Loading...
HomeMy WebLinkAbout06-22-10 REV-1500 Ex(oe-oa) 1505607122 oFFnaALUaeoN~Y PA DapaAment a Revenue Code Ysar FNa Number aun.u a IndMaua Taxes INHERITANCE TAX RETURN X01"' m '~ 2 0 1 1 6 6 5 5 2 0 8 2 2 2 0 0 9 1 2 0 4 1 9 2 2 ~I, Dsosdeat's Last Name Suffix Dscsderd's Ftret Name MI LANCE ~ MARY JAN ~ (It Applkable) Enbr 8urvlvirp Spouse's IMotmatlon Below ~, Spouse's Last Name Sufix Spouss'p First Name ~ MI 'a Soda! Secu Ntanbsr THIB RETURN MU8T BE FILED IN DUPLICATE IIYI THE m L~ REGISTER OF WILLS ~, I . FH.L IN APPROPRIATE OVALS BELOW ! • 1.Oripinal Return o 2. St•plemental Return o 3. Remainder Rat (dale a death prbr to 12-1 0 4. LJrrliled EstaN o 4a. Future Interest Compromlee (date o 5. Federal Estate T Return Required a dselh after 12-12-82) • 8. Decedent t>fed Testate o 7. Decedent Makdaitbd a Lhrktp Tn~M p 8. Total Number a Deposit Bow (Atfadt Copy avv~q (Attach Copy aTrust) 0 9. t.itlpatbn Proceeds Recdued o 10. Spousal Poverty Crodt (date a death o 11. Election to tax Sec. 9113(A) between 12-81-!11 and 1-1-98) (AMach Sch. 0) t3~8P01MENT - TI#8 8~1'ION MUST BE COMPN.ETED. ALL CORI~PONDEIICE AND tENTUIL TAX MIFOIMIATION 8110tA.D ltE T0: Wme Da Tebphone bar WI L L I A M R K A U F M A N E S Q Firm Name h REG LS U LY ~ m -:i N ~ FYat line a address !~ C ~,~ , , ' S` 940 CENTUR Y DRIVE ~~' ~ `~ - ,~ c~ r- ~ r r N ~. r Second Ans of addn~ ~ -~ SUITE B v° . ~ c, ~~; ~. FILED = ~ ~ ._ City or Post Oflloa Stets ZIPCode - .. ~ r __. W `''~` d - MECHANICSB URG PA 170554376 ~~ ~~--- ... comesporxtertrs e-rrglladdress: wrkaufman.wrklaw~comcast.net Under pansgtea a , l a.man. ewt I r~.w e~ornx»d a,l. rwm. w,no aooomp.ryl~ sa~d~.. «a aanaw-a, «-d to u,. a~ a my law carrot and a pnparer sun the parsons! repraardatlva la t>M.d on all Inhrrtalbn a whNh P-aPa-ar ha any kra.dedo SItiNA SON OR F0.1N0 RETURN EXECUTOR ~ ADDRESS 110 EAGLE LANE ETTERS PA 17319 SIGNATURE OF PREPARE R NT ESQ. ADORESs 940 CENTURY DRIVE. SUITE B. ME ANICSBURG. PA 17055-4378 pe and MMat, H b trw, ~~9 :,zoid PLEASE U8E ORKiINAL FORM ONLY Side 1 1505607122 1505607122 III I I -~v I cep l~eyvlh. IdunJ~~r ••••••••• • ••••• ••` ns1. ~ n.efl. n.~ ..f ril.-i. ~I J 1505607222 REV-1600 EX Deadent'e Name: MARY JANE L A N C E Decedent's 8ocbjl Securigt Number RECAPITULATION 1. Real estate (Sd~edub A) 2. Stodra and Bonds (Sd~edub B) 3. Ck~ssy Held Corporation, Partnership orSole-Proprietorship {Schedub C) 4. Mortgages ~ Notes ReosHabb (Schedub D) 5. Cash, Bank Dspoagx ~ MbosHansous Personal Property (Schedub E) 8. Jointly Owned Property (Schedub F} o Separate BIINng Requested 7. Infer-Vlvos Transfers & Misceganeous Non-Probate Property (Schedule G) o Separate Biginy Requested ~ 8. Togl Groan Asasts {total Lines 1-~ 9. Funeral Expenses 8 Adminbtrative Coats (Schedub H) 10. Debts of Decedent, Mortgage Lbbllttbs, & Lbna (Schedub 1) ' 11. Tool Deductions (total Lines 9 l~ 10) 12. Net Valw of EstaEs (Line 8 minus Lino 11) 13. ChargAbb and GovemmeMal BequesWSec 9113 Trusts for which an sbction to tax has not been made (Schedub J) 1 14. Net Valw Sut>)sct to Tax (Line 12 minus Line 13) TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of un.14 taxabb at the spouwl tax rate, or transfers under Sec: 9118 (a)(1.2) X 0. . 18. Amount of Line 14 taxabb 1 7 7 6 5 O t at Nneal rate X O.o45 17. Amount of Line 14 taxabb at sibling rats X .12 18. Amount of Line 14 taxabb at cogateral rate X .15 19. TAX DUE 1. ~' 0 . 0 0 2. 0 . 0 0 3. 0 . 0 0 4. 0 . 0 0 5. 1 5 1 5 . 4 8 s. 0 . 0 0 7. 1 3' 8 3 . 4 3 e. 2 8' 9 8 . 9 1 9. 5' 5 5 . 6 0 10. 4' 0 2 . 6 5 11. 1 0'' 5 8 . 2 5 12. 1 8 4 D . 6 6 13. 7 5 . 6 2 14 1 7 6 5 . 0 4. 15.1 ~ ~ ~ ~ ~ ~''~ ~ 101.1010 18. 9 9 . 4 3 17. D . D ~ 1s. I D . 0 0 19. 9 9 . 4 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ', • Bide 2 1505807222 15056!0722 I REV 1500 EX Pp~ 8 Decedent': Compkb Address: FHra Numtnr 21 o9osao DECEDENT'S NAME DECEDENTS SOC L SECURITY NUMBER MARY JANE LANCE 201!-188552 STREET ADDRESS CHURCH OF GOD HOME 801 NORTH HANOVER STREET CITY STATE ZIP CARLISLE PA 17011 Tax Payment and Crodits: 1. Tax Dus (Paps 2 Line 19) 2. CrodNalPaymsrrts A. Spousal Poverty Credk B. Prior Payments C. DbcouM 3. InMreatlPer-alty g applicabb D. Interost E. Penalty 1,000.00 39.97 (1) ! s799.43 Total CrsdNs (A + B + C) (2)', 11,039.97 Total InterestlPenaRy (D + E ) 4. M Una 2 b greater than Line 1 + Line 3, enter the dNferonce. Thb is the OVERPAYMENT. FlII M oval on Papa Z, Lim 20 to request a nsfund. 