HomeMy WebLinkAbout12-21-11J 1565616165
REV- i ~70o Ex (oru) (FI) `, ~ OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes "`"' "`"' ° County Code Year File Number
PO BOX z8o6o> INHERITANCE TAX RETURN r f
_ Harrisburg, PA iy128-0601 RESIDENT DECEDENT ~ ~ ~ ~ L ~v`
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
181-26-2233 09/26/2011 04/28/1917
Decedent's Last Name Suffix Decedent's First Name MI
GOLDBY HARRY C
(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 Return O 2. Supplemental Return O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
m 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
THOMAS E. FLOWER (717) 243-5513 ',
First Line of Address
FLOWER LAW, LLC
Second Line of Address
10 W. HIGH ST.
City or Post Office
CARLISLE
State ZIP Code
PA 17013
REGISTER OF `: FUSE ONLT, `.
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Correspondent's a-mail address: TOm@FlOwer-LaW.COm
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,
' true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
S NA E OF PER~ON RES ON OR FILING TU ((DATE
ADDRESS
PATRICIA A. ROSENDALE, CPA, EXECUTRIX, 255 HICKORY DRIVE, CARLISLE, PA 17015
SI OF PRE .R THAN REPRESENTATIVE ! Z D / ~ ~/
ADDRESS
FLOWER LAW, LLC; 10 W. HIGH ST., CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610165 1505616105 J
-~-f
is ' '-
L' / f~~
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: HARRY C. GOLDBY 181-26-2233
RECAPITULATION
1. Real Estate (Schedule A) .......................................... ... 1. 0.00
2. Stocks and Bonds (Schedule B) .................................... ... 2. 1,130,991.79
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. 147,943.83
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... ... 7. 101,325.00
8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 1,380,260.62
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 76,711.07
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 125.81
11. Total Deductions (total Lines 9 and 10} ............................... .. 11. 76,836.88
12. Net Value of Estate (Line 8 minus Line 11} ............................ .. 12. 1,303,423.74
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... .. 13. 1,172,098.74
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 131,325.00
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable
at lineal rate X .0 _ 1g.
17. Amount of Line 14 taxable
at sibling rate X .12 17,
18. Amount of Line 14 taxable
at collateral rate x .15 131,325.00 18 19,698.75
19. TAX DUE ....................................................... .. 19. 19,698.75
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
HARRY C. GOLDBY
STREET ADDRESS
825 N. HANOVER STREET
N. MIDDLETON TOVVNSHIP
..CITY STATE
CARLISLE
ZIP
PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19}
2. CreditslPayments
A. Prior Payments 18,713.84
B. Discount 984.91
3. Interest
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.
{ 1) 19,698.75
Total Credits (A + B) (2) 19,698.75
(3) 0.00
(4)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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 .............................................................................................................................. ^
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" 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? ........................................................................................................................ n ~
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)J.
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-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
HARRY C. GOLDBY 21-11-1045
tiT more space is needed, insert additional sheets of the same size)
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
C0/)t.6iNt. ~~ /a{S Y~a~~ii
~~~~ ms+ ~ ~l~t,,
Orrstawn Financial Advisors
Charlene L. Feuchtenberger
Assistant Vice President / Fiduciary Officer
Date of Death: 09/2b/2011 Estate af:;;,EeEate'.ofHarry C:?GOldby~:.
