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HomeMy WebLinkAbout09-23-10 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 10 0261 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 205-26-2115 02/25/2010 07/02/1928 Decedent's Last Name Suffix Decedent's First Name MI Bonin Martha G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~; 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) •- 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULCI BE DIRECTED T0: Name Daytime Telephone Number ti~~ Lisa Marie Coyne, Esq. (717) 737-046c~ ~, _. , C d. Firm Name (If Applicable) ~"` ~ ~_ _ ~ -' . q~ (`~( ~"` b#ESBi~TER ~J1./'.IfIRM.SE S..l'~.y ~. - .i~r a Coyne & Coyne, P.C. =~? ,,'~L~;m N ~-~ __.~~ ~ First line of address - ~ ~°~ ~%~ L'3 s'~ ' r 3901 Market Street ~~ C'~ ~ 'Z7 _-~. c_~~a-~ ;~ ~--. -_- Second line of address r~~ ~_ ... ', ~~ ;; "" `-~ ~ ~--~ N _..~. z L^ City or Post Office State ZIP Code UAtIW F~tt.LD Camp Hill PA 17011 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer h:as any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE . %~ ADDRESS Carol L. Maurer 3541 March Drive, Camp Hill, PA 17011 __ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Martha G Bonin Decedent's Name: 205-26-2115 RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. 0.00 2. Stocks and Bonds (Schedule B) .................................... ... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 68,912.90 6. Jointly Owned Property (Schedule F) Separate Billing Requested .... ... 6. 75,536.86 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 'a' Separate Billing Requested..... ... 7. 163,386.59 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 307,836.35 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 33,615.88 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 7,856.08 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 41,471.96 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 266,364.39 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. 266,364.39 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 266,364.39 18 39,954.66 19. TAX DUE .. . ................................................... ... 19. 39,954.66 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~; 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 10 o2s1 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Martha G Bonin 205-26-2115 _ --- -- - STREETADDRESS _ _ _ __ - 3541 March Drive ~_ CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 39,954.66 2. Credits/Payments A. Spousal Poverty Credit _ _ _ __ ___ B. Prior Payments 39,200.00 C. Discount _ -- - _ _ - ---- 1,997.73 - _- _- _ Total Credits A + B + C 2 ( ) () 41,197.73 3. Interest/Penalty if applicable D. Interest -- - E. Penalty _ _ - --- Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 1,243.07 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 6. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 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 :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ [~ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982; did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not 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, or a stepparent of the child is zero (0) percent [72 P.S. §9116(x)(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(x)(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(x)(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+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Martha