5. M Une 1 + Una 3 is groatsr than Llne 2, enter the dtfbronce. This b the TAX DUE. A. Enter the Irrtersst on the tax Oue. B. Enter the total of Lina 5 + 5A. Thb b the BALANCE DUE. (3) (4) (6) II (5B (~~ $ 0.00 s 240.64 s o.oo 1 o.ao Make Check Payable to: REGISTER OF WILLS, AGENT j PLEA8E AN8MIER THE FOLLOWIN~i QUE8TION8 BY PLACIN~3 AN "X" IN THE APPROPRIATE BLOCKB 1 • Db decedent make a transfer and: ' Mss No e. retain the use or income of the property transfensd; ' ^ b. rotaln the right to designate who shall use the property tronsfsmed or fts Income; ', ^ c. retain a rovsrobnary interest; or ' ^ ~ d. receive the prombe for Nb of eghsr payments, benefNs or caro? ^ 2• If death ooaxrod after December 12, 1982; dkt decedent transfer property wRhin ores year of death without reoehdrrg adequate consideration? ^ 3. Dkl decedent own an' "intrust for" or payabb upon death bank account or securky at hb or her dsath7~ ® ^ '-• Dkl decedent own an Individual Retirement Account, annuity, or other non-probate properly which ~~ contatna a benefldary designation? ® ^ IF THE AN8t#IER TO ANY OF THE ABOVE QUE8TION818 YEB, YOU MUST COMPLETE 8CHEDULE f3 AND FILE IT A~ PART OF THE RETURN. For dates of death on or a16er July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of tronsfero to o~ for the use of the survivMg spouse b three (3) peroent p2 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rote imposed on the net value of transfers to or for the use of the sunrh~ing spouse is zero (0) [~72 P S. §9118 (a) (1.1) (N)]. The statute does not axamot a transfer to a surviving spouse from tax, and the statutory requirements for dbdosuro of assets and filing a tax return aro atiN applicable even Mthe aurvivfng spouse b the only berreficfary. For dal3es of death on or after July 1, 2000: The tax rats Imposed on the net value of trairr:fsrs from a deceased chNd twenty-one years of ape or younger at death to or (ok the use of a natural paront, an adoptive parent, or a stepparent of the chiki b zero (0) percent [72 P.S. §9118(a)(1.2)]. ' The tax rate Imposed on the net value of tronsfen to or for the use of the deoedsnYa lineal bsnsfldarbe b four and one-haM (4.5) perrsnt, exoa~pt as noted in 72 P.S. §9118(1.2) [72 P.S. §9118(a)(1)]. The tax rate Imposed on the net vakis of transfers to or for the use of the decedent's slbNrrgs b tweh-e (12) peroent [72 P.S. j§~118(ax1.3)]. A sibiirrg ie defined, under Section 9102, as an indh-klual who has at bast one paront in common wNfr the decedent, whether by blood br ogtlon. III ~tE1r--1508 EIC+ (69B) 8CHEDULE E COI~IVVEALTH of PENNSYWMNA eaaserrANCETAXRETURN CASH, BANK DEPOSITS, & MISC. riE81DENT DECEDENT PERSONAL PROPERTY -_ kxAids the pmaseds of Wpsdon and the data the proossds were reoaMd by the eataos. '~ All properltl ~lntlyo~wned with the right of survhroMrip must be dbdoeed on Schedule F. ~,, ITEM ~ VALUE AT DATE NUMBER DE3CRIPTION ~ OF DEATH 1. SECURITY DEPOSIT -CHURCH OF GOD HOME, INC. -AFTER APPLYING OUTSTANDIN $6,810.00 CHARGES OF $4,090.52 AGAINST IT (SEE SCHEDULE I), THE HOME REFUNDED THE DIFFERENCE ($2,719.48) TO THE ESTATE -SEE ATTACHED CHECK STUB COPY 2. CHECKING ACCOUNT, M&T BANK, ACCOUNT NUMBER 82273485, INCLUDING ACCRUE ~ 5,237.48 INTEREST OF $0.27. ACCOUNT NOT RETITLED AFTER DEATH OF DECEDENTS HUS ND, HOWARD C. LANCE, THE JOINT TENANT SHOWN ON THE ACCOUNT -SEE ATTACHED STATEMENT ', 3. PREPAID FUNERAL ACCOUNT WITH MUSSELMAN FUNERAL HOME, LEMOYNE, PA - SE~ 2,820.00 SCHEDULE H DOCUMENTATION 4. 2008 FEDERAL INCOME TAX REFUND RECEIVABLE -SEE ATTACHED COPY OF PAGES 1 3.00 AND 2 OF 2008 FORM 1040. 5. MISCELLANEOUS PERSONAL PROPERTY: ~~ 445.00 1 WHEELCHAIR 1 RECLINER 1 WOOD NIGHTSTAND 10 SETS OF CLOTHING ~, ALL ITEMS IN FAIR TO GOOD CONDITION AND VALUED BASED ON THRIFT SHOP VALU~ TOTAL (Also enter on line (If more apace ie needed, insert additional aheeb of the erne size) HOWARD GLANCE OR MARY J LANCE 113 CREEK RD CAMP HILL PA 17011-7416 INTEREST PAID YEAR TO DATE 2.71 ACf_f111WT CIIMMAQV :;:<P:_;;:: >%:'sj:i.'~T....... Elil'......3ilQ::: :~?~~>~~~:P~ii~E»?>:>`>`':i JUL.25-AUG.26,2009 1 OF 2 HEST SHORE PLAZA 5 316.85 0 .27 •5 237.4a UNT ACTIV 07-25-• BEGIlN1ING BALANCE 08-03-• US TREASURY 303 SOC SEC 08-03-• KMART PENSION PL rN PMTS/CJ 08-20-0 CHECK NUMBER 3597 08-21-0 CHI( NUMBER 3518 08-26-0 INTEREST PAYMENT 05,316.85 1,204.60 105.05 6,626.5• 1,202.OOI 5,424.50 187.29~~ 5,237.21 0.27 5,237.48 3597 0d-20-09 1,202.00 3598 06-21-09 187.29 ANNUAL PERCENTAGE YIELD EARNED = 0.04 X LIPRESSEO BY THE SERVICE YOU RECEriED AT MIT 6AIMC; THEN PLEASE VISIT MMN.MTd.CON~EICCELLENCE AND COMPLETE OUR BE THE BEST NOMINATION FORK TO RECOON 2E AN MRT BANK ElIPLOYEE FOR PROVIDING YOU MITH AN EKCEPTIONAL CUSTOMER EKPERIENC~! ME APPRECIATE YOUR FEEDBACK! IIEMIER FDIC L.Op4A (eADYI .. ~ ,~~r _ __ ~-r_r THE CHURCH OF GOD HOME, tNC. 15514 oun n~ as roan ~e Na ~o~ce or~ra Twice r . r Mo a~couNrrruc~+ r~c~crc~rouKr 010550 REFUND 9/30/20 9 2,7L9. B 2,719. 