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HomeMy WebLinkAbout04-12-1015056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 1043 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 184-26-5249 11 /02/2009 04/28/1936 Decedent°s Last Name Suffix Decedent's First Name MI Musser ' Joseph g __ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI __ Spouse's Social Security Number __ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~,< 1. Original Return 2. Supplemental Return ,.:. ,, 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (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 Wilt) (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 Lisa Marie Coyne ' (717) 737-0464 Firm Name (If Applicable) __: __ _ REGISTEf~QF WILLS USE~lY `` ,, Coyne & Coyne, P.C. ~ ~ ~ ' -t,, +" First line of address. ~ ~ ?rte ~ ~ c -~ , ,.. _:. ~~. ~_.~ 901 Market Street ~ __ -~'~m --* ~ 4 ~ ;. ,~,- r ~,,,,_i r,- ,-~~, t Second line of address ~' Tr ~ ~,..~ ..... t .,~, ~-=_ ~„ City or Post Office State ZIP Code ~ ILED ~ : ,~} ~~ . Camp Hill PA ' 17011 ~ N ~; Correspondent's a-mail address: lisa~COyneandCOyne.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of prepargr other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPQWSjBLE FOR FItINGIRETURN / . _ II n naTF ADDRESS ~ Robin Gochenauer, 434 Ni~i~~ O tm Drive, Dillsburg, PA 17019 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE y/~/,~ ~=,E' t?31 s PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Joseph S Mussel' ' 184-26-5249 s Name: Decedent .. _ 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. 308,165.06 6. Jointly Owned Property (Schedule F) "' Separate Billing Requested ....... 6. ._ __ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 55 117 827 (Schedule G) Separate Billing Requested........ . , . 8. Total Gross Assets (total Lines 1-7) .................................... 8. 425,992.61 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 23,805.21 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 8,631.01 11. Total Deductions (total Lines 9 8~ 10) ................................... 11. 32,436.22 ', 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 393,556.39 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. 393,556.39 '' 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 .045 386,762.39 16. 17,404.31 17. Amount of Line 14 taxable __ __ at sibling rate X .12 17. 18. Amount of Line 14 taxable 6 794.00 ~ 18 1 019.10 ' at collateral rate X .15 . 19. TAX DUE ......................................................... 19. 18,423.41 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX PLLage 3 ~AAA~AM\T~!• ~'.~..r. r.ln~n Aflflr000• File Number __, 21 09 1043 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER S Musser _ 184-26-5249 Joseph _ __ __ _ STREET ADDRESS 5009 McDonald Drive _ _ _- Apt. #2 __ _ CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 19,423.41 2. CreditslPayments A. Spousal Poverty Credit _ B. Prior Payments 15,300.00 C. Discount 805.26 -- - Total Credits (A + B + C) (2) 16,065.00 3. InterestlPenalty if applicable D. Interest __ E. Penalty Total Interest/Penalty (D + E) (3) 0.00 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) 2,318.15 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 2,318.15 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ 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 "in trust 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 exemg_t 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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEAITHOFPENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MUSSER, JOSEPH S FILE NUMBER 21 - 09 - 1043 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 2006 Chevrolet Express Van--- See Kelly Blue Book 8,740.00 2 2001 