HomeMy WebLinkAbout01-24-12 1505610105
REV-1500 °` (~-~s, (~
PA Departmentof Revenue nsytvania OFFICIAL USE ONLY
pen
Bureau of Individual Taxes ~
"`°'""°""` County Code Year Fle Number
INHERITANCE TAX RETURN "'""
PO Box28o6oi Z ~ '
~ ~~0
Harrisburg, PA 1712s-o6oi RESIDENT DECEDENT /
: ~
_,,..
ENTER DECEDENT INFORMATION BELOW
Socal Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
191-18-4886 04/01/2011 :12/23/1923
Decedent's Last Name Suffix Decedent's First Name MI
,Foster Betty M
(If Applicable) Enter Surviving Spouse's Information BeloNr
Spouse's Last Name , Suffix Spouse's First Name MI
. E
_~..,~_._..__....~.,..m.... ~~.~. ... ..,..._., ...
Spouse s Social Security Number ',
..... ... .. .w~..w. _ ~._.__,
~~~~`~~~ THIS RETURN MUST BEFILED IN DUPLICATE WITH THE
~._~~_.~~~~ _ ...__.. REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (Date of Death
Prior to 12-13-82)
C~ .4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required.
death after 12-12-82)
dD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 '' 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. Elecction 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 CONFIDENTU\L TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Ronald E. Johnson, Esq ~ X717) 243-0123
corresponaenYs e-maifadaress: rejohnson~pa.net
PA 17013
Under penalties of perjury, I declare that I have examined this return, including axompanying schedules and statements, and to the t>~t of my knowledge and belief,
it is true, carted and complete. Declaration of preperer other than the personal representable is based on all infom>ation of wh~h preparer has arty knowledge.
SIG TORE O~~RESPONSIBLE FOR FILING RE?~1RN ~ - DATE
C/o 78`. ` e81
o ~78 Wesi
t~-,
Street, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
1505610105
Side 1
1505610105
-REV--1500 EX (FI)
L)ecedent's Name:. Betty M. Foster
Decedent's Social Security Number
191-18-4886
RECAPfTULATION
L Real Estate (Schedule A) ............................................. 1. 162,000.00
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. 214;221.44
8. Jointly Owned Property ($chedule F) O Separate Billing Requested ....... 6. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested:....... 7. 425,199 07
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ' ~ 801,420 51
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. i
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10.
11. Total Deductions (total Lines 9 and 10) ................................. 11.
12. Net Valu® of Estate (Line 8 minus Line 11) .............................. 12.
13. Charitable and Governmental BequestslSec 9113 Trusts for which "``""""
an election to tax has not been made (Schedule J) ......... . .............. 13.
14. Nat Value Subject to Tax (Line 12 minus Line 13) ........................ 14.
33,960.46
594.52
34,554.09
766,865.53
0.00
788,865.53
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 _.._,,, . _.. _.... ....._.;, . _..._.. _ ._ .._._ „______ _.._
(ax1.2) X .0_ - 15. 0.00
~.. ~._ .a.,~~, ,,,~,~ .,.w~n
16. Amount of line 14 taxable "~~`~"~`~""`~'
at lineal rate X .0~ 766,865.53: 1ti.
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.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610205
Side 2
34,508 95
0.00
0.00
34,508.85
O
1505610205 J
REV-1500 EX (FI) Page 3
Decedent's .Complete Address:
Flle Number
DECEDENTS NAME
Betty M, Foster
STREETADDRESS
921 West LoutherStreet -
CITY
Carlisle STATE
PA 21P
17013
Tax Payments and Credits:
L Tax Due {Page 2, Line 19)
2. Credits/Payments
A. Priorpayments 32,000.00
B. Discount 1,684.21
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(1) 34,508.95
Total Credits (A+ B) (2) 33,684.21
(3)
0.00
(4) 0.00
(5) 824.74
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 properly 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 properly, which
contains a beneficiary designation? ........................................................................................................................ ~ ^
1F THE ANSWER TO ANY OF THE ABOVE QUESTIONSIS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 1T AS PART OF THE RETURN.
y:
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 sunving spouse
is 3 percent [72 P.S.: §9116 (a) {1.1) (i)].
For dates of death on or after Jan. 1, 1995, thetax 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 stiN applicable even if the surviving spouse is the only beneficiary.
For dates of death on grafter July 1, 2000:
• The tax rate imposed on the nef 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 parentor 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 useof the decedents lineal berefiaaries 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 decedents siblings is 12 percent [72 P.S. §9116(a)(1.3)}. A sibling is defined,
underSection 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
LAST WILL AND TESTAMENT
OF
BETTY M. FOSTER
I, BETTY M. FOSTER, of North Middleton Township,. Cumberland County, Pennsylvania,
being of sound aril disposing mind, memory and understanding, do hereby make, publish and declaze
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 my just debts and funeral expenses, including my grave
marker, shall be paid from the assets of my estate as soon as practicable after my decease.
SECOND: I give, devise and bequeath the residue of my estate, of every nature
and wherever situate, to my children, equally, namely, DIANNE M. SCHOONOVER and DEBRA
A. SMITH,. provided that the shaze of either daughter who predeceases me or dies on or before the
thirtieth day following my death, shall be distributed to.her issue, .perstirpes, living on the thirty-first
day following my death, and in default of such then living issue, such shaze shall be added to the
share or shares for my other child.
THIRD:. I direct that all taxes that may be assessed in consequence of my death,.
of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary_ estate as a
part of the expense of the administration of my estate.
FOURTH: I nominate, constitute and appoint, my daughters, DIANNE M.
.. SCHOONOVER and DEBRA A. SMITH,. or the survivor.thereof,as~~Co~ExeEUtriees~~of this my
Last Will and Testament.
FIFTH: I direct my Executrices and her successors shall not be required to give
bond for the faithful performance of their duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last WiII and
Testament, consistin of three (3) typewritten pages, each identified by my signature, this ,?f
day of h , 2006.
~~1. ~~_ (SEAL)
Betty M. F ster
Signed, sealed, published and declared by the above-named Testatrix, Betty M. Foster, as and
for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence,
and in the sight and presence of each other, have hereunto su~se>;%pedett~i am~es as witnesses.
COMMONWEALTH OF PENNSYLVANIA )
SS
COUNTY OF CUMBERLAND )
I, BETTY M. FOSTER, Testatrix, 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 and Testament; that I signed it willingly; and that I signed it
as my free and voluntary act for the purposes therein expressed.
Sworn or .firmed to anal acknowledged before me by Betty M. Foster, the Testatrix, this
_ day of _. ~~; _ -,;, ~ `'~ , 2006.
T ~4., (SEAL)
NOTARIAL SEAL Betty , .Foster Testatrix '
SHELLY SEXTON, Notary Public - ~ i ~ ~'N
Cat'lisle Boro, Cumberland County ~ ~ FF; ~~ ~ '
iviy Commission Expires April 26, 2007 Not ~ Publi
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
. SS.
COUNTY OF CUMBERLAND )
--~--~ J
We, RONALD E. JOHNSON and 1 ~ ~(tUt'' ~'~'~i~~fJ~ ,the witnesses
whose names are signed to 'the attached or' foregoing instrument; being duly qualified according to
law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her
Last Will and Testament; that Betty M. Foster, signed willingly and that she executed it as her free
and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the
Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that
time 18 or more years of age, of sound mind and under no constraint or undue influence.
0 or~fi ed to and subscribed to before me by RONALD E. JOHNSON
~x~~ ~ ~~~~~i~", witnesses, this ~_~ day of
~ -ti~ f~ , 2006,
NOTARIAL SEAL
SHELLY SEXTON, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires April 26, 2007
REV-15o2 EX+ (11-08)
~~ ~~ pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHe,urnNCE Tnx RETURN REAL ESTATE
RESIDENT DECEDENT
oCUy rvi. r~stCi L1-71-UbU3
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 wllling 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
i. ~ ALL THAT CERTAIN tract of land situate in North Middleton Township, Cumberland County, 1.62,000.00
Pennsylvania containing .69 acres and being improved with a ranch style home known and
numbered as 921 West Louther Street, Carlisle, PA 17013
See Deed Book U, Volume 28, Page 952
(see settlement sheet attached)
TOTAL (Also enter on Line 1, Recapitulation.) $ 162,000.00
If more space is needed, insert additional sheets of the same size.
OMB Approval No. 2502-0265
~• A. Settlement Statement (HUD-1)
Q Conv. Unins.
