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HomeMy WebLinkAbout04-27-05 (2)~l'~'~.~ Rt~,S~Ex,6~, REV -15 0 0 t,t : I<<l~,l_,~.~t- t~tJl.->< COMMONWEALTH OF PENNSYLVANIA __ ~'• DEPARTMENT OF REVENUE INHERITANCE TAX RETURN _ _ _ _ _ _ FILE NUMBER T DEPT. 280601 2 1- 0~ 0 0 1 HARRISBURG, PA 17128-0601 ENT DECEDENT RESID COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ T ,-,~, ~ , ~ ,, 1~ - 09 - 39~~ W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W U Januar~r ~ ~, ~ 00~ ' Se pte.r~~bc~r ?0, 1917 REGISTER OF WILLS lLJ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~,r ~/~ ~ ~ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (dateotdeatnpdorto tz-to-az) a ~, w a ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise gate ordeam after tz-l2-ez) 5. Federal Estate Tax Return Required ~ a m ~ 6. Decedent Died Testate (A~tach ~nPy of wu) ~ 7. Decedent Maintained a Living Trust (Anach copy or Trust) 8. Total Number of Safe Deposit Boxes a ~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death between 12-3t-st and t-i-s5) ~ 11. Election to tax under Sec. 9113(A) (Attacn sch o) ~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL'"TAX.INFORMATION SHOULD BE DIRECTED 70~ ~' w z NAME .'1tt~ ~:~oUert Staui':Cer J COMPLETE MAILING ADDRESS ~"Iarlret Square I31c~~. . , . a FIRM NAME (~IApp~icab~e) 1. 1+' e S t i'ia 1T1 S t. S ~ P~1 170; T~eclZanicsUur~ ~ TELEPHONE NUMBER , 717-766-9673 Ot=FILIAL USF ONLY 1. Real Estate (Schedule A) (1) ~ ~ ~ Tnn ~~ 2. Stocks and Bonds (Schedule B) (2) 0 • 00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) n . 0 0 4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1 ,1~~ 0 • L~6 - Z (Schedule E) ' ~ 6. Jointly Owned Property (Schedule F) (6) 31 ~ 036 •1).0 , ~ ~ Separate Billing Requested - J 7 In1e~ \f.,nc Tronefere R Micrcllanannc Nnn-Prohafa. PfOnP.ftV (7) Q • Q Q ,, I_- a Q W Z 0 Q H a U 'a~~ (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) t~.j.7 , X16 • U6 9. Funeral Expenses & Administrative Costs (Schedule H) (9) ~-5 ~ ~~16 • 17 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Q . ~~ 11. Total Deductions (total Lines 9 & 10) (11) 15, l+16 . 17 12. Net Value of Estate (Line 8 minus Line 11) (12) 132 ~ 10 Q • 6 9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) ~ • 0~ made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ~- 32 , 10 Q • 6 9 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0 + 0 0 rate, or transfers under Sec. 9116 (a)(1.2) 0 x .0 ~~'~ ~~ (15) 16. Amount of Line 14 taxable at lineal rate ~- ~ Z + 100 • 69 x .0 ~~1- (16) 5 + ~~ • 5 ~ 0 x .120 (17) 0.00 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due • ra ~ • • 20. ?yBE ~ x .150 (18) 0 • 00 (19) 5, ~~~.~~.53 <:< st -~ ~~ Decedent's Complete Address: STREET ADDRESS ~iiPlene ~'. ??eile;, ?~?01 ::~piestnui~ ~-i;. CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0 ~ 00 B. Prior Payments ~ ~~ ; ~ 0 ~ 0 0 C. Discount [(`` nn (n~/~ C li \l . ,J \/ 3. Interest/Penalty if applicable D. Interest 0 . n 0 E. Penalty 0 00 n~ I ziP 17 Ol 1 (1) >, %~a~ 53 Total Credits (A + g + C) (2) ~ 5 t ~o, 00 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal Interest/Penalty (D + E) (3) Check box on Page 1 Line 20 to request a refund 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) 0.00 A. Enter the interest on the tax due. (5A) 0. 