8 0.0 2,719.48 ne,.a~so~ • ranwat:n r T.'Nf'Ti! c ins inA uaov .TaN~ r.aum>. Q ~~~ Ana ~ ~ nM --------.. - ~....- --'-- -. --. - --~ ~~:~ = inMrn ~rZ v e8~ v C - ~ v U"~ u ~ Q~ , a e enu r i e ~~8 Form U.S. Individual income Tax Return ~ t,e. - oe notwrib o. to tfik Fa the Jan 1 -Dec 31 a other hx nni endln 20 osm nw. tyta-coo ~I Your nrat rrme hN last nano Ysv'~seetsl ssour~r menu ~" tnetructlonsJ HOWARD C LANCE 34 -16-2974 lam! ~ B a Joint roturn, apoas's tkst none MI Last mine a 'a aoeW seeurigr mnnMr IRSIabN. MARY JANE LANCE 20 -16-6552 Otherwise, Horns address (number and sheep. B you have a P.O. box, sss inatrucaons. Aparlmsnt no. ou must enter your please print or type. 110 EAGLE LANE '~ social security ~ ~I number(s) above Ciy, town a pat oaks. N you haw a forslan address, see inahuctiom. 9fate 21P code . ~ I~ ~ ni ~ M ETTERS PA 17319 the ~rt axu d. CampMBrWt Check here if you, or yoix spouse if (ding JaMly, want $3 to go th this fund'! (see instrirctiala) ............... - ou ~ Spouse Filing Status 1 Single 4 Head of household(with qualifyi i If h lif i person). (See hild 2 X ons.) t e qua y ng pe, Married filing ~Oirdly (even ff ony ale had income) instruct but not your dependent, enter thr n is a c child s Ch ck l S Married filing separately. Enter spouse's SSN above & full name here. - y e on one box. name here . - s n Qualihin0 widow(er) with depatder lt da~a (see iratructiaris) E7(eml3tions ea X Yourself. If someone can claim you as a dependent, do not check box 6a .......... ~ ;,,dh', , 2 a ~ a e b ~ ~ b $ . , ~ ~ ~ . '' Na of c h a d n n (4} ~ Cl) De endent's (3h Dependent's c De ndents: social security relationship a ' ~ a""hO~ ~ number to you ~ uw I ~ .... . i e ~ ~ First name Last name see in ~ ~,~, Yau dw to dtvores %~ If more fan '~; ~~~ four d~p~ndeMs, see instructions. . '! aaa~ era ~ d Total number of exam tions chimed .................................................. a beNS.. 2 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ... . ...................... . ............. 7 Income Sa Tatable interest. Attach Schedule B if required ............. .. .................. , a 351. bTaoc-e~aenprt interest. Do not incllxie on line Sa....:........ 8b Attach Form(i) 9a Ordinary dividends. Attach Schedule B if required .......... ... ................... ... .. ~ 423 . W-2 Mn. Aha b Qualified dividends (see inshs) .................................. 9b - and 1~09l-R i0 Taxable refunds, credits, or offsets of state and local intwme taxes (see Instructions) ...................... 10 ~ ii tax was withheld. 11 Alimony received .................................................................... 11 12 Business income or (loss). Attach Schedule C or C-EZ .................... ....... 1~ Hyoi~ t60 ~ Os a w-~ 18 Capital gain a (loss): Att Sch D It regd. ff clot read, dt here .......................... - ~ 18 -3 000 . see instntctians. 14 Other gains or posses). Attach Form 4797 ............. ............................. 1 15a IRA distributions ........... 1Sa bTaxable amount (see instrs).. 1 1 664 . 18a Pensions and annuities...... 16a 50 364. bTaxable amolmt (see instrs).. 1 12 634. 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . 17 w, ut do End o b 18 Farm income or pose). Attach Schedule F ............................................. 1 aa ~~ dd ~~,, ery 19 Unemployment compensation.. .... ................. .............................. 18 p d ~0. 20a Social seuxigr benenfs........... ~ 20a~ 19, 671. ~ b Taxable amount (see instrs).. 2q 0 . F m 1~ V 21 Oth i 1 a . - er ncome ------------------------------------- 2 22 Add the amounts in the far ri ht ~Ilann for lines 7 h 21. This is ur total income..... - 12 0 28 Educator expenses (see instructions) ...................... 23 Adjusted 24 Certain business experaes of reaaviats, performing artists, and fee-basis d1o8>i government offidals. Attach form 1106 or 2106•EZ ................... 24 In©ome 25 Health savings account deduction. Attach Form 8889....... 25 28 Moving expenses. Attach Form 3903 ....................... 28 27 One-half of self-employment tax. Attach Schedule SE ...... 27 28 Self-employed SEP, SIMPLE, and qualified plans .......... 28 29 Sdf-employed health insrmKxs deductiari (see instructions) ............. 29 30 Penalty on early withdrawal of savings ..................... 