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HomeMy WebLinkAbout04-26-11s 1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue - Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN ~, 1 1 0 0 9 2 2 Hamsburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 0 0 5 6 2 3 4 0 8 2 9 2 0 1 0 1 0 2 7 1 9 1 5 Decedent's Last Name Suffix Decedent's First Name MI S p i c k l e r J R J o h n J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Narne 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 1 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) (:VKKt,F'VNUtN 1 - I F11, Jtl:l IUN MUJI Lit VVMF'Ltl tU. ALL t:UKKt,YVnUtnl:t AnU l:VntlUtn I IAL IA1C IntUKmAI IVn .~r'fVULU Lit UIKC~.1 to I V: Name Daytime Telephone Number W a y n e F S h a d e E s q u i r e ~~ 1 7 2 4 3 O r. X 2 0 ~ ~ Firm Name (If Applicable) i ~_~,~ -~=.Y First line of address 5 3 W e s t Second line of address City or Post Office C ar l i s l e State P A ZIP Code '- 1 7 0 1 =3 :f€~~ ILLS USE.ONLY ~" L 1 ~~,, ~--- `..% _ . f. ~7 _ -r f'r'1 I r ~, ~ _ ~ ` ~~ ~ } k.. ° ..._.F ..~ ~ ~ ' ~ - ~ c"a ~, - ; _. ~... _. ~ ..._ y DATE FILED '~ - ~ Correspondent's a-mail address: waynefshade(a~comcast.net 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. SIG ATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 48 South 8th Street Columbia PA 17512 SIGNATURE OF PREPA ~' ,THAN REPRESENTATIVE ~~~ ~/~ ennoeee 53 West Pomfret Street Carlisle PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 P o m f r e t S t r e e t J 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: John J• S p i c k t e r, J r• 1 6 0 0 5 6 2 3 4 RECAPITULATION 1 1 0 7 4 B 5. 7 7 1. Real estate (Schedule A) ........................................ 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. • 4 8 1 7 4 . 0 3 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ....... 5. 6. Join±ly Qwned Property (Schedule F) ^ Separate Billing Requested ....... 6• 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. • 8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 5 5 6 5 9. 8 0 9. Funeral Expenses & Administrative Costs (Schedule H) ....... ...... ... 9. 1 1 0 9 3 . 1 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ... ...... ... 10. 5 2 5 7 . 5 5 11. Total Deductions (total Lines 9 8~ 10) .................. ...... ... 11. 1 6 3 5 0 . 7 2 12. Net Value of Estate (Line 8 minus Line 11) ................ ...... ... 12. 1 3 9 3 0 9 . 0 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 5 4 2 0 0 0 an election to tax has not been made (Schedule J) ......... ...... ... 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) ............... ... 14. 1 3 3 8 8 9 . 0 8 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 0 0 0 15. 0. 0 0 16. Amount of Line 14 taxable 0 0 0 0 0 0 . at lineal rate X .0 1 g. . 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17 • 18. Amount of Line 14 taxable 1 3 3 8 8 9 0 8 2 0 0 8 3 3 6 . at collateral rate X .15 18. . 19. Tax Due ....................................... ...... ...19. 2 0 0 8 3. 3 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 7L505607221 REV-1500 EX Page 3 . Decedent's Complete Address: File Number 21 10 0922 DECEDENT'S NAME John J. Spickler, Jr. ___ STREETADDRESS 3 Far View Avenue CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: ~. Tax Due (Page 2 Line 19) (1) 20,083.36 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 16,000.00 C. Discount 842.08 Total Credits (A + B + C) (2) 16,842.08 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E ) 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) 0.00 (5) 3,241.28 (5A) (5B) 3,241.28 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 : ................................................................. ..... ^ X^ b. retain the right to designate who shall use the property transferred or its income; .......................... ..... ^ X^ 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 "intrust for" or payable upon death bank account or security at his or her death? .... ..... