HomeMy WebLinkAbout10-27-11T ~
150561D1D1
REV-1500 ex~°1.1°'
OFFICIAL USE ONLY
PA Department of Revenue pennsytvartia
oE...,.,F,.o..~,.~E Coun
Bureau of Individual Taxes ty Code Year File Number
PO Box ~8o6oi INHERITANCE TAX RETURN -
Harrisbura, PA 17128-0601 RESIDENT DECEDENT a f Zi ~~4 ~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
~ 7 o"Z - a y _ ~~~7 01/28/2011 09/09/1930
Decedent's Last Name Suffix Decedent's First Name MI
:Keener John
E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Keener Patricia _ _ S.
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return
O 4. Limited Estate
~ 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
O 2. Supplemental Return
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
O 10. ,Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
O 3. Remainder Return (date of death
prior to 12-13-82)
O 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
O 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
~uKKtJNUNDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Andrew C. Sheely, Esquire 717-697-7050
First line of address
127 South Market Street
Second line of address _ _ __
P.O. Box 95
City or Post Office State ZIP Code
Mechanicsburg ; PA 17055
REGISTER OF 1191 USE ONLY,
_.
-r-%'~ -
ri ~
~._
--~
DATE FILED -
- -=;
,~
~.._ -
^T?
Correspondent's a-mail address:andrewc.sheely@verizon.net
Under penalties of pe ury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct an mplete. Declara ' n of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF SO P LE OR FILING RETURN ~,T
7a~ll
AnnRFSC
Paul A. Keener, Co- cutor, 225 Ridge Road, Millerstown, PA 17062
SIGNAT OF P~2E ER HAN REPRESENTATIVE -
~.~LG~'!-~ L X - ~~~ ~ /~c~y C~
pnr5afcc
Andrew C. Sheely, Esqulre, 127 South Market Street, P.O. Box 95, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY -
1505610101
Side 1
1505610101 J
J 1505610105
REV-1500 EX
Decedent's Social', Security Number
Decedents Name: K2@n2r, John E ~ ~~ -,~ Z,r! -r C ~~ 7
RE CAPITULATION
1. Real Estate (Schedule A) ........................................... .. 1. $370,000.00
2. Stocks and Bonds (Schedule B) ..................................... .. 2. $709.875.50
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. $230,894.81.
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested....... . '7.
8. Total Gross Assets {total Lines 1 through 7) ............................ . 8. $1,310,770.31
9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. 61,963.78
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. . 10. 24,745.26
11. Total Deductions (total Lines 9 and 10) ................................ . 11. ' 86,709.04
12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12.
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. 1,224,061.27
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers und~~ sec. 9116
(a)(1.2) X .00 $612,030.63 15. 0.00
16. Amount of Line 14 +~~>ble
at lineal rate x .045 $612,030.63 16. $27,541.37
17. Amount of Line 14 taxable
at sibling rate X .12 17
18. Amount of Line 14 taxable - -
at collateral rate X .15 18.
19. TAX DUE ........................................................ . 19. $27,541.37..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~
Side 2
1505610105 1505610105 J
REV-1500 E~ Page 3 File Number
Decedent's Complete Address: a ~ " ~~' 4! ~ l
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) $27,541.37
2. Credits/Payments _
A. Prior Payments $23,000.00
B. Discount $1,210.49_
Total Credits (A+ B) (2) $24,210.49
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. -
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $3,330.88
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 ..........................................................................................
. ^ Ir~1
.
............................
d. receive the promise for life of either payments, benefits or care? .................................................................... ..
.. ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................
3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ............ .. ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ............................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116(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.
COMMONWEALTH OF PENNSYLVANIA
~ DEPAPh'MENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-961
NO. CD 014353
DUPLICATE
KEENER PAUL A III
225 RIDGE ROAD
MILLERSTOWN, PA 17062
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
--- fold
ESTATE INFORMATION: ssN: 172-24-sss7
FILE NUMBER: 211 1-0191
DECEDENT NAME: KEENER JOHN E'
DATE OF PAYMENT: 04/25/201 1
POSTMARK DATE: 04/25/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 01 /28/201 1
REMARKS:
SEAL
CHECK#111
10 ~ 523,000.00
TOTAL AMOUNT PAID:
INITIALS: DB
RECEIVED BY:
5 23, 000.00
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
REV-15~ 2 EX+ (11-D8)
~ Pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
tsrnre of FILE NUMBER
John E. Keener 21-11-0191
~~~ reap prvperry ownea solely or as a tenant m 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.
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 • Decedent's property located at 43 Texaco Road, Silver Spring Township, Cumberland County,
Pennsvlvania.17050. Tax Parcel #38-08-0567-009
Per appraisal by Allen R. Peffer, Peffer Appraisal Services $235, 000.00
2~ Decedent's property located at Lot 12, Keener Drive, Silver Spring Township, Cumberland
County. Pennsylvania. 17050. Tax Parcel #38-08-0567-151
Per appraisal by Allen R. Peffer, Peffer Appraisal Services $135,000.00
TOTAL (Also enter on Line 1, Recapitulation.) I $ 370,000.00
If more space is needed, insert additional sheets of the same size.
Coed R~eaidenda~l Dwelling
Effective Date: March 24, 2011 (Inspection Date)
Prepared For
Andrew C. Sheely, Attorney at Law
127 South Market Street,
Mechanicsburg, PA 17055
~~ B1l
Peffer Appraisal Services
Allen R. Pier
829 Meadow lane
CaenP Mi, PA 17011
Estate of 3oim E. Keener
43 Texaco Road
Silver Spring Township, Cumberland County, PA
' ' Peffer A sisal Se~i~
P
Real Estate Valuatia~ do ~ Allen R. Peffer
April 19, 2011
Andrew C. Sheely, Esquire
Attorney at Law
127 South Market Street
Mechanicsburg, PA 17055
RE: Estate of John E. Keener
Converted Residential Dwelling
43 Texaco Road
Silver Spring Township, Cumberland County, PA
Dear Mr. Sheely
_ I am pleased to present the attached report of my appraisal of the referenced real estate
as of the effective date identified in the attached report. The report sets forth my opinion of
market value, along with supporting data and reasoning, which form the basis of my opinion.
The value opinion is qualified by certain definitions, limiting conditions, and certifications,
which are set forth in this report. This report was prepared for and only intended for use for
estate settlement purposes and/or for possible sale of the subject property. The Estate of John
E. Keener is considered to be the client for this appraisal. It may not be distributed to or relied
upon by other persons or entities without my written permission.