3b 37 a Alimony paid b Recipierd's SSN.... - 31 a 312 IRA deduction (see instructions) ........................... 92 93 Student loan interest deduction (see instructions) .......... 3i3 94 Tuition and fees deduction. Attach Form 8917 .............. 3i4 9t6 Domestic production activities deduction. Attach Form 6963 ......... . ... 3S 318 Add lines 23 - 31a and 32 - 35 ................................... ...... .................... 0 . 37 Subtract line 36 from line 22.~This is ur usNd row income:.. - BAA For Disdosuro, Privacy Act, and Paperwork Redudlon Act Notice, see instructions. FaAO:rx. ton~oe Form 1040 (2008) Tax and Crodlts Shndard Daductlon People who checked any box on line 39a 39b, or 39c or who can be claimed as a dependent, see ins n~ctions. • All others: Single or Married nlmg separatey, S5,4b0 Married filing jointly or Qualifyirrqtg widow er), 510,90 Head of 58,000 Id, HOWARD C AND MARY JANE LANCE 346• 3t3 Amount fro m line 37 (adjusted. gross income) ........ . ................ . . . .............. ~' 3Ba Check if: { X e You were born before January 2, i 944, Blind. Total bows gpouse was born before January 2, 1944, Blind. t3taclad - 318a 2 b If your spouse itemizes on a separate rebtrri, oryouwere adual-status alien, see rostra and ck here - 3Nb c Check if sterldard deduction indudes rml estate taxes or disaster loss (sea Iratructiana)........ - 319c _ 40 Itemized dsduetlona (from Sdtedule A) or yow atardard deduction (see left Wargo) .................:. . . 40 41 Subtract line 40 from line 38 .........:............................................... 41. 42 If line 38 is over 19,g7 or provided housing to a Mldlfeatem displaced individual, see instructions. Otiierwlae, mtdtip~y s3,5~ by the total number of examptiorls claimed on line 6d .... . .................... 42' 48 Taxable int:ome. Subtract line 42 from line 41. ~ If line 42 is moro than line 41, rater •0•.. . ...................... . 44 Tax (see instrs). Check if any tax is from: a Form(s) 8814 b 8 Form 4972 .......................... M 45 Albrnatlw minimum tax (see instructions). Attach Form 6251 .. . ....................... 45 46 Add lines 44 and 4b ...................................... .. ................. - 46I 47 Foreign tax credit. Attach Form 1116 if required............ 47 46 Credit for child and dependent care expenses. Attach Form 2441.......... 48 4® Credit for the elderly or the disabled. Attach Schedule R.... 49 59 Education credits. Attach Form 8863 ....................... 50 51 Retirement savings contributions credit. Attach Form 8680.. 51 52 Child tax credit (sea instructions). Attach Form 6901 if required .......... 52 53 CredHs from Farm: a 8396 b 8839 c ~ 5695 ...... 59 54 Otller crs from Form: a ~ 3800 b 8801 c ~ 54 5t3 Add lines 47 through 54. These are your total credits .................................. '!Ef'. 57 Self-employWteM tax. Attach SdtedWe SE ............ ....... ......... . ................ 57 t~tlter 58 thuelwrted nodal security and Medicare tax from Form: a ~ 4137 b Q 8919 ...................... 58 _ Taxe8 ~ Additional tax on IRAs otiter qualified retirement ,etc. Attach Form 5329 if required ................... ~ 60 Adcfitional taxes: a ~ AFJC payments b usehold employWlerit taxes. Attach Schedule H ........... 110. 61 Add lines 56-60. TMs is r total tax.. - d7 0 . Payrllerlt5 6.2 Federal income tax withheld from Forms W-2 and 1099..... t32 3 . tf y~ ~ a L 89 2008 estimated tax payments and amount applied from X07 reb-m.. .... 69 84a Earned income kxedlt (EIC~ ..... .... ................... 64^ ild, attach b Nontaxable combat pay election..... - ~ 64b 1. 3ettedtde EIC. Qlri Excess social security and tier 1 RRTA hoc witfdleld (see iratmetions)...... 85 sff Additional child tax credit. Attach Form 8812 ............... t36 67 Amount paid with request fa adenalon to file (see Instructions).......... t37 M Credits from Form: a ~ 2439 b ~ 4136 c ~ 8801 d 08885. i9B 69 First-time homebuyer credit. Attach Form 5405 ............. N 70 Recovery rebate credit (see worksheet) .................... 70 71 Add lines 62 70. These aro r total - 71 3 . Refund 72 If line 71 is more then Ilne 61, subtract Ilne 61 from Ilna 71. This Is the amount you overpaid ........ . ....... 72 3 . Direct deposit? 78a Amount of line 72 you want refundea! to u. If Form 8888 is attached, check here . - ~ 78 ____ 3 . See instrudtons - b Routing ntunber........ XXX){XXX7IXX - c T e: Checking ~ Savings and fill in 73b, - d Account number....... . 73c, and 73d or Form 8886. 