Valuation Date: D9/26/2D11 Account:: :0994 ~-
Processing
Date: 09/27/2011 ,
Report Type: Date of Death
Number of Securities: 59
File I0: H. GOLDBY 0994
Shares Security Mean and/or Div and Snt Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 200 AT&T 1NC (0020681021
COM
flew York stock Bxchange
09/26/2D11 28.42000 28.OD000 H/L
28.210000 5,642.00
2) 5734 ADAMS EKPRESS CO (006212104)
COM
New York Stock Exchange
09/26/2011 9.48000 9.24000 H/L
9.360000 53,670.24
3} 100 ALTERA CORP (021441100}
COM
The NASDAQ Stock Market LLC
09/26/2D11 35.84000 33.96000 H/L
34.906D00 3,490.00
4} 100 AMERICAN E%PRE5S CO (025016109}
COM
New York Stoclc Exchange
09/26/2011 47.62000 45.Bb000 H/L
46.740000 4,674.00
5) 400 ARCHER DANIEL9 MIDLAND CO (D39483i0 2)
COM
New Yark Stock Exchange
09/2b/2011 25.53500 24.42000 H/L
29.9775D0 9,991.00
6) 100 8I0-REFERENCE LABS INC (090576602)
COM $.O1 NEW
The NASDAQ Stock Market LLC
09/25/2011 18.21000 17.fi8000 H/L
17.945000 1,794.50
7) 100 CATERPILLAR INC DBL (149123201)
COM
New York Stock Exchange
09/25/2011 77.00000 73.24D00 H/L
75.120000 7,512.00
8} 100 COGNIZANT TECHNOLQGY SOLOTION9 (192 446102)
CL A
The NASDAQ Stock Market LLC
09/ZS/2011 64.15000 61.58000 H/L
62.865D0D 6,286.50
91 100 COLLATE PALMOLIVE CO (194162103)
COM
New York Stock Exchange
09/26/2011 91.32000 89.55000 H/L
9D.435000 9,043.50
10) 200 DISNEY WALT CO {25468710fi)
COM DISNEY
New Yark Stock Exchange
09/26/2011 30.34000 29.68000 H/L
30.010000 6,002.00
11) 200 DIRECTV {25490A201)
COM CL A
The NASDAQ Stack Market LLC
09/26/2011 43.245D0 41.75000 H/L
42.497500 8,499.50
Page 1
This report was produced with Estateval, a product of Estate Valuations ~ Pricing Systems, Inc. if you have questions,
please cantaet EVP Systems at (818} 313-63D0 or www.evpsys.com. (Revision 7.2.0)
Date of Death: 09/25/ZOll Estate of: Estate of Harry C. Goldby
Valuation Date: 09/Zfi/2DI1 Account: 0994
Processing Date: 09/Z7/ZO11 Report Type: Date of Death
Number of Securitlea: 59
File ID: H. GOLDBY 0994
Shares Security Mean and/or Div and Int Security
or Par pescriptioa High/Ask Low/bid Adjustments Accruals Value
12) 688.705 DODGE & COX FDS (256206103)
INTi, 9TR PD
Mutual Fund {as quoted by NASDAQ}
09/Z6/ZO11 28.59000 Mkt
2fl.590000 19,758.95
13) 100 DOLLAR TREE INC (256746108!
COM
The NASDAQ Stock Market LLC
09/Z6/2011 77.b9D00 75.82000 H/L
76.7550DO 7,675.Sq
14) Z00 DOW CHEM CO (26D543103)
COM
New York Stock Exchange
09/2b/2011 24.520D0 23.08000 H/L
23.795000 4,759.00
15) 5DD EATON CORD (278058102)
COM
New York Stack Exchange
09/25/ZO11 35.94D00 34.O1OD0 H/L
34.975000 17,987.50
15} 200 EMEEL90N ELEC CO (291011104)
COM
New York Stock Exchange
09/25/2011 43.77000 4Z.D18D0 H/L
42.890000 8,578.00
17} 400 ERELON CORP (301b1,N101)
COM
New York Stock Exchange
09/26/2011 42,91000 42.16000 H/L
4Z.535DD0 17,014.OD
iB} 1D0 E}IXON MOBIL CORP (30231GiD2}
COM
New York Stack Exchange ~
09/Z6/2011 71.89000 b9.500D0 H/L
70.69500D 7,069.50
19) 3704.678 FEDERATEp MON SECS FD INC (3134131D5)
CL A
Mutual Fund ias quoted by NASDAQ}
09/26/2D11 10.22000 Mkt
10.220000 37,861.81
20} 946.309 FEDERATED EQUITY PDS (314172255)
CLOVBR VALUE A
Mutual Pond (as quoted by NASDAQ)
09/26/2011 12.93000 Mlct
12,4300DD 12,235,71
21} 6854,415 FEDERATED HIGH INCOME 8D FD (314195108)
CL A
Mutual Fund {aa quoted by NASDAQ)
09/26/2811 7,19000 Mkt
7.190000 49,283.24
22) 4516.715 FEDERATED TOTAL RETIIRN SEAS (31428Q1011
TOTL RET IN5TL
Mutual Fund (as quoted by NASDAQ)
09/26/2011 11.39000 Mkt
11.390000 51,445.40..
