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HomeMy WebLinkAbout05-26-10 (2)J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONL'r PA Department of Revenue ~ Bureau of Individual Taxes ~'' County Code Year File Number Po Box 2aosol .~,~~ ~~ INHERITANCE TAX RETURN q Harrisburg, PA 17128-0601 `~ °~« ~ RESIDENT DECEDENT ~ ~ Q 9 ~ ~ 8 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth /~s ~o q~S~ ~~ o3zooq D~1 ~~qa3 Decedent's Last Name Suffix Decedent's First Name Mi ,~ ,f}- u~ o li X S o A~ N N l~ (If Applicable) Enter Surviving Spouse's Information Below Spouses Lnnast Name Suffix Spouse's First Name MI ~'7' 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 O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number C hl,~FipC F.5 ~ Sfl! ELDS t t / 7r 7 7~~ o2O ~ Firm N/amAAe (If Applicable) ~ < /T First line of address ~ c ~ ~ u s ~~ ~zo~.v Second line of address City or Post Office h'I ~'CH ~ N/ C ~,Bk~QG State ZIP Code REGISTER 6F~IVILLS USE ~Y :`) '=~ I - 7 --c '~ hJ _> 1.71 >'-; ~ = ::j --t -~ DtYTE FILED F`y ' _,~1 _: ., ~T7 :~ ~~ - ;. y Correspondents e-mail address: CeSti~e~S•3© 1-~lmeast• /~e~ 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. e ct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA E OF PERSON RES E O FILING ETURN DAT - -aoio ADDRESS goNN/E B• h? e~y.¢oo /.~ 8/3 /yIe/vi//e u~tG~ {~~`.~.rxx, l~i~ ??033 JII~IVHI l.'R r RC / RCR I fICR I R~~ - -IV I vii ADDRESS C~h~if2L~S .E. SiSf/EZ.lJ.S~ (Q C/n~rse~ /Zvad, /he a.tiiCS~cri-g~ P,~¢ /7oS~' PLEASE USE ORIGINAL FORM ONLY 1505651047 Side 1 15056051047 --~ ~ 1,5056052048 REV-1500 EX Decedents Soci al Securit y Number -~+ `~ ~/ ~/ ~~~~~^ ~~N ~ ~ ~ 7 ~" Q D N /7, Decedents Name: J RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. 1. • Q 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. ~ 7 ~ Jr 3. oZ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. . 0 ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. gg ~ ~ 3 ~ ~ • ~ 8 Total Gross Assets (total Lines 1-7) .................................. .. 8. 1 7 3 ~ b ~ • ~ ~D 9 Funeral Expenses & Administrative Costs (Schedule H) ....... ........... .. 9. / !~ - 7 ~ $ / . 7 10 Debts of Decedent, kAortgage Liabilities, & Liens (Schedule I) .............. .. 10. Z e1 ~ S. S g 11 Total Deductions (total Lines 9 & 10) ................................. .. 11. S y I 3 • 3 12 Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. q ~ ~ ~ S ~ , q J 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which h l J d S d 13 • BB 0 ) ...................... u an election to tax has not been ma e ( c e e .. . 14 Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ~ ~ S 7 S ~ . / 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 .OD ~ ~ 15. • D d 16 Amount of Line 14 taxable G~ (p JF ~ S 0 ~j ~ ~ 3 y y S 2 9 at lineal rate X .0 . 16 • 17 Amount of Line 14 taxable at sibling rate X .12 . ~ ~ 17. . ~ 18 Amount of Line 14 taxable ~ ~' ' ~ d at collateral rate X .15 18. . 1 1 3 ~ ~ .~ a 9 19 TAX DUE....... ... .. 