~ RHS 3
Q FHA 2
1 6. File Number. 7. Loan Number: 8. Mortgage Insurance Case Number.
.
.
. 2012-017 0405550799 10-106.0627025
4.0 VA 5. ^Conv. Ins.
C. Note: This form is furnished to give you a statement of adual settlement costs. Amounts paid to and by the settlement agents are shown Items marked
"(p.o.c)' were paid outside the Dosing; they are shown here for informational purposes and are not inGuded in the totals.
D. Name 8: Address of Borrower: E. Name 8 Address of Seller. F. Name 8 Address of Lender:
Locksley Richards, Adeline Richards Estate of Betty Foster Wells Fargo Bank, N.A.
1198 Newville Road, Cadisle, PA 17015 2701 Wells Fargo Way, Minneapolis, MN
55467-8000
G. Property Location: H. Settlement Agent I. Settlement Date: O'V202012
921 W. Louttter Street PA Real Estate Setllemerit Seryices, LLC Disbursement Date: O'V202012
Carlisle, PA 17013 354 Alexander Spring Road, Cadisle, PA 17015
North Middleton Township
Teiephone:717-249-0333 Fax:717-249-7334
Place of Settlement TitleExpress
354 Alexander Spring Road, Cadisle, PA 17015 Printed O'V2012012 at 11:41 am
by BJD
100':: GrossAmouitt Due from Borower ~ 400. Gross Amount Due to Seller
101. Contract sales price 162,000.00 401. Contrail sees price 162,000.00
102. Personal 402. Pers al
103. Setlmement charges b borrower (line 1400) 11,095.50 - 403.
104. 404.
105. - 405.
Ad ristments for Items aid b seller in advance Ad ustments for items aid b setter in advance
106. Cityftown taxes to 406. Cityftown taxes to
107. County taxes to 407. Coynty taxes to
108. Assessments 01202012. b 06/30/2012 876,02 408. Assessment 01120/2012 to06/30/2012 876.02
109. 409.
110. 410.
111. 411.
112. 412.
120• Gross Amount Due from Borrower 773,971.52 420. Gross Amount Due to Seller 162,876.02
200: Amounb-Paid b or in BehaH of Borrower 500. Reductions In Amount Due to Seller
201. Deposit a earnest money 1,000.00 501. Excess depos (see inswtdlorts)
202. Pdnripal amount of new loan(s) 167,300.D0 502. Settlement charges b seller (One 1400) 11,798.46
203.. ExisB s taken su 'eG to 503. F~cisfln s taken su ect b
204. Lender Paid Closing Costs 1,000.00 504. Payoff of first mortgage ban
205. Over Tderance 40.00 505. Payoff of second narlgage loan
206. 506.
207. 507.
208. 508.
209. 509.
Ad ustmenta for items un aid b seller Ad'ustments for items aid b setler
210. Cityftown taxes to 510. Citlrftavm taxes to
211. County taxes D1/012012to0120/2012 2427 511. County taxes 011D72012to01/20/2013 24.27
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
~0• Total PaM b Ifor Borower 169,36417 520. Total Reduction Amount Due Seiler 11,822.73
300.', Cash'at Settlement fromito Borrower `, --. • 600. Cash at Settlementtolfrom Seiler
301, Gross amount due from borrower (line 120) 173,971.52 601, Gross amaint due to sells (line 420) 162,876.02
302, less amounts paid byftor borrower (line 220) 169,364.27 602 Less reductions in ariwunt due seler (fine 520) 11,62273
303. Cash QX From ^ To Borrower 4,607.25
~« 603. Cash 0 To ^ from Seller 151,053.29
Previous editions are obsolete Page 1 of 4 HUD-1
Z00..TotaLRealEstateBrokerFees :' $10,015.00 Paid From Paid From
Divisionofcorgmission Iihe700 as follows: Borrower's Seller's
701• $p•00 to Funds at Funds at
702• $10015.00 to Prudentlal Homesale Services Group Settlement Settlement
703. Cortsnission paid al settlement 10,015.00
800:' Rems Pa ble in Connection with Loan
801. Our aiginafion charge (Indudes Odginatlon Print0.000% a $0.00) $ (from GFE #1)
802. Your credit or charge (prints) for the spedOc interest rate chosen ; (from GFE #2)
803: Your adjusted odgina8on charges (from GFE A)
804. Appraisal fee to RELS ValuaDon $378.00 P.O.C. B (from GFE #3) . ~,W
805. Credit report to RELS Credit $22.00 P.O.C: B . (from GFE #3)
806. Tax service to from GFE #3
807. Flood certifice0on to from GFE #3
808. to
900. z Items Re aired b Lender to be Paid iti.Advarice,
901. Dafty interest charges from from 0112012012 to 02/01/2012 ~ $17.19001day (from GFE #10) 206.28
902. Mortgage insurance premium fa months to rtment of VA (from GFE #3) - 5,346.00
903. Homeowners insurance for 1 ears to USAA (from GFE #11) 597.83
~• months to from GFE #11
1D00. Reserves De osited with ender
1001. Initial deposit for your escrow arxxwnt (from GFE #9) 1,423.76
1002. Homeowner's insurance 3 months $ 49.82/monfh $149.46
1003. Mortgage insurance months $ O.OO/month $
1004. Pro taxes monies $ /month -
1005. County taxes 12 months $ 38.97/month $467.64
1~• ~~ 8 months $ 163.92lnwnth $1,311-.36
1007. Aggregate Adjustment $-504.70
::1100.,Ti0e:Cha es: -
110 . TiBe services and lender's tltle insurance fran GFE #4 1,504,75
1102. Settlement a closing fee to $
1103. Owner's tltle insurance from GFE # 116.88
1104. Lender's Dtle insurance $1,423.75
1105. Lender's Otle pdicy 8mit $167,300.00 LendersPolicy
1106. Owner's tltle priicy IimR $162,000.00 Owner's Priicy
1107. Agent's patlon of the total tltle insurance premium $1,268.29
1108. Underwriter's portion of the total tltle insurance premium $272.34
1109• Notary Fee i to Shell Sexton 40,00
120D. Government Recordin and Transfer Cfia es
1201. Government rewrding charges $ (from GFE #7) .164.00
1202. peed X2,00 Mort a $102.00 .Release $
1203. Transfer taxes $ (from GFE #8) 1,620.00
1204. City/County tax/stamps peed 51620.00 Mort e $
1205. StateTax/stamps Deed $1,620.00 Mort $ 1,620.00
1206. Deed $ Mat a $
`1300..'AddMlohal Set0eme6f Cha es~ ` ' ' :`
1301. Required. services that you can shop fa (from GFE #6) 119.00
1302. Final Wtr/Swr Bill to fJatlt Middleton Authod 123.4
1303, lax Service Fee to Wells F Flood & Tax Service $100.00
1304. Flood (Life of Loan) to Wells Fa Flood & Tax. $19.00
1305. to
''r r 11,095.50 11,798.46
'Paid outside of dosing by{B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(I~er. "Credft by lender shown on page t. "'Credit by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-1
,CbmparisoeofGoodFaittrF_stlmate GF and HUD-1.Cha "es , :
Cha 'es `fhafCannot lricrease• :HUD-1 Line Number
'
`Our ". - na6dn'di" .
~ : : ; #,801.
•Y "r aedit'cr'tdti nt5 for the s inferestrate chosen ~ # 802. '
Youradjuated:orlginatloncharges # :803'.
:Transfer taxes ~ ~.':: - : ,.. .. ;: #..1203 ,..
Cha'' es That fn Total Cannot Increase More Th'an.10°h
Govemmanhrecordingch~rges; <
. .. # 1201. ,
. Appraisal fee •. .: .. _ - .. .. # 8~
Credtt report # 805
-Mortgage..insuranceprernium :` . , #902
:;Title.senricesandlender'stiUe.insurance •....# .1101.:
Owaer's title Insurance ~ • '# :1103 ._
-,Tax.Service Fee ~.:: # .1303
Fbod:(L•Ife of Loan)-,. ,;,, •: • '; :#.1304 :..,
Ch " es.TtratCah•Chan e ~ ":-.
.. .
;Intliai depostl far'your esaow account - , .: # 1001 .
. Daily, intaest;chargesfiom •< #901 ~ :.. $17.19001d
Homeowrters insurance , ; #•.903 ;
#'
#, .. .
