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HomeMy WebLinkAbout10-14-111517561143 -J REV-1500 Ex (°'-'°' ; OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county code near File Number Bureau of Individual Taxes DEPARTMENT Of REVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 11 0152 Harrisburg, PA t7~28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207 30 6499 O1 29 2011 Decedent's Last Name Suffix Decet~ent's First Name MI MOYER EiARRY L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW - ~~ 3 Remainder Return (date of death n l R t t ~ ~ On inat Return : X 9 ~ e ur a 2 Supplemen ~ prior to 12-13-82) l'I 4 Limited Estate 4a. Future Interest Compromise) i_-i 5 Federal Estate Tax Return Required L -~ (date of death after 12-12-82 ~ F Decedent Died Testate ll X ~' - 7 Decedent Maintained a Living Trust 8 Total Number of Safe Deposit Boxes (Attach Copy of Trusl) --- - - ) ;Attach Copy of Wi _ 9 LdlgaUOn Proceeds Received 1 p. Spousal Poverty Credit (date of death J 11 Election to tax under Sec. 9113(A) L_~ between 12-31 91 and 1-1-95) (Attach SCh O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number Name JAN M WILEY 7:17 432 9666 First line of address 3 N BALTIMORE ST Second line of address City or Post Office DILLSBURG State ZIP Code PA 17019 _~ REGISTER OF WIL.itS USE ONLY _1-t - r . ,~ r~t -i .___ DATE:~iLED t__ , -,-t :.: = t ~- t .. ;.tt ~_••~ ~ -3 ,~ Correspondent's a-mail address: Under penalties of perjury, 1 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE /~ _ - ~~ G~ ~..,_ a_ ~ Vivian L. Warner L[71/2-~~~ ADDRESS 265 Ke West Boulevard Carlisle PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Jan M Wiley Dillsburq, PA 17019 \~ ~ Side 1 1505611]143 1.50561tJ143 1505610243 REV-1500 EX Decedent's Social Security Number oecear,nt~s Name Moyer, Harry L. 2 0 7 3 0 6 4 9 9 REC APITULATION 1. Real Estate (Schedule A)__. __... _._ .._ ... ..............__.._.... __ _. _. 1 2 Stocks and Bonds (Schedule B)__. _......._.._...____.____ .............__._ _ __ 2 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. _... 3. 4. Mortgages 8 Notes Receivable (Schedule D)._ ........._.._ _ __........_.._ _._ .._ 4. 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) _ 5 7 , 94 9. 5 9 6 Jointly Owned Property (Schedule F) '___ Separate Billing Requested........ _ 6. 14 , 337. 7 7 Probate Property Inter-Vivos Transfers & Miscellaneous N . ~ (Schedule G) I _ Separate Billinq Requested............ 7 g. Total Gross Assets (total Lines 1-7)......_._._ ..................._......_.........._........__.. 8. 22 , 287 . 3O -- - 9. -- Funeral Expenses ~ Administrative Costs (Schedule H) _... _ 9 14 , 8 8 9 ' 2 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. 10. 2 61.5 9 11. Total Deductions (total Lines 9 & 10)..__......._....__ ...............__........._......_._-. 11 15 , 15O . 81 12. Net Value of Estate (Line 8 minus Line 11)...._......._ ........ ....._........._........... 12. 7 , 136.49 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. 7 , 13 6 . 4 9 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 O . OO (a)(1.2) X .00 16. Amount of Line 14 taxable 7 , 13 6. 