G. Bonin 21-10-0261 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. (If more space is needed, insert additional sheets of the same size) -- - ,~~ ~ 111 ~:'~'"''. F,,~ ~~ Coyne 8~ Coyne 3901 Market Street Camp Hill, PA 1 70 1 1-4227 www. fnb-online. com Info-Line 1-800-817-8787 Customer Service 1-800-~55-5455 April 7, 2010 D ~C~(~ aPR - y 200 RE: ESTATE OF MARTHA G. BONIN SSN:205-26-2115 DOD: 2/25/10 Dear Sir or Madam, As .per your request, the following information is provided as of Date of Death: Savings # 100049808 Opened 2/15/02 Titled Martha Gloria Bonin Balance $100.70 Accrued Interest $.02 If you should have any further questions, please do not hesitate to contact me at 724-983-6068. Very truly yours FIRST NATIONAL BANK ~~~ ~ ~~~~ Deborah L. Bartosh IO PEl~1N „ BANKING I INSURANCE I INVESTMENTS I TRUST March 24, 2010 U ~ ~ ~ Q Lisa Marie Coyne MAR 2 ~ 2010 Coyne & Coyne Attorneys at Law B 3901 Market Street Y Camp Hill, PA 17011-4227 -!~' RE: Estate of Martha G. Bonin Dear Ms. Coyne: Listed below is the information you requested concerning the account(s) held b,y the above-name decedent with our bank. The balances were taken as of the date of death, February 25, 2010. #9517066406 Certificate of Deposit: Martha Gloria Bronin Opened: Mary 31, 2006 Balance: $54,465.72 + $1,148.23 Accrued Interest Date Rolled Over: May 31, 2008 If you have any further questions, please contact me at 610-369-6358. Sincere) , ~~~ DIANE L. MASON Assistant Vice President DLM:rms 1.800.822.3321 I www.nationalpenn.com I Philadelphia & Reading Avenues I P.O. Box 547 I Boyertown, f'A 19512 Member FQIC I Equal Opportunity Lender ' SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ___ _ __ __ ESTATE OF FILE NUMBER BONIN, MARTHA G 21 - 2010 - __ 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 TO DECEDENT A Carol Maurer Niece JOINTLY OWNED PROPERTY: ITEM LETTER FOR JOINT DATE MADE DESCRIPTION OF PROPERTY Include name of financial institution and bank account number . DATE OF DEATH % OF DATE OF DEATH DECD' NUMBER TENANT JOINT 'or similar identifying number. Attach deed for jointly-held real t VALUE OF ASSET I S VALUE OF NTEREST DE - estate. C EDENrs w rEREST 1 A 03/15/2008 Citizens Bank 20.84 ~0`%, 10.42 Checking Acct. 2 ~, A 09/13%2008 ' Citizens Bank 2,440.27. 50% 1,2.20.14 Checking Acct. 3 I A 07/29!1996 ;Bank of America 23,468.32'~~ .SO% 11,734.16 CD 4 A 07/29/2002 ', Bank of America 43,868.17 50°/~ 21,9 34.09 CD '' 5 A 04/02/2002 Bank of America 26,656.77 50%~ 13,328.39 'CD 6 A 01/03/2005 ~ PNC Bank 5,389.36 SO% 2,694.68 Checking Acct. 7 A 05/25/2006 ,PNC Bank 49,229.95 50`% 24,614.98 Savings Acct. i TOTAL (Also enter on line 6, Recapitulation) 75,536.86 5701 Horatio Street Utica, NY 13502 May 3, 2010 ~~:GI~'~ a ~ V'I Iii MAY , _ to o BankofAmerica''I Coyne & Coyne 3901 Market St Camp Hill, PA 17011 RE: Reference #: 0040610000483 Estate of: Martha Bonin (Date of Death-2/25/10] Below find financial information requested on accounts held in the name of the above-captioned decedent as of date of death: .................................. ccount Number: **********6719 CD Date of Death Balance: $23,468.32 ccrued Interest: $10.81 Status: ctive Opened 7/29/96 Martha Gloria Bonin itle: Mildred A Bonin - - .. Carol L Maurer Current Balancer $23,468..32 . ccount Number: ___ _ _ **********7743 CD Date of Death.. Balance: $43,868.17 ccrued Interest: _. 8.95 tatus: ctive Opened 3/21/02 itle: Martha Gloria Bonin Carol L Maurer Current Balance: $43,868.17 _ _ -- ccount Number: --_..