HomeMy WebLinkAbout12-14-091505607120
REV-1500 EX (06-05) OFFICU~L USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 60X.280601 2 1 0 9 0 8 4 7
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
203 10 4845 08 19 2009 12 06 1915
Decedent's Last Name Suffix Decedent's First Name MI
BOWERMASTER MARY K
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL iN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
I y ~ g, Decedent Died Testate ~
~ -- ~ (Attach Copy of Will) 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trusq
9. Litigation Proceeds Received ~ 10. Spousal Poveny Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
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CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIO SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JOHN E. SLIKE ESQ. 717 737 3405
Firn Name (If Applicable)
SAIDIS, FLOWER & LINDSAY
First line of address
2109 MARKET STREET
Second line of address
City or Post Office
CAMP HILL
State ZIP Code
PA 17011
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REGISTER OF~Y1jILLS USE O~,Y
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Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, includingg accompanying schedules and statements, and to the best of my knowledge and belief,
it is tytye, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
Donna M. Ewing
135 Pin Oak Drive, New Cumberland, PA 17070
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SIGNAi~1FjE OF PREPARER OTHE'C~PRESENTATIVE DATE
E /ly"~/~ ti ~^(J ~ John E. Slike Esq.. ~a h~/ ~ 9
Market Street, Camp Hill, PA 17011
Side 1
15056D7120 1505607120
1505607220
REV-1500 EX
Decedent's Social Security Number
oecedenraName: Mary K. Bowermaster 2 0 3 10 4 8 4 5
RECAPITULATION
1. Real Estate (Schedule A) ...................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................._........................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D) ............................._....................... 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 3 , 0 2 7 . 5 0
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 2 9 , 6 9 7 . 4 2
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested .............
7.
11 , 3 5 8 . 4 0
8. Total Gross Assets (total Lines 1-7) ............................._.................................. 8. 4 4, 0 8 3. 3 2
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9. 1 5 , 3 0 3 . 4 7
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 5 3 7 . 4 8
11. Total Deductions (total Lines 9 & 10) ............................._................................... 11, 1 5 , 8 4 0 . 9 5
12•
.........................
Net Value of Estate (Line 8 minus Line 11) ............................._.
12.
28, 242.37
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .............................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. 14. 2 8 , 2 4 2 . 3 7
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 .o0 0. 0 0 15• 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X •045 2 8, 2 4 2. 3 7 16. 1 , 2 7 0 . 9 1
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17, 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18, 0 . 0 0
19. Tax Due ............................................................................................................... 19. l , 2 7 0.91
20. FILL IN THE OVAL lF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ~X
Side 2
L 1505607220 150560722p J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-0847
DECEDENT'S NAME
Mary K. Bowermaster
STREET ADDRESS
1700 Market Street
Camp Hill
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. lax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InterestiPenalty if applicable
p. Interest
E. Penalty
Total Credits (A + B + C)
Total Interest/Penalty (D + E)
4. If tine 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
Check box on Page 2 Llne 20 to request a refund
g, If Line 1 + Line 3 is greater than Lirte 2, enter the difference. This is theTAX DUE
(1) 1,270.91
(2) 1,363.55
(3)
(4) 92.64
(5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. 7his is theBALANCE DUE (56)
Make Check Payable fo: REGISTER OF W/LLS, 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 transfenred or its income :................................ ^ ^x
c. retain a reversionary interest; or .............................~........................................................................... ^ 0
d. receive the promise for life of either payments, benefits or care? ........................................................... ^
2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................................................................................................................. ~ ^
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... [x] ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ................................................................................................................ ^
{F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ter: ~~ ~~~ ~'~~~N' ~3 __
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 statutedoes 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-0ne 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) p2 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)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by Flood or adoption.
1,300.00
63.55
Rev-1508 FJ(+ (6Aa)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSriVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bowermaster, Mary K. 21-09-0847
Indude the proceeds of Iltiga0on and the date the proceeds were received by the estate.
