HomeMy WebLinkAbout06-23-11 (2)(]fi~~t'4i.~
1505610105
OFFICIAL USE ONLY
REV-1500Ex`°z_11"~' '
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes ~
PO BOX z8o6oi INHERITANCE TAX RETURN ^ J ~ 'I ~ (, jt~~~
~~.w~ti„~„ an ~o,~R-n6oi RESIDENT DECEDENT J"t _I V
Date of Birth MMDDYYYY
................
......._...._._ ....___.........__..
................ _ ...
....__....___.......___.
01/09/1915
_.
Decedent's First Name MI
Charles r
(If Applicable) Enter Surviving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse's First Name __
_. _ _.
..... _. _ ..................
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
2. Supplemental Return O 3. Remainder Return (Date of Death
CiD 1. Original Return O Prior to 12-13-82)
Limited Estate
4 O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Regwred
O
. death after 12-12-82)
6. Decedent Died Testate
~ O 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) Attach Co of Trust.
( py )
ousal Poverty Credit (Date of Death
S
O 10
_
r Sec. 9113(A)
O 11 ~ At
a
O 9. Litigation Proceeds Received p
.
Between 12-31-91 and 1-1-95) ch Schedule O)
t
(
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Number
Name
__.
...
_.........
(717) 766-317
John M. Eakin
_
__ __ :-:z
_._ ___
__
_._ __
_.
REGISTER ~~l.S USE OAILY
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First Line of Address
___ . __
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,
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Market Square Building
_
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_. __.
Second Line of Address
__ _ __. _ --
O~
"_
„ __
- ~
_ B~DtTEFILED _._ ""'~"aRr4
City or Post Office State ZIP Code _ _ r,
Mechanicsburg PA 17053
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.
DATE
SIG RE OF PERSON RESPONSIB E OR FILING RETURN
ADDRESS
607 Lansvale St eet
SIGNATURE OF Pfi
'.~~
PA 17053
REPRESENTATIVE
,Z c' 9f
ADDRESS
Market Square Building, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY
1505610105
Side 1
1505610105 ~.~
._._.!
1505610205
REV-1500 EX (FI)
Decedents Name: Charles P. Wagner Jr Decedents Social Security Number
.......___.
':189-09-8948
RECAPITULATION
1. Real Estate (Schedule A) ........................................... .. 1.:.., _ .. .... _.,. .. _..,.~,_..':
2 576,502.10
2. ...........
Stocks and Bonds (Schedule B) .......................... ..
. _.. ., _._.._..__ _. _.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3.
4.
Mortgages and Notes Receivable (Schedule D) ......................... 4.
..
_ _ _.m. ,,,,___ ___,
5.
Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).....
.. 5. _ 27, 576.22
_„ ,,
6.
Jointly Owned Property (Schedule F) O Separate Billing Requested ....
... 6. 20,064.37
;
7 Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
. (Schedule G) O Separate Billing Requested..... ... 7.
$
', 624,142.69
8. Total Gross Assets (total Lines 1 through 7) ..........................
.
.. .
9.
Funeral Expenses and AdminisVative Costs (Schedule H) ............. g
...... 25 106.44
._ _........ _. ,
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10.
15,266.02
11. Total Deductions (total Lines 9 and 10} ...........................
11
.. .
40,372.46
12.
Net Value of Estate (Line 8 minus Line 11) ........................ 12.
...... 583 770.23
_ „~._ . ___ _. _.............
13 Charitable and Governmental Bequests/Sec 9113 Trusts for which ' ',
. an election to tax has not been made (Schedule J) ................. ....... 13. vV _ , __
14. Net Value Subject to Tax (Line 12 minus Line 13) ................. ....... 14. I 583,770.23
TAX CALCULATION -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_ __.~___....
16. Amount of Line 14 taxable
at lineal rate X A._
_.
