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HomeMy WebLinkAbout12-20-101505610101 REV 1500 °` t°~_~°' OFFICIAL USE ONLY PA Department of Revenue Perrtsytvama County Code Year file Number ~a Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg. PA i~izs-os01 RESIDENT DECEDENT ~ ~ ~ 0 6 ENTER DECEDENT INFORIA~4TION BELOW So~cial~~Security Number Date of Death MMDDYYYY .~-..1 ~ I ~ ~aT O) ~ DeoedenYs Last Name Suffix A1oN DQ (If Applicable) Entsr Surviving Spouse's IMormation Below Date of Birth MMDDYYYY ~ 7 Decedent's First Name MI Al E I C O Spouse's Last Name Suffix Spouse's First Name MI ®~1~T1'T~'1"1TT~fT1 ^ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL.IN APPROPRWTE OVALS BELOW f• 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13-82) O 4. Limked Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) tfi~ 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 SECTiiON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Cy~-RL s F ~N~ ~ i~ ~ o ~. First line of address E~ " Q (~L ~U~ ~ ~ ~ ~ "-~~ Second line of address ..J DATE FILED City or Post O(fioe State ZIP Code CorrespondenYse-mailaddress: Cew'ield53 (~Com~as~ yet 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, ft is true, correct and plate. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ESPONSI O 1 G RETURN DATE ADDR s A, N TNO Ha ~HEip yo ?5/.~ nc afic hdr 4~,Z fin mF~l. p~! ~o•.~ SIGNAT F PR ER NTAT f Cr' DATE ADDRE /+I2LES F, SH/ELOISS / (Q C/oas~r load 1 ~ ~G Mecl-sn~csha iPA I~osS` PLEASE USE ORIOINJIL FORM ONL Side 1 L 1505610101 1505610101 J 1505610105 REV 1500 EX DecedeM'$ Nom: M o n ~irl.prG, ~'m ~-+~ ~ ca G. Ii RECAPITULATION Decedent's Social Security Number ................................ 1. 1. Real Estate (Schedule A) ........:.... i own i irri noouoo ommo^i ^ooim oi~ ^in^ D 2. Stocks and Bonds (Schedule B) ........................................ 2. rv_ Q 3. Closely Held Corporation, Partroership wSale-Proprietorship (Schedule C) ..... 3. Q 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. ~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. / D 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. ~ ~ 1 D 9 7. Inter-Vnros Transfers & Miscellaneous Non-Probate Pr~erty (Schedule G) O Separate &'ll'xog Requested........ 7. D Q 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. N rs 9 ~ S `j 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ~ O ~ ` 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. ~{ 7 (o 11. Total Deductions {total Lines 9 and 10) ................................. 11. 0 ~, g 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 3 (0 ~ 9 13. Charitable and C~oXer,~mental BequestslSec 9113 Trusts for which an election to taDC t a not been made (Schedule J) ..............:.::.:...... 13: ;. _ p Q 14. Net ilalue to Tax (Line 12 minus Line 13) ........................ 14. ~. 3 b / 7 15. 16. 17. 18. 19. TAX DUE ............................................... ...:....... 19.~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMEtT[ transfers underSes. 