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HomeMy WebLinkAbout12-21-11s 1505610105 REV-1500 EX (oz-u) (Fp PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °"""T"E"`°`"`"`"°` County Code Year File Number Po Box zso6ot INHERITANCE TAX RETURN Harrisburg, PA i71z8-D6oi RESIDENT DECEDENT ' ~ ~ ' 1 l lJ o ~ ~' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 210-38-7128_ ~ gl Q~/~~~~ Decedent's Last Name Suffix Decedent's First Name MI __ ___ Stevens Eric T (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name.. Suffix Spouse's First Name MI N/A Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Retum O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENT Name Diane M. Dils, Esquire O 5. Fraderal Estate Tax Return Required U 8. Total Number of Safe Deposit Boxes O 11. Election to Tax under Sec. 9113(A) (A.ttach Schedule O) IAL TAX INFORMATION SHOULD BE DIRECTED T0: Daytime Telephone Number (717) 232-97?~ ~~ -, REGISTER~F IdtLLS USE ONLY ' ' '" _~ i ~) (~ First Line of Address ~ ~ ~ ~.- _~ , --, ~ , 1400 N. Second Street ', ~- ;-: ,". - .:~ - . ._; -. Second Line of Address _ \ y ,_ _ , i _, _.~_ ,. _,. ; .._ r ~v *-, Cit or Post Office DATE FILED '~ Y State ZIP Code Harrisburg ' ~ PA 17102 Correspondent's a-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, it is e, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. I. U E OF PERS IBL R FILING RETURN DATE ,lam __ /Z-Zt~ ~~ N. Second Street, Harrisburg, Pa. 17102 ~~'.'v v~r~CCrrr~y~v_~i rRCxrviHirvt DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number ' ! 210-38-7128 Decedent s Name: RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. ! 153,700.00 ': 2. Stocks and Bonds (Schedule B) ..................................... .. 2. '; 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. ' 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 124,214.41 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ' 0.00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 277,914.41 9. Funeral Expenses and Administrative Costs (Schedule H) ............. ...... 9. 7,951.15 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule i) ......... ...... 10. 68,820.00 11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. 76,771.15 '; 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. ': 201,143.26 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. ' 201,143.26 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES - --- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ _. _. (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable - ~` ` ~ ~~`~ ~ ~~ _ ~~ at lineal rate X .0 45 16. '' 9,051.45 17. _ ~ .. my . ~ ~ Amount of Line 14 taxable __ e e__ at sibling rate X .12 ' 17. 18. __ _ _ Amount of Line 14 taxable _e . _._ _ _P.. at collateral rate X .15 ' 18. 19. TAX DUE .................................................... .....19. 9,051.45 '' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 1505610205 1505610205 REV-150U EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Eric T. Stevens STREET ADDRESS - CITY ------ ----- STATE - -------- PA ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _.___ B. Discount 9,500.00 475.00 (1) Total Credits (A+ B) (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (q) 5. It Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 9,051.45 975.00 923.55 (5) 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 .............................................................................................................................. ^ 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(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. ' REV-1502 EX+ (11-08) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Eric T. Stevens 21-11-0883 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 fads. 