17. Amount of Line 14 taxable 583,770.23
at sibling rate X .12 _,.,,,,_
18. Amount of Line 14 taxable
at collateral rate X .15 _ _ _ _
15.
16.!
17. ' 70,052.43
18.'
19. TAX DUE .........................................................19. _
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610205 1505610205
70,052.43
O
REV-1500 EX (FI) Page 3 File Number
llwwerlnn4'c ~`AmnIp4P ~('I['IPP_SS~
Charles P. Wagner, Jr. __
STREET ADDRESS __ __ ___ __
607 Lansvale Street ____ __
CITY.. __ __ _ __ STATE _ ZIP
Marysville PA 17053
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 70,052.43
2. Credits/Payments
A. Prior Payments - _ _ __
B. Discount 3,502.63
-- Total Credits (A + g) (2) 3,502.63
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
66,549.80
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred .......................................................................................... ^
b. retain the right to designate who shall use the property transferred or its income ............................................ ^
c. retain a reversionary interest .............................................................................................................................. ^
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. ^
3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? .............. ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ........................................................................................................................ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before 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 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
[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(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)j. 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-1503 EX+ (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Charles P. Wagner Jr
FILE NUMBER
21-11-0450
eu ..~,.~e.w inintlv~wned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
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1Lv~ .^ 8ii0 Catllloh' P:arltway P:f'S. eox x2749
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(727) 56T-1000
;A T E S, i N C• wwMl.raymondiames.com
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This .agreement shall ectto the terms andfcondit ons ofthese piages. and is expressiy
subj
Primary Beneficiary
A.
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Primary Beneficiaries
& Percentage Allocation
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All pence Lases must be in whole numbers; if~n~ Igen~ beneficiary shares should totall 100 k for each prirnarY beneftciaryb~~aties.
Primary Beneficiary shares must total 100
This is a binding contract. Read it carefully before signtng.
By signing this Agreement, Owner ackrtowledgess ~ unde~the Agreement and will not be disbursed i a ~ rdan`de, ~~ ~nt~ ~m~e~nt
Owner agrees that certain assets are not perm reement which Owner afire PaY
even if they are held in this account; (c) there are fees associated with the A9
an attorney-in-fact acting under a Power of Attorney; end (e) ti'iis ~reement contains a binding and enforceable arbitratwn
be executed by
provision in the Sectlon entitled "Agreement to Arbitrate'
State of ~ ~ County of
Owr-e~ ~ Counry of
State of
Owner ~1nA~.W~bt?.r , 1. , by
Y~ day of
The foregoing, instrument was acknowledged before ma this 0 ~ Z ~ G ~ l ~.
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entificati¢h/~d'w)ho idldi~ ath~ • __ ~.ef r p p ~ f t ,t
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11381380 Rev.3100
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PAGE:23
._
rrn oc _ orara~ Mf1F.l G17 _ ?riAM T r1:
Name
t
REV-i5o8 EX+ (u-io)
~ pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Charles P. Wagner, Jr. 21-11-0450
Include the proceeds of litigation and the date the proceeds were received by the estate,
en nronerty iointiv owned with right of survivorship must be disclosed on Schedule F.
If more space is needeo, use aoaitionai sneers or paper ui uie ~d~~~~ ~~«.
Account Number 435082
Charles P Wagner Jr
Essex House Apt 116
20 North 12th Street
Lemoyne PA 17043
Date
3/25
Check# Date
4/18
1196 3/22
Amount
200.00
Other Debits
Statement Date 4/18/11
Page 2
Description
Tran. Date-03/24/11 Atm Terminal Id - Xe1851
500 South State Rd Marysville Pa
Checks/Withdrawals
Amount Check# Date Amount Check# Date
10,000.00 1197 3/23 14.70 1199 4/11
61.85 1198 4/12 7,279.00 1200 3/28
Daily Balance Information.