4 9 16. 321.14 at lineal rate X .045 17. Amount of Line 14 taxable 0 . O 0 17. O . O O at sibling rate X .12 18. Amount of Line 14 taxable O , OO 18. O • OO at collateral rate X .15 19 321.14 19. Tax Due........_ .... _ .................._........................................_.__........_........... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-11-0152 DECEDENT'S NAME Moyer, Harry L. - - _ __ __ -- STREET ADDRESS 265 Key West Boulevard CITY Carlisle ____-_ -- -- _ ---- STATF_ ~l ZIP PA 17015 Tax Payments and Credits: 1 Tax Due (Page 2, Line 19) 2. Credits/Payments A Prior Payments B Discount 3 Interest _ _ - _- 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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) 321.14 Total Credits (A + B) (2) 0.00 (3) (4) (5> 321.14 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;_ . _ ............ ...................__......_............___... ^ 0 b. retain the right to designate who shall use the property transferred or its income :........................ __..... ^ rUx~ c. retain a reversionary interest; oc ................................. ........................................_............_ ............... iJ d. receive the promise for life of either payments, benefits or care? ......................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer properly within one year of death without ^ ^ receiving adequate consideration? ...................................._....._...._................_.._..........__.......................... . 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ~~ contains a beneficiary designation? ...................................._..................................................._................. ^ LJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS tS 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 January 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 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)]. A sibling 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-'1508 EX+ (6-98) ,~ SCHEDULE E . ~ . CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~OMMONWEAL`H OF PENNSYLVANIA INHERITANCE iAX RETURN RESIDENT DECEDENT ESTATE OF Mover. Harry L. _ - FILE NUMBER 21-11-0152 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with the right of survivorship must be disclosed on schedule F. (If more space is needed, adaltlonal pages of the same sicc~ Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+(6-98) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF A. Vivian L. Warner B C 265 Key West Blvd. Friend Carlisle, PA 17015 OWNED PROPERTY• JOINTLY LETTER DATE I DESCRIPTION OF PROPERTY NCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH % OF DECD'S DATE of DEATH vAEUE of DECEDENT'S INTEREST ITEM FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSE INTEREST NUMBER TENANT JOINT ~oINTEV-HEED REAE ESTATE. 