0 0 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Eel! . 5 ~ Make Check Payable to: REGISTER OF WILLS, AGENT ~. ._ , ~. , PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" fN THE APPROPRIATE BLOCKS ,..~Tk,_~l 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :............... No ........................................................... b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or ................................................................. d. receive the promise for life of either payments, benefits or care? .............. ^ 2. If death occurred after December 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? ........................................................................................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE I^T AS PA ^ Jnder penalties of perjury, I declare that I hive examined this return, including accompanying schedules and statements, and to the best of my knowledge and belie(, it is true, correct and coRmplet,F THE RETURN. )eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. >IGNATURE OF ON RESPONS LE FILING RET N tDDRESS h03 Oakirood Dri~, Dover, P~ 17315 'F RE~ OT}!iER JFjAN REP,¢~ESENTATIVE ~- DATE >`."arket Squa~e~T31d~,, Plachanicsbur~, PA 17055 )r dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% 2 P.S. §9116 (a) (1.1) (i)). )r 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% 72 P.S. 9116 a 1.1 tI . le 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 surviving spouse is the only beneficiary. [ § () ( ) ()] .r dates of death on or after July 1, 2000: e tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. e tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116 a 1 e tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an ividual who has at least one parent in common with the decedent, whether by blood or adoption. r I iH 3 X GUNV UIJINS 4 VA NV IN' U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT ~.u ~~r~ [.u tw .u .u 5.u(,U S. SETTLEMENT STATEMENT 6. FILE NUMBER: WOOD.2201 7. LOAN NUMBER: 1032917 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked '(POCJ" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3198 (WOOD.220t.PFDIWO0D.2201123) . D. NAME AND ADDRESS OF BORROWER: RICHARD N. WOODARD and IRENE L. WOODARD 219 N. 23rd Street Camp Hill, PA 17011 E. NAME AND ADDRESS OF SELLER: ANN K. ALBRIGHT, EXECUTRIX of the Estate of Adelene M. Neiles F. NAME AND ADDRESS OF LENDER: BROADVIEW MORTGAGE COMPANY 95 E. WILSON BRIDGE ROAD WORTHINGTON, OH 43085 G. PROPERTY LOCATION: 2201 CHESTNUT STREET CAMP HILL, PA 17011 H. SETTLEMENT AGENT: 23-2402316 PURITY ABSTRACT COMPANY I. SETTLEMENT DATE: March 30, 2005 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 3329 Market Street Camp Hill, PA 17011 i 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 115,000.00 401. Contract Sales Price 115,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower (Line 1400) 7,440.61 403. 