The URL can be used to link to this page

Home My WebLink About08-19-11 1505610140 1500 EX (°'_'°) REV - OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN 2 1 1 0 1 2 1 7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 2 0 1 1 6 5 5 2 5 1 1 2 1 2 0 1 0 0 6 0 9 1 9 2 7 Decedent's Last Name Suffix Decedent's Firs t Name MI L E H M A N W I L B U R J (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 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) ^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 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. 0) GORFTESF'ONDENT -THIS SEGI ION MUST 8E COMPLETED. ALL GOKKESPONUENGE ANU GONhIDENI IAL lAX INFOKMAI ION SHOULU BE DIKED f EU IO: Name Daytime Telephone Number H E A T H E R D R O Y E R E S Q 7 1 7 2 .3 4 2 4 0 1 First line of address 4 4 3 1 N F R O N T S T Second line of address 3 R D F L O O R City or Post Office State H A R R I S B U R G P A ZIP Code ~ 1 7 1 1 0 REGISTER O€~ILLS USE ONLY -,•~ - _ ' -, __ ' _1~ i _c~ ,_J _. ,'~ -; ~_~~ -. _.'j -.. DiQ'FE FILED 0..- Correspondent's a-mail address: HROYER(a~SASLLP.COM 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 prepare~r has any knowledge. SIGNA SURE OF PERSON RESPONSIBLE FOR FILING RETURN DA E A~l DRESS 17 SIMMER DRIVE DILLSBURG PA 17019 SIGN9T RE OF PR~PA OTHER THAN REPRESENTATIVE DATiE 4431 N• FRONT ST•, 3RD FLOOR HARRISBURG PI! 17110 PLEASE USE ORIGINAL FORM ONLY ~"1 ,-i `.. _,~ ;--r-y C"..,J ~1Sd~~ Side 1 1505610140 150561D14D 1505610240 REV-1500 EX ~ecedent'sName: WILBUR J LEHMAN Decedent's Social Security Number 2 0 1 1 6 5 5 2 5 RECAPITULATION 1. Real Estate (Schedule A) ......................................... 1. .. 8 1 9 5 2 6 4 2. Stocks and Bonds (Schedule B) .................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 1 1 2 7 8 5 9 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested ..... .. 7. 3 2 9 5 3 . 4 6 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 2 2 7 6 9 2 0 3 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... 9. 2 0 0 2 0 ~ 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ...... 10. 1 2 9 9 . 1 1 11. Total Deductions (total Lines 9 and 10) ......................... ...... 11. 2 1 3 1 9 . 5 0 12. Net Value of Estate (Line 8 minus Line 11) ...................... ...... 12. 2 0 6 3 7 2 . 5 3 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........... ...... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................ ...... 14. 2 0 6 3 ~ 2 . 5 3 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 _ 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 0 6 3 7 2 5 3 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18, 19. TAX DUE ... ........................... .. ..... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0. 0 0 9 2 8 6. 7 6 0. 0 0 0. 0 0 9 2 8 6. 7 6 Side 2 1505610240 150561024[] REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 ]0 1217 DECEDENT'S NAME WILBUR J. LEHMAN STREET ADDRESS CUMBERLAND CROSSINGS 1 LONGSDORF WAY CITY STATE __ ZIP CARLISLE PA 17015 Tax Payments and Credits: 7 • Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 8,700.00 B. Discount 457.88 3. Interest 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. (1) 9,286.76 Total Credits (A + B) (2) (5) Make check payable to: REGISTER OF WILLS, AGENT (3) (4) 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 : ................................................................. ..... ^ Q b. retain the right to designate who shall use the property transferred or its income; .......................... ..... ^ c. retain a reversionary interest; or ........................................................................................... ..... ^ ^X d. receive the promise for life of either payments, benefits or care? .................................................. ..... