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HomeMy WebLinkAbout02-05-10 (2)1505607121 REV-1500 EX (os-05) PA DeparbnentofRevenue gureauoflndividualTaxes INHERITANCE TAX RETURN p0 BOX 28(]601 Hanisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW OFFICIAL USE ONLY County Code Year File Number 2 1 0 9 0 5 2 0 Social Securty Number Date of Death Date of Birth 2 1 9 1 4 6 6 9 2 0 5 1 5 2 0 0 9 0 9 2 7 1 9 2 6 Decedent's Last Name Suffix Decedent's First Name MI D e V O R E GEORGE D (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 ^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 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 Eopy 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 CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number MARK A MA T E Y A ESQ 7 1 7 2 4 1 6 5 0 0 Firm Name (If Applicable) _____ .____. __ _____... __ . ___ ~ REGISTER OF WILLS USE Ot~ ~ M A T E Y A LAW F I R M ~ o ~~ First line of address 4 T' pJ ~ P - ~ I ~ n n ,cam ._"j ~ ~ O . BOX 1 2 7 r;; r ; ~ ~: ~~ ~ Second line of address :a:.? ~ µr,} ~~~ Cit P t Offi = -„ __~ - Ti~ILED ~ ~ CS y or os ce State ZIP Code _ ~ r`1 j B OI L I NG S P R I NGS PA 1 _ ~i ° {n 7 0 0 7 0 Correspondent's a-mail address: Under penalties of p rjury, I dgHi~ l~ it is We, correct and completL/ elt~ral 419 GLENN AVE ed this return, other than the THAN REPRESENTATIVE accompanying schedules and statements, and to the best of my knowledge and representative is based on all information of which preparer has any knowkldge. BOILING SPRINGS PA 17007 DATE P.O. BOX 127 BOILING SPRINGS PA 17007 PLEASE USE ORIGINAL FORM ONLY Side 7 1505607121 1505607121 V _~ _J REV-1500 EX GEORGE D. DeVORE Decedent's Social Security Number 2 1 9 1 4 6 6 9 2 i. 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 & Administrative Costs (Schedule H) ........ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 11. Total Dedudtions (total Lines 9 & 10) ........................... 11. 162000,00 1 4 0 6 2 8, 4 7 9 6 5 7 4, 7 5 3 9 9 2 0 3, 2 2 3 5 9 5 3, 2 1 7 4 1 4, 6 8 4 3 3 6 7, 8 9 12. Net Value of Estate (Line 8 minus Line 11) .................. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........... 14. Net Value S~rbject to Tax (Line 12 minus Line 13) ........... ..... ..... ..... .. 12. .. 13. .. 14. 3 5 5 8 3 5 , 3 5 5 8 3 5 , 3 3 3 3 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. ,Amount of dine 14 taxable at the spousal tax rate, or transfers udder Sec. 9116 (a>(t_2>x.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 3 5 5 8 3 5 3 2 16 1 6 0 1 2, 5 9 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 16 0. 0 0 19. Tax Due ..............................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505607221 1 6 0 1 2, 5 9 Side 2 1505607221 1505607221 J REV-15Q0 EX Page 3 File Number ueceaent-s Vomplete Address: 21 09 0520 DECEDENTS NAME G__EORGE D. DeVOR_E _ _ STREET ADDRESS - - - 550 N HANOVER STREET _---- --- -- __ clTV I - - - - __ STATE ZIP - - CARLISLE PA 17013 Tax Payments and Credits: ~• Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ (U 16 012.59 B. Prior Payments 14, 950.00 C. Discount 786 82 Total Credits (A + g + C) (2) 15 736.82 3. InteresUPenalty if applicable D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total InteresUPenalty (D + E) (3) 0.00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 