19. , 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 15056052048 15056052048 RE~i-?500 EX Page 0 File Number ~~-Qg-~ 4 ~ 1 Decedent's Complete Address: DECEDENT'S NAtd~= ~ I Jo/+/uN ~1~ /3~uD~wc STREET ADDRESS j aas c~~~.so~ «vE clT~r nL, /~ /YJFCfiI,/~/(~!(~$l3u17Cs STATE n~ ZIP /7D SS Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Cretlits'Payments O (1' _ ~ v~ ys z~- A. Spousal Pcverty Credit f B. Prior Payments 3q 9D0, ee C. Discount 2~ ~ pp, o0 Total Credits (A + B + C) (2) 3. InterestlPenal~y if applicable D. Interest D 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. A- Enter the interest on the tax due. B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5) (5A) ~~o?~ DDO, Do ~/~ Sews, 29 3. 3SF (5B~ ~` /. ~i ~8. (03 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: `'es 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? ............................................................... _ ..... .~ 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? ....... ...... ~ ^ 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 (al (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, er 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 + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENTDECEDENTRN PERSONAL PROPERTY ESTATE OF ~ ~~~0~/ ~~-N~ ~ FILE NUMBER a~-o~-~79 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. 1f~em5 ~ personal{. in room ~ /~~~Qn /'i//Qye ~Sce i~1%zec~ /:5nh 4f/lichcctl heref'~ f a. Part;al ~et~d , Mi~hmat-k ~v,Su.r. ~ISg, / 7 .3. iPNC 13~~k Sq,vi nI_5,~s /~~'~ N0. Soo 380 //99 '~~~ o ~ see v~~uah'en /ever 41~achcal~ ~l, 6/kcl,~vq ~i2dK i¢ec~: ~,~3, .~ 37. s2 See t~afua~b~ ~eflEr' 4~fuclticl) TOTAL (Also enter on line 5, Recapitulation) I $ .Zy SS`s, '2~ (If more space is needed, insert additional sheets of the same size) L /~ %//Il ~'s O/C' 'T' l E/~1S ~iC' ~EiQS'0~1//~ ?'S/ D ~' /~td~oo~ o5u.~ : a? c~ies~, /Ji.rror~ 4ttcen szc dca/~ nyht~~~d ,, ate, oa ,~. o~ ~/l~ ~4/Jt~!S ~~, OD 3. .Qc ~I •~tr cha;r 'mss a~ `/- o% ~taf [•~ desk ~arfy ~/~~cca~/ .~S-,'00 S, ~'na~ T 6/e ~~5. 00 G. ~/~/- 6editcp- ~c c% ~cr --~. cc n Kid ~Q '7 sS.~aia// a/~ L'csKC~ %d . aO S. ,.2 lea/y O/d ~o%r Tds- U/•~i ~kclc~ o[~~ Color -d unk~c~ --o -- /~- ~y amid Xj o 0 ~~ ~~~ ~/yS ~J~a~LI" ~f o a /~• C ~S~ iN G~i'R,WG/ ~~d. DO ~~, ISG, ao Wachovia Bank, N.A. VA1138 13960 Lee Jackson Memoriak Highway Chantilly, VA 20151 Te! 703 934-1823 Fax ?03 934-1836 WACHQ~'IA November 27, 2009 To Whom It May Concern: Re: Joann Baudoux Joanns Baudoux account balance as of 8/14/2009 was $23,237.52. She also does not have a safe deposit box at Wachovia Bank, N.A. Sincerely, f` ~ Michael A. Schimmel Assistant Vice President 703-227-0072 REV-1510 EX ~ ~1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF ~ ~u d ~ ~t X~ JO/f NN f~ FILE NUMBER a / _ D 9 _ 8 ~ 9 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTANOTHE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE t . /~}CCO!lNTcS f/QD ~-~' i¢/1?~lP~E'./SE F'•N.