1 A 04105/1991 Citizens Bank Account: 26,901.84 0.500% 13,450.92 2 A 08110!1994 M&T Checking Account 1226614: 1,773.58 0.500% 886.79 TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. SCHEDULE ~ JOINTLY-OWNED PROPERTY (FILE NUMBER Harry L. _ ` 21-11-0152 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT 14,337.71 Form PA-1500 Schedule F (Rev. 6-98) REV-151 EX+(10-06) SCHEDULE H FUNERAL EXPENSES & COMMNHE ANCE~ AX RETURN ANIA RESIDENT oECEOENT ADMINISTRATIVE COSTS ESTATE OF ITEM NUMBE A. B. 1 Harrv L. FILE NUMBER 21-11-0152 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: See continuation schedule(s) attached ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) AMOUNT 11,540.40 Street Address City State Zip_ _ Year(sl Commission paid 2. Attorney's Fees The Wiley Group, PC 2,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zia Relationship of Claimant to Decedent 4. Probate Fees 149.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 699.32 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 14,889.22 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE W FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Moyer, Harry L. 21-11-0152 NUM ER DESCRIPTION AMOUNT Funeral Expenses 1 Ewing Brothers Funeral Home: 5,247.40 2 Rice Memorial Works: 6,293.00 H-A 11, 540.40 Other Administrative Costs 3 Carlisle HMW Physician Mgt: 318.69 4 Cumberland Law Journal (advertise): 75.00 5 Madison 8~ Assoc: 31.39 6 Mt. Rock Inpatient Services: 7'71 7 Register of Wills (filing fee): 30.00 8 Register of Wills (will copy): 5.00 9 The Sentinel (advertise): 208'78 10 USPS (overnight mail): 5.15 11 USPS: 17.60 H_B7 699.32 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (1 2-08) ;OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF (FILE NUMBER Mover. Harrv L. 21-11-0152 .,___~ ......... :........e,~ ti., .F.o ,~.,.-ndnnt or~nr to death that remained unpaid at the date of death, including unreimbursed medicaC expenses- (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+I'It-08) SCHEDULE J COMMNHERITANCEOTAX RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Moyer, Harry L. 21-11-0152 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NAME AND ADDRESS OF DECEDENT NUMBER PERSON(S1 RECEIVING PROPERTY Do Not List Trustees ;Words) ($$$) TAXABLE DISTRIBUTIONS [include outright spousal I. distributions, and transfers under Sec. 9116 a 1.2 1 Daniel Moyer Son 5,000.00 1620 Williams Grove Road Dillsburg, PA 17019 2 Darla F. Ptaszek Daughter 5,000.00 16 Shirley Lane Boiling Springs, PA 17007 3 Mitchell Ptaszek Grandson 5,000.00 16 Shirley Lane Boiling Springs, PA 17007 4 Vivian L. Warner Friend 265 Key West Blvd. Carlisle, PA 17015 Total ~ 15,000.00 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet, as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO T.AX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET[ Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ~. ~ z ~~, ~~~ ~~ ~' C~ I' ~ ~ ~ ~ D n~ ~ 3 HARRY L. MOYER ~i a ~ o o BE IT REMEMBERED, that I, HARRY L. MOYF,R, of 265 Key Nest Boulevard Carlisle, Pemrsylvarria, being of sound mind, memory and understanding, do wake, publish and declare this as and for my Last Will and Testament, hereby revoking and mak_~ng null and void any and a;l Wills and Testaments and writings in the nature thereof by me at and tune heretofore made. STEM 1: I direct that all my just debts and funeral expervses be paid Eis soon after