275.77 A. Enter the interest on the tax due. (5A) B. Enter the total of Line ~ +5A. This is the BALANCE DUE. (5B) 275 77 Make Check Payable to: REGISTER OF WILLS, AGENT ~t ~ ~~~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROP RI ATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the ro ert transferred; P P Y ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; .......................... ^ Q c. retain a reversionary interest; or ................... : d. receive the promise for life of either payments, benefits or care? ................. ...................................... ^ a 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ............... .. . ................... . .. ^ ^ Did decedent own an "intrust 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? .................................................................................................. X^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN ri .I { ~: 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~anuary 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 exemot 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)]. A sibling 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-1502 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECADENT ESTATE SCHEDULE A REAL ESTATE EORGE D. DeVt All real property owned exchanged b FILE NUMBER 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 a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 550 N. tiANOVER STREET 162,000.00 CARLISLE, PA 17013 SEE ATTACHED SETTLEMENT STATEMENT TOTAL (Also enter on line 1 S 00 (If more space is needed, insert additional sheets of the same size) I'ieNpns edilmns :nom ubsWnN 'a SCttlement Statement B. Tvne D/ Loan Imni I II III I !)/Xlil irll I I.,ndhuuk ~,~11'+! U.S. Department of Housing and Urban Development OMB ADDroval No. 2502-0265 1. i.1FHA 2 CIFmHA 3. ^Conv Unins. 6. File Number 4. OVA 5. Conv. Ins. 092117DRZYZGA 7. Loan Number 0264 08966 B. Modgage Insurance Case Number n arm n umo e o gne you e s a amen o x ua se amen cos s. moon s Da a an y e se en agen are s own. (:. NOte: Items markad'(p.o.c.rware pale misNe the clovng; Iney aro slwwn hero for mlermation purpoam entl era nnl inclueee in Ina totals. WARNING: It ie a crvna to knowingly make lalsa stalamenls to Ina United Slalvs en 1MS o. any olber simAar loan. Penalties upon convleuen tin inGVae a nna and im rlsonmenl. For tletails see: Tllla 18 U 5. Cade Sectipn 1001 and Sadion 1010. TilleE%pfeee $ettlemenl System Printed 0 912 52 0 0 9 at 09:43 RLH D. NAME OF BORROWER: Scott A. Drzyzga ADDRESS: 2244 Lindasy Lot Road, Shippensburg, PA 17257 ____ __ ____ E. NAME OF SELLER: The Estate of George Devore ADDRESS: _ ___ _ _ F. NAME OF LENDER: Wells Fargo Bank, N.A. ADDRESS: PO Box 5708, Springfield, OH 45501.5708 __ G. PROPERTY ADDRESS: 550 N. Hanover Street, Carlisle, PA 17013 Borough of Carlisle H. SETTLEMENT AGENT: South Central Home Settlements, Inc., Telephone: 717.532-7387 Fax: 717.532.6552 PLACE OF SETTLEMENT: 126 East Kln Street Shi ensbur PA 17257 I. SETTLEMENT DATE: 0912512009 _ J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 162 000.00 401. Contract sales rice 162 000.00 102. Personal Pro rl 4D2. Personal Pro ed 103. Selllemenl char es to borrower line 1400 5,354.79 403. _ 104. -_- 404. 105. 