HomeMy WebLinkAbout09-02-111505610140
RE
V-1500 EX ~o,_,o,
PA Department of Revenue
Bureau of Individual Taxes OFFICIAL USE ONLY
PO BOx 280601 INHERITANCE TAX RETURN County Code Year
Harrisbur PA 17128-0601 File Number
ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT 2 1 1 1 0 3 4 2
Social Security Number
Date of Death MMDDYYYY
1 8 9 0 9 1 6 1 4 0 2 2 7 2 0 1 1
Decedent's Last Name
A T T I C K S suffix
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS
^X 1. Original R
MI
eturn
^ 2. Supplemental Return
^ 4. Limited Estate ^ 3. Remainder Return (date of death
^ 4a. Future Interest Compromise (date of prior to 12-13-g2)
0 6. Decedent Died Testate death after 12-12-82) ^ 5. Federal Estate Tax Return Required
(Attach Copy of Will) ^ 7~ Decedent Maintained a Living Trust
^ 9. Litigation Proceeds Received (Attach Copy of Trust) 8• Total Number of Safe Deposit Boxes
^ 10. Spousal Poverty Credit (date of death
CORRESPONDENT -THIS SECTION MUST BE COMPLETED ALL CORRESPONDENCE AND C ^ 11. Election to tax under Sec. 9113(A)
Name (Attach Sch. O)
ONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
J A N L B R O W N Daytime Telephone Number
7 1 7 5 4 1 5 5 5 0
REGISTER OF WILLS USE ONLY
First line of address I I
I ~
J A N L B R O W N & I c? ._
Second line of address A S S O C I A T E S I :~ - 7 ___
~Ih- z
8 4 5 I ~, ,
S I R r ~'~ '- ; h:
T H O M A S C T i r-- i,
City or Post Office S T E 1 2 j ` ;1 '
,~,;, r,.~ ~~ _;.
State ZIP Code I_ I
DAr~ -
~ft~D -- ,
H A R R I S B U R G .
P A 1 7 1 0 9 _ - _= -,
Correspondent's a-mail address: BRENDAJLB VERIZON.NET y ~ -~ ~
Under penalties of er'u ` - ~
it is true, correct and co pleteeclarelahation of p eparer other thanutheincluding accom
SIGNATURE OF PERSON RHSP NS
personal represent five scbased on a~ ntformat on of wh ch preparerfhas any knowledge.
R FILING RETURN Y knowledge and belief,
ADDRESS DATE
845 SIR THO CT STE 1 ~" ~- ~°' ` ~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE H A R R I S B U R G
PLEASE USE ORIGINAL FORM ONLY
L 1505610140
Side 1
Date of Birth MMDDYYYY
0 5 2 9 1 9 1 6
Decedent's First Name
L E A H M A Y MI
Spouse's First Name
PA-~09
DATE
1505610140
~~
ti
1505610240
REV-1500 EX
Decedent's Name: LEAH MAY
A T T I C K S Decedent's Social Security Number
RECAPITULATION 1 8 9 0 9 1 6 1 4
1. Real Estate (Schedule A) .. , . .
.......
.
................
.....
Stocks and Bonds (Schedule B) . , , .
'
2
3. Closely Held Corporation, Partnership or Sole-Proprietorshi 5 6 9 2 1 5 7 4
p (Schedule C
4. Mortgages and Notes Receivable (S
) 3
h
c
edule D)
5• Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)
.. , , ... 5.
6. Jointly Owned Property (Schedule F)
7. Inter-Vivos Transfers &
Request
d
~
ll
'
6 3 7 5 7' 7 5
e
.... .
Miscellaneous N
(Schedule G) ~ 6•
n-probate Prop
e
rty
Separate Billing Requested .. , .
7
. .
8. Total Gross Assets (total Lines 1 throw h 7
9 ) .......
...
........ $.
9. Funeral Expenses and Administrative Costs (Sched
l
6 3 2 9
7 3 • 4 9
u
e H) ....
.... 9.
10. Debts of Decedent, Mortgage Liabilities
and Li 4 1 7 2
7 ~ 2 1
,
ens (Schedule I) . , , ..
