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Home My WebLink About12-22-11 (2) 1505610143 1500 ~ (01-10) ~ REV - OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes oernnrrerrornev~ue Po Box.28oso~ INHERITANCE TAX RETURN 21 11 0794 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 578 24 8866 05 29 2011 04 07 1911 Decedent's Last Name Suffix Decedent's First Name MI MITCHELL MABEL M (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 ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-52) 4. Limited Estate ^ ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required death after 12-12$2) (date of 6 Decedent Died Testate ^ f Will rr~ 7• (gttadeGOpy~of~rust)a Living Trust ~ 8. Total Number of Safe Deposit Boxes ) (Attach Copy o ^ 9. Litigation Proceeds Received ^ 10. Spousal P4vert Credit,~date ~f death ^ 11. Election to tax under Sec. 9113(A) between 12-31 X31 and -1-95 (Attach SCh. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number.A.,,,, LAUREN E BOGAR 717 7 3 ~? ~7 61 .:` _r~, -~'~~ .,:(l, ~ILY t~ USE REGISTER O~71N ~ b ~ r :apt tv , First line of address ~~ ~ ,~ ti-~ --~~ `- ONE WEST MAIN STREET -i .. Second line of address r~~ ` ' r' -~ . c. ,., DATE FILED City or Post Office State ZIP Code SHIREMANSTOWN PA 17011 Correspondent's a-mail address: Ibogar@bOgarlaW.COm Under penalties of pery'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 and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 7i,~~~~~t~-~ John L. Mitchell ~~ " ~~ 934 Woodridge Drive Enola PA 17025 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ~y~~n~, ~ ~p~ Lauren E. Bogar ~~ " ~I.~- l V -===~7 One West Main Street, Shiremanstown, PA 17011 Side 1 1505610143 1505610143 J REV-1500 EX Decedent's Social Security Number oecede~PsName~ Mitchell, Mabel M. 578 24 8866 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................ . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 12 , 144.30 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 18 , 630 .3 9 7. Inter-Vivos Transfers & Miscellaneous lynn; Probate Property (Schedule G) u Separate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1-7) .................................................................... . 8. 3 0 , 7 7 4. 6 9 9. Funeral Expenses & Administrative Costs (Schedule H) ............................... ........ 9. 6 , 023 • 50 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...................... ........ 10. 11. Total Deductions (total Lines 9 & 10) .......................................................... ......... 11. 6 , 023.50 12. Net Value of Estate (Line 8 minus Line 11) .................................................. ........ 12. 24 , 7$1.19 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. 24 , 751.19 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable 24 , 751.19 16. at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17 at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 0 0 18 at collateral rate X .15 . . 19. Tax Due .................................................. ............................................................... . 19. 1505610243 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610243 Side 2 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0794 0.00 1,113.80 0.00 0.00 1,113.80 DECEDENT'S NAME Mitchell, Mabel M. STREET ADDRESS 934 Woodridge Drive CITY Enola STATE PA ZIP 17025 Tax Payments and Credits' REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-0794 DECEDENT'S NAME Mitchell, Mabel M. STREET ADDRESS 934 Woodridge Drive CITY STATE: ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 0.00 (3) (4) (5) 1.113.80 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 :.................................. x c. retain a reversionary interest; or ............................................................................................................... x d. receive the promise for life of either payments, benefits or care? ............................................................ x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^ receiving adequate consideration? ............................................................................................. ....................... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or hoer death?....... ^ ^x 4. Did decedent own 2n Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^ 0 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, 1 B94 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statyte 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, 2b00: • The tax rate imposed on the net value of trahsfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Make Check Payable to: REGISTER OF WILLS, AGENT. (1) 1,113.80 Total Credits (A + B) (2) Rev-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Mitchell, Mabel M. 21-11-0794 - - ~ -~- , ,- . , _....-- .........- ..y.. ... -.......,. o ..p muaa ue mac~usaa on scneawe r. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Members 1st Federal Credit Union -Certificate of Deposit No. 44443-45. Principal balance at 11,583.67 date of death $11,578.34; accrued interest $5.33. 2 Black Persian Straller w/ Azurene Mink Collar -per appraisal 75.00 3 Black Sheared Rabbit Cape -per appraisal 35.00 4 Blue Fox Shawl Collar -per appraisal 20.00 5 Brown Dyed Mouton Stroller -per appraisal 75.00 6 Personal Property -Sold at private sale 300.00 7 Neill Funeral Home -refund of overpayment 55.63 TOTAL (Also enter on Line 5, Recapitulation) I 12,144.30 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) MEMBERS 1St FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 44443-00 10/04/1985 $392.91 $.08 $392.99 John Mitchell & Charlene Mitchell 05/29/2008 CHECKING ACCOUNT: Account Number/Suffix 44443-11 Date Account Established 04/30/1997 Principal Balance at Date of Death $21,389.56 Accrued Interest to Date of Death $1.65 Total Principal and Accrued Interest $21,391.21 Name of Joint Owner John Mitchell & Charlene Mitchell Date Joint Ownership Established 05!29!2008 INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 44443-05 Date Account Established 07/05/2000 Principal Balance at Date of Death $9,093.58 Accrued Interest to Date ofl Death $2.44 Total Principal and Accrued Interest $9,096.02 Name of Joint Owner John Mitchell & C harlene Mitchell Date Joint Ownership Established 05/29/2008 CERTIFICATES OF DEPOSIT: Account Number/Suffix 44443-40 44443-42 44443-43 Date Account Established 09/29/2006 09/29/2006 09/02/2008 Principal Balance.at Date of Death $2,285.98 $2,285.98 $5,234.15 Accrued Interest to Date of Death $1.49 $1.49 $2.41 Total Principal and Accrued Interest $2,287.47 $2,287.47 $5,236.56 Name of Joint Owner Christine Shultz Jeffrey Mitchell Charlene Mitchell Date Joint Ownership Established 09/26/2006 09/29/2006 09/02!2008 CERTIFICATES OF DEPOSIT: Account Number/Suffix 44443-44 44443-45 44443-53 Date Account Established 09/29/2006 09/02/2008* 09/29!2006 Principal Balance at Date of Death $2,285.98 $11,578.34 $2,285.98 Accrued Interest to Date of Death $1.49 $5.33 $1.49 Total Principal and Accrued Interest $2,287.47 $11,583.67 $2,287.47 Name of Joint Owner Amy Weller None Janelle Grosser Date Joint Ownership Established 09/29/2006 09/29/2006 'Rollover from ce~utificate 44443-5 5, originally established 1 0/02/2006. 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org CERTIFICATES OF DEPOSIT: Account NumbedSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 44443-54 09/29/2006 $2,285.98 $1.49 $2.287.47 Thomas Mitchell 09/29/2006 M M RS 1sTF ERA (:RE ON Danielle A. Kline Lending Insurance Support Specialist November 9, 2011 Estate of: MABEL M. MIl?CHELL Date of Death: 05/29/2011' Social Security Number: 578-24-8866 1 S CALtJ S - ~s ~~ ~ .. I~'1 ~'~~lL~',/"C L!(.~ll,/'d G~ rGLfifi~(.r/i ~aG - ll:~~r~tl. ~- '' .; 11/9/2011 This is to Cert_if y ____, _ ______ _ - WE RAVE THIS DAY EXAMINED AND APPRAISED THE I I, II Blue Fox Shawl Collar Origin: Finland 1 Length: Sweep: ,~ collar: I' Sleeve: II ~ li ~ Monogram: f 'I~ ~ FOR TFIE ESTATE OF: ! Mabel Mitchell i ~,~ ~ ;~ ~ 934 Woodridge Dr N Enola PA 17025 ii ' HAVE: DETERMINED ITS PRESENT CASH VALUE TO BE: ._- - -- ii -NSC.4LUS FURS ,k 4i ~ - -_ ; , -~~~- I'1 ~ _N f '20.04 Per ~`~. -_.., ~= :--~ ~ = ---•-"--- -------------•-- I :_>-- t www.m~scalusfurs.com • 4669 Jonestown Rd Harrisburg, PA 17109 Tei: (717) 5145-9878 • Fax (717) 540-5308 • email: muscaiusfurs@comcast.net ~J - _ __ _ __ - - -- _ -- - J //~ it S CALt.~ S ~s `~- Jf~/l~t'~'C' ~!