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................................................. ..... ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 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 1:0 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(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 four and one-h~~lf (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. 0.00 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.:i. §9116(a)(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-1 F;02 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER John J. Spickler, Jr. 21 10 0922 All real property owned solety or as a tenant in common must be reported at fair market value. Fair market value is defined as the pace at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real uropertv which is iointN-owned with right of survivorship must be disclosed on Schedule F. _ ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, House an of o groan own an num ere as Fax View Avenue, ax is e, 107,4 5.77 Cumberland County, Pennsylvania, valued in accordance with the net: proceeds of sale thereof to an unrelated third party TOTAL (Also enter on linE~ 1, Recapitulation) ~ $ 107,485.77 (If more space is needed, insert additional sheets of the same size) i:.. ~~~ ~ `` t~ y A. Settlement Statement HUD-1 ~~ ~ ICI ~:. ~._ OMB Approval No. 2502-0265 FINAL 1. ~ FHA 2. Q RHS 3. Q Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case: Number: 11-0026 0234650992 4. Q VA 5. Q Conv. Ins. , C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked "(p.o.c)" were paid outside the closing; they are shown here for Informational purposes and are not included in the totals. D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender: Marcia R. Rebuck Estate of John J. Spickler by his Executrix Joanne SunTrust Mortgage, Inc. 4445 Valley Rd., Enola, PA 17025 Meiskey PO Box 57028, Irvine, CA 92619=028 3 Far View Avenue, Carlisle, PA 17013 G. Property Location: H. Settlement Agent: 1. Settlement Date: 02/25/2Ci11 3 Far View Avenue Guardian Transfer, Inc. Disbursement Date: 02/25/x:011 Carlisle, PA 17013 4075 Market St., Camp Hill, PA 17011 Middlesex Township ' Phone: (717) 614-4098 Fax: (717) 723-4585 Place of Settlement: TitleExpress 4075 Market St., Camp Hill, PA 17011 Printed 0 212 5/2 0 1 1 at 10:23 am by JMG -:1.00 Gross Amount Due!from:~orrower 101. Contract sales price 118,000.00 102. Personal property 103. Settlement charges to borrower (line 1400) 4,342.29 104. 105. Ad'ustments for items aid b seller in advance 106. City/town taxes to 107. County taxes 02/25J2011 to 12131/2011 291.65 108. School taxes 02!2512011 to 06/30/2011 301.01 109. 110. 111. 112. 120. Gross Amount Due from Borrower 122,934.95 200, AmountaiRaid b or in Behalf of Borrower 201. Deposit or earnest money 1,000.00 202. Principal amount of new loan(s) 58,000.00 203. Existing loan(s) taken subject to 204. 205. 206. Seller Credit 650.00 207. 208. 209. Ad'ustments for items unpaid b seller 210. City/town taxes to 211. County taxes to 212. School taxes to 213. 214. 215. 216. 217. 218. 219. 220. Total Paid b/for Borrower 59,650.00 300. Cash at;Settlement froMto.'t3o(roWer 301. Gross amount due from borrower (line 120) 122,934.95 302. Less amounts paid by/for borrower (line 220) 59,650.00 303. e Cash ^X From ~ To Borrower eo no e ~ nn .. .. ............ ... -. -. 63,284.95 ...-.~'_ me corm, [ewse H asgsye . c[rrsntry veYd OMB control rYenbsr. No coMldeNieYly Is eesved; 1Ns dlaebsve le msndelory. sallhmanl process. dq0 Gross Amount bue;to Seffer _.. 