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HomeMy WebLinkAbout12-11-09 15056041046 REV-1500 EX (05-04) -~,~ t~ o~~ 'PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Dept. 28os01 INHERITANCE TAX RETURN /~ Hamsburg, PA 17128-0601 RESIDENT DECEDENT ~ I V ~ a~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~a~ 3a 7g~~ ~3a1 X609 ~) a~ Ig3o Decedents Last Name Suffix Decedent's First Na a MI F'~UL~~ SUS~~ P (If Applicable) Enter Surviving Spouse's InforMation Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Securit`~ Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Retum (date of death prior to 12-13=82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) t• 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. Q) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHIDULD BE DIRECTED T0: Name Daytime Telephone Number S~ ~ p ~A C0 R ~ 1 ~~ ~ I ~ T~~~ ~ a ~~_ Firm Name (If Applicable) _ ~"j REGIST R~OLS U3E`DNLYF . , {--f First line of address ~~ -~ ~ a Second line of address City or Post Office ~ ~~.o ~ ~ ~ Correspondent's a-mail address: State ZIP Code L PEA ~ ~0~3 ~~ela~'gbueS . cow SIGNATURE OF PREPARER - - -_ ' G"') ~ r - i'rl ~ ' z ~~ 3 ~ ~~ `. ~ 7 t y a: 4~ ~ ~ r : ) ` ~ r, ~ `, ~ . f ~ . :, ~i ~~ ~ t -~` ~ c,,7 O ~ FILED ADDRESS PLEASE USE ORIGINAL FORM ONLY STR~.E~ Side 1 15056041046 15056041046 J Under penalties of perjury, I declare that I have examined this return, including accompanying sch ules and statements, and to the best of my knowledge and belief, it is true, correct and complt'te. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 15056042047 REV-1500 EX Decedent's Social Security Number Decedent's Name: ". ` ~ ~ i...! ~ s .~ : ~ O. - ~. 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. • ~ Q 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. ~ ~ ~~ ' , • 6. Jointly Owned Property (Schedule F) G Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) G Separate Billing Requested...... .. 7. . 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ~.-.. 9 F l E & Ad i i t ti h l C t S d H 9 Q `~ G ~ ~ . unera xpenses m n ve ) ................... s ra os s ( c e u e .. . / . V 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) .............. .. 10. v 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. D ~ ~J , ~ O 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~., .p.., ~ V ~ ~' ~ .• O 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14 N t V l S b t t T Li 12 i Li 13 14 `1' ~ ~ ~ . e a ue u jec o ax ( ne m nus ne ) ...................... .. . , / 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 ~j (~ ~( ~Q " ~ ~ at collateral rate X .15 " 1 • V 18. • 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~a~~.SS O Side 2 15056042047 15056042047 REV-1500 EX Page 3 Pile Number Decedent's Complete Address: Utl.tVtlV 1 J IV/1MC ---~uS~ _P. ~ _ - -- -- - - - - - STREET ADDRESS ~ O ~~ ^ ~~ ~~ ~~~I~ -,~ CITY J ~~ • f a STATE ~~ ZIP 4 ~ O ~ i i lJ~- I l ` Tax Payments and Credits: 1. Tax Due (Page 2 Line 19} 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + g + C) (2) _ --- - - - 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) (5) (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~, V ~ ~ J 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 :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ^ 3. Did decedent own an "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 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 frling 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 isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98) scN~uu~E a COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF C y~ ~ ~ ~~ p ~~/ FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (Ii more space is needed, insert additional sheets of the same size) rev-,sosoc • n-sn SCHEDULE C-1 COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATE '""" E~~~ ~D~~" STOCK INFORMATION REPORT ESTATE OF ~'r, C `1t (_ (l ~'~, t ~ FILE NUMBER 1. Name of Corporation Address - City 2. Federal Employer I.D. Number 3. Type of Business State 4. State of Incorporation Date of Incorporation Zip Code Total Number of Shareholders ProductlService Business Reporting Year STOCK TYPE Voting !Non-Voting TOTAL NUMBER OF SHARES OUTSTANDING PAR VALUE NUMBER OF SHARES OWNED BY THE DECEDENT VALUE OF THE DECEDENT'S STOCK Common $ Prefierred $ Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? ^ Yes ^ No ff yes, Position Annual Salary $ 6. Was the Corporation indebted to the decedent? ^ Yes ^ No ff yes, provide amount of indebtedness $ Time Devoted to Business 7. Was there I'rfe insurance payable to the corporation upon the death of the decedent? ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ 8. Owner of the policy Did the decedent sett or transfer stock of this canpany within one year prior to death or within two years if the date of death was prior to 12-31-827 ^ Yes ^ No tf yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Atlach a separa~ sheet for additional Uansfers andlor sales. 9. Was there a written shareholder's agreement in effect at the time of the decedents death? ^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ^ Yes ^ No ff yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? ^ Yes ^ No ff yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ^ Yes ^ No H yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. .j. iF yy ~, ~- .* ., A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of finanaal statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. if the corporation owned teat estate, submit a fist showing the complete addressies and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decadent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedents stock. T - ESTATE OF REV-15Q6 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~~ ~L~ 1. Name of Partnership Address City 2. Federal Employer I.D. Number 3. Type of Business Product/Service FILE NUMBER Date Business Commenced Business Reporting Year State Zip Code 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9 10. Was there a written partnership agreement in effect at the time of the decedents death? ...... ^ Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedents partnership interest sold? ....................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .............. . .. . .................. ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • •- ~ ~ ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addressJes and estimated fair market values. If real estate appraisals have been secured, attach copies. SCHEDt~LE C-S PARTNERSHIP INFORMATION REPORT D. Any other information relating to the valuation of the decedents partnership interest. REV-1507 EX+ (1-97) ' SCNEDt~LE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF ~C n~ (~~ ~~ ~ L ~ FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) acv-,sae ex. I,a~l SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF C , , ~~ ~ (~ ~ ` ~ FILE NUMBER Include the proceeds of litgation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. ~~ K Accc~u ~ 3;~9 ~ ,. Sg TOTAL {Also enter on line 5, Recapitulation) ~ S ~,' ~ ,d~ ~ 3 ~~ (If more space is needed, insert additional sheets of the same size) REV~1509 EX+(1-9~ SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~.~t ~ ~ ~ I ~ FILE NUMBER fl an asset was made joirh within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. ~ ~ ~S~ B. C. JOINTLY-0WNED 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 ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) ~ S (If more space Is needed, insert additional sheets of the same size) REV-1510 EX+11A7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ES ATE OF ~ ~ _ . t ~ ~~ u~ FILE NUMBER 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 NUMB R DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIRRELATIDNSHIPTODECEDENTANDTHE DATE OF TRANSFER. ATTACH ACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ,. ~~~~ TOTAL (Also enter on line 7, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) EV-1511 EX+ (12-99) , SCNED~lLE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ~.~ p i~ t ~ FILE NUMBER ` Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 B. I ADMINISTRATIVE COSTS: '~='~2~E - ('A ~!~ 1. Personal Representative's Commissions Name of Personal Representative(s) c,~A1-~~~ ~--~~~[~-'' Social Security Number(s)I,EI`N Number of Perso~n-al-Representative(s} ~ lv~'J ~ ~~ ~ ~ _ Street Address ~ ~ U ~ c~~ ~ ~ ppnn City 1..~~0(a ~ State ~ Zip ~ 1 G Year(s) Commission Paid: ~.~9 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees 5. l Accountant's Fees 6. I Tax Return Preparer's Fees 7 IC 1~•W ~~• _I CJ. TOTAL (Also enter on line 9, Recapitulation) I $ ~ ~ ~ , L~ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEC-u~E ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Cp ~ S~ ~. ~ ( ~ FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LlstTrustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (12)] 1. 