The URL can be used to link to this page

Home My WebLink About01-12-10J 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 0 8 0 5 9 2 Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 203-34-0171 ;May 18, 2008 ,September 18, 1946 Decedent's Last Name Suffix Decedent's First Name MI _. _.. _ __ '; Baker Edward ' E (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 INAPPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) ,,:.,~ 4. Limited Estate s~ 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 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 717-697-7050 __ __ _....... REGISTER OF WILLS USE ONLY Correspondent's a-malt address: andrewc.sheely@verizon.net Under penalties rjury, I d tare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corn a compl e. Declaration o~,pr~(arer othe ap the personal representative is based on all information of which preparer has any knowledge. SIGNATUR OF ~S R~FSPONSIBL FAQ LING ~E wN DeT°/ ,~ AnnRFRR John B er, Executor, 1214 Rambo Road, Dyersburg, TN 38024 SIGNAT RE OF PREPARER OTHER THAN REPRESENTATIVE pnnR~cc Andrew C. Sheely, Esquire, 127 15056051058 N C'7 ° ~`"t ' ., c. ~ ~ tU _,: - ~ 1 '. ~ ~ - ItfATE~I[ED _.._ ____.....~ , .._ ___._. ,._ ._._ ._.._...r . ~ ~ t t ~ t w -.>> t~) i -t 1 _.. _ ~ HATE ~31/~9 Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number ;203-34-0171 Decedent's Name: Baker ~ Edward E . , 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. 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 9. Funeral Expenses i;<Administrative Costs (Schedule H) ..................... 9. ~? 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. ~„ „ .. . 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. i 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. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers und~~ sec. 9116 ~ ~~~~ ~ ~~~~ ~~~~ -- ~~ - -- __ (a)(1.2) X .0. 15. ~ 16. .._. _ M.~___,_ ,...r-__._..~. Amount of Line 14 ~°~~ble ~. at lineal rate X .0 16. 17. m ~~_.-.. ~. ~ ~-,.-,. , ~ emr. Amount of Line 14 taxable 0.00 at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 _. 18, 19. TAX DUE ....................................................... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.00 °:°"o 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Edward E. Baker STREET ADDRESS 1918 Kent Drive CITE' Camp Hill F~..rt!~~~.,.,, ...... 21 ~08 0592 DECEDENTS SOCIAL SECURITY NUMBER STATE ZIP PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit - B. Prior Payments _ C. Discount - Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest _ E. Penalty - Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) _ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) _ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 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 ^X a. retain the use or income of the property transferred :.............................................................................. ............ b. retain the right to designate who shall use the property transferred or its inwme :................................ ............ ^ 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? .................................................................................................. ? " " ............ ^ ^x .. or payable upon death bank account or security at his or her death in trust for 3. Did decedent own an ............ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................................................................ ............ ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers 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. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY wrAit Vt Edward E. Baker 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 UMBER DESCRIPTION 1. Belco Community Credit Union -Savings Acct. #485520 0 2. ~ U.S. Treasury Stimulus Check 3. I Decedents 2008 Federal Income Tax refund TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) FILE NUMBER 21-08-0592 VALUE AT DATE OF DEATH $3,377.43 $600.00 $894.00 4, 871.43 sl' Q Z v (~ Z ~ ~ p m N "~~^ ~ 4 .~ M Q i,R ~° 0 o N n C C ~r m N ~ ~ a r ~ ~ ~ N i m r ,C., ~ ~ c m ~ wz ~ ~ ~. cn m ~p n~ w ° 0 w m J b v D .~ ~~ '~~~0 m ya -~1 w W y .~ 3 ~g t ~ w m rz w~ i m i __ i ctl w o 0 ~ ~ - ~ > v O Yr o . ~ O ' i ~ .u z w ~ A 'd N w 0 ~ o ' ~. `° z cz ~ ~ Z _ A Z ~ ~ ~ ~ ~ w _~ ~ N ~ ~ o W - ~ o o ~ ~ ~ ~ . o z p ~ [P m m ~ om t ~ ~ Z Q ' ~ tp i r-Q 2 o ~ m va ~_ ~ 'sue w r~ ~° n ~ ~ ~ ui a t- rt, " y ~ N ~~~ .. ~J ~ ~ ~~ V X ; Q ~ ' ~Y ~ ' m A ;. S ~ m ~ ti m , ~ ~ ~ °- x z ~ `,~~, v ~ ~ O W m Q f O m w ~ O y 0~7 j ~~ a a . boo w s aI o.rt IAtt!~ 7~5~ ~~ ~- r. ~ o00 5 492,475.562 '~.!: CEteelc No. .• 06 18 08 46 AUSTIN, TEXAS 2309 11746749 . 2309 11746749 2009080D X30 08AKE. ANDOVERSTIMULUS Pay to ~m~~~nr~~~nrro~~rn~{r~r~r~r~rnr~~r~~nrnr~~~rr~rr~u~+ thearrkrof DYARD E BAKER 12~Q7 918 KENT DR CAMP HILL PA 17011-5930 49 $****b00*QO 10°10NAL0Or0~~*R YDID AFTER ONE YEAR xu~ •a ~wmKwwe~wrm Zed G9b9SBZTEG ua~eg esauayl ~ uyoC eES~60 6D EZ IBC REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDULE M FUNERAL EXPENSES & ADMINISTRATIVE COSTS ~~ ~Ni ~ yr Edward E. Baker ITEM DUMBER A• FUNERAL EXPENSES: 1' Parthemore Funeral Home 2. Funeral luncheon/meal FILE NUMBER 21-08-0592 Debts of decedent must be reported on Schedule I. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) JOhn Baker Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1214 Rambo Road _ __ _ _. __ city Dyersburg _ state TN .zip 38024 Year(s) Commission Paid: 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. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees ~. Reimbursements to Executor for expenses $~ Filing fee for PA Inheritance Tax Return TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) AMOUNT $2,119.85 $125.00 $475.00 $ss.oa $765.00 $15.00 3,567.85 i i 6~ _~• ~~ t~t~rr~~r~t _, ,~ ~._ S ~ ~ iE r ~... w.k.....,,. f k /~ .~ - ~ °~v. z ~ ~ ~~~ f t .~: . _ ~~ , #':d i REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDVLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE AF Edward E. Baker FII F NIIMRFR 21-08-0592 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical pYnnnaee tlr more space is needed, insert additional sheets of the same size) ,.~--- 1st Statement PENNSTATE 1 2 Milton S. Hershey Medical Center ~ eox ea3z9i This bill represents the portion remaining after your Plttcbwyh, PA tb26a-329 insurance company has processed your claim. Please send your payment for the full amount due. If you have any questions concerning how your insurance company processed your claim, please call them. EDWARD BAKER ~~~ 1214 RAMBO RD DYERSBURG TN 380246636 1n{I+{++I+I{+nn{,1+hr{+{I,,,{Innl{+,1{,curl{+I,+{lnr{1 Patient Name BAKER EDWARD E Statement Date 06/07/09 Service Date(s) 03106/08 _._--Hof-Sernce_.._.__ __ _.. OUTPATIENT 3/ 7 ~1' Account Number ~ 9520403 , New ChargeslAdj $ 7,847.30 New PaymentslAdj $ 0•~ Account Balance $ 7,847.30 Amount Pending Insurance $ 0.00 Amount You Owe _ $ 7,847.30 This new statement has been specially designed with you in mind. Let us know what other improvements we should make. Please e-mail your ideas to: 5tatementideas~a hmc osu edu or write to ,~ at: Penn State Milton S. Hershey Medical Center Statement Ideas, PO Box 854, MC A410 Hershey, PA 17033 DATE DESCRIPTION AMOUNT 03/06/08 GLUCOSE, BLOOD 15-~ 03/06108 LIPID PROFILE 71.00 . 