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HomeMy WebLinkAbout12-12-101505610143 REV-1500 Ex(°'-'°' PA Department of Revenue OFFICIAL USE ONLY Pennsylvania County Code Year File Number Bureau of Individual Taxes oerARTMENr OF REVEMIE Po Box.28oso~ INHERITANCE TAX RETURN 21 10 102 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 061 20 3323 09 25 2010 O1 10 1921 Decedent's Last Name Suffix Decedent's First Name MI EBERSOLE HELEN iq (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 Retum (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa. Future Interest Compromise 5. Federal Estate Tax Retum R utred (date of death after 12-12$2) ^ eQ g, Decedent Died Testate (Attach Copy of Will) ^ 7 Decader~ Maintamad a Living Trust 0 (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. b~tw eri PZ 31 ~~a d~t~lat~e5~f death ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Tel hone Numti~ MARIELLE F HAZEN 717 54332w~ -r,,`~i- First line of address 2000 LINGLESTOWN ROAD S Second line of address cn ~ fv ~s V~.~ =` c? tv ;~_= sn G.~3 City or Post Office I DATE FILED F - State ZIP Code HARRISBURG PA 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 has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 1~j~-~~--~ ~~~~arie Sheaffer /Z ~Z~ ~~~ earora Dr., Camp Hill, PA 17011 OF PR~PARER OTHER THAN REPRESENTATNE /2 20 l a DATE Marielle F. Hazen 2000 Linglestown Road, Suite 202, Harrisburg, PA Side 1 1505610143 1505610143 J REV-1500 EX ~ecedenrs Name: Ebersole, Helen Marie Decedent's Social Security Number 061 20 3323 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 703,382.87 4. Mortgages & Notes Receivable (Schedule D) ....................................................... . 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. . 5. 324,096.97 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8~ Miscellaneous N,nq Probate Property (Schedule G) u Separate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1-7) .................................................................... . g• 1, 0 2 7, 4 7 9. 8 4 67,466.81 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 2,089.02 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 11. Total Deductions (total Lines 9 & 10) .................................................................. . 11. 6 9 , 555.83 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12, 957 , 924 . O1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which '] 62 92 4 01 an election to tax has not been made (Schedule J) .............................................. . 13. . ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14, 195,000.00 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 0 0 (a)(1.2) X .00 . . 16. Amount of Line 14 taxable 0 0 0 16 0 0 0 . at lineal rate X .045 . . 17. Amount of Line 14 taxable at siblingrateX.12 20, 000.00 17. 2, 400.00 18. Amount of Line l4 taxable 175 000.00 at collateral rate X .15 ~ 18. 26 250.00 ~ 19. Tax Due ................................................................................................................. . 19. 28 , 650.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610243 Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-10-1026 DECEDENT'S NAME Ebersole, Helen Marie STREET ADDRESS 100 Mount Allen Dr. CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 28,650.00 2. Credits/Payments A. Prior Payments 27,217.50 B. Discount 1,432.50 Total Credits (A + B) (2) 28,650.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.0~ Make Check Pa able 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 :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ x d. receive the promise for life of either payments, benefds or care? ............................................................ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 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 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 January 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-1503 EX+~6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Ebersole, Helen Marie 21-10.1026 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 209111707 100 shares of Consolidated Edison Co. NY Inc. PFD - 94.98 9,498.00 Preferred Stock 2 256210105 3,095.975 shares of Dodge and Cox Income Fund -Mutual 13.479999 41,733.74 Fund 3 448108100 1,914.242 shares of Hussman Strategic Growth Fund - 13.279998 25,421.13 Mutual Fund 4 722005550 3,346.72 shares of Pimco Commodity Real Return Strategy 8.0800007 27,041.50 Fund Class D -Mutual Fund 5 72201P548 3,401.361 shares of Pimco Munigo Fund Class D -Mutual 10.7799995 36,666.67 Fund 6 893391882 4,570.384 shares of Pimco Real Return Fund Class D - 11.51 52,605.12 Mutual Fund 7 693390445 9,674.737 shares of Pimpco Total Return Class A -Mutual 11.5399995 111,646.48 Fund 8 922031307 3,875.969 shares of Vanguard GNMA Fund -Mutual Fund 11.0000003 42,635.66 9 922031869 3,005.657 shares of Vanguard Inflation Protected Securities 13.2700005 39,885.07 Fund -Mutual Fund 10 92204L104 13,969.929 shares of Vanguard PA Long Tenn Tax Exempt 11.3399997 158,418.99 Fund -Mutual Fund 11 00767Q782 Advisors Disciplined TR Unit 288 Insured Tax Exempt 21,178.73 Municipal port SER 1 Fee Based Cash -Unit Investment Trust Total of Continuation Schedule See attached page TOTAL (Also enter on Line 2, Recapitulation) 703,382.87 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen Marie FILE NUMBER 21-10-1026 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 12 o0767V567 Advisors Disciplined TR Unit 327 Insured Tax Exempt 20,637.20 Municipal Port SER 2 Fee Based Cash -Unit Investment Trust 13 01728LDG4 Allegheny County PA ARPT Auth Arpt Rev FRDG-SERIES A 21,600.00 5.00% -Municipal Bond 14 61745EL74 Morgan Stanley Dean Witter Discover & Co. MTN "Step 25,250.00 CPN" -Corporate Bond 15 708796KR7 Pennsylvania HSG FIN AGY Single Family Mtg REV SERIES 5,150.00 100A 5.10% -Municipal Bond 16 810827PU3 Scranton PA Sch Dist Series B 3.850% -Municipal Bond 26,000.00 17 8557o6NX0 State College PA Area Sch. Dist. RFDG 3.250% -Municipal 25,000.00 Bond 18 US Savings Bonds - Series E -Beneficiary is Decedent's 13,014.60 husband, Cletus Ebersole, who died on February 1, 2008. See attached inventory for bonds TOTAL (Also enter on Line 2, Recapitulation) 703,382.87 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) 9 Rev-7508 EX+j6-88) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ebersole, Helen Marie 21-10-1026 All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Refund -Apria Healthcare premium 30.12 2 Refund -Apria Healthcare premium 4,77 3 Refund -Auer Cremation Society 25.00 4 Refund - Verizon Telephone 17,82 5 Veterans Administration payment toward burial reserve 100.00 6 Citizens Checking Acct # 622291-994-B 5,995.48 7 Federated Prime Value OBL SVC -Money Market Account 202,061.87 8 M&T Bank Checking Acct. # 30190401 85,973.95 9 Wachovia Bank CD Act. # 24741209-2016226 29,887.96 TOTAL (Also enter on Line 5, Recapitulation) I 324,096.97 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+(10-06) COMM~H~, IDENTDECEDN~RNANIA SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Ebersole, Helen Marie 21-10-1026 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Marie Sheaffer Street Address 3405 Bedford Dr. city Camp Hill state PA zip 17011 Year(s) Commission paid 2010 8~ 2011 2. Attorney's Fees Hazen Elder Law 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 33,907.00 32,500.00 4. Probate Fees Register of Wills 727.