~V....__w,..~_ ..~_ **********7794 CD Date of Death. Balance: $26,656.77 ccrued Interest: $26.12 tatus: ctive Opened 4/2/02 itle: Martha Gloria Bonin Carol L Maurer No Safe Deposit Box found. Please note additional requests for information not related to date of death values or to close accounts. . should be directed to Bank of America Sales and Service Support at - - , . _ Bank of America Legal Correspondence R.S. & S. Center FL1-300-01-29 4109 Gandy Blvd Tampa, FL 33611 ioRecycled Paper i If you have any questions, please contact the party listed below. Should you need to forward any additional correspondence to us regarding this matter, please direct it to the address noted above. When contacting the Bank regarding this request please use the Reference # U040610000483. Sincerely, Operations Representative 315-738-5630 option 6 Account Number 622291973 5 Account Title MARTHA GLORIA BONIN OR CAROL M.AURER Date Opened 9/13/2008 Account Type Checking Principal Balance as of DOD $2440.27 Interest from Last Posting to DOD $ .00 ----, Account Balance as of DOD $2440.27 YTD Interest to DOD $1.96 T~ Citizens Bank D C~ (~ [~ ~ MAR 2 s 200 Account Number 6220674026 Account Title MARTHA GLORIA BONIN OR CAROL MAURER Date O ened 3/15/2008 Account Type Checking Principal Balance as of DOD _ $20.84 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $20.84 YTD Interest to DOD $ .Ol r~pr i~. IUIU 1U:~+Vnivi riuL ffriivn ~}i[`7U7~LT~T fi, + ~ ~ Ems' I . ^ QPNC ~ c~?~iG~E1ArAY Apxil 13, 2Q10 Lisa Marie Coyne Coyne ~& Coyne P.C. 3901 Market St Camp HiIX, PA 1 701 1-4227' RE: Martha Gloria Bonin SSN: 205-26-Z 115 DUD: ~ 02-25-2010 Dear Ms. Coyne: I~ ,T- Uzf~ J Tr; I _ In response to yaur request for Date of Death (DOD} balances for the customer noted above, our xecQrds shQw~the following: ~b@C]~~ ACCULIIIt Account # 9202513331 Established: 01-03-2005 1'vL4RTHA Cr B UNIlv CAROL L MAURER _ DOD balance: $ 5,359.21 + 0.15 accrued interest Savings Ascouat . Account # 500498133 9 Fstablislicd: +~5-25-240 MARTIiA GLQR~A, BQ~tIN CAROL L MAURER D(~D balance: $ 49,225.24 + 4.71 accrued interest Investment Account The decedent maintained InveStmetlt Account 1,6$34244.. For further infororation, you m.ay call the Brokerage Department at 1-500-762-6111. Page 1 of 2 A~ r I j. LU IU IU:4UHM rIV(~ ~HN~ 4T~1U7'L l~l Saf+c DepQSit ~o~c The decedent maintained safe deposit box 0453 MARTHA CrLORIA $ONIN Located at: ~ . 32nd Street $ranch . 140Q Camp Hill Shopping Center Camp Hill, PA ~ 7Q11 (717 761-2099 Vo, U~S~ ~'; _ 1 Please note that this a~iee provides date of death balances for deposit accourns (IRAs, CDs, Checking and Savings). We dc~ no# process ~ fi~na~tcial trstnsactians or provide statemeat~. I~you need assistance with any of these items, please call l -88 8-P1~1C-B,A~ (1-8$$762-?~~5~ or stop by Your local PNC ]Bank branch Qf#ice. Sincerely, National Financial Services Center FNC Bank, N,A. Member FDIC Page 2 of 2 REV-_'~tI(l E;x:-r ir4-U~? ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUML~ER Martha G. Bonin 21-~10-0261 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-15()0 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAhIE OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT ANU THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION l~ Ai'r-'JC=~.o." T,4XAB~E `4'ALUE i~ Allstate Annuity Contract No. GA16879847 Benefiary is Carol Maurer (Sole Residual Heir) 136,282.35 136,282.3: 2 Western National Life Annuity-- Policy No. 1WY02640 27,104.24 27 104 2 Beneficiary is Carol Maurer (Sole Residual Heir) , . NOTE----SEPARATE BILLING REQUESTED FOR THE FOLLOWING: 1 Allstate Annuity Contract. No. GA166881072----$136 282.35 , Benef: Robert Choma, 2145 15 Street, Bethlehem, PA 18020 (Nephew) 136,282.35 2 Allstate Annuity Contract No. GA16881071---$136,282.35 Benef: Theodore Bonin, 821 Peace Street, Hazleton, PA 18201 (Nephew) 136,282.35 3 Allstate Annuity Contract No. GA16881055--$136,282.35 ~ Benef: Daniel Palerma, 70 West Juniper Street, Apt. 305, Hazleton, PA 1820 136,282,35 ~ 4 Allstate Annuity Contract No. GA16881057---$16287.79 Benef: Hilary Bonin, 99 W. Green Street, West Hazleton, PA 18202 (Nephew 136,287.79 ----1 ------ TOTAL (Also enter on Line 7, Recapitulation) $ ~ 163, 386.59 If more space is needed, use additional sheets of paper of the same size. Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 May 19, 2010 Lisa Coyne Coyne & Coyne PC 3901 Market Street Camp Hill, PA 17011-4227 ~~ _ ~ ~ iR; You`re in €~o~d hands. ~--~ a Inl May `~ 5 2~~0 ~- Re: PJiartha G. Bonin Dear Ms. Coyne: We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the. owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Contract No: Date Opened: Ownership: Date of Death: Annuity Value as of Date of Death Cost Basis: Maturity Date: Interest Rate: Named Beneficiary: GA16879847 October 30, 2003 Martha G. Bonin February 25, 2010 $ 1.36,282,35* $ 133,627.00 10-29-2010 2% Carol Maurer *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 24654. ,Sincerely, Donna Gray Sr. Claim Examiner Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (86b) 635-4523 May 19, 2010 Lisa Coyne Coyne & Coyne PC 3901 Market Street Camp Hill, PA 17011-4227 Re: Martha G. Bonin Dear Ms. Coyne: D C~(~~ ~ MAY 2 5 2010 I We received a request to complete IRS Form 712 for the above referenced contract. The puri~ose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds a.s of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however„ provide the following information for estate purposes: Contract No: GA16881057 Date Opened: October 30, 2003 Ownership: Martha G. Bonin Date of Death: February 25, 2010 Annuity Value as of Date of Death: $ 136,287.79* Cost Basis: ~$ 1.28,627.00. Maturity Date: 10-29-2010 Interest Rate: 2% Named Beneficiary: Hilary Bonin *The actual amount paid may differ due to Market Value Adj ustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 24654. Sincerely, Donna Gray Sr. Claim Examiner You`re in ,load hands:. a Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 May 19, 2010 Lisa Coyne Coyne & Coyne PC 3901 Market Street Camp Hill, PA 1 70 1 1-4227 ~~ ~ «~ 1'au`re in 1~aod han~$:, L~ ~ l% ~ it IJ ~~lil ~~ MAY E 5 2010 L' Re: Martha G. Bonin - Dear Ms. Coyne: We received a request to complete IRS Form 712 for the above referenced contract. The pur)~ose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however., provide the following information for estate purposes: Contract No: GA16881055 Date Opened: October 30, 2003 Ownership:. Martha G. Bonin Date of Death: February 25, 2010 Annuity Value as of Date of Death: $ 136,282.35* Cost Basis: $ 133,627.00 Maturity Date: 10-29-2010 Interest Rate: 2% Named Beneficiary: Daniel Palerma *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 24654. Sincerely, Donna Gray Sr. Claim Examiner Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 Ydu`re in fond hands.. May 19, 2010 Lisa Coyne Coyne & Coyne PC 3901 Market Street Camp Hill, PA 