104. 404. 105. 405. Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance 106. County/Boro Taxes 03/30/05 to 01/01/06 406. County/Boro Taxes 03/30/05 to 01/01/06 358.92 107. City Tax to 407. ity Tax to 108. School Tax 03 30/05 to 07/01/05 375.90 408. School Tax 03/30/05 to 07/01/05 375.90 109. 409. 110. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 123,175.43 420. GROSS AMOUNT DUE TO SELLER 115,734.82 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money 500.00 501. Excess Deposit ee Instructions) 202. Principal Amount of New Loan(s) 92,000.00 502. ettement harges to Seller Line 1400) 8,813.11 203. Existing loan(s) taken subject to 503. Existing loans taken subject to 204. 504. Payo o first Mortgage 205. ayo o secon o gage 206. 506. 207. 507. (Deposit disb. as procee s) 208. 508. 209. 509. Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By eller 210. ounty/Boro Taxes to 510. County/Boro Taxes to 211. City Tax to 511. ity Tax to 212. School Tax to 512. School Tax to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 92,500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 8,813.11 300. 00. 301. Gross Amount Due From Borrower (Line 120) 123,175.43 601. Gross Amount Due To eller Llne 20 115,734.82 302. Less Amount Paid By/For Borrower (Line 220) 92,500.00 602. Less Reductions Due eller (Line 520) 8,813.11 303. CASH (X FROM) ( TO) BORROWER 30,675.43 603. CASH (X TO) ( FROM) SELLER 106,921.71 The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. Borrower ~~~ ~ i 1fV~LQ->~..-c~ ~ `^Gs~ RICH, RD N. W pARD IR NE L. WOODA D Seller ANN K. LBRIGHT, EXECUT IX BY: %~~" j. Page 2 ~~ L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 115,000.00 @ 6.01)00 % 6,900.00 PAID FROM BORROWER'S PAID FROM SELLER'S Ivlson o ommisslon Ine as o ows: FUNDS AT 0 FUNDS AT SETTLEMENT O ' SETTLEMENT ommisslon al a e emen ' o ' 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 80 oan nglnatlon ee .0000 o 802. Loan Discount 2.5000 % to to BROADVIEW MORTGAGE COMPANY 2,300.00 ppralsa ee o ' re I epor D ' o ' .Flood Cert Fee to FDSI 13.25 ax ervice ee o ' ocumen rep ee 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 03/30/05 to 04/01!05 @ $ 15.440000/day ( 2 days %) 30.88 o gage nsurance remlum or mon s o 903. Hazard Insurance Premium for 1.0 years to MOTORISTS MUTUAL INSURANCE COMPANY 341.00 POC 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 2.000 months @ $ 28.42 per month 56.84 1002. ortgage Insurance 1003. County/Boro Taxes months @ per month 2.000 months @ 39.41 per month 78.82 1004. City Tax 1005. Schoo Tax months @ per month 8.000 months @ 122.94 per mont 983.52 mon s per mon 1007. 1008. AGGREGATE ESCROW ADJ. months @ per month months @ per month -25.41 1100. TITLE CHARGES 1101. Settlement or Closing Fee 1102. E-Mail Document Retrieval to to PURITY ABSTRACT COMPANY 35.00 1103. Title Examination to 1104. Insured Closing Letter 1105. Document Preparation 1106. otary Fees to First American Title Insurance o. to ATT RNEY J. OBERT FFER to CA DE 12.00 6.00 1107. Attorney's Fees to me a es a ove I em num ers: 1108. Title nsurance to PURITY ABSTRACT COMPANY (REI SUE RATE PLT.05-21 840.38 (includes above item numbers: . en ers overage caner s overage . o ' vermg ee pac age o ' . o nnnl-Ir_ wwln ToA1JCCCA r•ueRr:Fc ~ILUV. VVYGRI\111 GIB 1 I~GV V.