~.ve/~ s~eaie~, Div@. a~` Y yd 9 Lou:sa Or., S4 %~ /o G, /Ylec/ja~%cS6urJ, Cum b, Co., Penna. /~// Va /ua / on3 aS v~ A! o. d. /rave ~cerr /`~etiYeu/ dory/ Jlavid ~P. Lyon/, C'bF, a,/` sari/ f~,~/Fi?iP,Ql.S~ vI~{, ce . .Toa.nne //. ~8u,u~lornx - c%nf no. /~e6 2 ,~i~z s ~~/ M kTk,14~L Fuu~S: <i4~ /V'o, 0101 2~,qg ~f42 $ 002 G, 8'I 7, 609 sh. ® ~~ 680 X31, 9~1, bo /oofo --o -- 31, 9~/.do T. ~„o. ~ /~•~n,e ~8. i/lacliado as are Q// ~,t ~//cam herein below. ~8~ /vo. of S~3 7~~7 ~~ o ooh S, ys~ 877 S~. ~ ~7,F7o ~y2, 929.8 /0090 -o " ~1-Fa, 91q ~~ 3, y3S. Ysv ~Sl~. Q %o0 3, 43S•Sy /oofo _o _ 3, y3S Sy ,i¢-NNk! Ti E~ ~~.) 9300 7057 6 So 7 00~ ~14z, 178, 90 /oofo -o - 1 g2, /78: Pa (~.J 9300 lobo -a,y. g 004 ¢ ~$Y~b.zt loo's -o -- ~~8, S/~f6.1: (~-~ y3oo 7124 7s~ b ooh ~/3l, 333.zo /oofo -- o- 131 333.u STityvOR,pD A-~.~T. , (G~ DOb,2 /51~3~{ ~¢~ 7 0 2/ ~ ab 3, ~,OZ /oofo - o - ~•~63y ~SFy~ o. k. SPS ~Q/'~NTAI~E avE OD07 ~Off~ //$ O O Z/ ~rZ10~ 35,/9 /DDI~D 'O -- ~,Z/D, 3.Sy~/9 ,If.Ts~/o ~: /L~cfua/ /r~u!/~p/:ca/,ms~ xic/ds F {~ a-~c e~ 3/. 9D(o . 5~/, a t~~ ~eKJ+se ~ v/~I' 3S. ~D in ~var s~' f~c t7.c,c~1`. ,¢~erpr%sr saiq/,~i:s :s .because. rYri ~+.9~4cr' Con~ihtCe~ h 9'!tK /NG/u4~eS ~S'o/!fe a ~ru d/ ~ d.0, d. TOTAL (Also enter on line 7, Recapitulation) $ J ~9, 3//, D / (If more space is needed, insert additional sheets of the same size) ~S`~tied. G, Genta~- S/~ OZ7 'f073 Sccd 4orn. Joann H• see ~a/kt f~'in J ~~ffer Q ~j`a clec~ ~'/~Np. ~/-09879 `{, b~~7. SFb /ooh --a-- `,c, ~4~T, S~6 Nov, 24. 2009 2:49PM PNC BANK 412-105-2747 ~- --_ ~~~ L>?AtIINO T!~ YIfAY November 24, 2009 Charles E Shields III Esq 6 Clouser Rd Mechanicsburg, Pa 17055 RE: Name: Joann H Baudoux SSN: 185-20-9650 DOD: 08-03-2009 Dear Mr. Shields: No. 2417 P. 1/1 In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking AccounC Account # 5140274073 JOANN I-I BAUDOUX LIVING TRUST JOANN H BAUDOUX TTEE U/A(P 12097 DOD balance: $4,847.46 + 0.00 accrued interest Interest paid 01-O1-2009 thru 08-03-2609 $0.00 YTD ' $aV1gg3 ACCOUnt Account # 5003801199 JOANN H BAUDOUX DOD balance: $1.02 + 0.00 accrued interest Interest paid 01-01-2009'thru 08-03-2009 $0.00 YTD Established: 11-02-1988 Established: 10-25-2001 Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any 5nancial transaetions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 1 REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ~~u~DUx, ,.t.,~N A / ,! FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' I/u,ncr-~,I F1omt , of Nett) Cumberland , PA ~1, R~7, S7 pa*f'i-e-more c~• See i ~'c~ %z~c~ Ba~c~:~~ona~ S'h~e~ and oS~ilv~jlt~'it' off' /~osi h'on r2~tard%rt4 ~unu al ~la,#e~ r~~iscs: Zee ms ~" fGiro Kjh I ~`i 9 z. ~z /%?%/~aqe .%"fe~r~s f B. ADMINISTRATIVE COSTS: ~ ~ /' 1. Personal Representative's Commissions Q rp Name of Personal Representative(s) 1"JOnn~e ~F7• ~aGhQ.CIO ~al ved . Street Address I o1$ i 3 111e1v~ Ile Lane City ~a i r` ~ State //4 Zip _~ aD3 3 Year(s) Commission Paid: N~I~ ______ 2. I Attorney Fees C~u,rlL'$ F• Sh1e~cls 'itS' CES~~,+,.~ I ~3, ~~~• ~D 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant No ONE E'LlG//3LC No'dE Street Address ___. __ City State Zip Relationsh"ip" of~Claimant to Decedent 1 /' 4. Probate Fees afita OhiQi 11 ~ ~ $5~ D~ ~~~~ C t;f 7 ~ i'~~S ~~ •~Q 5. Accountant's Fees ~ '~~id f ~am; ~-I'pn p'~ ~4XY- ~ I'}'oM ~ M U. S S U", o'~ ~is•~~ O~ rneehaniCSbK-~, P!