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 332.31 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 67,466.81 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 70-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Helen Marie FILE NUMBER 21-10-1026 ITEM NUMBER DESCRIPTION AMOUNT Cumberland County Law Journal Estate Notice 2 Hazen Elder Law -Disbursements The Sentinel Estate Notice H-67 75.00 37.91 219.40 332.31 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+~12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Ebersole, Helen Marie l 21-10-1026 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursad medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11.08) COMNIQ~r~RWNT ~ECER ET~RN ANIA ESTATE OF Ebersole, Helen Marie NAME AND ADDRESS OF NUMBER PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal I. distributions, and transfers under Sec. 9116(a)(1.2)] 1 Kathy Brock Friend Specific bequest 1255 Braggtown Road of thirty thousand dollars Dillsburg, PA 17019 2 Carla Frisch Friend Specific bequest of ten thousand 2606 Franklinville Road dollars Joppa, MD 21085 3 R. Lamar Gilchrist Friend Specific bequest of five thousand 300 N. 28th Street dollars Camp Hill, PA 17011 4 Vicki Roudabush Friend Specific beques of twenty 525 S. Market Street thousand dollars Martinsburg, PA 16662 5 Marie E Sheaffer Friend Specific beques of sixty thousan 3405 Bedford Drive dollars Camp Hill, PA 17011 See continuation schedule attached Continuation Total f OF ESTATE ($$$) Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet as a ro r NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 National Veterans Legal Services Program 2 Disabled American Veterans 3 Salvation Army Copyright (c) 2009 form software only The Lackner Group, Inc. SCHEDULE J BENEFICIARIES FILE NUMBER 21-10-1026 RELATIONSHIP TO SHARE OF ESTATE AMOU DECEDENT (Words) 254,308.00 254,308.00 254,308.01 ON LINE 13 OF REV-1500 COVER SHEETI ~ o~,acy.v Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Helen Marie Ebersole 09/25/2010 061-20-3323 Item Name and Address of Person(s) Number Receiving Property Relationship 6 Charlotte Stone Sister 104 Shull Lane Horseheads, NY 14845 7 Herman D Sturm Friend 4113 Darius Drive Enola, PA 17025 8 Candace A Svetz Friend 229 Oak Entrance Drive Clairton, PA 15025 9 Karen L Truax Friend 120 Delano Drive Pittsburgh, PA 15236 Share of Estate (Words) Specific bequest of twenty thousand dollars Specific bequest of ten thousand dollars Specific bequest of twenty thousand dollars Specific bequest of twenty thousand dollars Amount of Estate (SSA) 1 S REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No. 2010- 01026 PA No. 27- 70- 7016 Estate Of : HELEN MARIE EBERSOLE (first, Middle, Lastl Late Of: COMB KLAN COUNTYIP Deceased Social Security No : 061-20-3323 WHEREAS, on the 11th day of October 2010 an instrument dated August 25th 2008 was admitted to probate as the last will of HELEN MARIE EBERSOLE (First, Middle, Last) late of UPPER ALLEN TOWNSH/P, CUMBERLAND County, who died on the 25th day of September 2010 an WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: MARIE SHEAFFER who has duly qualified as EXECUTOR(R/Xl and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 11th day of October 2010. * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ~f - ~,~~ .~ 1 ~~ j; r.y LAST WILL AND TESTAMENT ~ ~~ -- `' ~ ~x ~ - c:~ ° OF v ~~~-.