Loan Teens
.Good Faith Estimate HUD-1 '
0.00 0.00
0.00 0.00
0.00 0.00
3,320.00 1,620.00
Good Faith Estimate HUD-1
180.00 , 164.00
375.00 375.00
23.32 22.00
5,346.00 5,346.00
1,314.85 1,504.75
100.00 116.88
100.00 100.00
19.00 19.00
7,458.17 7,647.63
$ 189.46 2.5403%
Good faith Estimate. HUD-1
2,500.00 1,423.76
34.38 208.28
400.00 597.83
Youririitial loan'amorrnt is $167,300.00
Your loan teroi.~ 30, years
YourinNial Interest rate is 3.7500°
Yourinidal monthly amount owed for princpal, interest, acid any nartgage $774.80 indudes
insurance is - 0 Prindpal
^X Interest
^ Mortgage Insurance
Can your interest rate rise? ^X No. ^ Yes, it can rise to a maximum of %. The fast change
will be on / / and can change again every years after / ! .Every change
date, your interest rate can inaease or decrease by %. Over the I'de of the loan, your
interest rate is guaranteed to never be lower than % or htghm than %.
Everi.H you make payments on~,time can'your loan 6alarioe dse? . ; ;, ^X No. ^ Yes, it can rise to a maximum of $
EverrTfyou make payments ontime can you monthly amount owed for ^X No. ^ Yes, the first inaease can be on I I and the monthly
principal; interest; and mortgage' insurance rise? : , amount owed can rise to $
The maximum it can ever rise to is $
,.... .
Does your loan have aprepayment penallj/7
^X No.. ^ Yes, your maximum prepayment penalty is $
Does;Xour loan Have a balloon payment? ^X No. ^ Yes, you have a balloon payment of 5 due in
years on I I
Totat monthly amount awed inciud}ng esaow account payments ^ You do not have a monthly esaow payment for items, such as property taxes
-': and homeowners insurance. You must pay these items diredly yourself.
X^ You have an additional monthly escrow payment of $252.71
that results in a total initial monthly amount owed of $1,027.51. This Mdudes prinapa( interest, ar
mortgage insurance and any items chedu~l bebw:
" X^ Properly taxes Q Homeowner's insurance
" ^ Flood insurance ^
,. ^ ^
Note: If you have any questions about the Settlement Charges and Loan Teens listed on this form, please intact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlemeht Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction I further certify that I have received a copy of the HUD-1 Settlement Statement
~~
r l_--
Locksley Richards Adeline Richards
Estate of Betly F
TheJ'IUD-1 Settlement Statement which I have prepared is a tNeand axurate account of this transaction I have caused or will cause the funds t0 be
disbursed in accoMance with this statement
SETTLEMENT AGENT ~' DATE
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010.
Previous editions are obsolete ~ Page 4 of 4 HUD-1
~ ~ ~,
Name of Borrower.
Locksley Richards
Adelina Richards Name of Seller.
Estate of Betty Foster Flle Number
2012-017
TltleExpress
Prepared 01/19/2012 at 3:33 pm
Note: This page is furnished to give you an itemization of the amounts shown on
Lines 1101,1103 and 1104 of the Settlement Statement (HUD-1). This page
accompanies bu# is not a part of the settlement statement. if a discrepancy
exists, the information shown on the Settlement Statement (HUD-1) applies. `Paid Fr'orn '
BOrroinier's
Funds'af ..
;Settlement' '.Paid From::
`: Sei{et's ' ,
Funds; aY• '.
`Settlement
~> ' Am'o'unts Inctudeit
1100 Title Charges s:In Line 7101::
1101. TiOe services and lenders title Insurance 1,504.75
a. WIre Fee $ 12.00
b. Processi Fee 49.00
c. Nota Fee 20.00
61.00
1102 Settlement or dosin fee
1103. Owners title insurance i $ 116.88 116.88
1104. Lenders title insurance i 1,198.75 $. 1,423.75
a. Endorsement900 EPL-Residential 50.00
b. Endorsement100 No ~dation 50.00
c. Endorsemeni 300 Surve 50.00
d. Closin Service Letter 75.00
(Tota11103+1104)
1105:"Lendet's:title" i lfrriiC'$167;300:00"
i1os:ow<ierstide" umiir$1~2;000:00~
.ti07.:'A' fs ~': `""ofihetotattWeiri`surarice: mium $ 1,268.29" ;
1108.: `Underwriter's`" of the tofal:title~iirsurance`piem 272.34`:
'(Tota11107+1:108)'
1109.
1110.
1111.
1112
ESTATE OF BETTY FOSTER
to 1/20/12 i ~ Date 1120/12
Locksley Richards
~~ ~ Date 1/20/12
Adelina Richards
~.. . ~
REV-i5o8 EX+ (li-1o)
' ~~ ' penlnsylvania
`- DEPARTMENT OF REVENUE
fNHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Betty M. Foster 21-11-0503
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. Checking account no: 411345 - Orrstown Bank -see letter attached 10,678.94
2. .Certificate of Deposit no: 4000035779 - Orrstown Bank -see letter attached ~ 90,025.89
3, Regular savings account no: 20428-00 -Members 1st FCU 3,869.78
4, Investment Savings account no: 20428-05 -Members 1st FCU 22,013.83
5, Certificate of Deposit no: 20428-41-Members 1st FCU 25,320.25
g, Certificate of Deposit no: 20428-42 -Members 1st FCU -see letter attached for Items 3-6 28,946.28
' 7, Savings account no:15004200600119 - M&T Bank 10,669.47
g, Checking account no: 2673058588 - M8~T Bank -see letter attached for Items 7-8 15,485.86
g, furniture and personal property (see appraisal attached) $7,000.00 - $4,950.00
Less: 1999 Chevrolet Malibu LS -reported as Item 10. 2,050.00
10. 1999 Chevrolet Malbu LS -proceeds from sale 3,500.00
11. The Sentinel -refund gp.23
12. ComcasE-refund 98.68
13. Ewing Brothers Funeral Home -refund 60.88
14. Carlisle Regional Medical - refund of overpayment 250:00
15. Nationwide Insurance -automobile insurance refund 319.60
16. Locksley D. Richard and Adelina M. Richards -reimbursement for real estates paid in advance (net) 851.75
(see settlement sheet attached to Schedule A)
TOTAL (Also enter on Line 5, Recapitulation} $ 214,221.44
If more space is needed, use additional sheets of paper of the same size.
June i 5, 2011
Ronald E. Johnson
Andrews & Johnson Attorneys at Law
78 West Pomfret Street
Carlisle, PA 17013
Fax: 243-0061
Re:_ Estate ofBettyM. Faster
Social Security Number 191-18-4886
Date afDeath ~/1/11
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
.FOLLOWING ACCOUN'T'S WITH ORRSTOWN BANK:
CHECKING ~iCCOrTNT
Account No.- 4i 134.
Account Type- Relation Interest Checking _ .
Date Opened- 12/15/97
Joint. Account tname/date)- No - .
Balance- $10,678.91
Accrued Interest- $0.03
CERTIFICATE OF DEPOSIT
Account No.- ~ 4000035779
Account Type- 12-17 Month Income CD
.Date Issued- 11/20/09
Joint Account (name/date}- No
Balance- $90,000.00 _
Accrued Interest- $25.89
.. Best Regards...