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... ^ Q 3. Did decedent own an "intrust for" orpayable-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? ............................................................................................. ..... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 128.88 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 requiremE;nts 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 u:se 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)]. 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. 9,157.88 0.00 REV-1502 EX+ (01-10) pennsylvania ~ SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WILBUR J. LEHMAN 21 10 1217 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price 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 property that isjointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 738 WEST MAPLE STREET, PALMYRA PA 81,952.64 (assessed value ] 1,641 x 7.04 CLR) TOTAL (Also enter on Line 1, Recapitulation.) $ 81,952.64 If more space is needed, use additional sheets of paper of the same size. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RESIDENTEDECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER WILBUR J. LEHMAN 21 10 1217 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PSERS -PENSION PAYMENT ]0/30/2010 _ 693.02 2. PSERS -PENSION PAYMENT 11/30/2010 693.02 3. MEMBERS 1ST CHECKING 367718-0011 10,194.48 4. MEMBERS 1ST SAVINGS 367718-0000 51,284.23 5. MEMBERS 1ST C.D. 367718-0043 5,036.86 6. REFUND -CUMBERLAND CROSSINGS -PRORATED ROOM & BOARD 2,401.00 7. NORTHWEST SAVINGS BANK - C.D. #XXXX025 5,007.47 8. NORTHWEST SAVINGS BANK - C.D. #XXXX390 5,026.85 9. NORTHWEST SAVINGS BANK - CD #XXXX033 7,486.11 10. GOOD SAMARITAN -REFUND OVERPAYMENT OF MEDICAL BILL 41.00 11. AARP -REFUND UNUSED PREMIUM 18.95 12. 2005 HONDA ACCORD -SOLD 13,000.00 13. RIVERSOURCE- UNLASHED CHECK- DECEASED SPOUSE'S INSURANCE POLICY 10,22].10 PROCEEDS (FLORENCE LEHMAN) 14. RIVERSOURCE- REFUND OF PREMIUMS ON DECEASED SPOUSE'S INSURANCE 173.02 POLICY (FLORENCE LEHMAN) 15. VETERAN'S BURIAL ALLOWANCE -COUNTY OF LEBANON 100.00 16. 2010 FEDERAL PERSONAL INCOME TAX REFUND Sqn nn TOTAL (Also enter on line 5, Recapitulation) $ 112.785.93 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER WILBUR J. LEHMAN 21 10 1217 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACHACOPYOFTHEDEEDFORREALESTATE DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION ~iFAppucna~e~ TAXABLE VALUE 1. PRUDENTIAL ROLLOVER IRA #XXXX6330; 8,075.82 100.00 8,075.82 BENEFICIARY RONALD LEHMAN, SON 2. PRUDENTIAL ROLLOVER IRA #XXXX6331; 7,948.92 100.00 7,948.92 BENEFICIARY RONALD LEHMAN, SON 3. PRUDENTIAL ANNUITY #E0461586; 16,928.72 100.00 16,928.72 BENEFICIARY RONALD LEHMAN, SON TOTAL (Also enter on Line 7 Recapitulation) I $ 32,953.46 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILBUR J. LEHMAN 2l 10 1217 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1. HOOVER FUNERAL HOMES & CREMATORY 7,521.00 2. FUNERAL LUNCHEON 188.61 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2, Attorney Fees: SMIGEL, ANDERSON & SACKS, LLP 6,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5 6 7, 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. City State ZIP Relationship of Claimant to Decedent Probate Fees: CUMBERLAND COUNTY Accountant Fees: Tax Return Preparer Fees: FINAL PERSONAL INCOME TAXES; FIDUCIARY RETURNS SENTINEL -LEGAL NOTICE CUMBERLAND LAW JOURNAL -LEGAL NOTICE SOCIAL SECURITY ADMTN -REFUND OVERPAYMENT PA AMERICAN WATER KREISER FUEL SERVICE MATT HINKLE -LAWN CARE MET ED -ELECTRICITY STATE FARM INSURANCE -AUTOMOBILE STATE FARM INSURANCE -HOMEOWNERS BOROUGH OF PALMYRA - SEWER/REFUSE MEMBERS FIRST BANK CHARGES -BILL PAYER FEES PEP BOYS -BATTERY FOR AUTOMOBILE 381.50 350.00 198.16 75.00 889.00 166.71 528.33 705.00 204.62 287.00 292.00 354.00 28.35 86.37 TOTAL (Also