All properly Jolntlyowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Capital Blue Cross -Refund of partial premium 126.00
2 HCR Manor Care -Refund of prepaid care 2,838.00
3 New York Life Insurance Company -Policy 29590927 48.80
Refund of premium
4 New York Life Insurance Company (2nd) -Policy #30381910 14.70
Refund of premium
TOTAL (Also enter on Line 5, Recapitulation) I 3.027.50
(If mon: space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+ (6.98)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Bowermaster, Mary K. 21-09-0847
If an asset waa made Joint within one year of the decedent's data of death, It must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Donna M. Ewing 135 Pin Oak Drive Daughter
New Cumberland, PA 17070
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASS % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1 A 11/28/1968 M & T Bank Acct #16785169 1.459.78 50.000% 729.89
2 A 4!13/2000 M & T Bank CD Acct #31003913918652 32,978.48 50.000°/a 16.489.24
3 A 2/22/1982 M ~ T Bank CD Acct #31003914375687 20,026.32 50.000°/a 10,013.16
4 A 2/22/1982 M & T Bank CD Acct #31003914375695 4,930.26 50.000% 2,465.13
TOTAL (Also enter on Line 6, Recapitulation) I 29,697.42
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bowermaster, Mary K. 21-09-0847
This schedule must be completed and filed 'If the answer to any of quesUOns 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLU&ION
(IF APPLICABLE) TAXABLE
VALUE
1 M Sz T Bank Checking Acct 9849961769 - Accoun 14,358.40 3,OOb.00 11,358.40
opened and made joint with Donna M. Ewing,
daughter on 07/16/2009.
TOTAL (Also enter on Line 7, Recapitulation) ~ 11.358.40
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+110-06) SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INRE3IDENTDECEDENTR" ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Bowermaster, Mary K. 21-09-0847
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
8,783.21
6. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name(s) of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Saidis, Flower ~ Lindsay 6,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 256.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 264,26
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 15,303.47
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF (FILE NUMBER
Bowermaster, Mary K. 21-09-0847
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Donna Ewing -Reimbursement for the funeral luncheon 230.54
2 East Harrisburg Cemetary 8 Cremation Services -Reimbursement to Donna Ewing 175.00
3 Neill Funeral Home, Inc. -Agreement No. 7412-200503 8.244.00
4 Neill Funeral Home, Inc. -Agreement No. 7412-200503 reimbursement for payment 133.67
to The Patriot News for the obituary notice.
H-A subtotal 8,783.21
Other Administrative Costs
5 New York Life Insurance Premium -Auto from checking acct 16785169 95.30
6 The Patriot News Company -Advertisement of Estate Notice 168.96
H-B7 Subtotal 264.26
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-0ti)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bowermaster, Mary K. 21-09-0847
Report debts Incurred by the decedent prior to death that remained unpaW at the date o1 death, Including unrelmbureed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Camp Hill Fire Company No.1 - 7127/2009 Transport from residence to Holy Spirit 25.00
Hospital
2 Heartland Pharmacy of Pennsylvania, LLC -Customer ID 237680 300.02
3 Holy Spirit Hospital 50.00
4 West Shore EMS-BLS - Cail Number 192320W; Patient Number 83210 81.23
5 West Shore EMS-BLS -Call Number 191705W; Patient Number 83210 81.23
TOTAL (Also enter on Line 10, Recapitulation) I 537.48
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+ (11-08)
SCHEDULE J
COM INHERITANCE TAX RETURNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
towermaster, Mary K. 21-09-08 47
NUMBER NAME AND ADDRESS OF RELATIONSHIP TO
D
E SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S) RECEIVING PROPERTY ooDo Cst
rr
ust s (Words} ($$$)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions and transfers
under Sec. ~116(a)(1.2)]
1 Barbara Ann Bowermaster Daughter One-fourth of
248 Maclay Street the residue set
Harrisburg, PA 17110 aside in Trust.
2 Donald E. Bowermaster Son One-fourth of
109 Water Street the residue set
Summerdale, PA 17093 aside in Trust.
3 Donna M. Ewing Daughter One-fourth of
135 Pin Oak Drive the residue set
New Cumberland, PA 17070 aside in Trust.
4 Edna Faye German Daughter One-fourth of
248 Maclay Street the residue set
Harrisburg, PA 17110 aside in Trust.