405. Adbslments for items aid b seller in advance _ AJustmenls for items paid by seller in advance 109, 409. _ 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 167 354.79 420. GROSS AMOUNT DUE TO SELLER 162 000.00 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De it or earnest none 4 000.00 501, Excess De sit see instructions 202. Princi al amount of new loans 145 800.00 502. Settlement cha es to seller line 14D0 14151.33 203. Existin loans taken sub' cl to 503. Exislin loans taken sub'ect to _204. 504. Pa off of First Mort a e Loan 205. 505. 206. 506. 207. 507. 208. Seller Assist 5 354.79 508. Seller Assist 5 354.79 209. 509. Ad'ustments for items tin aid b seller Ad'ustments for items tin aid b seller 213. - 513. 214. -- __- _ ___ _ ___ 514. 215. 515. 216. 516. 217. 517. 218. 518. -----_- 219. 519. 220. TOTAL PAID BYIFOR BORROWER 155154.79 520. TOTAL REDUCTION AMOUNT DUE SELLER _ _ 19,506.12 300. CASH AT SETTLEMENT FROM OR TO BORR OWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 301. Gross amount due from borrower line 120 167 354.79 601. Gross amount due to seller line 420_ ____ 162 000.00 302. Less amounts aid b Aor bonower line 220 155154.79 602_Less reduction amount due seller (line 520 _____ 19 506.12 303. CASH FROM BORROWER 12 200.00 603. CASH TO SELLER _ _ 142,493.88 SUeBpSTITUTE FORM 1099 SELLER STATEMENT, The information contained M1e,ein is important tar inlormalinn and Is being lurnishetl la Ina Internal Rovonue SerWC¢ II you ara reguiree to Nle a return, Ina A09 eDOVa~'c 1onsM1lules tneaGOa~s Prxeetls o~gisdl eniaclionhh hem Is reauired to bo reported and the IRS dele,minas Inat it nes not neon regaled. lne Genlracl Sales Price dascribetl on You aro roourced ny law le pmvga the selllemanl agent (Fed. Tax ID No. _) with your corral taxpayer Mentilicatmn number. N you tlo not Drovitle your correct taxpayer ieamilicatinn number, you may be subjxl to civil or cnminal panallles Imposee by law. Under Denalliee a1 Derjury. I candy Inal IM number shown on Ih,s statement is my coned taxpayer identincalion number. T1N' --_ /__.-_._ __.-.__ SELLERISISIGNATUREI51---_-__ -____.__.. ...___..-_ I __._. _...__._ _ __. ___._.. SELLERie) NEW MAILING ADDRE55. SFLLEn(5)PHONE NUMeERe'. IH) ~. DEPARTMENT OF HOUSING AND URBAN UEVFLOP}vIL'NT ~ ~ I~'~ Fie hunl5el 092117DR7 YZGA '°""'°"" "'°""" "°' ""'"""""" __ SrTTLEMEN T STATEME NT . . PACE 2 _ _ _ L SETTLEMENT CHARGES _ _ _ _. - - - fllle[zplcss_SeftlcmenlSyslem I'hinted09RA12009~t ~ I 14:35AS[ 70G I OTA~ SAI F.iNROKER S COMMIS_510_N__bq_5e_d__o_n pure $1G2,000.00 LL'7! G.D0 -~-- - --- _ 0 0 9 720 00 PAID FROM _ PAID F-ROM _ - Dvlslon v(commis.ion (line 70 0) agfollows: . 1 - -- - - - - DORROWER'S SELLER'S . --101. $ __._ 9.7 20.0 0 to K el I er Wllhams of Central PA J FUNDS AT FUNDS AT . _ _ _ _ _ _ 702. $ Iv ~ -- - - -- -- -- -- - -- SETTLEMENT SETTLEMENT 703.Ccmmissionpaidat5eglement ---~-----~~- - -- _- -- - _ BOD. ITEMS PAYA6LE IN_CONNECTION WITH LOAN -.__ 9 720 _ _001. Lvan Origination Fee /, -- - --- -- --~-~ _ --- ~ _. 802_ Loan Discopnl P~ - ~ - --- -- - __ _ - - _ _ - --- - _ 003 A misalfee -- _.--- - ----- - -- - -.._ --- ° ya - _-- - . iP_Susguehanlia Lending Group,lnc. _ 004_ Credlt Report - __ - __ - _. _. .