enter on Line 9, Recapitulation) $ 20,020.39 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OFREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER WILBUR J. LEHMAN 21 10 1217 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 NUMBER DESCRIPTION OF DEATH 1. PHILHAVEN -MEDICAL EXPENSE 15.00 2. MCLAUGHLIN & ASSOCIATES -MEDICAL EXPENSES 100.00 3. DEPARTMENT OF VETERANS AFFAIRS -MEDICAL EXPENSE 15.00 4. CUMBERLAND GOODWILL EMS -MEDICAL EXPENSE 100.00 5. CONTINUING CARE - RX 91.25 6. MEMBERS ] ST VISA 4672 XXXX XXXX XXXX 17.13 7. PSERS -REFUND OVERPAYMENT 960.73 TOTAL (Also enter on Line 10, Recapitulation) I $ 1,299.11 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WILBUR J. LEHMAN 21 t n t 217 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. RONALD L. LEHMAN Lineal 206,372.53 17 SUMMER DRIVE DILLSBURG PA 17019 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 8,700.00 Discount: 457.88 Interest Table Days Delinquent Balance Due Interest Year !this time period -- ---- this year ~ this period Before 1981 1982 -- -- 1983 - -- --- ' I 1984 _ -- --- - 1985 - -- --- - - 1986 -- --- --- I 1987 ~ 1988 through 1991' _ 1992 _ ___ _ --- 1993 through 1994 _ _ 1995 through 1998 _ _- _ _ __ __ __ _ _ ~ ~~ 1999 :_ -- -- ~~ _ 2000 2001 - -- ---- -- - --- - --- ---- - 2002 ~ --- ---- - - -- --- 2003 -__ _ ~ 2004 -- _ -_-_ _ - -- 2005 - - -- -- -- --- 2006 - -- ----- - -- --- 2007 -- -- --- 2008 ~ _ -- - 2009 ' _ _ _ 2010 ---- - - --- -- -~ - - ___ - _ ~ TOTALS _ _ _- - - Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: Continuation of REV-1500 Inheritance Tax Return Resident Decedent WILBUR J. LEHMAN 21 10 1217 Decedent's Name Page 1 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. DISCOVER CREDIT CARD -OVERPAYMENT _ 0.12 18. SOCIAL SECURITY -UNDERPAYMENT 675.00 19. REFUND -CAR INSURANCE PREMIUM UNUSED 62.47 20. STATE FARM -CAR INSURANCE REFUND 81.23 SUBTOTAL SCHEDULE E 818.82 GRAND TOTAL SCHEDULE E $ 112,785.93 Continuation of REV-1500 Inheritance Tax Return Resident Decedent WILBUR J. LEHMAN 21 10 1217 Decedent's Name Page 2 File Number Schedule H -Funeral Expenses ~ Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 19. LEBANON COUNTY TREASURER -PROPERTY TAXES 1,577.51 20. POSTAGE, COPIES, TOLLS, PARKING, MILEAGE 109.28 21. RECORDER OF DEEDS, LEBANON COUNTY -TRANSFER PROPERTY 64.00 22. MEMBERS FIRST -CHECKS 13.95 SUBTOTAL SCHEDULE H-67 ~ 1,764.74 ~~c~t 3~i1I ~n~ (7~ r~Y~rrcPrct I, WILBQR J. L8ffirIAN of the Borough of Palmyra, County of Lebanon and Commonwealth of Pennsylvania, being of sound mind, do hereby make this to be my Last Will and Testament, hereby revoking all Wills or Codicils by me at any time heretofore made. ARTICLE I I order and direct the payment of all my just debts and funeral expenses as soon as may be convenient after my decease. ARTICLE II I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal or mixed, and whe~:-esoever situate, unto my beloved wife, FLORENCE $. LEHKAId, to be hers absolutely. ARTICLE III In the event my beloved wife predeceases me, or in the event that she and I die in a common disaster, then I give and bequeath the sum of ONE THOUSAND ($1,000.00) DOLL{~tS unto my ~ a a daughter, DONNA GAtJRER, provided she survives me. `?~~ M ~'~ ,' =~~ ~ c.: ~- ~ "-~ `_~ ~ O o r j - ~~.~ ~ - _r ~ - -~ . `= ~~T W ``~ ~ ~~': ARTICLE IV All the rest, residue and remainder of my estate,, whether real, personal or mixed, and wheresoever situate, I give, devise and bequeath unto my son, RONALD L. L8ffi~[AN. ARTICL$ O I direct that my Executrix shall not be required to enter security in any jurisdiction in which she may act. ARTICL$ VI I nominate, constitute and appoint FLORffidCB 8. L$HMAN to be Executrix of this, my Last Will and Testament. In the event that she is unable or unwilling to serve in that capacity, then I nominate, constitute and appoint RONALD L. LB~IAN as Alternate Executor of this, my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~~ day of ~ a ~' , A.D. , 1991. ^, I'! _~.