5 Mary K. Bowermaster Irrevocable Trust Trust 100% of the 28,242.37
135 Pin Oak Drive residue in
New Cumberland, PA 17070 Trust for the
benefit of her
Total 28,242.37
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 15 00 cover sheet, as app ropriate,
II NON-TAXABLE DISTRIBUTIONS:
I A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART If-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET 0.00
Copyright {c) 2009 form software only The Lackner Group, Inc. Form PA-1500'ScheduleJ (Rev. 11-08)
LAST WILL AND TESTAMENT
OF
MARY K. BOWERMASTER
I, MARY K. BOWERMASTER, of Harrisburg, Dauphin County,
Pennsylvania, declare this to be my Last Will and Testament,
hereby revoking any will previously made by me.
I - I direct the payment of a7.~. my just. debts andf.uneral
expenses out of my estate as soon as may be practical after my
death and that I be interred in the East Harrisburg Cemetery next
to my deceased husband.
II - I bequeath certain items of my tangible personal
property in accordance with a written list made by me during my
lifetime. In absence of a list or designation on such a list, I
direct that my Executrix hereinafter named distribute my tangible
personal property among my children in as nearly equal shares as
possible and that the remainder of said tangible personal
property be sold and the proceeds added to the residue of my
G:Jt Glte
III. I devise and bequeath all the rest, residue and
SAIDIS,
HUFF &
~IASLAND
1'fORNEYS•AT•LAW
09 Market Street
Camp HiH, PA
remainder of my estate of what-ever nature and wherever situate
unto my daughter Donna M. Ewing, in Trust, nevertheless for the
benefit of my children, Edna Faye German, Barbara Ann
Bowermaster, Donald E. Bowermaster and Donna M. Ewing for as long
1
h~. /-s . /_3~
as Barbara Ann Bowermaster is living. My said trustee shall
administer the trust in accordance with the following provisions:
1. As much of the net income and the principal as my
trustee, in her sole discretion, may from time to time think
desirable may be distributed to such one or more of my children,
in such amounts or proportions as my trustee may, from time to
time, think appropriate; and
2. Arly net income not so distributed shall, from time
to time, be accumulated and added to the principal.
3. My primary concern is for the care and support of
SAIDIS,
H U F F 8z
MASLAND
ATTORNEYS•AT•LAW
1109 Market Street
Camp Hill, PA
my daughter Barbara Ann Bowermaster for the rest of her natural
life, and while my general purpose is to provide for her, I
recognize that it might not be desirable or necessary to provide
funds from the trust for her care. Accordingly, I direct that my
said trustee shall have full authority to distribute the income
from the trust among my children and that the distributions need
not be equal; that one or more of the eligible distributees may
be wholly excluded from any or periodic distributions; and that
the pattern followed in one distribution need not be followed in
others; that income may be accumulated to whatever. extent anc~ i.n
whatever amounts my trustee may think appropriate; and that my
trustee may give consideration to the other resources of each of
the eligible distributees as my trustee may think appropriate.
4. As soon as my daughter Barbara Ann Bowermaster is
deceased the trust shall terminate and the then remaining
principal, including accumulated income, shall be divided into
2
equal shares so that there will be one share for each child of
mine who is then living or then dead. My trustee shall
distribute one share to each of my children then living and one
share to each of my children then dead represented by living
issue.
5. Should my said trustee die or be unable to serve
as trustee before the termination of the trust then I appoint my
daughter Edna Faye German as successor trustee.
IV. I appoint Donna M. Ewing guardian of any property that
passes under this will or otherwise to my daughter Barbara Ann
Bowermaster and with respect to which I'm authorized to appoint a
guardian but have not otherwise specifically done so. Such
guardian shall have the power to use principal as well as income
from time to time for her support and to make payments for these
purposes without further responsibility to her.
V. I appoint Donna M. Ewing Executrix of this, my Last
SAIDIS,
HUFF &
MASLAND
ATTORNEYSMT•LAW
:109 Market Street
Camp Hili, PA
Will and Testament. Should said Donna M. Ewing fail to qualify
or cease to act as such then I appoint Edna Faye German to act in
this capacity. Neither of my personal representatives shall be
required to post bond in this or any jurisdiction.
IN WITNESS WHEREOF, I hav"e~ hereunto set my hand and seal on
this , the ~" d a y o f l~'~ ~}--t~r~,~.~ 19 9 9.
~~ /~( ~~ ~~ , ( SEAL )
3
Signed, sealed, published and declared by Mary K. Bowermaster
therein named, on this and one (1) other sheet of paper as and
for her Last Will and Testament, in our presence, who, in her
presence, at her request, and in the presence of each other, have
hereunto subscribed our names as attesting witnesses.