___ (P.O.C J 37_0.00 Buye r - - ----. --- _-- --- 1105. Lender's Inspection Fec ~ -~ - --~~-~ -- _ - 80G Mod a eA 6cahonFec__ 9.A. PP --- - - - -- -- _ u07_ Underwriting Keview _ _ -lo_Wells Fargo Bank N.A. _ ____ _ 800_._ Tax Service Fec to WFRETS - -- - -- _ - - -- L _ - - R 665.00 _ _. _ -- Do9_Molgage oroker Comp___ to Susquehann_a_Lendin Grou ,Inc 9 p --- U 1 ' - - L $1 320 95 POC by Lende R r - 100_ .0_0 - _ _ --- - _ 0. I locessng_Fev _- to Susquehanna Lendin gGroug Inc. , -- - --- ----- -- - _ _ _ 611. Flood Certificahvn Fee to WFFS - - --- - - --- _ __ 3.95.00_ - --- 900_ITEMS REQUIRED BY LENDERTO BE P/11 D IN ADVAN C E LR 19.00 --- _ _ _ _ _ _ _ 901. Interest From D912 512 0 0 9 to _1 010 112 0 0 9 _@8 204700 -- _ IQy 90 2 - - ~ Days LR _ - - -- _ _ . . MorgagelnsunncePremium for I v -- - - - - - - 122.82 _-... _ _ _ __ _ _ 903, hazard Insurance Premium for - ~-- __ ---- lv -- --- _. -- - __. - -- _ . 904. ---. __ ------ - 905. _------- -- - - ------ - _- -- -- W. RESERVES DEPOSITED WITH_LENDE R F 0 R - - - -- -__ --- _ _ _ _ __ _ _ 1001, Ilazardlnsurance - _ __ - 3 mo @ 8 43 33 / o -- - - - -- _. -- - -- -- - m ---- 1002. Madge Insurance Plo. @ $ 75.33 hno -_ -- -- Ll2 _ - „_ _ 129.99 -- _ ' ~o _.. _ -__ - 1003.CI~PP~edYTax_-- ----- -----mv.-@ ~- _ _- - _. ._ --- - ---. _..- -- -- ____ 1004. Ceun~Property Tax _. - _- 4 mP_@ 8 6455 hn - - - -_ -_.----- p 1005. School Taxes _ _ - -----4 mo. 0~8 152 49 hno LR __ 258.20 __ _ _ _ _ . _ 1009_AggregnteAnt~sisALstmenl to WeIIs Fargo Banl~ N.A. LR -- - - 609.96 - --- - 1100 _TITLE CHARGES LR - -- ,.._ _-__.-217.08 __ __ _ -- - -- 1.101_ Settlement or closing tee_ _ _ - - ~ - - ---- - --- ----- _ --- -- 1102. Abstract or title search - - -- - -- -- - - - --- 1103.Tillcexaminativn _-~- - ---~- __ -- - - 1104.1illeinsurancebinder - -- ---- -- --- -- __ _ __.__.- ___.. -- -- _ 1105. Document Pre aralivn _ ~ - _ - -- ____ P _ _ to Mateya Law Firm - --- -- - _ 1106_ fJotary Fees__.__ - - _ - _-~ -- - - - '150.00 -_ - 1107. Allant~'s_fees _ ---- -. _ -- -__. __. _ .- - - ..- ~ - Includes above items IJo. _. _. -. -._ - . _ 1108. 1me Insuranco - to SCHS Ascent for C onestoga'fitle Ins. Ca I - __- -- - _ __11ncludes_abovc dems No: -- --- - - --- ~ __ 1,051.08 - --- --- --. _ 11_9._Lender'sPPIrcY -. __ .__145,800.00 - - --- ~-------~-- _ --~ ---- _ _. ---- - -.. 1110 . Owner's Polic - -~- --~---- - Y 162,000.00 -1,051.88 - ~ -- - -- _ 1111 E:nd too, End 300 G1d 8.1 to SCH$ Agent tor_ Conestoga -- - Title Ins Co -- -- _ - - _-. . _ . 11.12.WIreFee lv OrrstownBank - -~~- - - _ - - 150.00 - -- - --- t i13. ClosingSvcLtr _-_ _ to SCHS Agent for Conestoga Title Ins Co 10.00 - ---------- ._ . 1200. GOVERNMENT RECORDING AND TRANSFER C H ARGES -- ---- 35.00 _ __ _ -- 1201. Recording Fees Deed 48.50 - -- __ ;Mortgage 8 76.50 - Release $ - _.. -- _ 12D2 CI /Corral lax/etam s ----~ -tY __Y____P_ Deed 81,62000 Morl i e$ 9 ~ - ` - ... _ _ 125.OU ___ 1203. Stale Tax/scam s___ -- ~~ ~ - ---~-- ---_-_P_ -- -Deed $ ,620 00_ 1 Morlg~e $ - - 1,G2g.00 _. _- _ 1204 _ __ ----- _.. _-1,G20.00 __- --- -- 1205. -- - --- - --- _ - _ _ _ __ _ 1300 _ADDITIONAL SETTLEMENT CHARGES - _ - - ---- __ _1301 Survey------ - --- _ _------ __ -.. _ __ _ --- -- 1302,pesl InsAeclion- --------~ _--- ------ - __ - - - -- - -- 1303. Ovemi ht Fee __ --- ---- -~- _- to South Central Home Settlements Inc - _ - --- - - _ __ __ t3o4,_2009School Tax lv Boralgh of Carlisle, Tax Collector - 30.00 1305. Transaction Fe_e- _ fo Keller Williams of Central PA _ ~--- 1,829.87 - 130G.IIomvWarrant - ~-~- -- r to American Home Shield - - _2¢0.00 250.00 - _ 1307_FinalWaterandSewer&II to Borough ofCatlisle - ----- ------- - ~ -- - ~- - --.... - `w5•~ -- --- 1308. _ _ - - ----- - __ 6.46 1400. TOTAL SETTLEMENT CHARGES _jcnler on lines 103, Section J and 502 Se ctwn Y) , _ III Ir)(FRllrl('AI! _ _ 5,354.79 - -- - 14,151.33 - )fl (lr 1111 ~I1 /INII iF_I,LER -"- lfl\'ll flfrtlY V1 iBW9i11hB HIIrL1 SP1Pl1mlII jIHIBmPI11 M111U 1!i9hPCIp1,11y k111N41P/lUn nIP11)PIP.I, IIISd1111P N1[I'li'PIIHP[I]Itlllltllll rtl PllPnPl ~1[9m/11\I11115PIIIPnI5111ai)P911111Y flOnMI111 U111y If1A h Ih1311ansa li 11IUIIhP111/Cer~III/Y)Ihal I ha.~e lacan Pd d ttryry VI111P IIVU 1 SPIIIPmPIII,.IWe1nPn1 rlIPV~PIe IOeolpeU UI P N n~drtl iev,~ -x ni._---~~-- ~-S~ WARnII`Ir lrl 'RIM!"inI<IlOWINI~IlMAI<i rAl ".I'':iglrlAl lII". ICI IIII- I IIIVI VIII I"111111111 I III.I 111111111;~gl 1111111'.111 gll!'.tlrY .q<11I IA 1'I ldgl 111 III'11PI1 IIfIVl1 VIII! 1.1,1 I•~,1 x Ills 11rn 'r ~I II IAN INt.I VUE Al11Vl. ANU II.II'12150NMFN11(Ift UEI AILS SIFIIIIFtB II 1 fll el ll wl cn1. 11f nlu 1 I.IP I 1 1 _ V i G(IUE uE( I ION 1001 qNU SFfTION 1010 ~ /.J PL11v . i i1 11.11 Iln1 B w 11 II .. lalgOm I Gy_ C~ ~ G `~~Z S~~ ~IAr REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RESIiDENT DECEDENT N PERSONAL PROPERTY GEORGE D. DeVORE 21 09 0520 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. EMBARQ 20.55 TELEPHONE SERVICE CREDIT REFUND ON ACCOUNT ACCOUNT NO. 717-243-8755-090 2. NATIONWIDE ALLIED INSURANCE CO 99.00 REFUNp ON INSURANCE POLICY ACCOUNT NO. 846361101 3. STATE FARM INSURANCE 28.66 REFUND ON AUTO INSURANCE POLICY NO. 550 9186-D25-380 4. PPL EL(=CTRIC UTILITIES CORP 43.61 REFUNp ON ACCOUNT ACCOUNT NO. 807707800500 5. CITIZENS BANK 137,089.69 CHECKING ACCOUNT ACCOUNT NO. 6100727793 6. COMCAST 46.96 CABLETELEVISION REFUND ON ACCOUNT ACCOUNT NO. 09547-36299601 7. 1994 CROWN VICTORIA VEHICLE 2,500.00 FAIR CONDITION 8. 1985 CUTLASS SIERRA VEHICLE 800.00 FAIR CONDITION TOTAL (Also enter on line 5, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) 7 REV-1510 EX + (8-9a) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE GEORGE D. DeVORE 21 09 0520 This schedyle must be completed and filed it the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE7HENAMEOFTHETRANSFEREE,THEIRREIATIDNSHIPTODECEDENTAND THE PATE OF TRANSFERATTACHACDPVOFTHEDEEDFDRREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE L TRANSAMERIGA LIFE INSURANCE CO 91,074.75 100. 91,074.75 NON-QUALIFIED TAX DEFERRED ANNUITY ANNUITY NQ26161505 2. MICHELLE De1/ORE -DAUGHTER 500.00 100. 500.00 GIFT GIVEN ON 4/28/09 CHECK NO. 1074 3. PATRICIA MERRITT -DAUGHTER 5,000.00 100. 5,000.00 GIFT GIVEN ON 416/09 . CHECK NO. 1Q69 TOTAL (Also enter on line 7 Recapitulation) ~ S 96 574 75 (If more space is needed, insert additional sheets of the same size) ' REV-1511 EX+(t0-O6) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GEORGE D. DeVORE 21 09 0520 Debts of decedent must be n:ported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME & CREMATORY, INC. 8,358.43 B. 1. Year(s) Commission Paid: 2. 3. 4. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) SUeetAddress City State Zip AttomeyFees MATEYA LAW FIRM Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) Claimant Street Address City State _ Relationship of Claimant to Decedent Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 5. I Accountants Fees 6. I Tax Retum Preparel's Fees Zip 424.00 7. CUMBERLAND COUNTY LEGAL JOURNAL -LEGAL ADVERTISEMENT 75.00 8. THE SENTINEL -LEGAL ADVERTISEMENT 208.78 9. KELLER WILLIAMS OF CENTRAL PA -REAL ESTATE COMMISSION 9,720.00 10. MATEYA LAW FIRM -DEED PREPARATION 150.00 11. STATE TAX RECORDING & TRANSFER FEE 1,620.00 12. KELLER WILLIAMS OF CENTRAL PA - TRASACTION FEE 250.00 13. AMERICAN HOME SHIELD -HOME WARRANTY 495.00 14. CHARLES SMITH -TRASH REMOVAL FROM RESIDENCE 350.00 15. JUNIOR'S RENOVATIONS -HOME REPAIRS IN PREP OF SALE 1,000.00 16. KA MULLENS LANDSCAPE SUPPLY -PREPARATION FOR SALE 152.00 17. RON KOSER'S ELECTRIC -ELECTRIC REPAIRS FOR SALE OF HOME 1,150.00 TOTAL (Also enter on line 9, Recapitulation) S 35.953.21 12.000.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12.03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8 LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER GEORGE D. DeVORE 21 09 0520 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. BOROUGH OF CARLISLE 1,829.87 2009 SGHOOL TAX ON REAL ESTATE LOCATED AT 550 N. HANOVER ST., CARLISLE, PA 2. BOROUGH OF CARLISLE 86.46 FINAL WATER AND SEWER BILL PAID FROM PROCEEDS OF SALE OF REAL ESTATE 3. PPL ELECTRIC UTILITIES 46.99 ELECTRIC SERVICE FOR RESIDENCE 4123109 - 5/22/09 ACCOUNT NO. 80770-78005 4. PPL ELECTRIC UTILITIES 56.99 ELECTRIC SERVICE FOR RESIDENCE ACCOUNT NO. 80770-78005 5. PPL ELECTRIC UTILITIES 57.00 ELECTRIC SERVICE FOR RESIDENCE 5/23/09 - 6/23/09 ACCOUNT. NO. 80770-78005 6. PPL ELECTRIC UTILITIES 36.93 ELECTRIC SERVICE FOR RESIDENCE 7/23/09 - 8/24/09 ACCOUNT NO. 80770-78005 7. BOROUGH OF CARLISLE 70.24 WATER SEWER FEES FOR RESIDENCE 2/26/09 - 6/1/09 ACCOUNT NO. 006519-000 8. BOROUGH OF CARLISLE 65.94 WATER SEWER FEES FOR RESIDENCE 6/1/09 - 8/27/09 ACCOUNT NO. 006519-000 9. BOROUGH OF CARLISLE 86.46 WATER SEWER FEES FOR RESIDENCE -FINAL BILL ACCOUNT NO. 006519-000 10. UGI GAS SERVICE 462.88 HEATING SERVICE FOR RESIDENCE 4/23/09 - 5/26/09 ACCOUNT NO. 202755833518 11. UGI GAS SERVICE 195.00 HEATING SERVICE FOR RESIDENCE 5/26/09 - 6!24/09 ACCOUNT NO. 202755833518 12. UGI GAS SERVICE 195.00 HEATING SERVICE FOR RESIDENCE 6/24/09 - 7/23/09 ACCOUNT NO. 20275583518 13. UGI GAS SERVICE 188.93 HEATING SERVICE FOR RESIDENCE 7/23/09 - 8/24/09 ACCOUNT NO. 202755833518 14. UGI GAS SERVICE 29 92 HEATING SERVICE FOR RESIDENCE 8/24109 - 9/23/09 FINAL BILL ACCOUNT NO. 202755833518 15. VERIZON TELEPHONE 6.07 TELEPHONE SERVICE -FINAL BILL ACCOUNT NO. 570828801609995Y TOTAL (Also enter on line 10, Recapitulation) E 7 414.68 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent GEORGE D. DeVORE Decedent's Name Page 1 21 09 0520 File Number Schedule I -Debts of pecedent, Mortgage Liabilities, 8~ Liens ITEM NUMBER DESCRIPTION AMOUNT 16. JUNIOR"S RENOVATIONS 4,000.00 OUTSTANDING INVOICE FOR RENOVATIONS TO RESIDENCE FOR HANDICAP ACCESSIBILITY SUBTOTALSCHEDULEI 4,000.00 GRAND TOTALSCHEDULEI S 7,414.68 ' REV-15fd EX+(g-pp) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES OF 3E NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Liat Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include ou ' ht sppoousal distributions, and transfers under Sec. 9116 (a~ (12)] 1. PATRICIA MERRITT Lineal 88,958.83 4864 SUMMER CITY ROAD EVENSVILLE, TN 37332 2. WILBERT (3. DeVORE Lineal 88 958.83 419 GLENN AVE , BOILING SPRINGS, PA 17007 3. MICHELLE peVORE Lineal 88,958.83 852 HAMILTON STREET CARLISLE, PA 