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 ~ 424 Ridge Avenue, East Pennsboro Township, Cumberland County, PA. 108,700.00 426 Ridge Avenue, East Pennsboro Township, Cumberland County, PA. 45,000.00 TOTAL (Also enter on Line 1, Recapitulation.) $ If more space is needed, insert additional sheets of the same size. 153,700.00 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Eric T. Stevens 21-11-0883 All property jointly-owned with right of survivorship must be disclosed on Schedule F. tit more space Is needed, insert additional sheets of the same size) REV-1504 EX+ {6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Eric T. Stevens SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER 21-11-0883 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporationlpartnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER Eric T. Stevens 21-11-0883 All property jointlyowned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-i5o8 EX+ (u-io) ~ ~ Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Eric T. Stevens 21-11-0883 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Verizon Refund 15.97 State Farm Insurance Refund 32.45 1995 Ford Sedan automobile 600.00 Federal Reserve Battik of Philadephia -Savings Bond Redemption 4,146.00 Ahold USA Inc. Pension 4,507.65 Prudential Insurance 1,000.00 Charles Schwab 82.36 The Hartford 113.79 Ahold, Inc. 401 (k) Savings 8,651.67 Fidelity Holy Spirit 401 (k) Plan 93,246.40 Members 1st Checking Account 8,508.50 Members 1st Savings Account 3,309.62 TOTAL (Also enter on Line 5, Recapitulation) $ 124,214.41 If more space is needed, use additional sheets of paper of the same size. REV-isDg EX+ (oi-iD) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Eric T. Stevens 21-11-0883 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER fOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INq.UDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FORlOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % of DECEDENT'S INTEREST DATE of DEATH VALUE OF DECEDENTS INTEREST 1. A . NONE 0 .00 TOTAL (Also enter on Line 6, Recapitulation) I; 0.00 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Eric T. Stevens 21-11-0883 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 ves. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME.OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FDR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPIICABIE) TAXABLE VALUE 1~ NONE 0.0( TOTAL (Also enter on Line 7, Recapitulation) $ I 0.00 If more space is needed, use additional sheets of paper of the same size, REV-1511 EX+ (10-09) ~ Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT - ESTATE OF FILE NUMBER Eric T. Stevens 21-11-0883 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1' Sullivan Funeral Home 4,030.00 Headstone Gingrich Memorials 1,675.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s) of Personal Representative(s) Michael E.Coulson WAIVED Street Address City -- -- _ State ZIP Year(s) Commission Paid: 2011 z• Attorney Fees: 750.00 3• family Exemption: (If decedent's address is not the same as claimant's, attach explanation} Claimant NONE Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 332.50 S• Accountant Fees: 1,000.00 6• Tax Return Preparer Fees: ~• Cumberland County Law Journal 75.00 Carlisle Sentinel 88.65 TOTAL (Also enter on Line 9, Recapitulation) $ 7,951.15 If more space is needed, use additional sheets of paper of the same size REV-1512 EX+ (12-08) ~ ' ~ Pennsylvania DEPARTMENT OF gEVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS w~Hi~ yr FILE NUMBER Eric T. Stevens 21-11-0883 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical ex ITEM penses. NUMBER DESCRIPTION VALUE AT DATE OF DEATH I ~ Taxes withheld from Ahold 401 (k) Savings 1, 730.33 Taxes withheld from Fidelity Holy Spirit 401 (k) Plan 18,649.28 Home Equity Loan -Members 1st 20,894.44 Mortgage -Members 1st 20,771.22 U.S. Post Office 67.07 Sewer/trash 552.00 Gas 264.66 Copy of deeds 4.50 Hampden Physician Associates 55.60 PP&L 60.31 East Pennsboro Ambulance 707.00 West Shore EMS 1, 755.82 Giant -Misc. 21.18 Register of Wills -additional short certificates 35.00 Direct N 62.84 ': Holy Spirit Hospital 8.29 Spirit Physican Services 483.29 Association Kidney Disease 46.09 Misc. Funeral Expenses 558.81 AT&T 65.40 Vascular Assoc. 