17011-4227 D L~(~~ ~ ~ MAY 2 5 2010 Re: Martha G. Bonin Dear Ms. Coyne: We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death, or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Contract No: GA166881072 Date Opened: October 30, 2003 Ownership: Martha G. Bonin Date of Death: February 25, 2010 Annuity Value as of Date of Death: $ 136,282.35* Cost Basis: $ 133627.00 Maturity Date: 10-29-2010 Interest Rate: 2% Named Beneficiary: Robert Choma *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 24654. Sincerely, Donna Gray Sr. Claim Examiner Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsinule: (866) 635-4523 May 19, 2010 Lisa Coyne Coyne & Coyne PC 3901 Market Street Camp Hill, SPA 17011-4227 Re: Martha G. Bonin Dear Ms. Coyne: l MAY 2 ~ 2010 ID We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Contract No: Date Opened: Ownership: Date of Death: Annuity Value as of Date of Death: Cost Basis: Maturity Date: Interest Rate: Named Beneficiary: ~~ ~ ~ «~. ~~u`re in good hands..: GA16881071 October 30, 2003 Martha. G. Bonin February 25, 2010 $ 136,282.35* $ 133,627.00 10-29-2010 2% Theodore Bonin *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges: If you have any questions, please contact me at 1-877-499-6418 Ext. 24654. Sincerely, C Donna Gray Sr. Claim Examiner _ SCHEDULE H ' ` ~ ~' FUNERAL FDCPENSES & COMMONWEALTH OF PENNSYLVANIA ~~~~~ ~~ INHERITANCE TAX RETURN RESIDENT DECEDENT _._ _ __ __ _ __. ESTATE OF BONIN, MARTHA G Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER' __ __ _ ~ -. __ __ A, FUNERAL EXPENSES: 1. ~ Hilary J. Bonin Funeral Home 2. I Diocese of Scranton--Grave Opening and Headstone Engraving 3. Niell Funeral Home 4. Honorarium for Priest and Pall Bearers 5. Flowers 6. Receptions B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Coyne & Coyne, P.C. 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant _ - _ Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Prothonotary 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 ', Filing Fee-- Inheritance Tax Return 2 ~' Extra Death Certificates FILE NUMBER 21 - 2010 - AMOUNT 7,500.00 850.00 599.00 300.00 318.00 800.00 1.5,000.00 95.50 15.00 60.00 Total of Continuation Schedule(s) 8,078.38 TOTAL (Also enter on line 9, Recapitulation) 33,615.88 Seale H ,. COMMONWEALTH OF PENNSYLVANIA Funer~ -'(--IlSeS INHERITANCE TAX RETURN ~?1jt11S"tt'c~V6- ~'(~ G~Ot1tiCllaeCl RESIDENT DECEDENT ESTATE OF BONIN, MARTHA G __ _. 3 Overnight Mailings 4 Postage 5 ~ Estate Checks 6 Patriot News-- Legal Advertisement 7 Cumberland Law Journal-- Legal Advertisement 8 Bank of America-- Bank Certification Fee for DOD Balances 9 Cleaning and Clearing.of Decedent's Room 10 ~' Wire Income Tax Preparation Fees 11 ~ Income Taxes Due 12 Reserves 13 Long Distance Charges for Executrix 1~ Missed Days of Work for Executrix FILE NUMBER 21 - 2010 - 100.1)0 88.00 ?~.OO 12 x.38 75.00 20.00 100.00 850.00 147.C-0 5,000.00 50.00 1,500.00 Page 2 of Schedule H . ~ SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE O F BONIN, MARTHA G FILE NUMBER 21 - 2010 - Include un reimbursed medical expenses. ITEM -- __ NUMBER DESCRIPTION AMOUNT -_ 1 _-- - AARP Health Insurance 185.75 2 Allstate Insurance 107.19 3 Uncleared checks 1, 7 3U.UU 4 Country Meadows Nursing Home 5, 542.93 5 West Shore EMS 176.03 6 Holy Spirit Hospital 1 14.18 TOTAL (Also enter on Line 10, Recapitulation) 7 856.08 RfV•1513 EX+ (9.00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT _._ I ESTATE OF FILE NUMBER BONIN, MARTHA