HomeMy WebLinkAbout09-08-10 (2)J 15056101D1
REV-1500 Ex ~o~_lo>
PA Department of Revenue pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes oEaAw',~E~-oFHE~E~~E County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
172-36-1707 12/08/2009 04/04/1946
Decedent's Last Name Suffix Decedent's First Name IVII
FURST DOUGLASS E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name I~11
FURST KAREN G
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FILL IN APPROPRIATE OVALS BELOW
C~ 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 Telephon~.~Vumber "``~
~,
George W. Porter, Es~~. (717) 533-71:x' ° ~a. ~~
REGISTER~
U ~ ., _~
SE O
N
j /
~y
First line of address ~ ~ /~~ "''C? ~ ' ,-. ~;
909 East Chocolate Ave _---' ~ ;
-~ r~ ~ . ~ .
Second line of address 'x ~,. . ,~> r~-Y
City or Post Office State ZIP Code I DATE FILED
Hershey PA 17033
Correspondent's e-mail address:
Under penalties of perjury, I deGare 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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSCSIV~2ESPONSI E F FILI RETURLy.. DATE
~-~- ~/t~
ADDRESS ~~
3910 Long Grove Road, Brookfield, WI 53045
SIGNATURE OF PREPgRER OTHER THAIy,REP SENTATIVE DATA
G/may /~~f/.i//'`_ ~ `G
AD
Hershey, PA 17033
PLEASE USE ORIGINAL FORM ONLY
Side 1
150561,0101 15056101D1
J
1505610105
REV-1500 EX
Decedent's Social Security Number
Decedents Name: FURST, Douglass E. 172-36-1707
RECAPITULATION
1. Real Estate (Schedule A) ............................................. 1. 112, 959.00
2. Stocks and Bonds (Schedule B) 2. 33,733..33
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0..00
4.
9 9 ( ) ...........................
Mort a es and Notes Receivable Schedule D
4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 43,873.93
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 872.00
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
7
201
53
278
(Schedule G) O Separate Billing Requested........ . .
,
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 469,639.79
9. Funeral Expenses and Administrative Costs (Schedule H) ........... ........ 9. 11,469.63
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... ........ 10. 2,906.00
11. Total Deductions (total Lines 9 and 10) ......................... ........ 11. 14,375.63
12. Net Value of Estate (Line 8 minus Line 11) ...................... ........ 12. 455,264.16
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................ ........ 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) ................ ........ 14. 455,264.16
TAX CALCULATION -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` 114,784.00 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16.
17. Amount of Line 14 taxable
16
340
480
,
.
at sibling rate x .12 17
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE ...................................................... ...19.
20. FILL IN THE OVAL lF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610105 15D561D105
0. X00
40,857.132
40,857.62
(7
J
REV-1500 EX Page 3 File Number
Decedent's Comalete Address:
DECEDENT'S NAME
DOUGLASS E. FURST
STREET ADDRESS
260 SILVER SPRING ROAD
STATE ZIP
IMECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 40,857.62
2. Credits/Payments
A. Prior Payments __
B. Discount
---------------------.. - -- ------- ----- ------ 0.00
Total Credits (A + B) (2)
3. Interest
(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) 0.00
5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 40, 857.62
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: Yes No
a. retain the use or income of the property transferred :.................................................................................... ...... ^ 0
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 Dec. 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? ................................................................................................................. ....... 0 ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 1S 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 Jan. 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i}].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (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 21 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 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 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 12 percent [72 P.S. §9116(a}(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ { I1-~8 i
~ Pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
.,rr.nr.rr ncrcnc~m
_____ __.
ESTATE OF FILE NUMBER
DOUGLASS E. FURST 21 09-1158
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pace at whtc:n property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real nrooertv that is iointly-owned with right of survivorship must be disclosed on Schedule F.
If more space is needed, insert additional sheets of the same size.