5>~-J~aa K. c~~~E~. Pbv.~RS ~F ~ ~% ~. ~~~o ~ e~R~~~clZ. ADrh~uiSz~A7aRS rJO~fv ~t~-Uxr~wSSS ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDVLE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on REV-1500 Cover Shel ESTATE OF `, S~ ( r ~` , ~~ FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ~ ^~Otlter NAME(S) OF LIFE TENANT(S) DATE OF BIRTH . ~ NEAREST AGE AT DATE OF DEItTH TERM[ OF YEARS LFE ESTATE (S PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ..........................................$ 2. Actuarial factor per appropriate table ................................................ . Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ NAINE(S) OF LIFE ANNINTANT(S) DATE OF BIRTH NEAREST AGEAT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years. 1. Value of fund from which annuity is payable ............................................$ 2. Check appropriate block below and enter corresponding (number) ......................... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^SemI-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period .........................................................$ ~4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (see instructions) ................................................. . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x L1ne 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4'x Line 5 x Line 6)+ Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is Headed, insert additional sheets of the same size) REV-1644 EX+ Is-e41 INHERITANCE TAX ~~ SCHEDULE "L" COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION INHERITANCE TAX RETURN FILE NUMBER RESIDENT DECEDENT OF TRUST PRINCIPAL I. Estate of ~~ t) Z11- (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Seetion 714 of the Inheritance and Estate Tax Aet of 1961 or to report_the invas~'on of trust principal. ~. Remainder Prepayment: A. Election to prepay filed with the Register of Wills on (attach copy of election) ate B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate $ 2. Stocks and Bonds $ 3. Closely Held Stock/Partnership $ 4. Mortgages and Notes $ 5. Cash/Misc. Personal Property $ b. Total from Schedule L-1 D. Credits: Complete Schedule L-2 1. Unpaid Liabilities $ 2. Unpaid Bequests $ 3. Value of Unindudable Assets $ 4. Total from Schedule L-2 E. Total value of trust assets (Line C-b minus Line D-4) F. Remainder factor (see Table I or Table II in ,r Instruction Booklet) G. Taxable Remainder value (Line E x Line F) (Also enter on Line 7, Recapitulation) III. Invasion of Corpus: A. Invasion of corpus (Month, Day, Yeor) B. Name(s) of Life Tenant(s) Date of Birth or Annuitant(s) S Age on date Term of years income corpus consumed or annuity is payable C. Corpus consumed D. Remainder factor (see Table I or Table II in Instruction Booklet) E. Taxable value of corpus consumed (Line C x Line D) $ P.EV•16a5 EX+ P-as) INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- FILE NUMBER t ~' ~uu~ SSA 1. Estate of f~- - (Last Name) (First Name) (Middle Initial) I1. Item No. Description Value A. Real Estate (please describe) total value of real estate $ (include on Section II, Line C-1 on Schedule L) B. Stocks and Bonds (please list) Total volue of stacks and bonds $ (include on Section II, Line C-2 on Schedule L) C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ (include on Section 11, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) Total value of Cosh/Misc. Pars. Property $ (include on Section II, Line C-5 on Schedule L) 111. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $ (If more space is needed, attach additional 8t/s x 11 sheets.) REV-1646 EX+ (3.841 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L-2 REMAINDER PREPAYMENT ELECTION -CREDITS- FILE NUMBER ~ ~~ I . Estate of i V ~` ^' (Last Name) (First Name) (Middle Initial) II. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets $ (include on Section II, Line D-3 on Schedule L) III. TOTAL (A1so enter on Section I1, Line D-4 on Schedule L) $ (If more space is needed, attach additional 8%z x 11 sheets.) REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet !ESTATE OF FILE NUMBER ~ s~iS P. ~~ ~~ This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: 1V. Summary of Compromise Offer: 1. Amount of Future Interest .........................................................