10
11. Total Deductions (total Li 9 3 6 5 ~ ~ 7
nes 9 and 10) .....
...... ...... 11.
12. Net Value of Estate (Line 8 minus Line 11) 5 1
~ 9 2 • 9 8
13• Charitable and Governmental Bequests/Sec 9113 Trusts for which 12
an election to tax has not been made
S 5 8
1 8 8 ~ ' S 1
(
chedule J) . , .
.
.......... ... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) 5 8 1 8
8 ~ ~ 5 1
..............14.
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
~ • ~ 0
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 _
16. Amount of Line 14 taxable 15
.
at lineal rate X .0
17. Amount of Line 14 taxable 16.
at sibling rate X .12 •
18. Amount of Line 14 taxable 17.
at collateral rate X .15
18.
19. TAX DUE .....
..........
........... ......19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A
REFUND OF AN OVERPAYMENT
L 1505610240
Side 2
1505610240
REV-1500 EX Page 3
Decedent's Complete Address:
nrnr...-.._._ _
LEAH MAY ATTICKS
- ---- --
STREETADDRESS
4905 E Trindle Road
Hampden-Townshp
--
ciTY - ---- -- --. _ ---
Mechanicsburg
Tax Payments and Credits:
STATE - _-_------
PA
• Tax Due (Page 2, Line 19)
2• Credits/Payments
A. Prior Payments (1)
B. Discount
3. Interest Total Credits (A + g) 2
()
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. (3)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4)
(5)
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TH
1. Did decedent make a transfer and: E APPROPRIATE BLOCKS
a. retain the use or income of the property transferred : .............
Yes No
....................................... ^° X
b. retain the right to designate who shall use the property transferred or its income; ^
c. retain a reversionary interest; or
d. receive the promise for life of either payments, benefits or care? ~ ~ ~ ~ • ~ • ~ ~ ~ ~' ~' ::::::::::::::::::: ~ X^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? X
3. Did decedent own an "in trust for" orpayable-upon-death bank account or securit at his or her death . ^ X
......... ^ X
4. Did decedent own an individual retirement account, annuity or other non-probate property, which ~ ^
contains a beneficiary designation?..._
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ^ ^
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate im ose AND FILE IT AS PART OF THE RETURN.
3 percent [72 P.S. §9116 (a) (1.1) (i)]. p don the net value of transfers to or for the use of the surviving spouse
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the u
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the
filing a tax return are still applicable even if the surviving spouse is the only beneficiary. se of the surviving spouse is 0 percent
statutory requirements for disclosure of assets and
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
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 bene to or for the use of a natural parent, an
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. ficiaries is 4.5 percent, except as noted in
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 7
Section 9102, as an individual who has at least one parent in common with the decedent, whether b blood o
[ 2 P.S. §9116(a)(1.3)]. Asibling is defined, unde
Y r adoption.
File Number
21 11 0342
REV-1503 EX + (g_gg~
COMMONWEALTH OF PENNSYLVANIA SCHEDULE B
INHERITANCE TAX RETURN STOCKS & BONDS
RE
SIDENT DECEDENT
ESTATE OF
LEAH MAY ATTICKS
FILE NUMBER
All property jointlyowned with right of survivorship must be disclosed on chedu e F 0342
ITEM
NUMBER
IPTION
~~ DWS GNMA Fund-S (SGINX); 4
537
17
h VALUE AT DATE
,
.
s
s
@ $15.26/sh OF DEATH
2 Dominion Resources Black Warrior Tr
t 69,237.21
us
DOM
( ), 1,000 shs @ $16.12
3 Capital Income Builder Fund CIA (CAIBX); 238.339 shs
@ $50.97/sh 16,120.00
4 Capital World Growth & I 12,148.14
ncome Fund CIA (CWGIX); 160.234 shs
@ $36.92/sh
5 Oppenheimer Pennsylvania Municipal Fund CI A M/F (OPATX);
3,073.473 shs @ $10.30/sh 5,915.84
6 AllianceBernstein Income Fund ACG
( ), 2, 750 shs @ $7, 74/sh 31,656.77
7 Allegheny Cnty Pa Hosp Dev Auth Rev 5.1250% 21,285.00
; par value $70,000
8 Pa St Higher Edl Facs Auth Rev 4
5% 57, 743.00
.