REV-1503 EX+ (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOUGLASS E. FURST 21 09-1158
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(1f more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDt~LE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
DOUGLASS E. FURST 21 09-1158
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
fit more space is needed, insert additional sheets of the same size)
REV-i5og EX+ (oi-io)
pennsylvania
DEPARTMENfOFREVENUE
INHERITANCE TAX RETURN
SCHEDVLE F
]OINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
DOUGLASS E. FURST 21 09-1158
70INTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET °!° OF
DECEDENT'S
INTERES~r DATE OF DEATH
VP,LUE OF
DECEDENT'S INTEREST
1. A• 06/02108 Americhoice Federal Credit Union Savings Account #31668-01109. 53.51 50% 26.76
Please see "Attachment i1."
2. A. 06102108 Ar~rerichoice Federal Credit Union Checking Account #31668-13 1,036.15 50% 518.08
Please see "Attachment I."
3. A. 05127/08 Members First Savings Account #232317-00 22.65 50% 11.32
Please see "Attachment E."
4. A. 05/27108 Members First Checking Account #232317-11 631.69 50% 315.84
Flease see "Attachment E."
TOTAL (Also enter on Line 6, Recapitulation) I $ 872.00
If more space is needed, use additional sheets of paper of the same size.
If an asset became iointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
REV-1510 E,<+ (GS-G9)
~~ ; pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
QOUGLASS E. FURST 21 09-1158
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSfEREE, THEIR RElAT30NSHiP TO DECEDENT AND
THE 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
1. Americhoice IRA Account #31668-21. (Julia F. Smith, beneficiary) 105,404.28 100 105,404.28
Please see "Attachment H."
2 Centric Bank IRA Acc,~unt #3021564. (Julia F. Smith, beneficiary} 100,000.00 100 100,000.00
Please see "Attachment D."
3 Graystone Bank Account #1730002639 (Julia F. Smith, beneficiary) 69,876.41 100 69,876.41
Please see "Attachment I."
4 Graystone Checking Account #1710000488 (Julia F. Smith, beneficiary) 2,920.84 100 2,920.84
Please see "Attachment I."
TOTAL (Also enter on tine 7, Recapitulation) $ ` 27$,201.53
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (1(l-Q9
`~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DOUGLASS E. FURST 21 09-1158
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1• 0.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) ----------------------_----_-----.-----_---------_._--_..__-._.__-___--
Street Address
City ------- --------------------------- ----------------- State -----
Year(s) Commission Paid: -------_-----_---.._.____--._.----_._---_.__--_-----.------.-------_-___-.---_---..___.----------._-__-.--
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address _ ___,_-.______^____
City _ __ _ ._...._-- _..-------_-------------..._---------- State __..__
Relationship of Claimant to Decedent ______,_____________ ____-_-____.-____
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
~~ Erie Insurance Hr,meowner's policy
s. Land Transfer title search
9. Advertising
~ o. Death certificates for deceased's mother
~~. Miscellaneous expenses
12. Checkbook print~~7g
ZIP
ZIP
10, 000.00
354.50
275.00
368.00
50.00
188.20
151.00
55.18
27.75
TOTAL (Also enter on Line 9, Recapitulation) f $ 11,469.63
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (1`1-081
~ pennsylvania
DEPARTMENT'OFREVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
DOUGLASS E. FURST 21 09-1158
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
~ pennsylvania SCHEDULE ]
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DOUGLASS E. FURST 21 09-1158
RELATIONSHIP TO DECEDENT AMOUNT OR ShiARE
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 • Julia F. Smith Sister
2. Karen G. Furst* Wife
*Filed for elective share under 20 P.S. 92201 and wiN be distributed the
real estate listed on Schedule A and the two automobiles listed on
Schedule E for assE~ts totaling $114,784 in value. ($112,959 + $1,000 +
$825.00 = $114,784} in satisfaction of claim
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE,
NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE ANEW GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space is needed, use additional sheets of paper of the same size.
213
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Attachment A
Historical Price Lookup -The Hershey Company Page 1 of 1
Choose a date and click the Get Quote button to retrieve stock data for that day.
