6]303938EE EE fJ5 Ol/198J 0)/3009 01/301) 13].50 f>5.]e 1.00% µ133t I(6)500957EE EE f)5 13/3986 IZ/2009 13/3016 8]).50 1)0.06 1.00% 8118.!8 K6>392JSeEE EE fJ3 31/1986 31/3009 11/3036 13).50 5)8.06 1.00% 011!.!8 Kg359089EE EE f>5 10/1986 30/20)9 10/2016 53).30 591.03 1.00% 8128.31 K66)/6810EE EE f)5 09/3986 09/3009 09/3016 13).50 191.03 4.00% {iLA2 K66039335FE EE f)5 08/1986 %/2009 08/2016 13).50 593.83 1.00% •118.22 1 of 3 ~~~~ ~h~°~c F '~C ~ Jam' Oq ~fG_1/~ Ci ~mU~ 6/4/2009 7: S 1 PM i 2of3 ..~ -......., ...--. o... rag3fa ~avlafgs nom~9j _. ir[p:uwwwaceasuryaliec~~ovibl,/Jril;Ynce K61236832E! ff 315 01/1986 0)/3009 0)/3010 13).50 591.02 1.00% 0131.]3 K62158006EE ff 1]5 06/1Po6 13/3009 06/3016 SJ].50 593.60 1.00% 0191.10 K56{9)698ff EE f)5 05/1986 11/3009 05/3016 S3J.50 593.60 1.00% 0191.10 K561WJ91EE EE SJ5 01/1986 10/2009 01/3016 53),50 59).60 1.00% •191.10 K%1918b5FE EE f)5 03/3986 09/3009 03/3016 53].50 193 B0 1.00% 0191.10 K56188JSSEE EE SJS 03/1Po6 00/3009 02/3036 331.50 593.60 1.00X 0111.!0 K561859llEE EE f>5 01/1986 0]/2009 018016 53L50 193.60 4.00% µ]1.1O K56183122EE EE S)5 12/1985 13/2009 13/30!3 53).50 f%.31 4.00% 019].)1 K361BOIIOEE EE f>5 l1/1985 11/2009 11/3015 13).50 S%.31 4.00% 0119.)1 K561%098EE EE f)5 10/1Po5 10/3009 10/1015 5]).50 f%.31 1.00% 011].]1 K561]02))EE EE f)5 09/1985 09/2009 09/2015 53).50 f%.31 4.00% 11]].11 K%185108EE ff f)5 08/3985 08/2009 Po/ZO15 53).50 f%.31 1.00% 0131.]1 K%1)10)3EE ff f>5 08/1985 08/3009 08/3035 13).50 f%.31 4.00% q1]].>1 K561)1330EE EE 3)5 0]/1PoS 0)/2009 0)/2035 53).50 f%.31 1.00% 011].)1 K5183J066EE FF SJS 06/1985 13/2009 06/3015 13).50 f%.91 1.00% 0136Af K53169796EE EE 3)5 03/1983 11/2009 05/2015 53).50 5%.91 1.00% 0191A1 K5316J02tEE ff fJ5 01/1985 10/3009 01/2015 13).50 SPo.91 1.00% 0310A1 K531b)OOEE EE 115 03/1985 09/3009 03j3015 33).$0 598.91 1.00% 01AA3 K53Ig681EE EE 315 ~ 02/1985 088009 03/2015 33).56 fPo.91 1.00% pi]tA1 K50881816EE EE SJS 01/1985 01/3009 01/2013 53).50 3Po.91 1.00% 01]1.11 K50]1N51EE EE fJ5 12/1981 13/3009 12/3011 µJ.50 3101.61 1.00% µ9f.11 K503095{)EE ff 5)5 11/1981 11/3009 ]]/3011 33).50 3101.61 1.00% 0195.11 K5018B630EE EE f)5 10/3981 10/2009 10/301{ 13).50 1101.61 1.00% µ15.1l KIB100316EE EE f)5 09/1981 09/2009 09/2011 53).50 3101.61 L00% µ)f.11 K48f03160EE EE 9)S 09/1981 09/2009 09/30]1 53).50 1101.61 1.00% 0195.11 KI)BJ3555EE EE S>S 08/1981 08/3009 08/301{ 93).50 5101.61 1.00% p1]f.11 KD860328EE EE f>5 O>/1981 0]/2009 W/3011 53).50 5101.61 600% µ9f.11 KIJ85>2J9EE EE !)5 06/1981 13/2009 %/3014 13).50 5101.10 {.00% µ{fA0 KI5592531EE EE 3)5 05/1981 11/2009 05/ZOt1 13).50 1101.10 1.00% 11{1.90 KM6693IIEE EE 315 01/1981 10/3009 0//2011 SP.50 9106.35 2.93% µµA0 K14656321EE ff f)5 03/1981 09/2009 03/2031 33).56 1106.35 3.93% i11]A1 K13800696EF ff S)5 03/1984 08/3009 03/2011 33).50 ;1%.35 2.93% f111A] K13]9)S30FE EE S>5 03/1981 0)/3009 01/2011 531.50 3106.35 3.92% g119A] K{2591633EE EE 315 1271983 ]2/2009 1L2013 33).50 3108.15 1.00% •1g9J1 K{33b923EE EE SJ5 11/3983 13/2009 11/2013 53).50 1308.15 1.00% µ19.5S K433]Jblff EE 9)5 10/1Po3 30/2009 10/2013 53).50 5113.1) 3.93% 0115.51 K101811J3EE EE S>5 !0/1983 10/2009 10/3013 331.50 5112.1) 2.93% 0169.0] K398N898EE FE 5)5 09/1983 09/1009 09/2013 53).50 5132.1) 