_ As a result of my analysis, I have formed an opinion that the market value as defined in
the report, subject to the definitions, certifications, extraordinary assumptions, hypothetical
conditions and limiting conditions set forth in the attached report, as of the effective date(s)
identified in the report, is:
* * *TWO HUNDRED AND THIRTY FIVE THOUSAND DOLLARS
($235,000)
Respectfully submitted,
Peffer Appraisal Services
Allen R. Peffer
PA Certified General Real Estaibe Appraeer
PA GA 001646-L
^
Peffer Appraisal Services
Summary I Report
Of
Vaca~rt Unimproved Land
Estate of john E. Keener
Lot #12, Keener Drive
Silver Spring Township, Cumberland County, PA
i
i
i
i
i
i
r
r
r
r
Prepared For
Andrew C. Sheely, Attorney at Law
127 South Market Street,
Mechanicsburg, PA 17055
Prepared By
Peffer Appraisal Services
Allen R. Peffer
829 Meadow Lane
Camp Hill, PA 17011
n
Effective Date: March 24, 2011 (Inspection Date)
Peffer Appraisal 5ervic~es
Real Estate Valuation & A Allen R. Peffer
April 8, 2011
Andrew C. Sheely, Esquire
Attorney at Law
127 South Market Street
Mechanicsburg, PA 17055
RE: Estate of John E. Keener
Vacant Unimproved Land - 3.85 Acres
Lot # 12, Keener Drive
Silver Spring Township, Cumberland County, PA
Dear Mr. Sheely
I am pleased to present the attached report of my appraisal of the referenced real estate
as of the effective date identified in the attached report. The report sets forth my opinion of
market value, along with supporting data and reasoning, which form the basis of my opinion.
The value opinion is qualified by certain definitions, limiting conditions, and certifications,
which are set forth in this report. This report was prepared for and only intended for use for
estate settlement purposes and/or for possible sale of the subject property. The Estate of John
E. Keener is considered to be the client for this appraisal. It may not be distributed to or relied
upon by other persons or entities without my written permission.
As a result of my analysis, I have formed an opinion that the market value as defined in
the report, subject to the definitions, certifications, extraordinary assumptions, hypothetical
conditions and limiting conditions set forth in the attached report, as of the effective date(s)
identified in the report, is:
~~***
* * * ONE HUNDRED AND THIRTY FIVE THOUSAND DOL
($135,000)
Respectfully submitted,
Peffer/AQppraisal Servi s
Allen R. Peffer
PA Certified General Real Estate Appraiser PA GA 001646-L
Peffer Appraisal Services
REV•1~503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDIJLE B
STOCKS & BONDS
FST4TF AF
John E. Keener
FILE NUMBER
21-11-0191
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)
' ~ FinancialNetwork- rlnanclal Netvrork
Investment Corporation
(~aCETra~COMPINT Member SlPC
Z00 N. Sepulveda i31vd„ Suite 1300
EI Segundo, CA 90245-SG72 ~ 310.3?6.3100
000906 XP420101
S
ORRSTOWN
FINANCIAL ADVISORS
A Tiwtirion of ExceUerue
April 1, 2011
JOHN E KEENER
29 SKYLINE DR
MECHANICSBURG PA 17050-1751
IIIII~IIi~I~ilI~lll~lalillil~ilil~I~~I~~i~rl~llaai~illa~Ilalana
Transfer of Assets
Account Numbcr: ~4N2-XXXX28
Financial Consultant Number: 26V
ROBERT RUSSOLI
Based on your instruction, we have transferred the following assets from your above-referenced account as
follows:
Date March 31, 2011
Amount(s): $588.81 to 4N2-XXXX60
Asset(s): 1,575.00000 shares of ORRSTOWN FINL SVCS to 4N2-XXXX60
Tax Lot Disposition Method: FIRST IN FIRST OUT
FINANCIAL NETWORK provides this notice to you as added security in the event that you did not authorize the
transaction or details regarding the transfer are incorrect.
Please contact us at the above address or telephone number with any questions that you may have regarding this
transaction.
The tax lot disposition method you have chosen was used for this transaMion. Tax lots have been selected and disposed ol'in accordance with This method. Por
specific information on the lots used with this transaction, please contact your Financial Consultant.
Tax lot information will only be displayed for partial dispositions. For full dispositions, all the available tax lots will be disposed ol~with the transaction.
to
m
0
0
0
eti
0
0
N
d~
a
>a
0
o,
0
0
0
C,earbalhrouah PersNng LLC, a suasiaiary ~J+
DI The Bank of New York Mtlbn Corparatbn QQ±
Pershrtlg lL~, me.~nxr ={NpP, N~~c, $IPI.
Orrstown Financial Services Inc, ORRF Historical Quote - (NASDAQ Capit...ket) ORRF, Orrstown Financial Services Inc Stock Price - BigCharts.com 4/25/11 12:03 PM
More Enter Keyword(s) ___ _s=artcH
IrAi:7~'S~•
~~
t
~Q Q
I~+I~tt-r,~lra ca. tiaz r at.az
~ 'v' orrf.. _..... ..._.._.~
Home Quotes News Industries Markets Historical quotes aigRaports
Tnis Histodwl Quotes tool albws you to look up a security's exad dosing price.
Simply type in the symbol and a historicel date to view a quote and mini chart for that sacuriy.
~r'~ Enter Symbol ;orrf EnterDate 1!28!11
.._°.~~r<~rr finan;:ial Senricas tnr.
- ... 26.44
2?.37
Z?,7i
28.P4
1k,585
PJfl Splits
a ._ r r a
Sponsored Links
91°/d Accurate Stock System
No Guessing - No Hunches - No Missed Trends... EVER! Leam More!
uvv:. MarketTr=_ncSo`twarexdm
Free Penny Stock Alerts
Join our 100% Free Newsletter & get our next big winner!
vn»:'. Perny5tockGains.com
500°h Stock Gains
We research 100's of stocks and email you the best. Sign up for free.
wvnv. Th aHOlPErry$(ccks. coin
Top 3 Daily Penny Stocks
Get the top penny stocks moving each moming so you can profit.
http~!;wvnv pennyinvestcom
Get started with a broker
~~I{.~_, rlil ,~ ~I ~ III ,.._
a
Scottrade: E7 Trades, 30-Day Guarantee. Trade with Fidelity Why Pay Mora? Switch 30-Day Guarantee.
Fast 6ceculions Clicc Hera. to OptionsHouse. Click Here.
Home I Ahout I Job Oooottunnies I Corroct Us I Feedback I Helo
Copyrght 2011 MarketVYatch, Inc. All rights reserved.
By using thrs sRe, you agree to the Terms of Use and Pirvacv Policy (updated 4/8/08).
Intraday Data provitletl b1' Thomson Reuters and subject to terms of use.
Historical antl current end-o/Coy data provided by Thomson Reuters. Intraday data tlelayM per exchange requirements. Dow ,ones Indexes (SM) from Dow Jones 8
Company, Inc. All quotes are in lop! exMange time. Real ame last sale data provided by NASDAQ.
More information on NASDAQ traded symbols antl their current financial status.
Inbatlay tlafa delayed 15 minutes for Nasdaq, and 20 minutes for oNer exchanges.
Dow Jones IrxlexesSM from Dow Jones 8 Company, Inc.
BEHK int20ay data rs provided by Thomson Reuters antl s at least 80-minutes delayed.
