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HomeMy WebLinkAbout10-25-11a~ ~ ,,.~' 15056051058 REV-1 50o EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes "" - -- _ PO BOX 280601 INHERITANCE TAX RETURN 21 11 0591 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth _ 161-34-4356 ', 05/06/2011 03/28/1939 -- - ---- - - - - -- --- Decedent's Last Name Suffix Decedent's First Name MI ----- - -- Mood _ _ Wilberta E (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 Retum t.'` 2. Supplemental Retum ~1 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) w~:~ 6. Decedent Died Testate l 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 Ca '+ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number Name Lisa Marie Coyne, Esq. _ -_ (717) 737-0464 - ___ Firm Name (If Applicable) REGISTER O;F'yVILLS USE ONLY '?`~ ___ -~ _ Coyne & Coyne, P.C. ,- ~ ~7 "I `, -; _ I ? ,. ~ a - ~ _. , ; ` First line of address - -- - I .. -._ - - - - - -- -- ---- - ' , -~ , 3901 Market Street ~ -, _ . , , Second line of address - _._, ~ ~ '~ ---~ - -- - __ _ _ __ _ _-- I DATE FiLiD ' _, ` City or Post Office - 'jf.3 State ZIP Code Camp Hill PA 17011 Correspondent's e-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, sed on all information of which preparer has any knowledge. ti i b t ve s a a it is true, correct and complete. Declaration of preparer other than the personal represen G TURE OF PERSON RESPONSIBLE FOR FILING RETURN PATE Susan M. Roth 440 West Locust Lane, Nazareth PA 18064 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 L J 15056052059 REV-1500 EX Decedent's Social Security Number Wilberta E Mood 161-34-4356 Decedent's Name: __ RECAPITULATION 1 50,000.00 1. Real estate (Schedule A) . ........................................... . 2 0.00 2. ...................................... Stocks and Bonds (Schedule B) . . 3. Closel Held Cor oration, Partnershi or Sole-Pro rietorshi Schedule C Y P P P P( ) .... 3. . 0.00 4. Mortgages & Notes Receivable (Schedule D) ............................ . 4. 0.00 5. p P Y )....... Cash, Bank De osits & Miscellaneous Personal Pro ert (Schedule E 5. . 30,408.93 6. Jointly Owned Property (Schedule F) ~~r°' Separate Billing Requested ...... . 6. 0.00 7. on-Probate Property ansfers & Miscellaneous N nter-Vivos T 64 10 085 j I Separate Billing Requested....... Schedule G . 7. . , 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 90,494.57 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ................... .. 9. 20,767.89 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) .............. .. 10. 378.00 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 21,145.89 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 69,348.68 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 0 00 an election to tax has not been made (Schedule J) ...................... .. 13. . 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 69,348.68 _.._ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 _ 1 5. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable 10,119.92 17 1,214.39 at sibling rate X .12 18 . Amount of Line 14 taxable 59,263.04 18 8,889.46 at collateral rate X .15 19 10,099.74 19 . TAX DUE ...................................................... . ... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT -- 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Ilcrnrtanf°c ['_mm~lete Address: File Number 21 11 0591 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Wilberta E Mood 161-34-4356 - _- - _ - STREETADDRESS 105 South 15th Street - _- __ _ -. CITY i STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) _ 10,099.74 2. Credits/Payments 0.00 A. Spousal Poverty Credit __ _- - 000.00 10 , B. Prior Payments C. Discount 504.99 -- -- Total Credits (A+ B + C) (2) 10,504.99 3. InteresUPenalty if applicable 0.00 D. Interest E. Penalty - Total InterestlPenalty (D + E) (3) 0.00 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 4 . Fill in oval on Page 2, Line 20 to request a refund. (4) 405.25 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 