my demise as may be convenient" i T~M~_ (give unto my daughter, llARI.A PTASZEK, the surn o~ Five Thousand Dollars ($5,000.00)_ IT ~ : I give unto my son, DANIEL MOVER, the sum of Five T~otisand llollars ~I ($5,000.00). ITF 1V~_4 I give unto my grandson, MITCHELL PTAS"LEK, the sum olf FSve Thousand Dollars ($5,000.00). -: I"TEM 5: All the rest, residue and remainder of my estate, of whatsc~evier nature and wheresoever situate, whether it be real, personal or mixed, including property o~er which I have i a power of appointment, I give, devise and bequeath unto my long time friend and companion, VIVLA.N L. WARNER. I"I'EM 6: I direct my hereinafter named Executrix to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estat~ ok the transfer of any property passing hereunder or otherwise passing by reason of my demise may be subject i and to charge such taxes against my residuary estate, it being my intention t#tat none of the aforesaid taxes,'cither federal or state, on any property required to be includ~d in my gross estate, under the provisions of any state or federal Iaw now in force or hereafter enacted, shall be proratu3 among the persons interested in my estate to whom such propet~jy is or may be transferred or to whom any benefit accrues. irl] -'J m ~~ ~ Q \ ~ ~ ~~ ~ ~ is tl ~ tU11 at W ~ ~ (~L~~ , ~ - " cab-` O o~U_~~ ~ ~ ~ ~ ~ r3~~ d T~ ~ O O A -O ~~m~~ ~~~~ ~ ~ ~- Page 7 of 3 1'TFM 7 I appoint VIVIAN L_ WARNER as Executrix of this ~iy Last Will ar~d Testament. Should VIVIAN L. WARNER predecease me, fail to qualifyy, cease to act or renounce probate, 1 then appoint my daughter, DAKLA I'TAS'I.F,K, as contrrigent Exet;utrix of this nrv Last Will and Testament. ITEM 8: I direct that my Executrix or her successor shill not be regt}ired to give bond for the faithful performance of their duties in any jurisdiction. I"TF: 9 _ My Personal Represc;ntntives shall have the following pov}ers in addition to those vested in them by Law and by other provisions of this, my Last Wil~ aid Testatnrnt, exercisable without court approval, and effective until distribution of all property: l _ To retain any or al] of the assets of my estate, real or perso ~, without restriction to investments authorized for Pennsylvania fid~iaries, as they from tune to time may deem proper, without regard to any'Iprincipal of diversification or risk. To invest in all forms of property without restrictio^ to in~{espnents authorized for Pennsylvania fiduciaries, as they from time io tirr~e may deem proper, without regard to any principal of diversificatio~r or risk. 3_ To sell at public or private sale, to exchange, or to lease for a~y period of time, any real or personal property and to give options l'or, sales, exchanges or leases, for such prices and upon such terms or conditions as they from time to time may deem proper. 4. To allocate receipts and expenses to principal or income or partly to each as they from time to time may deem proper. 