(~t'•~!r-tr c: ~GLr~r~lrri irG ~f~~~tc~~~~l- `; I'~LtS LS t0 Cer'~lfy __ 11/9/2011 WE HAVE THIS DAY EXAMINED AND APPRAISED THE 1 Black Sheared Rabbit Cape Origin: United States. Length: 28 inches Sweep: 90 inches Collar: Shawl Sleeve: Monogram: FOR THE ESTATE OF: Mabel Mitchell 934 Woodridge Dr Enola PA 17025 HAVE DETERMINED ITS .PRESENT CASH VALUE. TO BE: _ - ____ I~ MUSCALUS FURS ~ 35.00 Per ~~~--~ ;~ -~ ~ -------- ~- www.muscalusfurs.com •4669 Jonestown Rd Harrisburg, PA 17109 Tel: (717) 545-9878 • Fax (717) 540.5308- email: muscalusfurs~comcastnet 0 - Q 1 SCALDS ~~s ~^ ~~ 11/9/2011 Th-is is-to Certify WE HAVE THIS DAY EXAMINED AND APPRAISED THE Black Persian Stroller w/Azurene Mink Collar Origin: Afghanistan/United States Length: 33 inches Sweep: 60 inches Collar: Shawl Sleeve: Semi-Dolman Monogram: Trudy M Kauffinan FOR THE ESTATE OF: Mabel Mitchell { 934 Woodridge llr Enola PA 17025 HAVE DETERMINED ITS PRESENT CASH VALUE TO BE. MUSCALUS FURS 75.00 /~ ~~~ ~ ~ Yw' www.muscaiusfurs.com • 4669 Jonestown Rd Harcisburg, PA 17109 Tel: (717) 545-9878 • Fax (717) 540-5308 • email: muscalusfurs~comcastnet - ----- :~ o ~~ 17'h~s is to Certify li~si2oii I I~ VVE .HAVE THIS DAY EXAMINED AND APPRAISED THE ~ Brown Dyed Mouton Stroller Origin: United States Length: 32 inches Sweep: 7o inches Collar: Shawl Sleeve: Semi-Dolman w/Top Cuff Monogram: FOR THE ESTATE OF: Mabel Mitchell ~ 934 Woodridge Dr Enola PA 17025 HAVE DETERMINED ITS PRESENT CASH VALUE TO BE. ` MUSCALUS FURS ,% ~ 75.00 '~ $ -- / er / l • -----'1-~ ~ ~---------• www:muscalusfurs.com • 4669 Jonestown Rd Harrisburg, PA 17109 Tel: {717):545-9878 • Fax (717) 540-5308 • email: muscalusfurs~comcast.net o ____ _ __ __ _ _ - -- _ o __ __ _ __ ___-_ __- __ __. o Rev-7509 EX+ (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Mitchell, Mabel M. 21 11 0794 A. John L. Mitchell B. Charlene Mitchell C. Christine Shultz 934 Woodridge Drive Son Enola, PA 17025 934 Woodridge Drive Daughter-in-Law Enola, PA 17025 RD#1, Box 489 Granddaughter Millerstown, PA 17062 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE /o OF ° DECD'S INTEREST DATE OF DEATH DECEDENT'S NTEREST 1 A, B 05/29/2008 Members 1st Federal Credit Union -Savings 392.99 33 333% 131 00 Account No. 44443-00. Principal balance at . . date of death $392.91; accrued interest $.08. 2 A, B 05/29/20x8 Members 1st Federal Credit Union -Checking 21,391.21 33.333% 7,130.40 Account No. 44443-11. Principal balance at date of death $21,389.56; accrued interest $1.65. 3 A, B 05/29/2088 Members 1st Federal Credit Union - 9,096.02 33.333% 3,032.01 Investment Savings Account No. 44443-05. Principal balance at date of death $9,093.58; accrued interest $2.44. 4 C 09/26/20x6 Members 1st Federal Credit Union - 2,287.47 50.000% 1,143.74 Certificate of Deposit No. 44443-40. Principal balance at date of death $2,285.98; accrued interest $1.49. 5 D 09/29/2008 Members 1st Federal Credit Union - 2,287.47 50.000% 1,143.74 Certificate of Deposit No. 44443-42. Principal balance at date of death $2,285.98; accrued interest $1.49. Total of Continuation Schedule ee attached page TOTAL (Also enter on Line 6, Recapitulation) I 18,630.39 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY continued Mitchell, Mabel M. LE NUMBER 21-11-0794 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. JOINTLY OWNED PROPERTY ITEM NUMBER LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 6 B 09/02/20p8 Members 1st Federal Credit Union - 5,236.56 50.000% 2,618.28 Certificate of Deposit No. 44443-43. Principal balance at date of death $5,234.15; accrued interest $2.41. 7 E 09/29/2006 Members 1st Federal Credit Union - 2,287.47 50.000% 1,143.74 Certificate of Deposit No. 444434. Principal balance at date of death $2,285.98; accrued interest $1.49. 8 F 05/29/20Q6 Members 1st Federal Credit Union - 2,287.47 50.000% 1,143.74 Certificate of Deposit No. 44443-53. Principal balance at date of death $2,285.98; accrued interest $1.49. 