Select Date December
As of 12/08/2009
Price
High
Low
Volume
Actual Price
Split Adjustment Factor
X35.58
$35.86
$35.29
872,700
$35.58
1:1
Get Quot~
NOTE- the Closing Price. Day's High. Gay's Low. and D~~y's Volume have been adjusted to .account for any stock split:
dividends which may have occurred for this securfiy since; the date shown above. T he t?ctuai ?r€ce ~s not adjusted for si
dividends. The Split Adjustment Factor is a cumulative factor whch encapsulates atl spots srn~e the date: showy above.
price above is nat necessarily indicative of future price performance
Copyright ~i 199$-2403 Market',/4'atch earn Inc. i.JSe' agreement applies Historical and curren~ end-of-day data provides
Interactive Data Corp. lrtraday data is et least 29-Iniilutel, decayed. kIi times are EDT Intraday data provided by S&P C
and subject to terms of use
~. a~~..,:.: _ ::. ~._: ~_ x,~ ~~;~.
Copyright Thy.; t+ershr-y Co--u~any Privacy Policy ~
Attachment B
http://www.thehersheycompany.com/ir/pricelookup.asp 1 /13/010
~' '{~
fY /~
.~
NdAkNiN(~:;~luilifl.ffi,iti_t1i-1:Alsr.~ .;',~ ~ ;iii, ii~.i'iiliF ;,.,..ail l~fl'~rtiiirlNl, •.ii~~ic11„cr.~,:f.i'liulr'. ii.'ri_,l,r,~iJf-rlf~i,.i, ,iri" .:' "` ~ ,,. r. . ., -.. ,. ,
i r i J ~Sl.sui, i.r 1 Ln ,~., .~rt.iJHirY fNtlOif.~t.Mt~~.l r~•",~tC.i, i uh ~i~~~r. raxltKMl~ltn ,~Nll ~~Si7l. i :t~~a,. r~,di,~f<(-'>.
Harris Central N.A. 70.1558
Prudential Roselle, Illinois 719
IMPORTANT TAX RETURN QOCUMENT ATTACHED
Pay to JULIE F SMITH EX EST DOUGLASS E FURST
Ci0 GEORGE W PORTER
909 EAST CHOCLATE AVE
HERSHEY PA 17033
The sum of $*`**FIVE THOUSAND ONE HUNDRED AND SIXTY THREE DOLLARS AND THIRTY EIGHT
CENTS **'*
Computershare, Inc.
250 Royals St, Canton, MA 02021
~' 1 S~uuf~y f~ahu~aa rkt~lw nn Mack.
l~'0000 ~ ~ 5 5 6 Lll' ~:0 ? ~ 9 ~ 5 580: 0 t,~~i 2 ~ 5~~i80 5~~f L~l'
'd01D AF fER 6 tv9aNTNS
Check Number: 0000175561
17 Feb 2010
$****5,163.38****
Compulershare, In .
Authorized Paying A nt
;- ~
~~ ,
~~~~ ~~~~
Authorized Signaturels) ~~`
Attachment C
George ~V. porter
Attorney at Lazy
909 East Chocolate Avenue
Hershey, PA 17033
I.D. #42752
Phone: (717) 533-7130 Fax: (717} 533-9209
December 17, 2009
Centric Bank
P.O. Box 62090
Harrisburg, PA. 17106-2090
Re: Estate of Douglas E. Furst, deceased.
S.S. #172-36-1707
Dear Sir/Madam:
The above-named Douglas E. Furst died on December 8, 2009. Our firm is assisting the personal
representatives of the decedent's estate in settling the estate.
Would you kindly inform this office if the decedent had any of the following with your bank or any
branches thereof, as of the time of death? Please complete this letter and return it to this office in the
enclosed envelope.
1. Savings Account:
Account in the name/manes of:
Account Number:
Account balance on date of death:
Any accrued interest from date of last
Payment to date of death:
2. Checking Account: ~..~~- ~ , , Sn~i~~
Account in the name/names of:
Account number: ~ 9il b L4 2
Account balance on date of death: ~ Z ~ `~
3. Money Market Account:
Account in the name/names of:
Account number:
Account balance on date of death:
Attachment D
i,f
Centric Bank
December 17, 2009
Page 2
4. Individual Retirement Account:
Account in the name/names of:
Account Number:
Date account established:
Account balance on date of death:
5. Safety Deposit Box:
Account in the name/names of:
Box Number:
Key Number:
6. Mortgates or other debt:
a. Type:
b. Balance due at death:
c. Life insurance, if any,
Covering debt:
7. Other relevant information, if any:
Certificates of Deposit:
Account in name/names of:
Account Number:
Date account established:
Face amount, and balance at
Date of death:
~ ~~f7~
~~Z~s~ -
g-t-C~
1 ot,, ooc~ , c7~ -
If there are joint accounts, please indicate how the joint ownership is held, e.g. "joint tenants with
the right of survivorship, etc." and the date the joint account was established.