3.93% 11/f.1) K39985356EE EE SJS 0)/1983 01/2009 01/3013 3]1.50 5113.1) 2.93% O11f.f) K39981W5EE EE 715 06/1983 13/3009 06/1033 33).50 1111.66 1.]8% 0181.11 K399J8160EE EE f)5 05/1983 11/2009 05/2013 53).50 1111.86 1.)8% {1!3.16' K399)SOBBEE EE S)5 01/1983 10/2009 04/2013 33J.50~ 5130.96 2.99% 01S1Aq K349%129EE EE S>5 03/1983 09/3009 03/2013 33).50 3330.96 2.99% g3f1Aq KJ1992703EE H SJ5 02/1983 08/2009 03/2013 531.50 3161.96 1.00% 03J1A5 KJ4989031EE ff SJ5 01/3983 0)/3009 03/3013 531.50 3111.96 1.00% ~ g1)9A1 K31985512EE ff 115 12/3983 12/2009 12/3012 53)•50 5115.53 1.00% 01t]Ai K31981908EE EE !J5 !1/1982 11/2009 11/3013 53).50 3115.53 1.00% g1t].0] K3899>%2EE EE fJ5 30/1982 10/3009 10/2013 SJJ.50 (151.32 1.00% 0151.11 K28993112EE Ef f)5 10/1983 10/2009 10/2013 13).50 1156.32 1.00% 0191.11 K38989326EE EE f)5 09/1982 09/2009 09/2013 33).50 (151.32 6.00% 01f1A3 K2B985583EE EE f)5 08/1982 08/2009 08/2012 53).50 3{51.32 4.00% ;15113 K38981906EE ff 3)5 0)/1982 OJ/3009 O>/2012 13).50 3151.32 4.00% 0101A2 K2303]951EE ff 3>5 06/1982 12/2009 06/3012 331.50 5158.ifi 1.00% glf]A1 K23033928EE EE S>5 05/1982 11/2009 05/3012 53250 3158.16 1.00% 01flA5 K23019906EE EE 95 01/1983 10/3009 01/3032 fP.50 5158.16 1.00% 015].11 IQ3011699EE EE 715 03/1982 09/2009 03/2032 33).50 1158.16 1.00% Oifl.tf K21103858EE ff f)5 02/1982 08/3009 03/2012 531.50 1358.16 1.00% 019].11 K213Po>OBEE EE S)5 01/1983 01/2009 01/3012 33).50 3358.16 1.00% 015].01 K31391915EE ff f>5 12/1983 128009 13/1011 53).50 5163.06 1.00% giff.A IQ1390053fE QF f)5 31/1981 11/2009 13/2011 13).50 5162.06 1.00% giffAS K31385916FE EE SJ5 IO/1981 10/2009 10/3011 33].50 1162.06 6.00% 0101.]{ K31381)3]fE EE f)5 10/1981 10/3009 10/3011 53).50 5163.06 1.00% 0155.91 K20)6538>EE ff f)5 09/1981 09/2009 09/301( 53250 31113.06 1.00% µ1f.50 K30)1061)EE EE 315 Of/1981 OB/Z009 08/2013 53).50 3163.06 1.00% 0iff.sl K20>35850EE ff f)5 0]/1983 0)/2009 0)/2011 13].50 3162.06 /.00% p155.]1 IQO>11333EE EE S)5 06/1983 13/2009 %/3011 33).50 1166.05 1,00% 0101.!] K30>26)B2EE EE 3>6 05/1981 11/3069 05/3011 3l>.50 9166.05 1.00% g19]A] KlOJi18J%E ff fJ5 01/1981 10/2009 01/2011 53).50 1115.11 1.00% µ11A1 K19900812fE EE S>5 Ol/3981 09/3009 03/3011 33).50 11]5.11 1.00% gxix.st K19895838FE EE f)5 02/3981 08/3009 03/2013 13230 51)5.13 1.00% 0333A1 K19891052EE ff S)5 01/1981 0)/2009 03/3011 53].50 11)5.11 1.00% µ11µ K1Po861)3EE EE f)5 33/IPoO 13/2009 12/3010 SJ).50 f1M.3) 600% µ11A) III I /4/2009 7:51 PM Calculate the Value of Your Paper Savings Bond(s) _. http://www.treasurydirect.govBGSBCPrice K3890885)EE EE f>5 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NON-PROBATE PROPERTY ESTATE OF Jackson Ray Hammaker FILE NUYABER 21-09- 0754 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRPNSFEREE, THEIa RElATI0N5HIP TO °ECE°ENTAND THE DATE OF TFPNSFER. ATTACHACOPV OF TXE pEEO FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICN9LE TAXABLE VALUE f . Member s First IRA -Account #20225, Isabel Beatrice Hammaker, beneficiary $41, 286.58 100% $41, 286.5E i TOTAL (Also enter on line 7 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) $41, 286.58 MEMBERS 1'~ pBOBRALCB80lT t7NifTN ember Services Sti cet XXXXXXX225 HAN2(AKER,JACKSON D DUE DATE PRINCIPAL INTEREST Eff: 06/16/09 Pat: 06/16/09 Tlr: 1755 Time: 9:51am FEES NEVP BALANCE TRAM AMOUNTi SEQ epoeit tp IRA SAVINGS 15 Prev Hal: 41,286.58 5 8.93 0.00 0.00 41,295.51 8x931#220184 omment for TRA SAVINGS 15 APY Earned 0.72$ 06/05/09 to 06/15/09 ~ ithdrwl fs'om IRA SAVINGS 15Tranafor to taother Institution ~ 5 41,295.51- 0.00 0.00 0,00 41,295.511#220187 otal Current Year Contributions: 0,00 ' epoeit to IRA SAVINGS 10 Acct BXXXXXX536 HANNAKER,ISABELTranafer from another Iaa~itutioa 0 .. 