n
~~=~~=~
K-~
Jill R. Worthington
Deposit Processing Clerk 2695 Philadelphia Avenue
' ` Chambersburg, PA 17201
. 1.888.ORRSTOWN
wvvw.arrst~-~rn.c+~m
V1~t4J 1 VVYIV
BAl~
A Tradition o, f Excellence
Q ~~s~~
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Phone 888-502-4349
Fax _(302) 934-2955
Apri127, 2011
Andrews and Johnson
Attn: Ronald E Johnson
78 W Pomfret Street
Carlisle, PA 17013
Re: Estate of Betty M Foster
Social Security: 191-18-4886
Date of Death: April 1, 2011
Dear Sir or Madam:
Per your inquiry on Apri122, 2011, please be advised that at the time of death, the above-named decedent had
on deposit with this bank the following:
1. Type of Account
Account Number
Ownership (Names ofl
Savings Account
15004200600119
Betty M Foster
Debra A Smith (POA)
Dianne F Schoonover (POA)
1224/82
$10,669.32
,$ .IS
$10,669.47
Checking Account
2673058588
Betty M Foster
Debra A Smith (POA)
Dianne F Schoonover (POA)
01/l4/$6
$15,485.82
$ .04
Opening Date
Balance on Date of Death
Accrued Interest
Total
2. Type of Account
Account Number
Ownership (Names o, fl
Opening Date
Balance on Date of Death
:Accrued Interest
Total
$15,485.86
MEMBERS 1St
FEDERAL CREDIT L7NION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 20428-00
Date Acx:ount Established 04/20/1978
Prinapal Balance at Date of Death $3,869.78
Accrued Interest to Date of Death $0.00
Totat Principal and Accrued Interest $3,869.78
Name of Joint Owner None
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 20428-05
Date Account Established 08/21 /1995
Principal Balance at Date of Death . $22,013.83
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $22,013.83
Name of Joint Owner. None
CERTIFICATES OF DEPOSIT:
Account Number/Suffix 20428-41
Date Account Established 05/24/2010
Principal Balance at Date of Death $25,320.25
Accrued-Interest to Date of Death $0.00
Total Principal and Accrued Interest $25,320.25
Name of Joint Owner None
CERTIFICATES OF DEPOSIT:
Account Number/Suffix 20428-42
Date Account Established 05/24/2010
Principal Balance at Date of Death $28,946.28
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $28,946.28
Name of Joint Owner None
- E BERS 1sT FEDERA CREDI ION
anielle A. Kline
Lending Insurance Support Specialist
April 27, 2011
Estate of: BETTY M. FOSTER
Date of Death: 04/01/2011
Social Security Number: 191-18-4886
5000 Louise Drive P.O. Bog 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslstorg
LINDEN HALL ANTIQUES
211 N. OLD STONE HOUSE ROAD
CARLISLE, PA 17015
717-249-1978
To: Ronald E. Johnson, Esquire
78 West Pomfret Street
Carlisle, PA 17013
From: William G. Rowe, Appraiser
211 N. Old Stone House Road
Carlisle, PA 17015
Re: Personal Property Appraisal
Betty M. Foster Estate
921 West Lowther Street
Carlisle, PA 17013
Date: May 26, 2011
LIVING ROOM
Lamp
Wall hangings
Piano stool
Wing chairs -pair
Retainer
Sofa /chair
Lamps
Oak ice box cabinet
T.V. _
Mahogany stand
Lamp
Sewing machine
HALL
Dresser
Stereo set
Oval mirror
OFFICE
Desk /chair
Chest of drawers
Books /office supplies
DINING ROOM
Dining room set
Collectibles
Stand
Miscellaneous household
$15.00
$25.00
$25.00
$100.00
$40.00
$30.00
$20.00
$65.00
$30.00
$40.00
$20.00
$10.00
$15.00
$10.00
$30.00
$20.00
$15.00.
$10.00
$200.00
$15.00
$10.00
$25.00
Foster Appraisal 1 05/26/2011
..KITCHEN
.Small appliances
Pots /.pans
Table / 2 chairs
Miscellaneous household
Refigerator
LAUNDRY ROOM
Washer /dryer
Cart
Small freezer
Cabinet
SUN ROOM
Wicker patio set
Plastic patio chair
Exercise bike - no value
GARAGE.
Tools
Weedeater
Animal trap
Mower.
Riding mower -Simplicity 12.5
Miscellaneous tools
Ladders
Garden tools
Floor jack
Snow thrower
Miscellaneous garage items
Automobile -1999 Chevrolet Malibu LS, tow mileage, passenger side restored
BEDROOM #1
Bedroom set
Office chair
Collectibles
.Wheelchair
BEDROQM #2 ,
Bedroom set
T.V.
Miscellaneous household
BEDROOM #3
Bedroom set
Computer desk
Miscellaneous household
$20.00
$20.00
$45.00
$20.00
$40.00
$100.00
$5.00
$25.00
$10.00
$100.00
$15.00
$0.00
,$15.00
$20.00
$5:00
$35.00
$110.00
$5.00
$30.00
$20.00
$10.00
$25.00
$30.00
$4,950.00
$85.00
$10.00
$15.00
$10.00
$185.00
$10.00
$15.00
$100.00
$10.00
$15.00
Foster Appraisal 2 05/26/2011
ATTIC
Miscellaneous household
Fans
BASEMENT
Shop Vac
Ladder
Cart
Kerosun heater
Miscellaneous tools
Antique pump
Kitchen miscellaneous
$15.00
$10.00
$15.00
$10.00
$10.00
$10.00
$15.00
$25.00
$10.00
TOTAL $7,000.00
William G. Rowe
Foster Appraisal 3 05/26/2011
C
REV-1550 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
Betty M. Foster 21-11-0503
This schedule must be completed and Bled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER. DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE DF TRNiSFER. ATTACH A cow OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
IF APPLICABLE TAXABLE
VALUE
1• Edward Jones Account No: 377-0665-1-3-Transfer on death.
Established 1/6109.
Beneficiaries: Debra A. Smith (daughter) and Dianne F. Schoonover
(daughter)
See attached 406,245.28 100 0.00 406,245.2
2 IRA-Edward Jones Account No: 377-93619. Established 12/28/06
Beneficiaries: Dianne F. Schoonover (daughter) and Debra A. Smith
(daughter)
See attached 18,953.79 100 0.00 18,953.7
TOTAL (Also enter on Line 7, Recapitulation) $ I 425,199.07
If more space is needed, use additional sheets of paper of the same size.
Edward Jones Art Amundsen
21 West High Street Financial Advisor
Carlisle, PA 17013
(717) 258-4688
EdwardJones
May 11, 2011
Ronald E. Johnson
Andrews & Johnson
78 W. Pomfret Street
Carlisle,. PA 17013
RE: .Betty M Foster
DOD values 04/01/2011
Dear Mr. Johnson
The account for Betty M. Foster 377-06665 was a Single and an
IRA account 377-93619.
Enclosed are DOD values for April 1, 2011 as well as copies of the
beneficiary agreements for each account.
Since~ely,
!'f
' ~: -~!
Art Amundsen
AMA/ara
Date Printed: 11-May-2011
Financial Advisor: Art Amundsen r~ ~W~Tll~dneS
Phone:717-258-4688
Page 1 of 1
Historical Pricing for BETTY FOSTER SINGLE ACCOUNT
Symbol. DescriptiortlType
Date
Value
PTEPX PUTNAM PA TAX EXEMPTJNCOME FD SH BEN IN
/~. ~q. r y~ Net asset value (adjusted) 01-Apr-2011
8.6600 USD fro-~~'`~• -' 8
This report is provided by Edward Jones. The report was ca~ulated using third party information. This report is not intended to replace official
documents such as confirmations and/or account statements that should be retained for tax purposes. Past performance is no guarantee of future
results. Edward Jones does not provide tax or legal advice. You should consult your tax and/or legal advisor for your particular situaiion.The historical
cost basis information furnished herein ("Information') is for use by customer ('you'). only and is based on the purchase and sale information provided.
While Edward Jones believes that the information was obtained from reliable sources, Edward Jones does not guarantee the accuracy or completeness
of the Informatbn and Is furnishing the Information to You on an 'as-is' basis. EDWARD JONES MAKES NO WARRANTY OF ANY KIND, EXPRESS
OR IMPLIED, WITH RESPECT TO THE MERCHANTABILITY, FITNESS, CONDITION, USE OR APPROPRIATENESS OF THE INFORMATION. Edward
Jones is supplying the Information on the basis that the Information will be used by You for Your own use and benefd and not for resale or other transfer
to, or use by or for the benefit of, any other person or entity.
Date Printed: 11-May-2011
Financial Advisor: Art Amundsen
Phone: 717-258-4688
Page 1 of 1
Historical Pricing for BETTY FOSTER
Symbol DescriptiortlType
01728AU87 ALLEGHENY CNTY PA HOSP DEV AUT 2009A
~ooo Closing (unadjusted)
084538GF8 BERKS CNTY PA MUN AUTH REV 2009A-
~c~F o0o Closing (unadjusted)
256435GW2 DODGE CNTY NEB SCH DIST NO 001~~DS
Closing (unadjusted)
/v~ ~~~o
59259YBZ1 METROPOLITAN TRANSN AUTH N Y R 2010B-
Closing (unadjusted)
EdwardJones
Date
01-Apr-2011
Value
97.1650 USD ~S.3~g' ~''
01-Apr-2011 100.8790 US~~a D f ~• 9~
01-Apr-2011 98.5720 USDA 9j X37' ~
01-Apr-2011 101.5710 USI~~d~ ~Sy ~o
/v, aao
57586PD37 MASSACHUSETTS ST HSG FIN AGY H 2010-C
~.j~aoo Closing (unadjusted) 01-Apr-2011
664423DA5 NORTHEASTERN ILL UNIV ILL REV SYS REV BO
/n, ovv Closing (unadjusted) 01-Apr-2011
93.2600 USD ~ ~~ ~ `~ "O~
86.8120 USD ~ S. b ~ t. a p
This,report. is provided by Edward Jones. The report was ca~ulated using third parry information. This report is not intended to replace official
documents such as confirmations and/or account statements that should be retained for tax purposes. Past performance is no guarantee of future
resuRa. Edward Jones does not provide tax or legal advice. You should consult your tax and/or legal advisor for your particular situation. The historical
cyst basis information famished herein {"Information') is for use by customer ('you') only and is based on the purchase and sale information provtded.