Thank you for your consideration and assistance in this regard.
Very truly yours,
i _~~.
George W . otter
GWP/khan
Cc: Mrs. Julia Smith
2
~"
/,
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death.
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
VISA ACCOUNT:
Account Number/Suffix
Date Account Established
Balance at Date of Death
Name of Joint Cardholder
"Contractual Pledge of Shares
Estate of: DOUGLAS FURST
Date of Death: 12/08/2009
Social Security Number: 172-36-1707
~~~
MEMBERS lsr
FEDERAL CREDIT UMON
232317-00
07/05/2003
$22.65
$.00
$22.65
Julia Smith
05/27/2008
232317-11
07/05/2003
$631.69
$.00
$631.69
Julia Smith
05/27/2008
232317-40
02/20/2009
$42,000.00
$23.84
$42,023.84
Julia Smith
02/20/2009
4672090000284562'`
08/08/2007
$.00
None
RS 1ST F DER L CR ~~~~i~ANION
Danielle A. line
Insurance Services Specialist
December 24, 2009
Attachment E
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Attachment G ~
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_____.,
George ~V porter
Attorney at Law
909 East Chocolate Avenue
Hershey, PA 17033
I.D. #42752
Phone: (717) 533-7130
Fax: (717) 533-9209
December 17, 2009
Americhoice Federal Credit Union
9175 Bumblebee Hollow Drive
Mechanicsburg, PA 17055
Re: Estate of Douglas E. Furst, decease
S.S. #172-36-1707
Dear Sir/Madam:
The above-named Douglas E. Furst died on December 8, 2009. Our firth is assisting the personal
representatives of the decedent's estate in settling the estate.
Would you kindly inform this office if the decedent had any of the following with your bank or any
branches thereof, as of the time of death? Please complete this letter and return it to this office in the
enclosed envelope.
1. Savings Account: _
Account in the name/manes of: ~~ <<c~ ~ ~.s "r_ , r-- ~,~.~~:;t
7 ,
Account Number: ,~ s C.~~~ ~' -~ ~.~) (~ ~~
Account balance on date of death: `~ ~ 3 .`~ l
Any accrued interest from date of last .
Payment to date of death: iii ~' i~ ~,.
2. Checking Account: _
Account in the namelnames of: ~~- ~~ ~ ~5 ~ . ~- u.~',~~
Account number: _ _ __ _ ~_ 1 l,~ 1.,,c.b - ~ "~ _
Account balance on date of death: ~ t ~~ ..3~ ~
3. Money Market Account:
Account in the name/names of:
Account number:
Account balance on date of death:
1~ L~ r1 ~.
Attachment H
r
~1
' Americhoice Bank
December 17, 2009
Page 2
4. Individual Retirement Account:
Account in the name/names of: ! ~~%i~~-~~ ~5 ~'-~ . E'~~~ 5~1"
Account Number: '~ ~ ~ ~ ~ - ,~.. ~
Date account established: ~ ~.c.~ ~ ~., t ? ~ o c' ~;
Account balance on date of death: 1 ~ ~ , ~--~ v ~--(, ,~
5. Safety Deposit Box:
Account in the name/names of
Box Number:
Key Number:
6. Mortgages or other debt:
a. Type:
b. Balance due at death:
c. Life insurance, if any,
Covering debt:
7. Other relevant information, if any:
Certificates of Deposit:
Account in namelnames of:
Account Number:
Date account established:
Face amount, and balance at
Date of death:
N ,~' i -tom
1v . ,~~
Vii'°y~~
If there are joint accounts, please indicate how the joint ownership is held, e.g. "joint tenants with
the right of survivorship, etc." and the date the joint account was established.
Thank you for your consideration and assistance in this regard.