401. Contract sa es price 118,000.00 402. Personal roperty 403. 404. 405. Ad'ustments for items aid b seller in advance 406. City/town taxes to 407. County taxes 02125/2011 to 1213112011 291.65 408. School taxes 02/25/2011 to 06130/2011 301.01 409. 410. 411. 412. 420. Gross Amount Due to Seller 118,592.66 500, Rsd'uatiope In Arnoutit t)4e to!Seller 501. Excess deposit (see instructions) 502. Settlement charges to seller (line 1400) 10,456.89 503. Existin loa s taken subject to 504. Pa off of first mort loan 505. Payoff of second mortgage loan 506. Seller Credit 650.00 507. 508. 509. Ad ustments for items un aid b seller 510. City/town taxes to 511. County taxes to 512. School taxes to 513. 514. 515. 516. 517. 518. 519. 520. Total Reduction Amount Due Seller 11,106.89 60U. cash at Setttementaoltrom 5elldr _ _ 601. Gross amount due to seller (Ilne 420) 118,592.66 602. Less reductions in amount due seller (line 520) 11,106.89 603. ra Cash X~ To ~ From Seller a. a epency mey co a on, ^ you sre rs n o c 107,485.77 • S IY deelyned to proviM tM perUes to • RESPA covered tnunsdlon with Intartnetian during IM TN Previous editions are obsolete Page 1 of 4 HUD-] J00. Total Reai`Estate BrokecFees '7;080.00 Pald FCOjl1 Pdld From '- Division of commission(Iine700):as.foAows: _ :. ''BOf'rOVJef''S ~~eLlet S 701. $3,540.00 to Hooke, Hooke&Eckman FUndS at F1aRdS at- 702• $3,540.00 to Coldwell Banker Homestead Group Select Pro Settlemetlt ~eialemenf 703. Commission paid at settlement 7,080.00 704. Broker Fee to Coldwell Banker Homestead Group Select Pro 300.00 __ _ _. 800. Items Pa able in :onnectjon with Goan 801. Our origination charge (Includes Origination Point °k or $0.00) $1,818.00 (from GFE #1) 802. Your credit or charge (points) for the specific interest rate chosen -1,218.00 (from GFE #2) 803. Your adjusted origination charges (from GFE A) 600.00 804. Appraisal fee to Erik J. Reisser (from GFE #3) 250.00 805. Credit report to Credco (from GFE #3) 18.00 806. Tax service to (from GFE #3) 807. Flood certification to Corelo is (from GFE #3) 6.00 808. to .900. iltems Re wired b ILender to be'Rai.d in Advance' 901. Daily interest charges from from 0212 2011 to 0310112011 ~ $7.3500/day (from GFE #10) 29.40 902. Mortgage insurance premium for months to (from GFE #3) 903. Homeowner's insurance for 1 ears to Allstate $420.13 P.O.C. B* (from GFE #11) 904. months to from GFE #11 1000:: Reserves De .osited with Gender __ . 1001. Initial deposit for your escrow account (from GFE #9) 463.14 1002. Homeowner's insurance 3 months $ 35.011month $105.03 1003. Mortgage insurance months $ 0.00/month $ 1004. Property taxes months $ O.OOlmonth $ 1005. County taxes 2 months $ 28.611month $57.22 1006. School taxes 9 months $ 72.66/month $653.94 1007. Aggregate Adjustment ~ • $-353.05 1100. Title Char es__ _ .. 1101. Title services and lenders title insurance from GFE#4 918.75 1102. Settlement or closing fee to $ 1103. Owners title insurance (from GFE#5 342.00 1104. Lenders title insurance $831.75 1105. Lenders title policy limit $58,000.00 Lenders Policy 1106. Owner's title policy limit $118,000.00 Owners Policy 1107. Agent's portion of the total title insurance premium $933.94 1108. Undervuriter's portion of the total title insurance premium $239.81 1109. 1200: Government.Racordin andTi•anisfar Char es 1201. Government recording charges $ (from GFE #7) . 152.00 1202. Deed $62.00 Mort a e $90.00 Release $ 1203. Transfer taxes $ (from GFE#8) 1,180.00 1204. City/County tax/stamps Deed $1,180.00 Mort $ t205. StateTax/stamps Deed $1,180.00 Mort a e$ 1,180.00 1206. Deed $ Mort a e $ 1207. $ __ -1300. Additional!Settlement Char es 1301. Required services that you can shop for (from GFE #6) 83.00 1302. Tax Service Fee to ValuTree Services 83.00 1303. Home Warranty to American Home Shield 435.00 1304. Plumbing to Hoovers Plumbin & Heatin Inc. 511.89 1305. Radon System to American Radon Solutions 750.00 1306. 