Name Address
.~.e,cA ~ ~~.es~.-~----- ~'(~tl~ t ~~' Cam..
~ ame A d ess
SAIDIS,
,HUFF &
MASLAND
A77'ORNEYS•AT•I.AW
2109 Market Street
Camp Hill, PA
4
SAIDIS,
-HUFF &
MASLAND
ATTORNEYS•AT•LAW
2109 Market Street
Camp Hill, PA
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF CUMBERLAND
WE, the undersigned, the testatrix and the witnesses,
respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument
as her Last Will and Testament and that she sigr~~ed willingly for
willingly directed another to sign for her), and that she
executed it as her free will and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the testatrix signed the will as
witnesses and that to the best of their knowledge the testatrix
was at that time eighteen years of age or older, of sound mind,
and under no constrain or undue influence.
9l~Cc n.~Jl ~ r.~/ti/1 ~~..t~i `,
Marx Bowermas er, Testatrix
ess
Witness
Witness
Subscribed, sworn to and acknowledged before me by the
testatrix, and sub cribed and savor to before me by both
witnesses, this ~~ day of ~C~b~n~r , 1999.
Notarial Seal
Jo Smith, Notary Public
Camp Hilt Boro, Cum esrt~ay ~°2000
My Commission Exp
5
Q M8TBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MD-l2
Law Offices
Saidis, Flower & Lindsay
2109 Market Street
Camp Hill, Pennsylvania 17011
Re: Estate o : Marv ~K. Bowermaster
Social Security: 203-10-4845
Date ofDeath.• August 19, 2009
~Aw
SSP ~~ 4 ~9
Phone (888)502-4349
Fax (302) 934-2955
September 22, 2009
Dear Sir Dr Madam:
Per your inquiry dated September 16, 2009, please be advised that at the time of death, the above named decedent had on
deposit with this bank the following:
1. Type ofAccount CheckfngAccount
., Account Number 16785169
Ownership (Names ofJ ~ Mary Bowermaster*
Opening Date
Balance on Date ofDeath
Accrued Interest
Total
2. Type ofAccount
Account Number
Ownership (Names o, f}
Opening Date
Balance on Date ofDeath
Accrued Interest
Total
Donna MEwing*
11/28/68
$1,459.72
$ 0.06
$1,459.78
Checking Account
9849961769
Mary Bowermaster*
Donna MEwing*
7/16/09
$14,358.40
$ 0.10
- $14,358.50
3. Type ofAccount Certificate of Deposit
Account Number 31003913918652
Ownership (Names ofJ Mary Bowermaster*
Donna MElving*
.Opening Date 4/13/00
Balance on Date ofDeath $ 32,974.54
Accreted Interest $ 3.94
Total $ 32,978.48 ---------------------•----------------
4. 7j~pe ofAccount Cert~cate of Deposit
AccountNun:ber 31003914375687 .
Ownership (Names ofJ Mary Bowermaster*
Donna MEwing*
• Opening Date 2/22/g2
Balance on Date ofDeath $ 20, 000. DO
Accrued Interest $ 26.32
Total ----------------------
$ 20, 026.32 ----------------
5. Type ofAccount Certificate ofDeposit
Account Number 31003914375695
Ownership (Names of} MaryBowermaster*
Donna MEwing*
Opening Date 2/22/82
Balance on Date ofDeath $4,927.23
Accrued I»terest • $ 3.03
Total •---------------------------
$ 4,930.26 ----------------------------------
6. 7j~pe ofAccount Certificate of Deposit
Account Number 31003914375702
Ownership (Names o, fl Mary Bawermaster*
Donna MEwing*
Opening Date 10/II/82 Closed 7/16/09**
** Please contact the Capital Harrisburg Branch for all additional information on accounts closed prior to the date of
death.
'• Please be advised, there was no safe deposit box found for the above decedent.
* If upon reviewing the information above, you believe there are additional accounts not referenced, please provide
us with an account number and/or name of any possible joint account holder. For any additional information on the
above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact
our Capital Harrisburg Office # 71?-233-6435.
Sincerely,
/IID~
Tracie Hare
Adjustment Services •
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