41,295.51 0.00 0.00 41,295.51 #220189 here Dividend 8.93 ~uthorizefl by ~' :D Source:. ^ Driver Lic ^ SigCard ^ Knows ^ Other --r-- 'urreat Certificate Promotions: 7-Month Term: 1.75$ APY 15-ffionth Term:~~2.00$ SPY Open yours todayl JACKSON R HANNAKER EV-1611 EX+(72-99) SCNEp1~LE M COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE 7AX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jackson Ray Hammaker 21-09-0759 Debts Ot del;etlent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t Michael J. Shalonis Funeral Home $5,539.57 2. Rice Memorial Works -engraving and headstone 3,350.00 s. Funeral luncheon and donations - Wesiey United Methodist 500.00 a. Cemetery lots -Perry Heights, Marysville 260.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name or Personal Representative(s) Isabel B. Hammakef Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 15 Sharon Road Ciry Enola State PA Zip 17025 Year(s) Commission Paid: 2. AnorneyFees Ar:drew C. Sheely, Esquire, per agreement 325.00 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Street Address City . _ State _ Zip Relationship of Claimant to Dea:dent 4. Probate Fees 98.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Reserves to file final income tax return, accountings 500.00 10,572.57 TOTAL (Also enter on line 9, Recapitulation) $ (It more space is needetl, insed additional sheets of the same size) Michael J. Shalonis Funeral Home 206 Maple Avenue Marysville, Pennsylvania 17053 Fax (717)-957-2077 Michael J. Shalonis, Owner Phone (717) 957.3451 We Care About Service To You Saturday, June 13, 2009 Mrs. Isabel B. Hammaker 15 Sharon Road Enola, PA 17025 Dear Mrs. Hammaker, Thank you for selecting our funeral home to provide services for your family during your time of bereavement. T hope that you tbund our services, so far, to be of the highest standards that we always try to achieve. The following is a summary of the service chafes as previously explained and provided in written forth on the services for. JACKSON RAY HAMMAKER 1. Profraaioed Services Basic Service Of Funeral Director & Staff $ 1225.00 Embalmingg $ 475.00 pressing, Casketing, Cosmetics, Details $ 250.00 $1,950.00 2. Ux Of Facilities, Staft And E uipment Use Of StaffAnd Facilities Fnr Funeral Ceremony 3. Automotive Equlpment Transfer Remains To Funeral Home Hearse TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT Merchandise Casket: Baron. Bronze " Outer Burial Container Greve Liner Acknowledgement Cards Register Book Memorial Folders 125 CASAADVANCES Cemetery Charges Paid Newspaper Notice Church or Clergy Certified Copies of Denth Certificate 4 FIOWCfs Ceme[ery equipment S 395.00 $395.00 $ 175.00 $ 200.00 $373.00 52,720.00 $1.075.00 $770.00 $ included $ included $included $1,845.00 $ 473.D0 $ 213.57 $ 50.00 $ 2d $ 2DO.oo $ ? 