9116 '~;~ 16. Amount of Line 14-taxable at lineal rate X .0~ 17. Amount of L1ne 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 TAX CAWULATiDN,-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amou[ot of Line 14'taxable at the spousaF 1~ rate, or 1505610105 Side 2 1505610105 O COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280807 HARRISBURG, PA 17128-0601 RECEIVED FROM: JONES RONALD 12 BOND ST BRIDGEWATER, NJ 08807 ESTATE INFORMATION: SSN: 12412-1653 FILE NUMBER: 2110-0664 DECEDENT NAME: MONTUORE AMERICO DATE OF PAYMENT: 08/26/2010 POSTMARK DATE: 08/24/2010 COUNTY: CUMBERLAND DATE OF DEATH: 05/30/2010 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-961 NO~I. BCD 013255 I ~~, ACN ASSESSMENT I ~' AMOUNT CONTROL ', NUMBER ', ', TOTAL AMOUNT I REMARKS: RECEIPT TO ATTORNEY SEAL CHECK# 4500 INITIALS: HW '~ RECEIVED BY: GLENDA FARNE TRASBAUGH REGISTER OF WI LAS ~'I~~ TAXPAYER II ', I i i COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT.280601 HARRISBURG, PA 17128-0801 RECEIVED FROM: HATCHER ANTHONY 942 WESTERN CHAPLE RD WESTMINSTER, MD 21157 PENNSYLVANIA INHERITANCE ANb ESTATE TAX OFFICIAL RECEIPT ~~ ESTATE INFORMATION: SSN: ~ 2412-~ 653 FILE NUMBER: 2110-0664 DECEDENT NAME: MONTUORE AMERICO DATE OF PAYMENT: 08/24/2010 POSTMARK DATE: 08/23/2010 COUNTY: CUMBERLAND DATE OF DEATH: 05/30/2010 TOTAL AMOUNT REMARKS: RECPT TO ATTY SEAL CHECK# 4239 INITIALS: MAV~ RECEIVED BY: TAXPAYER __ REV-1162 EX(11-96) NO.I ~D 013248 ', ~'~ ACN ~ 'ASSESSMENT I CONTROL ~ NUMBER 'i i ~I AMOUNT ', '~, ------- 101 ~ I $2,052.00 ~~ ~~I ~~~~ PAID: I~~ I, I ~ ~, i i ~ III~ GLENDA FARNE REGISTER OF WI I ~I, ill i ~!, S2,052.00 '~ ! ~ i ~ , ,III ~RASBAUGH LS'. II i i I'~ i ES i o F n-tou7"u.o RF, i9-rrlE'R /Co ~ - ~ i 4E wo . ,z i ~o - G ~ y 1 ~X C~ ~C L ~ l1c~ ~iuiX o~ dir. I~nh~cbl~~ ~-xgbfa r~ cc r S !~1 Q ~ l i /XO~r l t o s F __.. awn ~r re s .%/ v hto a ~. ~Itcs ~ s t Ci S i P L~~ Q o ilt O e Sf~s ak Qta~ ,~o ~ v r ua~ I i '~ ~ I _ %7ct /IPit 4i~litrhl` ~ ~ 3 Zi 9 ~ f8 /O . 9G f3Ja a /far /~ = a /73.08 a 0~• /•~ ~ O R V d~1C..t Q ~$ 7~6 r37 i i I I II i ~i - ~ ~ I -I I li i i i i FJC Page 3 Flls Number A ~-~Q - nt's Complete Address: ENTS NAME ~¢MeriCO G, /Yl,onfuor~ ETAODRESs oZS/~ 'Rol o L'oh.rt STATE ZIP nlech~nicsbur PA~ ~ ~ ~ 17oss- Payments and Ctr+edits: ax Due (Page 2, tine , 9) ~ (1) ~ ~~ y. ~a Prior Payments :~,Q 5~. ov oZ, 5ti5. ° ° . amount /O S . ~0 13 S• aO Total Credris (A + B) (2) ~~~ 860. °O f oZ, /LrO. o0 1<,~~ ~ o0 (3). O Line 2 Ls greater them Line 1 + tine 3, enter the dilfererpce. This is the OVERPAYMENT.. O FiN M oral on Page 2, Line 20 to request a rotund. (4) t.Kpe 1 + Line 3 is greater than Line 2, enter the differerpce. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. yap six PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN '7C' IN THE APPROPRIATE BLOCKS 1. Did decedent rtralce a harpsfer and: Yes No a. retain the use or irpcorrpe of the property transferred :.......................................................................................... ^ b. retain the right to designate who shaA use the properly transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. ff death occurred after Dec. 12, 1982, did decedent transfer property witlpin one year of death without receiving adequate oorpsideration? .............................................................................................................. ^ 3. Did decedent own an up 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 captains a beneficiary designation? ........................................................................................................................ ^ ANSVYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. of death on or after Jury 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 t {72 P.S. §9116 (a) (1.1) (i)). 