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Home My WebLink About02-14-111505610101 'J REV-1500 Ex`01.1°' ~' OFFICIAL USE ONLY PA Department of Revenue pennsylvama County Code Year File Number OEPMMEMT Of REVENUE Bureau of Individual Taxes INHERITANCE TAX RETURN ~~"""" "~~~~~~~ "~ ~~~~~ ~~~~~~ 21 10 ~ 0 9 5 2 Po Box s8o6o1 Harrisburg PA 1')128-0601 RESIDENT DECEDENT ' I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY j 181-52-4887 ',09/05/2010 :.12/14/1970 . ~ ~ i._ _._.... _.._____~___ ~ Decedent's Last Name _.._ ___w...~ .~_ ~ _~ .~ __- _.._ Suffix Decedent's First Name MI _... Theal Stephen R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name _. - __ ___ ___.,,,. W ___,. _ __ _.. E Suffix Spouse's First Name MI ~~ ._ .._... _..._ - _.-_.__ ~ w._..._.~~ _ ..,. S.W... .,.,..,_,..., ,,,~_.,. .,..,,,.. _ ....._._,,.~~.~_ Spouse's Social Security Number ~ .,-.,.._..,..7 ,......_...~_ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ ~~ _ _~_._._ _~._..___J REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 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) O 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 Telephone Number _ _ ___ Andrew C. Sheelv. Esquire ~ _....~..._..~..._. 717-697-7050 First line of address :127 South Market Street c rnnrl hno of aft[trPCS P.O. Box 95 City or Post Office Mechanicsburg State ZIP Code __..._.. PA '17055 REGISTER WILLS USF~ILY -. ~ ~ "T' 1 l C ~~ W ~ ~ - LJ ~ ~ tS, ` p1-TE FILED ~ __ ~ -_.I Correspondent's a-mail address:andrewc.sheely@verizon.net Under penalties of perjury, I declare that I ve amined this return, in g accomp ying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declar Ion o reparer other an p onal repre ntative is based on all information of which preparer has any knowledge. ~n~rc SIGNATURE OF P RESP S FO N ~- // ~~ r pnr1RFCR Samuel R. T , Ad .,101 rush Lane, Mechanicsburg, PA 17055 _ SI RE F P P E O HAN RESENTATI ~Ai j`/ ~/ n ccc ~!/ Andrew C. Sheely, Esquire, 1 outh Market St.,P.O. Box 95, Mechanicsburg, PA 17055 - .._ _.__ PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J REV-1500 EX Decedents Name: Theal, Stephen R. RECAPITULATION 150561D105 1. Real Estate (Schedule A) ............... .................... . . . . 1 2. Stocks and Bonds (Schedule B) ............ ...................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 2. ..... 3, 4. Mortgages and Notes Receivable (Schedule D) ...... .......... . ..... 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 4. ..... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. 7. Inter-Vivos Transfers 8 Miscella ..... g, neous Non-Probate Property (Schedule G) O Separate Billing Requested .... .... 7. 8. Total Gross Assets (total Lines 1 through 7) ....... .................. ... . 8. 9. Funeral Expenses and Administrative Costs (Schedule H) .. ............. .... 9, 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... .... 10. 11. Total Deductions (total Lines 9 and 10) .......... ................... .... 11. 12. Net Value of Estate (Line 8 minus Line 11) ....... .................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not be ... 12. en made (Schedule J) ..... , , . 13 14. Net Value SubJect to Tax (Line 12 minus Line 13) .... , ... , 14 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unc+~~ Esc. 9116 (a)(1.2) X .0. 