~-C,'t.~'~, o•"~ -_ (SEAL) Wilbur J. Le ~ an SIGNED, SEALED, PUBLISHED AND DECLARED by Wilbur J. Lehman the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request and. in his presence and in the presence of each other, all being present at _; t ~ ave subs 'bed our namesG esses.f- - ~ Addre s : ~2.. s ~ ~~1 'y f ~1. h v _~ ~~~_ ~~.~- Address : ~~ L~ K a COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF LEBANON ) WILBUR J. T.F.HMAx whose name is signed to the atttached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed the instrument as my Last Will; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn and acknowledged before me by Wilbur J. Lelvaan, the Testator on this, the /' ~ day of '~ ~C<~) , n , 1991. 1 _ _ __ __ - ~ ___-_ Wilbur J. Le an ..... --- ~ ~~.~x y, No ary Publ c - .._ , My Comm. Expires: , /;(/~/y/ COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF LEBANON ) We, William M. Brandt and Charlene R. Hurst, the witnesses whose names are signed to the attached instrument, being duly qualified according to law, do depose and say that we were present and sak* ;Wilbur J. Lehman sigz~ and execute the instr~:ment as his Last Will; that he signed 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 that time 18 or more years of age, of sound mind and -under no constraint or undue influence , Sworn and subscribed befo me by William M. Brandt and Charlene R. Hurst, witnesses, thi d of .~1 ~ _, 1991. ~ -~' ~~ Wi ess Ne ary ?u l i c ~~ _ ~ ~o t. ~ ~-~~. ~ .~ f- My Comm. Exp.: r.~~~/ri Witness :,e:y Fu~l:~, `,:': .:r, AODOPALMYP,ASBOPOUGHX BILL R LEBANON COUNTY lIIII~~II~II~IIIII~~~I~I~IIII~IIII~IIIII~I~~I~IIII 16-01751 PAYABLE TO: MARCH 1 2010 GIS ID: i ~ - ~~R7A"17-~S47RA-00100 LEBANON COUNTY TREASURER O:t?NTROLiJUMBER:: 38013664 400 SDUTH EIGHTH STREET, ROOM 103 .-"°.rSESSEDVALCJE: 12200 LEBANON, PA 17042 PRQPERTYLt3GATICIR:': 738 W MAPLE ST FORWARDING SERVICE REQUESTED PALMYRA PA 1 7078 I iii ill ill! II II I I II iii ~ III n~ ui nnu ~nrnt~nnrrnn nrrn PALMYRA BOROUGH 42746 T68 P1 ~~*~*~~*~*AUTO'~*3-DIGIT 170 STATEMENT" f3F TA)i:E LEHMAN WILBUR J COUNTY TAX @ 20.00 MILLS 244.00 LEHMAN RONALD L POA BOROUGH TAX @ 17.00 MILLS 207.40 17 SUMMER DR LIBRARY 6.10 DILLSBURG PA 17019-9545 PAYMENT DUE AS FOLLOWS: BY 4/30/2010 PLEASE PA`r' 448.35 0 P LEA E PAY ,~ BETWEEN 5/1/2010 & 6/30/ 201 S 4 57.50 22 EE SS pp p L 55 AFTER 6~E3,011R+O11iISPP'i~RT90N FOR YOUR ~ TA 3CO www.lebcounty.org CONTROL N0. 3801 3664 PASSWORD LBYJWWNK E FiDS 2010 REAL ESTATE TAX PALMYRA SCHOOL DISTRICT LEBANON COl1NTY, PA STATEMENT DATE: 71i/2010 I~~~Iil~~~lilr~r~~~fif~l~~l~i~~~l~l~~i~rl~l~i~~~~lli~~~i~~~III """*"*"'"*"""AUTO"3-DIGIT 170 T 179 B 732 LEHMAN WILBUR J 17 SUMMER DR DILLSBURG. PA 17019-9545 I~RO~~FI°~~` IF~I~~i~T l~ GIS ID#: 16:2287837-354268-0000 738 W MAPLE ST PALMYRA PA 17078 ASSESSMENT TAX ORIGINAL: 12200 $1.159.61 HOMESTEAD EXCL: 559 $53.13 FARMSTEAD EXCL: 0 $0.00 NET: 11641 $1,106.48 RECORD NO: R199181 ~ l i i TAX L?ESCI~IP T IOP,i ~ TAY, ;SATE ~ 2°., ! ~9S . _'. r „T ~ ' ~'- r y {' --~,• ,~,~- ,,,,-~_.i SCHOOL REAL ESTATE ~ 0.09505 UNTIL 8131/2010 $1.084.35 UNTIL 10!3112010 ; $1.106.48 AFTER 10131!2010 j $1.217.13 l , I TOTAL ~ t$`1,084.35 collections group 546 `Wendel Road KEYSTONE ~ ~g~g 0300(fax 724-978-0339 LOCAL OFFICE INFORMATION LEBANON COUNTY MUNICIPAL BLDG ROOM 113 400 S. EIGHTH ST LEBANON, PA 17042 717-272-3770 OFFICE HOURS DAILY 8:00 AM - 4:00 PM CLOSED SATURDAYS SUNDAYS & HOLIDAYS Your enclosed tax bill may include a tax reduction for your homestead and/or farmstead property. As an eligible tmmestead and/orfarmstead property owner, you have received tax relief through a homestead andior farmstead exGusion which has been provided