Fleetwood Truck Camper -- See Attached Appraisal 2,200.00 3 2001 Ford F250 pick-up Truck-- See Kelly Blue Book 8,910.00 4 Utility Trailer 250.00 5 Gun Collection-- See Attached Appraisal 1,400.00 6 Duck Decoy Collection and Misc. ammunition 144.00 7 Misc. personal property and tools 300.00 8 Sovereign Bank 11,206.79 Savings Acct No. XX~~XXX8681 9 Sovereign Bank 61,416.77 Checking Acct. No. XXXXXX0858 10 Sovereign Bank 50,710.06 Money Market Acct. No. XXXx:XX4565 11 Sovereign Bank 11,608.33 CD NO. XXXXXX8084 12 Sovereign Bank 13,641.17 CD No. XXXXXX9082 13 Sovereign Bank 13,641.17 CD No. XXXXXX9090 14 Sovereign Bank 10,368.86 CD No. XXXXXX0888 15 Sovereign Bank 10,368.86 CD No. XXXXXX0896 16 JanneyMontgomery Scott-- Money Management Acct. 3,631.32 Total of Continuation Schedule(s) 99,627.73 TOTAL (Also enter on Line 5, Recapitulation) 308,165.06 2006 Chevrolet Express Van -Private Parry Pricing Report -Kelley .., http://www.lib,.com/KBB/UsedCars/PricingReport.aspx?WebCatego... bQmg > i~Sd~ > Van/Minivans > > dress Van > 2006 > 1500 Pasapnyor ~'"C11evr EXp~es~Ya~: 54t~`P~a~senger / Trade-In Value Private Party Vatue BtUE 800Ny PRIVATE PARTY VAtt1E ~ Hr5.5 Suggested Retail Value CPO Value Condition <, ~„.~- ,~:-- Yalue Photo Gallery I~~ EXCellent Compare Vehides r+ewr ¢9,415 Blue Book Review i GOOCI:, .: l#~ , Consumer Ratings -- Find Your Next Car Fair $y~865 More Photos Spedflcations s + ~ Shopping Tools Free CARFAX Record Check Auto loan from 4.24% APR Get Your Credit Score Now Get a Free Insurence Quote Payment Cakufator f~ctended Warranty Quote Prk1t For Sale Sign euy A usED cnR -' OA 4h1e book CWTM L ~ _-I Near ZIP ~~ Yo View Ads, Cridt FIND THE R1GNT CbR Compere used vs. Negf ~ ~ To View 4ist, Gidc YlEW ANOTHER VEHtCtE r------ ~_ __ ~T-_, Or Search by Category Or Change ZIP Code 1 of 1 0 Save Vehicle Print ~ Email ;u BOOKt•IRRK as ~::. ©., ,.- ~.:Y - i' ~ :_ r~ ,, ~ 2 3 ~~~ ~~, t ~ ~ fit { t ~ ~ g d s.. ,`, • ~. ~~~ ~[~ ;~ ~ F 12/19/2009 6:4~ AM ~~ Scott Sheaffer, Auctioneer 2103 State Road Duncannon, PA 17020 Phone 717-834-3568 Fax 717-834-3153 TO: Coyne & Coyne, P.C. Attorneys at l.aw 3901 Market Street Camp Hill, PA 17011-4227 717-737-0464 RE: Estate of Joe Musser Date: December 28, 2009 DESCRIPTION ~ AMOUNT 2001- Fleetwood Truck Camper, VIN:IEJGR080212301782 $2,200.00 Camper is equipped with a generator, air conditioner and solar panel. Condition: Good, Fleetwood is no longer manufacturing campers however; there is a buyer demand for used campers in this size range. TOTAL $2,200.00 Appraisals are based on fair market value of the items at the time of examination. If you have any questions please contact Scott Sheaffer, cell 717-648-7797 2001 Ford F250 -Private Party Pricing Report -Kelley Blue Book BLUE BOOK' PRlYATE PARTY VALUE 'iN"="' http://www.kbb.com/KBB/~7sedCars/PricingReport.aspx?WebCa~tego... Condition .:.; - :.: Value Excellent ;10,410 Good $9,760 Fair __~g~grQ--~ More Photos ~" ~~y,,,; t, ~ k>_~ C ,~ t• 4~' ~~ ~, ~: h 4 `t ~G ~. \. ~wv~ ~ 1 of 1 12/31/2009 5:46 AM -- ....._ ~, ,. .~' ~~ ~::... ~ .~ ~ ~,1~ •~ ..,. ~~ ~ ~ ~~ ~~ ~ ~ l ~ ~ M. .. .;,.. _ . ~ (~ ~~,~ .' ;i l ~ ~R --. ~ ~ ~ ~' .0~ ,_ ~ ~ ~ ~ ~- ~-- ~, ~ _F N. u ~ , (ffJ~_ r.Mw ~:~.-~^ '~~ Ste'' . ~ , . ~/'\ ~~~ ~ ~~; ~~ ... .., ., p.1 d~ Mar 22 10 0$;19a FARMER BOY FURM1IITURE F 7178343153 I~Iacch ~ 1, 201 ~ Fart~er Boy Furniture Sett Sheaffer, .auctioneer 2] a3 State Road Duncannon, PA 17020 Phone: 71 ?-834-35b8 Fax: 717-534-31 ~3 -ro. c~yne~ ~ Coyne, P.C. ~.ttorneys at Lam 3901 lvfa~rket Street Camp Hail, PA 17t1 I 1-4227 717-737-04 Re..