$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ......$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0% ......................$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% ...........................$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$ (If more space is needed, insert additional sheets of the same size) r REV-1648 EX (11-99) SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 01101/92 TO 12!31/94) INHERITANCE TAX DIVISION ESTATE OF ~ FILE NUMBER S.~.csa~ P. -~-~u~~ This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. ~, . Taxable Assets total from line 8 (cover sheet) ............................................ 1 . ~. Insurance Proceeds on Life of Decedent ................................................ 2. 3. Retirement Benefits ................................................................ 3. 4. Joint Assets with Spouse ............................................................ 4. 5. PA Lottery Winnings ............................................................... 5. 61a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6b. s 6c. ~ ' ~ 6 SUBTOTAL (Lines 6a, b, c, d) ........................................................ 7 Total Gross Assets (Add lines 1 thru 6) ................................................. 7. 8. Total Actual Liabilities .............................................................. 8. 9. Net Value of Estate (Subtract line 8 from line 7) ........................................... 9. if line 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit. If not continue to Part II. Income: 1. TAX YEAR: 19 2. a. Spouse ........... 1a. 2a. b.' Decedent .......... 1 b. 2b. c. Joint ............. 1 c. 2c. d.' Tax Exempt Income .. id. 2d. e Other Income not listed above ........ 1e. 2e. f. Total ............. 1f. 2f. 4.'' Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) _ + (3f) Obi Average Joint Exemption Income .................................................... . If line 4/b) is greater than X40.000 -STOP. The estate is not eligible to claim the credit. It not. continue tc 1. ', Insert amount of taxable transfers to spouse or $100,000, whichever is less .................... . 2. ', Multiply by credit percentage (see instructions) .......................................... . 3. ~~ This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet . .............................. . 4. ' For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ............................................................. 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Paverty Credit .Include this figure in the calculation of total credits on line 18 of the cover sheet...... . 3f Part 1. III. 2. 3. 4. 5. SCHEDULE 0 COMMONWEALTH Of PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN (SPOUSAL DISTRIBUTIONSI RESIDENT DECEDENT ___ ESTATE OF r- FILE NUMBER ~Sw1-~ ~ ~ ~i~tt L~K Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the " " Trust (marital residual A B By-pass Unified Credit etc ) If a trkist or slmllar arrangement meets the requirements of Section 9113(A), and: 'a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then (he transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) ~o be included in~he election to have such trust or ; similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement. PA T A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DADT Q• Cn+n~++.o dnnn.i n+:nn nn.+...,I.... ..i ..II :..+.......L..:....1...1...1 :.. 1']~.i A t~-...L:_L iL_ n__u__ nA~n i~~ _ ._ a_ _~__.~__ REV-1&9 EX * (1-9~ (It more space is needed, insert additional sheets of the same size) T REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No . 2009- 00293 Estate Of : SUSAN P FOULK CERTIFICATE OF GRANT OF LETTERS PA No . 2 9 - 09- 0293 (First, Middle, Lasi) Late Of: EAST PENNSBORO TOWNSH/P CUMBERLAND COUNTY Deceased Social Security No: 296-32-7805 WHEREAS, on the 27th day of March 2009 an instrument dated November 27th 2007 was admitted to probate as the Last will of SUSAN P FOULK (First, Middle, Last! late of EAST PENNSBORO TOWNSH/P, CUMBERLAND County, who died on the 1st day of March 2009 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARYto: DA VlD J CORDIER and SANDRA KCORD/ER who have duly qualified as EXECUTOR(R/Xl and have agreed to administer the estate according to law, a1I of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VAN/A. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 27th day of March 2009. egtsier o i s eputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) Last Will and Testament OF SUSAN P. FOULK I, SUSAN P. FOULK, of Dauphin County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: Except as otherwise provided herein, I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by the Executor out of the property passing under ITEM V of this Will, as an expense and cost of administration of my estate. The Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor to pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of adminis~ation of my estate. ITEM III: I give to David Cordier and Sandra K. Cordier, or the survivor thereof, if living at the tune of my death, all of my jewelry, all of my books, all of my pictures, household furnishings, and all other articles of household or personal use or adornment and all policies of insurance thereon. In the event they do not survive me, I make this gift to St. Andrews Episcopal Church in Lower Paxton Township, Harrisburg, Pennsylvania. ITE~VI IV: It is my intention to leave nothing in this Will to my daughter, Susan M. Shirk, but my love. Page 1 ~~ . ~~ _ STEM V: 1 give the residue of my estate to David Cordier and Sandra K. Cordier, or the survivor thereof. If they do not survive me, I make this gift to St. Andrews Episcopal Church, Lower Paxton Township, Harrisburg, Pennsylvania. ITEM VI: The Executor shall possess the following powers, each of which maybe exercised in a fiduciary capacity only: (a) To retain any investments I have at my death, including specifically those consisting of stock of any bank even if I have named that bank as the Executor. (b) To vary investments and to invest in bonds, stocks, notes, real estate mortgages or other securities or in other property, real or personal, without being restricted to so-called "legal investments" and without being limited by any statute or rule of law regarding investments by fiduciaries. (c) To sell either at public or private sale real and personal property scverally or in conjunction with other persons, and tv consummate sale(s) by deed(s) or other instrument(s) to the purchaser(s), conveying a fee simple title. No purchaser shall be obligated to see to the application of the purchase money or to make inquiry into the validity of any sale(s). The Executor is authorized to execute, acknowledge and deliver deeds, assignments, options or other writings as necessary or convenient to any of the power conferred upon the Executor. (d) To mortgage real estate and to make leases of real estate. (e) To borrow money from any person, including the Executor, to pay indebtedness of mine or of my estate, expenses of administration or inheritance, legacy, estate and other taxes and to assign and pledge assets of my estate established by this Will. (fj To pay all costs, taxes, expenses and charges in connection with the administration of my estate established under this Will. Page 2 ~+ ~' ` T (g) To make distributions of income and of principal to the proper beneficiaries, during the administration of my estate, with or without court order, in such manner and in such amounts as the Executor deems prudent and appropriate. (h} To vote shares of stock which form a part of my estate and to exercise all the powers incident to the ownership of stock. (i} To unite with other owners of property similaz to property in my estate to carry out plans for the reorganization of any company whose securities form a part of my estate. (j) To disclaim any interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a will, as an appointee under the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee of an inter vivos transfer, and as a donee under athird-party beneficiary contract. (k} To prepare, execute and file tax returns of any type required by applicable law, and to make all tax elections authorized bylaw. (1) To employ custodians of property, investment or business advisors, accountants and attorneys as the Executor deems appropriate, and to compensate these persons from assets of my estate or trust, without affecting the compensation to which the Executor is entitled. (m} To do all other acts in their judgment necessary or desirable for the proper and advantageous management, investment and distribution of the estate