23) 209 FRESENIU5 M8'D CARE AO&CO KCiAA {35802910 6)
SPONSORED ADR
New York Stock Exchange
09/26/2011 70.870D0 68.92000 H/L
69.8950D0 14.508.06
Page 2
This report was produced wiCh EstataVal, a product of Estate Valuatfona & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (8181 313-6300 or www,evpsya,eam. (Revision 7.2.0)
Date of Death: 09/26/2011 Estate of: Estate of Harry C. Galdby
Valuation Dates 09/26/2011 Account: 0994
Processing Date: 09/27/2011 Report Type: Date of Death
Numher of Securities: 59
Pile ID: H, GOLDBY D994
9hazes Security Mean and/or Div and int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
24) 2D000 GENERAL ELEC CAP CORD MTN HE (36962G3K81
New York Bond Exchange
DTD: 10/19/2007 Mat; 10/i9/2012 5.25
09/23/2D11 104.4700D 104.17000 A/H
1D4.320000
Int: 04/19/2011 Co 09/26/2011
251 300 GENERAL MLS II4C {370334104)
CODE
New York Stock Exchange
09/26/2011 39.56000 38,85000 H/L
39.215D00
261 50 GOOGLE INC {36259P508}
CL A
The NASDAQ Stock Market LLC
09/26/2011 532.9300D 513.25004 H/L
523.090000
27) 200 GRACE W R & CO DEL NEW {38388F108)
COM
New York Stock Exchange
09/26/2011 35.91500 33.22000 H/L
34.567500
281 100 HAWKINS INC (420261109)
COM
The NASDAQ Stock Market LLC
09/26/2D11 32,37000 31.46000 H/L
31.915000
Div: 0.32 Ex: 09/21/2811 Recs 09/23/20 11 Fay: 10/07/2011
29) 300 HEALTHSPRING INC {42224N101}
COM
New York Stock Exchange
09/26/2D11 35.79000 34.6300D k/L
35.2100D0
30} lOD INTERIUITIONAL BDSINESS MACH3 (459288101)
COM
New York Stock Exchange
09/26/2011 174.70000 169.Bfi000 H/L
172.280000
31) 100 JOHNSON & JOHNSON (478160104}
COM
New York Stock Exchange
09/26/2011 62.650D0 62.01000 H/L
62.43000D
32) 60D KRAFT FOODS INC {50075N104)
CL A
New York stock Exchange
09/26/2011 34.32000 33.65000 H/L
33.985000
33) .100 MWI VETERINARY SOPPLY INC (55402X105)
COM
The NASDAQ Stock Market LLC
09/2b/2011 71.3BOOD 67.77000 H/L
69.575000
34) 500 MICROSOFT CORP (594918104)
COM
The NASDAQ Stock Market LLC
09/26/2011 25.52000 24.73000 H/L
25,125000
35} 1D0 MIDDLEBY CORP (596278101)
COM
The NASDAQ Stock Mazket LLC
20,864.00-
457.92
11,764.50
2fi,154.50
6,913.50
3,191.50
32.00
10,563.00
17,226.00
6,243.04
20,391.00
6,957.50
12,562.50
09/26/2011 73.04000 68.85000 H/L
70.945000 7,094.50
Page 3
This report was produced with EstateVal, a product o£ Estate Valuations ~ Pricing Systems, Inc. if you have questions,
please contact EVP Systems at (818- 313-6300 or www.evpsys.com. (Revision 7.2.0)
Date of Death: 09/26/2011 Estate of: Estate of Harry C. Goldby
Valuation Date: 09/26/2011 AccounC: 0994
Processing Date: 09/27/2011 Regort Type: Date of Death
Number of Securities: 59
File 13]: H. GOLDHY 0994
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Sid Adjustments Accruals Value
36) 100 NASIIAQ OMK GROUP INC (631103108)
COM
The NASDAQ Stock Market LLC
09/26/2011 25.06000 29.00000 H/L
24.530000
371 580 PNC FINL SVCS GROUP INC (693475105)
COM
New Yor3~ stack Exchange
09/25/2011 49.57000 47.39000 H/L
48.480400
38) 2886 PPL CORP (643517106)
COM
New York 6toCk Exchange
09/26/2011 26.86000 28.48790 H/L
28.673950
Div: 0.35 Ex: D9/D7/2011 Rec: 09/09/2011 Pay: 10/0 3/2011
39) 200 PEPSICO INC (713448108)
COM
New York Stock Exchange
49/25/2011 62.04000 60.73000 H/L
61.385048
Div: 0.515 Ex: 08/31/2011 Rec: 09/02/2011 Pay: 09/ 30/2011
46) 1513 PETROLEUM & RES CORP (716549100)
COM
Nea York Stock Exchange
09/26/2011 23.45010 22.35000 H/L
22.906050
41} 160 PRUDENTIAL PINL ZNC (744320102}
COM
New York Stock Exchange
09/26/2011 46.26000 43.89000 H/L
45.075000
42) 200 QUALCOMM INC (747525103}
COM
The NASDAQ Stock Market LLC
09/26/2011 50.89060 49.24000 H/L
50.055000
43} 260 RAVEN INDS INC {754212108}
COM
The NASDAQ Stock Market LLC
09/26/2011 56.55000 46.01000 H/L
49.280000
44) 61fi RIVUS BOND FUND (769657106)
COM
New York Stock Exchange
69/26/2011 18.51000 18.35000 H/L
18.430000
45) i1fl4.fl33.ROWE_,T PRICE CAP APPRECIAT FD (77954M105) .