9 G 05/29/2006 Members 1st Federal Credit Union - 2,287.47 50.000% 1,143.74 Certificate of Deposit No. 44443-54. Principal balance at date of death $2,285.98; accrued interest $1.49. TOTAL (Also enter on Line 6, Recapitulation) 18,630.39 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) SCHEDULE F JOINTLY OWNED PROPERTY (Continued) Estate of Mabel M. Mitchell File Number 21-11-0794 SURVIVING JOINT TENANT'S ADDRESS RELATIONSHIP TO NAME DECEDENT D. Jeffrey Mitchell 15038 Clayton St. Grandson Thorton, CO 80602 E. Amy Weller 902 Sheffield Ave. Granddaughter Mechanicsburg, PA 17055 F. Janelle Grosser 401 Pitt St. Granddaughter Enola, PA 17025 G. Thomas Mitchell 335 4th St. Grandson New Cumberland, PA 17070 MEMBERS 1St FEDERAL CREDIT UNIION SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interesfto Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 44443-00 10/04/1985 ' $392.91 $.08 $392.99 John Mitchell & Charlene Mitchell 05/29/2008 CHECKING ACCOUNT: Account Number/Suffix 44443-11 Date Account Established 04/30/1997 Principal Balance at Date of Death $21,389.56 Accrued Interest to Date of Death $1.65 Total Principal and Accrued Interest $21,391.21 Name of Joint Owner John Mitchell & Charlene Mitchell Date Joint Ownership Established 05/29/2008 INVESTMENT SAVINGS /{ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date tlf Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CERTIFICATES OF DEPOSIT: 44443-05 07!05/2000 $9,093.58 $2.44 $9,096.02 John Mitchell & Charlene Mitchell 05/29/2008 Account Number/Suffix 44443-40 44443-42 44443-43 Date Account Established 09/29/2006 09/29/2006 09/0212008 Principal Balance at Date oil Death $2,285.98 $2,285.98 $5,234.15 Accrued Interest to Date of Death $1.49 $1.49 $2.41 Total Principal and Accrued Interest $2,287.47 $2,287.47 $5,236..56 Name of Joint Owner Christine Shultz Jeffrey Mitchell Charlene Mitchell Date Joint Ownership Established 09/26/2006 09/29/2006 09/02/2008 CERTIFICATES OF DEPOSIT: Account Number/Suffix 44443-44 44443-45 44443-53 Date Account Established 09/29/2006 09/02/2008" 09/29/2006 Principal Balance at Date of Death $2,285.98 $11,578.34 $2,285.98 Accrued Interest to Date of Death $1.49 $5.33 $1.49 Total Principal and Accrued Interest $2,287.47 $11,583.67 $2,287.47 Name of Joint Owner Amy Weller None Janelle Grosser Date Joint Ownership Established 09/29/2006 09!29/2006 'Rollover from certificate 44443-55, originally established 10/02/2006 5000 Louise Urive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established. Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 44443-54 09/29/2006 $2,285.98 $1.49 $2.287.47 Thomas Mitchell 09/29/2006 M M RS 1sT ERA CRE ON Danielle A. Kline Lending Insurance Support ;specialist November 9, 2011 Estate of: MABEL M. MITICHELL Date of Death: 0512912011'.. Social Security Number: $78-24-8866 REV-1151 EX+ (10-06) p N SCHEDULE N COMMNHEWREAN ETF R TSRNANIA FUNERAL EXPENSES ~ RES~'ITT°'~"~" °~`E°~"`~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Mitchell, Mabel M. 21-11-0794 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 1,130.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zi° Yearls) Commission raid 2. Attorney's Fees Bogar & Hipp Law Offices 3,990.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationshi° of Cllaimant to Decedent 4. Probate Fees 118.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Cpsts 785.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 6,023.50 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Mitchell, Mabel M. FILE NUMBER 21-11-0794 ITEM NUMBER DESCRIPTION AMOUNT Funeral ExQenses 1 Esther's Country Kitchen -funeral luncheon 1,130.00 H-A 1,130.00 Other Admini trative ost~ 2 Muscalus Furs -appraisal fee 35.00 3 RESERVES: -Costs to conclude administration of Estate, including filing of PA Inheritance 750.00 Tax Return and Inventory, preparation and filing of Fiduciary Income Tax Returns and gravemarker H-B7 785.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV•1513 FJ(+ (11-08) SCHEDULE J COMM_Q~R DEN~E ECEDEEN~RNAN~A BENEFICIARIES ESTATE OF FILE NUMBER Mitchell, Mab 1 M. 21-11-0794 NUMBER NAME AND ADDRESS OF PERSOW(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE I~ TAXABLE DISTRIBUTIONS [include outright spousal (Words) ($$$) distributions, and transfers under Sec. 9116 a 1.2 Charles J. Mitchell Son One-third of rest 602 Lake Meade Drive , residue and East Berlin, PA 17316 remainder John L. Mitchell 934 Woodridge Drive Son One-third of rest, Enola, PA 17025 residue and remainder T. Donley Mitchell 335 4th Street Son One-third of rest, New Cumberland, PA 17070 residue and remainder Total Enter dollar amounts or distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro i NON-TAXABLE DIS RIBUTIONS: II. A. SPOUSAL DISTRIIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX: IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTEF2_TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET Copynght (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)