G 21 - 2010 - RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do. Not List Trustee(s) __ __ __ I TAXABLE DISTRIBUTIONS (include outright spousal distributions) Niece 1O0'%~~ ~t~ Residual 1 Carol Maurer Estate Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shE~et II. ~! NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT 'BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET No. 20/0- 00269 PA No. 29- 90- 026/ Estate Of : MARTHA G BONIN (/-first, Middle, Last) Late Of : HAMPDEN TOWNSHIP CUMBER, LAND COUNTY Deceased Soci a1 Security No : 205-26-2 9 95 WHEREAS, on the 17th day of March 2 010 an instrument dated February 11th 2005 was admitted to probate as the last will of MARTHA G BONIN /rust, Midd/e, Last) late of HAMPDEN TOWNSH/P, CUMBERLAND County, who died on the 25th day of February 2010 and WHEREAS, a true copy of the will as probated i s annexed hereto . THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Geri 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: CA ROL L MA URER who has duly qualified as EXECUTOR(R%X) and has agreed to administer the estate according to law, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CA RL lSL E, PENNS YL VAN/A . IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 97th day of March 2090, * *NOTE * * ALL NAMES ABOVE APPEAR ~ ~ (FIRST, MSDDL~,, LAST; I -_ ' -- - _ 1 - -- _ I l Last V~lill aid Testament BE IT KNOWN that I, n ~~^~ r~ L~~~~ , ~ ~,:~,~~,,~,,, [Name of Testator], ~, a resident of ~ .~~,~~,~ .~.,_.~ ,County of ~ ~~ ~f~~, in the State of '~n„-~ 4 ~ ~,~.~~~J..~ ,being of sound and disposing mind and memory and over the age of eighteen (18) years, and not being actuated by any duress, menace, fraud, mistake or undue influence, do make, publish and declare this to be my last Will and Testament, hereby revoking all my prior Wills and Codicils at any time. made. I. MARRIAGE AND CHILDREN: I am married to ,and all references in this Will to my [him or her]. I have the following children: ,`~~` Y~ [husband or wifej are references to Name: Name: Name: Name: II. EXECUTOR: Date of Birth: Date of Birth: Date of Birth: Date of Birth: ~ s ~ ` /~, ~T1 r I a ppoi nt /~,~.~~.c.--L~ :~~-~~ i ~ ;~ ~ L h ~ of , _ .~=-~- ~ ~• .. ~~:1'?~ ~ ~~~,~~, ,1~,,~;'~ , as Executor of this my Last Will and Testament and provide that if this Executor is unable or unwillin to serve then I a oint `~' '~ f - { alternate Executor. My Executor shall be authorized to carry out all provisions of this Will and pay my just debts, obligations and funeral expenses. I r'urther provide my Executor shall not be required to post surety bond in this or any othe~urisdiction, aia~ _,.; direct that no expert appraisal be made of my estate unless required by law, c;'/ ~ ~ =~` `~--` -, ~ .~ ~~ ~ - T~7'Z.7 ,, . r t --~ C~ ~.~ f `'_~ I(I. GUARDIAN: ~~ ~ ='-~ `~ ~ `~ ---- ~ ~ ~ ~--m ' t ..r ~--^~--t In the event I shall die as the sole parent of minor childreh, then I appoint ~--~~ ~:~; -~~-~ - _~~t ti s t..__ _..:.._ ~~ as Guardian of said minor children. If this named Guardiaitis~~able or ~.:~ y~-=~ unwilling to serve, then 1 appoint as alternate Guardian. ° IV. BEQUESTS: _ ~~ I direct that after payment of all my just debts, my property be bequeathed in the manner following: ~~~ _t% / Name: ~~..~-.;~!'~~ ~~,~a ~~ .~ Address: ,3 5r ~ I ~??r.,~,~.