SFi HEN TNR'
Mutual Fund {as quoted by NASDAQ}
x9/25/2011 19.37000 M}ct
19.370000
46) 25773.196 ROW£ T PRICE SHORT TERM HD FD (77957P105)
COM
Mutual Fund {as quoted by NASDAQ)
09/26/2011 4.83060 Mkt
4.830000
2,453.00
28,218.90
82,753.02
1,010.10
12,277.00
103.00
34,647.78
4,507.50
10,013.00
9,856.00
11,352.88
22,950.22
124,484.59
Page 4
This report was produced with EstateVal, a product of Estate valuations ~ Pricing Systems, inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.avpsys.com. (Revision 7.2.0)
Date of Death; 09/26/2011
Valuation Date: 09/26/2011
Processing Date: 09/27/2011
Estate of; Estate of Harry C. Goldby
Account: 0994
Report Type; Date of Death
Number of 5ecuritles: 59
File lll: H. GOLDBY 0994
shares security Mean and/ar Div and Int Security
or Par Description High/Ask Low/Hid Adjustments Accruals Value
47) 100 SPDR SERIE5 TRUST (78464A7fi3)
8&P DIVID ETF
NYSB Arca Equities Exchange
09/26/2011 49.18400 47.94100 k/L
48,562500
Div: 0.43328 Ex: 09/16/2011 Rect 09/20/2011 Pay; 09/28/2011
48) 214 SEALED AIFt CORD NEW {81211K100)
COM
New York Stock Exchange
09/26/2011 17.88000 17.28000 H/L
17.5eaaoo
49) 200 TJX COS INC NEW {872540109)
COM
New York stock Hxchange
09/26/2011 57.95D10 S6.fi4000 H/L
57.295050
50) 100 UNITEDHEALTH GROUP INC 191324P102)
COM
New York Stock exchange
09/26/2011 48.84000 47.56000 H/L
48.210000
51) 814.341 VANGDARD/WELLINGTON PD INC (9219352011
ADMIRAL SHARES
Mutual Fund (as quoted by NASDAQ)
09/26/2011 51.30000 Mkt
51.3DD000
52} 3752.345 VANGUARD HD ];NDBX FD INC {921937108)
COM
Mutual Fund (as quoted by NASDAQ)
09/26/2011 11.03000 Mkt
11.030000
53) 2517.618 VANGUARD FI]CED INCOME SECS FD (922031810}
INTRM DWGRDAD
Mutual Fund (as quoted by NASDAQ)
09/26/2011 10.D8000 Mict
lo.aeoooD
541 4674.357 VANGDARD FIXED INCOME 8HCS PD (922031836)
STRM INVGRA AD
Mutual Pond (as quoted by NASDAQ)
09/26/2011 10.60000 Mkt
10.680000
55) 3066.853 VANGDARD FDCED INCOME SHC5 FD (922031869)
INFL PROT BSCS
Mutual Fund {as quoted by NASDAQ)
09/26/2011 14.10000 Mkt
14.100DOp
S6) 30D VANGUARD WDRLD FDS (92204A504)
HEALTH CAR £TF
NYSE Arca Equities Exchange
09/26/2011 57.35006 56.23000 FI/L
56.790000
57) 100 VANGUARD INDEX FD9 {922908611)
8M CP VAL ETF
NYSE Area Equities Exchange
09/26/2011 57.23000 55.53000 H/L
56.380000
58) 300 VERIZON COMMONICATIONS INC I92343V104)
COM
New Yark Stack Hxchange
09/26/2011 36.41000 35.89000 H/L
36.1250D6
4,856.25
93.33
3,762.12
11,459.01
4,821.00
41,775.69
41,388.37
25,377.59
49,975.53
43,242.63
17,037.OD
5,638.00
10,837.50
Page 5
This report was proc9uced with EstateVal, a product of Estate Valuations & Pricing systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-63D0 or www.evpsys,com. {Revision 7.2.0}
Date of Death: 09/26/2011
Valuation Date: 09/26/2011
Processing Date: 09/27/2011
Shares Security
or Paz Description
S9) 440 XILINX INC {983919101)
CDM
The NASDAQ Stock Market LLC
09/26/2011
Total Value:
Total Accrual:
Total: $1,130,991.79
Estate of: Estate of Harry C. Goldby
Account: 0994
Report 'T'ype: Date of Death
Number of Securities: 59
File Ib: H. GDLDHY 0994
Mean arsd/or Div and Int Security
Nigh/Ask Low/Hid Adjustments Accruals Value
29.17000 28.09000 H/L
28.630000
11,452.tl0
$1,129,345.49
$1,646.35