17013 4. JAMES DeVORE Lineal 88 958.83 12 MAPLE LANE , NEWVILLE; PA 17241 II. 1 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIA NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. REV-1500 COVER 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) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 14 950.00 -- --- J- Discount: __- - _ 786.82 Interest Table Year __ I Days Delinquent _-- - - - B a l Interest ~ c __ - ____ _ Y ~ ---- -- _ ti this time nod j this ear Pe this period _- . _- Before 1981 - -_ }- I -- - ~ -- - -_ 1982 _ -__ -_-- _ -- ----_ ' 1983 __ _ __ ----_ ~ -_ - __ - 1984 _ -- ---- -__-- - _ . - _ _ - - - 1985 -- - - i _ - _ _ _-- - __ - - - - __ i - -- -- - - ~ 1987 _- -- i--- _- _ - - - - : - - _ - ~ - 1988 throw h 1991 -- -- -_ _ - ~; - 1992 - _ - - - _-_' 1993-throu~h_1994 -_ - 1995 through 1998 -- 7 899_ -_ - - _ 2ooa__------ - _ -- -- 2001 - -- - __ -- -_ -_ -- ------ --- --a-- - ---- 2003 ---- ---- -- _ --- _I - - - I- - - -- - ~_2004 - - -- ---- - - - __i 2005 -- --- -- -- - - I _ - . _ _ _ - _, ~ -- - 2006 _ --- - - - __ _ _ _ i 2007 . - _ ~ - - - - , ----- -- _-_-- 2008 -~ _ - - _ -- --_- -+--- 2009 ---- _ -- - _ ._ -- - - __ _ - _ -- ------ - ---- -_ - -- -_- -, _ _ _ -_ _ - _-_ -~- _ _ - - - __ - -- - -- I- -- -- TOTALS - - _ _ _ _ Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: -. ___ Penalty: • LAST WILL AND TESTAMENT OF ~~~~~ GEORGE DEWEY DEVORE I, GEORGE DEWEY DEVORE, a resident of the City of Frostburg, County oY Allegheny, State of Maryland, being of sound and disposing mind and memory, and not acting under duress, coercion, or undue influence of any person whomsoever, do make, publish and declare this instrument in typewriting as i \ my 1a.st Will and Testament, hereby revoking any wills and codicils previously _,,,_ a9@.do. ?~mQ..__. __ _. _ RST: I direct my Executrix, hereinafter named, to pay all my dust debts and funeral expenses as soon after my death as may be practicable. SECOND: I give, devise and bequeath all the rest, residue and remainder of my estate and property of which I may be seized or possessed or to which I may be entitled at the time of ~ death, wherever situated and of whatever nature, be it real, personal or mixed, to ~ Wife, THERESE LUISE DEVORE, oP City of Frostburg, County of Allegheny, State of Maryland, as her sole and absolute property, if she shall survive me. THIRD: In the event that my said Wife shall not survive me, then I give, devise and bequeath all the rest, residue and remainder of ~ estate and pro- perty, absolutely and forever, to my children surviving me of City of Frost- burg, County of Allegheny, State of Maryland. FOURTH: Except as otherwise provided, I have intentionally omitted to provide herein for any other relatives or for any other persons, whether claim- ing to be an heir of mine or not. ~ FIFTH: A. I nominate, constitute and appoint ~Y Wife, THERESE LUISE DEVORE, Executrix of this, ~ Last Will and Testament. If my said Wifs Pails to survive me, or otherwise fails to qualityr as Executrix, then I nominato, constitute and appoint Mother, DELLA CERTRUDE DEVORE, of City of Frostburg, County of Allegheny, State of Maryland as Substitute Executrix of this my last Will and Testament. B. I direct that the Executrix and the Substitute Executrix hereinabove appointed be permitted to serve without bond or surety thereon and