10.00 $1,174.57 TOTAL FUNERAL CONTRACT LESS: Credits granted $200.00 Discount allowed $200.00 BALANCE DUE If there ere any questions or rnncerns that remain unanswered. please call me. Sincerely, /~i~~-~- Michael J. Shalonis Owner $5,739.57 55539,57 c~ ~~ ~O" ~ ~~~ ~'' d°~ WWITE-Oifloe YEILOW-Peotluctloii PiNl4-CuaYOmei 4pL[Y~NApC3~~treriohi Y~ ~~ t3Rta~R i~tiRM L 1~ roc tcs~yxv r ~~~~ FoWndatlon By Fri 0 Oarved Letteratl ~upph®r ...... ~F~1At.~i Since .~ 9~1 ~ arawirrq Required ack. a 5243 Simpson Ferry Road, Mechanicsburg, PA 17050 ~ Drafter _ bate Flbc'd ('I17y 766;5522 . Fax (717) 7&6-9007 ^ ~~ndbl®st 9y Pound. 47rd~rad wwv,,gingrichmemorlals.com Manufacturer Positfan Verified so~D ro: ~.r'.. ±~n~-N-r-s .- , s~ a x©r H am r,~ a~Ccr bate of order ~l ° ~ 6 - O S ~ ~ s~„ ta+~ >k', ~ Cemetery ~~,{l,X vs u,~'~ly~~a7 1'tc~~ 9 y ~~ ~'~ Q ~ ~ Location ~,~<~leH ~ +~l i+N~=="-~`C''~ 1'~ Center ever ,_,....,~_ dra~res Lot f~~oita ~i±,~,"i~~" ",,, +~, ~ ~..(~t1„~--~---sue APPrOx. Date of Oompl9tion_~+ow~x hntA .~ '~e~r,ra 17 Vase ^ Corner Ponta ~M~ Prloe $ Fsruntfadort $ ~ 1'~' S.,! I tl.{trBS b gerNUl1T Dtl ell nuns Bnd dat/N.1o1' $ acoaraoy 9tid adopt full NBpMmIWINy for enyorrars or omi®Blona, THBeE WI4L®!! A# AQCg1tON'~t.L CM111M@E pOR kNY LTfrTttRIN4.Ab0Et170 Tklla 'MEMOpIgL AFTER EREt:TEO ON TiIC $ II 136METpnY. ~ __._ wrn,n~+inca Tet.ccm-PrtlauCtlnn PINK~DUetomei OOLD~NROD~grsnoN f. RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARMER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 HAMMAKER JACKSON RAY Receipt Date: 8/13/2009 Receipt Time: 10:08:17 Receipt No.: 1057847 Estate File No.: 2009-00759 Paid By Remarks: ISABEL B HAMMAKER JN ------------------------ Receipt Distribution ------ ------- -------- --- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 60.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 8.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & C R M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 4311 $98.00 Total Received......... $98.00 REV-1513 E%+ (9.001 COMMONWEPLTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jackson Ray Hammaker NUMBER I 1. NAME AND ADDRESS OF Sec. 9116 Isabel Beatrice Hammaker CMEDULE J BENEFICIARIES RECEIVING PROPERTY FILE NUMBER 21-09-0759 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Truateels) OF ESTATE Wife ~ 100% Rest,Residue , Ramainriar of Fatafa 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-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S (If more space is needed, inseN additional sheets of the same size) ~ ~; LAST WILL AND TESTAMENT OF JACKSON RAY HAMMAKER €~ i I, Jackson Ray Hammaker, of 15 Sharon Road, Enola, Cumberland', County, Pennsylvania, being of sound and disposing mind, memory and'I understanding, do make, publish and declare this to be my Last Will' and Testament, hereby revoking all Wills and codicils heretofore made by me. ITEM I. I direct that all my debts and funeral expenses, including my cemetery lot and gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my death as part of the expense of the administration of my estate. ITEM II. i devise and bequeath all of my estate of every nature and wherever