All quotes are In local exchange time.
http://bigcharts.marketwatch.com/historical/default.asp?symb=orrf&closeDate=1%2F28%2F11&x=38&y=26 Page 1 of 1
Name of Company Number of Shares High Low Avg. Value
ACCENTURE PLC 590 52.47 51.38 51.93 30,638.70
(ACN)
AFLAC INC. 500 58.70 56.72 57.71 28,855.00
(AFL)
ALCOA 1,900 16.55 16.00 16.28 30,9:32.00
(~)
BECTON DICKINSON
& CO (BDX) 320 83.95 82.41 83.18 $26,617.60
CHEVRON
CORPORATION 300 94.85 92.83 93.84 $28,152.00
(CVX)
CLOROX COMPANY 370 64.42 63.60 64.01 $23,683.70
(CLX)
CONOCOPHILLIPS 400 71.61 69.86 70.74 $28,296.00
(COP)
COSTCO WHSL CORP
NEW COM 390 73.58 71.75 72.67 $28,341.30
(COST)
EXXON MOBIL CORP 300 79.89 78.87 79.38 $23,814.00
(XOM)
GENL DYNAMICS
CORP COM (GD) 300 76.20 73.85 75.03 $22,509.00
HARRIS CORP DEL 530 48.52 45.96 47.24 $25,037.20
(HRS)
HARSCO 1,000 32.92 31.44 32.18 $32,180.00
(HSC)
INTERNATIONAL
BUSINESS MACHINE
CORP (IBM) 175 161.92 158.67 160.30 $28,052.50
JOHNSON & JOHNSON 380 61.00 60.00 60.50 $22,990.00
(~~
Name of CompanX Number of Shares High Low Av~ Value
•
NEW JERSEY
RES. CORP 650 42.98 42.05 42.52 $27,638.00
~~)
NORFOLK
SOUTHERN CORP 435 62.50 60.22 61.36 $26,691.60
(NSC)
NOVARTIS AG
SPON ADR 440 56.33 55.63 55.98 $24,631.20
(NVS)
PENN NATL
GAMING, INC. 1,000 37.46 36.16 36.81 $36,810.00
(PENN)
POLARIS INDS
INC (PII) 530 75.97 74.50 75.24 $39,877.20
SCANA CORP
COM (SCG) 680 42.77 42.02 42.40 $28,832.00
SOUTHERN
COPPER CORP 600 44.97 43.60 44.29 $26,574.00
(SCCO)
SYSCO
CORPORATION
(SYY) 825 29.72 29.08 58.80 $48,510.00
VERIZON 775 36.39 35.58 35.99 $27,892.25
TOTAL $667,555.25
2
REV-15;)8 EX+ (6-98) ~
~~ SCI~IEDIJLE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John E. Keener 21-11-0191
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. Decedent's personal property appraised by Chuck Bricker, Auctioneer $26,955.00
2. West Shore Investment Club -Check #501 $4,164.30
3. Orrstown Bank -cash in brokerage account #4N2-790282 $588.81
4. Wells Fargo Account #3531-2286, cash account -date of death value $1,087.78
5. Bank of America checking account #0000 8946 4133 $928.60
6. Orrstown Bank checking account #111000275 $180,538.13
7. Vehicle - 2004 Ford 150 truck, VIN 2FTRF17214CA88574 $8,500.00
8. Vehicle - 2000 Jaguar, VIN SAJDA24C6YLF07451 $8,000.00
9. Health insurance refunds $132.19
TOTAL (Also enter on line 5, Recapitulation) $ I 230,894.81
(If more space is needed, insert additional sheets of the same size)
APPRAISAL
Personal Property of ~p ~ ~ K, ~~N ~~ CS i ~-7~ r~X /-} c. U f2c,1. M ~CGjB 9 /~~}, 17t^s ~
Appraised by Chuck E. Bricker AU094-L Date ~ - > ~-- ~/
ITEM VALUE ITEM VALUE
~ C ~ ~5 .3 ~, u o ~a ,~' , ~E u~ s~2 l3~ c a
d ~'/G E ,C3 i~i2E~} ~ D, a~ /R cDi`rP,~2~5 0 ~U, c~ b
LL ~/U . C ~ ~C/ ER Q () D C( E A. ~r GL
M~ d- s; tid 2U, a~ s(~OP ~ ~vr /G,Gu
z ~ lZ t` G L E v D U .T(M ~ (rE.s ~ t, o
c l E r Lu Rht~ ~~,
G/~/~~5 C~c ifFs /ZC=~ ~ od
`3;Gt3 ~,5 ,P, ~ i r~ ~a/`-t P,
~ U,U~i; ~~U P~~ ~'F ftE 7~R_ 1 ~"p, ad
~L,Uc
S/~J ~ s F~ UG,oy ~ 9~t2~;~ r r ~ c ~uET ~,5',d v
P ,U~ c / ~ ~5 0~ ,B d-D, ~NCGf C- 2 d E2 ./ C Q
y ~~w~ /~ ~~
LET ~ Gv Kd o,~3E I U,au
G,at% ft' iE 2Y DrZIL~--
S K SZ tills
G, ~o
o~
LE ~ /titer D o 5E 2s ~ c~ ~ w-/,~}s~ 7~ocs ~ fi,c~
C'° ~R`%~ ~~N~ElZ U,G~ 3 r/YcP T GKS ,3C,i~
~~~' ~T 2v, o a d S. LL' ,uc~/Es ~U, c b
s U~
LlJ~ /~ K-1-/ N T /S/'f' /7 O v it/T
Lv'U~cQ D LfCf~ 5" ~ t?~
I Jam, ~ ~
31J, 0 V ts- y JCL- 811x lit/SDC(~t=TS
`' !~/SE -
~- { TC.cJ S c% ~G,Gd
3~ O b
~(~,G G
SM/~-~ / /R co,c,,
fJT/ L /r~ ~tiEr D ~~
v a~ ~ u5 c~fi~~ti~s
~ G s ~ tis ~; ~~;
S, La
~GJ~ / c ,U ~ S K
c ~ ~ /'~
` ~
L, L $S G L'~ ~U N G ~NEr
UST ~2 R / ~ L ~ GU 5 5 Li Ny 1 D uU
/r7 6C
dJ
(j (}j~
S~D ~U ~ ~ < v~y ~ dE
C -GL X17,5
C mss: ER
SS (, tiJi~L~NCI(LC5- PLIL~hS -f3iTS
~ M%l ~` s ~ c 5.
1 U. ~v
5,t~~
G OC
lt/E r'N y / C SI-~uT U,U gGO~ ~~ R ~ ElliCU;sEd % ~ aC. L+
GvH/If R~/N i /Slf /~JGu,v7 !60 ~n ' lc.'M Z,~1/LFi2 d ~u ~ GO~t
~ ~r/~OL~<N9 Tf9-~GES - /~C Dc t~ J L-< R/ EE12E ~7~0 O/Esc=L `tycl.