16. Amount of Line 14 +~~able 15. at lineal rate X .045 17. Amount of Line 14 taxable 16. at sibling rate X .12 18. Amount of Line 14 taxable 1 ~• at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT $120,000.00 $3, 748.34 $123,748.34 $18,681 93 $53, 786.59': $72,4x8.52 $51,279.82 $51,279.82 L Side 2 1505610105 Decedents Social Security Number 181-52-4887 __,___~ i 1505610105 REV-1500 FJ( Page 3 Decedent's Complete Address: Stephen R. Theal gracGTennaece 4316 Allen Road C'T" Camp Hill Tax Payments and Credits: 1, Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments - B. Discount $2,200.00 $115.77 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the differences Th~'ISnathe OVERPAYMENT. FNI in oval on Page 2, Line 20 to request 5. If Line 1 + Line 3 is greater than Line 2, enter the diilference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. (3) (4) $8.18 0 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a Vansfer and: .......... es ^ ^ property transferred• ....................................................................... a, retain the use or income of the ~••••••••• ^ ^ X b. retain the right to ~signate who shall use the property transferred or its income : ............................................ ........................ .. ^ . c. retain a reversionary interest; or ............. ............................................................................... receive the promise for life of either payments, benefits or care? .................. d . 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ........ . ^ without receivir-y adequate consideration? ........................................................:............................................ Did decedent own an "in trust for" or payable-upon-death bank aaount or security at his or her death? ............. . ^ ^ 3. 4. Did decedent own an individual retirement account, annuity or other non-probate property, which ............... . ^ a • des' nation? ................ contains a beneficiary Ig ........................................................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTK?NS fs YES, YOU MUST CtN~PLETE SCHEDULE G AND FILE R 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)J. For dates of death on or after Jan. 1, 1~not exam t aetrartsfer toto artsurviv ng spouse fromntax and the statutory raga remen~ for I~'sclo~re of ssetsr and [72 P.S. §9116 (a) (1.1) (ii)J. The statute does p ~ is the onl benefiaa filing a tax return are stilt applicable even if the surviving spou y ry• 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 a a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)j. The tax rate i ai the net value of transfers to or for the use of the decedent's lineal benefraaries 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 trleaastf+~to or~fot ithece sterlontvhnth ~ tae b~~ether by bloodt oar adopfron116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has a Pa Flle Number 21-10 - 0 9 5 2 STATFpA i ZIf17011 (1) $2,307.59 Total Credits (A + B) (2) $2, 315.77 REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THEAL SAMUEL R 101 WINDRUSH LANE MECHANICSBURG, PA 17055 ACN ASSESSMENT CONTROL NUMBER -------- fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 181-52-4887 2110-0952 THEAL STEPHEN R 12/03/2010 12/03/2010 CUMBERLAND 09/05/2010 TOTAL AMOUNT PAID: REMARKS: CHECK# 1016 SEAL INITIALS: SAP RECEIVED BY: N0. CD 013739 AMOUNT $ 2, 200.