established under this Will. ITE~yi VII: tiny person who has died at the same time as 1 have, or in a common disaster with me, or under such circumstances that. the order of our deaths cannot be established by proof, or within thirty (30) days of my death, shall be deemed to have predeceased me. Page 3 _~_._ __ ~ ITEM VIII: If a beneficiary under the age of twenty-one (21) years is entitled to receive assets under this Will, the Executor shall receive those assets as Custodian for the beneficiary under the Pennsylvania Uniform Transfers to Minors Act. The Custodian may receive and administer all assets authorized by law, and shall have full authority as provided in the Pennsylvania Uniform Transfers to Minors Act to use assets in the manner the Custodian deems advisable for the hest interests of the beneficiary. I also designate the Executor as successor Custodian of any property for which I am custodian under any Uniform Gifts to Minors Act or Uniform Transfers to Minors Act. ITEM IX: I appoint David and/or Sandra I~. Cordier, of Camp Hill, Pennsylvania, to be Executors (herein referred to as "Executor"). The Executor is specifically relieved from the obligation of filing bond or entering security. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding three (3) pages, at the end of each page of which I have also set my initials for greater security and better identification this ~~1 day of N o,, ~ nn b ~ ~ , 200. ~- Susan P. Foulk Page 4 W \~~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA } SS: COUNTY OF } .~--- We, ~a . ' ' 1 r' f~l ~ and ~}~ ~ ~- ~ L. _ lav-~ ~vnw ;the Witnesses whose names are signed to the attached or forego' g instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix, Susan P. Foulk, sign and execute the instrument as her Last Will and Testament; that Testatrix signed willingly and that she executed said Will as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen (18} or mare years of age, of sound mind and under no constraint or undue influence. / ~j C Witness Witness Swom to and subscribed before me this day of 2Q07. Notary Public My Commission Expires: (SEAL) We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. j ~'? ~ ~ SEAL ~~~ Residing at ~.~ • ~ G,~?.~~/t-~c~ Residing at ~~ ~--+ ~-~-, i~~'~ l [ -e ~.s Rt.~.1.c.~ Pte- 1 ~oc~. ~ _ _~ COMMONWEALTH OF PENNSYLVANIA } SS: COUNTY OF DAUPI-iIi~l ) -~z~~~: On this, the ~`t~lday of , ~~_~•~ ~~C~, ~~HBS; fore me, a Notary Public, the undersigned officer, personally appeared Emi y~ Long Hoffman, known to me (or satisfactorily proven) to be a member of the bar of the highest court of said state and a subscribing witness to the within instrument and certified that she was personally present when, Susan P. Fou1k, the person whose name is subscribed to the within insdnunent, executed the same, and that said person acknowledges that Susan P. Foulk, executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. --~ ~- z ~~~N~~~_~~ .~~ ~=r~aNS~LV~~it~ N.tuy r~Llic ~ ~ . j ~fl`rtv-uaL. s~a~ Patty ! . Strohecker, ~iotary Publi:. City of Narrisourg, Dauphin County ?~1y;,emmissione~¢iie3lanuan,~tb:2G11 ~r ~pG c~,,~Op9' ~~o ~~~~ ~~A ~~ rd ~ b ~ Cs'1 O ~~ C ~ ~ W ~~ ~[~ ~~ ~~ ~ ~ c ox ro C~ ~ ~ ~~ a b~~ ~ ~ ~~ 9 ~ ~ ~ ~ ~~~~~ ~ cNa ~G OOO b ~ ~ O x Crl "~ ~O N ~'' ~~' ~ '~ N ~ w ,.C x ,.c.` ~y/ This estate jewelry appraisal was prepared by Henderson & Co. Jewelers, Inc. Windsor Park Shopping Centier Mechanicsburg, PA 17050 (717) 766-7771 for: Sandi Cordier 15 N.12a' Street Lemoyne, PA 17043 Estate of Susan Foulk This appraisal was prepared March 19, 2009. The following metal prices are from the date of death, March 1, 2009. The price of gold was approximately;950 per ounce platinum ;1100, per ounce. The following equipment was used in preparing this jewelry appraisal: Binocular Microscope Dial Gauge Table Gauge Electronic Scale Color Master Stones Polariscope Touchstone & Adds The appraiser was David A. Henderson, Gemotogist of stitu ~ of America, no. 3561240. G.I.A. grading termindogy was used in preparing this, jewelry appraisal. This appraisal was prepared for esratie purposes only. The values given represent a fair price that the fbems could be expected th bring in a reasonable time period if sale was necessary th settle the estate. This is based on prices obtained fnr similar items in our area at the time this appraisal was prepared, or recent auction prices for similar