~v..~v i....+ .... ... ~. _., .-- 1201. Recording Fees: Deed $ 39.50; Mortgage $ 72.50; Releases $ 112.00 I oun a amps: ee o gage 1 150.00 tate Ta tamps: Revenue Stamps 1,150.00; Mortgage 1203 , . 1204. ASSIGNMENT OF MORTGAGE to RECORDER OF DEEDS 27.00 ~ ~eF R ER O D D 1 w nr~c Isou. Huul I IVI~'+G JG 1 • •x.•---_- 1301. Survey to Pest Inspection to PENN PE T, INC. 1302 40.00 . 2005 COUNTY/BOROUGH TAX to JANET L. MILLER, TAX COL ECTOR 1303 472.94 . 1304. SEWER 1/1/05-6 30/05 60.00 to CAMP HILL BOR U H 30.83 29.17 250 OC TRANSACTION FEE to REMAX REALT SSOCIATES, IN 1305 . . idnn TnTni SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 7,440.61 8,813.11 By signing page 1 of lhls statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page statement. PURITY AB T O P N Settlement Agent REV-1502 EX+ (6-98i _•~ ~`. ~' SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~.,,~ .~1D3.?,T,:s I TTY, :1, I?3{~ r T_ T~"' 2105-0155 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. ,nT,T, ~:'IL~`~`i' C'~~3ZTi~.i:3•; I-Iouse and. T,ot of Ground s=ituate in t;i1e ~orou~h of ~a~ri.p 'ii11, Count~T of Cumberlan and State of Pennsy7_vani_a, presentl~r I•~notian and nu?Tabereci as 22`1 Chestr_ut Street, frlore partic- uluary descr:Lbed as fol)_av~s: 33~?GT3`I33~I:31f~ at a p:i..n at the sou_3.i~.tirestr;r7 ~r corner of the intersection of 22ncZ and ~~,hestnut .::>treets; tli.ence South lh de frees r~:~ ra~it~utes crest;, 10%0.0 feet to a pin; thence lTo,~th ~~3 de~;r. ees 00 r•~li_t~utes }lest, 67.10 feet to a stale©; thence 3iorth 16 de ,reel I_l.f~ minutes .~ ast, 100.70 feet to a pi_n; thonce aouth i;'~2 de;rces 22 rlinutes 3~ast, 6'j.l® feet to a pain, tl~.e I~1_ace of I3~,G:~?iTIT~G. Sold to Richard 3?. ~~ood.a~~'d and Zrone l,. ~loodai'd, his t~a~_fe, .for `';7.15,000.00, 7.15,000.00 TOTAL (Also enter on line 1, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 115,000,00 J www. h~~ar^ a. com F-IAAFt' c Al_1CT I Ohd 717--~f:~~:-•Fl~'.~+E~, ~ttlement 311er: E,~; AIVN AI_BRIGI-iT E~3 OAK WC1,C~rD ~ I?R DOV~I~ Fc~Ai ~"17.?1 ri i~ ~3 ~, : ;_ Item Description F~ri.r_~e [?ty Ta~t:~al ______________.__ - Mayt~cl w~sher^ ~ 1 ?~`~.4?r~ - F=~lanter^ lax 1 k'r.75~~ 13ax lat 1 1.7`°, - Typewr^i.tc~r^ ~ 1 1.04 - r r^ r o d e r^ ~~ i s 1 '~ . ~~~'~'~ _. Sweeper, 1 ~'r. ~;~-Zr - ToG-~ster^/oven i 1.4?rrZr - Gh~ise lol_tnr~e ~ 1 ~. ~''~'r~ - Rid i o 1 7. ~4~ - L i. ~ h t 1 1 f3 . ~ r7r - Lat 1 ~. ~,~ - Coffee pat 1 4''. ;~5N4~ - C e r^ a m i c t• r^ e e 1 ~~ . -~ r~ Lot 1 4?r . C ~r r7r t?I ~- Pawl 1. 4'r. ~'.~~~~ - Ra~~st.er 1 ~'.4h1~'~ - E~- a x tat 1 E., . 4?r 4?r --• Set of di.stie5 nar^i.tal<e 1. .:~7. ~I~ -- Lot 1 ]. ° ~'rih FCett l E'5 - ~rclSe 1 1. i:~r y --~ Candleholder^s 1 ~~. ~r~ - GG-~ndlehal.ders 1 ~I. ~'C4'r4~ -- £' 1 e n d e r, 1 .::, . 4"r 4'r -- `r c1t~~'5 .... T ~.: tx m = . ;''' A m i! i_r r. ~; ° ~_~ ~~, ,I . 