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Home My WebLink About09-18-09• ~ 1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number Po Box 2sosol 2 1 0 9 0 3 0 5 Hamsburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 9 2 0 9 6 2 5 4 0 3 0 1 2 0 0 9 0 8 3 1 1 9 1 7 Decedent's Last Name Suffix Decedent's First Name MI G E O F F R E Y L E O N S (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 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required ^X 6. Decedent Died Testate ~ death after 12-12-82) 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 ~~ 9 2~ 5 3 ~.-~ _. ~ ,. _+ Firm Name (If Applicable) REGISTER F~~S USILY ! } .-'> I R W I N & M c K N I G H T P C'=~'` ~ First line of address :. cn =:.~ ~ :_~ ~;__~j ~7~,~Y~ ~ ,~~»~ 6 0 W E S T P O M F R E T S T R E E T ,J'~J~~' ~ ''w Second line of address ~~ _~ tU ` ~ ---y rs .~ ~ ~, ~-.r {t City or Post Office State ZIP Code I DATE FILED C A R L I S L E P A 17 0 1 3 Correspondent's a-mail address: Under penalties of perjury, 1 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. Dec tion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ERSON RES NSI OR FILING RETURN DATE 9~i~ /0 ~ 725 YEAGER ROAD Y/ ~/ WELLSVILL SIGNATURE OF ARER OTHER THAN REP ESENTATIVE ADDRESS 60 WEST PO R T STREET CARLISLE PLEASE USE ORIGINAL FORM ONLY 1505607121 Side 1 PA 17365 ~j DATE PA 17013 1505607121 `~ ,b ~~ ~ ~\ ~~ 1505607221 ~j~ S~~ ~ ~.~` ~ , ~~ C~ REV-1500 EX Decedent's Social Sic n b r Decedent's Name: LEON S• GEOFFREY 0 9 2 0 9 6 2 5 4 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1 .................................. 2. 2. Stocks and Bonds (Schedule B) 0 • E 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................ 4. 9 5 4 1 7 4. 8 5 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• • 7. Inter-Vvos Transfers & Miscellaneous N Probate Property 8 1 0 2 3 9. 7 7 (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 7 6 4 4 1 4. 6 2 9 4 2 6 5 0. 7 0 .......... 9. Funeral Expenses & Administrative Costs (Schedule H) ...... . 1 8 9 7 3. 8 8 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... ...... 10. 11 6 1 6 2 4 • 5 8 11. Total Deductions (total Lines 9 & 10) ..................... ...... . 12. Net Value of Estate (Line 8 minus Line 11) ................... ...... 12• 1 ? 0 2 7 9 0 . 0 4 13. Charitable and Governmental BequestslSec 9113 Trusts for which 5 7 0 0 0 0 ~ an election to tax has not been made (Schedule J) ............ ...... 13. • 1 6 4 $ 7 9 0 . 0 4 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 0. 0 0 15 0. 0 0 (a)(1.2)x.o _ . 16. Amount of Line 14 taxable 1 5 1 5 7 9 0. 0 4 16 6 8 2 1 0. 5 5 at lineal rate X .045 . 17. Amount of Line 14 taxable 2 5 0 0 0. 0 0 1 ~ 3 0 0 0. 0 0 at sibling rate X .12 . 18. Amount of Line 14 taxable 1 0 5 0 0 0 0 ~ 18 1 5 7 5 0. 0 0 at collateral rate X .15 . 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ,~ 1505607221 Side 2 8 6 9 6 0. 5 5 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0305 DECEDENT'S NAME LEON S. GEOFFREY STREET ADDRESS 34 BULLOCK CIRCLE CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CretlitslPayments A. Spousal Poverty Credit B. Prior Payments 65,000.00 C. Discount 3,737.76 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 86,960.55 Total Credits (A + g + C) (2) 68, 737.76 Total InterestlPenalty (D + E ) 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) (4) 0.00 (5) 18,222.79 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 18,222.79 Make Check Payable fo: 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; ............................... ^ ^X c. retain a reversionary interest; or ................................................................................................ ^ X^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ^ Q 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)]. 