items. The condition of the gems and their mountlngs was factored in when arriving at these values. This jewelry appraisal does not represent an offer to buy nor does Henderson & Co. Jewelers have a stake in these items. (1) UNIFORM CULTURED PEARL STRAND This is a single knotted strand of Akoya Cultured Pearls 25 inches long (as is). There are 70 pearls on this necklace. A 14K white gold filigree fish hook clasp secures the strand when wom. PEARLS: Seventy Akoya (salt water) Cultured Pearls Shape: round Diameter: 7.5 mm uneven Color: light cream Luster: fair Complexion: spotted Nacre: thin to medium ESTATE VALUE ....................................................................$200.00 (2) SPRING BANGLE WITH AMETHYSTS The mounting of this by-pass spring style bangle bracelet is 14 Karat (stamped) yellow gold. Both ends of the bangle have a lantern-like setting. Each setting has a round cabochon amethyst on the end and two emerald cut amethysts on the top. A 2.85 mm split tube gives the bracelet its' spring. Condition of bangle at time of examination was very good. Total weight of mounting with gems is 6 dwt/9.3 gr. AMETHYSTS (Emerald Cut) 4-6 mm to 4.25 mm Color: saturated violet to red violet, some color banding Clarity: eye clean AMETHYSTS (cabochon) 2 - 5 mm rounds Color: saturated violet Clarity: moderate inclusions ES'T'ATE VALUE ...............................................................$225.00 (3) U. S. GOLD COIN RING A 1926 U.S. 2~/s dollar coin is back set in this approximately 14 Karat yellow gold ring. Condition of coin and ring at time of examination was good. Total weight of coin and mounting is 7.3 dwt/11.4 gr. (coin 2.5 dwt -ring 4.8 dwt). ESTATE VALUE ...............................................................$225.00 (4) U.S. GOLD COIN PENDANT This pendant consists of a coin edge frame with set screw and a $5 U.S. gold coin (1907). Condition of coin and frame was very good. (coin frame has a base metal jump ring and screw). Total weight of coin and frame - 6.3 dwt/9.7 gr. (coin 5 dwt -frame 1.3 dwt). ESTATE VALUE :............................................................ X235.00 {5) DIAMOND CIRCLE PIN This is a traditional circle pin assembled from components cast in 14 Karat white gold. There are twenty six round diamonds bead set in this brooch. A pin stem and safety catch secures this 1 3/16 inch pin when wom. Condition of brooch was very good at time of examination. Total weight of mounting with diamonds is 2.6 dwt/4.1 gr. DIAMONDS: Twenty Six Round Brilliant Cut Genuine Diamonds Diameter: 2.5 mm Weight: .05 ct. each, 1.30 ct. T.W. Clarity: VS Color: G-H ESTATE VALUE ............................................................500.00 (6) MULTI-STONE FLOWER PIN One 14 Karat (stamped) yellow brooch of cast construction. This 2 3/16 in. x 1 5/16 in. brooch consists of three flowers with stems and leaves. One flower is set with a cluster of six sapphires; one flower is set with a duster of six rubies. The remaining flower is set with a cluster of six green dyed chalcedony (to simulate emeralds). The stones are round and prong set. Condition of pin at time of examination was very good. Total weight of mounting with stones is 8.3 dwt/12.8 gr. SAPPHIRES: Six Round Faceted Genuine Blue Sapphires Diameter: 2.25 mm Color: Inky blue Clarity: moderate inclusions -color zoning RUBIES: Six Round Faceted Genuine Rubies Diameter: 2.23 mm Color: reddish pink Clarity: moderate inclusions CHALCEDONY: Six Round Pre-formed Dyed Chalcedony ESTATE VALUE ............................................................. X250.00 ~~) PEARL AND DIAMOND RIBBON PIN A cluster of eleven oval cultured pearls accented by five round diamond melee form the focal point of tf5is brooch. Loops and tails of flat gold with a Florentine finish on one side simulate ribbon tied around a bunch of flowers. Dimensions of brooch are 2 inches x 1~/a inches. Condition of brooch at time of examination was very good. Total weight of mounting with gems is 6.4 dwt/10.0 gr. PEARLS: Eleven Oblong Fresh Water Pearls Size: 7 mm x 5 mm Color: white Luster: very good DIAMONDS: Five Single Cut Round Genuine Diamonds Diameter: 1.7 mm Weight: .02 ct. each, .10 ct. T.W. Clarity: VS Color: ] ESTATE VALUE ............................................................. $150.00 ($) DIAMOND AND SAPPHIRE RING This bow motif ring was assembled from platinum components (not stamped). A