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Home My WebLink About06-14-10 (2)---~ REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File N mbar PO 60X.280601 INHERITANCE TAX RETURN ~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 10 0 0 3 6 9 tN 1 tR DECEDENT INFORMATION BELOW Social Security Number Date of Death 446095292 02162010 Decedent's Last Name r EDWARDS (ff Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~~ Date of Birth 10081921 Suffix Decedent's First Name I', MI LUCILLE S Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH TF~E REGISTER OF WILLS ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of ~eath prior to 12-13-82) ^ 4. Limited Estate ^ qa, Future Interest Compromise (date of death after 12-12-82) ^ 5. Federal Estate Tax Return ~tequired ^ g. Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe De sit Boxes pd ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and t-1-95) ^ 11, Election to tax under Sec. 9113 A ( ) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA ame SAMUEL L. ANDES Finn Name (If Applicable) First line of address 525 NORTH 12TH STREET Second line of address City or Post Office LEMOYNE I I Correspondent's a-mail address: I aw a n d es @ a o l. c o m Under penalties of e 'u I declar th t I h i p ry ry, e a ave exam ned this return, including accompanying schedules and statements, and to the best of my knows it is true, correct and complete. Decl tion of preps ther than the personal representative is based on alf information of which preparer has any k dge and belief, owledge. SI URE F RSON RESPONSI L FO RN TE William D. Edwards ~ ADDRESS 3709 Falkstone D ' echanicsburg, PA 17050 SIGNA RE PRE R T THA SENTATIVE DATE Samuel L. Andes -- ~ ADDRESS 525 North 12th Street, Lemoyne, PA 17043 Side 1 1505607120 150 5607120 J b TION SHOULD BE DIRECTED TO: Daytime Telephone Numbe 7177615361 REGISTER OF WILLS US ONLY C? ~I ~ C7 ! o ` r.~..l.. ~ 1 Ili ;^: r. ...i_.~ •...f ~.. tl ry- f~ ~1 E ..~ i ~_. .i C- ; (-~(.~ it :I~+ ; • ~' ~ .~ State ZIP Code DATE°.F]i,~ED ... -- -~ - :~ -_ _ PA 17043 . ~ ~, ,~ -~~ ~~ 1505607220 REV-1500 EX Decedent's Social Securi Number ~ecader,rs Name: E D W A R D S, L U C I L L E S. 4 4 6 0 9 5 2 9 2 RECAPITULATION i 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. 7 5 81 2 3 . 4 9 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 4 6 , 7 4 0 . 2 1 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 12 2 , 5 ~6 3 . 7 0 9. Funeral Expenses & Administrative Costs (Schedule H) ............. ............................ g. 2 , 6 h 0 . 0 9 10. Debts of Decedent, Mort a e Liabilities & Liens Schedule I 9 9 ( ) ............................... 10, 1 3 , 1 (9 8 . 2 7 11. Total Deductions (total Lines 9 ~ 10) ..................................................................... 11 • 1 5 8 ~ 8 . 3 6 12. Net Value of Estate Line 8 minus Line 11 ( ) ............................................................. 12. 106, 65.34 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, 1 0 6 , 6 ~ 5 . 3 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at linealrateX .045 106, 695.34 16. 4, 81.29 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. '' 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ..................................................................................................................... 19. 4 , 8 ~ 1 . 2 9 II 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 10 - 0 0 3 6 9 DE ED N ME Edwards, Lucille S. ~ STREET ADDRESS 3709 Falkstone Drive CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 4, 8 01 .2 9 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments ~ C. Discount 3. Total Credits (A + B + C) Interest/Penalty if applicable (2) 0.0 0 p. Interest E. Penalty I, I Total Interest/Penalty (D + E) (3) I, 0.0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Pa e 2 Line 20 to re f t d 5. g ques a re un If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) I 4, 8 01 .2 9 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4 ~ 8 ~ ~ . Z 9 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIA~'E BLOCKS 1. Did decedent make a transfer and: Y s 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? ....................................................................................................................... a 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 PAR 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 th 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 s ouse 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 re uirements 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 u~e of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. i 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) p rcent, 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 ( ) (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 r adoption. ~ 4 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Edwards, Lucille S. FILE NUMBER 21 - 10 - 00369 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with survivorship must be disclosed on schedule F. right of ITEM NUMBER DESCRIPTION 1 Investment account with LPL Financial consisting of various investments all listed on the statement attached hereto. 2 ~ Miscellaneous clothing and personal effects UE AT DATE OF DEATH 75,523.49 300.00 TOTAL (Also enter on Line 5, Recapitulation) I 75,823.49 m r 0 c fto r c n rn r r SU Cf ~1 Z n c v .. 0 w 0 N O 0 N CD O -~, N r Z r D x Z~ ~~ n~ ~Z ~O D~ m r v :U ~ D ,~ .g ,~ ~i c v ~S 0 ~ ~ ~ ~ - ou ~ 0 ~ ~ g2 W o= ~ Dv `~ ~ ~ D ~~ ai o a ~ ~~ D 0 ~ ~~D '-gym DAD o Z z C n z ~ v ~ ~ N r- y C ~ ~ ~ N ~: ~ ,~ D 0 0 ~ Q 00 ~ ~ O V ~ ~ °° o '~ _ c i, ~' A I V 0 N rn N O 0 ~v $. v ~~ D w /~/~ V' N rn O 0 v V v ~_ ~~ D a~ d d m v ~ W ~ W ~ N W W W ,p ae O W •'- ~ ~ N -fl a° W O N J i r ~I ~ ~: Z ~ ~ r~- b .. + . E ~ r o ~ o ~ ~ ~ I ~ ? F-+ r ~ ~ ~ Z': I m I ~ ~ n n D o r= r= m m I CO N ~ r I O A ~ v 0 j ~ C ~ ~ ~ ~ +rt e O O p O ~ 0 O n ~ W ~ ~ ~ D D Q O ~ ~ ~ ~ N ~ ~ ~ rn ~ N "Q ~ N ~ ~ o N ~ n : ~ o ' ~ ° '_ ~ ~ 0 3 ~ ~ . + 1"- , ~ m 3 V V C! m W O O ^`<~ GWJI O A Ill ~ a~~~~'~3 ~ ~ ~ c1 ~'r~~~~~~pp_~~ Opp ~N ~ N ~~~ V V D r go3,R' ~~~~ ao o ~a ~ ~~~~ ~ ~ ~` c ~~~.<~~~~~ ~ ~ Qo ~ ~n~~<9~ ~ s y ~ ~ ~ $ ~ a z '~ ~3~ `r°'~` ~, v O ~°~~ °~~ ~ >>~~ ~ poz mcn ~~3 o.~~c ar'St Q. v~w~ D o ~ ~~ ~, fan D„ vo ~ D . 03,~' ~n~R3o'~ o n m0 ~ D v ~~~~.~~~~~ ~.o ~ ~ ~ ~~o~~~~&~ ~ D ~ ,~~ ~~~ ~~~~~~ ~ ~+ n, ~ ~~a~aa r ~ c a~ c v3 ch• ~ ~~ ~ ~~~ ~~ ~ a ~~~ ~Dg~ ~_ ~ g~~.g~~~ ~~ N ~ rn o A 0 ~ ~~~ ~a ~ o ~.~~"ate ~ ~~ o g ,~ a~ n o ~<oo~~ o ~ ~ ~~ ~~ .~~.g a~g-'.~ o' a a~ f~ ~`~~ ~`g ~"~ 3 ~N o g~m ~~ rn ~p ~ 'o ~ o ~ ~' v ~~a°~~ g~~ N q~a~ a ~~ tea' ~g~ g 8 • tD ~ _ 0 0~ ~~tR~~a' 3 0 o "C ~~.~~~~8~~~a w ii ~ ~ ~' ~~~~,~~~ m ado a°o o ~ ~_ ~°o~~o ~ ~y ~g tC `~°~~ ~ ~~~ ~ ~q~~~ ~~ ~~~~ -~ ~ a~~o $ ~ ~ N ~o~cg~or~ 8 ~ N W ~~ A W ~ n sy m 3 a .Q C 0 rn ca 0 w I ~ '-D ? N ~ ~ ~ ~ co ~ ~ ~ # C ~ cn ~ V O ~ ~ p .~' Q w D. p-~C~-n~Cn -~~~c~m~~ p + poz-p=C m _ ~. o°o -W~~pm w ' o ym r= ~ °w ~ ~n ~ ~ -n p "I = C7 C ~ m n o ~~ o ~ w D 0 o A ~ ~ S ~i V v 0 N ~~ N o D o ~ J ~.~. o ~- .* ~ m o m w a° W ~..0~, O O D v N ~~~ SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN j RESIDENT DECEDENT ESTATE OF ~ FlLE NUMBER Edwards, Lucille S. I 21 - 10 - 0036 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP T DECEDENT William D. Edwards 3709 Falkstone Drive Son A Mechanicsburg, PA 17050 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT DATE MADE C~F~SCRIPTIO~OF PRO~ERTkY Include name o nanclal ins on an ban account number DATE OF DEATH o ~o OF ' DATE OF DEATH TENANT JOINT or similar identifying number. Attach deed for jointly-held real estate. VALUE OF ASSET DECD S INTEREST VALUE OF DECEDENTS INTEREST 1 A 2007 Checking account No. 164485-11 with Members 442.81 50% 221.41 First Federal Credit Union 2 A 2007 Savings Account No. 164485-00 with Members 33,563.27 50% 16,781.64 First Federal Credit Union 3 A 2007 Savings Account No. 2458 with New 48,022.77 50% 24,011.39 Cumberland Federal Credit Union 