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. 0.00 REV-1508 EX + (6-98) ~ ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER LEON S. GEOFFREY 21 09 0305 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 See Attachment Page(sl TOTAL (Also enter on line 5, Recapitulation) I $ 954 174 85 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 1 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MEMBERS 1ST FEDERAL CREDIT UNION -SAVINGS ACCOUNT #139068-00 4,917.61 2. MEMBERS 1ST FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT #139068-45 10,539.69 3. MEMBERS 1ST FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT - #139068-46 11,160.73 4. MEMBERS 1ST FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT - #139068-47 10,902.16 5. MEMBERS 1ST FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT - #139068-49 10,965.53 6. MEMBERS 1ST FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT - #139068-50 10,777.93 7. MEMBERS 1ST FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT - #139068-52 30,726.46 8. MEMBERS 1ST FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT - #139068-53 10,105.27 9. COMMERCE BANK -CHECKING ACCOUNT #536937196 8,512.65 10. COMMERCE BANK -CERTIFICATE OF DEPOSIT #1800229 22,705.49 11. COMMERCE BANK -CERTIFICATE OF DEPOSIT #1800230 20,592.92 12. COMMERCE BANK -CERTIFICATE OF DEPOSIT #1800746 25,029.55 13. COMMERCE BANK -CERTIFICATE OF DEPOSIT #1801171 30,026.72 14. COMMERCE BANK -CERTIFICATE OF DEPOSIT #1801195 15,036.29 15. COMMERCE BANK -CERTIFICATE OF DEPOSIT #1800652 ~ nn~ a~ SUBTOTAL SCHEDULE E 227,001.63 Continuation of REV-1500 Inheritance Tax Return Resident Decedent LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 2 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 16. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #2786 37,524.47 17. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #2198 51,329.81 18. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #7957 25,727.44 19. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #9538 10,689.62 20. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #2443 10,879.53 21. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #3231 10,880.29 22. WACHOVIA BANK -CERTIFICATE OF DEPOSIT #8187 3,509.44 23. STAMP COLLECTION -SOLD 3,200.00 24. PNC BANK -CERTIFICATE OF DEPOSIT #31800280313 11,045.31 25. PNC BANK -CERTIFICATE OF DEPOSIT #31800327654 20,497.33 26. PNC BANK -CHECKING ACCOUNT #5080352032 52,166.95 27. DIAKON LUTHERN SOCIAL MINISTRIES -COTTAGE REFUND 126,109.24 28. PERSONAL PROPERTY -APPRAISAL ATTACHED 648.00 29. F&M TRUST -CERTIFICATE OF DEPOSIT #020-2990413 5,000.00 30. F&M TRUST -CERTIFICATE OF DEPOSIT #020-2990403 ~ a~~ ~a SUBTOTAL SCHEDULE E 375,134.72 Continuation of REV-1500 Inheritance Tax Return Resident Decedent ,LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 3 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 31. F&M TRUST -CERTIFICATE OF DEPOSIT #020-2990402 5,441.79 32. F8~M TRUST -CERTIFICATE OF DEPOSIT #020-2978671 11,542.92 33. F&M TRUST -MONEY MANAGEMENT ACCOUNT #70-74603 3,652.42 34. NAVY FEDERAL CREDIT UNION -SHARE SAVINGS #0204226005 10,413.59 35. NAVY FEDERAL CREDIT UNION -TRUSTEE SAVINGS #1540066006 39,309.77 36. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #15400660630016 27,101.86 37. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #15400660630022 25,899.63 38. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #15400660630025 23,990.27 39. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #15400660630026 24,037.58 40. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #15400660630027 48,547.72 41. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #15400660630028 24,222.81 42. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #15400660630029 11,086.94 43. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #02042260620039 30,874.62 44. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #02042260620040 14,907.80 45. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #02042260620044 ~4 11R QR SUBTOTAL SCHEDULE E 325,146.70 Continuation of REV-1500 Inheritance Tax Return Resident Decedent ZEON S. GEOFFREY 21 09 0305 Decedent's Name Page 4 File Number Schedule E -Cash, Bank Deposits, 8< Misc. Personal Property ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 46. 47. NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #02042260620045 NAVY FEDERAL CREDIT UNION -SHARE CERTIFICATE #02042260620046 5,203.61 21,688.19 SUBTOTAL SCHEDULE E 26,891.80 GRAND TOTAL SCHEDULE E $ 954,174.85 REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER•VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER LEON S. GEOFFREY 21 09 0305 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 INCLUDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND THE DATEOFTRANSFERATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE See Attachment Page(s) TOTAL (Also enter on line 7 Recapitulation) I $ 810 239 77 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 5 File Number Schedule G -Inter-Vivos Transfers 8r. Misc. Non-Probate Property ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE,THEIRRELATICNSHIPTODECEDENTAND THE DATE OF TRANSFER. ATTACHACDPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IF APPLICABLE( TAXABLE VALUE 1. MEMBERS 1ST FEDERAL CREDIT UNION 508.01 100. 508.01 SAVINGS ACCOUNT #184778-00 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 2. MEMBERS 1ST FEDERAL CREDIT UNION 11,005.74 100. 11,005.74 CERTIFICATE OF DEPOSIT #184778-41 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 3. MEMBERS 1ST FEDERAL CREDIT UNION 11,179.54 100. 11,179.54 CERTIFICATE OF DEPOSIT #184778-43 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 4. MEMBERS 1ST FEDERAL CREDIT UNION 16,792.58 100. 16,792.58 CERTIFICATE OF DEPOSIT #184778-45 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 5. MEMBERS 1ST FEDERAL CREDIT UNION 20,509.03 100. 20,509.03 CERTIFICATE OF DEPOSIT #184778-47 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 6. MEMBERS 1ST FEDERAL CREDIT UNION 10,167.85 100. 10,167.85 CERTIFICATE OF DEPOSIT #184778-48 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 7. MEMBERS 1ST FEDERAL CREDIT UNION 13,754.97 100. 13,754.97 CERTIFICATE OF DEPOSIT #184778-49 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 8. NEW YORK LIFE -ANNUITY #75604010 15,678.62 100. 15,678.62 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 9. ALLSTATE LIFE INSURANCE COMPANY 12,984.94 100. 12,984.94 ANNUITY #GA0589425 (PNC INVESTMENTS) BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 10. ALLSTATE LIFE INSURANCE COMPANY 45,284.24 100. 45,284.24 ANNUITY #GA19380194 (PNC INVESTMENTS) BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 11. METLIFE (PNC INVESTMENTS 6,007.09 100. 6,007.09 ANNUITY #940039955 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 12. METLIFE (PNC INVESTMENTS) 6,006.40 100. 6,006.40 ANNUITY #940022131 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 13. AIG ANNUITY 11,397.25 100. 11,397.25 ANNUITY CONTRACT # 3FJ18879 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 14. AIG ANNUITY 12,024.26 100. 12,024.26 ANNUITY CONTRACT # FJ243247 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 15. AIG ANNUITY 54,049.78 100. 