~ Closeoc.~ IocEO, /'fi~l,lD~/ 6. Tax Return Preparer's Fees l c5h'•~) ~. ,,¢dd%fi'o.na~ O~rOba~"e ¢te ~Yo. 00 ~~ ~i~:~1g fez "~ ~/~e~rS1~!" o~ /.tJ~~//s ~I.S.Oo IQCi/ri~Okr~ ~°r ~IoS>~e~ I?erh~~ /Yi2~~%I~t~ /"~'~eol°ZGS, TOTAL (Also enter on line 9, Recapitulation) $ ~, /g 7, ~~ (If more space is needed, insert additional sheets of the same size) ,SST, p~ ~fl-u DO ~,y~c ~ ,Tof~NN r~/. L7eecr~enfs ~auUhfer anal ~ceecvfr;x 1 ~ ~~s tM ~a.%r~c, Vf~ G~~i~c~ %S a~D~oro yc. ~ i1c (4~ hours 4c~a,y ,{row ice DD~ace 8~ ,~XeCwl~7'iX i/ICur~ ~ ~l~vWirr' ~/aenses: ~. Recep ~i o~ ~r ~arrii/y ~ {-~: ~itQs at ~A/c~dccs, C/a r~'or~ '`o?o ~ 3,~ ~3 ~t'j~h'on ~r ~ae~i~ tird ~, ytds ~~t hPe %~ ~ >ia,/ se~v %~ e ~ ~~~1/eys ~~s~urr2nf; /1~euJ Ckm~er-l~urd, ~A a~~ 9/ C. ,E,~sy d~7iri,T , shoes ~nr dcet.~crrt ~r bur!a/ $ ~`f• 9R ~ ~rp ~/%/ ~AifuI /~1e/lioa;af' ~ltur~i ;~ n~.i~is~~tn~/ ho~~i~ of SC/~!/iGe /oo.oo C/4l"iop G(AiIGI n!c/ilol~'SJ~' C~hurtli ~~' ~Sal~fQ Qs .1~, , f ~/rq ~ ~,bvve %~irts ~~e C/.inea~ as /ooh de~u~/,dzs Qs .s ~icsfo~~y HtMpfen 2.~n, Gario~~ ~/~. ~d~yirl~ ~'" ,~Xe~J~^%x umo~ her ~ ~r~s h~4~t ,~u,ric~ ~ netYSS~ta.!-t~l 6y c~iSfivtca ~elled l~k.6/ G. I~crkins ~~w~ca.J~ta #-louse , C~arion, Pi4, /~hP.~t,/C~'asf -fir Sarre 6v- Morn ~ nr~ ~ .~ur~ ~,I ~db.'F7 H. IZ/11t ~a.c~~user C~~n^io~, A~, 'D;hner ~r Same ~,yexuni~ ~a~e ~wri a~ J ~~oy.4 $ x. Cnwr~yd~r~d NlG.hri o~"r ~ N ~ {I , pA•, I,d d~; r~ ~r ~ke~ri~ cturQ, erg soh d a~ o~ c! eaf~ so s.s ~ Ise o~lo la ~ A~f- f~.~,1,Q,raa d~ rQ~r w~Yt hnorn~ ~ 1 Sy•07 eovt,~'d . ~~5~. 2/ ~Sr d~ ,~~uDOGCX, -TDf~N~UJy FiGE ND. 2/-o9-.S79 P ~ ~ .~ TT~e~r~i~vr ro ~ e~s/~• f/. .~t~ms F, ~', ,y ~r Z T f•`l ~31sS. ~~ ~-~at~~yzJ ~ ~g2.82 ti92..~2 ~roSSMan ~ cSM~~S Penns~~y~.a ~-I~e-r~ ct~ Es~x.t' 7Mc l2.cc! Rev, cc/. J a~" ~'ect: 9~?7 ~~) ~oihfs otr,~ 7i'faf arnc~ ~c ~Xe~u~ars ~u f~ es is ~ s e~ fa , f rK~fi f~ d«eden t ;s 6uri'ea~ in a S~ii4rb/e ax~a~~Dro~ricc~c ~71ar~ricr. ~/~ou~~r ~Ge~~'/!f ~ 6t/i`/ is S~~~lt !~5 l~i~ ~x4ri rlg iue ~y.,/~nSCS sl' oar aff~/ets ~ ~° ~inc`a/ $u,r~ces, i'f- ass d~eh /'1 e /~ ~ta~ /1~; ('ZcL/ ~ wul /1C qso aad /e ~po~ C~r/x/~ sus ~ar /nw/~pOc /JCrs`~s ~u/'i/1g ~ {unerQ/~ero~ n~~. ,6~ ~ea'~e~/ a~ o~~-`iA/~ lyi~ o~dl~i ~fa/ c`os~s. Sew, /17~ C'alfcis ~sf: 33 ~Q, 1~,~ e. lv~f 3, at Gsv 6s/ ~i~1 •la,, o, e.~ /93~) _ ~ ~p~ %s 4'i/6t'c~E~/ ~r yOlfi' /~'at~i re,~/'e~tcG an~r C~t~'en - i e~ ce. / ~rceeccfr;?r neecre~/ ~ ~~ ve/ '~ 1~uN~ ~Zl sues %n orq~er ~ aG/~ ~v /L°?sD/1~t6`~i ~u~i~!/ `ier 5~~erv~SO~f. dcefies. C~J !. ~,r{ol~c ~/ /~d/)tZ, /YecJ C.GG/n~a~~ ~iQ Jmorn Cy~ ~®~~d / Zi/n ~ (.1L1`ioi'1 ~/~ 77~/I/ ~i~'~i y.4 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER ~,4~~ o ~X, ~"o~Nnl H. a! - 09 - ,879 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH m a cys o5fnre ~ e@vunf ~ y5~ 8~ a. i maey's ,s~,~e ,~l~~dant ~3io.78 ,3. /llaCys ~~ ,~@~oart~ ~/2/. ~P y, i¢ ,A~,~2P /17t d. Care ~`7G. SFO C ~ ' ~ ~ zap 7, d6 o i ~ /~ nu~~y art G . ~ ~e~aahy ~i/~ityt° {/~ 0 7~ 77 T TOTAL (Also enter on line 10, Recapibalation} $ ~, ass SS (If more space is nee~etl,. insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 3/~-uDO(,lX~ JD~NN Ef. FILE NUMBER a!