4 A 2007 Share Account No. 564-00 with Susquehanna 11,451.53 50% 5,725.77 Valley Federal Credit Union TOTAL (Also enter on line 6, Recapitulation) 46,740.21 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PO BOX 2806D1 HARRISBURG PA 17128-0601 TAXPAYER R E S P O N S E REV-1543 IX AFP (08-OB) EST. OF LUCILLE S EDWARDS SSN 446-09-5292 DATE OF DEATH 02-16-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calcu sting the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy o this form and return it to the above address. This account is taxable in acr_ordance with the Inheritance Tax laws of the Commonwea th of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No . 164485 -11 WILLIAM EDWARDS 3709 FALKSTONE DRIVE MECHANICSBURG PA 17050 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART 0 CHECK ONE BLOCK ONLY Date 12-03-2003 Established $ 442.81 X 50.000 $ 221.41 X .045 $ 9.96 TAXPAYER RESPONSE To ensure proper credit to the ac ount, two copies of this notice must accomp ny payment to the Register of Wills. Make check payable to "Register of Wills, As nt". NOTE: If tax payments are made within three months of the decedent's date of d ath, deduct a 5 percent discount on the tax due. Any Inheritance Tax due will becom delinquent nine months after the date of deat . A. ~ The above information and tax due is correct. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register o Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) # Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ WORK C TOXPAYFR CTrNATI1R~' TCI CDLJAAIC A111b1aCD nwTc FILE N0. 21 ACN 1,0112739 DATE 013-05-2010 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E Po Box zso6ol HARRISBURG PA I7IZS-o6o1 TAXPAYER RESPONSE AC N REV-1543 EX AFP (OB-08) DAT E EST. OF LUCILLE S EDWARDS SSN 446-09-5292 DATE OF DEATH 02-16-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 N0. 21 1112738 0 -05-2010 TYPE OF MEMBERS 1ST FCU provided the Department with the information below, which has been used in calcu] potential tax dua. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy t and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonweal Pennsylvania. Please call C717) 787-83z7 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTTnNc Account No. 164485-00 WILLIAM EDWARDS 3709 FALKSTONE DRIVE MECHANICSBURG PA 17050 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date O 1-13 -1997 Established $ 33,563.27 X 50.000 $ 16,781.64 X .045 $ 755.17 PART 0 CHECK ONE BLOCK ONLY TAXPAYER RESPONSE ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. sting the his account. this form h of To ensure proper credit to the acc unt, two copies of this notice must accompa y payment to the Register of Wills. Make check payable to "Register of Wills, Age t". NOTE: It tax payments are made wi hin three months of the decedent's date of d ath, deduct a 5 percent discount on the tax due. Any Inheritance Tax due will becom delinquent nine months after the date of deat . A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART z~ and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance z $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due g $ PART DEBTS AND DEDUCTIONS CLAIMED 0 ~, DATE PAID PAYEE DESCRIPTION AMOINT PAID TOTAL CEnter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) WORK C ) TAXPAYER SIGNATURE TFI FPHf)NF NIIMRFR HATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PD BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (Od-OB) EST. OF LUCILLE S EDWARDS SSN 446-09-5292 DATE OF DEATH 02-16-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYRE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. NEW CUMBERLAND FCU provided the Department with the information below, which has been used in calcu sting the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, Please obtain written correction from the financial institution, attach a copy o this fors and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwea th of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTION Account No. 2458 WILLIAM D EDWARDS 3709 FALKSTONE DR MECHANICSBURG PA 17050 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART a CHECK ONE BLOCK ONLY Date 03-03-1967 Established $ 48,022.77 X 50.000 $ 24,011.39 X .045 $ 1,080.51 TAXPAYER RESPON; To ensure proper credit to the ac ount, two copies of this notice must accomp ny payment to the Register of Wills. Make check payable to "Register of Wills, Ag nt". NOTE: If tax payments are made w'thin three months of the decedent's date of eath, deduct a 5 percent discount on th tax due. Any Inheritance Tax due will beco a delinquent nine months after the date of death. A. ~ The above information and tax due is correct. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3LJ below. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register o Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 +fi 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due g $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AM UNT PAID TOTAL CEnter on Line 5 of Tax Computation) ~ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 M E C ) WORK C ) TAXPAYER 4T(,NATIIRF TFI FPNf1NF NIIMAFR T1ATF FILE N0. 21 ACN 1,0111463 DATE d3-03-2010 SUS UEHANNA Q ALLEY FEDERAL CREDIT U N I O N March 4, 2010 Re: Susquehanna Valley Federal Credit Union Account #564, Lucille S. Edwards DOD 02/16/10 To Whom It May Concern: Fallowing is tho ir~ormation requested an the accvur~t of Luctllo S. Edwards. 564-00 (Base Shares) Owner: Lucille S. Edwards Joint Owner: William D. Edwards Date of Date Ea.lance: $7,454.53 Accrued Interest: 0 564-10 (Life Savings Insurance) Owner: Lucille S. Edwards Date of Death Balance: $4,000.00 Accrued Interest: $2.00 If you require any additional information, please feel free to contact our office. Kind Regards, .~ Cathy L. McLaughlin HR/AP Manager www.SVFCU.org IL SCI~DULE H ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DE A11AAIw1I~Tfl AT1~ /C /'Y1~T~ ~7./Ir~flrN7 ~ ~~'\~ ~YG W ~ 7, 7 CEDENT , ~ ~ ESTATE OF Edwards, Lucille S. FILE NUMBER 21 - 10 - 0036 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOU T A. 1 Neill Funeral Home ~~ 745.72 2 Giant Foods (reception after funeral) !i i I ~~ 262.19 B. ADMINISTRATIVE COSTS: ~~ 1. Personal Representative's Commissions ~ ~I I ~I Social Security Number(s) / EIN Number of Personal Representative(s): ~, ICI Street Address City ~ State Zip Year(s) Commission paid 2. Attorney's Fees Samuel L. Andes 1,000.00 3. Family. Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant I Street Address City State ZiP ~I Relationship of Claimant to Decedent ~'~ 4. Probate Fees Register of Wills II 311.50 5. Accountant's Fees 6. Tax Return Preparer's Fees i 120.00 7. Other Administrative Costs 1 The Sentinel (advertising) 155.68 TOTAL (Also enter on Ilne 9, Recapitulation) 2,670.09 Schedule H Ft,nei~al E & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~~ ~~ b~dl 1NI lf.ted RESIDENT DECEDENT ESTATE OF Edwards, Lucille S. Cumberland Law Journal FILE NUMBER 21 - 10 - 00369 Page 2 of Schedu. 75.00 eH SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, ~ LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Edwards, Lucille S. FILE NUMBER 21 - 10 - 00369 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Capital Area Health Associates (medical bill) i 30.00 2 Messiah Village (payments due for January and part of February) I 12,680.48 3 Alert Pharmacy 62.66 4 Reimbursement to PA Public School Employees Retirement System for pension overpayment '~, 425.13 TOTAL (Also enter on Line 10, Recapitulation) ~ 13,198.27 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Edwards, Lucille S. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Thomas L. Edwards 102 North CR 5602 Castroville, TX 78009-1908 2 William D. Edwards 3709 Falkstone Drive Mechanicsburg, PA 17050 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Son Son FILE NUMBER 21 -10-I SHARE OF ESTATE (Words) 50% 50% Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET NT OF ESTATE ($$$) 0.00 1