~n r ~ --, - r- HELEN MARIE EBERSOLE _ ( ; l_J 1 - =~ Q". I, HELEN MARIE EBERSOLE, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III I give, devise and bequeath my tangible personal property in accordance with any memorandum I have handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. To the extent no such memorandum is found, or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal property shall be added to my residuary estate and pass under Article IV hereof. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath as follows: A. TWENTY THOUSAND ($20,000.00) DOLLARS to my friend, CANDACE A. SVETZ, of Clairton, Pennsylvania. In the event that CANDACE A. SVETZ fails to survive my death by thirty (30) days, then her share shall be distributed to her daughter, KAREN L. TRUAX, per stirpes; B. TWENTY THOUSAND ($20,000.00) DOLLARS to my friend, KAREN L. TRUAX, of Pittsburgh, Pennsylvania, per stirpes; C. FIVE THOUSAND ($5,000.00) DOLLARS to my friend, R. LAMAR GILCHRIST, of Camp Hill, Pennsylvania, per capita; D. TWENTY THOUSAND ($20,000.00) DOLLARS to my friend, VICKI ROUDABUSH, of Martinsburg, Pennsylvania. In the event that VICKI ROUDABUSH fails to survive my death by thirty (30) days, then her share shall be distributed to her parents, HARRY and GENEVIEVE ROUDABUSH, of Martinsburg, Pennsylvania, per capita; E. TWENTY THOUSAND ($20,000.00) DOLLARS to my sister, CHARLOTTE STONE, of Horseheads, New York. In the event that CHARLOTTE STONE fails to survive 2 my death by thirty (30) days, then her share shall be distributed to her husband, RICHARD STONE, per capita; F. TEN THOUSAND ($10,000.00) DOLLARS to my friend, HERMAN D. STURM, of Enola, Pennsylvania, per stirpes; G. SIXTY THOUSAND ($60,000.00) DOLLARS to my friend, MARIE E. SHEAFFER, of Camp Hill, Pennsylvania, per capita, H. TEN THOUSAND ($10,000.00) DOLLARS to my friend, CARLA FRISCH, of Joppa, Maryland, per stirpes; and I. THIRTY THOUSAND ($30,000.00) DOLLARS to my friend, KATHY BROOK, of Dillsburg, Pennsylvania. In the event that KATHY BROOK fails to survive my death by thirty (30) days, then her share shall be distributed to her husband, RUSSELL BROOK, per stirpes. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath in three equal shares to the NATIONAL VETERANS LEGAL SERVICES PROGRAM, of P.O. Box 65762, Washington, DC 20035, the DISABLED AMERLCAN VETERANS, of P.O. Box 14301, Cincinnati, Ohio 45250-0301 and the SALVATION ARMY, of 1122 Green Street, Harrisburg, Pennsylvania 17105. Article V I nominate, constitute and appoint my friend, MARIE E. SHEAFFER, of Cumberland County, Pennsylvania as Executrix of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint my friend, HERMAN D. STURM, of Enola, Pennsylvania, as successor Executor of my Last Will and Testament. I direct that my Executrix or successor Executor be 3 permitted to serve without bond. In addition to those powers granted by law, I grant them power to distribute in cash or in kind, in like or in unlike shares, and to file any qualified disclaimer I could have filed if living. My Executor or successor Executrix shall receive reasonable compensation for services rendered to my estate. Article VI In addition to the powers conferred by law, I authorize my Executrix and successor Executor, in her/his absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executrix or successor Executor; and to pay from my estate reasonable compensation for all their services, 4 (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, HELEN MARIE EBERSOLE, hereby set my hand to this my Last Will and Testament, on , 2008, at Harrisburg, Pennsylvania. ~~ ~ 5. r HELEN MARIE EBERSOLE In our presence, the above-named HELEN MARIE EBERSOLE signed this and declared this to be her Last Will and Testament and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name ~. ~ ~~ Address I, HELEN MARIE EBERSOLE, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and Acknowledged before me by HELEN MARIE ~ °'SOLE, the Testatrix on :~u (~ uS ~ ~_< , , 2008. ota Public ~~ HELEN MARI R OLE.