While Eduvani Jones believes that the. information was obtained from reliable sources, Edward Jones does. not guarantee the accuracy or canpleteness
of the Information and is famishing the Information to You on an 'as-is' basis. EDWARD JONES MAKES NO WARRANTY OF ANY KIND, EXPRESS
OR IMPLIED, WITH RESPECT TO THE MERCHANTABILITY, FITNESS, CONDITION, USE OR APPROPRIATENESS OFTHE INFORMATION. Edward
Jones is supplying the Information on the basis that the Information will be used by You for Your own use and benefit and not for resale or other transfer
to, or use by or for the benefit of, any other person or entity.
Date Printed: 11-May-2011
Financial Advisor: Art Amundsen
Phone: 717=258-4688
Page 1 of 1
Historical Pricing for BETTY FOSTER
Symbol DescriptiorUType
151405GU5 CENTER AREA SCH DIST PA O BDS
~` aoa Closing (unadjusted)
Edwardlones
Date
01-Apr-2011
140864AR0 CARBON CNTY PA AREA VOCATIONAL ASE REV B
1v, aDO Closing (unadjusted) 01-Apr-2011
368497FR9 GEISINGER AUTH PA HEALTH SYS R 2009A
/v, ooa Closing (unadjusted) 01-Apr-2011
639438TU4 NAZARETH.PA AREA SCH DIST 2008 A
lo, ooa Closing (unadjusted) 01-Apr-2011
118612LQ1 BUCKS CNTY PA INDL DEV AUTH RE 2009A
/o, o0o Closing (unadjusted) 01-Apr-2011
709223VW8
Io,ooa
PENNSYLVANIA ST TPK COMMN TPK TE REV BDS
Closing (unadjusted) 01-Apr-2011
Value
86.2340 USD ~8b ~ 3 ~o
94.4640 USD I ~ `~`fG • '~~
95.8820 USD ~ ~S ~~ ~ ~-v
101.6440 USD ~~~ ~G ~ h/o
95.8980 USD ~ ~-~~' ~ °
92.4720 USD 9 ~' y ~~ ao
Thls report is provided by Edwani Jones. The report was calculated using third party information. This report is not intended to replace official
documents such as confirmations and/or account statements that should be retained for tax purposes. Past performance is no guarantee of futuro
results. Edward Jones does not provide tax or legal advice. You should consult your tax and/or legal advisor for your particular situation. The historical
cost basis information furnished herein ('Informaton') is for use by customer ('you') only and is based on the purchase. and sale information provided.
While Edward Jones believes that the information was obtained from reliable sources, Edward Jones does not guarantee the accuracy or completeness
of the Information and is furnishing the Information to You on an 'as-is" basis. EDWARD JONESMAKES NO WARRANTY OFANY KIND, EXPRESS
OR IMPLIED, WITH RESPECT TO THE MERCHANTABILITY, FITNESS, CONDITION, USE OR APPROPRIATENESS OF THE INFORMATION. Edward
Jones is supplying the Information on the basis that the Information will be used by You forYourown use and benefit and not for resale or other transfer
to, or use by or for the benefit of, any other person or entity.
Date Printed: 11-May-2011
Financial Advisor: Art Amundsen
Phone:717=258-4688
Page 1 of 1
Historical Pricing for BETTY FOSTER
Symbol Descriptiot>/Type
70917NXG4 PENNSYLVANIA ST HIGHER EDL FAC 2003A
/o, 000 Closing (unadjusted) r! ~' ~. A Rio~~
60415NG63 MINNESOTA ST HSG FIN AGY AL HSG FIN BDS
fo, 00~ Closing (unadjusted)
7622124N5 RHODE ISLAND HSG & MTG FIN COR SHIP
~ooo Closing (unadjusted)
709207EM2 PENNSYLVANIA ST PUB SCH BLDG A BDS
/oi6oo Closing (unadjusted)
76221 RCJO RHODE ISLAND HSG & MTG FIN COR SHIP
Closing (unadjusted)
~d~ GAD
614707PU5 MONTOUR PITTSBRGH PA SCH DIST 2007
fp, acb Closing (unadjusted)
~Warc~,~01185
Date Value
01-Apr-2011 79.5030 USD ~ T 9's"d • .3 v
01-Apr-2011 86.5800 USD~B Ls~ - o ~
01-Apr-2011 89.0720 USD ~ ~/'~ 3 3• Ga
01-Apr-2011 86.4600 USD ~ 8G '`/~ • ° ~
01-Apr-2011_ 94.9830 USD ~~'~~~ ~~
01-Apr-2011 100.5130US~~o~~~ ~O
This report Is provided. by Edwani Jones. The report was calculated using third party information. This report is not intended to replace official
documents such as confi(mations and/or account statements that should be retained for tax purposes. Past performance is no guarantee of future
results. Edward Jones does not provide tax or legal advice. You should consult your tax and/or legal advisor for your particularsituatbn.The historical
cyst basis information famished herein ('Informatbn') is for use by customer ("you") only and is based on the purdiase and sale information provided.
While Edward Jones believes that the information was obtained from reliable sources, Edward Jones does not guarantee the accuracy or completeness
of the Information and is famishing the Information to You on an 'as-is' basis. EDWARD JONES MAKES. NO WARRANTY OF ANY KIND, EXPRESS
OR IMPLIED, WRH RESPECT TO THE MERCHANTABILITY, FITNESS, CONDITION, USE OR APPROPRIATENESS OF THE INFORMATION. Edward
Jones is supplying the Information on the bests that the Information will be used by You for Your own use and benefit and not for resale or other transfer
to, or use by or for the benefit of, any other person or enfit)r.
Date Printed: 11-May-2011
Financial Advisor: Art Amundsen
Phone:Z17-258-4688
Page 1 of 1
Historical Pricing for BETTY FOSTER
Symbol DescriptiorUType
70917REY7 PENNSYLVANIA ST HIGHER EDL FAC FIRST
%U, voo Closing (unadjusted)
7092226D4 PENNSYLVANIA ST TPK COMMN REGI 2001
Closing (unadjusted)
o?o, o00
70917NLV4 PENNSYLVANIA ST HIGHER EDL FAC FIRST
/O, ovv Closing (unadjusted)
246579GC4 DELAWARE VALLEY PA REGL FIN AU 2002
Closing (unadjusted)
/O, Ooo
17476NDL9
~~; ovo
06051 VNP7
j y ao4
CITIZENS NAT BK SEVIERVILLE TN CD 1.9%11
Closing (unadjusted)
BANK AMER NA CHARLOTTE NC CD 1.2%12
Closing (unadjusted)
Edwardlones
Date
01=Apr-2011
01-Apr-2011
01-Apr-2011
01-Apr-2011
01-Apr-2011
01-Apr-2011
Value
93.6060 USD '~ 9.~~ o. ~ o
102.2980 USD¢~2D; ~~`• Cev
102.3120 USDA/D„7~~ .ZD
98.7830 USD ~ 9~ ~~• 30
100.3554 USDf yy;~.ZGIo • SS
100.6558 USCG /7i j~~' 3 °~'
This report is provided by Edward Jones. The report was calculated using third party information. This report is not intended to replace official
documents such as confirmations and/or account statements that should be retained for tax purposes. Past performance is no guarantee of future
results. Edward Jones does not provide tax or legal advice. You should consuR your tax and/or legal advisor for your particular situation. The: historical
cost basis information furnished herein ("Information") is for use by customer ('you°) only and is based on the purchase and sale information provided.