10.56 Quantum Imaging 262.00 Dr. Siam 66.48 Hershey Med Center 1, 576.14 Associated Cardiologists 111.69 TOTAL (Also enter on Line 10, Recapitulation) ~ 68,820.00 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10)• ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT CJ 1 A 1 C UF: FILE NUMBER: Eric T. Stevens 21-11-0883 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RE oTN tSList Trustee(sjNT AMOOF ESTATE ARE I TAXABLE DISTRIBUTION$ [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• Michael E. Coulson Stepson 50% Michael S.Coulson Stepgrandson 50% i ENTER DOLLAR AMOUNTS IFOR 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: L 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, use additional sheets of paper of the same size. LAST WILL AND TESTAMENT ..._ ~.. © _,. OF r~., -~ ~<.. ~ ,.... ERIC T. STEVENS ~=_=~~ ~ ~~~ ~. / --a ~~'~ ~ `'^~ -~ I, Eric T. Stevens of 426 Ridge Avenue, Enola, Cumberland County, Pennsy~ania, ~„", 17025, being of sound and disposing mind and memory, do make, publish, and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I diirect that all inheritance and estate taxes becoming due by reason of my death, whether such taxed may be payable by my Estate or by any recipient of any property, shall be paid by my Executor out of the property passing under this Will, which is not specifically devised or bequeathed, as an expense and cost of administration of my Estate. My Executor shall have no duty or obligation bo obtain reimbursement for any such tax paid by my Executor even though on proceeds of insurance or other property not passing under this Will. ITEM II: II hereby exercise all powers of appointment, which I may have at this time of my death in favor d'f my Executor, and all property subject to all such powers shall be included in my Estate. ITEM III: ~ direct that my bodily remains be disposed of at the discretion of my Executor. ITEM N: ~ direct that all my household furniture and furnishing, automobiles, books, pictures, jewelry, china, linen, silverware, wearing apparel, and all other like articles of household or personal use or adornment pass to and become part of my residual Estate and pass as set forth under ITEM V below. ITEM V: I dive, devise, and bequeath all of the rest, residue, and remainder of my Property (real, personal, and mixed) to be divided equally between Michael E. Coulson, now or formerly of 84 Fronq Street, West Fairview, Cumberland County, Pennsylvania, 17025 and Michael S. Coulson,) now or formerly of 424 Ridge Avenue, Enola, Cumberland County, Pennsylvania, 1702, provided they survives me as set forth herein. In the event that Michael E. Coulson or Michael ~. Coulson does not survive me then I give, devise, and bequeath all of the rest, residue, and ren~sinder of my property (real, personal, and mixed) to the remaining one. ITEM VI: In the settlement of my Estate, my Executor shall posses, among others, the following powers to be executed for the best interest of the beneficiaries: (a) 7['o sell either at public or private sale and upon such terms and conditions as ih~-y Executor may deem advantageous to my Estate, any or all real or personal estate or interest therein, whether owned by me severally or in Conjunction with other persons or acquired after my death by my Executor, a-nd to consummate said sale or sales by sufficient deeds or other instruments to the purchaser(s), conveying a fee simple title, free and clear of all liens or trust and without obligation or liability of the purchaser(s) to see to the application of the purchase money or to make inquiry into the validity of Page I of 1 :~~ -,, ..?vY r~ri ~. ~ ~~ --r, said sale(s); also, to make, execute, acknowledge, and deliver any and all deeds, assignments, options, or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executor in this Paragraph VI (a) or elsewhere in my Will. (b) To pay all costs, taxes, expenses, and charges in connection with the administration of my Estate. My Executor shall pay all legal expenses of my last illness and my funeral expenses. (c) To distribute my Estate in kind or in money. If any assets are distributed in kind, they shall be distributed at their respective value(s) on the date(s) of their distribution. (d) To retain any investments I may have at my death so long as my Executor may deem it advisable to my Estate so to do. (e) To vary investments, when deemed desirable by my Executor