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; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable 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? ........................................................................................................................ ^x ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (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 twelve (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. REV 150 EX+ (ll-0S) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Wilberta E. Mood 21-11-0591 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 is jointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. a. Settlement Statement (IHITD-I) ca,~ Apptov~ iso: 2592-0Q63 T f. [~FtiA 2 ~~ 3. ~Caar.E3~s. 4, ©VA s. ~ Cosy Ls. ` 5. FdeNaraber -- 7. fearNnne&r. - - - B_ MoetQr~ece,~set5anba: ~ - ~ C. Nt7CE: 'Chic farm is fm ro >e~ yon x stavaaea afacaaf s mss. Amannts pan[ m aed by Se agentffie s)wrn~ IDtASmabx! '(yoc.T' xnac poid outside d& ~: dxy aacs6orwr Batt tot iofamatinod paapoaGt aaal sae sot iedwled is theloraB. ~ D. NameXcAddnss~ ~5'~/ /~- ~ Armaud S. Apa ~j~, 735 ttedc it<7l Rood fewisbetzy,PA 17334 E.tW~edtAdd~ofSelfa{a~ Fsteec ul W'r+eFta iw D3ood ~ do Liar t.,vYrt, Figase ! 396IhM1artaSUeet 13 CaapR~,PA F. Name & Address of fender: lQiA ~ Cz Pcopaty foeation: t03 Sow PitlcwAh Saco[ CrapH11,PA t10It Place oT Sdtfement: 1320 K tad Street H. i~ of Sew A~ 6 kxdan iJ_ GaatiaBfirm Iiarrisburg,PA f7ItD ~# t. (2aaiu8 #3atc: 8-30-2Di2 Dis6ncxrant Dtva: 3-30~20tt ~5eMr4 TeawuetiM 1 00000 IOQ. Praaut '~- fQ3. w t400 ~3 403. ]04. ~. i(rs, iDS. f05, tmeer b A06 m O7_ t08. AaseasaYeots b 4tas. Asa~rs ~ 109. ~. t to. 4to: 1fi. ~ 41L 53 S3 1r 50 000 , ?AS :-arra~ Paid .r ha r4ehafF st trrrnwer ~. Rrd it Arawt Dae>M-Sk9cr 20t. 21f of~w s 502. Serffeamt bselta f400 4!9.72 203. s tdcer to 503- s io 304_ i 5(W.PayeH'aCSna-raatEageloor E 20s. ! 306. P'esroffo£secavtmrdgagahno i j( sob. sue. ao~. ~ sal. srfa. too. ~. i;, sits c~ m 21.1_ tam &s st.i_ taus tQ i sta. A ~ 2f3, ; St3_ 2t4, Sf4. 215. S 3. s 215, 315. t7 517. ; 2f8. SIE. 219. Sf9_ 228 T Pain 947 72 300. C 60k Gam at islTeea 5aller 301. Carats anaru dae loos Hoaowa S3 :83 501. ('nassmraat dneta seitcr 42D SO Q00.00 302. Lest saarots 320 btlki redretians is aaomt due se>3er ~ 447.72 305. From To vrtr 53 .tB Ya Fina Sere 44052.28 C'ER7iPICATlON : f h@vera~aSYterie+rad~IiEiD-f Seglemeaf aed ~/Lrbcst ofnyimoo*ledgeacailaelie[iris s ane and aooarMC statmnent of atf receipts serreats made ms acmoat orbs sac' z dris tra~ar. f father caRfy dra I vdfampyafthc~ft3.1 Sn ~. .~. ~ ~ - T si~trxe alSatmruer e~~ Side alt3oecrnarr of Sdkr She dSelkr 1 . ~-~ - t^a..... 700. tt.f 1tet F,~ fhnlaer r~ ~ Deed Fmm t~id l<m~ ltd ~, s soalo_0o ~ Borrowers Bailer's Ibvision ~ 700 ~ r:~ ~ ~~ at 70 . setuanae settlement 702 s to 743. Commission 'd at Settlement 704. 800. ftara is Coaaation witL Loan SOI.O~r GFE Yt} a02. Yaur ssedit ar rots for the "fic itderest rats chosen S ~ ~+~) 803, Yo+r la:G ' fee ro (frem f~E P3 845. to Kfioe~ (;d~E 1R) ao6. r,~ s to o1~ ~ 847. Flood cettlfiacstion t~ ctE as) sae. ' t~s. ~ so $1a. 8I3. 8I4. I rns Leaderta 1?aidia 90f.Dail iakreat 5ooe (OoaG'FErto) 911. m (Eton C,l~t tty 9113, sir~ce s to (tront~FE#t1y 904. 905. I IWI.LWiat 'for escmwaccount t~F~E~ (402. itasuan¢e s s 003, 1004. taxes ° mnWbs S month S 1006. atatdhs month S t00T, L 00 1101_ itk services Imula'c tide msarance KRom t1t~ w0 I IO . temera or fee 1143. flMwxr" s title i (lton fiFE #51 538.75 1104. irndor's tidy i S 1tO5.t I l06.Orvae~s title }mat S 0 imtnance 1 f08. thider~s ' s>f the total title is S f 09, Hoed - ' 11.10. Costs&rTNkSeech 21.00 11 I . B 20(1.00 f i Try 12(11. Govetrara~t CeftBiratiorr thwaGFE471 14.00 1242 DeodS 00 Rtleeses 50.00 1203. (Am t8+b#3I 1204. t7ead 500.00 S SOOAO ! os. rleetl 500.04 s s0o 40 (206. c~#s1 [302.201 taxes tit S ~ Z78.44 546.32 1343.201112012 School texts 167 S 18(13.44 1502.04 301.44 1304. Sewer- (54.00 50.00 100.04 1305, 1400. Total SetflarrntG3a eater on tiaea I SeGien J and St1 Section 3669.83 