center round diamond is prong set with eight semi bezel sapphires around it forming a bow. Two ribbons of metal form loops each set with eight round single cut diamond melee. The airline shank has a slight curve at the shoulders. Condition of ring at time of examination was good. (beads on most exposed loops are showing wear and center stone is chipped). Total weight of mounting with gems is 7 dwt./10.9 gr. CENTER DIAMOND: One Old European Cut Genuine Diamond Diameter: 7.24 mm Depth: 4.38 mm Weight: 1.40 carat by formula Clarity: VS2 Color: I Comments: This diamond has an open culet. The girdle is thin to knife edge. This is the reason for chipping. DIAMOND MELEE: Sixteen Round Single Cut Genuine Diamonds Diameter: 1.7 mm Weight: .02 ct..each, .32 ct. T.W. Clarity: SI1 to I1 Color: I-J SAPPHIRES: Eight Straight Baguette Cut Genuine Blue Sapphires Dimensions: 4 mm x 2 mm Color: medium to saturated blue Clarity: eye clean ESTATE VALUE ......................................................................... $2,500.00* *This value reflects the cost of recutting and approximate weight after recutting to remove damage and knife edge (1.17 ct. - 7 mm x 4.27 mm depth). C9) SEVEN DIAMOND BAND RING This is a Fish-Tail style setting with a knife edge shank. The ring mounting was cast in iridium platinum (stamped 10°!o iridium, 90°fo platinum). There are seven round diamonds in the ring. Condition of ring at time of examination was very good. Total weight of mounting with diamonds is 2.0 dwt/3.2 gr. DIAMONDS: Seven Round Brilliant Cut Genuine Diamonds Diameter: 2.8 mm to 3 mm Weight: .10 carat each, .70 ct. T.W. Clarity: SI Color: G-H ESTATE VALUE ....................................................................$365.00 (lo) SEVEN DIAMOND BAND RING This is a Fsh-Tail style setting with a knife edge shank. The ring mounting was cast in iridium platinum (stamped 10% iridium, 90% platinum). There are seven round diamonds in the ring. Condition of ring at time of examination was very good. Total weight of mounting with diamonds is 2.0 dwt/3.2 gr. DIAMONDS: Seven Round Brilliant Cut Genuine Diamonds Diameter: 2.8 mm to 3 mm Weight: .10 carat each, .70 ct. T.W. Clarity: SI ' Color: G-H ESTATE VALUE ....................................................................$365.00 (11) PEARL AND SAPPHIRE CIRCLE PIN This yellow gold open work circle pin was cast in 14 Karat gold (stamped). The diameter of brooch is 1 5/16 inches; it consists of 30 twisted rope like rings interlocked like a chain. Six cultures pearls alternating with small sapphires accent the piece. Condition of brooch at time of examination was good (brooch is slightly out of round, there is one small break). PEARLS: Six Akoya Cultured Pearls Diameter: 4.5 mm Color: white -light rose' Luster: good Complexion: mostly smooth Nacre: medium SAPPHIRES: Six Round Faceted Diameter: 2.5 mm Color: medium to medium dark blue Clarity: hary included ESTATE VALUE ..................................................................$150.00 (12) PLATINUM SAPPHIRE BAND RING This eternity band is iridium platinum. Calibre cut sapphires are channel set around the ring. Condition of ring at time of examination was fair (all sapphires are abraded). Total weight of mounting with sapphires is 1.9 dwt/2.9 gr. SAPPHIRES: Twenty Nine Step Cut Square Genuine Sapphires Dimensions: 2 mm Color: saturated blue Clarity: moderate inclusions ESTATE VALUE ....................................................................$100.00 (scrap +) (13) PLATINUM ENGAGEMENT RING WIfH ifIVE DIAMONDS The mounting is iridium platinum (stamped 10% iridium 90% platinum). Around center diamond is elevated above the four small stones on the shank. All stones are in four prong settings. The ring's shank is rounded. Condition of mounting at time of examination was good. Total weight of mounting with diamonds is 2.3 dwt/3.6 gr. CENTER DIAMOND: One Round Brilliant Cut Genuine Diamond Diameter: 6.92 mm to 6.98 mm Depth: 4.36 mm Weight: 1.28 carat by formula Clarity: SI1 Color: G Comments: Some abrasion is visible. There is a small cleavage on the girdle. SIDE DIAMONDS: Four Round Single Cut Genuine Diamonds Diameter: 2.2 mm Weight: .04 ct. each, .16 ct. T.W. Clarity: VS2 - SI1 Color: G-H ESTATE VALUE ...............................................................;2,450.00* *This figure represents estate value after repolishing diamond to remove surface damage.