Very truly yours, ~,
~ ~ ~
~'' ~~~~~'~ `~~
~.~--t Cam" G,-'/.~1 ~ .
c~` ~ ~ . \ ~- Ct r l w t~. ~ 1 ~.- <.. ~. < <.~ C: ~L` `~C` ~ Z E.. (,C:~...- ~. `~
George W. P er
~ `~ , ;-~ a.s t tiro
C :~~ j r..t.C~.z l'~~
l~ i t Ir~.~ S
r
1 ~•
c• -~ -_>~.u" ~ i is ~ `~~ ~'.
GWP/khan
Cc: Mrs. Julia Smith
2
~~
SS
~g~
~~ti
~evrg~ `i~ Pnr~e~
~~~o~°xt~y a~ Lctrt.P
909 East Chocolate ~4,ven~xe
~-Tersh~y, PA 1'743
I.D. #42752
Phone: (717) X33-713Q Fax: (717) X33-9209
.lanuary ZIP, 2A l U
Graystone Towner Bank
359 Old Gettysburg Road
Camp dill, Pli 17011
fie: ~,y~~te of I)vuglixs ~: 1~"tsrsf, d~~r~ase~C
S.S. ~t ~2~-3~ ,~?fly
Deer ~ir'/Madam;
The al~ave-named D4u~lAS ~. Fu~t died on De~~'ibflr g, 2009. Oux firms is assisting the persar~ai
xeprasentatjves of tl~e decedent's est~~te in ~~ttljng the e~ffite.
Would yR?u~ kindly inform this office i~th~ de~COdQnt had any Qftlie following with yaut' b~k ~r any
branahos thccec~f, as o~il~e time of dea#h~ Please ac~~plAto tlti9 latter and return. it to this oi~ce in the
encluscd envelope.
1. Savln~s ,~ccQt~nx: i~
A,ccnun~t in the nam4(s) of; ~,~ ~ ! ~ t~
Account Nurnl~er: ~,~ ~~ c1v~ ~ ~ ~
Aecn~nt bala~ncc~ can dates of dez~th: ~ ~, ~ ~ ~ . '~ ~
t-.ny accrudd i~ntcrest from date vi' last
nay~nent to Date of death: / ~,~, ~b
r
Name afDeath E~c~ne.Llciary (if and}; ~2~L rte- ~Smf .
Data account ~Pencd: ^, c~ ~ ~[~~
AccUUnt in t~-e natri~(S) of
l~,cetiunt number:
Account balanec~ oi~ ~ci~ta of death:
Naz~ric cif Death Beneficiary {il'any):
Date account bperlGt.I:
~' ~ ~' .~~~ ~'. /wry ~'
l ~f"dD. l~f.~ '~ 1~~,
~oorzoo~ Attachment I x+~~ av:z~ o~oa~s~~~v
~/Z I96L-099-LZL ~u~) ~ue8 auo~s~Cea
J 89 ~8Z 6Z-u~['-OIOZ
LAST WILL AND TESTAMENT
of
DOUGLASS E. FURST
I, DOUGLASS E. FURST, of Mechanicsburg, County of Cumberland and
Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do
hereby make, publish and declare this as and for my Last Will and Testament, hereby
revoking all other Wills and Codicils heretofore made by me.
FIRST: I direct my funeral and last sickness expenses and my just debts to
be paid as soon as possible after the probate of this my Will. After the payment of my
debts and expenses, I give, devise and bequeath my property and estate as hereinafter
provided.
SECOND: All the rest, residue and remainder of my property and estate, real,
personal or mixed, wheresoever situate and of whatsoever the same may consist, I give,
devise and bequeath to my sister, JULIA F. SMITH, per stirpes.
THIRD: I hereby authorize and empower my Executrix and Trustee to
lease, mortgage, pledge, sell or convey any and all of my estate, real, personal and mixed,
using her discretion as to the manner, time and terms thereof, and to convey the same by
proper deeds or other instruments, and no person dealing with my said Executrix or
Trustee shall be responsible for the application of any proceeds or purchase monies. I
.. ~~--~
Douglass E. urst
Page 1 of 4 pages
further authorize my Executrix and Trustee to manage my estate and property and to
invest and reinvest the principal thereof at her discretion in such form of investment as
may commend itself to the best judgment of my said Executrix and Trustee.