Amount
71.00
275,. J0
Date Balance Date Balance Date Balance
Beginning Balance 24,224.93
3/22 29,177.48 3/28 23,687.78 4/12 19,464.27
3/23 24,162.78 4/01 26,819.27 4/18 9,466.08
3/25 23,962.78 4/11 26,743.27
REV-15o9 EX+ (D3-iQ)
~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER:
ESTATE OF:
Charles P. Wagner Jr 21-11-0450
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Audrey I. Hite
B.
C.
~r..~rn v n~uwtcn DDADFRTVe
607 Lansvale Street
Marysville, PA 17053
Sister
-_ lFTTER pA~ DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
DATE OF DEATH % OF
DECEDENTS DATE OF DEATH
VALUE OF
ITEM FOR )O1Ni MADE IDENTIFYING NUMBER. ATTACH DEED FORJO[NTLY HEU) REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT5 INTEREST
NUMBER TENANT JOINT
1. A• 11/26110 1st National Bank of Marysville CD #3068261 Principal $10,000.00, 10,026.10 100 10,026.10
Matures 11/2612011, Int..75%
2. A. 11/26110 1st National Bank of Marysville CD #3068262 Principal $10,000.00, 10,038.27 100 10,038.27
Matures 11/2612012, Int. 1.1%
TOTAL (Also enter on Line 6, Recapitulation) I $ 20,064.37 .
If more space is needed, use additional sheets of paper of the same size.
...>,,.r
~~Date.K Tax
Opened: 11/26/.2010 Term: 12 Months ID:189-09-8948 Number: 3068261
Certificate of Deposit Account Number: 3 0 6 8 2~ 1
Dollar t
Amounto[Ten Thousand and 00/100's
Deposit: S 10 , 0 0 0. 0 0
This Time Deposit is Issued to: Lssuer: First National Bank of Marysville
Division of Riverview Ntl Bank, 200
~-Charles P Wagner Jr ~~ Front Street
Audrey I Hite Marysville, PA 17053
Essex House Apt 116, 20 North 12th Street
Lemoyne, PA 17043
Not Negotiable -Not Transferable -Additional terms are below. By (~(!~. ~
Additional Terms and Disclosures
This form contains the teams for your time deposit. Ir is also the Minimum Balance Requirement: You must make a mWmum deposit to
Truth-1a~Savings dlsciosnre for those depositors entitled to one. There
are addfional temrs and dsclosures on page two of this foam, same of opm ~g ~~ of $ 5 0 0. 0 0
which eapiain or expend on Wore below. You should keep o~ copy of ® You must maintain Was minimum balance on a daily basis to earn We
Was form.
Maturity Date: This acco~mt matures 11 / 2 6 / 2 011 aonua( Percentage yield dsclosed.
(See below for renewal information.) WiWdrawals of Interest: Interest ^ accnrai ^ credted dining a
Rate Information: The interest rate for this accormt is 0. 7 5 0 % term car be wiWchawn:
w1W an annual percentage yield of _ 0. 7 5 0 %. This rate wlll be
paid until We maturity date specified above. Interest begins to accrne on Early Withdrawal Penalty: If we consent to a request for a wlihdtawal
the business day you deposit any nonc~h item (for example, a check). that is otherwise not permuted you may have to pay a penalty. The
Interest will be compounded d a i l y .penalty wW be ai amount equal to: 9__ mo n h. 1 o s ~ o
InterestwW be credted madded to balance monthly, Merest .
interest on the ~ouot wiWchawn.
® The manual percentage yield assumes that interest remains on deposit Renewal Polley:
unW maturity. A withdrawal of interest wW reduce earnings. ^ Single Matur![y: If checked, Was accamt will not aromatically
~ If you close your accoutrt before Interest 1s credled, you will not rerow. L~terest ^ wW ^ wW not accrue after maturity.
receive We accnred interest ® Automatic Renewal: It checked, Was account will at>fomatlcally
The NUMBER OF ENDORSEMENTS needed for withdrawal or any renew on the mabuity date. (see page two for terms)
other purpose is: 1 Interest ^ wW ®wW not acenre after final maturity.