without the intervention of any court or courts, except as required by law. C. I hereby authorize and empower ~9 said Executrix or Substitute Executrix, in her or his absolute discretion, to sell, exchange, convey, transfer, assign, mortgage, pledge, lease or rent the whole or any part of my real or personal estate; to invest, reinvest, or to retain investments in my said estat®; and to perform all acts and to execute all documents which my said Executrix or my said Substitute Executrix may deem necessary, convenient or proper in regard to my property. SIXTHS A. I n~ainate, constitute and appoint my Wife, THERESE LUISE DEVORE, Guardian of the person and property of my minor Children. If sly said Wife fails to survive me, or otherwise fails to qualify as Guardian, then I nominate, constitute and appoint my Mother, DELLA GEkTRUDE DEVORE, Substitute Guardian.. B. ect that my Guardian and Suba~te Guardian hereinabove appointed be permi~ to serve without bond or sur thereon for the faithful performance of her duties, and I direct that the Guardian and Substitute Guardian hereinabove appointed be permitted to serve without the intervention of any court or courts, except as required by law. SEVENTH: Wherever in this, my Last Will and Testament, it is provided that aqy person shall benefit hereunder if such person shall survive me, such person shall be deemed not to have survived me if he or she shall die within thirty (30) days after my death. IN WITNESS WHEREOF, I have,, on this 2nd day of February , in the Year of our Lord, nineteen hundred sixty-four, set my hand and seal to this, my.Laat Wi].1 and Testament, consisting of two typewritten pages, this page included, the preceding page hereof bearing my signature." '"" - GEORGE ~ ~ 0~~'-'~ ~~`0~^SEAL) Y DEV The foregoing instrument consisting of two typewritten pages, including the page on which we have subscribed our names as witnesses, was, this 2nd day of February , 1964, signed, sealed, published and declared by GEORGE DEWEY DEVORE, the above~ased Testator, to be his Last Will and Testamem, in the presence of all of us at one time and at the same time, we, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do verily believe that the said Testator is of sound and disposing mind and memory at the date hereof. ~-~ i~~r/,~~ s~ r~i. ~ ~i~t/~ c~ ~ /~ d~3 ~~/~~ ~~~ C'c ~ ~- MATEYA LAW FIRM A PROFESSIONAL CORPORATION P.O. BOX 127 Boiling Springs, Pa 17007 Phone 717-241-6500 Fax 717-241-3099 www.mateyalaw.com February 3, 2010 Cumberland County Register of Wills Cumberland County Courthouse Hanover & High Streets Carlisle PA 17013 Re: Estate of George D. DeVore No. 21-09-0520 To Whom it May Concern, Enclosed herewith, please find an original and three (3) copies of the REV-1500 Inheritance Tax Return and Inventory for the above-referenced matter. Please accept the original for filing and return the remaining time-stamped copies to me in the enclosed self-addressed stamped envelope. Thank you for your usual fine service. If you are in need of additional information or have any questions, please contact my office. I may be reached at (717) 241-6500 or by a-mail at mam(a~mateyalaw.com. Sincerely, V'~-~'~ Mazk A. Mateya, Esq. MAM/aa ,~„ Enclosure o Q o cc: Wilbert G DeVore, Administrator ~~m ~ ~ r 419 Glenn Ave ~ vi~ tit Boiling Springs PA 17007 ono a. ca_ ~~, ~ ~ -~, ~~~ ~ c ice, o