under the Pennsylvania Taxpayer Relief Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. Optional Payment Plan -See reverse for imoortant information 1st Installment 7/31/2010 $276.62 2nd Installment 8/31/2010 $276.62 3rd Installment 9/30/2010 $276.62 4th Installment 10/31/2010 $276.62 $1,106.48 $1,217.131 www.lebcountv.orq If a receipt is desired, please include aself-addressed, stamped a2ssa Control #: 38D13664 envelope along with the top and bottom portions of this bill. Password: LBYJWWNK , MEMBERS 1St FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Accrued Interest from 01/01/10 to Date of Death Name of Joint Owner Date Joint Owner Removed CHECKING ACCOUNT: 367718-00 '~ 0 9/1 812 0 0 9 $51, 275.80 $8.43 $51,284.23 $63.42 Florence E. Lehman-Deceased 10/01/2009 12/17/2009 Account Number/Suffix 367718-11 f Date Account Established 09/18/2009 Principal Balance at Date of Death $10,193.61 Accrued Interest to Date of Death $.87 Total Principal and Accrued Interest $10,194.48 Accrued Interest from 01/01/10 to Date of Death $12.86 Name of Joint Owner Florence E. Lehman-Deceased 10/01/2009 Date Joint Owner Removed 12/17/2009 CERTIFICATES OF DEPOSIT• Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Accrued Interest from 01/01/10 to Date of Death Name of Joint Owner '*Opened by transfer of shares from 367718-00. VISA ACCOUNT: Account Number Date Account Established Balance on Date of Death Joint Cardholder VISA closed Date 'Contractual Pledge of Shares. Estate of: ~Ibur J. Lehman Date of Death: 11/21!2010 Social Security Number: 201-16-5525 1 367718-43 05/25/2010* $5,032.75 $4.11 $5,036.86 $36.86 None 4672090000359679" 02/04/2010 $17.13 None 12/15/2010 • , ti__._ ~`~ ` MEMBERS 1sT FEDERAL CREDIT UNION ~~~ C/6~ Leigh-An a Stallings ~~t~~C Lending Insurance Support Specialist December 21, 2010 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org ( p Prudential Uecerr.ber 3 ":, 1010 ELAlI~;E A bVE~~Er{r pRL'rp SECtRITIES I.LC '~`!A r^^,~~i t?17j 944-6369 Ref~i~e,:,ce 1`ut?tber: b~0?374',ZQ~ 1818948 Accounts and CODS-:CXXXXX633G ?.^gisir~cior~s: W(Lt~~.RJ L1rHMAN CD"J9-XXXxXX633 ! ~Rt~UENTIAL TKUST C0~1PA?'.Y C1. Ti-iE R~LLOVErR iftA OF ~'J;LBI:K J L$NMAN " ~~';, -~ ~ --~ '_ ~ E Z~ry~ LL. ' Drat ~~15 ~~'einur?: %ha letter iS .r. ragarc'.:v your recent to?ephane call, , As of :rie close of bl~sit~asa on T'ovember 19, 20 I0; the abore referen~zd acccants we: s valued as iollowF: .~lecountNumber ShareB'n(ance .tiAt~`PricePerSligte Markrr~'rrlue OOt1G-XXX:3CX;Yb3.i0 8iD,D2 59.97 58,0?S.SZ D009.~'sr,XXXX6331 ~ ?97.284 $9,97 $7,9L6.92 As changing market conditions may cause the I~et Asset Vah~e (ItiAV} to tlvct±istte or a daily basis, the accot:n' v Blues are suoject to change. if you have questions or rued furtbcx assistance, r"lease contact the Prudential vlutuat Fund 53rvioe Center fit (8Q0) 225-.85? ~io:~day throug:~ Friday between 8:30 a.t:t, and 6:04 p.m. ~as'.crr. time, For accoun; inforr;.etion ti~at is avrilaula 24 hours a da}--, 7 days a week, you may uccese your account online at www.pruden:i ~.l.com, Sincerely, JoaAnre :Uforsc Sharehnl%e~ services Soecial[st III 9rUdantlal Investme~tita Pr~de~:is+ fAUtuel Fur~~ $yrvgyg t.l.C P 0 Bo.~ 9855 Prr;icenr:9, R, 42~da ;6u0) 326-14L2 wut N.7r'1C9ia~ fl l : pfT, Values ,r. Prudential Statement PrudeNial Annuities A Business of Prudential Financial. Inr. P.o. BnX »> December 27, 20]0 Philadelphia, PA I)17fi~7960 (R8R)77X~?aHs WILBUR J. LEHMAN l7 SUMMER DR Owner: WILBUR J. LEHMAN DILLSBURG PA 17019 Annuitant: WILB IwIAN Contract Number: 046158 Contract Date: 03/02 Market: Non-Qualified !f you have any questions, please contact your financial professional, or the Prudential Annuities Service Cente>r toll free at (888) 778-2888. The values provided on this statement are calculated as of l 1/l9/201U. Any activity after this date is not