ACCOUNT OWNERSHIP: You have requested
and Intend the type of account marked below.
^ fidvidnal
® Joint Accwmt - WiW SurvlvorWip `~""~°,~„`~"'""°
^ Joint Account - No Survivonrhlp ~ 4~ ~~ ~~,,,
^ Ttvst: Separate Agreement Dated
^ Revocable Tnrst or ^ Pay on DeaW
Designation as defined In this agreesrent
(Beneficiaries' names and addresses)
TIN: 189-09-8948
® Taxpayer I.D. Number -The Taxpayer ^ Exempt Recipients - I am an exempt
Idenriflcation Number shown above (TIIV) is redptent under the Luemal Revenue Service
my correct taxpayer ide~ntiflcation number. Regulatiaais.
® Backup Withholding - I am not sut~ect A provision for my slgnatuce, certifying
to backup withholdng either because I have under prnalty of penury the tTatementa
~t been notlfled that I am subJect to backup checked in this section and that I am a U.S.
withholding as a result of a failure to report person (including a U.S. resident allay), is
all interest or dvideacls, or the Internal contained on the first copy of this
Revenue Service has notiflexl me that I am no certiflc:ate.
longer sut~ect m baclmp withholding.
ENDORSEMENTS -SIGN ONLY WHEN YOU REQUEST WPI~RAWAL
X
X
X
Ej(~j ® O 1993 Bankers Systems, Ina., St. Cloud, MN Form CD-AA-LAZ (1) 6/10/2005 READ PAGE TWO FOR ADDITIONAL TERMS ~____ , _....
Account A
First National Bank of Marysville
Division of Riverview Ntl Bank, 200 Front
Street
ysville, PA 17053
IMPORTANT ACCOUNT OPENING /NFORMATION: Federal law requires
us to obtain sufficient information to verify your identity. You maybe
asked severe/questions and to provide one or more forms of
identification to fu/fill this requirement. /n some instances we may use
outside sources to confirm the information. The information you provide
is protected by our prnracy po/icy and federal /a w.
Enter Non-individual Owner /nformat/on on page 2. There is additional
Owner/Signer Information space on page 2.
~ ,
N,m. ~ • •
Charles P Wa ner Jr
Rel,tionship to
Account lOwnw
and/or Signor, etc./ Primary Owner .,_
Addieu Essex House Apt 116, 20 North
12th Street; Lemo ne PA 17043
Mailing Address
li/ dif/erent)
Home Phone
Work Phone
MoM'/~ Phone
E-M,i/
Birth oats O 1 / 0 9 / 1915
SSN/r!N 189-09-8948
Gov'tlssuedPhatolD,
Type, Number, Siei~
/ssue Dete, Exp. Date Dr Lic A62-48-5348; VA;
01 / 0 9 / 2 014
Other lD
/Description, Oefailsl
Employw'sNeme
& Address retired
r~wous
• •
Name • •
Audre I Hite
Rd,tionship to
Account (Owner
and/or Signer, etc.! Joint Or
Address 607 Lansvale Street; Ma~rysvil~le,
PA 17053-1145
Mailing Address
(if di//~rentl
Home Phone (717) 957-4385
Work Phone (
Mobile Phone
E-Mall
eirfhD,t, 01/01/1924
SSN?IN 207-22-1845
Gov't/ssuedPhofo/D,
Type, Number State,
/ssw Dsfe, Exp. Date Dr Lic 07576956; PA; 03/09/2013
Other lD
(Description, Details)
Emp/oyer'sN,me
& Addiwss retired
Previous
r ®®2003 Bankers Systans, inc., St. Cloud, MN Form MPMP-LAZ-PA 4/19/2004
greemenr ware: 11/Lb/LUlU
internal Use
.,,
Charles P Wagner Jr
~.