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 .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 a tax return are st~l applicable even if the surviving spouse is the only beneficiary. of death on or after July 1,2000: 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 rlaptive parent a a stepparent of the cthilri is 0 percent [72 P.S. §9116{a)(1.2)]. tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in "1 P.S. §9116(1.2) [72 P.S. §9116(a)(1)1. he tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent p2 P.S. §9116(a)(1.3)]. Asibling is defined, under 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. __ REV-150BIX • (tA7) SCHEDULE E COMMONWEALTH of PENNSYLVANIA CASH, BANK DEPOSITS, 8i MISC. ~""E~ `~o~ o ~`~" PERSONAL PROPERTY ESTATE OF FEE ~ IYlonfuort, A-rner-co G ', ~ a~-/o_~65~ Indude tits proceeds of litigation and the dale the proceeds were received by the estate. Aq propeAy JoirrUyowned with Ute right of ~ must be disclosed en Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION ~ I OF DEATH ~. R ot[.OHomF /y10~8lGE fIOAIE ~15~37 ,d 7~ 9 t ~ ', Meld t /y01y /111GbL~IP T~eRUlf ', ~ f3~~Q oa ,~ . !9d 9 ~/ds,~lo6i/c C P , !~/il' /~3 ,ldN 2 ~ w 7/rCD 3 / "`f~ ,, Sold ~ Pdrys At~fir en+~ $~V[t.4¢ g00 Go/'sucll (~d.,l,~cs~in I y I Sa.DD 0 • 3. 2nrenf,-r of ~~f-e>n?s ~ ?rR~ kr Ste 'i~mita~ion ~S~i~I' e~` ~ pf/xtclita/ I, 1~ o o S. 00 TOTAL (Also enter on line 5, Reca~itul~tipn) I S 'rf, /S S, Ov (If more space is needed, insert additions sheets of the same size) ~~~ ,'l FsT of McNTCto~2~', ~~K~lCo Fic~ Mo. Zi-~a-66Y ,, _____ / C.~r~ Tv _ 7r -~~T"" ______ _.~._.~_..~...v..~~ L ________ .___.. ._...._.______.__..._._.,.. l~t~-,~httd fylJS~ ~~i~z~!'t. ~..._...__-___...~._~. ~' '~7S.d-D _~____. . /~IiSC. ~ t wit. ~ ! lSb. o0 ~~ i t t ~I- ii- __ ~ __ fSb•oa _..._____~~___.._._.___.__t_.._~. ---_- __...__..__.. __.~_._.o___- _ ~__ --+--r-----_ - -.----____. __.________ __~_.__ _/hisr c~s~~~G t~~~/JSi.Cs ~'~ ~' ~ r`3S. GID __._.__ ! lvG~ ~ --..~--- l~itlKGd ~r/~. ~_...__.~_.__--_.-_...--------- -~_ s /~ ~/fI0 .___ _.- ___________._. ----------- D/ ---'~~3~"-,~c~l ~tP~Gi~~~ ~1X~L4~_ na~!ro~ --iAo /stt p -- - -- ~ I r~il--- •I~Ry 4~ CI/yt ~f ~_.z_ -----_--._ _ _.. ~I S. OQ ______ -.-.----_-__._____ ~ ________ ___._---__-_-_.____.W_____._.__.__~__.1_~_~.-.~~_,_____.__._.__~~,_ Dw/ %ri~ ~/ ~ ,75; oa ___.____._~__._______ ~~ ~R __..__~.~.________._.. _....~..___._ ~~I _._A _..___.----------_- +-....-_.~.___~~.._.______..___- _._....____.. _. ~i'S[. ~Cor ~ I s3v.oo - ---.. ____..__.__________.~ _ _ Sher: _41~~___r ---__ _.__.._ __-..___._.__..__.___._:__.--_- ----_.__._---_---_.__ ~ C ._ ~~~ .a11iSG._ ~w~tt ~1~[s¢ ~ ~~.lifL I'I 7S. ~'° -. ~S~ ~/it/fiI • s~tUd I,I a .' &a~ DF luou7"uo~e~', ~AIEI2lC'o ~icE n~ro. ~I-io -may ~. '' ~a~+~0 ~iern~}t~ t' . ~ ~~- ~ _ _. .. .. _ _... - __ ~ , its?