74 Amount of line 7P want lied to 2009 estimated tax ....... - 74 Ar11OUrtt 713 Arttota-t you owe. Subtract line 71 from Ilne 61. For details on how to pay, see instructions .............. - 75 YtDIJ OtA~ 78 Estimated tax nal sae instructions ................... T6 Third Party ~ you want to allow another person to discuss tMs return with the IRS (sue ittahttctions)2 .......... X Yea. Completie folbwirtg. No ~ - ~ Ptxxa - ~ - Un~r Mnaltiss of perjury, I dsdero fat 1 lane examined 1~ rsbim ant aorornpanyUq schedules end staMnaMs, end b the bent of knowNdps and ~O beasf, fay are Ws, corroct, and comPNts. Dederaflon orplbperor (other fan taxpeyeq R based on aN irdormetlon of which pre~arer amt Wxnvbdfs. Joint retum7 Yov siprature ~'[~ OaOs Your oxupatton phone number see instructions. ~ ~ ~ ~ RETIRED sporae's sbnabrs. N rrt ro m stpn. Date epoussb ooarpetlon t ~r your re~cbyrds. i- RETIRED Date rots sSN ar PTNV Paid tyre ~ William R. Kaufman CPA JD Chedrfseu~ero X ~0 -38-7696 p~~+s Flnn'a name DeMuth Mana ement Consultants Use On «a~"mpbre] 940 Cantu Dr stN 3 2871292 zt ~a"d Mechanicsburg, PA 17055-4376 ~ Phone no. (17 7) 790-9001 Form 1W0 (2008) Foinottxt. tatsroa J RE~--,s,oEXtlg.sa> SCHEDULE d INTER-VIVO5 TRANSFERS & ~TM of PENNSnvnNa a,HEwrANCETIVfRETURN MISC. NON-PROBATE PROPERTY REr oEC~EHr E8 ATE OF MARY JANE LANCE F ~ 21090840 This schedule moat be oomplsted and flkd ff the answer to any of questions 1 through 4 on the reverse side of the REV-1500 OVER SHEET is yes. REM NUI~ER Mc~~r~oP~~tNe OvTOOfrAw~oA~~eR. ATTAg1A00PVORTFlD~DFORIIPJO.~TAIE DATE OF DEATH VALUE OF ASSET 9i OF DECD'S' INTEREST EXCLUSION prA!'P6M,MLq TAXABLE VALUE 1. BANKERS LIFE AND CASUALTY COMPANY ANNUITY CONTRACT :11,683.43 100% 111,683.43 NUMBER 7649188, PAYABLE ON DEATH IN EQUAL SHARES TO EACH OF DECEDENT'S 2 CHILDREN LISTED ON SCHEDULE J, PART I -SEE ATTACHED BENEFICIARY LETTERS 2. KMART CORPORATION EMPLOYEES' RETIREMENT PENSION PLAN 1,500.00 100% 1,500.00 DEATH BENEFIT -SEE ATTACHED CERTIFICATE BENEFICIARY IS DECEDENTS ESTATE TOTAL more spans is needed, insert addRional sheets of the rims BANKERS LIFE AND CASUALTY COMPANY CLAIMS ADMINISTRATIVE OFFICE P.O. Box 1937 Carmel, IN 46.082-1937 (800) 621-3724 March 25, 2010 DALE R-LANCE 110 EAGLE LANE ETTERS PA 17319 Insured: MARY LANCE Contract Number: 7649166 Dear DALE R LANCE: We again. wish to extend our deepest sympathy to you and your ~`amily for your recent loss. Your claim on the above mentioned contract has been .approved and processed. The benefits have been calculated as ',follows: Death Benefit $11,683.43 Your Share $5,991.72 Claim Interest. ~ $26.60 Taxable Amount ~ $1,018.32 Federal Tax Withholding $0.00 Final Benefit Amount ~ $6,018.32. A form 1099R will be mailed at the end of this tax year for the taxable amount. BANKERS LIFE AND CASUALTY COMPANY _ .CLAIMS ADMINISTRATIVE OFFICE P.O. Box 1937 Carmel, IN 46082-1937 • -(800) 621-3724 March 2 5 , 2010 i BETTY HECKERT ~' 6104 JEFFERSON DR2VE READING PA 19606 Insured : MARY LRI~TCE Contract Number: 7649166 Dear BETTY HECKERT: We again wish to extend our deepest sympathy to you and your ~amily•for your recent loss. Your claim on the above mentioned contract has been approved and processed. The benefits have been calculated asfollows: ... ~ ,. Death Benefit ~ $11,683.43 Yo r Sh re 5 991. 1 u 7 $ , Claim Interest $26.0 Taxable Amount ~ $1,018.32 ~ ~, Federal Tax Withholding $0.00 Final Benefit Amount. $6,018.31 ~, A form 1099R will be mailed at the end of this tax year for tY~.e taxable amount. I • REV 1517 EX+(~p-p8) SCHEDULE H FUNERAL EXPENSES & caya~oNwEA~TH of rENNSrivAN1A ADMINISTRATIVE COSTS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY JANE LANCE FILE N 21090840 --- -_ -~ Debts of dscedsnt must be roporbd on Schedule I. ITEM NUMBER DESCRIPTION ' AMOUNT A. FUNERAL EXPENSES: 1. MUSSELMAN FUNERAL HOME, LEMOYNE, PA-AMOUNTS COVERED BY PREPAID FUNERALACCO~INT 12,820.00 -SEE ATTACHED INVOICE 2. MUSSELMAN FUNERAL HOME, LEMOYNE, PA-AMOUNTS IN EXCESS OF PREPAID FUNERALACC~UNT 404.87 -SEE ATTACHED INVOICE B. ADMINISTRATIVE COSTS: 1. Personal Reprossntative's Commisabna Name of Personal ReprssentatWe (s) Street Address City Stab Zip _ Year(s) Conxniesion Paid: 2. Attorney Fees 3. FamNy Ezsmptbn: (K decedent's addross is not the same u claimant's, attach sxplanafion) Claimant Stroet Address City Stab ~ _ Relationship of Claimant to Decedent 4. Probeb Fees CUMBERLAND COUNTY REGISTER OF WILLS 5. Aooountant'a Fees 8. Tax Return Preparors Fees DeMUTH MANAGEMENT CONSULTANTS -FORMS 1041 and PA-41 7. THE PATRIOT-NEWS CO. - ESTATE ADVERTISEMENT -SEE ATTACHED INVOICE 8. CUMBERLAND LAW JOURNAL -ESTATE ADVERTISEMENT -SEE ATTACHED INVOICE 9. BANK SERVICE CHARGES - M8T BANK 1,700.00 145.00 300.00 190.73 75.00 20.00 TOTAL (Also enter ~ Una 9, more space is needed, insert additional sheets of the sarr>a size) r 7 ~ofdneral Ezpen~es of . `':MARY ,7AN~ .LAN~:E ~ ~ 5ep,~ . 