Portfolio Endnates
Daily Deposit #043440997 $22,263.12 Accrued Interest $ 2.39
Charlena L. Pe
Assistant vice
/~Fidu~iary Offieer
Date :~
Page 6
This report was produced with EstateVal, a product of Estate Valuations ~ Pricing Systems, Inc, if you have questions,
please contact EVP Systems at fe18) 313-6300 or www.evpsys.com. {Revision 7.2.0)
REV-i5o8 EX+ (u-io)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
HARRY C. GOLDBY 21-11-1045
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. CASH HELD IN ORRSTOWN ADVISORS ACCT. N0.50 00 0994 0 07 22,265.51
2, M&T BANK MONEY MARKET ACCOUNT N0. 1955 60,575.30
3. ORRSTOWN BANK CHECKING ACCOUNT N0.0001 46,060.53
4. M&T BANK CHECKING ACCOUNT N0.8291 4,214.49
5, REFUND, CHURCH OF GOD HOME 9,803.75
g. HOFFMAN ROTH FUNERAL HOME, REFUND OF EXCESS PREPAID AMOUNT 4,505.82
7. HIGHMARK, REFUND OF UNUSED PREMIUM 249.90
g. NEW YORKER MAGAZINE, PARTIAL SUBSCRIPTION REFUND 35.00
g. NEWSWEEK MAGAZINE, PARTIAL SUBSCRIPTION REFUND 135.59
10. TIME MAGAZINE, PARTIAL SUBSCRIPTION REFUND 43.84
11. COMCAST, REFUND 14.90
12. PA BUREAU OF UNCLAIMED PROPERTY 39.20
TOTAL (Also enter on Line 5, Recapitulation) $ 147,943.83
If more space is needed, use additional sheets of paper of the same size.
welcome to ivt~it untme rsanicuig
SEPTEMBER 28, 2011
Accounts Transfers
Yage 1 of 1
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BIII Pay Customer Service
ACCOUNT SUMMARY > SAVINGS DETAIL
Power Money Market ~~~~~
Related Links: Transfers & Loan Pavments
Statements & Documents ~ Sign ug for Electronic Statement & Document
Delivery
Export Data (Order New Checks ~ FinanceWorks'~"
Account Power Money Market 1955 Total Balance $60,575.30
Available Balance $60,575.30
View Calendar View Calendar
snow Last 10 Transactions _ or - view From To GO
~~TZt7f1£
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t~Post Date Transaction Description Credits/Debits Total Balance
09/13/2011 INTEREST PAYMENT $20.43 $6Q,575:30
09/01/2011 TIAA-CREF DISTR. ANNUITY $3,871.13 $60,554.87
08/12/2011 INTEREST PAYMENT $25.45 $56,683.74
08/01/2011 sTIAA-CREF DISTR. ANNUITY $3,871.13 $56,658.29
07/25/2019. In~ Branch Transfer~thdrawal -$50,000.00 $52,787.16
'Depending on when your statement generates, you may not see a full 90 days of history. If your statement has just been
gerxerated, you may get a message indicating that no transacBons are available from 61 - 90 days.
m 2011 Manufacturers and Traders Trust Company. Users of this web site agree to be bound by the provisions of the M&T Web:Banking Teens and
Conditions. View the Terms and Conditions, Privacy Policy or Security Information.
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View Transactions for: MoneyMak 0001 Current Balance: 46,060.53
Available Balance: 46,060.53
Current Transactions View Range: Since Last Statement ~ 7 Davs ~ 15 Davs ~ 30 Davs ~ All
Date: ~: Ref/Check No: Description:
09/26/2011 View Imacie Deposit
09/21/2011 EFT NATL FIN SVC LLC
PPD
09/16/2011 286 Check 286
Totals (this page): Transactions: 3
Debit: Credit: Balance
31,066.33 46U60.53
1, 399.04 14,994.20
(9,113.25) 13,595.16
Debits: (9,113.25) Credits: 32,465.37
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SEPTEMBER 28, 201'.