Audrey I Hite
Essex House Apt 116
20 North 12th Street
Lemoyne, PA 17043
- • • ~ •
The specified ownership will remain the same for a//accounts.
^ lnd/v/dua/ ^ Corporation -For Profit
® Joint with Survivorship ^ Corporation -Nonprofit
(not as tenants in commonl ^ Partnership
^ Joint with No Survivorship ^ So% Proprietorship
(as tenants in commonl ^ Umited Uabi/ity Company
^ Trust-Separate Agreement Dated:
i I • •
(Check appropriate ownership above.!
^ Revocab/e Trust
~ ~ I I I
(Check appropriate beneficiary designation above./
^ if checked, this is a temporary account agreement.
Number of signatures required for withdrawal: 1
The undersigned authorize the financial institution to investigate credit
and employment history and obtain reports from consumer reporting
agency(iesl on them as individuals. Except as otherwise provided bylaw
or other documents, each of the undersigned is authorized to make
withdrawals from the account(s), provided the required number of
signatures indicated above is satisfied. The undersigned personal/y and
as, or on beha/f of, the account owner(s) agree to the terms of, and
aCk!1.P!NI4,~1CQ=l<etht„~1f+pP~Y(ies/ of this~document:and-the fo/%wing:
® Terms and Conditions ~ Prnracy
® Electron/c Fund Transfers ® Truth in Savings
® Substitute Checks ® Funds Avai/ability
^ Common Features ^
LX J
r Charles P Wagner Jr l
LX J
Audrey I Hite
LX
LX
X
^ Authorized Signer (lf checked and account is individua/and consumer
purpose, the last of the above signers is an Authorized Signer.!
IP•9e 1 012)
- .. Tax ,
Date -
,~-Q"p~ed; _ 11/~,ti/2010 _Term: ~a rRnntl,s _ ID: 1 89-oe-8948 Number: AOti82F,2
Certificate of Deposit Account Number: X06826 ~F
Dollar
Amount ofTen Thousand and 00/100' s
Deposit: ~ S X10 , 0 0 0. 0 0
This Time Deposit is Issued to:
Charles P Wagner Jr
Audrey I Hite
Essex House Apt 116,
Lemoyne, PA 17043
Issuer:
20 North 12th Street
~:...
Not Negotiable -Not Transferable -Additional terms are below.
....~
Additional Terms and disclosures
This form contains the terms for your time deposit. It is also the Minimum Balance Requirement: You mt>st make a minimum deposit to
T~-1a,,Savln~ dlscloc~u+e for ttwse deppeogsitors eatifled to one. There
are addtlonal teams and d~scl~ ow: You should keep acne ~ of op~ this aceouut of S 5 0 0. 0 0
which ezpialn or expend ®You mnct maintain this midmnm balance on a daily bests to eam the
this foam. 1 1 / ~ ti / ~ 012 ~~ percentage yield dsclosed.
Maturity Date: This account matures
(See below for rrnewal iniormatlon.) Withdrawals of Interest: hyterc.+rt ^ accrued ^ ctedte~d dining a
Rate Information: The interest rate for Was account is 1. 0 9 0 % term can be wiWchawn:
with an annual percentage yield of _ 1.10 0 %. This isle wW be
paid untll the mahuity dale specified above. Interest begins to accrue on Early Withdrawal Penalty: If we consent to a request for a withdrawal
the busineBS day you deposit any noncash item (for example, a ~. that is otherwise not permitted you may have to pay a penalty. The
h~terest wW ~ compounded ~1 a;~ v penalty wW be an amount equal to: ~ mon t h e i n t e r e s t
InterestwWbect+edted _aaea }o balance monthly.
• interrslt on We amount wlWdrawn.