~ppraisal trf dun Collection for the Estate of Joe l~Iusser p.1 Serial ~ ~ Item aescriptio~ ~ ~ ; ~Ppraised Vatu® RMt~49fi03 Rerning#an SP 1~ gauge A-utati.c Semi-Automatic $7~.0 1 Q7'25~G unl~nown 3a8 Savage Model '95.1_~aver Acfiion ~~ 1Ceystflne Pump E.K T~rton, t~Miiac~elph~ $30~: $ 7 ~4.Q{~ :82386 Brou~ing 12 ~aug~ ~ern'r-A~.rt~matc $ZQO ~0 ~~ ~'~ ~ ~ ~ If you hale any questions, please feel free to contact me on r~ty ce11: 717-648-'7'%97. '1'liank wou, ~-~ \ Scott Sheaffer Sovereign Bank 184-26-5249 . f r~°' # . w' ,~.x t ~ Pir '~,~j ~ ~ r „~, ~~ ~~ ate;, DATE OF DEATH: November 2, 2009 ESTATE OF SOCIAL SECURITY #: Account #: 0774038681 Type: Saving Open date: 6/4/1993 In the name of: Joseph S Musser Date of Death Balance: $11,206.79 Int.(YTD) from 1/1/2009 to 9/30/2009 ~ $34.97 Accrued interest to date of death: $1.47 ' Other Info: Account #: 1681790858 Type: Checking Open date: 4/27/2007 In the name of: Joseph S Musser . Date of Death Balance: $61,416.77 Int.(YTD) from 1/1/2009 to 10/21/2009 $58.71 Accrued interest to date of death: $1.98 Other Info: Account #: 2334084565 Type: Money Market Open date: 8/2/2008 In the name of: Joseph S Musser Date of Death Balance: $50,710.06 Int.(YTD) from 1/1/2009 to 11/2/2009 $485.94 Accrued interest to date of death: $0.00 Other Info: Account #: 2335538084 Type: CD ~ Open date: 12/13/2005 In the name of: Joseph S Musser Date of Death Balance: $11,608.33 Int.(YTD) from 1/1/2009 to 1 013 1 /2009 ~ $189.07 Accrued interest to date of death: $0.81 Other Info: Account #: 2335539082 Type: CD Open date: 9/15/2006 In the name of: Joseph S Musser Date of Death Balance: $13,641.17 Int.(YTD) from 1/1/2009 to 10/31/2009 ~ $286.96 Accrued interest to date of death: $2.77 Other Info: Joseph S. Musser Page 1 of 2 Sovereign Bank ESTATE OF Joseph S. Musser SOCIAL SECURITY #: 184-26-5249 DATE OF DEATH: November 2, 2009 Account #: 2335539090 Type: Open date: 9/15/2006 In the name of: Joseph S Musser Date of Death Balance: $13,641.17 Int.(YTD) from 1/1/2009 to 10/31/2009 ~ $286.96 Accrued interest to date of death: $2.77 Other Info: Account #: 2475170888 Type: CD Open date: 5/6/2008 In the name of: Joseph S Musser Date of Death Balance: $10,368.86 Int.(YTD) from 1 /1 /2009 to 10/31 /2009 $175.47 .. Accrued interest to date of death: $1.65 Other Info: Account #: 2475170896 Type: CD Open date: 5/6/2008 In the name of: Joseph S Musser Date of Death Balance: $10,368.86 Int.(YTD) from 1 /1 /2009 ~ to 10/31 /2009. $175.47 Accrued interest to date of death: $1.65 Other Info: Account #: 2335539066 Type: In the name of: Joseph S Musser CD CD ~ Open date: 9/15/2006 Date of Death Balance: Account closed prior to death Int.(YTD) from 1/1/2009 to 3/17/2009 ~ $76.89 Accrued interest to date of death: $0.00 Other Info: Account closed on 03/17/09. Account #: 2335539074 In the name of: Joseph S Musser Type: CD Open date: 9/15/2006 Date of Death Balance: Account closed prior to death Int.(YTD) from 1/1/2009 to 3/17/2009 $76.89 Accrued interest to date of death: $0.00 Other Info: Account closed on 03/17/09. Page 2 of 2 I ~, Citizens Bank- Account Number 6200944699 Account Title JOSEPH S MUSSER Date O ened 11/18/2002 Account T e Checkin Princi al Balance as of DOD $64836.47 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $64836.47 YTD Interest to DOD $100.34 Citizens Bank- Account Number 6213096659 Account Title JOSEPH S MUSSER Date O ened 8/24/2005 Account T e Checkin Princi al Balance as of DOD $34791.26 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $34791.26 YTD Interest to DOD $51.94 ESTATE OF MUSSER, JOSEPH S FILE NUMBER 21 - 09 - 1043 Th is schedule must be com leted and filed if the answer to an of uestions 1 throu h 4 on a e 2 is es. ITEM ' DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE VALUE NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST (IF APPLICABLE) 1 Lincoln Financial 5,468.34 5,468.34 Annuity No. XXXX0678 (Both Children are Beneficiaries) I 2 Lincoln Financial 4,228.73 4,228.73 Annuity No. XXXX9427 (Both Children are Beneficiaries) 3 I ING Annuity 52,343.13 52 343.13 (Both Children are Beneficiaries) , 4 MetLIfe Annuity 27,975.20 27,975.20 (Both Children are Beneficiaries) 5 SunLife Annuity 27,812.15 27,812.15 ~ (Daughter is Beneficiary) ~~ II ~ ,. . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY TOTAL (Also enter on line 7, Recapitulation) 117,827.55 ING ~ January 14, 2010 Lisa Marie Coyne 3901 Market Street Camp Hill, PA 17011 Policy Number: COl 2147-OY Policy Owner: Joseph Musser Decedent Re: Date of Death Value ' ~~ ~q ~~Qd e ~ 2s Z~~o Dear Ms. Coyne: Thank you for your inquiry regarding the date of death value on the above listed contract. The dollar amount listed is the account value as of the listed date of death. Joseph Musser Policy Number: C012147-OY Date of Death: 11/02/2009 Date eath. Value $52,343.1 Date of Death Cost Basis $66,866.82 If you have questions or would like additional information, please call our Customer Contact Center, toll free at (800) 366-0066, Monday through Thursday, 8:30 am to 6:3.0 pm and Friday 8:30 am to 5:30 pm Eastern Time. Sincerely, Policy Owner Services lp Annuities are issued by ING USA Annuity and Life Insurance Company and distributed by Directed Services, LLC, member NASD. Both companies are members of the ING family of companies. 909 Locust Street ''~'~2~~y; "_'"<<":;" Des Moines, IA 50309-2899 LNG LISA Annuity and Life Insurance Company 1 ,f, ~, ~ ~ t ,fLife ,j'"~.0. Box 10366 Des Moines IA 50306-0366 - ~' ,~';' ,.. i; LISA MARIE COYNE' COYNE & COYNE 3901 MARKET ST CAMP HILL PA 17011-4227 ~,.f-''" ~~ ~_ . ~t~ '~ ~ ~, , ~,~ , MetLife December 21, 2009 Copy to: MICHAEL AKERS JANNEY MONTGOMERY SCOTT 20 ERFORD RD STE 315 LEMOYNE PA 17043 RE: METL~FE INVESTORS i(VS~RANCE COMPARIY CONTRACT 4100790163 - OWNER JOSEPH MUSSER Dear Ms. Coyne: Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the date of death and the account value on that date are: Date of Death: November 2, 2009 Account Valu . $27,975.20 If you have any questions, please contact your representative or call our Customer Service Center at 1-800-343-8496 Monday through Friday between 8:30 a.m. and 6:30 p.m., ET. Sincerely, Crystal Barr, FLMI, ACS Sr. Annuity Representative -Post Issue Processing MetLife Annuity Operations and Services From: a ~ ~:s,~ • y ~r, s Sun Life Financial Apri15, 2010 Coyne and Coyne Attention: Lisa Coyne Via Fax.: ~71'7~ 737-5161 0410512010 14:37 #115 P.0011001 RE: Sua Life Financial Focus Five Plus Fixed Annuity Contract Number KA13135226-01 Joseph S. Musser (Deceased) Owner _ Joseph S. Musser (Deceased) Annuitant Dear Ms. Coyne, Thank you for your recent request for informatzon regarding the contract referenced above. We are pleased to assist you. As of November 2, 2009, this contract had a Surrender Value of $27,821.15. VVe hope this information has been helpful. If you have any questions, please contact our Customer Service Department at (800) 3l?-3b53. Sincerely, r ~~~ .~ Ashani i~ijekoon Correspondence Representative 31833977 SCHEDULE H ' ~ FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA /"~YI'NI~ 1 1~~ INHERITANCE TAX RETURN RESIDENT DECEDENT _ .--_ - ------- _ -1- ESTATE OF MUSSER, JOSEPH S Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER A. FUNERAL EXPENSES: 1. Hetrick-Bitner Funeral Home, Inc. 2. Reception 3. Honorarium B. '~ ADMINISTRATIVE COSTS: 1. ~I Personal Representative's Commissions FILE NUMBER 21 - 09 - 1043 AMOUNT 711.00 600.00 150.00 II Social Security Number(s) / EIN Number of Personal Representative(s): I Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Coyne & Coyne, P.C. 3. ~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ', Claimant 4 Street Address City State Zip Relationship of Claimant to Decedent ', Probate Fees Cumberland County Register of Wills 15,000.00 272.00 5. ~ Accountant's Fees i 6. Tax Return Preparer's Fees 7. I Other Administrative Costs 1 ~I Postage 2 II' Sov r' e i n Bank-- DOD B g alance Cemfication Service Fee 1 Total of Continuation Schedule(s) 88.00 20.00 6,964.21 TOTAL (Also enter on line 9, Recapitulation) 23,805.21 I ~, Sci~~edule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~~ ~~~ RESIDENT DECEDENT ESTATE OF MUSSER, JOSEPH S 3 ~ Cumberland Law Journal-- Legal Advert. 