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Accounts Transfers BIII Pay Customer Service
ACCOUNT SUMMARY > CHECKING DETAIL
Power Checking b>.~~~ .~ .~ f
Related Links: Transfers & Loan Payments ~ °` "" F
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Account Power Checking 8291 Total Balance $.993.99
Available Balance $3
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View Calendar View Calendar
snow Last 10 Transactions _or- view From To GO
Date Transaction Descrlotion CreditslDebtts Total Balance
09/27/2011 Highmark WPA EFT -$220.50 $3,993.99
09/13/2011 SERVICE CHG WAIVE- RELATIONSHIP $24.00 214.49
$4
PRICING ,
09/13/201 ] MONTHLY SERVICE CHARGE -$24.00 $4,190.49
09!13/2011 INTEREST PAYMENT $0.15 $4,214.49
09/02/201:1 US TREASURY 303 XXSOC SEC $1,244.60 $4,214.34
08/291201:1 Highmark WPA EFT -$220.50 $2,969.74
08!12!2011 SERVICE CHG WAIVE- RELATIONSHIP $24.00 190.24
$3
PRICING ,
08!12(2011 MONTHLY SERVICE CHARGE -$24.00 $3,166.24
08/12/2011 INTEREST PAYMENT $4.72 $3,190.24
0 8/0312 0 1 1 CHECK NUMBER 3540 -$45,000.00 $3,185.52
Depending on when your statement generates, you may not see a fuU 90 days of history. ff your statement has just been
generated, you may get a message indicating that no Uansactions are available from 61 - 90 days.
® 2011 Manufacturers and Traders Trust Company. Users of this web site agree to be bound by the provisions of the M&T Web Banking Terms and
Conditions. View the Terms and Conditions, Privacy Policy or Security Information.
https://onlinebanking.mandtbank.comJhistory/HistoryChecking.aspx?Id=1 9/28/2011
REV-1.Si0 EX-F (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
HARRY C. GOLDBY 21-11-1045
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 DESCRIPTION OF PROPERTY
NUMBER INQUDE THE NAME OF THE TRANSFEREE, THEIR RELAIIDNSHlP TO DECEDEM ANO DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
THE DATE OF TRANSFER. ATTAQiACOPY OF THE DEED FDR REAL ESTATE. VALUE OF ASSET INTEREST iF APPLICABLE VALUE
1~ KATHLEEN S. NERANGIS, NIECE, JULY 6, 2011
50,000.00 100 3,000.00 47,000.00
2 CHARLES THOMAS BUTLER, NEPHEW, JULY 6, 2011
50,000.00 100 3,000.00 47,000.00
3 HOUSEHOLD FURNISHINGS CONVEYED TO ABOVE NIECE AND
NEPHEW BY INTER VIVOS DEED OF GIFT, IN WHICH DECEDENT
RETAINED THE USE UNTIL DEATH, VALUED PER ATTACHED
APPRAISAL 7,325.00 100 7,325.00
NOTE: THE DECEDENT MADE CERTAIN LIFETIME CHARITABLE GIFTS
WITH ANNUITY INCOME RETAINED, WHICH ARE NOT LISTED HERE.
TOTAL (Also enter on Line 7, Recapitulation) $ I 101,325.00
If more space is needed, use additional sheets of paper of the same size.
Hoyle s Laughlin, n Laughlin Auctions, Inc.
P.O. Box 2
S3!QOdstock_ VA 22664
DATE : December 14, 2011
APPRAISAL FOR: The Estate of Harry C. Goldby
CLIENTS: Kathleen Nerangis
Charles T. Butler III
LOCATION OF APPRAISAL: Route 37 Storage
Unit 609
3862 Valley Pike
Winchester, Virginia
DATE OF INSPECTION: December 8, 2011
TYPE OF VALUE TO BE ESTIMATED: Current market value
Telephone: X40-459-8383
Fax: 540-984-8082
Email: Laughlin@shentel.net
DATA SOURCE: Personal inspection has been made of all listed items giving consideration to quality, condition and availability.
LIMITING CONDITIONS:
I certify that, to the best of my knowledge and belief:
• The statements of fact contained in this report aze true and correct.
• The reported analysis, opinions and wnclusions aze limited only by the reported assumptions and limiting conditions,
• and are my personal, unbiased professional analysis, opinion and condition.
• I have no present or prospective interest in the property that is the subject of this report, and I have no personal interest or
• bias with respect to the parties involved.
• However, I may be hired at a future date to conduct an auction of all or part of the items listed in this report.
• My compensation is not contingent on an action or event resulting from the analysis, opinions, or conclusions in, or the use of this
• report.
• I have made a personal inspection of the personal property that is the subject of this report.