,I~SS UJ~' SN LU;M , Lt' CLO KES 0 T/ T~(Z Gv F(Lo>/~ ~-U E /
STEP ~d k
~ 4VS~ C- tC~L G6 ~ L; ~P~~~cS L ~.,J55
S ELF vti ~ rs ~ O Gm Cllr ~ ~,~.~.~, ..~--
~ ~. v z%~ N / cvt-t
~ G ca S'lyify ~`~ SSc,t, 3S7 M/~-~: R E vu~~~i~ ~'~.'~L. Gc
3
ti°DEEkE ~ .P ~'`cv1 ~t~~ ~ 0 ~b l~~ ~R ~~~~~L,/-~~tlc~v~~2, ''~ :~~~
j6h/,l,',(~EE12E p/ESE~ ` ZERO MU(.c)El~ 00,00 .~c1''ct ~~N 2' J0 -I/ v..S ~57i, ~~
Page 2 of 4
t Period
8~~-'tI t'Ih OQ>Il
B iYl 8 H P PEI 10
Atutt~bsr arf` checks. en
Accou~ Aber: 06a
JOrHN E
~3~. ~ - _ _ '
'~' ~ ~ 1 ,.
..:
Accormt Neer ~" 4I~3
Be ' dale o~'~-~v-Il $ 1,O~SS:60
C Posted - i40.(i0
Service Charges and Other Fees - 18.00 .
Eading Balaace on 02-11-i1 ~ 95.60
-.,
- :. .. .. _ _ ..:
Date ~~
Posted Amo~-t{~) ~._~
01-24 i4@~=_ ,_ _ ~ -, ~ -
-; ,~
960 C3~ekc i -.
02-11 3.~- ;; .
943 6`~ ' ~he~~ ~ Fee - .
02-11 ~5.t~0- 928.6b' Mommy ~i_Pee _
Check # Paski~ e
_ - - - ,..
;:.: .
1389 01-~ 140.00
-.
':~ _
~~ i .
_
Date ~Iattce~ . ~:. _
,.. _._. _. .,.w.-_ -_..
__.;;. ."fie ..._ $a~an _ __
Beginning 1,0~6i.60 4i-2~ 945:60 02-i1 928:60
' QRRSTOWNBANK
A Tra~kkon of Excellence
Date 2/25/11
Primary Account
Enclosures
John E Keener
29 Skyline Dr
Mechanicsburg PA 17050
N
C7
O
0
N
N
O
.-a
N
N
O
O
ti
O
O
N
t~7
O
O
O
O
50+ Interest Checking Image 111000275 (Continued)
--- CHECK SUMMARY ---
Date Check No Amount Date Check No
1/31 3933 44.40 1/28 3935
1/28 3934 174.55
* Denotes missing check numbers
Dailp Balance Iaformatioa
Date Balance Date Balance Date
1/26 180,909.18 1/31 180,493.73 2/27
1/27 180,748.68 2/11 30,493.73
1/28 180,538.13 2/25 30,490.73
Page 2
111000275
6
.Amount
36.00
Balance
30,495.40
Interest Rate Srm®arp
1/25
THANK YOU FOR BANKING WITH ORRSTOWN•BANK
0.050000$
N
00
ll~
O
H
Z
W
U
0
0
Q
Q
A
W
a
A
H
fs+
Q
0
x
H
H
C7
H
W
a
Wr~
fn
[W
~+
W
0
~']
W
W
h
H
W
~I
~I
;i
~~
~~
i
i
~ ~ ru
~ U f7J
`m p
`o 0
J
Q
D ~
O .-~
O "a
J
? ~~
W
Q ~
W O
LL U'1
~~
~ ~
U ~
W
N ~
0
Ul
0
i
Q
J
}
Z ~
Za ~
0
m¢
Z~
m
Nd
o~
T
a
(~
.a
O
Q
m
x
0
n
n
Q
a
~- O
QOO
' REN-1511 EX+ (10-09)
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
tsrATE OF
John E. Keener
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
a. FUNERAL EXPENSES:
1' Musselman Funeral Service
2 Rolling Green Cemetary -grave opening
FILE NUMBER
21-11-0191
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) PeUI A. Keener
street Address _225 Ridge Road
city _Millerstown
_ State PA zIP 17062
Year(s) Commission Paid; 20 ~~
2• Attorney Fees: A.~o%ta/ ~• .~'~ire~ / ,ye~,,u~
/ z 7 S. /Na-ke. /- S~-ti-~ A9ee int. c S ~ D~ I7aSS
3~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
claimant Patricia S. Keener
street address 29 Skyline Drive
city _Mechaniesburg __ state PA zIP 17050
Relationship of Claimant to Decedent Spouse
4• Probate fees:
5• Accountant Fees:
6• Tax Return Preparer Fees:
~• Legal Advertising: The Sentinel
$ Legal Advertising: Cumberland County Law Journal
s. Misc. Postage
~o Filing Fees
~ ~ Reserves to conclude Estate administration, including first and final accounting, final income tax and
fiduciary returns.
TOTAL (Also enter on Line 9, Recaoitulationl ~ s
$8,191.76
$1,395.00'
$23,125.00
$23,125.00
$ 3,500.00
$927.50
$715.00
$176.92
$75.00
$17.60
$15.00
$700.00
61, 963.78
Ir more space is needed, use additional sheets of paper of the same size.
~IlIl~c~~IIICIl~II71
~11.Il II71~II'~.1~
ltd!®Il1CIlcf?, ~IIll~.
Established 1895
Brian C. fl4usselman, FD.
Supervisor
William G. Pegan, FD.
P.0. Box 137
324 Hummel Avenue
Lemoyne, PA 17043-0137
(717) 763-7440
To Funeral Expenses of JOHN E .KEENER
Feb.2,2011
Patricia Keener
29 Skyline Dr.
Mechanicsburg, PA 17050
2011
February 2
PROF.SERVICES,FACILITIES,AUTOS $3
995
00
(Limo not included in charge ,
.
"Classic" Metal Casket
" 2,150
00
Sentinel" Lined burial vault .
1,200.00 $7,345.00
Cash Advance Items:
Copies of death certificates $120.00
Minister's honorarium 100.00
Newspaper death notices 576
76
(Patriot-News, Hagerstown Herald .
& Chambersburg Public Opinion)
Tip for honor guard 50.00 $846.76
TOTAL
$8,191.76
FOR APPOINTMENT PHONE 717-763-7440
_ PRENEED COUNSELOR SALES RECEIPT
a ... ~._~i ~Vti `v`'! ,L 7'ti vLittii~ f Li\ti~ ~ ~`;j "1 il f1(}('1Q?~~
- - -t_:'
DATE_ I-~~-~~
RECEIVED FROM_ Q ~ -fir-; ~, c. ~~ ~~ ~ ~-
Name of Purchaser -
THE AMOUNT OF (9 z -rh('~~ c cj r~ ~.,
--~1 ~ '1" l~ rc = ~ ~ ~~ r-l r rc~ Y1 ' r1 c f ~ ~' - ~"~~ DOLLARS j $ /~3 ~ `_; ~
AS: DOWN PAYMENT ^ REGULAR PAYMENT ^ CREDIT CARD CHARGE
CASH ^ CHECK ^ CARDTYPE
`v ~ S J~
FOR THE PURCHASE OF INTERMENT RIGHTS AND/OR MERCHANDISE AND SERVICES FROM THE ABOVE NAMED CEMETERY.