5. To borrow money from persons or institutions, themselves included, and to mortgage or pledge any or all real or personal property as they in them sole discretion shall choose, without regard to the dispositive provisions of this instrument 6. To compromise any claim or controversy asserted by or ag~irtst my estate or trust estate. I 7. To make distribution in cash or in kind or partly in cash and'~aitly in kind, and in such manner as they may determine, and at valuations finally to be fixed by them. IN WITNESS WHEREOF, I have hereunto set my hand and seall~this 31" day of December, 2010. TNESS_ -. __~(SEAL) HARR L. M ~ R COMMONWEALTH OF PENNSYI.VANtA . SS COITN"I'Y OF YORK We, MARRY L. MOVER, JAN M. W1LEY, ES(1lJIKE ~rrd M. SUSAN McMICHAEL, the Testator and the witnesses respectively, whose nameslare signed to the attached or foregoing instrument, being first duly sworn, do hereby declare [b the undersigned ~~ authority that the "I estator signed and executed the instrument as his last W ll end Testament and that he had signed willingly (or willingly directed another to sign for ~rb), and that he i executed it as his free and voluntary act for the purposes therein expressed, d , teach of t ~e witnesses, in the presence and heazing of the Testator, signed this Last Will ~1 Testament as witness and that to the best of their knowledge the Testator was at t}~e time eiglr~keen (18) years of age or oldci, of sound mind and under uo constraint or undue influence. i C! --- --~ HARRY OY7H, ~.--~ ! _ _ y~_ }~ -NESS y i ~TNESS I Sworn to and subscribed before I me this 31" day of December, 2010. ,~ ti.T, 1 I f NOTARY PUBLIC MY COMMI5S10N EXPIRES: r_-~7,nworrr~xrri of ~NSnvavw r~oerri s.d ~ s- o~ c3ro~+.., ewwr ~ Ur,n,,,p solo, YoA oa+dr eonn+~on ~+.f ~~.2o~a .,,~, p,,,.~,._...~ ~._..~",.~... wins. I Page 3 of 3 SAFE DEPOSIT ~ ? BOX INVENTORY PA Oepartmenl of Revenue u~soa~il >;,,.E, ~~~ Sn~ ,E'r.~~i:~ty or Dcatl~, Cert~f.c<,te Number Date of Death ~ l ~ f ~ ~ °U `f ! ~~ ~~~z~ii PLEl15E USE ORIGINAL FORM ONLY ( ) ,nty (;ode Yeas - i~t Vnm )er Suft~x f i,.;t NafTl@ Oeceden;s, t as[ Name ~~~ ~ ® nlmRFSS of DFCF:nENT sTFll_~I - // ~ fJIU ~ -„y ~ ~ ~C~ ^/~~i~~ ~,Ta,E ~- ~ ~_ - _ _ ZF c~~;. _ __~ ~/ ~' . 2 4 5 ~ ~,~~ ~c ~ - -- - - _ - __ _ - _ _ __ ~ OPENING OF iHF G THE © NAME AND ADDRESS f PERSON REOUFSThN SAE( DE POSIT BOX / C NAME: ~ v ~ C~~ ~. L ~d?~( L~ ~ ,- _. - _ - -_ ._ _. - - - -- -- - - _ _ ~T _ PCC~D' ZI c f ---- - - -.. -.. __ _ Rtt T ADDRF S / ~y/ F ( Y /A c// ~ t/[.. - _ - - ._ OF PERS NT DE ~ ON(S) F'RE SENT AT TH~BOX OPk NIN G , . HIF' (IF ANY lU Df CE ~NAME ADDRESS AND F.TLATION __._ _ -- -- _ -- -- - a NAME _...-_ - - RF LL~IONSHI _ C<'; ;ERE-FT ADDRF`.>5; _ ~;IT>' ~ TF ~ _ b NAME` i - - - _ Rf LATIONSHIP -_-- -. - - - _.- - -- --- _ E ' -- _ _ Sl REL T ADDRESS ~ . ,. ~ r y ~T E T, r _ a C( D ZIF ~ ±~ - --- --- - ~ NAME _ RELATIONSHIP - __ -._ _._... __ __ - _ __. Cliy STATE ZIP CODE SiREFT ADDI ESS _ _- --- - --- - - NAME AND ADDRESS (>F T INANC IAt INSTITUTION NIHFRF THE SAFE DF.POSIT HOX IS L __. _. - Nnnn[ ~ ~ 1 ~ / ~~~ ~1 lC - ---- - _ _ _ _ S T RFE 1 ADDkE SS - - - _. - -- - - (;TTY- q STATE ~> IfP CODE , i~< ). -- - - 1 v AST EM RY F - - - - NAME OF PERSON MAKING EAST ENTRY ' DATE AIVD ME ii z 2 ~ . O -f ~ [,Z .. ~ 9~ ; ~-~ ~ V~ u ; ~ ~ (~ ~ r ter ~ _ - ~ ~~ - _ --- -- -- -- -- - - -- - --- -- -- - DAT