4 'i, Patriot News-- Legal Advert. I 5 CI Income Tax P reparation Fees 6 i Furniture Appraisal 7 ~ Bank Fees and Estate Checks 8 ~ Cleaning Apt. and Trash Removal 9 ~ Inheritance Tax Filing Fee 10 Moving Furniture out of Apt. I 11 I', Toll Calls for Executors 12 ~ Reserves i 13 Mileage for Executors @ $.55/mile 14 Missed Work for Executors 15 ~~, Inventory Filing Fee FILE NUMBER 21 - 09 - 1043 75.00 134.21 500.00 25.00 50.00 300.00 15.00 250.00 50.00 3,000.00 550.00 2,000.00 15.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA I LIABILITIES, & LIENS INHERITANCE TAX RETURN i RESIDENT DECEDENT ESTATE OF FILE NUMBER MUSSER, JOSEPH S 21 - 09 - 1043 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Verizon 163.27 2 PPL 17.99 3 Coyne & Coyne, P.C. 2,756.25 4 Uncleared Checks 800.00 5 New Bloomfield EMS 214.00 6 Stonebridge Health and Rehab 4,679.50 TOTAL (Also enter on Line 10, Recapitulation) 8,631.01 REV-1513EX+ (9-00) ,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MUSSER, JOSEPH S SCHEDULE J BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I ~ TAXABLE DISTRIBUTIONS (include outright spousal distributions) i 1 i Robin Gochenauer 2 Jeffrey L. Musser 3 i Betty Hazzard 4 ~ Tom Sheaffer FILE NUMBER 21 - 09 - 1043 RELATIONSHIP TO AMOUNT OR SHARE DECEDENT OF ESTATE Daughter 1/2 Residual Son Misc. Personal Prop. and 1/2 Residual Friend $5,000.00 Friend Misc. Personal Property ($1,794.00) ~ Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover 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 SHE REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA ..~~ ._ . CERTIFICATE OF GRANT OF LETTERS No . PA No . 2 7 - 09 - 7 043 Estate Of : JOSEPH S MUSSER (First, Middle, Lastl Late Of : HAMPDE,N TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : ~ 84-26-5249 WHEREAS, on the 6th day of November 2 0 09 an ihs trurnen t dated August 17th 2009 was admi tied to probate as the last will of JOSEPH S~ MUSSER aria tea, araa~vac, a.a~a~ late of HAMPDEN TOWNSH/P, CUMBERLAND County, who died on the 2nd day of November 2009 and, WHEREAS, a true copy of the will as probated i s ann-exed 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 tray granted Letters TESTAMENTARY to: ROBIN L GOCHENAUER and JEFFREY L MUSSER who have duly qualified as EXECUTOR(R/X) and have agreed to administer the estate according to 1 aw, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand. and affixed the seal. of my office on the 6th day of November 2009. .~ a ~-- yy Register o ills in .! DeP Y * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) _ ~~ ~~~ ~A~T ~~]L1L AND TAE ~~'~~1~~ENT ~, ®~ ..~ --~ ~_ ~. ,~®~~~~ ~ o MU~~~R N Q ~'~ c~a ca ~~ { ~.:~ I, JOSEPH S. MUSSER the Township of Hampden, County of Cumberland, Commonwealth of ,. Pennsylvania, declare this to be my Last Will and revoke any Will or Codicil previously made by me. ITEM 1: Upon my demise, I direct that my body be cremated and my ashes be buried next to my, beloved wife, Shirley R. Musser in Woodland Memorial Gardens, 4855 Londondery Road, r ~ Harrisburg, Pennsylvania with a graveside service lead by Pastor Hockenberry of Bethel Church of God New Cumberland, Pennsylvania. I further direct that there be no viewing or memorial service. ITEM ?: I direct that all my just debts and funeral expenses be paid as soon as practical after my death. ITEM 