2011 CdTwp Tax Escrow to Penn G Davis 500.00 ' F' ` ` • ~ t o ~ • 4,342.29 10,456.89 *Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. **Credit by lender shown on page 1. ***Credit by seller shown on page 1. Previous editions are obsolete Page 2 of 4 HUD-~ Com arison of Good Faith Estimate GF and HUD-1 Char es Char es That .Cannotlncrease 'HUD•1,l.ineNumber Our origination charge # 801 `Your'credit or charge (points) forthe specific' interest'tate chosen # $02 'Youradjust~d origination charges `' # 803 Transfer'taxes # ' 1203 'Char es'That Can Chan e ':Initial deposit For your escrow account ', # 1001 Gaily interest charges from # >90 $7;3500/day Homeowner's insurance # g03 Title services and lender's title insurance >' # 1101 <Owner's title insurance # 1103 Loan Terms Good Faith Estimate HUD-1 - 1,818.00 1,818.00 -1,218.00 -1,218.00 600.00 800.00 1,180.00 1,180.00 Gqod Faith.. estimate HUG-1 175.00 152.00 450.00 250.00 18.00 18.00 6.00 6.00 83.00 83.00 732.00 509.00 -223.00 pr -30.4645% Good Faith Estimate HUL)•'I ~ 1,656.00 463.14 29.40 29.40 480.00 420.13 1,254.00 918.75 500.00 342.00 .Your initial loan amount is $58,000.00 -Your loan term is 30. years Your initial interest rate is 4.6250% Your initial monthly amount owed for principal, interest, and any mortgage $298.21 includes insurance is Q Principal Q Interest Mortgage Insurance Can your interest rate rise? ~ No. ~ Yes, it can rise to a maximum of °k. The first change will be on / / and can change again every years after I I .Every change date, your interest rate can increase or decrease by %. Over the life of the loan, your interest rate is guaranteed to never be lower than °k or higher than %. Even ifyou make payments on time,: can your loan balance rise? XD No. ~ Yes, it can rise to a maximum of $ Even if you make payments on time, can your monthly amount owed for ;i QX No. ~ Yes, the first increase can be on / 1 and the monthly principal interest, end mortgage insurance rise? amount owed can rise to $ The maximum it can ever rise to is $ Doesyourloan have a prepaym~nt.penalty? ` QX No. ~ Yes, your maximum prepayment penalty is $ Doesyour loan have a balloon payments ', ^X No. ~ Yes, you have a balloon payment of'$ due in years on / / Total monthly amount owed including escrow account'payments ~ You do not have a monthly escrow payment for items, such as property taxes ' and homeowner's insurance. You must pay these items directly yourself. > QX You have an additional monthly escrow payment of $136.28 that results in a total initial monthly amount owed of $434.49. This includes principal, interest, any mortgage insurance and any items checked below: ', XQ Property taxes QX Homeowner's insurance Flood insurance ~ School Taxes ^ ^ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Previous edrtrons are obsolete Page 3 of 4 HUD-~ ..- - HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipte~ and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. ~~.( ~ ~ 117 / ~ Ill Marcia R. Rebuck ,~. The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to bey disbursed in accordance with this statement. ETTLE ENTAGENT ~~~~ 4 , DATE WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 1E: U.S. CODE SECTION 1001 AND SECTION 1410. Previous editions are obsolete Page 4 of 4 HUD-J REV-1 ¢08 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER John J. Spickler, Jr. 21 10 0922 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~, Cas 161.17 2. M&T Bank, account # 15004200944351 35,465.24 3. M&T Bank, account # 25004920103005 200.04 4. M&T Bank, account # 439290 6,560.95 5. M&T Bank, account # 2500492003 5 844 400.08 6. Shipley Energy, refund of unused fuel oil account 506.21 7. AAA, membership refund 43.75 8. The Sentinel, subscription refund 8.48 9. Hoffman-Roth Funeral Home & Crematory, Inc., refund of funeral bill 100.00 10. Conexis, COBRA credit balance refund 4.21 11. Highmark Blue Shield, refund of unused premium 691.54 12. Kemper, refund of unused premium 665.00 13. Miscellaneous books 420.00 14. 