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1502 EX+ (11-OS) ~ pennsylvania DEPARTMENT Of REVENUE INHERITANCE TAX RETURN occmFNT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Stephen R. Theal FILE NUMBER 21-10-0952 ~_n__a .... ewe .. a ~t which nrnnerty I real property owned solely or as a tenant in common must be reported at fair marKet vague. rarr n~a~ ~c~ .a,~~ ,~ ~~~~~~~- -- -••- ~ -- - would be exchanged between a willing buy that is oinltij-ownede1with right of survi orship mustllbe disclosed onaSchedulenF ledge of the relevant facts. Real property j Attach a copy of the settlement sheet if the property has been sold. VALUE AT DATE ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. OF DEATH NUMBER DESCRIPTION $120,000.00 i. 4316 Allen Road, Camp Hill, Lower Allen Township, Cumberland County, PA. Tax Parcel No. 13-24-0797-092 (See attached settlement sheet) $120,000.00 TOTAL (Also enter on Line 1, Recapitulation.) $ If more space is needed, insert additional sheets of the same size. ,~Q~SMENT~* ~-. Settlement Statement HUD-1) 's ~ a 1a 4 P g~M DF~t~ OMB Approval No. 2502-0265 _,.---- -- - -- Loan Number: 7 -~ - _ __ Insurance Case Number: 8 M~9e _ --- - t ~ ~ FHA 2 ~ i RHS . ~~ 8. file Number. 3.~~ Corw Unins ` ~ 1 4 VA 5. ~ ~i Conv. ins. __ - -_. ~ r , _ _ _- --- _ _ __ _ - --- to and by the settlement agent are shown. Items marked f actual settlement costs Amoun ------ _ t i t o a statemen C Note: TMs tome is fumistied t0 !~ you - ---- ___ _ _ _ _ - acted in the totals. o c )" were paid outside the dosing; they are shown here for iMormatbnal and are rat i (p Name & Address of Lender: F w -_ ---- . __-- I D. Name 8 Address of Bonower: r ~ STE E PHEN R T~ HEAL. ESTATE . MEMBERS 1ST FEDERAL CREDIT UNION WILLIAM M WILHELM 4201 GETTYSBURG LOT 16 14318 ALLEN RD PA 17011 5000 LOUISE DRIVE ~MECHANICSBURG PA__ 17055. _ CAMP HILL. _--_-- -_ -- PA __17011 __ __ CAMP Hill .---_-- _ --- ~ - -- __ ~ H. Settlement Agent: j I. Settlement Date: ~ G. Properly Locatkxi: MEMBERS 1ST SETTLEMENT SVGS 717.795-5170 % 1/28/2011 ~ I 5000 LOUISE DRIVE PARCEL # 13-24-0797-092 IMECHANICSBURG_ - _ ___--._ PA 17055 - _. i--__ _.- _- -_ 4316 ALLEN RD ~ Piac~ of Settlemgnt: 5000 LOUISE DRIVE ,,DISBURSEMENT DATE (CAMP HILL PA 17011 li i MECH/WICSBURG_-- -- _ - .. _ PA__ 17055__ X1/28/2011 - _---_1- _-_ - --.._ __. ~ ~ -- f ~ ~_ - ~ _ . - -- ""~'"_ _. . ~ ~ ~ ~ '...._' ^' -~~ ~ -_...^ 120 000.00 n. _ ~ . ~ ~- 120,000.00: . -~ - - - ~ ,.. ~. - _ ~ .~ . ~~. . _ __- _- 370.251 - -- "'- ~ 34.44' ~:__ _ 37.17', -~. ' _- - 1000.00 _ --_-8,835.00'. _ _-0.00, ~~ 31 836.48!. --- . - , e_-~'I --- _ 18.00 m-1 _ - - _ _...1.0.00 ~_.: 120,441.x'. ~---~- -~ ( 41,535.84)_,, ~'-- - ~ 78,x.02. ___ _ _ _ -- - Huo-1 __ --_ ---- --- -------- - - page 1 of 3 Previous ed'fions are obsolete The Public Reporting Burttert for this collecbon of informa8on is estimated at 35 minutes per response for cofiecting. revlev+^n9, and reporting the data. This agency may not collect this infonnatbn, and you are not required to comma tis designed tolprovide the parties to currently valid OMB control number. No confidentiality is assured; this disclosure's mandatory. a RESPA covered transaction with information during the settlement praess. . _ ----------y--- Paid From Paid From i --_ .,--- ' - T00rT~1 Real Eetate Broker:Fsaa Borrower's < Sellers _ Division of commiesbn pine 700) as follows: ENTURY 21 PIS IONERI LTY INC. t Funds at Funds at geNbmeni Settlement ~' 0 701.E 3 828.00 3 600.00 So MARGARET STUSKI -_ 7 7 425.00 . 