~, ,~~~n~, Relationship: Property.: Name: f' Address: _ Relationship: Property: Page 1 wwwsocrates.corn ©ZOOG, Socrates Media, LLC Name: Relationship: Name: Relationship: Address: Property: ... Address: Property: V. SIMULTANEOUS DEATH OF SPOUSE: ~'~~ -'~ In the event that my [husband or wife} shall die simultaneously. with me or there is no direct evidence to establish that my [husband or wife] and 1 died other than simultaneously, Idirect that [I or my husband or wife) shall be deemed to have predeceased [me or my husband or wife}, notwith- standing any provision of law to the contrary, and that the provisions of my Will shall be construed on such presumption. VI. SIMULTANEOUS DEATH OF BENEFICIARY ~i~- ~ If any beneficiary of this Will, including any beneficiary or any trust established by this Will, other than my ! (hus- band or wife], sha{I die within 60 days of my death or prior to the distribution of my estate, I hereby declare that I shall be deemed to have suivived such person. VlI. ALL REMAINING PROPERTY; RESIDUARY CLAUSE: ~'Vj I give, devise and bequeath a{I of the rest, residue and remainder of my .estate, of whatever kind and character, and wherever located, to my [husband or wife], provided that my [husband or wife] survives me. I make no provision for my children, knowing that, as their parent, my [husband or wife] will continue to be mindful of their needs aril requirements. If my [husband or wife] does not survive me, then I give, dev~se and bequeath all of the rest, residue and remainder of my estate, of whatever kind and character, and wherever located, to my chiidrer~ per share; but if any child predeceases me, then his or her share will pass, per share, to his or her lineal descendant<_, natural or adopted; if any, who survive me; but if there are none, then his or her share wiN lapse and pass equally as part of the shares of my other named children; but if none of my named children survives me or leaves a lineal descendant who survives me, then according to the order of intestate succession iri the State of VIII. ADDITIONAL POWERS OF THE EXECUTOR: My Executor shall have the following additional powers with respect to my estate, to be exercised from time to time at my Executor's discretion without further license or order of any court: - r, Page Z wwwsocrates.com C) 2004, Socrates Media, LLC IX. OPTIONAL PROVISIONS: - I have placed my initials next to the provisions below that I adopt as part of this Will. Any unmarked provision is not adopted by, me and is not part of this Will. _ ~~ If any beneficiary to this Will is indebted to me at the time of my death, and the beneficiary evidences this debt by a valid Promissory Note payable to me, then such person's portion of my estate shall be diminished by the amount of such debt. :(: tt: Any and all debts of my estate sh~`II first be paid from my residuary estate. Any debts on any real property be- queathed in this Will shall be assumed by the person to receive such real property and not paid by my Executor. I direct that my remains be cremated and that the ashes be disposed of according to the wishes of my Executor. I direct that my remains be cremated and that the ashes be disposed of in the following manner: I desire to be buried in the ~~~~t,~ ~~~--C~t~ cemetery in :~ ~~~~~~..~ •- ~~ County, ~ ~., X. SEVERABILITY AND SURVIVAL :, If any part of this Wi{I is declared invalid, illegal or-inoperative for any reason, it is my intent that the remaining parts shall be effective and fully operative, and that any Court so interpreting this Will and any provision in it construe in favor of survival. Testator's initials: ~~ (r ~ ~~_ ~ _- ~ ~~ ~' Execute and attest befare a notary. ~ ~ --c., ~-~- Caution: Louisiana residents should consult an attorney befare preparing a will. _~_==} =s.