~~~~ COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marielle F. Haan, Notary Public Susquehanna 'IV~p., Dwphm Cowty My Commission l;xpi~ Sapt. 2.3, 2010 We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and Subscribed to before me by ~.JC.h n l f'cr 119G~ t7r)GL _ and ~-/9-RCi S. rYJI L L EK_ witnesses, on f}vGU~f dS , 2008 Not ub l COMMONWEALTH OF PENNSYLVANIA Notarial Seal MarieUe F. 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A!W ~ ,m OO~pp ~W:Oi.A iOS;Q~ :A:~d Aj0 'O.A!N!W IDiW IV •O q 'O , ~-+ i O f0 0 °D ~ V ' ':~ ° lrn~-°i-~~o iw~rn~wja`!,s°o=o 'c`.a 'OO i°O ~`~ ;o iR~ ~{ i w; V! .. c; z; r.i n ~: D~ m: o; 0~ i~ i~ ;p ~o O V v rn 0 Z a 0 O ~ C G ~~ d~ m~ y y Q ~ m p ~rs~ 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502349 F ax (302)934-2955 October 27, 2010 Hazen Elder Law 2000 Linglestown Road, Suite 202 Harrisburg, PA 17110 Re: Estate of Helen Marie Ebersol Social Securi~: 061-20-3323 Date of Death: September 25, 2010 Dear Sir or Madam: In response to your request, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following accounts: 1. Type of Account Checking Account Account Number 30190401 Ownership (Names of) H Marie Ebersol Opening Date 08/28/64 Balance on Date of Death $85,973.40 Accrued Interest $ .55 Total ~~ +We were unable to locate any safe deposit box for the above-mentioned decedent. ++For further account information, closures and/or reimbursement of funds please call the West Shore Plaza Office at #717-731-1730. •+'~rhis lelta does not include any accounts in which the deceased may have beat listed as Power of Attorney, CYi.Qodian of Uniform 7Yan~ers, RepresattatiHe Payee, or TYvgtee unda~ a Written Agrean~t S ly, I S e M Kimble Adjustment Services ~' ~~~ 2 ~ 2Q~Q " ^Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 09/2010 Page 1 of 1 Total Price Totai Value Total Interest YTD Interest X2.250.00 $13,014 60 $10,764 60 $0.00 Bonds: 1-4 of 4 Serial # Series Denom Issue Date Next Final Accrual Maturity Issue Price Interest interest Rate Vafue Note d206795420e E $500 01/1979 01/2009. $375.00 $1,790.60 ;2,165.60 MA d206795436e E $500 05/1979 05/2Q09 X375.00, $,1,81.1 60 X2,186.60 MA m207609328e E $1,000 02/1979 __ 02/2009_ .$750.00; $3,581.20 ;4,331.20; MA m207609343e E $1,000 04/1979 04/2009 $750.00; $3,581.20 X4,331.20. MA Totals for 4 Bonds $2,250 00 #10,764.60 Notes NI Not Issued NE .Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earnin interest hm,•~~www_trea~urvdirect.govBC/SBCPrice 10/27/2010 r ~~ ~ y~ i ~,, ` .t~~ AT THE O,R I~GINAL MATURITY. HEREOF WILL PAY ~~/"`/~~-~..-~~ o~~~l~~±~i`'-.5~~~a~,'T+~' ` . ~ wxcSSUE(DATE of 4 :I ', Tn Cletus F. Ebersole 186-1E3-0608 April 197.9 109 North 34f1 Str®®t, {yOMTHI _ ~I VFlRI^~ Camp Hill, Penna. 1701.1 ~l~tx ~. ra:~sr cc, r ,98UIH6 AC.£HT«9 , ~~ ~ _ ~ :~ I,x ~ H, Marie ;~bersole - r DECLRRATIONQF nl, seMen«Nwe u.x..un+oinYa ~.cc u•+aa^..«^HSw- •„pi~~! ~!'i .,TfOTn[RiMf.ho CDYMrow! iuRR K w~q Oww wOYtY ~M- NDEPENDENCE 'sYmin .»o e.,m...»o oaM«rce.Y+w :o«w.xcu.ra. •+wen .•rxa+.. .~, ~ ., 0 w.s na.on " 1~P.a.....r..T4 o.~„ 1 / i 1 w r t •- x_1.1-s ~ _ _ s__. x_ -_L i_t .:,.,i'._.;.t _ ~,_L_._ .. !` 1!Y •11 do VS Y •" a~3:RE!•^.Ta&~T2.aS.l S,nR3"F!S/,a4~:'!F . ~_~. i AT THE ORIGINAL MATURITYHEREOF WILL PAY ~J~ ~-..-.~~~'t~ `- ~' ,.~,-- v "` ~-~-'~• ISSUE D A T E -' ~~- - .. - WHICH IS 7NE fIR54 DAY OF d . _. Ta Cletus I'.T~+'beffiIs©le ~186~-18-0606 -~,A~RI~•=-~$'~~:-•- 109-North 34th Street ~,~a~`', Oamp Hill pA 17011 ~~~~~~ `I, < ; H, l~iarie Ebersole DECLAAAi1DN OF ~sw.esnwm wx+rirwow+Ya .Y SO~e .c~uv~w°NOY.uronin~ Ui+z°`"`~-^~~ NDEPENDEtdCE. ' ~'~"~'~ w -~ eirccnna wwa~n`.:urc~l. _ -- - r^; 3 l p M v - ~ _____ -_ Opt Cletus ~'. . - _S;tN;; rrtAµ w /~ )S ~i~;R~l.