_ oq _~7Q 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. k3oNNlE 'i8A-ufldux M~}CH/fDo D~4uGHTt~2 ~ g ~~~f l x813 ~'1~Ivi lle La.rle dNLy CN/t,D~ v• I~~~~,-x, IAA aao33 s~r.t M~Kes d;s~-.'.6_ ~ NotF: ,¢~eT Ty,~ , Cc{~'oh ~ dece~enl's ~i rir~ -gust. ~ccid ~i /,'•ty -~l"kSf {has bu?n un{unded, dvrMa,nt GMT{ YtDi' used ~r S~MG years. Dis~ds:fio" ~~t/Srom Was ~, ~ said ~ohr1 ~~ Bawdoct,c )1'lttllac,~o, ~or Con veh i eNc~ cvtit~l pI^ac%a - ; ~(~. a..~,~,f~; n~ a 11 .~ {~, l~~r c(i reel,, chi 5{-r~ ~ t~-'a.~~e `~ Fur w ff 1 1'7^'pkYl R GY~~1~ QS ~I JCCCtc.I'l- i ~t 1~.! ~'~LO u~ `~te r~;nv~~oraf~'dn eF ~atd T~usf. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) d, Last Will of JOANN H. BAUDOUX 'S x 1, 10ANN H. BAUDOUX, a resident of Cumberland County, Pennsylvania, declare that this is my Will. 1 Hereby revOlCe all II1y previous wiuS and CvuiCilS. Article One Introductory Provisions Section 1. Marital Status am not currently married. Section 2. Children a. The name(s) and birth date(s) of the children of JOANN H. BAUDOUX are: Name Birth date BONNIE BAUDOUX MACHADO January 13, 1947 All references to the children of 70ANN H. BAUDOUX in this instrument are to these children and any children subsequently born to or adopted by her. 1 p t. Article Two Appointment of My Personal Representatives Section 1. Nomination of My Personal Representatives I appoint the following to be my Personal Representative: (I) BONNIE BAUDOUX MACHADO; THEN (2) RICHARD A. MACHADO If, for any reason, any Personal Representative(s) named above are unable or unwilling to serve, the next named successor Personal Representative(s) shall serve until the successor Personal Representative(s) on the list have been exhausted. Unless otherwise specified, if Co-Personal Representatives are serving, the next following named successor Personal Representative shall serve only after all of the Co-Personal Representatives cease to act as Personal Representatives. Section 2. Waiver of Bond No bond or undertaking shall be required of any Personal Representative nominated in my will. Section 3. General Powers My Personal Representative shall have full authority to administer my estate under the laws of the Commonwealth of Pennsylvania relating to the powers of fiduciaries. My Personal Representative shall have the power to administer my estate under the Pennsylvania Probate, Estates and Fiduciaries Code. 2 • Article Three Disposition of My Property Section 1. Distribution to My Revocable Living Trust c_ R I give all of my property of whatever nature and kind and wherever located to my revocable living Trust of which i atri a Trustor, known as: JOANN H. BAUDOUX, Trustee, or their 2 ~ i~~SQrs in trust, under the JOANN H. BAUDOUX LIVING TRUST dated .SAN ll and any amendments thereto Section 2. Alternate Disposition If my revocable living trust is not in effect