~ ~ ,__ --- ~r~ .~ !N WITNESS WHEREOF, I have hereunto set my hand this~_ day of /~-~' !.3 ``-..i ~ ~ ~--`' , --, ~-`C~ ~ (year), to this, my Last Will and Testament. <~~ =..~ `~ .___ _ ~ a Testator Signature:1~~ ~.~~~~ f.~r~~~~=~ ~~, ~,_.~.r~' _ X!. WITNESSED: The testator has signed this will at the end and on each other separate page, and has declared or signified in our pres- ei~ce that it is his/her last will and testament, and in the presence of the testator and each other we have hereunto subscribed our names this ! ~' ~-, ,r._of f= ~-E' U~ , 20 C`~ 5~ l ~, 'A'itness Signature: --s~.~ `~ ~. Address. ~-. ,4-v ~"~... ~ /`f',~T'L- ~ l ~ 7 v wv~n~socsates.com Page 3 ~r- _~ -, . - - ~- '.a ~_~~' - _, _.. } ~.'~ ..~. © ?C04, Soaates PJ~edia, LLB , Witness Signature: Address: Witness Signature: Address: ACKNOWLiE©GMENT State of County of We, , ,and the testator and the witnesses, respectively, whose names are signed to the attached and foregoing instrument; were sworn and declared to the undersigned that the testator signed the instrument as his/her Last Will and that each of the witnesses, in the presence of the testator and each other, signed the wil{ as a witness. Testator: Witness: Witness: Witness: On ;;~ '-( f' ~~' ~ before me, J ~! ~~( ,, /t{, /~t,~ ~-'1~ ~,~ ,appeared ' r~~ ~~->'~~- t~`~cr'~ 1` r'; ~~tvr` ~/ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged tc me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instru- mentthe persons}, or the entity u on behalfpf which the person(s) acted, executed the instrument. WITNESS my hand and official seal`'.:. !'' ,~'~ 1« !~ ,~ Signature of Notary: ~~ 1~ __ ,~ ' _ NOTARIAL SEAL JOHN M. MUNDIE, NOTARY PUBLIC '' .!WEST NAZLETON BORO, LUZERNE COUNTY MY CaMM{SSION EXPfRES DEB. 29, 2006 ~--~~ ~,~ Affiant Known_ Produced ID Type of ID b 1~, ~ ~,~ ~ ~2 ~ ~- c ~ ~?., ~~ (Seal} Page 4 J wwwsocrates.com ©Z004, Socrates f/~edia, LL= ~~ iii A PROFESSIONAL CORPORATION ~ ~ ~ `''" ' ~~ ATTORNEYS AT LAW Henry F. Coyne 3901 Market Street 717-737-0464 Lisa Marie Coyne Camp Hill, Pennsylvania C~~~ ~~ Fax: '717-737-5161 Jaime L. High 17011-4227 Q~P'S ~~UR .coyneandcoyne.com CUMP~R~ _~'4~? CCU . PA September 21, 2010 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Martha G. Bonin, Deceased No. 21-10-0261 Dear Madam: We represent the Estate of the Late Martha G. Bonin. Enclosed please find an original and two (2) copies of the Inheritance Tax Return for this Estate. Please docket the original and return to this office a "clocked-in" copy with the enclosed envelope. Also enclosed is check no. 6771 in the amount of $15.00 which is the filing fee for this matter. Thank you for your assistance. If you have any questions, please contact me. Very truly yours, COYNE & COYNE, P.C. /~~'' L ~ Marie Coyne LMC/amd Enclosure ° Cc: Mrs. Carol Maurer, Executrix ,, w~~ 1t k 4 ~Q 1 ~ ~^~ I s~ ~~ 1~ Q 1~ ~~ ~1 ~` ~~- ~, ,'~ N~ i <~ ~ ~~ a ~w~ ~ w ~~ ~ ~ ~ _ V T d ~-I ~ ~ ._...._. ~ W Y z~~ ~ cti ...._. Z Q J_ 0 ~ 2 ~ ~ ~ ..r. ', O T ~ O a Q M .j 0 ~ 1 VJ H -~ U ~ - ~ ~ . V v ~ ~~~ ' ~ ~ ._. • ~ ~. ~ ,.fl U ..~. ~ao ~ a~ ~'., ~ i • ~ U OU ~'_. O ..w- • .• ~ F- __... ..~... ~ ~ __... z x'_ ~; ~ . . d ~ ~ ~ .~, ~ ~ lei ~~~"~~ . I`~ ,'~ ., y ,~~t~ h r . r ' .., j, f' ~ ,. ~ Y . .. ZY ~' , ti- F, ~ ~Pr 'F,'- t~ ,} r ~~~ ~~ ~ , - a ' } ~'~ ^ ~ :. .~ ~ ~t ~ ~ i. ~v ~~~" ~ r ~ ~ . M ..'^t