_ , - _ .. ,. /'ii•G j ~~ _ . ~ _ _ .. _ _ _ - - ;: _ ___ __ ~-- ~ _ . _ __ _ . i ~ _. o ._ _ _._ _ ,~ __. __ .. _ _ _ . __ . - -_ _ _. __- _.-_ ~r _..___ __ ___..._~__ _~ 1~.~.,s+t , 5 0 • 0 0 + ~ ~ ~ ____ __~~._._..____ -_ . __ __ . 7 5 0 0 + ____._ _ ~_. ~ ~.._ ~ ... ~.~_ __~.... _. _.mw__.. .r.. _ _, ..__. __ 50.00+'' ~I ... ~ • . _. ~ .~._ ._. ..._. _...... __ __ 85 • 00+ .. ... _ _ ~ , .. _ I r. ,{... .. _. _ 50.00+~ _._ _...~ __ _ 35.00+ . ~' i . + / 15 00 i I ._ _... ~ _. ~ ..A ._e ._. __ . ~_m. . - __ ..--} ____- _ ._ • 75 00+ . .. • -----.__ 1 0 0 5 0 0 ~ _ . _... . _ ., . _._ , ~,~. ... e _. . - ___..----.__.~____ _ .....TM_ _._ .__~..._. ....~......., _ _~.._..,, _ _.m ~~.....; . _, _. . ..._. __ ~.n ,~ ..m, . ._. _. .._._. _.. __ ~ ~._ .n.~__... __..._._ a ..... I .... . . .. .m....,.. ....,. _ .._ _. _~ __z~.. ~~__ I ...._w_.. __.. , . ~..m...~ _..a ...._.... _ _._ __ . _ . ... ~~_a a,mm I __..m.~ .. ~. ~,. .. ._.~.u.. _ . d i' _ _ _- is-_.__. , ~ _..... ,.. .......,,I .., ~ .,_...,.,.. .,.. ,..,,....,. __..... _. IRV•171d CA ~ (IiUJ SCHEDULE F CAMMONVYEALTHOFPENNSYLVANU JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESI NT DECEDENT 1 ESTATE OF rnGnt6lOrG, ~MGrrCO G. ~~ 'R! .~/-/O -~oG~if Man asset wss made joM wghin one yssr of the dsladsnt's dslt of death, k must be reporbd on SchsduM G. SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. 'F3 I en ~ he >Netchtr 9'y 2 Wts'fta-n Gta~~l ^?oad ! S i s'Itr Wc~fminsfte^, MD, .71157 ! i s. ~onald C. Jonas I ~.t t'3. onol ~firetf n ephGw ~ C. I I~ i II III JOINTLY-0WNED PROPERTY: fTEY NUMBER LETTER FOR JOINT TENANT DATE WIDE JONT DESORPTION OF PROPERTY klcklde name d1il~anclaiirMbib(tion a(d bank axoult numbs a sinYa klentlyk(p number. AtleCh DATE OF DEA % aF DECD'S DATE of DEATH VALUE OF deed br jokltly-held rod eafale. VALUE OF INTEREST DECEDENTS INTEREST 1. A~ el ~JI~/D f I'~ LM ~ ~8f ~• Cl~a~~' Lt n % os'1 ~, 5av; nas /~e~#: N"• 13030- oo Pri nc: pa.l DS3, ~6ie. 2 i1 ' ~-~r. Znt. 1 x.10 I ~ 53, 47 g, 4 ( ~ X 53, 4 78.1,4 33~ X17 826.30 2• i4, Q, ~ fiµ/ol t11cr,nbtrs 1s;f Fec~ CtYd~~ union II'', ~~, Ci+cr,IC%•,~ ~e~l': N•• 13030- 11 I! i ~~. z,t. s. ~ ~I ~ 7Y, 79 3.78 '~7 ~, 773, I 3310 ~~ ~/, 4~~ 59 (SCG /t ~ua~i in lb~?.1" a~"~LC,~ttd) ~ 1a8, 2s~.b ~ ~~ Nori : ~FCN ~r/i.~ /o/ 3 3 ~ 40 /D1 33~ 41 /ol 3~4 4Z /01 33y ~f3 1 A~t.vab htCh t+srws.r~lt~ ~.ret~-ly ~ iria ~ ei' ~, ~t/. b~ Idhr- d O.Tca .T•.ar tG . Zoo, o ph'.n ro I, r Jit ff~;S t1e•.~ttrn x+05 been selc~~ ~ TOTAI,(Aiso enter on 1)rle 6, ~' _ ~,Z, 750. Sq (If more space is needed, insert additional sheets of the same sire) ~ I -_ I - -_ St MEMBERS 1~ PBDB1tAI.CREDIT i1NION REGUU4R SAYINGS ACCOUNT Acxount NumbeN Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Totat Principal and Accrued Interest Name of Joint Owner Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Acxount Number/Suffix Date Account Established Prinapal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Name of Joint Owner Date Joint Ownership Established Estate of: Americo G. Montuore Date of Death: May 30, 2010 Social Srcurity Number. 