While Edward Jones believes that the information was obtained from reliable sources, Edward Jones does not guarantee the accuracy or completeness
of the Information and is furnishing the. Information to You on an °as-is' basis. EDWARD JONES MAKES NO WARRANTY OF ANY KIND, EXPRESS
OR IMPLIED, WITH RESPECT TO THE MERCHANTABILITY, FITNESS, CONDITION, USE OR APPROPRIATENESS OFTHE INFORMATION. Edward
Jones is supplying the Information on the basis that the Information will be used by You for Your own use and benefit and not for resale or other transfer
to, or use by or for the benefit of, any other person or entity.
'bete Printed: 11-May-2011
Financial Advisor:. Art Amundsen
Phone:717-258-4688
Page 1 of 1
Historical Pricing for BETTY FOSTER
Symbol Description/Type
06051 VQF6 BANK AMER NA CHARLOTTE NC CD 0.55%11
ay ~ ~p Last day of prices
Closing (unadjusted)
36159UNN2 GE MONEY BK SALT LAKE CITY UTA CD 1.1500
'y`'3~ oo a
36186N2E9
%r OOU
912810FR4
/o, o00
912810PV4
/5~°p°
Closing (unadjusted)
GMACM MTG LN TR 2004-J2 20340625 5.75000
Closing (unadjusted)
UNITED STATES TREAS BDS TIPS 2.375%25
Closing (unadjusted)
UNITED STATES TREAS. BDS TIPS 01.750%28
Closing (unadjusted)
EdwardJones
Date
29-Apr-2011
01-Apr-2011
01-Apr-2011
01-Apr-2011
01-Apr-2011
01-Apr-2011
Value
100.0118 USD ~ .h j 4Ua • `~.S
100.6979 USD 73~ ~d~~y7
~tert-Trade y ~ a S Da
9~•~S
112.7812 USD ~~~ `~ ~8' r0
102.5312 USf~~~ ~~ ~~
This report is provided by Edward Jones. The report was calculated using third party information. This report is not intended to replace official
documents such as confirmations and/or account statements that should be retained for tax. purposes. Past. performance is no guarantee of future
reeults. Edward Jones does not provide tax or legal advice. You should consult your tax and/or Legal advisor for your particular situation. The histo~cal
cost basis informatbn furnished herein ("Information') is for use by customer ('you') only and is based on the purchase and sale information provided.
While EdwardJones believes that the information was obtained ftom reliable sources, Edward Jones does not guarantee the accuracy or completeness
of the Irrf~mtation and is furnishing the Information to You on an 'as-is' basis. EDWARD JONES MAKES NO WARRANTY OF ANY KIND, EXPRESS
OR IMPLIED, WITH RESPECT TO THE MERCHANTABILITY, FITNESS, CONDITION, USE OR APPROPRIATENESS OF THE INFORMATION.;Edward-
Jones is supplying the Information on the basis that the Informatioh will be used by You for Your own use and benefit and not for resale or other transfer
to, or use by or for the ber-efit of, any other person or entity.
Date Printed: 11-May-2011
Financial Advisor: Art Amundsen
Phone:717-2.68-4688
Page 1 of 1
Historical Pricing for BETTY FOSTER IRA
Symbol DescriptiordType
373334GB1 GEORGIA PWR CO SR NT 5.65%40
~9~ v~ Closing (unadjusted)
EdwardJones
Date
01-Apr-2011
Value
99.7568 USD ~/~g~ ~: 79
This report is provided. by Edward Jones.The report was calculated using third party information. This report is not intended to replace official
documents such as c~firmations and/or account statements that should be retained for tax purposes. Past performance is no guarantee of future
results. Edward Jones does not provide tax or legal advice. You should consult your tax and/or legal advisor for your particular situation. The historical
crost basis infom5ation furnished herein ('Information') is for use by customer ('you")only and is based on the purchase and sale information provided.
While Edwani Jones believes that the information was obtained from reliable sources, Edward Jones does not guarantee the accuracy orcompleteness
of the Information and is fumishing the Information to You on an "as-is" basis. EDWARD JONES. MAKES NO WARRANTY OF ANY KIND, EXPRESS
OR IMPLIED, WITH RESPECT TO THE MERCHANTABILITY, FITNESS, CONDITION, USE OR APPROPRIATENESS OF THE INFORMATION. Edward
Jones Is supplying the Information on the basis that the Information will be used by You forYour own use and benefit and noYfor resale or other transfer
t0. or use by or for the benefit of, any other person or entity. _
Edward Jones A count Number: ~ ~ ~ ~ ~ ~ G 4 .~~ / -3
Client Name: [? a5 t~
Destination: Estates
IR Number: [L:.~~~. Date: f O
. .° .. . ` 't'r,~artsfet On Deat~t• f3erieflciary Desigeia#ioit ~ornt
In order to divide assets equally among designated Beneficiairies, complete the y(, (whole numbers) column with °EquaL"
Otherwise, please indicate numerical percentages in whole numbers. Primary Beneficiary sham must total 100g(,. Contingent
Beneficiary shares should tota110096 for each Primary Beneficiary. (Percentages entered in fields A - li carrot exceed 10096)
Pritnhr f3eneificlary Designations
96 {Mliom numbers) Name US. SSN (req) DOB (opt) address & Phon # opt
~96A ~~ (' ~. S ~ .~~Byla~-~~ 1 4 l~xtt ~ s rn
~~ ~g ~ t~9 !~ i~ a ' n
9bC
9~D
....
~Itiillldari~l~r~ai+~iB~isllfdiiyi,tSesight*fion~-•IMPOIYfAI~'f;•Any`t~eneiic~ary~desigriations indl~ated In the••~oilowing'secti'on`••
will incur addkional fees. (Please sea page 6, "~ee~ for TOQ") . .
96 (afiolenembers) Name US. SSN (req) ~•Dbi3 (opt) • ~• ~~ Address & Phone # (opt)
4bE
a~ F
96~
96H
faoewrt f3enefldary Designations
~, ,Primary
a~ts~s) Beneficiary ~ Name US. SSN (req) DOB' (opt) r i Q W r~~ss r& P pne # t)
yb.~._._ C~ E G e 1 ~~ -~7 T~'~
' 9~~ ~e S ~~iz -~ ~~ w ~u w` ,
a; -
~_ 9b~ ~ e.. /1_ 1~F_7g, a w.on
~ q6..~ ~ ' NeVPt' - ~~ ~
96 ~.bt';~~~~ps ~+ e~tlaiet~,~2'.~~+r !0 =~'$02 ~ ' ~
96.
A~dditloial' Cbhilnlpitif ~Bufeficiairy DesighaiUUoii~ = iMPCiFtTAh(T: Any'l3tneficiarji •d9signatidns ~indlcated in ~~he following'
'section ierill trrcur additional fees. (Please see page f; "Fees for TQD.") ...:... .. _ . ....
~, (wlnb Primary .. .
rnunbers) Beneficiary Name U.S. SSN (req) DOB (opt) Address & Phone # (opt)
°~
Account Owner's Initials (not required}:
page 1
'Ackrlliirilil~dglrielr~
The undersigned Owner(s) adcnowladge(s) and confirm(s) the following: (a) Owner(s) has/have been furnished with and given
the opportunHy to review the Edward Jones Transfer on Death information Statement, Transfer on Death Agreement (the
`Agreement") and Transfer on Death Beneficiary Designation Form (the "Beneficiary Form'); (b) Owner(s)_ has/have retained
a copy of said documents; (c) the Beneficiaries indicated on the Beneficiary Form are eltglbie to receive assets under the
terms of the Agreement; (d) said Beneficiaries and the percentage allocated to each respective beneficiary on the Beneficiary
Form aro a true and a~xurate designation of the Owner's/Owners' wishes; (e) ibis Agreeirwnt wntains binding and enbrceable
arbl6ratlon provisbns b tM sedbns titled ''Arbitration Dtselosure^ and'~lgreement to Arb "starting on pegs 1S,
para~aph 1- and (f) the Owner named is Q married / ogle, and the Owner named
is ~ married ! Q single atthe time of Owner's/Owners' e~cecution of this Agreement.
Nob: M a®snt under r of attorney. custodian, ardian or conservator CANNOT wb is Agreement.
~ ~ 0
Signature of Owner' r ~ Date
Signature of Owne Date
~$p0111fi'1~ COh581'It ' ~ .. ~ .. ~ ~ ; . .. ~ ~ .. .
NG~ H 11p O[dnsr b mertied, has not named Owner's Spouse as 1009(, primary Beneficiary, and lhres in a community
properly stale, the Owner's Spouse is raquN~sd b eaacub the Spousal Consent before the Beneficiary Form will be.
aoapbd by the Eduard Joss: national headquarters In ~. fouis, Missouri.