02E 7D3. Commission paid at settlement -- - ~ 704. I 800. Itsms Pa able in ConneeUon with Lan S 375.00 (from GFE M1) ___ _--------- 801. Our origination charge r credtt or charge (points) for the specific interest rate chosen S - Y (hom GFE >K2) --- i (~ GFE A) 375.00 _ _.__ _j ou 802. 803. Your adjusted origination charges - (from GFE S3) 300.00 _ _ -.--_ _ ~ 804. Appraisal fee to $ 300.00 (from GFE ff3) _ 15.00 _ __._ 805. Crodit roport to $ 15.00 (from GFE ~3) --- 808. Tax service to *3) - ---- { 807. Flood certficetion ----- ~' -- _-- ~ 808 a. ,- Exclude last day in'cak~ - IInB 901 -900, llama Required'by Lender to Be Paid in Advanss 12ldey4. S 36.49 from GFEifto -- ~ , ~ 901. Dairy interest charges from 1 /28/2011 to 1731!2011 onths to (from GFE fF3) _ -- - ------ ____~ for m 902. Mortgage Jnsurenee premium Years to ~ (from GFE fk11) - -- ~ for 903. Homeowner's insurance ~ ' - _ _ -~ -- 904.'a. _-- -- 1000. Rraserws Depoalbd with i,ender from GFE fl9) 463.36 ___-- ~ 1001. Initial depoatt fbr your escrow account r month 5 months ®S 37:33 pe 111.99 -- -~ 1002. Homeownefs jnsurance 3 par month S 0.00 - 1003. Mortgage insurance months ~ S --- months ~3 :40.96 per month 5 12 491:52 ---~ I, 1004. Property fazes .73.81 per month S 8 months ~ S . 5.88.88. J 00 0 1005. SCHOOL TAX months S per month 3 . ~ _729 03 ---~ 1006. a. -S -- 1007. ppgregate AdJwtment ----- - 1100, Title Cha es (from`GFE *4) 978.75 _ _--+ 1101. Tttb serviaea and fender's tttb insurence s; -__ __ ._-1 25 69 1102. Settlement or eloeing fee ___; . (from GFE ff5) 1103.Owner's tRb insurance, - - - S ---- X245 75 --~ _ _ _ ENDORSEMENTS 100 300 8:1 A . 1104. Lender's tttk insurance P 88 800:00 PENN ATTORNEYS OHIO BAR'TITL ~ __ _ E 1105. Lendsl's tttb-poll limft 3 120 000.00 =-- 11 Og. Owner's title policy limtt S i 11 OT. AgeM's Portion of the'total title insurence premium S __ _- 1 --- - 315.00 ` _.__-. t 108. llndennriter's rtion of the tota~4ftb insurance premium -~ --- -- __ ---- --- 1109. a.' _ _ 1200. Govemmsnt Recordin and TpnsferCha (from GFE #'>) 202.50 __~ ~ 1201. Government recoMing charges ' e 90.00 Releases S 00 Mortgeg S 62 ------ (from GFE ff8) 1 200.00 . 1202: Deed i 1 200_00 t 203'. Transfer taxes _ peed E f 200.00 Mortgage S - - 1204. CitylCounty taxlstamps ~ 3 1 200,00. ~ ' f' ' _J 1205. State'taxlstamps 1206. s• ASSIGNMENT OF MORTGAGE. :50.50 -- - 1300.'Addltlortai (from GFE ir6) ----- - -. 1301. Required services that You can shop for _-~--- _ _-____ 1302. S 20.00 __.10.00 1303. 00 1304. NOTARY FEE.. DIANE SMITH. t3os.a. 3,660.35 8,635.00 CERTIFICATION t of all receipts and d accurst e and belief, it is a UD S men element. act~on~ItfurttrertcenffY that lowhavgee I have carefully reviewed the e en s n ettb m l s ft s fn e t o accou disburaeme s eon my Date:1~28/201_1__ ~ w ~ Alyt"„i Date:1/26/2011 $BIbX HEAL ESTA EP EN Borcower WILLIAM M WILHELM Date: __-_.. _ Date: Seller: Borrower: _ ~ j l a rxls which were received To the best of my knowledge the HUD-1 Settlement Statement which I have prepared is a true and accu a u the undersigned as part of the settlement of m d b 11 n y and have been or will be disburse Settlement Date:1 /28120 Date: _ Agent: --- MEMBERS 1 T SETTLEM NTENTE the United States on this or any other similar form. Penalties upon conviction can include