03!06108 PROTHROMBIN llME - . _ . _.___........ _... _. __.-25.00 03!06108 CBC W1PLT/DIFF AUTO 53.00 03/06/08 URINALYSIS-BASIC 8 MICROS 42.00 03/06/08 LIDOCAINE 1 3•~ 03!06108 NITROGLYCERIN 0.4 4.30 03/06/08 FENTANYL CITRATE 2 3.00`` Corttlnuad.on ttert page.... P For billing questions or insurance changes: Para preguntas acerca de su facture o t:antbios de seguro contemns con representantes disponibles pars asistir a la comunidad hispana. Phone: (717) 531-5069 or (800) 2542619 Available Hours: Monday, Tuesday & Wednesday $:00 am to 5:30 pm Thursday & Friday 8:00 am to 4:30 pm Written Correspondence: Penn State Milton S. Hershey Medical Center Patient Financia{ Services Department PO Box 854, MC A410 f. ~ . , . Hershey, PA 17033-0854 , - Please Note: Your physicians will bill separately for their professional services..:.. NERSHE,rsT-01 I i ...:: ENN A `~ ~ - - St~tbmarrt Date: 06/07/09 Milton S. Hershey Medical Center PO Booc 643291 PithSburgh, PAt5264-3291 CHECKS SHOULD BE MADE PAYABLE AND SENT TO: MS HERSHEY MEDICAL CENTER PO Box 643291 P'rttsbat gh, PA ] 5264-3291 L,+IIJ,I+.+1+I+I(,++h+I+,II+++I+II+(++,„111-+,Il ~~ .PaUeni N __.._.... -- Acr:~ot u-+ry,hpr . Date D e amt± _ BAKER EDWARD E 9520403: Upon Receipt Amount Due Amount Pald $ 7,847.30 S " Check here if your addl8ss or insurance information haS ahanggd. J Please indicate charges on the bade of this lam. To pay by credit card: For your convenience, you may pay by visa. MasterCard or Discover Card. Please indicate your credit and preference, provide the account information, and sign below. Account No. _ Expiration Date CW Code Signature b•d L9b9SBZTEL ~aHeg esta~aul 13 ~4oC ebSt60 60 EZ i~C -- Clinical Practices of the ~r~OEfti `Four ~'i:. ^d:.:i~e~~: Page 1 Unhretrsity of Pennsylvania Thank you for choosing the Clinical Practices of the Glottal Practices of the University of Pennsylvania University of Pennsylvania for your health care. This .is a sox 757s statement of your account(s) for PhysiciaNHealth Care PHILADELPHIA PA 79175-7579 Provider servtceS on1yyL. You may receive a separate bill for 7V0t0~~ severalll~oAcnations wtiim the Health Syste- ~ovidEd at Telephone 800-406-1177 Mon-Fri S:OOAM - 6:OOPM EST EDWARD BAKER 1214 RAMBO RD DYERSBURG TN 38024-6636 I„I 1, l„I, 11,,,. r I, I r e„I, I I, r, I I„r r l l„I I,,,,, l 1, I„I I, r, I Accotang ~urr~t~tary ___ . Statement Date 01/03/09 Patient Name EDWARD BAKER Account Number 055863336 Total Charges $ 745.00 Amount Y®!tl f3we $ 50.00 Detailsllnformation on Reverse You have felled to respond to our previous notices. Please tooted !Eris ofrrce immediately to avoid further ~ollectior- proceedings. The reverse side of this statement details the PhysiciaNHealth Care Provider involved aft our care. far your convenience, the charge(s) for services) provided ac~aogun (sj haspbeen ter(nizedadjustment(s) made to your If you wish to pay.by credit card, please complete the stub below and return R In the enclosed envelope or contact us at 800-406-1177 to pay by phone. Most major credit cards are accepted as payment.. The Universety of Pennsylvania Health System provides urgently needed setvices to all persons without regard to their ability to pay. If you are haven difficulty paying your bill, please contact us at 800-406-177 to determine the type of funding for which you may be eligible or to make payment arrangements. Our