3~, 20;09 The ~Patric-t-News Co. 812 Market St. Harrisburg, PA 17101 Inquiries - 717-255-8213 WILLIAM R. KAUEMAN 940 CENTURY DRIVE MECHANICSBURG PA 17055 ~e ~a~iot~~ews Naw you know INVOICE ALA CHARGES ARE NET ACCT #~ 1~ AD ORDER #~ 12AIE EDITION ADDTL. INFO. ~ Ar-t>QS~dI 58182 WIINam R. Kaufman 0002010724 09/18/09 REGULAR BASII~C AD CHARGE 581.91 58182 WNMam R. Kaufman 0002010724 09/25/09 REGULAR BA61~C AD CHARGE 581.91 58182 WU6am R. Kaufman 0002010724 10/02/09 REGULAR BAlS AD CHARGE 561.91 A~F~DAVIT CHARGE $5.00 TOTAL: $190.73 REMITTANCE ADDRESS The Patriot News Co. 23794 Network PL Chicago,lL 60673-1237 Please include ~e Account # or Ad Order # (above) with your remittance-Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Progfs oif Publication CUMBERLAND LAW JOURNAL S2 80UTH BEDFORD STREET CARLI8LE, PA 1701 S Tele: (71 ~ Z4~1N Fex: (71 ~ ZIO-ZAAS October 9, 2009 Cumberland Law Joumal is published every Friday by the Cumberlam County Bar Association and is designated by the Court of Common Pleas as the offs al legal publication for Cumberland County and the legal newspaper for publication legal notices. TO: William R. Kaufman, Esquire Mary Jane Lance Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Joumal. I Advertisement inserted on following dates: September 25, October 2, and October 9, 2009 Advertising Cost $ 75.00 Proof of Publication $ 0.001, Second Proof Request $ 0.001, Payment received $ 75.001 Total Amount Due $ D.qp Becky H. Morgenthal, Executive Director sEV-1s1z EX,+(ts.0~ ~ ~ SCHEDULE 1 C.OAiNrONN1EA1.TNOFPENNSYLVANIA DEBTS OF DECEDENT, NFR:RRANCE TAX RETURN ~e~"T~~NT MORTGAGE LIABILITIES, & LIENS E8TATE OF MARY JANE LANCE FILE NUMBER' 21090840 Report dsbb incurred bar the dsaedsnt prig to dsAth which nmAlnsd unpaid as of the dab of death, Include unrehnburssdi, n~sdiaal expsnsss. n'EAA VALUE AT DATE NUhMER DE PTION T 1. CHURCH OF GOD HOME, INC. -OUTSTANDING ROOM ~ BOARD, SUPPLIES, AND SERVICES 14S 24,090.52 DEATH -SEE ATTACHED INVOICE 2. SNOKE FAMILY PRACTICE, CAMP HILL, PA -PHYSICIAN SERVICES 57.77 3. CARLISLE HMA -PHYSICIAN SERVICES -SEE ATTACHED INVOICE 26.28 4. 2009 PERSONAL TAXES -CARLISLE BOROUGH TAX ACCOUNT -COUNTY PER CAPITA 5.50 5. CONTINUING CARE RX -FINAL PHARMACY EXPENSES 222.58 TOTAL (Also enter on line 10, RelAtion) ~ '54,402.65 more apace is needed, insert Additional sheets of the same size) STATEMENT ,' R~SIa~NT ST~IT~MENT FROM f UaCH'OF (10D NOME, INC Statement pAte Due Dats ACCOUNTNUMBER t N F~74~IQVERSTRE~T CA~LISi.E; PA 17013 08/31/2009` Upon Receipt 802849 . ti T=249-5)22 : . t4 080.52 AMOUNT PAIp 5 Please. make Ch+~ck payable to CHURCH OF QOp NOME, INC MARY JANB LANCE Remlt Td: c/o DALE LANCE CHURCH OF GOD HOME, INC 110 EAGLE LANE= 801-N HANOVER STREET ETTERS,'PA 17319 CARLISLE, PA 17013 Please detach and retu-n this portion with your remittance to the address above. Comments , _ ... __ _,,. ~~ __~ Balance Fonlvard $1,202.00 $1,202.00 07/09/09 - 07/09/09 OT-Therapeutlc activities .... 1 $28.60 $28.60 $1,230.80 07/09/09 - 07/09/09 PT Therapeutk: activiUes.; ; ~ 1 $28.60 $28.60 $1,259.20 08/05/09 - 08/21/09 Room & Board 17 $236.00 $4,012.00 $5,271.20 08/09/09 - 08/09)09 Wash Cream 1 $5.36 $5.36 $5,276.56 08/09/09 - 08/09/09 Briefs - Xtra Large 1 $9.06 $9.06 $5,285.82 08/13/09 -08/13/09 Dry Comfort Liners 1 $5.73 $5.73 $5,291.35 08/19/09 -08/19/09 L/XL Briefs 1 $27.40 $27.40 $5,318.75 08/19/09 -08/19/09 Adult Wipe Tubs 1 $4.07 $4.07 $5,322.82 08/19/09 - 08/19/09 Dry Comfort Users 40 pk , .= 1 $17.18 $17.18 $5,340.00 08/20/09 - 08/20/09 Payment Check # 3597 ,,~, '~ ~ ~ $1,02.00 $4,138.00 08)20/09 -08/20/09 Payment Check # 3597 $1,02.00 $2,936.00 08/20/09 -08/20/09 Wash Cream ~ ,,; 1 ~ $6.36 $5.36 $2,941.36 08/20/09 -08/20/09 Boost DM 4oz 120 oc 20 $1.05 $21.00 $2,962.36 08/20/09 - 08/20/09 Adult W ipes Refills ~ J ° t ~ ; ~ + 1 ; ~ $2.88 $2.88 $2,965.24 08/20/09 - 08/20/09 FF Resource flavor 4oz 120 oc ~ ~ ~~ ~ ~~ `$0 ` ~ , , $0.80 $64.00 ~ $3,029.24 08/21/09 - 08/21/09 X Jello r ; 21 ~ ' $0.25 $5.25 $3,034.49 08/22/09 -08/22/09 Laundry , 1 $23.42 $23.42 $3,057.91 08/22/09 -08/22/09 Telephone Bask: Charges } ;1 ` ~ $21.29 $21.29 $3,079.20 08/26/09 - 08/25/09 Reversal of Payment Check # 3597 -REV $(1,22.00) $4,281.20 08/25/09 -08/25/09 Payment Check # 1684 ~~~ ~ ~ ~>~°`E '"~f `~'~ ' ~ - ~~. $90.68 $4,090.52 ~~~t T . _ , _; ~" Y >. $4,090.82 t ,... ~~/ ~~ r FACILITY NAME RESIDENT NAME ACCOUN NUMBER CHURCH OF GOD HOME, INC MARY JANE LANCE 802849 TO REORDER CALL• AMERICAN SOLUTIONS FOR BUSINESS (800) 328-4827, EXL 1842 FAX (920) 834-5873 I _~_~ CHARQES MNi ON THIS BTATENIENT ARE NO/f PiCLUD£D ON ANY HO8PITiILL. OR STATEMENT ,~ 073109 ~3~IG19T 1~ SIiPATI>OR' /QDe>~ LE1I ] illVMe.3 L~liCi,lWl= 199x00 ~110DIIT TO Be P71ID BY CO IM8 ;13.14 073109 1QDIC11Rt PAYI!!!IT -S2.S6 073109 11iDIC118i 3.DJD8?NiNT -63.30. Iaaursaoe 8alanwe 0.00 Prt#eak ~alaaoee 13.14 071209 >,LHRIOHT IID IlIPATIENT BIIeYlQ LiV 2 INV/e{ L>tI1CL,lf>•RY 1129.00 >111OfJpT TO B!0 PAID St CO I118 {13.1{ _073109 1¢DIC>liti P11lYiM'! -4].56.. 073109 IQDIC>•Ri aD.TQB'PMENT -63.30 Ineuraace 8aiances "-~ 0.00 ~ P~tent`paiaaase 13:14 ~ 49 G~ '', ~~ 08/ 16 / 09 PLEASE INDICATE YOUR ACCOUNT NUMBER WHEN CALLINQ OUR OFFICE: 712661 Curreat 31-60'Daya- 61-90 Daye >90 Dayr Totai `•Ia 'pindiaQ 26 26.. 0.00 0 00..... ~ 0.00 26.98 ' 0.00 - 76.28 SENDINOUIWES/R\YMENTSTO: - ..~ - C1iLI~ NM71 PllYBICIA9 Mi1171O>DI PO 102 2!1629 _ ai'L11f?1-, 0}>• 303641699 717 5190753 UR632 733Yaw 00¢637 00¢533 00001/00007 920i!lY02 HOTS: ChuOes and peymente not eoppwlrg w 0NS atstemsM ae appear an neon morolh's eaoeeenae~ - - - - w -lr-- __ REW1813 EX+(9-00) ~ 1 SCHEDULE J cowEAITH of PBarenvi~wA BENEFICIARIES selderrA~ r~x Hen,RN Ress~ENr oec~NT NUMBER 1. 2. NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY TAXABLE DISTRIBUTIONS [hduds outright spousal dtl~tributions, and transfsn3 under Sec. 9118 (a) (1.2)] DALE R. LANCE, 110 EAGLE LANE, ETTERS, PA 17319 BETTY L. HECKERT, 6104 JEFFERSON DRIVE, READING, PA 19tXl8 "' -EACH BENEFlCL4RY RECEIVED 4096 OF THE RESIDUARY ESTATE AND 6096 OF THE BANKERS LIFE AND CASUALTY ANNUITY ON SCHEDULE G, LESS 5096 OF THE ESTATE'S INHERRANCE TAX AS CALCULATED ON THIS RETURN. Do Not List Tnnfrs(sk) !, SON DAUGHTER Ei~(ifftDOLLARAMDUPITSFORDISTRIBIJilON68HalVMABOhIEONLNre81a7FIFt0U0F118,ASAPPf~PPoATE,C7N 1600 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER 3ECTK)N 9113 FOR WHICH AN ELECTION TO TAX IS NOT.BEING MAbE 1. II. B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS 1. EBERIY'S MILL CHURCH OF GOD, 115 CREEK ROAD, CAMP HILL, PA 17011 1D96 OF RESIDUARY ESTATE; NO APPORTIONMENT OF INHERITANCE TAX AS A CHARITABLE ENTRY «. ... 5875.ti2 TOTAL OFPART II -ENTER TOTALNON-TAXABLE DISTR~UTiONS ON LN4E 13 OF REV-1500 COVER SFIEE!T I S 675 tit (If more space is needed, insert sdditlonal sheets of the cams size) ~.. ~...~ E X GRANTED TEMPLATE William Kaufman Page 1 of 1 From: RV, Inheritance Tax Extension [RA-InheritanceTaxExt~state.pa.us] 8tt~nt: Wednesday, May 26, 2010 3:50 PM 4 To• 'wrkaufman.wridawi>~COmcast.net' Cc: 'gfamer~ccpa.net' 8ubJ~ct: Mary Lance, Est. ':7 r ~ ~~n~~;~~ir~n~ DEPAR~'i~ti;NT;ciF.R~Y~AIIJb The toHowing message Js beMg serrt fiiorn an unmonitored acccounL PJease do not reply. Re: Estate of Mary Lance File Number 2109-0840 Dear Sir or Madam: This is in response to your request far an extension of time to file the Inheritance Tax Re~um for the above estate. in accordance with Section 2136 (d) of the Inheritance and Estate Tax Ad of 1995, tie ti for filing the return is extended for an addmonal period of six months. This extension will av id the imposition of a penalty for failure to make a timely return. However, it does not prevent i Brest from accxuing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 11/22/10. Because Sfactio~ 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional exteh ion(s) will be granted that would exceed the maximum time permitted. We now otter you the option tD request your extension n'quest vis a-mail. Please the foliowintl e-mail address: - Please contact me th any qusatlons or concerns at 717-787-6327. Sincerely, Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division Please do not reply to this email. This mailbox fs not monitored and you will not receive a response. For assistance, vish u# on the web at www.rovenue.atate.na.w or call us at 717-787-8327 The intorrnaUon transmitted is MMsnded only for tlro psroon or entity to whom k is addressed and may contain oonNdeintlal a~ndlor prNNeped material. Any use of this IMorrnaMon other than by the intended rodpknt Is prohibited. if you receive thk mess Nt error, Abate send a reply email to the sender and dsbte the material from any and aft computers, 5/26/2010 ,~ ~: ~, I Lv F--' COO P~ LAST WILL AND TESTAMENT OF MARY JANE LANCE I, MARY JANE LANCE, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind and body declare this to be my