a fine t o WARNING: It is a crime to knowingly make false statements For details see: Title 18 U.S. code Section 1001 and Section 1010. nment i . so and impr ---------_-- HUD -" Page 2 of 3 Previous editions are obsolete REV:15os EX+ (6-98) SCNEpVLE E COMMONWEALTH OF PENNSYLVANIA ~~I"I/ BAN^K,,DwEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Stephen R. Theal Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolrtty-owned with rlpht of survlvorshlp must be disclosed on Schedule F. ITEM 1. Decedent's 2001 Ford Windstar LX, VIN #2FMZA51401 BB67148,127,000 miles 2. Contents owned by Decedent at 4316 Allen Road, Camp Hill, PA, per Chuck E. Bricker appraisal 3. Decedents final paycheck from Commonwealth of Pennsylvania 4. Sovereign Bank Checking Acct. #2671028873 -value at date of death 5, Verizon Refund 6. ~ Erie Auto Insurance Refund 7. ~ Comcast Refund FlLE NUMBER 21-10-0952 VALUE AT DATE OF DEATH $1,000.00 $620.00 $1,640.15 $390.70 $ 21.11 $54.00 $22.38 I 3,748.34 TOTAL (Also enter on line 5, Recapitulation) S (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA OFFICE OF THE BUDGET COMPTROLLER OPERATIONS Andrew C. Sheely 127 S. Market Street, P. O. Box 95 Mechanicsburg, PA 17055 Dear Mr. Sheely: October 21, 2010 BUREAU OF COMMONWEALTH PAYROLL OPERATIONS P.O. BOX 8006 HARRISBURG, PA 17105-8006 FAX: (717) 772-3104 The enclosed check represents payment to you on behalf of Stephen R. Theal as the representative of his estate. Please note that you as the representative will receive a "Form 1099-Misc." in the amount of $1,887.55 at year's end. The form will be in the name of the ESTATE OF STEPHEN R. THEAL and the TIN #27-6814932 and should be kept along with this letter for tax filing purposes. PAYMENTS (PAY DATE AFTER DATE. OF DEATH) PPE DATE PAY DATE 9/3110 10/21/10 TYPE PAY HOURS DEDUCTION GROSS AMOUNT* NET Sala 75.00 $1,305.00 Annual 16.23 $282.40 Personal Sick 3.00 15.00 $52.20 $261.00 $260.45 $1,640.15 LESS NON-TAXABLE GROSS DEDUCTIONS: AMOUNT EXPLANATION OF NON-TAXABLE DEDUCTION $13.05 _ Pre Tax Medical APPRAISAL Pvrs~-r~d prapsMy a# ~~~~ ~f7`~h~~- ~,~1 -fit F~ #~cl ~ GAMP ti ~c.. c_ t~~~ ~~ o i l ~k E. tM~cker AFL ~ - tote ~ y J ? _ ,~ ~ ~ Y~#a~E YA{~1 ~~ ~g a._. CY- ~g~ a t x"~ ,~L~'c~RdS, cos . ~ ~ .„ .. _:~_ __ ...'~ - P,c, ~d , ;S U i ~ ;~~-~ a VF ~ "~ ~ ~ , ; : ~; G+1 ~..~.: U t~ T •~ : _ T~ IUD ,, ~.., r R. d. T ~ c. ~ A,p~ r.d 1 ~ ~ ~ ~ ~` y~ ~ ~ ~, f'?AA~- ~ ~-f u j`t N ,t~? ~ ISMS - PvT,s ~'A~ s ~ o , ~~ o ~r l ~~~~ ~ ~ ~. . .~ ..µ ._ - __ REV-1511 EX+ (10-09) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF Stephen R. Theal Decedent's debts must be reported on Schedule I. FILE NUMBER 21-10-0952 ITEM DESCRIPTION AMOUNT CUMBER A. FUNERAL EXPENSES: $12,652.47 1• Malpezzi Funeral Home 2. Gingrich Memorial -headstone $2,040.00 3• J. C. Snyder, Florist -flowers $356.16 e. ADMINISTRATIVE COSTS: $0.00 I, Personal Representative Commissions: Name(s) of Personal Representative(s) Samuel R. Theal, Adminisrator street address _101 VVindrush Lane Mechanicsbur _ state PA zIP 17055 City _ 9 Year(s) Commission Paid: $2,500.00 2. AttomeyFees: Andrew C. Sheely, Esquire, as per agreement 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 _ $309.50 4. Probate Fees: $200.00 5. Accountant Fees: 6. Tax Return Preparer Fees: $8.80 ~, Misc. Postage $15.00 e. Filing Fee s. Reserves to conclude Estate Administration, including final accountings, state