947.72 CERTIFICIITIQN : I Aeue tarefitlly H11fl-1 Sextleme~ ~an~tt a>rd to the b~ utmy knowkd8e ~d hie/l-iey£ it is a tree and acwralt t c+f all made on y account ar by mt " this t~ ir/` I rec ~ a Dopy of 1Le'HUD-1 nest mat t I,/,~l I Signatwe of Borrower SiBnanac of 8ormwer Sitmatate of Suer J SignsKUre of Setkr "Tfie HtJD-T Settleman Statement wkich i hrn prepraed is a (rut ~d accurate sccaAatt of the funds disMnsad cu m tre disbursed iw ttce nndersi~~ as pert of the settlaneat of this transataion. Signatiue of Settlement Ageu1 Ike Jl'~1~1~'" ~iitaiit~dbi~wt>a~was' ~rlEoiifr~~s~ aeila~+aus6ssdFsRsreeiptsame`[~amoraasa~tsagimernc~~r~r~iicai'satnaoctiar: t~iNiasml~aiNr ~moeivedewpyoFtirc'l~f1D-2 asatt'9imaawrti ' ~~~~_ `tltc HU@-1 Seiil+enw~ 9uve~saNF vdre~Yftrweit~tLLa~can+3e aE'~r tttwis~rs~tras~s€ te-bc ~bg fl-c ~13n1~r ~~ WARNING: }t is a cranelo -atowingiy make false statemems ro die flnited Stag on ttris or any oilier simt7ar form, Peaalti~ upon canvictim can inciude a fine imprisimmetrt. F~ ddaiis see- Tide t8 U.S. Code Searon 10~I and Section f O10. REV-1508 EX+ (6-98) r COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Wilberta E. Mood 21-11-0591 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. (If more space is needed, insert additional sheets of the same size) MEMBERS 1St FEDERAL CREDIT UNION REGULAR 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 Name of Joint Owner 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 Name of Joint Owner 109-00 06/01 /1950 $77.04 $.00 $77.04 None 109-40 02/07/1998' $7,955.37 $2.21 $7,957.58 None *Opened by a Transfer of Funds From the Regular Savings Account 109-00 )~ ,C, ` ~~ ~~~~~~ /(~ ~~_ . ~ 3 \ 2~1 1 M M ERS 1ST FEDERA CRED T NION ~l- ~~~- Danielle A. {filirre Lending Insurance Support Specialist June 2, 2011 '~~ ~~ Estate of: WILBERTA MOOD Date of Death: 05/06/2011 Social Security Number: 161-34-4356 5(1(1(1 T.nnlca Tlri~ra nn T2,.., nn -n,r,,,..ti,,.~.,...t__.._ T,_._.. ,.,,.~,. ........ ...... ---- < ;\ `\ ~\;` U~~ \~ ~, ~~ ~ ~~N ~~~~ -;'^\ ~ 'r 'd ~ ~ O ~ ~+ O L. ', ~ o ~ W ~ •~ ~..~1~~~ Ri 3 ~ a w Q w W A, F W Wd c4 W U d' x Q O H A U ~ ~ ~ ~ ~ b ~ o C0N C~ N ~ ~ U ~~ ~O o p 0 oa , ~: "o~ ~a:w ;; ~ 'b a A ~ ~ .a o a ~ z A A a w n C~ ~ ,b N ~ ~ .i O C~ ~ ~ ~ coo ~ ~ ao O ~ o ., ,x O M ~ N O A ~ d ti z ~ ~ ~ O Z ~ a ~ ,~ V A ~ iw L.' a~ U O r~ a A ~ o C ~ p J ~~ ~ Q ~ ,F o v ~~ O ~ ~' ~ b~ ~±' ~ ~ o _ ~ N ~ O w ~ ~ J Q ~' -w ~ -' p ~, c ,- _~ _ o ~+ C~, ~ v U Fa J ~r. O 7. ~ c -d o 0 W .II M O~ O~ M O N c~ O~ ~r N .~ Li 0 'd 0 0 W ~i U 0 0 U c~ a~ a'~-+ O 0 z M O M N v cd O U N N M N w a U ~ ~ F ~q+ U A ,:Q M&TBank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Coyne and Coyne PC 3901 Market Street Camp Hill, PA 17011 Re: Estate of Wilberta E Mood Social Security: 161-34-4356 Date of Death: May 6, 2011 Phone 888-502-43 `WSJ F ax (302) 934-2 June 6, 2011 L..~tii C ~~ r•~ I ca O rvC___- 0 ~- Jr Dear Sir or Madam: Per your inquiry on May 25, 2011, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 9846285246 Ownership (Names o, f) Wilberta E Mood Opening Date ; 04/17/08 Balance on Date of Death $9,907.04 Accrued Interest $ .07 Total $9,907.11 For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the West Shore Plaza Street Office at #717-731-1730. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement Sincerely, Tammy Spencer Adjustment Services REV-t51~1 EX+ (03-09j ~ Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Wilberta E. Mood 21-11-0591 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. ATTACH A COPY DF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE I. Western National Annuity (beneficiary is Zoe Buhosky, sister of decedent) -- 10,085.64 100 0.00 10,085.64 as of 3/31/11 TOTAL (Also enter on Line 7, Recapitulation) $ 10,085.64 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Wilberta E. Mood 21-11-0591 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Myers-Harner Funeral Home 6,355.00 2. Burial & Headstone Engraving 425.00 3. Honorarium 100.00 4. Reception 202.21 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) _ Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 8,000.00 3. Family Exemption: (If decedent's address is not the same as nlaimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 149.