Last Will and Testament and revoke any and all Wily and Codicils previously made by me. ITEM I: I hereby direct that all just debts, funeral expenses, all administration expenses, including inheritance tax shall be paid from the assets of my estate as soon as practicable after my decease. ITEM II: I hereby give, devise and bequeath'ajll of the assets of my estate, real and personal, wheresoever situate and in whatsoever name, to my Husband, HOWARD C. LANCE, ii he survives me by thirty (30) days. ITEM III: In the event that my Husband fails tlo survive me by thirty (30) days, I hereby give, devise, and bequeath all of the assets of my estate, real and personalJ, wheresoever situate and in whatsoever name as follows: (a) Ten percent (10~) to the EBERLY'S MILL CHURCH OI,F GOD, 115 Creek Road, Camp Hill, Cumberland County, Pennsylvania. (b) Ninety percent (90~) to my children, BETTY LOd I'HECKERT, and DALE R. LANCE, per stirpes. Page 1 of 4 __ _ _ ~. _ ~ ., ITEM IV: If my Husband and I die in a common disaster or from illness or disease under circumstances where it is not possible to determine with certainty which of us survived the other, it shall be conclusively presumed my Husband pred~,ceased me. No person, to whom any gift or interest shall have bieen given by the terms of this will shall be deemed to have surviveid me who shall have died at the same time as I, or in a common disjaster with me, or under such circumstances that it is difficult or impossible to determine which of us survived the other. ITEM V. I confer on my executor to sell or otherwise ~~convert any real or personal property at public or privatle sale, gat such time or times, in such manner, and for such price'', or ,prices, and on such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient. conveyances, assignments, and transfers of the property, wwithout liability of any purchaser for the application of any consideration; to borrow money and to secure its payment 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; to remain any investments at discretion; to invest and reinvest at discretion, without restriction'to so- called "legal investments"; to make distribution in cash or in kind; to allocate and distribute kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in cash or in kind, or partly in each; and'to do Page 2 of 9 ~ f .__ T. _. _._ _ _. _._. _.. _._ all other acts and things necessary or appropriate in the management, administration and distribution of my estate, ITEM VI: I hereby appoint My Husband, HOWARp~C. LANCE, as Executor of my estate. If for any reason he should f1i1 or cease to act, I appoint my son, DALE R. LANCE, as Executor. ITEM VII: The Executor shall qualify and serve without the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have set my hand and seall to this, my Last Will and Testament, .consisting of this and '',the preceding two (2) pages, this ~~ day of ~Ve'-i~'18&'~,~- 2003. J LANCE We, the undersigned, hereby certify that the'fpregoing Will was signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament, in the 'presence of us, who, at her request and in her presence and in t2iejpresence of each other, have hereunto set our hands and seals theljday and year above written, and we certify that at the time of tk~e execution thereof, the said Testatrix was of sound and di'isposing mind and memory. SEAL) Residing at: ~,$~, 8UT'T'~"~I~-~ . "[~' '~ (SEAL) Residing at: /~d~ j ~,,,,~j'A~t. /UEI./ Cv~16tt2LAA.D~~ ~ ~C~ Page 3 of 4 ....:..... i ~GOMMONWEALTH OF PENNSYLVANIA (COUNTY OF CUMBERLAND ss. We, Mary Jane Lance, William R. Kaufman, and _iAn€~ sue.. floss .77?. , the Testatrix and the Witnesses, respectively, whose names are signed to the attached or fojregoing instrument, being first duly sworn, do hereby declare to fhe undersigned authority that the Testatrix signed and executed the instrument as her Last Will, that she signed. it willingly, and that she executed it as her free and voluntary act for the' purposes therein expressed, and that each of the Witnessesllin the presence and hearing of the Testatrix signed the Will as al Witness and that to the best of their knowledge, the Testatrix was~at that time eighteen (1B) years of age or older, of sound mind and under no constraint or undue influence. Sworn to, acknowledge and subscribed before me by Mary Jane Lance, the Testatrix, and sworn to and subscribed before m~ by William R. Kaufman and ~~~. n~~;~g, the Witnesses, this ~ l 1 day of HpV~g~Z , A. D . , 2003 . '~ ~[ Notary Pub is ~p~~Pg6~1io ~' 9~pt 14. Z007r Page 4 of 4 ~- - - Te at ix