for any reason, I give all of my property to my Personal Representative under this will as Trustee, who shall hold, administer and distribute my property as a testamentary trust, the provisions of which are identical to those of my revocable living trust on the date of execution of my will. Article Four Death Taxes Section 1. Definition of Death Taxes The term "death taxes," as used in my will, shall mean all inheritance, estate, succession and other similar taxes that are payable by any person on account of that person's interest in the estate of the decedent or by reasor. of the decedent's death, including .penalties and interest, but excluding the following: a. Any addition to the federal estate tax for any "excess retirement accumulation" under Internal Revenue Code Section 4980A. b. Any additional tax that may be assessed under Internal Revenue Code Section 2032A. 3 o s c. Any federal or state tax imposed on ageneration-skipping transfer, as that term is defined in the federal tax laws, unless the applicable tax statutes provide that the generation-skipping transfer tax is payable directly out of the assets of my gross estate. Section 2. Payment of Death Taxes pursuant to the terms of my revocable living trust; all death taxes, whether or not attributable to property inventoried in my probate estate, shall be paid by the Trustee from that trust. However, if that trust does not exist at the time of my death, or if the assets of that trust are insufficient to pay the death taxes in full, I direct my personal representative to pay any death taxes that cannot be paid by the trustee from the assets of my probate estate by prorating and apportioning those taxes among the beneficiaries of this will. Notwithstanding any other provision in my trust, all death taxes incurred by reason of assets transferred outside of my trust or probate estate shall be assessed against those persons receiving such property. Article Five General Provisions Section 1. No Contest Clause tf any person or entity other than me singularly or in conjunction with any other person or entity directly or indirectly contests in any court the validity of this will, including any codicils thereto, then the right of that person or entity to take any interest in my estate shall cease, and that person or entity shall be deemed to have predeceased me. Section 2. Captions The captions of Articles, Sections and Paragraphs used in this will are for convenience of reference only and shall have no significance in the construction or interpretation of this will. 4 o Section 3. Severability Should any of the provisions of my will be for any reason declared invalid, such invalidity shall not affect any of the other provisions of this will, and all invalid provisions shall be wholly disregarded in interpreting this will. Section 4. Governing Law This will shall be construed, regulated and governed by acid in accordance with the laws of the Commonwealth of Pennsylvania. 