; par value $25,000
9 Philadelphia Pa Arpt Rev 4
5% 24, 998.75
.
; par value $50,000
10 Pottsville Pa Hosp Auth H 42,595.50
osp Rev 5.5%; par value $35,000
11 South Fork Mun Auth Pa Hosp Rev 5% 32, 942.70
; par value $10,000
12 Bank of America Corporation 5
6% 8, 536.60
.
; par value $5,000
(Death put allowed redemption at par value
)
.
13 Bank of America Corporation 5
8% 5, 000.00
.
; par value $50,000
(Death put allowed redemption at par value
)
.
14 The Bank of New York Co 50, 000.00
mpany Inc 5.25%; par value $20,000
(Death put allowed redemption at par value
)
.
15 General Motors Acceptance Corporation 7
125
D 20, 000.00
.
(
0%; par value $10,000
eath put allowed redemption at par value
)
.
16 General Motors Acceptanc
C 10,000.00
e
orporation 6.75%; par value $45,000
(Death put allowed redemption at par value
)
. 45, 000.00
line 2, Recapitulation) $
(If more space is needed, insert additional) shOeets of thle sam
s
569 215
74
i e~
e .
Continuation of REV-1500 Inheritance Tax Return Resid
LEAH MAY ATTICKS ent Decedent
Decedent's Name
Pagel 21 11 0342
File Number
Schedule B -Stocks 8 Bonds
ITEM
NUMBER
17 DESCRIPTION
General Motors Acceptance Corporation 6.4%; par value $40,000
(Death put allowed red VALUE AT DATE
OF DEATH
emption at par value.)
40, 000.00
18 Merrill Lynch & Co Inc 6.11%; par value $20,000
(Death put allowed redemption at par value
)
2
. 0, 000.00
19 Protective Life Insurance Company 5.5%; par value $10,000
(Death put allowed rede
mption at par value.)
10,000.00
20 Prudential Financial Inc 6%; par value $30,000
(Death put allowed red
emption at par value.)
30,000.00
21 SLM Corporation 6%; par value $21,000
16,036.23
SUBTOTAL SCHEDULE B
116, 036.23
GRAND TOTAL SCHEDULE B $
569,215.74
REV-1508 EX + (6-98)
S
CHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF
LEAH MAY ATTICKS FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.l 0342
ITEM All property jointlyowned with right of survivorship must be disclosed on Schedule F.
NUMBER
~ • M&T Checking 11477164 DESCRIPTION VALUE AT DATE
OF DEATH
23, 926.28
2 Raymond James Account 48912814; cash balance
34, 821.44
3 Aetna reimbursement
2.10
4 AF&L Insurance Co; LTC insurance cancellation refund
232.74
5 American Home Mortgage Settlement Fund; securities class action; pro rata share
272.01
6 Medicare reimbursement
18.18
7 United States Treasury; 2010 1040 overpayment refund
1, 635.00
8 Mountz Jewelers; jewelry sale proceeds
2, 850.00
(If more space is needed, insert additional h~eets of the same s ie) line 5, Recapitulation) $
63 757.75
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE 7AX RETURN
RESIDENT DECEDENT
ESTATE nf`
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
LEAH MAY ATTICKS FILE NUMBER
21 11 0342
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES: DESCRIPTION
~• Neill Funeral Home Inc
2 Premier Caterers; funeral luncheon
B. ADMINISTRATIVE COSTS:
~ • Personal Representative Commissions:
Name(s) of Personal Representative(s) Jan L Mober
Street Address 2217 Southfield Road
city Harrisbur
State P_ A __ Zlp 17104
Year(s) Commission Paid: 2011
2. Attorney Fees: Jan L Brown & Associates
3• Family Exemption: (If decedent's address is not the same as claimants, attach explanation.)