RECEIVED BY CEMETERY SALES COUNSELOR
DATE BY ~,~~v~ __~
NAME ~-~, ~-._~ ~. ~~/~_
GEN 8002 (6/02) ~~
- v
The Sentinel
www.cumberiink.com
~~t~'dlPs
ANDREW C. SHEELY
127 SOUTH MARKET ST
MECHANICSBURG, PA 17055
71797-7050
AD NUMBER PAGE NO.
394908 1 of 1
BILL DATE SALESPERSON
03/24/11 wolfc
START DATE STOP DATE
03/10/11 03/24/11
AD NUIbBER AD DESCRIPTION CLASS LINES
394908 EXECUTOR'S NOTICE LETTERS TESTAMEN 10 PUBLIC NOTICES 32 * 2 cols
Publication Insertions Rate Net Amount Gross Amount
3 THE SENTINEL -LEGAL 3 LGL $169.92
TOTAL AD CHARGE $1gg,g2
3 PROOF OF PUBLICATION 01PRF $7.00
Purchase Order Est.JohnKeener PAY THIS AMOUNT $176.92 $212.30*
*AFTER 04/18/11
Thank you for advertising with The Sentinel! Deadline for
in-column legal ads is 4:00 p.m. two business days prior to
date of insertion. For questions, call (717) 240-7130.
THE SENTINEL
c/o LEE NEWSPAPERS
PO BOX 540
WATERLOO IA 50704-0540
000336
• ANDREW C. SHEELY
127 SOUTH MARKET ST
MECHANICSBURG, PA 17055
nerwm u+w pvruun wim your payrnen[
Check # ~ Credit Card
o^®^®a~
Acct #: I I i ~ ~ I I
Ems. Date: ~ ~
Name on credit card
Signature
Please make checks oaVable to:
THE SENTINEL
c/o LEE NEWSPAPERS
PO BOX 540
WATERLOO IA 50704-0540
Legal
Ad Number 394908
Billing Date 03!24/11
Amount Due $ 176.92
~' $
THE SENTINEL
c/o LEE NEWSPAPERS
PO BOX 742548
CINCINNATI OH 45274-2548
~r~n~i~~~ur~r~~u~~r~n~n~r~~~~~n~n~~~r~u~~~~~n~i~n~~~
21540200000003949080000DOOODODD000212300000D176929
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
Tele: (717) 249-3166 Fax: (T17) 249-2663
March 25, 2011
Cumberland Law Journal is published every Friday by the Cumberland County
Bar Association and is designated by the Court of Common Pleas as the official legal
publication for Cumberland County and the legal newspaper for publication of legal
notices.
TO: Andrew C. Sheely, Esquire
John E. Keener Estate
RE:
Legal advertisements must be received by Friday Noon. All legal advertising
must be paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on following dates:
March 11, March 18, and March 25, 2011
Advertising Cost $ 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment received $ 75.00
Total Amount Due $ 0.00
Becky H. Morgenthal, Executive Director
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal.
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
vlz:
March 11 March 18 and March 2~ 2011
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
Reeaer, Joha E., deed.
Late of the Township of Silver
Spring.
Executor: Pahl A. Keener c/o An-
drew C. Sheely, Esquire, 127
South Market Street, P.O. Box 95,
Mechanicsburg, PA 17055.
Attorney: Andrew C. Sheely, Es-
quire, 127 South Market Street,
P.O. Box 95, Mechanicsburg, PA
17055, (717) 697-7050.
_.___-
Li Marie Coyne, ditor
SWORN TO AND SUBSCRIBED before me this
25 of March, 2011
Notary
NOTARIAL SEAL
DEBORAH A COLLINS
Notary Public
CARLISLE BOROUGH, CUMBERLAND COUNTY
My Commission Expires Apr 28, 2014
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17613
KEENER JOHN E
Receipt Date: 2/11/2011
Receipt Time: 13:16:24
Receipt No.: 1064399
Estate File No.: 2011 -00191
Paid By Remarks: PAUL A KENNER JR
DB
--- - ------------------- Receipt Distribution
-----
--------
-------
----
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 410.00 CUMBERLAND COUNTY GENERAL FUN
WILL
SHORT CERTIFICATE 15.00
24.00 CUMBERLAND
CUMBERLAND COUNTY
COUNTY GENERAL
GENERAL FUN
FUN
JCS FEE
AUTOMATION FEE - 23.50
5.00
---- BUREAU OF
CUMBERLAND RECEIPTS
COUNTY & CNTR
GENERAL M.D
FUN
Check# 221 ------------
$477.50
Total Received......... $477.50
REV-1512 EX+ (12-08)
`F Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John E. Keener 21-11-0191
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. Verizon -final bill $96.40
2. PPL -final bill $649.00
3. Chuck Bricker appraisal -personal property
$150.00
4. PAAuto Brokers -service fee $55.00
5. United Water -final bill $129 97
6. Buchanan & Erb -fuel oil, final bill $1,277.40
7. Garman & Sons Mechanical $1,021.74
8. Mechanicsburg ordance fee $29.63
9. Decedent's 2010 Federal Income tax liability $13,707.00
10. Decedent's 2010 State income tax liability $771.00
11. Silver Spring Township Authority -sewer $243.50
12. Decedent's County and Township Real estate taxes -Keener Drive property $251.33
13. Decedent's County and Township Real estate taxes -Texaco Road property $418.88
14. Alan PefferAppraisal Services -real estate $1,050.00
15. Rodney Westhafer-Maintence to upkeep Estate properties during marketing period $1,900.00
16. Humana $34.00
17. Decedent's school taxes -Keener Drive property $755.87
18- Decedent's school taxes -Texaco Road property $1,259.79
19. Check printing fee $14.75
20. Patricia S. Keener -reimbursement for property insurance $230.00
21 ~ Keener, Inc. -Maintence to upkeep Estate properties during marketing period $700.00
------
TOTAL (Also enter on Line 10, Recapitulation) $ 24,745.26
If more space is needed, insert additional sheets of the same size.
~OB'INVOICE ___
c a s~cx~l~- ~ s
wwtYBwttE,. PIt 17053
PH 717967-4!174
EM 41a-1186
--- ~
3 ~ • •
~_
a
~ ~
~
` ~ + M
__._
F---
i
r- ~
_
r-- ~
r--- ----------------, --_.._ ---
------- ~
. -. - ~~
-
r---
~
~,
{ ~~
tvaHK UHLEHED BY
CUSTOMER APPROVAL `~\ \ ~ O
SIGNATURE
AUTHORIZED SIGNATURE .