Items ADpraised:
-White Pine & Mixed wood 7 drawer cupboard, circa 1880's, 2 delft end panels - $1,100.00
-36" Commemorative "Moliere" plaque - $180.00
-Korean reproduction "Wedding" chest in red lacquer- $300.00
-Large "Flemish" tapestry, reproduction, faded, "as is" condition- $175.00
-Overpainted pine 9 pane corner cupboard, broken arch top, single door over 2 doors- $135.00
-Reproduction Chinese kneehole desk, circa 1960's- $365.00
-"Venus" bronze statue- $135.00
-Oak 20 drawer dental cabinet- $975.00
-"Fancy" gilt frame mirror- $180.00
-Oriental style reproduction hall stand- $110.00
Appraisal Page 1
-French figural mantel clock- $215.00
-2- hand carved/hand painted religious icons- $400.00
-4- Carved & painted Japanese wooden figures- $500.00
-Gilt Eagle "bulls eye" mirror- $325.00
-'Oriental rug, approx. 9'x12'- $850.00
-2- bronze statues, Charles I & Seated man- $480.00
-Walnut 3 over 2 drawer dresser base, crotch grain drawer fronts, replaced brass pulls- $165.00
-Tunisian "prayer" rug- $450.00
-Slag glass parlor lamp- $285.00
TotLal~Appraisal: $7325.00 ~~
~~f~O~u~G~~_
Hoyle S. Laughlin II - VA License # 000905
Appraisal Page 2
Hoyle S Laughlin, II
Laughlin Auctions, Inc.
P.O. Box 2
~a~,,,,.o- v e o~~
DATE• December 14, 2011 Telephone: 540-459-8383
Fax: 540-984-8082
Email: Laughlin@shentel.net
APPRAISAL FOR: The Estate of Harry C. Goldby
Appraisal Fee: $185.00 (One Hundred Eighty-Five Dollars)
Please make check payable to: Hoyle S. Laughlin II
P.O. Box 2
Woodstock, VA
Appraisal Page 3
REV-IS1L EX+ (10-09}
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
- --
ESTATE OF FILE NUMBER
HARRY C. GOLDBY 21-11-1045
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I' ORGANIST, HONORARIUM 250.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) PATRICIA A. ROSENDALE, CPA
Street Address 255. HICKORY ROAD
City CARLISLE _ _ _ State PA ZIp 17015
Year{s) Commission Paid: TO BE PAID IN 2012
Z• Attorney Fees:
3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees:
S• Accountant Fees:
6• Tax Return Preparer Fees:
~• PUBLISH ESTATE NOTICES, THE SENTINEL (189.54), CUMBERLAND LAW JOURNAL (75.00)
8. ADDITIONAL SHORT CERTIFICATES
s. MOVING & STORAGE
~o. BANKING FEE
>>. TAX RETURN FILING FEE
12~ HOYLE LAUGHLIN, PERSONAL PROPERTY APPRAISAL
38,578.71
35, 973.00
815.50
264.54
32.00
577.52
19.80
15.00
185.00
TOTAL (Also enter on Line 9, Recapitulation} $ 76,711.07
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (1.2-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
HARRY C. GOLDBY 21-11-1045
Report debts incurred by the decedent prior to death that remained unpaid at the date of death. including unrPimhurcPrl morll~al e,..,o„~e~
_...._. _ _,._,.,, ,,, ,~,,,,,,,,,,~ ,,,~c~~ auwuviiai sneeCS Oi If12 SBI1te SIZ2.
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE ~
BENEFICIARIES
ESTATE OF: FILE NUMBER:
HARRY C. GOLDBY 21-11-1045
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• LISA NERANGIS LIMOGES GREAT-NIECE 2000
2 NICK NERANGIS GREAT-NEPHEW 2000
3 STEPHEN NERANGIS GREAT-NEPHEW 2000
4 WENDY BUTLER CURTIS GREAT-NIECE 2000
5 TODD BUTLER GREAT-NEPHEW 2000
6 KATHLEEN AND NICK NERANGIS NIECE & HUSBAND 10,000
7 CHARLES T AND ROBYN BUTLER NEPHEW & WIFE 10,000
8 KATHLEEN NERANGIS (TAXABLE PORTION OF LIFETIME GIFTS) NIECE 50,662.50
9 CHARLES T. BUTLER (TAXABLE PORTION OF LIFETIME GIFTS) NEPHEW 50,662.50
II
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
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.
CUMBERLAND COUNTY HISTORICAL SOCIETY
2 MUSICAL ARTS SOCIETY OF CARLISLE
3 J HERMAN BOSLER MEMORIAL LIBRARY
4 SEE ATTACHED LIST OF FOUR (4) CHARITIES SHARING RESIDUARY ESTATE
2500
2500
5000
RESIDUE
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space is needed, use additional sheets of paper of the same size.
1,172,098.74
REV-1513 EX+ (O1-10)
~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE ~ r• ~ 1f'fI/~~~~~011~
BENEFICIARIES
ESTATE OF: FILE NUMBER:
HARRY C. GOLDBY 21-11-1045
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 trensfers under
Sec. 9116 (a) (1.2).]
1.
.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.