Claimant
Street Address
City
Relationship of Claimant to Decedent State ___ ZIP
4. Probate Fees: Cumberland County Register of Wills
5. accountant Fees: Parks & Company
6• Tax Return Preparer Fees:
~~ Cumberland Law Journal; legal advertising
8 The Patriot-News; legal advertising
9 Vital Records; 15 death certificates
10 Executrix travel from/to Florida/Pennsylvania
If more space is needed, use additional sheets oOf pap r olf he same si eine 9, Recapitulation) $
AMOUNT
283.03
840.00
19, 079.00
19, 079.00
659.50
850.00
75.00
259.28
163.00
439.40
41727.21
REV-1512 EX+ (12-OS)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT
,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF
LEAH MAY ATTICKS FILE NUMBER
21 11 0342
Report debts incurred by the decedent prior to death that remained unpaid at the date of death
includi
,
ITEM ng unreimbursed medical expenses.
NUMBER
DESCRIPTION VALUE AT DATE
1. Associated Cardiologists PC OF DEATH
67.80
2 Azizkhan Internal Medicine As
i
soc
ates
62.26
3 Center For Kidney Disease & H
rt
ype
ension
7.75
4 East Pennsboro Ambulance Ser
i
I
v
ce
nc
95.20
5 In Your Home Care
5, 753.00
6 Jan L Brown & Associates; legal services 7/6/10-2/27/11
2, 931.25
7 Lincare Inc
228.10
8 Mobile X Ray Imaging Inc
39.53
9 Quantum Imaging And Therapeutic Associates
3.50
10 Sally Harris
104.53
11 Verizon
72.85
TOTAL (Also enter on Line 10 Recapitulation) I $
If more space is naariari ~„~ rt a,,, ~ 9 365 77
~~~a~ anaets or me same srze.
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
wir-iC ur:
LEAH MAY ATTICKS
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
j. TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
FILE NUMBER:
21 11 034;
RELATIONSHIP TO DECEDENT
Do Not List Trustees)
AMOUNT OR SHARE
OF 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:
1• Market Square Presbyterian Church
20 South Second Street, Harrisburg, PA 17101
581,880.51
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. 581 880.51
LAST WILL AND TESTAMENT -
OF _
,.~.-
LEAH MAY ATTICKS
I, LEAH MAY ATTICKS, now domiciled in Cumberland County, Pennsylvania, declare
this to be my Last Will and Testament. I revoke all other wills and codicils that I ma have
Y
previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after m
Y
death.
Art_
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from an
Y
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations which exist
at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath to my sister, ELIZABETH G. ATTICKS, of Cumberland
County, Pennsylvania. In the event that ELIZABETH G. ATTICKS predeceases me or fails to
survive me by thirty (30) days, I give, devise and bequeath the remainder of my estate, of whatsoever
nature and wheresoever situate to the MARKET SQUARE PRESBYTERIAN CHURCH, or its
successor(s), of 20 S. 2°d Street, Harrisburg, Pennsylvania, to be used at its discretion.
Article V
I nominate, constitute, and appoint my sister, ELIZABETH G. ATTICKS as Executrix
of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any
reason whatsoever of my Executrix, I nominate, constitute and appoint my attorney, JAN L.
BROWN of JAN L. BROWN & ASSOCIATES, or its successors, or an attorney of Jan L.
BroH~n & Associates, or its successors, currently of 845 Sir Thomas Court, Suite 12,
Harrisburg, Pennsylvania, as successor Executor of my Last Will and Testament. I direct that my
-2-
Executrix or successor Executor be permitted to serve without bond and in addition to those
powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike
shares and to file any qualified disclaimer I could have filed if living. My Executrix or successor
Executor shall receive reasonable compensation for services rendered to my estate.
Article VI
In addition to the powers conferred by law, I authorize my Executrix and successor Executor,
in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate or
personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
pnor to my death,
(g} to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
-3-
interest in at time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of fees in
effect while their services are performed.