~~ NC281 JOB INVOICE
--
TOTAL LABOR
TOTAL MATERIALS
~~--~-n--
TOTAL MlSCELLANEOU5 j~
SUBTOTAL
----- -------- 7 AX ~ ~3
GRAND TOTAL O~,
1
Peffer Appraisal Services
Real Estate Valuation & Analysis Allen R. Peffer
Andrew C. Sheely, Esquire
127 South Market Street
Mechanicsburg, PA 17055
INVOICE
Real Estate Appraisal Reports: Estate of John Keener
Apri120, 2011
(1). 3.23 Acres, Keener Drive, Mechanicsburg, PA
(2). 43 Texaco Road, Mechanicsburg, PA
Fee Breakdown:
(1) 3.23 Acres, Report $400
(2) 43 Texaco Road, Report 650
Total Due: $1,050
Tha/nk You!
C~~~~ ~
Peffer Appraisal Services
Allen R. Peffer
829 Meadow Lane
Camp Hill, PA 17011
829 Meadow Lane, ^ Camp Hill, PA 17011
Phone: 717-439-6962 ^ e-mail: alpeffer@msn.com
STATEMENT
C ilyc ~~. /~ I~ ~ c!L C ~ ,•4 Uc'T 10~~~fZ
~ 3 T~K:~ c ~ ~~~
To .A-~uy s n~ ~~r ~ rTy,
~ /~l CcICI~~U t ~ s [~ yr29 : ~A ~ )7 d 5~
TERMS ~~'P('`~~S.~L oATE1 ~7-!I
:7 D/ ~Erv~~ CSiA- %~ ~
1~-U, t
~/Vr~7. 3409 MADE IN U.S.A.
398894444
77 Hartland St, Suite 401
~ P.O. BOX 280431
East Hartford CT 06128-0431
f
Management Services
iRB30100098201*
iN KEENER
SKYLINE DR
~HANICSBURG PA 17050-1751
~~~III~~~~I~I~II~~~~~~III~~~I~I~I~~~~II~~I~II~I~~~~I~
Col~c~ion Notice
Phone: 800-759-3867
April 15, 2011
Re: Humana - MA
Claim amt:
Claim No:
Ref . No
LDQ9
$34.00
398894444-HU
977958175
is a request for payment of this account, which has been placed by
~a Insurance with us for collection. Please make your check payable
~mana, indicate the reference number listed above on the check and
t your premium payment along with the top portion of this letter to
Following address:
Humana Insurance Company
P.O. Box 533
Carol Stream, IL 60132-0533
ier, if you wish to dispute this account, please refer to the notice
ie reverse side of this letter or contact our toll-free number
'd below.
SERVICE CENTER HOURS
1-888-545-4170
Mon. - Fri. 8 a.m. to 10 p.m. EST
Saturday 10:00 a.m. to 4 p.m. EST
sincerely,
Receivable Management Services
Please consider this as notice that if payment is made by
consumer check we will convert this check to an electronic
debit to your account via ACH and if the check is returned
NSF, we will represent the check via ACH debit.
ro view & pay Online: WWW.RECEIVABLESONLINE.COMiA000UNTVIEW
USERID = 398894444 & PASSWORD = 39093267
IMPORTANT: REFER TO CLAIM NUMBER IN ALL COMMUNICATIONS
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
.RE ACTING AS A DEBT COLLECTOR. THIS LETTER IS AN ATTEMPT TO COLLECT
DEBT AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
J 1000218063
PA-40 - 2010
Social Securit
N
y
umber
172249897 Name(s) JOHN E KEENER
12 PA Tax Liability. MuRiply Line 11 by 3.07 percent (0.0307)
.
13 Total PA Tax withheld. See the instructions.
12
2 D 51
13 0
14 Credit from your 2009 PA Income Tax return
.
15 2010 Estimated Installment Payments.
14
0
16 2010 Extension Payment. 15 1280
17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only)
18 Total Estimated Payments and C 16
17 17 D 0
redits. Add Lines 14, 15, i6 and 17.
18 D
Tax Forgiveness Credk. Submit PA Schedule SP 2 98 D
.
19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased
19b Dependents, Part B, Line 2
PA Schedul
SP
19 d D D
,
e
20 Total Eligibility Income from Part C, Line 11, PA Schedule SP.
21 Tax Forgiveness Credit f 19 b D D
2 D
rom Part D, Line 16, PA Schedule SP. 0
22 Resident Credit. Submit your PA Schedule(s) G-R with your 21 0
PA Schedule(s) G-S, G-L and/or RK-1.
23 Total Other Credits. Submit your PA Schedule OC.
24 2 2 0
TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21
22 and 23
25 23 0
,
.
TAX DUE. If Line 12 is more than Line 24, enter the difference here.
26 Penalties and Interest
See th
i 2 4
2 5 2 9 8 0
.
e
nstructions.
Enter Code: X
If including form REV-1630/REV
16 2 6 0
-
30A, mark the box.
Y D
27 TOTAL PAYMENT DUE. See the instructions
.
28 OVERPAYMENT. It Line 24 is more than the total of Line 12 and Line 26, enter
the difference here.
2 7
2 8
D
The total of Lines 29 through 35 must equal Line 28 9 2 9
.
29 Refund -Amount of Line 28 you want as a check mailed to you.
efund
30 Credit -Amount of Line 28 you want a
2 9
s a credit to your 2011 estimated accou R
31 Amount of Line 28 you want to donate to the Wild Re 3 D 9 2 9
source Conservation Fund.
32 Amount of Line 28 you want to donate to the Military Family Relief Assist
33 A 0
D
ance Program.
mount of Line 28 you want to donate to the Governor Robert P. Casey Memorial
Organ and Tissue Donatio
A 3 2
3 3
n
wareness Trust Fund. D
~4 Amount of Line 28 you want to donate to the Juvenile (Type 1) Diabetes Cure
Research Fund.
3 4
5 Amount of Line 28 you want to donate to the PA Breast Cancer Coalition's Breast
and Cervical Cancer Resear
h F
3 5 0
c
und.
ignature(S). Under penalties of perjury, I (we) declare that I (we) hav D
e examined this return, including all
mmpanying schedules and statements, and to the best of my (our) belief, they are true
correct
and
,
,
complete.
our Signature
Spouse's Signature
if filin
joi
tl
,
g
n
y
'eparers Name and Telephone Number E-File opt out Y
Date
717-352-3737
OCKER 8 ASSOCIATES, PC
Firm FEIN
232744907
Preparer'sSSN/PTIN P00050093
Page 2 of 2
1000218063
1000218063 J
~7 10/06/2011 7:26 AM
mio~o 2010 rTOFII~i E KEENER 172-24-9897 Pa e:
ix and ~ Amount from line 37 (adjusted gross income) , .. • • • , . • .. _ _ .
39a Ch
k
X Y
di 38 110, 002
ec
~
re
ts
ou were bom before January 2, 1946, 8 Blind. ~ Total boxes
if: S
pouse was bom before January 2, 1946, Blind. checked - 39a 1
b If your spouse itemizes on a separate return oryouwere adual-status alien, check here - 39b
40 Itemized deductions (from Schedule A) or your standard deduction (see instructions)
......
41 S
b 40 19 117
u
tract line 40 from line 38 .. , ... • ..
............................................
............
i 41 90, 885
xempt
ons. Multiply $3,650 by the number on line 6d
........................................