1995 Chevrolet Lumina 1,650.00 15 . Household contents 3 3 5.00 16. Rowe's Auction Service, net proceeds of public auction of personal ~~roperty 388.00 ---_ TOTAL (Also enter on line 5, Recapitulation) $ 48.174.03 __ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent John J. Spickler, Jr. Decedent's Name Page 1 21 10 0922 File Number Schedule E -Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. Repu is Services, Inc., ream ursement or overpayment o tras rem~ova 4 .75 18. Kemper, refund of unconsumed homeowner's insurance premium 269.00 20. The Patriot News, refund of unused subscription 74.72 21. Guardian Transfer Corp., real estate tax escrow refund 137.68 22. Cumberland Star Masonic Lodge, membership refund 25.00 23. PPL, electric service refund 19.21 24. Conestoga Memorial Park, 2 burial plots, entered in memorandum form as of no 0.00 value on the basis that we attempted to donate them to various churches, fire companies and the Salvation Army. No organizations were interested in them, and there will be a $95 fee for each of them to simply transfer them to the heirs at no value. SUBTOTAL SCHEDULE E 574.36 GRAND TOTAL SCHEDULE E $ 48,174.03 M&T Bank 499 Mitchell Street, N[illsboro, DE 19966 September 20, 2010 Wayne Shade Attorney At Law 53 West Pomfret Street Carlisle, PA 17013 RE: Estate of John Spickler Date of Death: August 29, 2010 Social Security Number: 160-05-6234 Dear ~Mr. Shade: 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. Account Type ........................... Savings Account Account Number ....................... 25004920035844 Ownership (Names off .............. John Spickler Opening Date ...........................10/04/83 (account closed 09,08/ 10) Balance on Date of Death .........$400.08 Accn.~ed Interest $ 0.04 Total ....................................... $400.12 2. Account Type ........................... Savings Account Account Number ....................... 25004920103005 Ownership (Names o, fl .............. John Spickler Opening Date ...........................10/04/83 (account closed 09/08/ 10) Balance on Date of Death..........$200.04 Accn.~ed Interest $ 0.02 Total ...................................... $200.06 • Page 2 3. Account Type ........................... Savings Account Account Number ....................... 25004920109996 Ownership (Names off .............. John Spickler Opening Date ...........................08/25/93 Balance on Date of Death.........$0.00 Accrued Interest $0.00 Total .......................................$0.00 4. Account Type ........................... Checking Account Account Number ....................... 439290 Ownership (Names off .............. John Spickler September 20, 2010 G-pening Date ...........................09/01 /67 (account closed 09,/08/ 10) Balance on Date of Death .........$6,560.95 Accn,~ed Interest $ 0.01 Total ....................................... $6, 560.96 5. Account Type ........................... Savings Account Account Number ....................... 15004200944351 Ownership (Names off .............. John Spickler Opening Date ...........................03/23/68 (account closed 09/08/ 10) Balance on Date of Death.........