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 500.00 7. Appraisal of real estate 350.00 a. Patriot News --legal advertisement 116.45 9. Cumberland Law Journal -- legal advertisement 75.00 ~o. Inheritance Tax Return filing fee 15.00 i 1. Postage 88.00 i z. Total from Schedule H, page 2 4,391.73 TOTAL (Also enter on line 9, Recapitulation) $ 20,767.89 (If more space is needed, insert additional sheets of the same size) A B C D E 1 _ ESTATE OF WILBERTA E. MOOD _ _. _ 2 Estate No. 21-11-0591 _- ~ _ 3 _ 4 _ SCHEDULE H (Continued)• t- _ _ _ - 5 - _ _ -- ~ _ _ ~ _ g _ FUNERAL AND ADMINISTRATIVE COSTS, PAGE 2 - ~ -- - 7 'i _ ~ 8 Item No. _ Description I Amount 9 13 'Community Life Team EMS -- medical records _ __ - - - $29.64 __ 10 14 -_ I Harrisburg Police Department -- accident report - - -- ~ $15.00 -- 11 15 ~ Star Med -- medical records -- $92.37 12 16 Trash Removal Fee-- prepare real estato for sale _- - $50.00 13 17 ' ',Mileage for Executrix at $0.51/mile __ _ ~ - $320.00 14 l 8 ~ Cleaning supplies -- _ - - - I - ~ $50.00 - 15 19 I Settlement costs for sale of real estate _ _ - -- - ~ $947.72 __ 16 20 Dash Investigative Services - -_ - _ - - $327.00 _ 17 22 _ __ Mileage for Executrix at $0.51/mile - _ - - - - - $510.00 _ 18 23 ' Toll Calls for Executrix ~ 50.00 19 24 I _ Reserves ? $2,000.00 20 ~ _ 21 ~ TOTAL: __ - ,.__$4,391.73 22 REV-1512 EX+ (12-08) r ;; pennsylvania SCHEDULE I ~. DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Wilberta E. Mood 21-11-0591 ae~~~r debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses, If more space is needed, insert aggitionai snee[s or one same size. P,EV-1513 EX+ (tl 08) pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Wilberta E . Mood 21-11-0591 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. Susan M. Roth niece 100% of residual 2. Zoe Buhosky (beneficiary of Western National Annuity) sister 1085.64 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ ~ If more space is needed, insert additional sheets of the same size. .- L 1. K ~~~~ ~~ ~~ ~~:~~1 V ^ ,` l ~ti+ ~~ . .. ~~ f J A~ '-~4 1.,~~ i I Y P ~~r~~~C ~l~~ ~o ~~~~ ~ ~' j ~~ 'Y ~_~ ~_ T7 J ~- --;s ~ -j-3 .-ir _ __ _ r ~~ ~~ ~~ Y ~J _ I, WILBERTA E. MOOD of 105 South 15"' Street, Borough of Camp Hill, Cumberland County, Pennsylvania,. declare this to be my Last Will and revolve any will or codicil previously made by me. ITEM 1 Upon my demise, I direct that my body be cremated and my ashes be disposed of in accordance with the instructions I have provided to my Executrix. ITEM Z: I direct that my funeral expenses be paid as soon as practical after my death. ITEM 3: I direct that all taxes and interest and penalties thereon that may be assessed in ~. ^~ Q Ls O ~ ~ consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my Estate. ITEM 4: I give, devise and bequeath TWO THOUSAND DOLLARS ($2,OOO.Ofl) to the Helen Krause Animal Shelter, Dillsburg, Pennsylvania, or its successor, a "no-kill" charitable animal care facility provided that the Helen Krause Animal Shelter shall take possession and care of my cats so that. the natural lives of my cats shall be preserved. Should Helen Krause Animal Shelter no longer hold the status of a "no.-kill" animal shelter, I direct my personal representative to donate my eats, to another "no-kill" charitable .animal care organization which will insure that the natural lives of my cats shall be Page 1 of 7 preserved and that charitable animal shelter shall be given TWO THOUSAND DOLLARS ($2,000.00) for the care of my cats. Should I no longer have eats at the time of my death, this bequest will abate. ITEM 5: I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wheresoever situate, together with insurance thereon, to my niece, SUSAN ROTH of 440 West Locust Lane, Nazareth, Pennsylvania 18064, providing she survives me by thirty (3 0) days. ITEM 6: Should my