® The annual percentage yield assumes that interest remalnt on deposit Renewal Policy:
until maturity. A withdrawal of interest will reduce earnings. ^ Single Maturity: If checked, this account wW not antomaticelly
® If you close yon account before interest is credted, you w1ll not renew. Interest ^ wW ^ wlll riot accrue after matrnity.
receive the accrued interest. ® Automatic Renewal: If checked, this account will arrtomatlcally
The NUMBER OF ENDORSEMENTS needed for withdrawal or any renew on the maturity date. (see Page two for terms
older purpose ls: 1 Interest ^ w!ll ®wW not accltue after 11ne1 matrnity.
ACCOUNT OWNERSHIP: You have rued
aund intend the type of account marked below.
^ Indvidual
® Joint Account - W1W SunvivorsWp ,`„"id~°"~'"'
^ Joint Accost - No Sunvivorshlp w ~ ~~
^ Trust: Separate Agreement Dated
^ Revocable Trost or ^ Pay oa DeaW
Designation as defined 1n this ~
(Beneflclaries' names and addresses)
TIN• 189-09-8948
® Tazpeyer I.D. Number -The Taxpayer D Ezempt Redpients - I am an exempt
Identification Number shown above (TIIV) is redpient adder the h>feinal Revenue Service
my correct taxpayer ideatiflcation number. Regulallons.
® Backup Withholding - I am not stut~act A provision for my signahure, curtifging
to backup wlthholding either became I have under penalty of pertnry the statements
riot been unrifled that I am suui~Ct to backup checked In thin section and that I am a U.S.
withholdng as a result of a failure to report person (including a U.S. resident alien), L----
all inferrer or dvldends, or the Internal contained on the first copy of this
Revenue Service has unrifled me that I am no certificate.
conger subJect to backup wlthholding.
By /ol'+'t-~ ~~
-1 F1vDORSF.MENI'S -SIGN ONLY WHEN YOU REQUES .- ~3'TI$DRAWAL
X __
X
c,.~~® O 1893 Bankers Systems, Inc., St. Cloud, MN Form CD-AA-LAZ 111 6/10/2005
g - - --
READ PAGE TWO FOR ADDITIONAL q'F,1tMS ._---
First National Bank of Marysville
Division of Riverview Ntl Bank, 200
Front Street
Marysville, PA 17053
Account A
~irst National Bank of Marysville
Division of Riverview Ntl Bank, 200 Front
Street
Marysville, PA 17053
IMPORTANT ACCOUNT OPENING INFORMATION: Federal law regwires
us to obtain sufficient information to verify your identity. You maybe
asked several questions and to provide one or more forms of
identification to fulfill this requirement. In some instances we may use
outside sources to con/irm the information. The information you provide
is protected by our prnracy policy and federal law.
Enter Non-Individual Owner Information on page 2. There is additional
Owner/Signer /reformation space on page 2.
e • e
Name Charles P Wa net Jr
Relationship to primary owner
Account /Owner
and/or Signet etc)
Essex House Apt 116, 20 North
Address 12th Street; Lemo ne PA 17043
Mailing Address
lif drffgentl
Home Phone
Work Phone
Mobile Phone
E•Mail
eirih Date O 1 / 0 9 / 1915
SSN?!N 189-09-8948
Gov't/ssuedPhoto/D, Dr Lic A62-48-5348; VA;
Type, Number StaL,
/slue Dst~, Exp. Oste 01 / 0 9 / 2 014
Other lD
DDescription, Detsilsl
Employer'sNeme retired
& Addisss
nvwus
• e e
Name Audre I Hite
Relationship to Joint Or
Account (Owner
and/or signer, stcJ
607 Lansvale Street; Marysville,
Address PA 17053-1145
Mailing Address
(if di/ferenfl
Home Phone (717) 957-4385
work Phone ( -
Mobil~ Phone
E-Mail
03/08/1927
eirrhDate
SSN?rN 207-22-1845
Gov'flssuedPhotolD, Dr Lic 07576956; PA; 03/09/2013
Type, Number Stste,
/ssus Date, Exp. Date
Other ID
(Description, Detsilsl
Emp/oyersNsme retired
& Address
Previous
Finnnciel l
greemenr ~dtC- ,,~or~~1~
lnterna/ Use
~.. -
Charles P Wagner Jr
Audrey I Hite
Essex House Apt 116
20 North 12th Street
Lemoyne, PA 17043
~ • e ~ e
The specified ownership will remain the same for all accounts.