IN WITNESS WHEREOF, I, LEAH MAY ATTICKS, hereby set my hand to this my Last
Will and Testament, on ~~ o~ `7 2006.
~ ~ ~~- ,.
LEAH MAY AT CKS
In our presence, the above-named LEAH MAY ATTICKS signed this and declared this to
be her Last Will and Testament and now at her request, in her presence, and in the presence of each
other, we sign as witnesses.
Name Address
~~
-4-
I, LEAH MAY ATTICKS, Testatrix, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my Will,
and that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
LEAH MAY ATTICKS, the Testatrix
on >' "o~ `~ 2006.
No ry blic
COMMONWEALTH ot: PfNNSnYANu
NOTARIAL SEAL
lA000E11NE A. NEILX NOTARY PUBLIC
lO1NER PATRON TWP., DAUPHNI COUNR
MY COMNLSSFON EMPIRES DEC. 17, 2007
LEAH MAY ATT KS
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
by~~, ~~ ~; ~ ~ ~ LL L n/i; v ,fie ~~
andl~A~Tr/P //. ~ifrc.c.E~~BEn,
~-i tnesses, on _ 1 - ~ ~} , 2006.
~ ~L
N tart' blic
COMMONWEALTH OF PENNSYLVANIA
1ACOUEIINE A7KECl1; OlAR1' PUBLIC
~~ PAXTON TWP. DAUPHIN COUNTY
MY COMMISSION EXPIRES DEC. 17, 2007
-5-
~%
Witness
,-
~~ ~ ~ ~
Witness
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA ~ SS
COUNTY of CUMBERLAND
File Number 2 011 0 0 3 4 2
Personal Representative(s) of the Estate of Leah MaV Atticks
deceased, depose(s) and say(s) that the items appearing m the following inventory include all of the perso~l~assets whQrever situa~~
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation place~~p~osrte ea~li~item of sud
inventory represents its fair value as of the date of the decedent's death, and that Decedent: owned no real estate 6~tside-of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory ;~l• rn r?~ _
I verify that the statements made in this Inven- ~ ; ~ ~ ~" ? --?
°{~ --
tory are true and correct. 1 understand that false state- ~ - ' ' - -
ments herein are made subject to the penalties of Jan L Moberg _._..~ ~ .~ ; _._ ;T+
~G
l8 Pa. C.S. § 4904 relating to unsworn falsification to r`=' -r,
authorities.
Attorney -- (Name) Jan L Brown
_ (Supreme Court I.D. No.) 67993
(Address) 845 Sir Thomas Court Suite 12 Harrisbur PA 17109
(Telephone) 717-541-5550
DATE OF DEATH
27/2011
PA 17050
FIGURES MUST BE TOTALED
DWS GNMA Fund-S (SGINX); 4,537.17 shs @ $15.26/sh
Dominion Resources Black Warrior Trust (DOM); 1,000 shs @ $16.12
Capital Income Builder Fund CIA (CAIBX); 238.339 shs @ $50.97/sh
Capital World Growth & Income Fund CIA (CWGIX); 160.234 shs @ $36.92/sh
Oppenheimer Pennsylvania Municipal Fund CI A M/F (OPATX);
3,073.473 shs @ $10.30/sh
AllianceBernstein Income Fund (ACG); 2,750 shs @ $7.74/sh
Allegheny Cnty Pa Hosp Dev Auth Rev 5.1250%; par value $70,000
(Attach additional s/reels as needed)
DECEDENTS SOC. SEC. NO.
189-09-1614
973.49
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such tigures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b))
LAST RESIDENCE
4905 E Trindle Road
69,237.21
16,120.00
12,148.14
5,915.84
31,656.77
21,285.00
57,743.00
Form RW-09 rev. 10.13.06
Continuation of Inventory
Leah May Atticks
decedent Name 2 011 O D 3 4 2
Page 1
Description of Inventory
File Numbe
• ~ ~• ~ ~~a~ ~~~ CUI rats Huth Rev 4.5%; par value $25,000
24, 998.75
Philadelphia Pa Arpt Rev 4.5%; par value $50,000
Pottsville Pa Hosp Auth Hosp Rev 5.5%; par value $35,000
42,595.50
32, 942.70
South Fork Mun Auth Pa Hosp Rev 5%; par value $10,000
Bank of America Corporation 5.6%; par value $5,000
(Death put allowed redemption at par value.)