niece, Susan Roth, predecease me or fail to survive my death by tlZirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate of every natL~re and wheresoever situate, together with insurance thereon, to my niece, ZOE CARUSO of 4098 Windy Road, Orefield, Pennsylvania 18069, per stirpes. ITEM 7: My Executrix or her successors shall have the following powers in addition to those given by law to be exercised by her ul her absolute discretion, which powers shall be applicable to all property 11e1d by her, effective without the order of any court and until the actual distribution of all such property: a. To retain any investments at discretion including stock of any corporate fiduciary hereunder or of a holding company controlling it; b. To invest and reinvest in the executrix's discretion as permitted under Act 28 of 1999, as C W ~~ ~~ amended, the "Prudent Investor Act," with the specific right to invest in stocks, bonds and real estate, including non-income producing .residential real estate for Elie occupancy of any present income beneficiary or beneficiaries, and in such diversified, proprietary money market and mutual funds, including such mutual funds of any corporate fiduciary hereunder or those of any successor or affiliated corporation or a holding company controlling it, as my executrix deems appropriate; c. To sell, to grant options for the sale of, or otherwise convert any real or personal property or interest therein, at public or private sale, for such prices, at such time, in such manner and Page 2 of 7 r . upon such terms as they may think proper, and tq execute and deliver good and sufficient conveyances, assignments and transfers thereof without liability of any purchaser to see to the application of the purchase money; d. To borrow money and to secure the repayment thereof by mortgage of real or personal property, pledge of investments or otherwise, Without liability on the part of the lenders to see to the application thereof; e. To comeromse claims by or against my estate or any trust created hereunder; f, To allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries or trusts, in cash or in kind, or partly in each; g. To register investments in the naive of a nominee or to hold the same unregistered in such form that they will pass by delivery; h. To join in any recapitalization, merger, reorganization or voting trust plan affecting isYVestments.; to deposit securities under agreement; to subscribe for stock and bond privileges; and generally to exercise all rights of security holders; i. To manage, operate, repair, alter or improve real estate or other property, and to lease real estate and other property upon such terms and for such period as my executrix deems advisable even for more than five (5) years and beyond the duration of any trust; j. To deduct administration expenses upon either the federal estate tax return or fiduciary . ~ income tax return with or without adjustment as between principal and income, as my .corporate or ,- ~ disinterested executrix shall determine; k. To associate with them in the absence of a corporate fiduciary, an accountant, custodian ~_ -~~ and investment advisor, and other agents and to compensate them from principal or income or both, as ~~ my executrix shall determine, such compensation to be a reduction of the compensation of my executrix; Page 3 of 7 1. To associate with her at any time, in her absolute discretion and of her choice, a corporate fiduciary which shall have the same powers as my executrix, such designation by my executrix and acceptance by a corporate fiduciary to be in writing; in. To combine, without prior court approval, any trust herein with any other trust with substantially similar provisions, although such other trust may have been,ereated by separate instruments and by different persons, and, if necessary to protect different future interests, to value the assets at the time of such combination and to record the proportionate interest of each separate trust in the combined fund; provided however, that no such combination shall be