and federal income $600.00 tax returns, liabilities 18,681.93 TOTAL (Also enter on Line 9, Recapitulation) ¢ If more space is needed, use additional sheets of paper of the same size. ~t~~ Fi~~renal' '+~ Fiin~r~ ~ ~R11 t;rlMlrt! ~. t01 W~ri tart 1Mitetir~stt!Ner~.M i7~965 't11RAt.Cr-~AiYNlltXi~~J-1-~ ~~ ICriA~#I~YCRI t tti~160dM RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse S ware Carlisle, PA 1713 THEAL STEPHEN R Estate File No.: Paid By Remarks: 2010-00952 SAMULE R THEAL wZ ------------------- Fee/Tax Description PETITION LTRS ADM RENUNCIATION SHORT CERTIFICATE JCS FEE AUTOMATION FEE Check# 1499 Total Received......... Receipt Date: 9/16/2010 Receipt Time: 10:43:46 Receipt No.: 1062612 Receipt Distribution ------ ------- -------- --- Payment Amount Payee Name 210.00 CUMBERLAND COUNTY GENERAL FUN 5.00 CUMBERLAND COUNTY GENERAL FUN 16.00 CUMBERLAND COUNTY GENERAL FUN 23.50 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- $259.50 $259.50 REV-1512 EX+ (12-08) pennsylvania SCHEDULE I DEPARTMENT Df REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Stephen R. Theal Page 1 21-10-0952 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE OF DEATH NBER DESCRIPTION i. Mortgage Payoff of Bank of America home loan, Account #088383604, per settlement sheet $31,836.48 2. Settlement Costs: Real estate commissions, Real estate transfer tax, notary fee, per settlement sheet $8,635.00 3. Check printing fee - PNC Bank $17.99 4. Exxon Mobil -final credit card balance $7422 5. Verizon -final phone bill $29.65 6. ATT -final long distance bill $18.01 7. Sovereign Bank -final credit card balance $4,362.16 8. Jackson Siegelbaum -final bill $25.00 9. Pulmonary Medical Associates -final bill $25.00 10. Shane Bouder -trash removal $110.00 11. Sewer & Trash -final bill, adjusted per settlement sheet $128.29 12. BAC home loan service -mortgage payments since death $1,633.40 Decedent died in his residence requiring various improvements and substantial remediation prior to settlement. including the following debts for renairs and imnrovements ne~sssarv to bring the home to a reasonable condition. 13. Innovation Carpets -removed and installed new carpet $1,105.00 14. MC Designs -kitchen repairs $1, 372.00 15. Criberi Painting $1,450.00 16. Sears -new gas range and installation fee $515.42 17. Faircloth Plumbing and Heating - furnace repairsrnstallation $1,575.00 18. Lowes -misc. items $14.00 19. Radle Electric $255.00 TOTAL (Also enter on Line 10, Recapitulation) I $ If more space is needed, insert additional sheets of the same size. REV-512 EX+ (12-08) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Stephen R. Theal Page 2 FILE NUMBER 21-10-0952 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 adtl~UOnal 5nee[s or [ne same site. REV-1513 EX+ (9-00) SCNEpt~LE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stephen R. Theal NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. Samuel R. Thea1,101 Windrush Lane, Mechanicsburg, PA 17055 2. ~ Doris D. Thea1, 101 Windrush Lane, Mechanicsburg, PA 17055 FILE NUMBER 21-10-0952 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Father 50°!o Rest, Residue & RPmainriPr of FstatP Mother 50% Rest, Residue & Remainder of Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX 15 NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S (If more space is needed, insert additional sheets of the same size)