Bank of America Corporation 5.8%; par value $50,000
(Death put allowed redemption at par value.)
The Bank of New York Company Inc 5.25%; par value $20,000
(Death put allowed redemption at par value.)
General Motors Acceptance Corporation 7.1250%; par value $10,000
(Death put allowed redemption at par value.)
General Motors Acceptance Corporation 6.75%; par value $45,000
(Death put allowed redemption at par value.)
General Motors Acceptance Corporation 6.4%; par value $40,000
(Death put allowed redemption at par value.)
Merrill Lynch & Co Inc 6.11 %; par value $20,000
(Death put allowed redemption at par value.)
Protective Life Insurance Company 5.5%; par value $10,000
(Death put allowed redemption at par value.)
Prudential Financial Inc 6%; par value $30,000
(Death put allowed redemption at par value.)
--.. SLM Corporation 6%; par value $21,000
8, 536.60
5, 000.00
50, 000.00
20, 000.00
10,000.00
45, 000.00
40,000.00
20, 000.00
10,000.00
30, 000.00
16, 036.23
M&T Checking 11477164
Raymond James Account 48912814; cash balance
23, 926.28
34, 821.44
Subtotal I c
'F 13,15.7/.5()
Continuation of Inventory
Leah May Atticks
Decedent Name
Pa e2 2011 00342
Description of Inventory File Number
Aetna reimbursement
AF&L Insurance Co; LTC insurance cancellation refund 2.10
American Home Mort a 232.74
9 ge Settlement Fund; securities class action; pro rata share
Medicare reimbursement 272.01
United States Treasu 18.18
ry; 2010 1040 overpayment refund
Mountz Jewelers; jewel 1,635.00
ry sale proceeds
Unum Life Insurance Com 2,850.00
Group Account M&T Bank Co por lion rica
3,000.00
Subtotal $ -~-
-~ 8, 010.03
Grand Total $
635,973.49
JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
JAN L. BROWN, ESQUIRE
JACQUELINE A. KELLY, ESQUIRE BRENDA F. KEPHART, LEGAL ASSISTANT
CHRISTA M. APLIN, ESQUIRE JUDITH A. EBERSOLE,.gDMINISTRATIVEASSISTANT
September 1, 2011
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Register of Wills ~ L ~~ w
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Cumberland County Courthouse
;C'i`-
One Courthouse Square _ _ -"- -
Carlisle, PA 17013 ~~ ~-~
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Re: Estate of Leah May Atticks ~
File No. 2011-00342
Gentlemen or Ladies:
Enclosed please find the following items for filing with the Register of Wills:
1. Inventory.
2. An original and one copy of the Inheritance Tax Return.
3. Check payable to the Register of Wills in the amount of $30 to cover the filing fee for the
Inventory and Inheritance Tax Return.
4. Check payable to the Register of Wills in the amount of $100 for payment of the
additional Grant of Letters probate fee.
Please time stamp and return our file copies of the Inheritance Tax Return and Invento
ry
If you have any questions, feel free to contact this office.
' cerely,
~ ~~~---
bfk Jan L. Brown
Enclosure
Olde English Gap 845 Sir Thomas Court Suite 12 Harrisburg, PA 17109
Telephone (717) 541-5550 Fax (717) 541-9223 Email: jlbassoc@verizon.net www.janbrownlaw.com
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JA1V L. BROWN & ASSOCIATES
ATTORPJEYS AND COUNSELORS AT LAW
OLDE ENGLISH GAP
$4v SIR THOMAS COURT, SUITE 12
il-IARRISBURG, PA 17109
Register of Wills
Cumberland Count}~ Courthouse
One Courthouse Sq
Carlisle PA 17013
$2.28 ~
US POSTAGE
FIRST-CLASS
062S0007824161
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