permitted if the effect of such combination would be (1) to violate the applicable rule against perpetuities; (2) to disqualify any interest in one or more. of such trusts for a deduction for federal estate tax purposes which would otherwise be allowable; or (3) to cause the loss of the exempt status of one or more of such trusts from the imposition of the generation-skipping tax; n. To exercise any stock options which they may receive; to. borrow such funds from any f~ source as my executrix may deem necessary for the exercise of such options; and to pledge assets as my executrix deems appropriate for this purpose; o. No trustee shall be required to qualify before, be appointed by, or, in the absence of a breach of trust, account to any court '(and failure to account alone shall not be considered such a breach); nor shall trustee b.e required to obtain the order or approval of any court in the exercise of any power or decision granted hereunder; p. To allocate any generation-skipping transfer tax exemption from the federal generation- skipping transfer tax to any property to which I am deemed the transferor wader the provisions of Section Page 4 of 7 ~~ r~+~1\1 4"- .~J 2652(x) of the Internal Revenue Code of 1986 and its .successors, including any property transferred . under my will and any property not in my probate. estate and any property transferred by me during life as to which.no allocation was made prior to my death, to the extent necessary to cause the inclusion ratios applicable to such transfers to be zero; q. To disclaim any interest in property without court approval; and r. To do all other acts and things necessary or appropriate , in the management, administration and distribution of my estate or trust. ITEM 8: Tn the event any legatee or devisee named in this will dies under such circumstances that there is not sufficient evidence to determineabsolutely where such legatee or devisee survived me, I direct such legatee. or devisee shall be presumed to have predeceased me and devise and bequeath the giff in-favor of that legatee or devisee.to such persons and in such manner and in such proportions as set forth in this will for distribution if the legatee or devisee predeceased me. ITEM 9: Until distributed, no gift or beneficial interest shall be subject to anticipat;.on or ~ voluntary or involuntary alienation. ITEM 10: I appoint my niece, SUSAN ROTH, Executrix of this my Last Will. Should my niece, STJSAN BOTH fail to qualify or ceases to act for any reason as my Executrix, I appoint my niece, ZOE CARUSO, alternate Executrix of this my Last Will. ITEM 11: I direct that my personal representative or her successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. Page 5 of 7 IN WITNESS WI~REOF, I have hereunto set my hand and seal to this, my Last Will and Testament; this_ day of ~ ~ ~~1~ , , 2009. BERTA E. MOOD ~ Signed, sealed, published and declared by the above-named Testatrix as and for her Last Wi11 and Testament in our presence, who, at her request; in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. " r f ~/ ~ ~lS~ur~ residing at ~~'P~.~r~.~."'t:~ ~ ~1 i ~:~5 r ~r ~~ ~~, ~`,r+~'~-'n"-ih. residing at ~J ~ ~ ~i~ ~ Page 6 of 7 4' t ~ ., „ a COMMONWEALTH OF PENNSYLVANIA ) ) ss: COUNTY OF CUiVIBERLAND ) We, WII,BERTA E. MOOD, ~S;z~ /~'1~ft ~~ ~ , and ~~ ~ m.~v ,the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and valuntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witness and that to the best of his or her knowledge,: the Testatrix was at the time eighteen (18) years or older, of sound mind and under no constraint or undue influence. ~- Witness Subscribed, sworn and aclmowledged before me ~ ~~ ~~ by WILBERTA E. MOOD, the Testatrix, and subscribed and sworn to before me by ZL~:~ ~'t~tz•1'-~' ~za,.~ ~ and ~ r • L ,the witnesses, this _~2 day of ~~'~ ;~ -~ , 2009. Notary Public ~, (SEAL) ~t"OM1AD11 ' ~xu-~ aF-:~t~KltiYtYANrw. NO'TA.R~At SE..Al: ti~nry E. :Gaye;'Ncisry Pi~blit. Page 7 of 7 • Hsmpde~?awnst~ip, CumOertsnd Covni ` Iii1X.~COrtffS'ti~siort fxpires.lut~e 7 x, 2Qt~2-