$35,465.24 Accnced Interest $ 0.64 Total ....................................... $35, 465.88 The above named decedent had a safe deposit box. • Page 3 September 20, 2010 * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please contact our High Street Carlisle branch at 1 West High Street, Carlisle, PA 17013 or # 717-240- 4536. Sincerely, Charlene Warrington, Adjustment Services 1-888-502-4349 REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER John J. Spickler, Jr. 21 10 0922 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ , Hoffman-Roth Funeral Home & Crematory, Inc., funeral service 778.22 B ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: State Zip 2. Attorney Fees Wayne F. Shade, Esquire 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant 4. Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills of Cumberland County, PA 5, I Accountant's Fees 6. ~ Tax Return Preparer's Fees 8,000.00 323.50 7, Cumberland Law Journal, advertise Letters Testamentary 75.00 8. Weaver Memorials, Inc., tombstone engraving 145.00 9. CenturyLink, telephone service 69.63 10. PPL, electric service 13.32 11. The Sentinel, advertise Letters Testamentary 198.16 12. PPL, electric service 22.09 13. Shipley Energy, fuel oil 194.45 14. PPL, electric service 8.47 15. York Waste Disposal, trash removal 48.75 16. York Waste Disposal, trash removal 48.75 17. PPL, electric service 12.34 18. Dillsburg Septic, septic system pumping and inspection 263.00 TOTAL (Also enter on line 9, Recapitulation) $ 11,093.17 (If more space is needed, insert additional sheets of the same size) John J. Spickler, Jr. Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent Page 2 21 10 0922 File Number Schedule H -Funeral Expenses ~ Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 19. Shipley Energy, fuel oil 409.49 20. PPL, electric service 18.00 21. Register of Wills, file inheritance tax return 15.00 22. Register of Wills, reserve for filing Account, etc. 450.00 SUBTOTAL SCHEDULE H-B7 ~ 892.49 REV-1 ~12 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER John J. Spickler, Jr. 2 ]~ 10 0922 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Home Instead Senior Care, in-home health care 4,675.59 2. ~ PPL, electric service 3 . ~ CenturyLink, telephone service 4. ~ Calaman's Lawn Service, lawn care 5. ~ Lincoln Financial Group, pension reimbursement 6. ~ Formprest Cleaners, laundry services TOTAL (Also enter on line 10, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 68.3 8 44.38 116.60 341.68 10.92 5,257.55 REV-1513 EX + (9-00) a COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER J onn J. ~ icxier, .r r. G 1 1 ~ ~ ~~~ RELATIONSHIP T'0 DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List'~rustee(s) OF ESTATE j TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Joanne Meiskey Collateral 66,944.54 48 South 8th Street Columbia, PA 17512 2. Jean Smith Collateral 66,944.54 1301 Manor Street Columbia, PA 17512 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET jj, NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Bosler Library, miscellaneous books 420.00 2. First United Church of Christ 5,000.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 C~DVER SHEET $ 5,420.00 (If more space is needed, insert additional sheets of the same size;i REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: _ 16,000.00 Discount: Interest Table 842.08 Days Delinquent ~ Balance Due ~ Interest , Year this time period this year this period _ ~, Before 1981 ~ ~ ____ ~ 1982 ~ ~ '~ _ ~ _ 1983 __ -- - - -- - _ 1984 '~ 1985 ' !' ~ -- - --- -- _ 1986 -'; - -- - - ---- ------- --- I! --- -- -- ~, _1988 through 1991 r- - _--~-- ----- --+- ---- -- -~I 1992 _ ~ _ _ -------- 1993 through 1994 ___ ~_____-__-_ -- - --- - 1995 through 1998 ~______ - J 1999 ~- 2000 ~ ~ _ __-_ _ _ ~ ~ 2001 2002 2003 ----- - -- f- -------~----- - --- - 2004 -~ --- ' 2005 ', , 2006 ------ -t-__ - --- -- - -- -i ~nn~ I 2008 _ I ---------- - 2009 ~' t - --- --- _ _ --- -' ~ -- -- -- -- TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable am~~unt: Total Balance Due on January 17, 1996: Penalty