situate to my wife, Isabel Beatrice Hammaker, if she survives me by thirty (30) days. ITEM III. If my wife, Isabel Beatrice Hammaker, predeceases me or dies on or before the thirtieth day following my death, I make the following specific devises and bequests: A. Pearl necklace unto Donna Jane Cassel L; B. Saphire ring unto Linda Louise Shuff; and C. Sewing machine unto Connie Graham. ITEM IV. I devise and bequeath all of the rest, residue and remainder of my estate of every nature and wherever situate in the 1 i ~; following manner: I! i A. Fifty percent equally unto Harry Robert Hammaker and Janet McCann and their issue, per ~i stirpes. B. Fifty percent equally unto Donna Jane, Cassell, William Paul Graham and Linda Louise &huff and their issue, per stirpes. ~~ ~~ z. ITEM V. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my! Will or otherwise, shall be paid out of the principal of my 'residual estate. ITEM VI. I appoint my wife, Isabel Beatrice Hammaker, Executrix of this my Last Will and Testament. In the everYt of her renunciation, death, resignation or inability to act for arty reason whatsoever, I appoint Harry Robert Hammaker, Executor of, this my Last Will and Testament. I relieve my Executrix or Executtor from the necessity of posting security in connection with hey or his duties as such in any jurisdiction in which she or he may bje called upon to .act. ITEM VII. This Willis not the product of any condract or agreement between me and my wife, Isabel Beatrice HammakerY and my wife shall be free to dispose of any property (whether dcquired under this .Will or otherwise), either during her lifetimle or by Will, as she deems proper in her sole discretion. ITEM VIII. In the event my wife, Isabel Beatrice H~mmaker, dies under such circumstances that there is not sufficient widence to determine absolutely whether she survived me, i direct Ifor I'i 2 i purposes of this Will that she shall be conclusively presumed to have predeceased me. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Wili and Testament, which consists of ~ pages, to each of which I have affixed my signature this ~~ day of OC~D bFr' , one thousand nine hundred and ninety five (1995). Jackson Ra Hazt a 3 f~ ~ COMMONWEALTH OF PENNSYLVANIA ss .. COUNTX OF ~~ ,1XOr-/' /~ i We, Jacks~on Ray Hammaker, and la~'(!)G/!')'i l ~~5//1~i~4--- , and ~ r4L~,.p~ ~a/r,fP ~~{p~,yyk~' the testator and th witnesses. respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declar~ to the undersigned authority that the testator signed and executed the i ', instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the~~purposes therein expressed, and that each of the witnesses, in the presence and hearing of .the testator, signed the Will as witness anal that to the best of their knowledge the testator was at that time',eighteen years of age or older, of sound mind and under no constiraint or undue influence. _ Subscribed and sworn to and acknowledged before me by Jackson Ray Kammaker, Testator and subscribed and savor to and acknowledged b,~fore kk~~,,yy ~, [(~ ~1.53i/tCi •E+t, , and T~- ~'~ ~r3J~'- rfc~nYUtoktr, witn s~his j 15~!t. day of ~~f„L,.E~.- 1995. ----• ~--- ISOed ~~ ~y,q, ryNary ~,ax_~~`(, I ~'~~ ~~~ ~~7~ »" ~ 4 ~~ ~ -