and to vest in such bonds, stocks, notes, money markets, real estate mortgages, or other securities or in such other property (real or personal) as he shall deem wise, without being restricted to so-called "legal investments." (f) To mortgage real estate and to make leases of real estate. (g) To borrow money from any party to pay the indebtedness of mine or of my Estate, expenses of administration or inheritance, legacy, estate and other taxes. (11) To vote any shares of stock which form a part of the Estate and to otherwise exercise all the powers incident to the ownership of such stock. (i) In the discretion of my Executor, to unite with other owners of similar ProPeR3' ~ carrying out any plans for the reorganization of any corporation or company whose securities form a part of the Estate. (1) To distribute my personal property directly to the Guardian of the person of any minor beneficiaries hereunder. (k) The right and discretion to elect the most appropriate settlement options for any pension plans, individual retirement accounts, or other employee benefit options as deemed most appropriate by my Executor, assuming such election shall be in accordance with procedures established by the plan's administrative committee or administrator, as the case may be, if such elections have not been made prior to my death. (1) To do all other acts in judgment of my Executor necessary or desirable for the proper and advantageous management, investment, and distribution of my Estate. (m) The right to engage accountants, attorneys, appraisers, and other agents, as deemed necessary by my Executor, to render advise to and/or represent my Page 2 of 2 Executor, as my Executor deems necessary or appropriate to the administration and preservation of my Estate. TI'EM V~: Any person who shall have died at the same time as Testatrix or in a common disaster with him, or under such circumstances that it is difficult or impossible to determine who died first, or who shall fail to survive Testatrix by a period of thirty (30) days, shall be deemed to have predeceased' him. ITEM V : I nominate, constitute, and appoint Michael E. Coulson and Michael S. Coulson to equally share in the duties of being my Executor (herein referred to as "Executor"). In the event of death', resignation, refusal, or the inability of one of them, then the other will serve as sole Executor. M~+ Executor is specifically relieved from the duty or obligation of filing any bond(s). ITEM IX: In all references herein to any Executor, Guardian, Beneficiary, or other, the use of any particular gender or the plural or singular number is intended to include the appropriate gender or number'as the text of this my Last Will and Testament my require. IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will and Te ent, consisting of this, the next, and the preceding two (2) pages this j'~ day of 2Q11. ~~ ~~7 Eric T. Stevens, Testatrix Page 3 of 3 SIGNED, SEALED, PUBLISHED, AND DECLARED by the above-named Testatrix, Eric T. Stevens, as and for his Will, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. ~l, r . ~ _ fitness Name F itness`N~ime r .~-,~. fitness Name ~~~ ~~~~e•~~ ti~-~ Address Address S Address Page 4 of 4 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF u~ . I, Eric T. Stevens, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executted the instrument as my LAST WILL; and that I signed willing as my free and voluntary act for the proposes therein expressed. Sworn to or ed and 1 owledged before me by Eric T. Stevens, the Testatrix, this _~~~~y of 2011. \ ~~ ~ ~: Eric T. Stevens Notary Public My Commission Expires: ~S~) ~~~~1~7'N OF PENNSYLVANW NohAal SseY Rulhanne MY C~ ~ ~~Notsry Public Member, PMruyhr~ ~ ~1~ Aswaatlon of Noterles AFFIFAVIT COMMONWEALTH OF PENNSYLVANIA: COUNTY OF . SS: "~-~ ~~~~~v~~` ~~~~~ ~ ~.i _. and L~. ' , r.