FOURTH: All estate, inheritance, succession and other death taxes, imposed
or payable by reason of my death, and interest and penalties thereon, with respect to all
property comprising my gross estate for death tax purposes, whether or not such property
passes under this Will, shall be paid out of the principal of my general estate, as if such
taxes were administration expense, without apportionment or right of reimbursement. I
authorize my legal representatives to pay all such taxes at such time or times as may be
deemed advisable.
FIFTH: I nominate, constitute and appoint my sister, Julia F. Smith, to be
the Executrix of this my Last Will and Testament.
SIXTH: I direct that no Executor or Trustee or Guardian shall be required
to give any bond, and that if, notwithstanding this direction, any bond is required by any
law, statute or rule of court, no surety shall be required thereon.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~'~ day
of f~ r ~ ~ , A.D., 2006.
Douglass E. urst
Page 2 of 4 pages
SIGNED, SEALED, PUBLISHED, and DECLARED by Douglass E. Furst,
Testator above named, as and for his Last Will and Testament, and we, at his request, in
his presence, and in the presence of each other, have subscribed our names as attesting
witnesses thereof.
~~c,~' Address ~t1lt~ S'wer 5^' ~, ~ ~ .
Testator
~e~ ~~'} 17 b~3-C-
?.~C'~`,. /'~ , y:t _ Address ,~~= ,~ L~.,~ ~ ~% 1. , .c ,~v ~,(-,
,~.
Witness
Address ® _
Witness
7v
Page 3 of 4 pages
STATE OF PENNSYLVANIA
COUNTY OF ~Gt GC;~ h.l rl...-
SS
.~
and v~~ ~ ~'% ~{ ~'L-- ~ ~ ~.-~ ~~ ~t ~~l ,the Testator and the witnesses,
respectively, whose names are signed to the aforegoing Will, being first duly sworn, do
hereby declare to the undersigned authority that the Testator signed and executed the
foregoing instrument as his Last Will and Testament in the presence and hearing of the
witnesses and that he had signed willingly and that he executed it as his free and
voluntary act for the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator and each other, signed the Will as witness and that
to the best of their knowledge, the Testator was at the time eighteen years of age or older.,
being of sound mind and under no constraint or undue influence.
Testator
Subscribed, sworn to and acknowledged before me by Douglass E. Furst, the
,~
Testator, and subscribed and sworn to before me by C-~ -~o r~~ L't.~ s ~ ~y ~ ~ ~~ and
r ,/ j ~~ ~ ~ , ~ ~~ ~ ~ ,witnesses, this ~ ~-{~~ day of ~,d r ~
2006.
t'-` _ o
~~ ~~
~~ SEA NOTARY PUBL C
E~ ~, ~~~ Page 4 of 4 pages
Notary PubYc
PALMYRA BOROUGH, LE4MION COlM11Y
MY Commiaaion ExpNea Nov 2, 2004
George ~N. ~''orter
~t.ttorney at Law
909 fast Cfuicolate Avenue
~-lersFiet~, Pennsylvani417033
I.?~. #42752
September 7, 2010
(~1 T) 533-7.130
SAX (~1 ~) 533-9209
Register of Wills for Cumberland County
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Douglass E. Furst, deceased.
File No. 21-09-1158
Dear Sir/Madam:
Enclosed please find two originals of the inheritance tax return
in the above-referenced estate for filing with your off ice.
Also enclosed is a copy of the tax return which I ask that you
time-stamp and return to my off ice in the enclosed envelope.
Also enclosed are two checks: First, a check to the order of
the Register of Wills in the amount of $65.00 which covers the
filing fee and additional letters in the above estate. Second,
a check in the amount of $40,857.62 made payable to "Register of
Wills, Agent" which represents the inheritance tax due in the
estate.
Thank you for your attention to this letter.
Very truly yours,
'
1~/
~' te
'
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a
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r-,
°~sr`~ ,
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, ~~ n .~; -
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George T~: Porter ~ ~ ~ ~' ~'
GWP/vet ~ rn ~ -:; ;
Enclosures cn~ 4° ~
~-'
CC : Ms . Julia F . Smith, Executrix ~--7a~ _
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