54,049.78 ANNUITY CONTRACT # FJ230016 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY SUBTOTAL SCHEDULE G I 247 350.30 Continuation of REV-1500 Inheritance Tax Return Resident Decedent LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 6 File Number Schedule G -Inter-Vivos Transfers 8G Misc. Non-Probate Property ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE,'fHEIRRELATIDNSHIPTODECEDENTAND THE DATE OF TRANSFER.ATTACHACCPYOFTHEDEEDFDRREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 16. AIG ANNUITY 12,156.45 100. 12,156.45 ANNUITY CONTRACT # FJ228621 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 17. EDWARD JONES 446,069.76 100. 446,069.76 SECURITY ACCOUNT #377032231 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 18. MERRILL LYNCH -ACCOUNT #872-45206 74,391.12 100. 74,391.12 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 19. NAVY FEDERAL CREDIT UNION 11,338.40 100. 11,338.40 IRA #0204226906001 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 20. PROTECTIVE LIFE INSURANCE COMPANY 2,947.24 100. 2,947.24 ANNUITY #FM0056339 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 21. PROTECTIVE LIFE INSURANCE COMPANY 9,677.46 100. 9,677.46 ANNUITY #PS0000654 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY 22. PROTECTIVE LIFE INSURANCE COMPANY 6,309.04 100. 6,309.04 ANNUITY #PS0000358 BENEFICIARIES: JOEL R. GEOFFREY AND ALAN F. GEOFFREY SUBTOTAL SCHEDULE G I 562,889.47 GRAND TOTAL SCHEDULE G $ 810,239.77 REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & IN R SIIDENT DECEDENT N ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LEON S. GEOFFREY 21 09 0305 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 756.96 2. CARLISLE MEMORIALS -INSCRIPTION 350.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees IRWIN & McKNIGHT, P.C. 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address Ciiy State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 5 Accountants Fees 6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 7. REGISTER OF WILLS -FILING FEE 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 9. THE SENTINEL -ESTATE NOTICE 10. REGISTER OF WILLS -SHORT CERTIFICATES 11. M&T BANK -STOP PAYMENT 12. M&T BANK -WIRE TRANSFER 13. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 14. ALAN F. GEOFFREY -REIMBURSEMENT OF POSTAGE/SHIPPING 15. ALAN F. GEOFFREY -REIMBURSEMENT FOR TRASH HAULING 39,250.00 406.00 1,250.00 30.00 75.00 187.54 20.00 30.00 25.00 55.00 30.20 185.00 TOTAL (Also enter on line 9, Recapitulation) I $ 42,650.70 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER LEON S. GEOFFREY 21 09 0305 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 See Attachment Page(s) TOTAL (Also enter on line 10, Recapitulation) I $ 18 973 88 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 7 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, 8< Liens ITEM - NUMBER DESCRIPTION AMOUNT 1. UGI -UTILITY 308.73 2. MET-ED -ELECTRIC 95.46 3. CUMBERLAND CROSSINGS -NURSING 5,857.10 4. CONTINUING CARE RX -MEDICAL 59.97 5. EMBARQ -TELEPHONE 40.31 6. NAVY FEDERAL CREDIT UNION -CREDIT CARD 6.35 7. UNITED STATES TREASURY -QUARTERLY TAX PAYMENT 10,000.00 8. MERRILL LYNCH LIFE INSURANCE COMPANY -REIMBURSEMENT OF 255.96 ANNUITY PAYMENT 9. NATIONAL JEWISH HEALTH -REIMBURSEMENT OF ANNUITY PAYMENT 282.50 10. ELCA FOUNDATION -REIMBURSEMENT OF ANNUITY PAYMENT 282.50 11. LEBANON MUTUAL INSURANCE COMPANY -INSURANCE 128.00 12. SUN AMERICA FINANCIAL -REIMBURSEMENT OF ANNUITY PAYMENT 344.56 13. ALLSTATE LIFE INSURANCE COMPANY -REIMBURSEMENT OF ANNUITY PAYMENT 115.03 14. LINCOLN FINANCIAL - REIMBURSEMENT OF ANNUITY PAYMENT 824.91 15. PHILIP K. MILLER & ASSOCIATES -MEDICAL an nn SUBTOTAL SCHEDULE I 18,691.38 Continuation of REV-1500 Inheritance Tax Return Resident Decedent LEON S. GEOFFREY Decedent's Name Page 8 21 09 0305 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, 8~ Liens ITEM NUMBER DESCRIPTION AMOUNT 16. THE CITY COLLEGE FUND -REIMBURSEMENT OF ANNUITY PAYMENT 282.50 SUBTOTAL SCHEDULE I 282.50 GRAND TOTAL SCHEDULE I $ 18,973.88 REV-1513 EX + (g_00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LEON S. GEOFFREY ~~ no n~nG .,., RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] See Attachment Page(s) 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 TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See Attachment Page(s) TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 57 000.00 (It more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent •LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 9 File Number Schedule J -Beneficiaries - 1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. ALEXANDER P. GEOFFREY 2. BEYLA GEOFFREY 3. AMELIA GEOFFREY 4. TAMASIN GEOFFREY 5. RACHEL STERN 6. ESTHER GEOFFREY 7. KAREN ENNIS 8. RUSSELL J. GEOFFREY 9. CHERYL U. GEOFFREY 10. LAURA U. GEOFFREY 11. RYDER U. GEOFFREY 12. VITA GEOFFREY 13. ALAN F. GEOFFREY 14. JOEL R. GEOFFREY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Collateral Collateral Collateral Collateral Collateral Sibling Collateral Collateral Lineal Lineal Lineal Lineal Lineal Lineal AMOUNT OR SHARE OF ESTATE 10,000.00 10,000.00 10,000.00 10,000.00 25,000.00 25,000.00 20,000.00 20,000.00 50,000.00 50,000.00 50,000.00 25,000.00 670, 395.02 1/2 REMAINDER 670, 395.02 1/2 REMAINDER Continuation of REV-1500 Inheritance Tax Return Resident Decedent LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 10 File Number Schedule J -Beneficiaries - 2B B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. CONGREGATION BETH TIKVAH OF CARLISLE 20,000.00 PO BOX 814 CARLISLE, PA 17013 2. INDEPENDENT LIVING RESIDENTS ASSOCIATION FUND OF CUMBERLAND CROSSINGS 5,000.00 1 LONGSDORF WAY CARLISLE, PA 17013 3. AMERICAN CANCER SOCIETY OF CARLISLE 2,000.00 PO BOX 720366 OKLAHOMA CITY OK 73162 4. UNITED WAY OF CARLISLE 2,000.00 145 SOUTH HANOVER STREET CARLISLE, PA 17013 5. AMERICAN FOUNDATION FOR THE BLIND 2,000.00 11 PENN PLAZA, SUITE 300 NEW YORK, NY 10001 6. BOSLER LIBRARY 2,000.00 158 WEST HIGH STREET CARLISLE, PA 17013 7. CITY COLLEGE FUND OF NEW YORK 2,000.00 139TH STREET & COVENANT AVENUE NEW YORK, NY 10031-9986 8. NAVY-MARINE CORPS RELIEF SOCIETY 2,000.00 875 N. RANDOLPH ST SUITE 225 ARLINGTON VA 22203 9. JEWISH FAMILY SERVICES OF HARRISBURG 2,000.00 3333 N. FRONT STREET HARRISBURG, PA 17110 10. HILLEL FOUNDATION AT DICKINSON COLLEGE 2,000.00 PO BOX 1773 CARLISLE, PA 17013 11. AMERICAN RED CROSS 2,000.00 79 EAST POMFRET STREET CARLISLE, PA 17013 12. APPALACHIAN TRAIL CONFERENCE 2,000.00 PO BOX 807 HARPERS FERRY WV 25425-9988 13. USO 2,000.00 2111 WILSON BLVD., SUITE 1200 ARLINGTON VA 22201 14. UNITED NEGRO COLLEGE FUND 2,000.00 8260 WILLOW OAKS CORPORATE DRIVE, PO BOX 10444 FAIRFAX, VA 22031-8044 15. AMERICAN INDIAN COLLEGE FUND 2,000.00 8333 GREENWOOD BLVD. DENVER, CO 80221 SUBTOTAL SCHEDULE J-26 51,000.00 Continuation of REV-1500 Inheritance Tax Return Resident Decedent -LEON S. GEOFFREY 21 09 0305 Decedent's Name Page 11 File Number Schedule J -Beneficiaries - 2B B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 16. HABITAT FOR HUMANITY, INC. 121 HABITAT ST. AMERICUS, GA 31709-3498 17. LAW ENFORCEMENT LEGAL DEFENSE FUND 1611 NORTH KENT STREET SUITE 901 ARLINGTON VA 22209 18. ELDER HOSTEL 11 AVENUE DE LAFAYETTE BOSTON, MA 02111-1746 2,000.00 2,000.00 2,000.00 SUBTOTAL SCHEDULE J-2B I 6,000.00