^ lndividual ^ Corporation -For Profit
® Joint with Survivorship ^ Corporation -Nonprofit
(nof as tenants in common) ^ Partnership
^ Joint with No Survivorship ^, Sole Proprietorship
(as tenants in common! ^ Limited Lrabllity Company
^ Trust-Separate Agreement Dated:
,' /' e e
(Check appropriate ownership above./
^ Revocab/e Trust
I e e ~
(Check appropriate beneficiary designation above.)
^ if checked, this is a temporary account agreement.
Number of signatures required for withdrawal: 1
e r -
The undersigned authorke the financial institution to investigate credit
and employment history and obtain reports from consumer repor7ing
agency(iesl on them as individuals. Except as otherwise provided by law
or other documents, each of the undersigned is authorized to make
withdrawals from the account(s), provided the required number of
signatures indicated above is satisfied. The undersigned pArsonally and
as, or on behalf of, the account owner(s) agree to the terms of, and
acknowledge receipt of copy(iesl of, this document and the fo/%wing:
., .,
® Terms arid Conditions ® Privacy
® Electronic Fund Transfers ® Truth in Savings
® Substitute Checks ® Funds Availability
^ Common Features ^
LX +
r Charles P Wagner Jr
LX
r Audrey I Hite
LX
[. ~
^ Authorized Signer (lf checked and account is individual and consumer
purpose, the last of the above signers is an Authorized Signer.) Ip,ge t of 2l
F,~rZa® ra ~nn~ esnters Systems, lnc., St. Cloud, MN Form MPMP-LAZ-PA 4/19/2004
REV-1511 EX+ (10-09j_
~: pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF
Charles P. Wagner Jr
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION
NUMBER
A. FUNERAL EXPENSES:
1' Michael J. Shalonis Funeral Home
B.
i.
2.
3.
4.
5.
6.
7.
a.
s.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State _
Year(s) Commission Paid: _____.. __._ _
Attorney Fees:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant __ ___
_. __.
Street Address
City State
Relationship of Claimant to Decedent _ __.... _. __... _._
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
The Sentinel, estate notice
The Cumberland Law Journal, estate notice
Register of Wills -Filing Fee
FILE NUMBER
21-11-0450
ZIP
ZIP
AMOUNT
6,425.78
18, 000.00
377.50
198.16
75.00
30.00
TOTAL (Also enter on line 9, Recapitulation) I $ 25,106.44
If more space is needed, use additional sheets of paper of the same size.
i~ Pennsylvania
w DEPARTMENT OF REVENl1E
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
ESTATE OF
Charles P. Wagner Jr 21-11-0450
.. .. ~ __. __.__ ._ ~__.~ f1.~F .e»,~innd unpaid at the dake Of death, including unreimbursed medical expenses.
if (1•IOF2 SpBC2 IS neeueu, uiaei~ auwu~nm ~~~~~~~ ~~ ~~~~ ~~•~•- ~•--~
REV-1513 EX+ (01-10)
i~t' Pennsylvania SCHEDULE ~
BENEFICIARIES
INHERITANCE TAX RETURN
REStDENT DECEDENT
ESTATE OF:
Charles P. Wagner Jr RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Tri
I TAXABLE DISTRIBUTIONS [IncluSec 9116t(a) (lsZj jistributions and transfers under
1. .Audrey I. Hite 'Sister.,...