CARNEGIE INSTITUTE OF PITTSBURGH, 4400 FORBES AVE., PITTSBURGH, PA 15213 25% of RESIDUE
2. WESTERN PA SCHOOL FOR THE BLIND, 201 N. BELLEFIELD AVE., PITTSBURGH, PA 15213 25% of RESIDUE
3. PHIPPS CONSERVATORY, ONE SCHENLEY PARK, PITTSBURGH, PA 15213 25% of RESIDUE
4. PITTSBURGH HISTORY & LANDMARKS FOUNDATION SCHOLARSHIP FUND, 100 W. STATION 25% of RESIDUE
SQUARE, SUITE 450, PITTSBURGH, PA 15219
TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 100% of residue
If more space is needed, use additional sheets of paper of the same size.
c:\wp51 \wil is\goldby.wil
LAST WILL AND TESTAMENT
OF
I>TA,RRY C. GOLDBY
I, HARRY C. GOLDBY, of 825 North Hanover Street, Apartment 110,
Carlisle, .Cumberland County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making void any and all former Wills, Codicils, or
writings:in the nature thereof, by me at any time heretofore made.
FIRST: I~ hereby order and, direct my Executor, hereinafter named, to pay
all ,my just debts; funeral expenses, testamentary expenses and all Inheritance, Estate,
. Transfer; and Succession Taxes; as soon as may be conveniently done after my death.,,
out of my residuary estate. '
SECOND: I direct that all of my furniture, furnishings and other personal
property be divided equally between my niece, KATHLEEN S. NERANGIS, of
Winchester, Virginia, and my neph~i:l, ~:HA€~'LEs TE-iOir~AS BUTLER, of Phippsburg,
Maine.
THIRD: i give to each of my following relatives the sum of Two
Thousand ($2,000.00) Dollars:
A. LISA NERANGIS LIMOGES, my great-niece;
B. NICK NERANGIS, mygreat-nephew;
C. STEPHEN NERANGIS, my great-nephew;
c:\wp51 \wills\goldby.wil
D. WENDY BUTLER CURTIS, mygreat-niece;
E. TODD BUTLER, my great-nephew;
FOURTH: I give to the CUMBERLAND COUNTY HISTORICAL
SOCIETY, the sum of Two Thousand Five Hundred ($2,500.00) Dollars.
FIFTH: I give to the MUSICAL ARTS SOCIETY OF CARLISLE, the
sum of Two Thousand Five Hundred ($2,500.00) Dollars.
SIXTH: I give to the J. HERMAN BOSLER MEMORIAL LIBRARY,
the sum of Five Thousand ($5,000.00) Dollars.
5
.~~,~
SEVENTH: I give the sum of Ten Thousand ($10,000.00) Dollars to my
niece, .KATHLEEN S: NERANGIS and_ NICK NERANGIS, her husband, jointly, and the
~~
sum of Ten Thousand ($10,000.00) Dollars to my nephew, CHARLES THOMAS
BUTLER and ROBYN BUTLER, his wife; jointly. Each couple is to receive the sum of
Ten Thousand ($10,000.00) Dal{ars, not each individual.
EIGHTH: All the rest, residue and remainder of my estate, I give, devise
and bequeath in equal shares, to the following Pittsburgh institutions:
A. CARNEGIE INSTITUTE OF PITTSBURGH.
B. THE WESTERN PENNSYLVANIA SCHOOL FOR THE
BLIND, located on Bellefield Avenue, Pittsburgh, Pennsylvania.
C. PHIPPS CONSERVATORY, specifically for the proposed
"Hi//side Project" behind the present buildings, in memory of my sister, Dorothy Goldby.
2
c:1wp51 \wills\goldby.wil
D. PITTSBURGH HISTORY AND LANDMARKS FOUNDATION
SCHOLARSHIP FUND, of Pittsburgh, Pennsylvania, for scholarships or its general
purposes.
LASTLY: I hereby nominate, constitute and appoint PATRICIA
ROSENDALE, C.P.A. as Executor of this my Last Will and Testament. Should she be
unwilling or unable to serve in such. capacity for any reason, I nominate, constitute and
appoint the ORRSTOWN BANK, of Carlisle, Pennsylvania, or its successors, as the
• Executor of my Last Will and .Testament. No Executor shall be required to file bond in
this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ,.
.~ ~ ~ day of , 2008.
~_
rry C. G by
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
~~~
3
c:\wp51 \wills\goldby.wil
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, HARRY C. GOLDBY, Testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledg before me, by HARRY C:
. GOLDBY, the Testator, this. ~n~ _ .day of ~ , 2008.
H ry C. G dby, Test
NOTi4RIAL SEAL
MERI:ENE d MARHEVKA, NOTARY
MY COMMI~SbN EXPIRES JUNErB 120 Q
4