1.4?r Gommi=_>_>ian ~t ~+4~. r7r~4'r/• `' ~ ~ ~~ ! Lr•=ss ad.j~_t~+~mEnt~ a ~ --~~1r`:3. E,4~ hd c~ t d ~_t c~ t ca ~ c 1 1 ~:a r~ : ~~ 7 4 . ~r G www. haar^s. cam I-iAAR' S AIJCTIOhd -717-~-4~3~::-£~~:MFG -, -n r. ~c~t E? a I['.1v.'i-- i. 1......iulL'i l VJWLJ. tlac~lr"4„ CUlil { {~~{~~ S (iUC fIOhJ 717--4~,L-'Cl~'4G Settlement FahJhl F~LDRIGI'-IT ~ F'age: 1 Seller: E,~~, • C~~?, C]f-1F; WC]C]D JAR . D©VER F'tl'. :'31`.7,=,1.°i Item Descr"i. Fti.on F'rice G?ty Total Scc?t i. oral sofa 1 1. ~~ _. i]ed~^oam s~_ti.t 1 ~4~.4~17~ - Dox s~~r"ing anCl mattress i. ~4?~ ~: L. ~~ -- T~al~le and chair"s 1 Ste. ~~ -'- Fl r" m .c?hair 1 ~ . ~~ - Single lied 1 t~. ~~ - D1Tiette SC-'t 1 i.7. ~~ -- Coffee tcrlale 1 ic:. ~~ -- D e s I-t i ~-_~~. ~4~ -- Desk t.~f-~ai.r i. i i. ~~ --' ~?ox lot 1 ~'. `;fit -' Set o~F t~_tbs 1 1"7. ~~ -- r~I,:Ji^a.t:':#hf' lot i J~. X171 -~ hri i. x e r 1 16 . ~~ . - L i. ght 1 5. 0@ -' D o x lot 1 0. 5~~1~ - t:ids light 1 ~.750~ --' L_amF t~afale 1 15. ~~ _.. La o w l s 1 3. QI I~ -° StaTlCi 1 7. ~~ -- F='i.tcher 1 4.0~ -. L o ~_t n q e r. t~~ a i r° 1 ~.~~ - Lalacl~F~Uard 1 ;+.I~~ - DU>~ dishes ~ 1~. ~ ~ ~ y~ ~ - f2~_t_y 1 1~. ~0 -' Tv stand 1 1. ~~ ._. St t:l o l 1 4. ~~ - Do x records 1 ~:~. -~~ -- hi~:~ y o set 1 6. ~~ -' Stool ~ 1 ~. ~IZ+ - t_icPubs i ~.~:W~~ - Ironini] k~oard--hamper ~ 1 ~.5-~'~~IZ~ -. Candl.ehol.ders i 0.'c:~~~ -- C{:~tairit=t i E,. X171 -- Deh~_Im:idi~Fier 1 ~. ~~~~ ._ r_y,-,}~ o'P disht~s 1 ~6. ~IZ.I -- Chair i ~. ~~~~ --' 1~ lash car"ds 1 1. ~~ -~ I~Ja 1 1 't a L-~ ]. e 1 5. ~~ REV-1508 El(• (1-971 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER ~»rr~~r~r ?~. ~rrlr,r,s X105- 0155 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned wkh the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~• x/11/05, net proceeds fror~. sale of household furnishings . `~ 3 r L)_.L~.6 2. 3/2/05, capital Blue Cross, refund. 371.18 3 Richard T. and Irene L. 'oodard, refund of 2005 County and Boroufrh ta.ces. 358.92 I+. Richard T1. and Irene L. '~~ oodard, .refund of unexpired Scl~iool tax from 3/30/05 to 7/1/05. 375.90 TOTAL (Also enter on line 5, Recapitulation) I S 1 ~ 4,$ 0 , 46_ (If more space is needed, insert additional sheets of the same size) PNCBAIV< February 15, 2005 J Robert Stauffer Attorney at Law 1 W Main St. Mechanicsburg, PA 17055 RE: Estate of Adelene M Neiles (Deceased) SSN: 184-09-3988 DOD: O l -29-2005 Dear Mr. Stauffer: scp In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5140046337 Established 12-01-1957 ADELENE M NEILES ANN K ALBRIGHT DOD balance: $6,090.48 + $0.60 accrued interest Savings Account Account #5130062958 Established 03-08-2002 ADELENE M NEILES ANN K ALBRIGHT DOD balance: $55,910.88 + $70.83 accrued interest Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~. Erica L Schlegel 1-800-762-1775 P7-PFSC-04-F 500 First Ave. Pittsburgh PA 15219 Member FDIC REV-1509 EI(+ 112-88) -,~ SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER !1D}~L~~ITE II. I~;~ILJs'S 2105-07.55 Joint tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. ~TI,r K. ~LI3RTGIIT f~03 Oalrwood Drive Dover, PA .17315 Dau. ,titer B. c. Jointly-owned property: ITEM NUMBE LETTER FOR JOINT TENANT MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S % INT. DOLLAR VALUE OF DECEDENT'S INTEREST ~• A 12/1 Checl~in~ .'lccount I?o. . 