reflected in this statement, If you surrender this contract you will lose the right to future annuity benefits under the contract. In addition, all or part of the distribution may be subject to federal andlor state income tax. You may also be subject to a l0 percent penalty tax for early withdrawal. You may want to consult with your tax adviser if you have any questions concerning the applicable tax treatment, as Prudential cannot offer tax advice. Although great care has been taken in preparing this statement, we reserve the right to amend the statement as needed. For additional information about the benefits available to you, please refer to your original contract. Account Summary as of 11/19/2010 Investment Option Number of Units Unit Value Dollar Amount I Year Fixed-Rate Option ------- ------- $ 16,928.72 Total Contract Fund Value: $16,928.72 Surrender Value as of 11/19/2010 Contract Value $16,928.72 Misc. Fees $0•~ Surrender Charge $567.50 Gros?- psis . ~ ~ y /f~'i. y7 Recaptured Bonus $0.00 NAA157. HARX Annuities are issued by The Prudential Insurance Company of America and Pruco Life {nsurance Company (in New York, by Pruco Life Insurance Company of New Jersey), all located in Newark, NJ, or by Prudential Annuities Life Assurance Corporation, Shelton, CT. Annuities aze disvibuted by Prudential Annuities Distributors, Inc., Shelton, CT. All are Prudential Financial, Inc. companies and each is solely responsible for its own financial condition and contractual obligations. `Pyramis is a registered service mazk of FMR LLC. Used under license. Valuc:State 92009 Cash Surrender Value as of 11/19/2U10: $16,361.22 Amount Available for Withdrawal Without Surrender Charges as of 11/19/2010: $1,692.87 Beneficiary Information Primary Beneficiaries RONALD L. LEHMAN Secondary Beneficiaries TRICIA G. LEHMAN Please see the beneficiary designation information in your contract for more details, II~~F~'1'1-IWE~T SAVINGS BANK Where people make the difference. '100 LIBERTY STREET - P. O. BOX '128 - December 29, 2010 Heather D. Royer, Esquire Smigel, Anderson, and Sacks, LLP 4431 North Front Street, 3`d Flr. Harrisburg, PA 17110 RE: Estate of Wilbur J. Lehman Dear Ms. Royer, WARREN, PENf~ISI'LVANIA '16385 Listed below please find the account information that you requested in your letter dated December 13, 2010 for the Estate of Wilbur J. Lehman. Going forward, please forward any requests for estate information to the following aaldress: Northwest Savings Bank Attn: Research Department 100 Liberty St. PO Box 128 Warren, PA 16365 Account Number: 1853013025 Date Opened: 03/24/2000 Account Owner(s): Wilbur J Lehman or Florence E Lehman Account Type: Certificate of Deposit Interest Rate: 2.48% Date of Death Balance: $5007.47 Accrued Unpaid Interest: $7.47 Date Account Closed: 12/24/2010 Balance at Closure: $5008.16 Northwest Direct: 1-877-672-5678 www.northwestsavingsbank.com Account Number: 830712390 ~ Date Opened: 8/17/1985 Account Owner(s): Wilbur J Lehman or Florence E Lehman Account Type: Certificate of Deposit Interest Rate: 3.698% Date of Death. Balance: $5026.85 Accrued Unpaid Interest: $26.85 Date Account Closed: 12/24/2010 Balance at Closure: $5043.06 Account Number: 1853013033-- Date Opened: 03/24/2000 Account Owner(s): Wilbur J Lehman or Florence E I_,ehman Account Type: Certificate of Deposit Interest Rate: 2.97% Date of Death Balance: $7486.11 Accrued Unpaid Interest: $10.31 Date Account Closed: 12/24/2010 Balance at Closure: $7492.34 There were no Safe Deposit boxes in the decedent's name. If you have any further questions regarding the above-mentioned information, please contact us at 1-800-572-6972, extension 7119. Sincerely, ~ ~ , ~ D ~ ~ ~ '`~'~-`' Katharine Groff Research Department i ~,e 6011. Linglestown Road Harrisburg, P.417112 1717) 652-8888 R'arren R. Hoover, Jr., Secpervisor ~~' 9 ~ ~ ~ _ ~ ~~ t I ,, ~ L~. ,... Route 422 ~ Lucv Avenue P.O. Box 475 ~~~ T~~ Hershc;v. P.A 17033 / 1717) 533-7700 P°°`t'tH°m" & Cru~tost [ac. Sheldon K. Hoover, Supervisor "Our Family.Serving Foiu• Family for Five Generations" „ ~,, t www.hooverfuneralhome.com "~'"" - - -- t `.' Ronald Lehman 17 Surmner Dr. Dillsburg, PA 17019 Funeral Expenses for Wilbur J. Lehman January 2, 2011 Professional Services, Use of Facilities, Automotive Equipment and Necessary Documents $ 3,795.00 Merchandise Selected Gemini, 20 ga. steel casket $ 1,275.00 Grave Liner $ 860.00 Memorial Folders $ 35.00 TOTAL FUNERAL HOME CHARGES $5,965.00 Cash Advanced Items Flowers $ 225.00 Cemetery Charges $ 6>0.00 Clergy $ 200.00 Lowering Device, Greens & Tent $ ~ ~j,00 Harrisburg Newspaper $ 115.00 Monumentlnscription $ I(;0.00 6 Death Certificates @ $6 ea $ 36.00 TOTAL CASH ADVANCED CHARGES ~ 1,591.00 TOTAL FUNERAL & CASH ADVANCED CHARGES ~ 7,556.00 Payments and Adjushnents $ 35.00 November 22, 2010 credit $ 35 p0 BALANCE DUE: $ 7,521.00 rf~S~~'~ ~i A,~ G-~K ~ I v 3 ~J V Funeral Homes & Crematory, Inc. Sheldon K. Heaver, Supervisor Warren R. Hoover, Jr., Supervisor Route 422 & Lucy Avenue 6011 LinglPStown Road P.O. Box 475 Harrisburg, PA 17112 Hershey, PA 17033 {717)652-8888 (7171533-7700 / FOR FTC COMPLIANCE DECEASED ~~ ~ Irili~Cr J DATE OF DEATH ~^ PLACE OF DEATH_ 1~~5 t i~ DATE OF STATEMENT L ~ ~Z~Z-- ~ a A. CHARGE FOR SERVICES SELECTED !. Prohas/orta/ Servlcea: /' Transfer of Remains to Funeral Home .............. !_~/ Embalming ......................................................... Services of Funeral Director and Staff .............. Drrsssing, Cosmetakr,)y ant Castrating ............. 2 FeUNt/ea, EquJpment sod AstaHd ServJeea:. Use of Feciitlies 8 Staff (or Viewlrtg/Visitatton.... Use of FaclilbeS & Staff for Funeral Ceremorry .. Use of Facilhles & Staff for Memorial Service .... Staff for Graveside Service Only ........................ Staff for Procession & Graveside Service .......... 3. Automotive EqulpmenC Casket Coach ................................... ................ Service Van ...................................... ................ Sedan .._......._.._........__ ................... ............... Limousine .................._.........------ -------.. 6. Other Selvlosa/Feei(ides/Equ/pment .................. r .. ..~.~+ ...........r~.-~~..y...yam......'.[d..r ......................... ............................................................................................................ TOTAL OF SERVICES SELECTED ........................................................ S ~ ' " S B. CHARGE FOR MERCHANDISE SELECTED Casket Ior other r~j tacte) .- ....................................................................~ \ fir. Name/NO. f '~_, 1V Material ~ ~ Color SI r-2 ~rL/~ Outer burial comalner .............................................................................l. ~G nn - NameMo. l~Tf f~t~1~~!'~ Material G71 ~.Y~.L~p-{ ,,~ Acknowledgemem eards ............................................................................ Register Book ......................................................................................._.... Memory folders/pmyer cards ...................................................................... Cbthing ...................................................................................................... Undergarments .......................................................................................... Extedor Ceske[ Cruciffx .............................................................................. Temporery Grave Marker ........................................................................... Crematlon Um ............................................................................................ TOTAL OF MERCHANDISE CHARGES .................................................... $~ C. SPECIAL CHARGES ^ Forwan)ing remains ta: ^ Receiving remains from: Immediate buriel ......................................................................................... Direct aemation ......................................................................................... Other .......................................................................................................... TOTAL OF SPECIAL CNARGES .............................................................. $ TOTAL FUNERAL HOME CHARGES ............................................................ $-e~uLi.s~ (rMS foist does nW irlcrude Cas/r Advanced STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED >f Crwgre an Doty /or mode llama tAat en used. II we aro raquirW by law iro use any trams, av w!a erplaln the roerona in wdgng below. I! you sNectsd a /unara/ whleh raqulres ambelm/rrg, such es a hrra~s! with viewing, you may Mw to pay Ior smbalmfng. You do nor hew to pay Ior arMalming N you dW oat approve H a N yarn raYCred arrangemena suer a9 d/ract cremation or lmmsdlire burial. d wo charged Ior ambaaning, wa w1N arplaln below. CASH ADVANCES Certified Copies of Death Certificate ~ S ~_ each .~(,t,_ FIOWBfS ZZ•S_ Clergy ~ 1~C,) __ Berton ____ Musician Soloist -- Paid Newspaper Notices ~i_ Cemetery f ! _.~,~L ;LV - ` Other Cemetery Charges _ Monument Inscription ~ Lowering Device, Greens & Tent _ ~~ Coroners Fee TOTAL OF CASH ADVANCE ~~ S $ We charge you for our services in obtaining: (Flowers, Inscriptions, Newspaper Naeces, and Cemetery Chargesy SUMMARY Total Funeral Home Charges ............ ............................... $ ~~ Sales Tax . ii app(icable .................... ............................... $ ---- Total Cash Advance .......................... l ............................... $ GRAND TOTAL $~(Ks.~, Less Credhs and Payments $~~~w^ $~ Total Credits ...................................... .............................. $ ---- BALANCE DUE p $ _ ~~ ~~ '~ Billing To: _ ~~ _ _ DISCLOSURES r- ~~ - Reasonfor emb min ~~j r If an law, cemetery or crematory requirements have required the purchase of y items ti . ~`aw or uirement is expiainetl below ~,,~ t ~~Y~xr-cy R 11fF~L~T TM «sy wumpy cn ow Cabbl and« oular Donal CenYarer adtl in <onnataw won eus aenxe l9 ale axprw wXlan w ~. a any. tix.nae by ma menulaCnaer. THIS FUNERAL NOME MAl(ES NO WARRANTY, EXPRESSED OR IMPLIED, INCLUDING AN IMPLIED WARFWlTY OF MERCHANTABILRV ANO AN IMPLIED WARRANTY OF FlTNESS FOR A PARTICULAR PURPOSE WITH RESPECT TD THE CASKET AND/OR OUTER BURIAL CONTAINER. ACKNOWLEDGEMENT AND AGREEMENT I hereby acknowledge that I have the legal right to anange the final services Ipr the tlaceesed, and I authorize Mis funeral establishment to perform sorvices, famish goods, arXi Incur outside charges specirred on this Slatenlem. I admowledge chat I have received the General Prke List and have been offered for review the Casket Price List arld Outer Burial Container Price List. Terms of Payment: Futl Payment is due no later than 30 days from Final Bill. n any payment "a: not pab when due, an unanticipated LATE CHARGE OF 1 Vi°„ per month tANNUAL PERCENTAGE RATE 18X) an ale unpaid Oalerrs wiN oe Due. I agree to pay me Balance Due Ii6180 On U1is Statement plus a,,y Ute Charge, At Ina even I detach in Payment to sue hlnerel earebllahmeflL 1 agree b pay mesonade aaomeya tees and coon costs in addition to any Lale Charge applicable. I untlerstantl orb agree h Nh Slal«nent end ihel INs Ic in addition to the eatuuty i~e0 by law upon me estate W me deceased. By my sipnarura Uebw, I her~j agree b ae of the above antl ecknovaedge receipt of a copy al mis Statement. Social Security Number X Signed Oeted ____ Social Security Number ACCEPTANCE This lunarai establishment agrees to provide all services-. merchandisp and cash advanp~ indicated 111 this Statemern.