43 T
bl
i 42 3 650
axa
e
ncome. Subtract line 42 from line 41. If line 42 is more than line 41, enter -4-
..................................
44 T
a3
87, 235
ax (see instr.). Check if any tax is from: a ~ Form(s) 8814 b ~ Form 4972
44 17 3 8 0
..................
45 ARernative
i
i
m
n
mum tax (see instructions). Attach Form 6251
................................
46 Add li
44 45 1.095
nes
and 45 ..... -
.....................................
...........................
47 Forei
n t
di
A 46 18, 475
g
ax cre
t.
ttach Form 1116 if required 47 12 8 ,
48 Credit for child and dependent care expenses. Attach Form 2441 48
49 Education credits from Form 8863, line 23
50 Retirement savings contributions credit. Attach Form 8880 50
....... 51
51 Child tax credit (see instructions)
...........
................... 52
52 Residential energy credits. Attach Form 5695
53 Other credits from Form: a ~ 3800 b ~ 8801 c ~ 53
54 Add lines 47 through 53. These are your total credits
...
...............................
55 Subt
t li
f 54 12 $
rac
ne 54
rom line 46. If line 54 is more than line 46, enter -0- ... , ..... • • . •
.......
55
18
347
...
:her 56 Self-employment tax. Attach Schedule SE ,
......
57 Unre
orted so
i
l
i 56
p
c
a
secur
ty and Medicare tax from Form: a ~ 4137 b ~ 8919
aces
58 Additi
l
57
ona
tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required
59 a ~ Form
W
2
b 58
(s)
-
,
ox 9 b ~ Schedule H c ~ Form 5405, line 16 S9
60 Add lines 55 throu
h 59
Thi
i
g
.
s
s our total tax
' ~' ~ • • - 6
~
61 Federal i
t 0
18, 347
ncome
ax withheld from Forms W-2 and 1099 61
ments
y
62 2010 estimated tax payments and amount applied from 2009 return . _ 62 4 , 64 0
__~ 63 Making work pay credit. Attach Schedule M
..................... 63
you have a
~ardying
64a Earned income credit (EIC)
......... ........................... 84a
Bd, attach b Nontaxable combat pay election 64b
~edule EIC. 65 Additional child tax credit. Attach Form 8812
....................
65
66 American opportunity credit from Form 8863, line 14
............ 66
67 First-time homebuyer credit from Form 5405, line 10
............ 67
68 Amount paid with request for extension to file . • . 68 16, 000
69 Excess social security and tier 1 RRTA tax withheld gg
70 Credit for federal tax on fuels. Attach Form 4136 70
71 Credits from Form: a ~ 2439 b ~ 8839 c 8801 d 8885
LJ t.__I 71
72 Add lines 61,62, 63, 64a, and 65 through 71. These are your total payments -
..................
n 73 If line 72 is more than li
60 72 2 0 , 64 0
ne
, subtract line 60 from line 72. This is the amount you overpaid
74a Amount of line 73 ou wa
t
f 73 2 293
ct de osit?
P - b Routing number n
re
unded to you. If Form 8888 is attached, check here - ~
~ ~ ~
XXXXXXXXX 74a
2 , 2 9 3
- c T e: ~ Checking ~ Savings
actions. - d Account number XXXXXXXXXXXXXXXXX
75 Amount of line 73 ou want a lied to our 2011 estimated tax - 75
tOUnt 76 Amount you owe. Subtract line 72 from line 60. For details on how to pay, see instructions
-
7
l1 OWe 77 Estimated tax enal ~ " ~ "' ..... • .
p t
(see inst
ti 6
y
ruc
ons) • ........ • 77
i~d Pall'ty Do you want to allow another person to discuss this return with the IRS (see instructions)? X Yes. Complete below. No
g~C~nee Designee's Personal identification number (PIN) -
name - MICFIAEL DOCKER CPA 514 6
Phone no. -
~n Under penalties of perjury, I declare that I have examined this t 717-352-3737
re urn and accompanying schedules ani
they are true, correct, and complete. Declaration of preparer (other than taxpayer) rs based on all infori
're Your signature Date Your occupation
return?
age 12. RETIRED
> a copy Spouse's signature. If a joint return, both must si n.
>ur 9 Date Spouse's occupation
rds.
Print/Type preparer's name Preparer's signature
d MICHAEL D OC]CER, CPA
parer Firm's name - OCKER & ASSOCIATES, PC
'! Only Firm's address - 414 8 LINCOLN WAY E
FAYETTEVILLE PA 17222-1
and to the best
rh preparer has
Daytime phone number
Date Check if PTIN
LO/06/11 seit-empioyea P00050093
Firm' EIN 23-2744907
Phone no.
717-352-3737
Form 1040 (2010)
J REV-276 1003617121
Application for
Extension of Time to File
REV-276 EX (09-10)
PA DEPARTMENT OF REVENUE 2O 1 ~
OFFlCUt~ USE ONLY F~C
OFFICIAL USE ONLY
K E Print the first two (2) letters of the last name dfor a PA-40. Print the first two (2) letters of DO NOT STAPLE
the name if a PA-41, PA-40NRC, PA-40NRC-AE, or PA-20S/PA-65. If PA-40NRC, PA-40NRGAE, or PA-40, PA-41, PA-40NRC, PA-40NRC-AE
PA-20S/PA-65
PA-20S/PA-65, enter the entity name starting with the first box of the "last, Estate, Tnut, or Entity
" ,
APPLICATION FOR EXTENSION OF TIME TO FILE
Name
and continue until you have used all the space available (if needed). If you do not have enough
f (See reverse for filing instructions. Be sure to answer all questions
)
space
or the name, do not use the address line. See instructions for Rduaary accounts.
Vnur Cnrial Cnrurifii Ar,~mF.e. r.__--_-,_ .. . ,. .- _. .
PLEASE PRINT OR TYPE ALL INFORMATION
172249897
Last, Estate or Trust, or Entity Name
KEENER
Spouse's Last Name or Name of Trustee for Estate or Trust
First Line of Address
Second Line of Address
29 SKYLINE DRIVE
City or Post Office
MECHANICSBURG
JOHN- E KEENER ESTATE'
First Name MI Mark the appropnate space with an "X'
if filin
in P
l
JOHN g
ennsy
vania for the first time
E First Time PA Filer
TYPE OF RETURN
Spouse's First Name MI Mark the appro_ppriate space with an "X°
for the kind of PA Return
ou
ill fil
y
w
e
X PA-40 Individual Tax Return
PA-40NRC Cor4wlidated Nonresident Tax Return
Daytime Telephone Number PA-4oNRC-AE Nonresident Consolidated Tax
Return. Athletes & Entertainers
PA-41 Fiduciary Income Tax Return
PA-20S/PA-85
Indicate the taxable year. Mark the
appropriate space with an "X"
State ZIPCOde X Calendar Year
PA 17050 beginning r'
-'t
_ so-tso33 1 ~ 6
313
PO BOX:.95
MECHANICSBURG, P%', 13D55 _ .~p~r ~ 1Z, Zpl/ .~ ';
o`>•derof~ P14' . 1~~1 1 Q`~ ~~1fL.~:'(JI L ~ ~ ~ t •1 !~U .OCR
O N~ T/f ~ w s ~J 5~~~~/~~ll ~.( s ° ~o
~RRSTOWI~BANB
• ATtaditionofLscellsiue .