3: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residu estate as a ~' part of the expense of the administration of my Estate. ITEM 4: I give, devise and bequeath the sum of Five Thousand Dollars ($5,000.00) to my good friend, BETTY L. HAZZARD of 3509 Walnut Street, Apartment #1, Camp Hill, Pennsylvania 17011 provided she survives my death by thirty (30) days. If she does not surviv e my death by thirty days, then I directed that these funds become part of my residuary estate and- distributed in accordance thereto. ITEM 5: I give, devise and bequeath my utility trailer, gun collection and hunting apparatuses to include my duck and goose decoys to my good friend, THOMAS SHEAFFER of 67 Page 1-of 8 Sheaffer Farm Lane, New Bloomfield, Pennsylvania 17068 provided he survives m y death by thirty (30) days. If he does not survive my death by thirty days, then I directed that these items become v~~ part of my residuary estate and distributed in accordance thereto. ITEM 6: I give, devise and bequeath my vehicles and camper to my son, JEFFREY L. MUSSER of 70 Mulligan Drive, Etters, PA 17319. ITEM 7: I give, devise and bequeath my burial plots to my daughter, ROBIN GOCHENAUER of 434 Wooded Run Drive, Dillsburg, PA 17019. - ITEM 8: I give, devise and bequeath the contents of my house tom children Y ,JEFFREY L. MUSSER and ROBIN GOCHENAUER, in equal shares, to be divided as they may see fit. 11 ~M y: I give; devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate, together with all insurance thereon, in equal shares, tom chil Y dr'en, JEFFREY L. MUSSER and ROBIN GOCHENAUER, provided each survive my death by 30 they ( ) days. Should either JEFFREY L. MUSSER or ROBIN GOCHENAUER predecease me or fail to survive my death by thirty (30) days, then I give, devise and bequeath that deceased heir's share to my grandson SHANE MUSSER. ITEM 10: Should any beneficiary entitled to a share of my estate not have attaine d the age of twenty-five (25) years. at the time of distribution to him or her, I devise and bequeath the share of such beneficiary to my daughter, ROBIN GOCHENAUER, as Trustee, to be held in se arat p e trusts, to hold, manage, invest and reinvest the share so received, in accumulation of income thereon, and to use and v ~ apply the income and principal, or so much thereof as, in Trustee discretion ma be y necessary or appropriate for such benefici ` ary s maintenance, support, and education (including college education, both graduate and undergraduate) without regard to his or her parents' ability to provide for such Page 2 of 8 maintenance, support or education, or to make payment for these purposes,' without further responsibility, to such beneficiary's parents or to any person taking care of such beneficiary. Any principal or income not so applied shall be distributed to such beneficiary absolutely when he or she attains the age of twenty-five (25) years. If he or she dies before attaining the age twenty-five (25), the Trust shall terminate and such share shall be distributed to his or her personal representative. Should the principal of any trust herein provided for be or become too small in the trustee's discretion so as to make establishment. or continuance of the trust inadvisable, the trustee or my personal representative may, without court approval, make immediate distribution of the then-remaining principal and any accumulated or undistributed income outright to the person or persons and in the proportions they are then entitled to income. Upon such termination, the rights of all persons who might otherwise have an interest as succeeding income beneficiary or in remainder shall cease. ITEM 11: No interest in income or principal of my~ estate or any.. trust created hereunder 1 ,shall be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary of my