E OF CON 1 ACT TO FZFNT BOX ~ NUMBER OF BOX - - - T tT LE UNDER WHICH BOX I ~- REOU ESTED ;GJv9 ~5 1 O SOX m NAME AND ADDRF S OF PERSON(S) HAVING ACC. __ ___ _ __ _. _ - _ _-. _ _ i ___ -_- - -- -- - ___ - ___ -__ _._ 3 NA~~ ~ ~f~C /J-/~C ~~ Gl ~~C~u l(~C ~ar~~ ~ h NANF_ c t/ r~, ~~i~ _ -- _ - L _ /C~~L C. L-1 _ -_~7 - - - ~ /1 _ -- STRf E t A ]DRESS STRFE? ~DDZE ~S ~ ~u Cn Y ~ S ATE ZIP CODi-_ CH Y ,_ SATE ZIP CO ~' - - - -- -- _ - n` I ®NAtJ't_ ANI1 TITLE OF-E-ivtF'I~7Y£F TAKING THE INVEN TOFZY r1•~~,~~7 „~~ (~•!.~>,~IX V ~ ~--~'~1u )C/ L f- ~~ - . - ----- - - -_-_._. ----- - - -.--- - _ _ _ --- - - I - - (- ~ If • es, a. Da n YES t. _ NO ~ WAS A WIEt IN 7HE BOX E ® te of will _ _ - _ -. _.. nal representative. if named in the will d Name vid address of perso NA. MI i` _ __.- --. ;ucE, I <<-55 TTY TAT- 'IPC c. Name and address of ,~tloniry- if any NAr`AE _ - _ _. _ _- --- _~ ~ IzE : F .A )~, ESS CI iv_ LjP S~~tJ~J'11:[)4E~ E~nr,[1(il;~+vnE{6 ri C7, / (\i 1 ~J~ t.F :::, I ~ SAF~_DEF~~SIT .BOX It~~l~I'~TO~Z`~ _ , - __ INSTRUCTIONS __---- _ -_ _ __ 1 r - __ ~~ (1) Cash kcport lolal only ~ (2) Stoc ks Est n de I ~~E r ~ common or preferre c F:ert+1iC'He warrant or o h ,;' + ~ r_;r,c +n bcx ~ uc k.; a+r r~ he d~- ignaled by name of cornp,ury, cr, +6r..ate number, date of cE rirf t~aie Warne in wh+ch st(r ~ ~ u~red, and number c share ~ and class of stock (3, Obliya[ions of U S_ Government. Number of itc>ms, date of +s;ue, lace ~~~h~r, + ~ ~ eti u~ wfuch req~>IrreF ancJ [ype of ownership_ ~ e ~antly hela pay.' is on. death, etc- (4) Bonds De +y rate by n me, amount, Sena! number, r~r other dr >fgnation c '. _+~ Fit ncJs; i (5) E3ank and Savings and Loan Passbooks- State name of depositor, nur b.,~ ,~' t+o~~k i=~st dale aGPear+~~q +n book- Warne of bank 1 i i a'~d branch and haiancc r6} Jewt icy. Coins, S?arnpS, Manuscripts, etc. Llst and descnbe as fully En >`,'~~ ,E. i (7) Deeds, Mortgages. Current Insurance Policies or other evidences of f~uie;btedness- L+st and des~iit+e as fully as posy e i ($) All other contents I (9) Return cornpieted town to' DEPAI{THEM OI REVENUE _ ~ ~~ . [3~~ ~~~rl C ~ ~'- I DEPT 78060' FiAFtRI`.;BURG. PA T717R 060' -- f I C M DESCRIPDON ITEM - -.-- _ ___ _ - - ~ 1 ~ <1 ~~ ~(f' / ~ L ~~`~7 ~' f /i'~CY~x! f~Ory f~ V' /+`G v] /~C~~'_ t'I-~,'/!C'f ~C(~/~-J L. ~' ,I Pr It -- - - -- ~( ~~- I ~c rr~ c~~ ~v~C ! _. __ - -- i - __ -- -_ _.-_ - -_.. _ _. - II i ~~{G.CI f t-C~ C'/~ ~~/ ~ I'-~,_. ~L-/I ~ ~~ ~ f V~.,~~ _ --_ _fjC.'1..~~L7~~I l (,~~~~-\., _ _-..- _ -~ f ~ _ 1 ! ~c ~~r f L-~ ~ ~1l/t ~cq uric P 1 S ~ _ ! ~ h ~~ ~ ,~~-~. t= 1-1,~~U_~ iZ~.~~~~~- __ -- ___ -- 7_ C. - - J - - ; _ - - ~/ ff -- ~- J __ _ - _ - I '~ . _ _ _ _ F -G _ - _ __ - ~ ___ - ____ ___ - - - _ } __ - , _ ~' -- - -L------ r FY UNDER PENAL rv OF PE R --- _ -- _ _ _ -- - ~ i _--- ---- _..__ -- JURY rHAT THE ABOVE RECORD IS 1 PERSON RECEIVING COPY O i TORY ~ CT AND ConnPt I rF TO r1aE BEST OF Y KNOwt_EDGE AND BF (-IEF I . _ _ _ __ SAFE DEPOSIT BOX INVEN ~j / /' i /i ~ ' ~ \ }OX 9E1 OW Pf21NT fJAME i+ND CHE C'R P~PR OPRIAi ~ ~'RiNT AMF= ` ` / _~ ____. __-__.