1 signed this, my last will, on ~ Q' -. ! C( f J J N H. BAUDOU 5 The foregoing Will was, on the day and year written above, published and declared by JOANN H. BAUDOUX in our presence to be her Will. We, in her presence and at her request, and in the presence of each other, have attested the same and have signed our names as attesting witnesses. We declare that at the time of our attestation of this Will, JOANN H. BAUDOUX was, according to our best knowledge and belief, of sound mind and memory and under no undue duress or constraint. V~ S Ad -ess: ~~ ~ ~~3~ 6 Address: / ~~ COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN We, JOANN H. BAUDOUX, ~~N~~ ~~~j~tsG~, and~~~[a;I.V~L ~r ~~~~~'the "Testatrix and the witnesses, respectively, whose names are signed to the foregoing Will, l~faving been sworn, declared to the undersigned officer that the Testatrix, in the presence of witnesses, signed the instrument as her last Will, that she signed, and that each of the witnesses, in the presence of the Testatrix aid in the presence of each other, signed the Will as a witness. H. BAUDUUX Subscribed and sworn before me b JOANN H. BAUDOUX, ~~~ ~ :y1 ~~t~ and ~• 1~~.E , /~/ , 1997. ~~ Notary Public My commission expires: _- ~. NuTt+.R(AL SLRL Ctl!!1PJi~ L. REESE, PJotary Fublic Hershey, PF', Dauphin County ~''',~ Can~mis~!or< Expiry: Play 10,19a~i the Testatrix, and by the witnesses on 7 CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-19911 May 25, 2010 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Joann H. Baudoux No. 21-09-0879 Dear Register of Wills: TELEPHONE (717) 766-0209 PAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Joann H. Baudoux Estate as well as Check No. 2018 in the amount of $15.00 for the filing fee, Check No. 2020 in the amount of $40.00 for additional Probate, Check No. 2021 in the amount of $1,445.29 for the Inheritance Tax due and Check No. 1652 in the amount of $3.34 for interest due. Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, III Attorney-At-Law CES/mjj Enclosures r-.~ ~-~ : ~, :: T? }~ _ C7 ~ --y ~ ~~ ~ ~~ _ -.~ rJ, ._:: __, ~~ .. ' _T'i _ _ '~ . • ~ f +- ~ I V G REV-1162 EX111-961 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: MACHADO BONNIE B 12813 MELVILLE LANE FAIRFAX, VA 02203 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER -------- fold ESTATE INFORMATION: SSN: ~s5-20-9650 FILE NUMBER: 2109-0879 DECEDENT NAME: BAUDOUX .10ANN H DATE OF PAYMENT: 1 1 /02/2009 POSTMARK DATE: 1 1 /02/2009 couNTY: CUMBERLAND DATE OF DEATH: 08/03/2009 NO. CD 011935 AMOUNT 101 ~ 539,900.00 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK# 2002 INITIALS: DM RECEIVED BY: REGISTER OF WILLS 539,900.00 GLENDA EARNER STRASBAUGH TAXPAYER w~ ~ ~ o ~ Q T F" ~n m `~ ~ 0 N O J a~ cn ~ ~ ~ Q ~ .~ a> o ~ :~ ~ ~ ~ ~ U p ~ ~ ~ ~ ~? o J ~ i d'N V ~ ~ ~ M } I` Q o U a ~ ',.~, (`') r~ o d ~ ~ ~ ~ ~ a o =gym ~ ~ U w W cn Z W ~ N J '- =_ ~ ~ M M J ~ ~ _M _ J ~ ~ ~ _= W Q ~ T ~Q~a 2 _ W ~ I- J I- W ~ N =_ Cn m ~ -~ C'3 ~ ~ ~ w ~ U Q = oCUrU -.. ~~ ~ .~ - Uca~ i _ ._ r ~ C ~ Z { -" e_ u~, ~. ~ +..a ~~ ~:- cn .~ ~~ ._~ _ ~ ~ ; L~` N U ~~ ~ ~~ ~ ~ ~~ V"I 7 y ~ ~ u-J _ ~ ~ ~ ~ O O -~ ~ p m ~ ~ 7 ~ m ~~ ~ o 0 r-