Tile undere~rred hereby declares that he/site (a) is the spouse of the Owner ("the Owner's Spouse"); (b) is familiar with the
assets oontstned in the Acxount; (c) consents to the designation of the beneficiary. or beneficiaries of the Account: and (d)
agteas not to melee aty claim against the beneficiary or beneficiaries or against Edward Jones as a result of -the distribution of
,ratty sessCs in the Account pursuant to tits terms of the Agreement. Thin consent shall be revocable by the Owner's Spouse by
eracxrtkrg the Ftevocatlon of Spousal Consent Form and filing it with the Edward Jones national headquarters in St. Loins,
Missouri, prior to the Owners death.
Signaturo of Owner's Spouse Date
Printed Name
Nob: if and oMy If an hr+testmatt entativs is sent at the time the Owner(s) etntcub(s) the Agreement, then the
invesfrnerrt representNive shonW s r it
Signature of Investment mate ~ ~ p
Nob: K the Owner is unable b sign because of a physical disability, two unrelated a disitrbrestsd witnesses must sign.
Si~adua of Witness 1 Date
Slgnet<ae of Witness 2 Date
Notary i~cknowle~~lneltt ~ . :... .. .
Note: The amaeutlon M thin contract must be notarized under any of the following-eondRions:
• N sn invecbnsnt representathre is not present at the time the Owner(s) execute(s) the Agreement;
• M WilSasnss aro required b streaub the Agroement; and/or
• If the Owner's Spouse eraecubs the Spousal Consent.
. State of ~
ss.
County of ~
On this day before me, . a notary public, personally appeared
who is/are known to be the individual(s) described in and who executed the TOD Agreement, .and acknowledged that
f-e/she/they signed the same as his/her/their free and voluntary act or deed, for the purposes therein stated. Given under
my hand and seal this day of 20
Notary Public Signaturo My commission expires:
Page 2
~STQ~ NAB. ~gT~.
ACCODNT NOMBER: 377-93619~,~ -
~1RY HNS~ier:4rrt: a
DIANA P $~ONOoV$R
xi2 Oi,>? LANDINK3 RD
YORRTOgIN
DAZ'$ QF $7RTA/TRIIST: 04/04/1949
DBBRAk A $MITfI
1624 ~IALNOT SQ'Z'i'OH RD
1~S9tVZhLS
DAPS OF BIRTH/T1~,QST: 10/06/154
EdwardJones
~~sx~=NArror~ - ~ Ac;i
BRANCH #:_03772 DAIS: 12/Z8/2~6
SpOUSH3 (Y/Ny : ITT FQ~'AL
VA 23690 GOOD
SSN/TAX ZD #r $-177421293
SPOIISE$ (Y/Nj : N EQtiTAL
PA 17241 0000
StSBT/TAX II7 #: 8177421184
~ oa a~rsa=cr~~ nos=~-~t~r
t ~ delijoa0l ib0 eiwvs ~ to ravote +~nr of an r~ i mac s r .m marled .nd rESiae in a oDmCaunity ar ar:ini property iif~. a poedoa
d tldi ttoobadt m-y be ftufo~aet a ~ a4q~'rr ' or marliel property ~ r Ar thus of my dam.
it ~ ~ s~etiei t~l lilrt is ~ eartr.~iia !~#T sear - erg Tan ad lam'!' isd~aa4t~14 74sr apeaese !e ads bst~e3aty, y0m' am0et ~ »~ lditoeas tLt tpleaot bbM~
I ~ dlt: tpottle dtba AOOh! ^areld Aoes®t tlolder.lf aay pottioa of qdt amaouet b dEm[m~Od t0 be or mlrittt propettr. J oasaear m aad !~ ba dr Aeooimt 1~ld1r'a
daipadOs of a aestBviaq tNOtet mm mc. Y ilgreE to eonvsp~, tipos Oath Of Bts Ao00Wpt Holder, u4' loterest in ma ap~mtmity or ~xrri(dl ptoperry t0 the deaigmted beaatiditq~.
~Aiw0ai9pClpQ hats 9igm4~eof'@VLaesE
• Y mda~at i6at lyI aeiliprM t penm ~u0-Bite: her'Cbildrm." "Lae." ae'4elCeads~" is bmdloilaiet cf atl oe t t ~~ aooounC aoa if L becaals neoeaaah' lift SQtvu~
Jow r diMrbl~ rMetr b t'SUQtm Or thlir 4s~loMAQrtola, men 6dvVUd JoaKt NDI require a Judfoltl determioWon of the pettooe enticed m roadvr a 4i0tctbutlon of mua betbte
k dative<a aawq a aaq parasn. I s~daadad tb11i $ w~ t proorsdigt; ia'caaa m aoalos au+4 a ~ d~resmiradon.
[1NdOt paotllitt of p?e~pOr. Y dlit fir aowbEr lhowra on tlr$lbnm It my eorreot Taspgyer Jdestitlctrion Nom.
+ i Yaw raoaMad aat asad.tha>htNrd Tvaa ltecfeemeot ~oome Ageee,~me abaioarre. +nd Self,Du+swed JadividWl )~tiren>erlc 1',oeount CuaodLt Agreement. Dlfclotnre aad
3da0me of Pile >tod ~pOoLr 8dwaad Jom as aMiOdlan in ~eadtiae adm tho taoetc atnd oa~adtdoae oormdned rvithm.
• Y >,odonrao4 lAlt ~ doiCrn»at ~0ari mJ ievtlomrat, rapraemat<ve eD >~t my Verhai intpta7dona tp iota and/or termioare eattitia a~evket.
• Y mdMf4od mtt eq1' ieurei t~d/or'tet9slaedoa oueOOdLt fia w3e teotomatiaetiy ha dadueopd ttom my tYCCMmtand tVSO iede~tSld tLe wn-W fee L due id tbt amo~ittt It open toe my
Poiltas sit oMoOitrast
" ~ ~mds+ered IIMKKi)ridu+H w r+a~a sdnrd Jotter m vWQr my ~ 1 opm an tuootmt: (~1 mva provide my rnme, eddtett, dace of b~, wd omen iolbr~tion that
pemsNib+ i0dddlM tntattto6 p i tlooL! ~et;turigr mm-bec: l~W apnCmed. J mint praaeoc a $dMUd Jeaa a gewaeoanasi Lund ~ document: ta10, (4)9dwerd Joie tmiy
verify fir iafonallliiiio I pro~ri0e frith a W4d Putt' MrYioe ptnvider. t agree 60 provide Vte ragtdred informwtion tad CoCUmaotr tD 8d~vird Joae~ tmd altta to me verMgldoII
4f ttrc6 Btl4aiti~toa.
"~ 'i'ii ~ ~IfTAfi!~A A1i~'CSA~DN ~tdVl$ION, t?N PA xf'9 7~ PAiItAIf~APiEC 14 OF T~ ~Vi'A~ YOIV'ES ~' ~CCOCRdY'
A1!', Iil~ ]ltA~ ~ CtY T~ PAR'LII'8.
C"ege 1 of t
~. ab ~ ?AOby
S®'+AUTHIRA
DOC-NQ:Q61228-04$69 S$G'Il,•OR CODE:. 001
EdwardJones
AQOOtXNT N~7MB1~.R: _ - - . ~RAri1C,~i'#• • - DA'T~•
i~WA~tA J01~4 YNDTt~UAY. >Q'lr~•t~nt>R:>r ACCOI7IV`r'
AUY"$ORYZAT'YOtN, ADOp'~ ~~~b~V'T and BE1~~CYAX.t''Y DESIGNA~'tC?N
t.~m:cam cis) r~as~,m z~+ ^ xam nom, ^ alma-z~ ^ sn~~a zsv-
1a1~l
~k+oamt i Name l ~`t d ~!'`
Addtrae ~~1 Y{1, ~~~s` .r~=~- c~ L~~ r ~ i,~. ~ ~ Sao _ z~ Lzd 1.~
Dtre of lsiett ~~ Lt~~ saeSat seo~tty i-r ~ ~ f ~ ~~i'! Y '.,~_ _~ _,_/__~
C~car, lt~e if equal for A~,L... ( ('rT
v
Addree~ ~ ~ Date of Birth/Tttlst _,_.~~_~;~Z
~y „~ D~~UI ~'1 State Z~,~~~~ SSriJ~a~ ID# ~' ToT f~
xa~ ~ . ~? rsr~
Add~s~~o~,.~ /~.l y~11 ~,~~ ? /~ Data of Bix~'Trast ,~~ L'`~ .~
c~- _ l ~ E~ i~ey _ z~ ~17~ ssrtJT,ic l 7?- ~~7 - /1~~'
xeme spy? (YJI~
Addt+een Data of Birt17J'lY'tr,81: J J
. TOTALS MUST BE EQUAL 1009h
^ I Amy tl,e show ba+dioi~ry f1MD m Husks #u}~ or ap prbr dpigaaflans. I toadq~nd shit ~ ! am msQied aa0 redds in a coamaumity or mental prat Albs. a POt1$ba
of this yCCOmit alfy'bt; tylijeot b 10fdt tfass'! aouoaetileyr or Aoadml ptoptaty liwa st fhs ti®e of ~ death.