estate or of any trust created hereunder prior to the beneficiary's actual receipt thereof. My Co-Executors or Trustee shall pay over the net income and the principal to the beneficiaries herein designated, as their interests may appear, without regard to any attempted anticipation (except as may be specifically provided herein), pledging or assignment by any beneficiary ~f my estate or of any trust created hereunder and without regard to any claim thereto or attempted levy, attachment, seizure or other process against said beneficiary. ITEM 12: My Co-executors shall have the following powers in addition to those given by > . to be exercised by them in their absolute discretion, which powers shall be applicable to all property ~~'~ ~" ~`4. held by them, effective without the order of any court and until the actual distribution of all such property: Page 3 of 8 .- _ -------_~s ____ ----~- t ~r a. To retain any ,investments at discretion including stock of any corporate fiduciary hereunder or of a holding company controlling it; b. To invest and reinvest in the co-executors' discretion as permitted under Act 28 of 1999, as amended, the "Prudent Investor Act," with the specific right to invest in stocks, bonds and real estate, ', including non-income producing residential real estate for the occupancy of any present income beneficiary or beneficiaries, and in such diversified, proprietary money market and mutual funds, including such mutual funds of any corporate fiduciary hereunder or those of any successor or affiliated corporation or a holding company controlling it, as my co-executor and trustee deem appropriate; c. To sell, to grant options for the sale of, or otherwise convert any .real or personal property or interest therein, at public or private sale, for such prices, at such time, in such manner and upon such terms as they may think proper, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof without liability of any purchaser to see to the application of the purchase money; d. To borrow money and to secure the repayment thereof by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; e. To compromise claims by or against my estate or any trust created hereunder; f. To allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries or trusts, in cash or in kind, or partly in each; g. To register investments in the name of a nominee or to hold the same unregistered in such form that they will pass by delivery; h. To join in any recapitalization, merger, reorganization or voting trust plan affecting investments; to deposit securities under agreement; to subscribe for stock and bond privileges; and generally to exercise all rights of security holders; Page 4 of 8 i. To manage, operate, repair, alter or improve real estate or other property, and to lease er ~ roe u on such terms and for such period as my co-executors deem advisable .,al estate and oth p p rty P ,ven for more than five (5) years and beyond the duration of any trust; To deduct administration expenses upon either the federal estate tax return or fiduciary J• _~ °` ncome tax return with or without adjustment as between principal and income, as my corporate or 3isinterested executors shall determine; k. To associate with them in the absence of a corporate fiduciary, an accountant, custodian ' or and other agents and to compensate them from principal or income 'or both, as and investment advis , ecutors shall determine, such compensation to be a reduction of the compensation of my co- my eX eXeCLitorS; 1. r To associate with them at any time, in their absolute discretion and of their choice, a co orate fiduciary which shall have the same powers as my executors, such designation by my co- re executors and acceptance by a corporate fiduciary to be in writing; combine without prior