~f~.ur~G ~t~ -~ "j//p _ t _,/ ~~ -vr_., -Tr^^^~ sa-s^. r^~t-rm°~,trn^~a~e~'xt i f ` ~ ?~=i ~~_~ ~ qT THE o~IGI•:4L `~a. VR1iY HEREOF WILL PAY ~ ~ _ _ ~~ ~`'.s ~.~1 Ida'~~3#~~'`~~fJl~~~'~'~~~~~~1(~~,~ . _ ~.-_wv. -av...nkv- ... - r~.`~~- ~` ~ ~~~ ~ f~ Cletus ~'. Ebersole 186-15-0606 ,,~~`~- 109- N, 34th St. ' ~° ~ ~, ' Camp Hill , Pa. 17011 ~ ~ , ._~_~ ~. Or ~ H. i+~arie Ebersole ~ ~ ~~~~. z. .~y. ~''~ ¢~ .o, ~,~a~ w~~„w~~... .~.o .~...,,w.l.~. We,.,d.- ~ lilticrou ..._, ~ ~ .,... .ro„«Yn,....ero„oe~.....,m ..~. yun ~'~~K:`"` .. ~ 6(N .. ^~-~ SCM![O.~DO.IFO.A~Dxwcm.r,w Mff«r - '° ,ac< Ur ocrnm.+ca[ :~ ~ , j3 4, p t/ WU ,~ , t {{ s~~:~ero« rrJJ N w`ik s'C. ~~ ... -a i A$yr„~Y..~'4xGA7..AC hr4d:S~.t1..:,iW1i. d" ?w;t:+i-.C?4C4.'G`LPT4'S Ci1~~G.s.S.i3_Ws...A3]~vl+'tii4il:LtlhtiiQY! _-_ _ _ __ _ __ - __ _ __ ,,. r 1 '.. ~' ~~ F 1 s S ISSUE DATE Yl;ilCfi !S TNL i-iRSf i:AY Or ~A~rwiik n~~:ir x ~ rrtusr cep _, 1 _~~,+~ Nv x,973 ~~ ~l~ Citizens Bank Account Number 6222919948 Account Title MARIE E SHEAFFER FBO HELEN M EBERSOLE Date O ened 1/8/2009 Account T e Checkin Princi al Balance as of DOD $5995.48 Interest from Last Postin to DOD $ .00 Account Balance as of DOD YTD Interest to DOD $ .00 I''41X 'L'!"dI151I11551UI1 lU/'LEi/"LU1V 1:'LEi::i'/ YM YA(it': 1/VV'L t''d.X 5C!"VCS ,~ ~.0 ~(a 1 cue, 3 1H~~ Wachovia Bank Balance Confirmation Services P O Box 40028 Roanoke, VA 24022 October 26, 2010 HAZEN ELDER LAW ** Refereaoe ID: 3193416 SUBJECT: Verification /Confirmation of Aooollnt and Balance Information provided for: Castomer: HELEN MARIE EBERSUL (SSN# XI~QC-XX-33Z3) Date of Death: September 25, 2010 Aooaart ~~ TYPe Numbe CERTIFICATE OF R~{}06226 DEPOSFf LEGAL TITLE: H MARIE EBERSOIE MARIE E SHEAFFER PUA Deoo~t A~ccoalrt Information Dde of Death Average Bnlanoe Date Bahmoe ~ 4/6/2004 Maturity h~taed Accrued Y'1'D Date Date Rate Iderat Idet<at Paid Cloned $67.48 $866.65 lU/Z7llU lU Page 7 of 2 u A 7FN F.i n~ ~w An Estate Planning, Elder Law and Special Needs Planning Lain Firm ~. ,_r_-- 2000 Linglestown Road, Suite 202 Harrisburg, PA 17110 info@hazenelderlaw.com December 21, 2010 CERTIFIED MAIL Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Helen Marie Ebersole File No.: 21-10-1026 Social Security No.: 061-20-3323 Inheritance Tax Return To: The Register of Wills: www.HazenGtaer,.uw.~~l•= ~.: (71'~ 5444332 Fax: (717) 540-4313 na r~ ~g0 ~ rn ~~ r n ~ N ~: t7 ~ Q ~ C~ p -v t.#' ~~~ ~ ?n xr a--~ fia ` ~i w Enclosed for filing please find the original a~ d a cocop of thee firbstvpagee of the Inheritance Tax Return and Inventory, along wrt pY Inheritance Tax Return. Please date stamp the closed e lf-addressed enavnlope~py of the Inventory and return them to my office m the en Also enclosed is a check for the filing fe duethe amount of $30.00 and a check in the amount of $27,217.50 for the inheritance tax If you have any questions or require any additional information, please do not hesitate to contact me. Sincerely, Nicole M. Kerns Enclosures cc: Marie Sheaffer, Personal Representative *Certified Elder Laiu Attorney by the National Elder Law Foundation as authorized by the Pennsylvania Supreme Court i o00 I W , /~ Q r I C y + N m _ 2 ~ N ~ 1 aDUU Ong ~~~ I~ ~N ~ ~~ d cp 0 s`~7.4~~ O Q rd - -x ~~~ M ~~ tV ^ ~ ~© ~. .) N t-r~ t.~s ~ CAS.. i =,.~ ~ ~ ~ C~ ~ a ~ c ,~ ~_.._ ..~~ ~- -. _.__..__ =1 ~" ;`~ '."' ~~~ :1 ~~ .:-~ ~~ ~7 ~~ ,nl _--- -<7 ---~ ...~- u'1 rte- m ~~"~ ~ ..o 0 0 0 o' 0 ti m 0 0 0 N N O O Q ~ ~ a~'~ Q ~ a W ~ a~ w ~ .~ J ox 0 0 N O a~ ,~ ~ ~ U s M a~ ' ~ ~ .~ o ~ o U ~ o ~~a¢. ~~ ~ ; o ,~' ~ ~ U .~ 'on ~ ~ U O U