customer service representatives are available Mon-Fri between 8:00 AM and 6:00 PM EST: Payments vwnli be applied to the oldest open balance on your account includin -any accounts that have been transferred'to collec~ona. Insurance Infr~rmation Insurance 1 CIGNA FJ(ISTING EXPLO Insurance 2 LtFE30URCE HMO Please indicate changes to insurance information on the reverse side of this form. ff tientai or vision insurance is listed above, that insurance is only bailed for applicable service. PLEASE DETACH HERE AND RETURN THIS STUB WITH YOUR PAYMENT Clinical Practices of the University of Pennsylvania i;7r=:z:~. o r~E~':1};S PAYfiic`~' 'ti.: CPUP (Clinical Practices of the University of Pennsylvania) Credit Card: L V4SA '~I C=1 MasterCard ~ ~7 AMIX Cartl N~rtber: Amaunl Charged: ~ Exp. Date Name an Card Patient Name Account Number EDWARD BAKER 055863336 Amount Due Amount Encloses $ 50.00 -~, Due Date 01118!09 Clinical Practices of the University of Pennsylvania i30X 7579 PHt(ADELPHlA PA 19175-7579 Irr,IILh,,,rllbrrl,1,lrerrJ,Ll,i,rrH,Irrlrr,Il,Lrrrllrl 9 • d G9ts9S8Z T EG .~a~eg esauayl 'S uyoC eSS ~ 60 60 E~ T ~C MAKE CHECKS PAYABLE TO: Metro Med Services 71N- 23.73a9s23 Billing Office P.O. Box 726 New Cumberland, PA 17070 patient Name: BAKER, EDWARD E. Patient SSN: XXX-XX-0171 Date of Service: 5/172008 12:35 From: HERSHEY MEDICAL CENTER To: MANORCARE HLTH SVC-CARLISLE primary Payor: Cigna Healthcare Secondary Payor. Biil Patient I~ ~~i~ PLEASE MAKE ANY CORRE~IONS TO ADDRESS ABOVE. 5/17/08 Mileage 8115108 Adjustment -Insurance total ,~-^---- ~, - -' ~MASTERCARD -""~~' `DISCOVER ---- VISA INVOICc DATE 1112312008 RVN NUFd6ER 08-27176 - i . $562.50 Local Telephone: 1-717-2146018 Para Espanol Ilarrre ?-866-7'24-4114 Tall Free : 1-877-214-6018 FAX; 1-717-214-6020 ema1: info~ambulancet~lingoffice.com EDWARD E. BAKER 1214 RAMBO RD DYERSBURG, TN 38024636 I~II~MVIIII9I~I DETACH AND RETURN TOP POFlTION WITH YOUR PAYMENT. Cade . Qty Un1t Pnce . A0428 1 450.00 A0425 35 10.00 Total l~scounts / Charge AaJiustmenfs _ Payments 450.00 350.00 -237.50 800.00 -237.50 0.00 '**YOUR ACCOUNT IS PAST DUE*`" This claim will be submitted to a third-party collection agency if payment is nat received within 10 days. You will be responsible for all collection fees incurred. NONPAYMENT MAYAFFECT YOUR CREDIT Metro Med Servtese, an z+4-sole PAY THIS AMOUNT III $562'S~ ~. BAKER, EDWARD E. 1~-27176 °'~~~ L • d L9b9S8Z T EL ~asleg esa.~ayl R ~4oC eSS = 60 60 EZ 1: ~C ;vb",I<E CHECKS :~'.':;:'y=~-~ ~u: Camp HiU Fire Company No 1 ~N. ~~~ Billing Office p.0. Box 726 New Cumberland, PA 17070 Patient Name: BAKER, EDWARD E. Patient SSN: XXX XX-0171 Date of service: 5/9/2006 10:59 From: RESIDENCE To: HERSHEY MEDICAL CENTER Primary Payor. Cigna Healthcare Secondary Payor. BiU Patient I 1~1 ?t.I:..E;:c S.4i Jic ,1'•!Y CCRtiECI I:;!d:~ iQ %.~DF=SS.:..60?'r. Date 5/09/08 Mileage 5109/08 Oxygen 8/22108 Payment Tote! ~`.-J ,i.':S;~f<C.~hD i. D~SCr~~F;, !iS I ~:F:iOUi•IT iF!\:OI•^5 ~,.TE 11!13/2008 FIJfI hIUt,12ER. i ~ 08-27697 ~ $798.00 ~ ~..J ------.__..__. Local Telephone: 1-717-214-6018 pare FsparlW !lame 1-866-724-4114 Toll Free : 1-877-2146018 F/~(: 1-717-Z14-6020 email: info(p~ambulancebiNingoffice.oom EDWARD E. BAKER 1214 RAMBO RD DYERSBURG, TN 38024-6638 i~n~pomn~ii IMF-i~,:.Nr...-~.2T:.'.h1?"-_-G"I'tit `e:ITH YiatP ?: .. ~..~'J'.' _. Procedure Toter Code Qty Unit Price ~~ A0425 15 21.00 315.00 A0422 1 107.00 107.00 -324.00 1,122.00 0.00 -324.00 *"THIS IS AN LIlVRFS4LVED 8lLL** Your account has now been trarlsfemed to our Collection 8i Credit Department. '"IMMEDIATE ACTION !S NECESSARY""' .. Camp Hill Fire Company No 1, 8TT 214601$ .