court approval, any trust herein with any other trust with m. To substantially similar provisions, ,although such other trust may have been created by separate instruments and b different"persons,~and, if necessary to protect different future interests, to value the assets at the y time of such combination and to record the proportionate interest of each separate trust in the combined fund• rovided however, that no such combination shall be permitted if the effect of such combination ~P ould be 1 to violate the applicable rule against perpetuities; (2) to disqualify any interest in one or w () such trusts for a deduction for federal estate tax purposes which would otherwise be allowable; more of or 3 to cause the loss of the exempt status of one or more of such trusts from the imposition of the () generation-skipping tax; Page 5 of 8 n. To exercise any stock options which they may receive; to borrow such funds from any source as my executors may deem necessary for the exercise of such options; and to pledge assets as my executors deem appropriate for this purpose; o. No trustee shall be required to qualify before, be appointed by, or, in the absence of a breach of trust, account to any court (and failure to account alone shall not be considered such a breach); nor shall trustee,be required to obtain the order or approval of any court in the exercise of any power or ~' ~ ~ decision granted hereunder; p. To allocate any generation-skipping transfer tax exemption from the federal generation- - skipping transfer tax to any property to which I am deemed the°transferor under the provisions of Section 2652(a) of the Internal Revenue Code of 1986 and its successors, including any property transferred under my will and any property not in my probate estate and any property transferred by me during life as . to which no allocation was made prior to my death, to the extent necessary to cause the inclusion ratios applicable to such transfers to be zero; . q. To disclaim any interest in property without court approval; and r. To do all other acts and things necessary or appropriate in _ the management, administration and distribution of my estate or trust. ITEM 13: -Until distributed, no gift or beneficial interest shall be subject to anticipation or voluntary or involuntary alienation. ~ "~ ITEM 14: I appoint my children, JEFFREY L. MUSSER and ROBIN GOCHENAUER as Co-Executors, of this my Last Will. ~ . Page 6 of 8 ~' ._ _.... - _ I -. - ~ 4 ersonal representatives, Trustee, or their successors, shall not ITEM 15 • I direct that my p ' e bond for the faithful performance of their duties in any jurisdiction. be required to giv WHEREOF, I have hereunto set my hand and seal to this, my Last Will and IN V'dITNESS ~. ~ ,, 2009. Testament, this ~ daY ~, S ublished and declared by the above named Testator as and for his Last Will and Signed, sealed, p resence who, at his request, in his presence and in the presence of each other, have Testament m our p , ~ , hereunto subscribed our names as attesting witnesses. residing at ~ ~ ~3 ~ ~ ~1.~-~ siding at ' 1 Page 7 of 8 COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) We, JOSEPH ~ S. MUSSER, -~ Il~ I 4~~Pd~- and /~ ~ ~. the Testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first- duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the will as witness and that to the best of his or her knowledge, the Testator was at the time eighteen (1~8) years of older, of sound mind I and under no constraint or undue influence. Subscribed, sworn and acknowledged before me CS ~r by JOS PH S. MUSSER, the Testator, and subscribed and sworn to before me ~ by n,~.. ~ ~'~~~~' and ~ ~- c~ the witnesses, this _~ day of , 2009. _ _ ~ - 4isa ~R~raa~aYhn~,''~otary-~~~lic ~~` ~! Page 8 of 8 ~~ ~~ ~~O.dJ f~cL ~ ~ v • coo ~~J~