12412-1653 13030-00 02/18/1972 $53,466.21 $12.70 $53,478.91 Blanche Hatcher Ronald Jones 01/14/2002 13030-11 12/16/1980 $74,767.84 $5.94 $74,773.78 Blanche Hatcher Ronald Jones 01/14/2002 MEMBERS 1 /~/'~pF~EDERAL i w ~ ~/•""~ Leigh- ne Stallings Lending Insurance Support July 28, 2010 UNION 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-23281 • wwwmemberslst.org i...-t-.r. --__... _ _.._ -'~-~ 7~~0/% atv~i?'`vu,~c S,tt. REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Aq o h •i''llt, o rZj /TM P.,1't ~,o (r. FILE Debts of decedent must be reported on Schedule I. ITEM .NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES,,, ~~~~ ~~ ~~ _ L y 1. hQ.~PCtZt ~'N/Iwt./t.C ~of'!'tC ~ ~1'1QCj-Mtltsbu-~a /"~' ! III ~ 6~O.Z~.77 B. ADMINISTRATIVE COSTS: ~, 1. Personal Representative's Commissions L / ~!I Name of Personal Representative(s) ~j ~gf~'tier ! ~ Social Security Number(sNEIN Number of Personal Representatives ! streetAddreas ~ ~lancltt Hatcher f~~ wtsfrrra Cha ~l deoRd ~ city Wtsfnninsfu•' state MD ~p ~ $ Year(s) Commission Paid: ! 2. Attorney Fees C ~ ~' I bs E . s h~ P.~~3 ~ ! ! 3. Family Exemption: (fl decedent's address is not the same as claimant's, attach explanation) !!I I! claimant No oaE Eu6/,BLE ~ ~' Street Address !, I~-- City State Zip ! !! .f~-- Relationship of Claimant to Decedent / ! 4. Probate Fees puti.l f?it'I ~nat~ ~Iistae. OT 5~101r{ tT,exf'i ~~c.aes ~~ ! 5. Accountant's Fees JRnGT 8/~ta~Cbi~t r (-~ ~/Z $to~ o1f /1~CCIIMNCS,~t -b do close-out I o40~ PA-go,Q~. t'e~l-~In•, ~ 6. Tax Return Preperer's Fees ! ~! , II ~. Il`d++rt*ti s %~ ~ ~ Cwxberla+d Law, SorRrna,l ~ !! $• ~4.~f/er~is%.~ %n C'arir/isfer ~T'~.I ~, 9, F% ~ ~ R ishr v~ w~//s '' 9 ~ lo. ~.td, f, one/ P~ ba~~ l 1. Rt iM~u/'SsA/6/fla f fn~etr~CS F. ~i. ~s/S ,~' i~s/" p/wt~a~vln ~'s~~ G2tr'~+' ~ M~~ t ~ -,~, (vhf d;sf. eo.I,Is, ~ . ~esr~i-r.~ ~,, TOTAL Also enter on line ( 9, Recapit lati j (If more space is needed, insert additional sheets of the same s¢e) i! I SCNEp1~LE N FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS ~, ?0~. vo ~f,787. o0 NONE X99. St') o?Saoo X75, 00 f1yS.o~ ~` /S, o0 none ~b o. oo, s /©, ~ ~ o, 33 REV-1512 EX~ (12-03) scN~ou~E ~ coMMDNwEaln~ of PEivNSnvnNla DEBTS OF DECEDENT, iNHERRANCE Tnx RETURN MORTGAGE UABIUTIES, & DENS RESENT DECEDENT ESTATE OF /Yt-dh .~ u ~ rt ~ ~~'MItA"I Go G . I FILE NUMBER Report debts incurred by Me decedent prior to death which remained unpaid as of the dab of deaM, including un rated medical expenses. ITEM ' VALUE AT DATE NUMBER DESCRIPTION I OF DEATH ~~~S.oG ~~ i~o C'str.-t - b.~ t,~nt er,~tsl ~~us ~-M n~ra6i/e ~M~ ~~t ~3f~0, 00 3. vu-; ~.~ '~, ,P G Z, s9 TOTAL (Also enter on line 10, Recapittdati~n) ~ I S.?7 bS (If more space w needed. insert additional sheets of the same size) I ~I ............_ REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF rae nusente~ on kore.~ mer-ico G. NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY • RELATIONSHIP TO DECE (} ~ Do Not List Trusbs(s I TAXABLE DISTRIBUTIONS ['irxlude outright spousal distrilwtions, and transfers under Sec. 9116 (a) (1.2}j 1. (spouse, Nina nlontkore~ PnedcuAs¢d her '', husl~td, ~ deeea~tmt' huY~t,, on ~. '', 16, toot ). !, oZ. ~lahaht ~a}~cr ~ Cw ~ II ''f" s ~~t~tr, v~ r S t s f ?x~ q pfd I~t3hrN Chaaxl road hes#'m. r~s-Irr... r+1 D o~ I t s7 '' scN~ou~E ~ BENEfiCIARIES 3. 