1957 511 ~00l~6337 • X091. o~ ~o"' ;~ 3, 045.54. 2 ~ . 3/~'s/ . aa.vin~s /lccou.nt ilo. 51- . , . 2002 3oob295~. 55~9~1.71 5c~;~ 27, 990.6 TOTAL (Also enter on line 6, Recapitulation) I ~ jl, X30 . ~}.'~ (If more space is needed insert additional sheets of same size) REV-1511 EX+ (12-99) f ~~~~, SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ~DELI~IIL: II. TdIsII;L;S 2105-0155 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. IloffY~tan-Roth Funeral home, 219 I;orth hanover St., :~arlislc, Pennsylvania. Ii'uneral Expenses. a7 x,510.00 2.~ iof_f.nan-Roth I~'uneral ?rode, Deat}1 Certificates. 25.00 B. ADMINISTRATIVE COSTS: }'?one 0.00 t. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AttorneyFees~ J. Robert Stauffer, Esq., attorney fee. 3,600.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 1?One Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of ?-fills of Cumberland County, Pennsylvania. Letters i'estamentary. 306.00 5. Accountant's Fees 6, Tax Return Preparer's Fees ~ Cumberland Law Journal, Estate Ilotice, 75.00 . %3, Hest Share EIIS, transport services. 103.00 9. Pennsylvania lmerican 1r~ater Co. , t•rater. 13.39 10. I'PL Electric Utilities, electric. 2n•05 11. RCS Construction, snots removal 2/21.05 to 2/25/05. 50.00 12. ~~'erizon, final telephone bill. 9•L}1.~ 13. RuS Construction, snot~r removal on ~/~!jo5. 25.00 11~_. I~'amily home health Care Products, hospital Bed. 110.00 15. '..'est Snore Oil Go. , Inc. , IIeatin~; fuel. 39~-I-• 73 1-6. 'rhe Sentinel, Estate Ilota_ce. 115.5 TOTAL (Also enter on line 9, Recapitulation) I $ CAR~IL:D FORi;'t~R (If more space is needed, insert additional sheets of the same size) P1~GI~ - 1 REV•ISII E%+ 17.88) i COMMONWEALTH OF PENNSYLVANIA INIIERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or :1DLLEITL Ii. I1>;IL}I;S 2.105-155 ITEM DESCRIPTION AMOUNT NUMBER 17. Richard Cassel, haulier--; trashfrom premises. 1&. Pennsylvania Arner:ican da ter ':o., tiaater. 19. PPL Electric Utilities, electric. 20. Purity Abstract Company, Ilotary lees. 21. Remax Realty Associates, I.nc., lar. Certification fee. 22. Recorder of Deeds, real estate transfer tax. 23. Janet L. I.i17_er, Tax Col lector, 2005 County and I3orou~,h Tax. 217.. :~arnp Ii~i11,I7orou.„h, aet~7er to 3/?0/05. 25. I~ernax Fealty Associates, Inc., transaction fee. 26. Pennsylvania American ~>ia ter Co., final vaster F3i11. 27. PPI, Ll©ctric Utilities, final electric Bill. 2~i. Inheritance 'pax Return, to Ile~ister of ~,`i11s. ~, X5.25 11.6L}. 20. y~3 6.00 5.00 1,150.00 1~72.91~ '9.17 250.00 7.77 7.~1 1, . 00 Total............~15,1~16.17 PAG1 - 2 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES ~1DE.T_;i,IiE ii. ITIJIL,;; NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)j 1. A?YFI~I K. !>zLBl?IC7IiT 603 Qalzt~rood Drive Dover, P~ 17315 FILE EMUN BFILE EMUN B R RELATIONSHIP TO DECEDENT Do Not List Trusteels- 2105-01;5 AMOUNT OR SHARE OF ESTATE Daughter Entire Estate. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size)