FILE NUMBER:
21-11-0450
AMOUNT OR Sh
OF ESTATE
Entire Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
L
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET. ~
If more space is needed, use additional sheets of paper of the same size.
~,~~t ~iYY ~.~b ~Ce~t~.mc~~t
flf
CHARLES P. WAGNER, JR.
I, CHARLES P. WAGNER, JR., of the Borough of Lemoyne, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this my Last Will and
Testament, hereby revoking and making 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 expenses as soon after
my decease as the same can conveniently be done.
2.
I direct that there shall be paid out of my residuary estate all estate,
inheritance and like taxes together with any interest or penalty thereon imposed by
the Government of the United States, or any state or territory thereof, or by any
foreign government or political subdivision thereof, in respect to all property
required to be included in my gross estate for estate, inheritance or like tax purposes
by any of such governments, whether the property passes under this will or
otherwise.
3.
I give, devise and bequeath my entire estate, real, personal and mixed of
whatsoever nature and wheresoever the same maybe situate, to my sister, AUDREY I.
RITE, absolutely and in fee simple.
4.
Lastly, I nominate, constitute and appoint my sister, AUDREY I. RITE, to
be Executrix of this my Last Will and Testament. In the event my sister predeceases
me, or should she be unable or unwilling to serve in such capacity, then in such event, I
nominate, constitute and appoint, R. KEITH RITE, to be my Executor in her place
and stead. I further direct that no bond or other security be required of my personal
representatives to guarantee faithful performance of their duties.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ %~~
day of July, 2008
,-,
Charles P. Wagner, Jr.
COMMONWEALTH OF PENNSYLVANIA )
SS
COUNTY OF CUMBERLAND )
I, CHARLES P. WAGNER, JR., the testator, whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed and executed the same instrument as my Last
Will and Testament; that I signed it willingly, and that I signed it as my free and
voluntary act and deed, for the purposes therein expresse~d.~ (SEAL)
L ` `f~~
Charles P. Wagner, Jr
Sworn and subscribed to before ~.~~
me this ~'~'~ day of July, 2008 ~~u~,i sou
HEIOI N I~150N
Notary PubNc
,~ ~~ 1 ~~ ~~ ~'~~~'~~ a~s+tM000tNr
Notary Public ~ ~~"'m~O" ~~~ ~"" z~, zoi ~
COMMONWEALTH OF PENNSYLVANIA.)SS
COUNTY OF CUMBERLAND )
We, the undersigned, R. Keith Hite and John M. Eakin, the witnesses whose
names are signed to the attached or foregoing instru nt and saw theft q ator,led
according to law, depose and say that we were pres
CHARLES P. WAGNER, JR. ,sign and execute the instrument as his Last Will
and Testament; that the said testator executed it as his free and voluntary act for the
purposes therein expressed; that each of us, in the hearing and sight of the testator,
signed- the Will as witnesses; and that, to the best of our knowledge, the testator
was, at the time, eighteen (18) or more years of age, of sound mind, and under no
r.nnstraint. duress or endue influence.
Sworn and subscribed to before
,~~
me this day of 7~1y, 2008.
Notary Public ~~ M ~~oN
Notory ~'~ ~,
C~"~ iExP ~ .ism z~. zot i
JOHN M. EAKIN
ATTORNEY AT LAW
MARKET 54UARE BUILDING
MECHANICSBURG, PA. 17055
TF_LEPHGNE (7177 766-3172
FAX 17177 fi91-3281
June 22, 2011
Register of Wills
1 Court House Sq.
Room 102
Carlisle, PA 17013-3322
RE: Charles P. Wagner Jr. Estate # 21-11-0450
Dear Ladies:
Enclosed is four copies of the above inheritane~ tas an enclosed invent ry too
with time stamps m the enclosed envelope. Also, th
be filed. Thank You!
Very Truly Yours,
~~~„~ ,~-~ ~y~1c,.ti
John M. Eakin
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