~_,'_ " _ .. . , ., -, _.._ .... $798.00 _ BAKER, EDWARD E. 0$-27697 - ~~ .~.~~ g•d G9ts9S8ZiEG ~a~eg esa~ayl '8 ~4aC e9S~60 60 Ez i~C Jul 23 09 09:56a John & Theresa Haker 7312856467 p.9 ~~ ~~ n ~~ m .S O d m V V ~ ¢• m as 'v ~~ ~~ D '~ ~ ..Q ~ ~ o a c o ~ ~ g ~ ~ ~ Z' ~3 ~~ ~ C ~~{ ~ ~ $ ~ ~ ~~ S Q ~ ~. w x ~ ~ N ~ Z .i ~ m C -_I C N '° ~ O ;# a ~ ~+ Z Q ~~ ~ ~ ;? o g €< <~ p -< ~,;~ . ~;-, M: r.:.; ~~ ~'S ~ kfi~ R C .,; ^'x .a ~:;`% r ~~: R<: v C. yx pp ~. r s ~~~ Oi~ •. C+#X. r `= wf 4 ,; ~ ~ ~~ t = ?:~ ''y- ~ `~; ~1 a+ .a .M in ca ~q' O 4o A N O rD m I~,~.s : ,i i;sss.~~ N ~1 N !~l O O O ~~~~~ Q~; m O O N O A A m C) .< ~, O r ~ p~ a ~ C) ~ _ .O ~ .~ H ~ ~ w ~ M V d~ n ~ ~ V 7 ~ c 3 ~i ~ g~~m.. O $' 0 3 0. ~ =x~ ~ p .3 . o ~gu, ~ ~' ~ G~ m ~ CS ~~ 7 G o m '~ 8 m o n ° ' ~ m~ ~ = w -mac ° o ~ a ~ ~ o O • ,~. ~ w 7 ~ ~~ ~ Z . obi ~ ~ . g ' $ ~_ -y r - y O 07 a A p "' ~ O O ~ Z ~ a ~ m 3 S~ IC g ~-~ ° ~ V ~. N ~'~.m 7 ~ ~, ~~ .dig 7 ~d ~ ~. m m~ O '~ ao c ~ m~v ~ ?~~ ~~ ao ~ (n~/3 ~ . Q m ~ - m m ~ ~ _ f ~' i S "" ~ ~ v ~ pr n eoX 8077 ~ ~ ~ Po London. KY~0742 -w #BO 0000228105184 8 98 WWIFESTLINE--------- ~ n m `~ ~ ~* ~ ~ ~ ' R ~ ~ W m (~ ~ ' EDWARD BAKE 1214 RAN60 RD a ~ `4 ~ p ~ ~ ~ 3 fl 0 Q ~~ OYER88URG, TN 98024-8896 ~ z ~ ~ '- o V p c `~ I~I~i..1.1~.I.I~~i~i~.t.1..1,.1~1,.1.I~.I.I..I~.I.I..t.1 1 Billing Date: 05!01108 Page 1 of 6 ~,r•.•~ Telephone Number 717 737-0530 ' ~'" . Account Number: 717 737-053p p87 52Y ~~ EDWARD E BAKER Account Summary MoU~Tng~ AOolring? i.ass.vztleot~s Previous Chagos $ 27.79 Across the street ar across the Payment Received Apr 23. Thank You. - 27.78 patron, one caU can do it all. ~ ~ Call us forlntemet, phone and 9alan~ . enterfarrrment in your new home. Nvw Charges Verizon(page 3) $ 42.63 F~~ Verizon Long Distance(page 6) 4.26 Oet Verizon ~FiCS ®Super--Fast Total New Charges Duo May 28 $46,89 Internet and Unlimited CaBfngt Total Due a'~•~ Speeds of up to 5/2 Mbps and unlimited calling to anywhere rn the U.S. and Canada, at! for only $69.99 a month plus faxes & f~aes with a 1 year agn3ernent. Celt us of 1-877-282-2659 today. Offererxis 6/30/08. Service availabrfity vanes. 0iuasdons about your biN? CaN 1800 880-2215 See page 2 for all other Verizon contact information. Ghango of biNing address? Go to verizon_corntbillingaddress or see page 2. ~ Detach & return payment slip with your check, payable to Verizon. 210•HBRBAI Account: 717 737-0530 087 52Y o0o~,6,roooa„oe~l 33-PA P063 ~~ Nsw Charges Due: May 28, 2008 ,,,n,osao ""'"°" Total Due: S 48.89 0 5010 8 ^ Yesl !want to be a Literacy Champion. Sign me up fora St monthly donation Amount Paid to Verizon Reads. ~ ~00^ 00022616 O1 AV 0.312 ECP12611 0082 EDWARD E BAKER 1918 KENT DR CAMP Hltl PA 17011-5930 ...III...lil~~~~~~ll~~~ll,I~I~I~i~~~~ll~Il~~~~~~III~~1,~1~~ Verizon PO BOX 28000 LEHIGH VALLEY PA 18002-8000 lu~lllul~ll.nli~nnhllnl~llu~lln~ll~nu~lli 1097170737053D087002802109000006000DDOOODD000000046896000D0 pi •d L9b9SBZiEL ,aa~eg esa,~ayl ~ uyoC eLS=60 60 Ez i~C REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER TART Edward E. Baker 21-08-0592 i 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)) 1. John Baker, 1214 Rambo Road, Dyersburg, TN 38024 Brother 100% Rest, residue of FcfafP ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) ` - LAST WILL AND Tai/STAN[ENT OF EDWARD E. BAKER 1, EDWARD E. BAKER, of 19l 8 Kent .Drive, Camp Hill, (bower Allen Township), Cumberland County, Pennsylvania, make, publish and. declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. I{'IRST: I direct