1Z o Wald C. ,Topes n t~hc.~ 'I I a.l fond ~'recf "~ d9e.tva~ic,r, NT o $8 u7 j ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIAI II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 21-/o-~~y AMOUNT OR SHARE OF ESTATE 'l~. ~2 REV-1500 COVER SHEET TOTAL OF PART D -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET I (If more space is needed, insert additiional sheets of the same size) I ~ _. - - __ - - - I, AMERICO MONTUORE, of the Township of Upper AI en, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and un tending, do make, publish and declare this my Last Will and Testament, hereby revoking and ~ ' g void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, pt wheresoever situate, I give, devise and bequeath to my beloved own use and benefit absolutely. 3. In the event my said wife should predecease me or die at alr in an accident or disaster common to both of us, I hereby direct all t of my Estate to be distributed as follows: a.) one-half share to my sister, Blanche Hatcher, and m; her husband, Curtis Hatcher, as tenants by entireties. In the predecease me, then their share is to be distributed to their d per stirpes. b.) one-half share to my wife's nephew, Ronald C. Jorn 4. I nominate, constitute and appoint my wife's nephew, Ronal of this my Last Will and Testament. In the event that he should unwilling or unable to act as such Executor, I nominate, constitute Phyllis Loveridge, to be Executrix in his place and stead. In the ev t me or for any reason be unwilling or unable to act as such Executrix, I appoint my nephew, Anthony Hatcher, to be Executor in her place they shall not be requinxl to fik bond or other security in the Office of purpose of administering my Estate. ~oort after my decease as mixed, whatsoever and '~ MONTUORE, to her same dme I do, such as residue and remainder they both r, Amy Frisch, stirpes. Jones, to be the Executor me or for any reason be point my wife's niece, t she should predecease rtrinate, constitute and :ad. I further direct that Register of Wills forthe IN WITNESS WHEREOF, I have hereunto set my hand ar~d sal this /•S day of A.D. 1998. f AMERICO MONTU ~ (SEAL) Signed, sealed, published and declared by the above-Warned CO MONTUORE as and for his Last Will and Testament, in the presence of us, who at 's nest and in his presence, and in the presence of each other, have hereunto subscribed our n as witnesses. ~. GEORGE M. HOUCK (1912-1991) CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHA1vICSBURG, PA 17055 December 17, 2010 Register of Wills Cumberland County Court House 1 Courthouse Squaze Cazlisle, PA 17013 Via Hand Delivery 'T~LEPHONE (717) 766-0209 FAX (717) 795-7473 Re: Estate of Americo G. Mo~tuore No. 21-10-0664 Deaz Register of Wills: Please find enclosed for filing 2 copies of the Inheritance Tax Return fob th ~, Montuore Estate as well as Check No. 96 in the amount of $29.42 for the Inheriltar and Check No. 97, in the amount of $15.00 for the filing fee. Thank you for your kind attention to this matter. Very truly yours, Chazles E. Shields, III Attorney-At-Law CES/mjj Enclosures e Americo G. cIe Tax due -..~ i7 ~] a t -..3 ~~% .-~ ~ ~ ~~ ~ ~~