)Fria Bair tattwafrd e~.tlll~ is ti o.mrrta>iry ~+reety efib - ~ yen tare 101' 7aur epaaa >ta ttila 6ees$tlrr~, yatnr ttpooet ttantt eipa sail tAUana t>te etraen+.e
tidwrs
t ttn to tpdoe o?me above aemtd /loooum Holder. YE auy lm~ at this actouau 4 dtaetmiaad b be Community ar masitii txopartY. Y uomeer m end iota to the Aoeouat IYWda'a
deeidAidofa ota beiMAC~Y oiler ttwn one. i aeeee as ooenresY. upon Oadt of rile Aocougt lloldpq aq' la4aat in the ot~w4iq or agtcigl psopdi3+ m the Aesf6ia0td
(~.
~ Data 31~atnaoC~Vlm~ae ~
• I agdtaewq ~ 1t~Ast)o~ a PaKSOfi aa4 bB or her 'titiid+aed.' 'lerte,' os'dnoendeeq' as heae~ittriq of iQ to ~ portion of my aoootanR and it It baCamet ' ate)30vtacd
Janet m d~6rss ~lteate to 6vlnti epndim or thole dieoraderpe, thm 80vreead Iona v+ti$ require i iudlciil dbasmhaegon of tlae pmrmaa emided .s =eoeir. a ateuAwdm of saes belbre
iL dalweta aaalse b aRy ~ C eodeauitd tlac k Mi8 tagVke t pigoeadi~ ip ot>,nt t0 metro tavsh a legit deoaaion.
• tikila piertilm of pee,}iey, Y ttetdd~ ~t did mmi6elr ~hoan on thla N~ ia,my oornrs 9htxpaye~c Id~ebftigttioa Nunn6es.
• I haw ieaelvro sal iwd toe 8dtt+ktd Joaee l~latsiaec ACCOtmt Agreameea D1:aioatte, sad 31af-Diroaea Lativignal Raikemcnt ACOOOffi Glmtodial AtrEtYaem, riiaoba~e and
Sebdsla of Fast dlttd iwioe>3de~d ]Ctai ee outlodEt+o iu eoooRdeuaa v.[th the rant and ooadhbm eaa4tined Vutthbtw
* I tmdedpad tMt iltie dopptoeo< ilb+ra atiDr iaveamtuit reptip0odtltre b atxxpt tqy vedtai htiphitxions to iuitiatr itdlor ternoaaata ar:olta eawioee.
I aadettiam Chit aqy anneal endfor eo~onfinefon Cttitodiai IIedt will tatlmm-ttaSy h; dedttmd frost my tlCootutt ead also the aMtiil tx b dtte if 4ta iooouat is span tar soy
potAea of a erlimoder year.
f I eadanarod 8ue(lNsdaat itnv tagtaaee i3aetaal Jima to verily aqr iaeatiRy whatt Y open ua sooou~ t~ xaopc pmride ray name. addte6e, date of blrm. lad other inEu+aadotn ums
ptstaoaiRy taC,tatc6 as i etxdal ascatity nuenbar: p~fE requested, I must ptneut m 8daritd Joma i ~ovemtpeatt hawed idtndfioiflon dooumeta; t1ad, (4~tlrratd Iogoe mU'
rQ~y As i~tsedoa I privHt tMlth a third pariy et:rice ptrvidttr. Y agree b proYide the ttkpidred i0dsrmatloII tmd dat~nn ~ Adwaed JC,ta sad a«tets b tW readtlostlon
a<and- .
• '~ ~S ~ITAII~ A 11~1J+i<i AiR>s[i'RfiY>oDN >E!~D'V~Ohi, ON PACE 7, PA1tA~RA>P~Y 3Y t7ri''~ >dlD`PVARi? YQI~ t6liI8NT ACCO~NiT
Ri~Ca if1AY 1118 )E<YY'!~ >'AiCr~S.
tff Bolder a demand, aptiture ctbp>eHdry 3S requirad.)
Hare
a Nttooe (Elev. 9 JnAe 2QOd)
REV-1511 EX+ {10-09)
~ . pennsylvania
` DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES AND
RESIDENT DECEDENT I ADMINISTRATIVE COSTS I
ESTATE OF FILE NUMBER
Betty M. FASter 21-11-0503
Decedent's debts must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Ewing Brothers Funeral Home -prepaid 0.00
2 Evans-Shade -burial expense 100.00
B.
1.
z.
3.
4.
5.
6.
7.
8
s
10
11
12
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State _
Years} Commission Paid:
Attorney Fees:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
(;tty State -
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
B-H Agency -real estate appraisal
PP&L -electric bill
Craig Anderson -lawn mowing and maintenance
CV Roofing Systems -roof repairs
Linden Hall Antiques -appraisal
Check charge
250.00
325.00
36.36
300.00
2,062.80
95.00
15.00
TOTAL (Also enter on Line 9, Recapitulation) $
ZIP
ZIP
11,300.00
427.50
If more space is needed, use additional sheets of paper of the same size.
SCHEDULE H -continued
Funeral Expenses, Administration Costs and
Miscellaneous Expenses
ESTATE OF FILE NUMBER
Betty M. Foster 21-11-0503
13. Nationwide Insurance - aut mobile insurance premium
14. PP&L -.electric bill
15. Commonwealth of PA -car egistration
16. North Middleton Township unicipal Authority -water/sewer
17. Kough's Oil -heating oil
18. Allied Waste -trash dispo
19. Fo'ster's. Garage -car inspection
20. Neidlinger Fine Homes -ceiling repairs
2 L PP&L -electric bill
22. R.K. Sollenberger, 2011 school real estate taxes
23. Mountain View Electric -repair electric breaker box
24. Craig Anderson -lawn care
25. PP&L -electric bill
26. North Middleton Township Municipal Authority -water/sewer
27. PP&L -electric bill
28. , Allied Waste -trash disposal
29. FP&L -electric bill
30. Craig Anderson -lawn care
31, Kough's Oil -heating oil
32. North Middleton Township Municipal Authority -water/sewer
33. PP&L -electric bill
34. Craig Anderson -lawn care
35. Kough's Oil -heating oil
36. James Smith -sink repairs
37: PP&L -electric bill
38. North Middleton Township Municipal Authority -water/sewer
39. York Waste Disposal -trash disposal
40. Prudential Homesale Services Group -real estate commission
41. Recorder of Deeds -1 °!o real estate transfer tax
42. North Middleton Township Municipal Authority -final water/sewer
43. Shelly Sexton -notary fee
(See settlement sheet attached to Schedule A for items 40-43)
44. Re§erve for closing and accounting
45. Register of Wills - PA Inheritance Tax Return -filing fee
$427.90
$30.84
$36.00
$82.30
$142.46
$48.54
$55.00
$550.00
$436.53
$1,967.02
$670.00.
$350.00
$37.25
$82.30
$29.95.
$49.73
$31.01•
$365.00
$200:22
$82.30
$25.85
$400.00
$134.19
$18.75
$50.14
$82.30
$49.73
$10,015.00
$1,620.00.
$123:49
$40.00
$800.00
$15.00
TOTAL ~~~ ~a o~ ~~e 9, xecapm~aeoo> $ 33,960.46
REV-1512 EX+ (12-08}
r Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES 811 LIENS
ESTATE OF FILE NUMBER
Betty M. Foster 21-11-0503
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
~ - Pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Be M. Foster 21-11-0503
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. 'Debra A. Smith daughter 50%
-1624 Walnut Bottom Road, Newville, PA 1741
2 'Dianne M. Schoonover daughter 50°fo
II
112 Old Land Road, Yorktown, VA 23692
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.
If more space is needed, use additional sheets of paper. of the same size.