that all .inheritance, estate, transfer, succession and death taxes, as well as my just debts and funers.l expenses, of any kind whatsoever, which may be payable by reason e~f ~~ny death, shall be paid out of the principal of my .estate. as the same can conveniently be done. ' ± ,~1D: I give, devise and beck ~.ze~ath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any..., -~: ,. property over which I hold power of appointment and together with any insurance .. .. policies therec3rt, „unto my brother, JOHN BAKER, of 1214 Rambo Road, Dyersburg, Tennessee, provided he survives rr~e by thirty (30) days., ,. ~. . 'T'H RD: I acknowledge that I a~~a the father of TODD E. BAKER, and further state that TODD E. BAKER is not a i~xarned beneficiary of this, my Last Will and Testament, as, appropriate distributions ari~f gih:; have been made to him during my lifetime. ~~: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries ac;*.ing hereunder the following powers, w ~~_ applicable to all property, exercisable without court approval and effective until actual distribution of` all property: (~'1) To sell, at public. or private s~~le, or to lease, for any period of time, any real or personal property and to give option: for sales, exchanges or leases, for such prices and upon such terms {including reedit, with or without security) or conditions as are deemed proper. This includes the power to give .legally sufficient instruments :for transfer of the property and to .receive the proceeds of any disposition. {B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivision, improvement, zoning ar management of real estate and to impose or extinguish restrictions on real estate. (C;) To compromise any claim or controversy and. to abandon any property whi~;h is of little or no value. {d) To invest in all forms of property, including stocks, cornrnon trust funds and mortgage investment funds, withoL:f. restriction to investments authorized for ,~ . . Pennsylvania. fiduciaries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E} To exercise any option, right or privilege granted in insurance policies or in other investments. . {F) To exercise any election or privilege given by the Federal and other tax lawns, including, but not necessarily being limited to, personal income, gift and estate or i~the~itance tax laws. {G} ~ To make distributions to my herein named beneficiaries in cash or in kind or partly i.n each. (H) ~ To borrow money from then~seives or others in order to pay debts, C~ ~:l taxes, or estai.e or trust administration expenses, to protect or improve any property held under my~ will, and for investment purposes. '(1) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plant, employee stock ownership plait, or any other type of qualified plan), to the extent provided for by tl,~~ plan or the law. F_1.FTH: I nominate and appoint ~~{:)~iiiV RAKER, Executor,. of this, my Last Witl and testament. I direct that my Ex~:ct~tor and his successor shall not be 7. req.ui~red .to pest security or a bond for the pe~r•fi~rmance of their duties in any jurisdiction. 1N WITNESS WHEREOF, I have here~,~r~±.o set my hand and seal to this, my Last Will and 'T'estament, this > ~ day of 1~f~r~;h, 2008. ~~-~ -~-~-----~-~ (SEAL) EDWARD F. KA~.EK Signed, sealed, published and declared F~~~ the above-named Testator as and for his l.,ast Will~fEnd Testament in our presence, who, at his request, in his presence and in the presence cxF each other, have hereunto su}~~scribed our names as attesting witnesses. Address acne .. r• Address- ,, ,~~4 17C..>..~" Names. :~