I:0 3 L 3 ~ 50361: 10 3 008 74'411' 0 i06
IAOUNT OF YOUR PAYMENT
1700
r for the taxable year
_~ t PAYMENT" BLOCK ABOVE.
s made herein are true and correct.
• $ ;~ knowledge and belief, the state-
,.m,.,~ that I am:
.....-...-`..., y~ .+.~.~~,,,y v. a is ua~ vi ure myncsr wurt ur tspecrry JUrIS01CU0n)
A public accountant duly qualified to practice in (specify jurisdiction)
A person enrolled to practice before the Internal Revenue Service.
A duly authorized agent holding a power of attorney. (The power of attorney need not be submitted unless requested.)
A person standing in close personal or business relationship to the taxpayer who is unable to sign this application because of illness,
absence, or other good cause. My relationship to the taxpayer and the reason(s) why the taxpayer is unable to sign this application are:
Relationship Reason(s)
SIGNATURE OF PREPARER OTHER THAN TAXPAYER
DATE
Where to File: Mail extension and payment, if applicable, to:
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280504
HARRISBURG, PA 17128-0504
1003617121 1003617221
~970M1$/2U71 1,2c46 PM
!~ eQ
m `TAT
~artment ofrthe;Treasury
rnal R2venfia'SoniiFo a
- _,. '... ...._. --....:...r .ter .,.- _ _....
_ - __
ail To: Department of the Treasury
Internal Revenue Service
P.O. BOX 370-09
CHALrL D OCKER, CPA
- - - - - - - - - - - - - - - - - CUT HERE - - - - - - - - - - - - - - - - - -
4~~8~- ATplcation for Automatic Extension of Time
• File U.S. Individual Income Ta:x Rpt~rrn •M'No.,s4s-oo74
tment of the Treasury
our name(s) (see instructions)
TOI~i E KEENER
ddress (see instructions)
i 9 sKn=NE nRZVE
ily, town, or post office State ZIP ~
'~CHANIC38URG PA 17
wr social security number 3 S
72 -,Z 4 - 9s$ 97 pouse's social securi
rivacy Act and Paperwork Reduction Act Notice, see page 4
. -~••••~~.~.,:ivwrw~cuaomtyroF1010 $' ZO 640
5 Total 2010 payments 4 , 64 0
6 Balance :due. Subtract line 5 from line
4 (see instructions) 16 , 0 0 0
7 Amount you are paying (see instr.) .. ~ 16, 000
8 Check here if you are °out of the country' and a U.S.
citizen or resident (see instructions) .. , , _ ..
...........
9 Check here if you file.Form 1040NR or 1040NR-EZ'ahd
did. not receive wages ac an o,,,.,r.,..e.. ~....:>~._ :...
Form 4868 (2010)
RSV-1613 EX+~9-00)
SCNEDt~LE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John E. Keener 21-10-0191
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Patricia S. Keener, 29 Skyline Drive, Mechanicsburg, PA 17050 Spouse 50% Rest, Residue &
Rr?mainriar
2. Shan L. Westhafer, 4020 Mountain View Road, Mechanicsburg, PA 17050 Daughter 50% Rest, Residue &
Remainder
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert additional sheets of the same size)
,_ ..
LAST WILL AND TESTAMENT
OF
JOHN E. KEENER
I, JOHN E. h~ENER, of Mechanicsburg, (Silver Spring Township),
Cumberland County, Pennsylvania, make, publish and declare this as and for my
Last Will and Testament, hereby revoking all other Wills and Codicils heretofore
made by me.
FIRST: I direct that all inheritance, estate, transfer, succession and
death taxes, as well as my just debts and funeral expenses, of any, kind
whatsoever, which may be payable by reason of my death, shall be paid out of the
principal of my estate as the same can conveniently be done.
SECOND: I give, devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate, including any
property over which I hold power of appointment and together with any insurance
policies thereon, as follows:
(a) Fifty percent (50%} thereof unto my wife, PATRICIA S. KEENER,
provided that should PATRICIA S. KEENER predecease me, I give and bequeath her
share equally unto my granddaughter, ERICA SILER, of Mechanicsburg,
Pennsylvania, and my grandson, RODNEY J. WES'I'HAFER, of Mechanicsburg,
~ Pennsylvania, share and share alike; and
(b) Fifty percent (50%) thereof unto my daughter, SHARI L.
WESTHAFER, of Mechanicsburg, Pennsylvania, provided that should SHARI L.
~, WESTHAFER predecease me, I give and bequeath her share equally unto her issue;
share and share alike.
~' THIRD: In addition to all powers granted to them by law and by other
provisions of this Will, I give the fiduciaries acting hereunder the following powers,
applicable to all property, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease, for any period of time,
any real or personal property and to give options for sales, exchanges or leases, for
such. prices and upon such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give legally sufficient
instruments for transfer of the property and to receive the proceeds of any disposition.
(B) To partition, subdivide, or improve real estate and to enter into
agreements concerning the partition, subdivision, improvement, zoning or management
of real estate and to impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to abandon any
property which is of little or no value.
(D) To invest in all forms of property, including stocks, common trust
funds and mortgage investment funds, without restriction to investments authorized for
Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted in insurance policies
or in other investments.
(F) To exercise any election or privilege given by the Federal and other
tax laws, including, but not necessarily being limited to, personal income, gift and
estate or inheritance tax laws.
(G) To make distributions to my herein named beneficiaries in cash or in
kind or partly in each.
(H) To borrow money from themselves or others in order to pay debts,
a
taxes, or estate or trust administration expenses, to protect or improve any property
held under my will, and for investment purposes.
2
~+ ~ •~
(I) To select a mode of payment under any qualified retirement plan
(pension plan, profit sharing plan, employee stock ownership plan, or any other type of
qualified plan) to the extent provided for by the plan or the law.
FOURTH: I nominate and appoint my nephew, PAUL A. KEENER, III,
of Mechanicsburg, Pennsylvania, and my friend, ANDREW C. SHEELY, of
Mechanicsburg, Pennsylvania, Co-Executors of this, my Last Will and Testament. I
direct that my Co-Executors or their successor shall not be required to post security or
a bond for the performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my
Last Will and Testament, this ~~ day of January, 201 I.
~. ~'` (SEAL )
JO E. KEENER
Signed, sealed, published and declared by the above-named Testator as and for
his Last Will and Testament in our presence, who, at his request, in his presence and in
the presence of each other, have hereunto subscribed our names as attesting witnesses.
Address 1 ~ U~
Address ~~~-~.~~fx..,•t~+c~s,~~~~ >4
,....~/ 7~>.SJe
Name
~:.
y
Narru~~
3