__ -_ ._.. r_ _ -. UATF F}GX P PP R ___ _ - ~ OATF . O C`iFCK n. t'RIN~ i TLF . r -~ _l I ~ ~~/ I ' Ad r s. i10~(I I ~ ( -~ pr~ Idi f1` ~ f la __ _ _-- _-_ F _ _ - - _ I 8'1.~ addlt+on ach At NOTE R 9 ' P _-- -- ~ j ---- ry L of form. a neces s of to "' x 1 ~S the f E n c t ~ e o ' t c r 3 s 44~5(h(7)iC)G! or i a Fi; , ~ , Ir (+ i9 [ i ~ i Thr nn<.e.t.on~ ~ n, r l ec,E; .> ~oc s,~Fe Ten, s ~^_u ` + ~~~ e~ f ,. . r rr,, ~~! and erson 3i eoreq ntdliveS or [se esta+e i he C ah nnnweaiih may also us r,Ee .n n ~~~on xchanoF o as o _ P ` ~oc+ai 56~Uiu~J r u b ~!o >- ---- -. -__._ ruhiblsihE;; c ,mo~..,e I'h~+7er ~rn,.lirG'r ci_~:.nq ~nt~d?nh Ita.c.~fu,n, -.=°7~F `_+fP i r_pose aw -~ p + ~ I , "` _ ~ ~ ~ ~' ~9arch 18, 2011 l~he Wiley Group \ttn tan M Wiley Esq L~(i ~~' Church St Ste 101 I)illshurg PA 17019 f~rate of f1ARRY L'~1OYER 1)atc of Death: Jan 29, 201 I ESN: 207-30-6499 Dear SirliVladam: {)ne Citizens I?rive KOP112 kiverside, 1ZI 02915 In accordance with your request; the attached information sheet has been provided in ?he above: decedent's ~~ame as of his/her date of death. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667 ~lllCf're dim Badger--~ Decedent Account P~oc sing IZF,F#: 480532 -- - -_ -- --- - --- - - - - - 6100748197 !~(,COUnt Number -- -- -- - - -- -- - - --- IIARRY L MOVER/ VNIAN L Wf Account Title __ -- --- -- -- -_ Date Opened 4/5/ 1991 ---__ --- --- -- - -- --- -- -_ -- - -_ - - ~- C heck~ng -- -- - _- -- ----- ~ Account Type - . - - - -- -- ---- - -- $26901. Princ,rpal Balance a5 of DOD i - -~~ -_ - - -- - ~ --- - Interest from Last Posting to DOD -- - - _- --- - -- -- -- - -- ---- ~ - - -- -- - $26901.8 Account Balance as of DOl~ ---- -- - -- _ -__ _- -_ - 0 ~, YZ I) Interest to DOD ---- -_ ---_- ------ - -- - MBTF~~nk 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services The Wi1eY Group 130 W Church Street. Suite 101 Dillsburg, PA 17019 Re: Estate f ttam'--~' M-°yer Scc:u! S~curit__ y ~ ~~~' _3~-~'4g2011 Date ~f_Deat____1?-Janud~29 _----- Phone 888 -502 -4 ;49 Fax (302} 934-295 ;vlarch 21, 2011 rch 11, 2011, please be advised that at the time of death, the above-named decedent ha Dear Sir or Madam: Per your inquiry on Ma on deposit with this bank the following: Checking Account 1. TYPe ~fAccount 1226614 Arc~ount Number Harry Moyer Ownership (Names o~ Vrvian L Warner 08/10/94 Opening Date Balance nn Date of Death $1, 773.58 $ 00 Aa-n~ed Interest $1,773.58 7ora1 Safe Deposit Box Z 'T'ype of Account 74 /Carlisle Pike Box Numf~er/Locarion Harry Mover Ownership (Names o~ Vivian L Warner 08/04/99 Opening Date ther account information, closures and/or reimbursement of funds please call the Carlisle Yike Office at #717-795-1710. For fur We were unable to locate any safe deposit box for the above-mentioned decedent. not include any accounts in which the deceased may have been listed as Power of Attorne}', Custodian of uniform Transfers, This Ictter does ment Representative Payee. or "Trustee under a Written Aga'ee Sincerely_ •. Tammy Spencer Adjusunent Services .' ~~~`~- <<: ~~!/~~ :~ ~ ~~t ~__ <<~ ~~v ~~~~_ ~~ O c~~ ~? _ ,- ~-' ~ - - = l ~. ~~ _,_ --- t-- J =I_: ~' - L~C_ ~: W v s ~~ ~~~ 3u ~o 0 ,~, ~ ~ Q' o ;~ ~ ~- ~ ~ o ~ ~ ~ ~n .~ ~ ~ •~ x~o~