`.u ~f rl'.ls,..c ,the wi esses whose names or fore om are signed to the attached g g msttument, being duly qualified according to law, do depose and say that we were present andl saw the Testatrix sign and execute the instrument as his Last Will; that the Testatrix signjed willingly and executed it as his free and voluntary act for the propose therein expressed; that each subscribing witness, in the hearing and sight of the Testatrix, signed the Will as a witness; and that to the best of our knowledge, the Testatrix was at that tune 18 or mere years of age, of sound mind and under no constraints or undue influence. Sworn to or affirmed and subscribed before me by _ ~~.,Q ' and ~ - witness this day of ~ , 2011. . .~ ~~ti~11~ ~~ Wi ess M1 i. ~ ~ ~ ess ,~ ,~. °, Witness '/ ~L~rtlJ i1~Q, Notary Public My Commission Expires: (Seal) COMMONWE,q~m OF PENNSYLVANW Rufhsnns K~on~ Seal ~ ~~~ ~ Public Member, Penneyb,~ ~1~ ~e0on or Notaries IN RE: In the Estate of Eric T. Stevens IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA File No. 21-11-0883 FAMILY SETTLEMENT AGREEMENT AND NOV4~, this ~ day of October, 2011 came the heirs of the Estate of Eric T. Stevens and the Executor of said Estate, and intending to be legally bound, do !hereby agree as follows: 1. Eric T. Stevens is deceased, having died August 2, 2011, in the County of Cumberland, Pennsylvania. 2. The heirs of said Eric T. Stevens, as set forth in :his Last Will and Testament, are as follows: a. Michael E. Coulson and Michael S. Coulson. 3. Pursuant to the Last Will and Testament of the deceased, all of the assets of his estate ,are to be divided equally between Michael E. Coulson and Michael S. Coulson. 4. The deceased is the owner of two parcels of real estate: 424 Ridge Avenue, East Pennsboro Township, Cumberland County, Pennsylvania and 426 Ridge Avenue, East Pennsboro Township, Cumberland County, Pennsylvania. 5. Michael E. Coulson and Michael S. Coulson agree that the real estate located at 424 Ridge Avenue, East Pennsboro Township, Cumberland County, Pennsylvania shall be placed into the name of Michael S. Coulson alone. 6. The parties agree that the value of said real estate is $108,700.00 and that said amount shall not be distributed one-half each between the parties. 7. The parties agree that the balance of the estate shall be divided one-half each. 8. Michael E. Coulson and Michael S. Coulson agree that the inheritance tax due and owing on the value of the real estate located at 424 Ridge Avenue, East Pennisboro Township, .Cumberland County, Pennsylvania, specifically, the sum of $4,891.50 shall be paid to Michael E. Coulson, out of the one- half share of the residuary estate of Michael S. Coulson,. 9. The parties agree that the real estate and mobile home located at 426 Ridge Avenue shall be deeded into their names as tenants in common, one-half each and that they shall share the expenses of said real estate and mobile home, until said real estate is sold. At the time of sale, the parties agree to share the net proceeds, one-half each. 2 10. All partieis hereby acknowledge that this Family Settlement Agreement be filed with the Register of Wills of Cumberland County, Pennsylvania. IN WITNESS WHEREOF, the parties hereto have signed their hands and seals the day and year first above written. fitness ` " ~~~ ~~ Witness SEAL Michael .Coulson, Exec or/Heir ~ ~ SEAL Michael S. Coulson, Heir 3 ~~ ~ ~~ ATTORNEYS AT LAW 1400 NORTH SECOND STREET (FIRST FLOOR FRONT) HARRISBURG, PENNSYLVANIA 17102 ARTHUR K. DILS PHONE: (717) 233-8743 DIANE M. DILS FAX: (717) 233-2567 December 20, 2011 Cumberland County Register of Wills ~.- :. ~; Cumberland County Courthouse ~?Q --== -:- ... :., One Courthouse Square ~ ~ ~ ~:_ -~- c~ Carlisle, PA 17013 _''?~ ~ r~ qtr'^'~[^l r- i -_ r /J '3 .lJ'\. RE: Estate of Eric T. Stevens ~~= `s~ ~~- _ _~ No. 2111-0883 ^-11-'~ Wes" ~J '~~' Dear Kris: Enclosed is an original and two copies of an Inheritance Tax Return to be filed in your office. Also enclosed is my check in the amount of $15.00 to cover the cost of the f ling of the Inheritance Tax Return. Enclosed is aself-addressed stamped envelope to return aclocked-in copy of the Return to me. Thank you for your assistance in this matter. -----~ - truly~yours, Diane 1~olrbi DMD Enclosures Cc: Michael E. Coulson - ~~',f- u!~~i~t~ ~ .~ CLERK. i'HAN'S 33ER~.ANI', - 0. ~ ~ Q ~ ~ 417 Z ~ o '~ o ~ Q ~ t :~: ~ 4 ""-~. r ^~ ':+f ~i ~. ,~~ ~~( i( o ~ O .~ p[, Q U ~ ~ ~ o ~ U U ~ ,b o a ~~ ~ °' ~- o ~ °' U ~ ~ ~ ~ ~ ~ 3UpU U