HomeMy WebLinkAbout03-08-12 (2).~
REV-1500 EX (02-11)(FI)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
1505611185
OFFICIAL USE ONLY
County Code Year File Number
INHERITANCE TAX RETURN 21 11 1256
RESIDENT DECEDENT
to I tK utctUtN r INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY
161-56-2337 11032011
Decedent's Last Name Suffix
WETHERELL
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
Date of Birth MMDDYYYY
12081960
Decedent's First Name M I
JOHN S
Spouse's First Name M I
THIS RETURN MUST BE FILED IN DUPLNCATE WITH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
® 1. Original Return ^ 2: Supplemental Return ~ 3. Remainder Return (Date of Death
^ 4
Limited Estate
^
4
F Prior to 12-13-82)
^
. a.
uture Interest Compromise (date of 5. 1=ederal Estate Tax Return Required
6
Decedent Died Testate
^ death after 12-12-82)
7
D
d
1
"
.
(Attach Copy of Will) .
ece
ent Maintained a Living Trust
(Attach Copy of Trust.) 8.
Total Number of Safe Deposit Bo>aes
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THI5 SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime: Telephone Number na
VICKY ANN TRIMMER n ~~~
-T"] ~ ,
717-620-0 '~'' ~~
~~. t~l~ 1 C
REGISTERb SE ONpY r
~. -~= r"T'1 f ; v ''
First Line of Address C.,. ;--,
t
:' >
PERSUN & HEIM, PC ~`- '~~ = ~ _=~
Second Line of Address ~
r-iJ
PO BOX 659
City or Post Office State ZIP Code
MECHANICSBURG PA 170550659
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
UHIt
a _a9-
4124 NANTUCKET DRIVE MECHANICSBURG, PA 17050
JIIiIVHLUftgUF- rRtf'AF~R OTHF~THAN REPRESENTATIVE f DA
L
PO BOX 659 MECHANICSBURG, PA 17055-D659
PLEASE USE ORIGINAL FORM ONLY
1505611185
Side 1
OM4647 3.000
1505611185
~J 1505611285
REV-1500 EX (FI)
De:cedent's Social Security Number
161-56-2337
Decedent's Name: L E T H R I I n N N C
RE CAPITULATION
1. Real Estate (Schedule A) 1 18 6 , 6 0 0.0 0
2. Stocks and Bonds (Schedule B) . 2. 16 3 , 8 7 3 • D 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3 ^ • 0 0
4. Mortgages and Notes Receivable (Schedule D) 4
0 • 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 115 , 415.0 0
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g 0 • 0 D
7. Inter-Vivos Transfers 8 Miscellaneous Non- Probate Property
(Schedule G) ~ Separate Billing Requested 7. 211, 911.0 D
8. Total Gross Assets (total Lines 1 through 7) 8 6 7 7 , 7 9 9 . fl fl
9. Funeral Expenses and Administrative Costs (Schedule H). s. 18 , 0 2 2. 0 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 2 2 D , 0 D 2 • 0 0
11. Total Deductions (total Lines 9 and 10) , 11 2 3 8 , 0 2 4 •0 0
12. Net Value of Estate (Line 8 minus- Line 11) 12
13.
Charitable and Governmental Bequests/Sec 9113 Trusts for which . 4 3 9 , 7 7 5 • D 0
an election to tax has not been made (Schedule J) , 13 D • D D
14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. 4 3 9 , 7 7 5.0 D
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 _ 0.0 0 15. 0.O D
16. Amount of Line 14 t xable
o 4~
atlineairatex
17. .
434,775.00
Amount of Line 14 taxable 1s. 19,565.00
at sibling rate X .12 0• D O 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 5, 0 0 0. 0 0 1 a. 7 5 0.O D
19. TAX DUE 19. 2 D , 315.0 0
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505611285 150!5611285
OM4648 3.000
REV-150siEX (FI) Page 3
Decedent's Cemnlatp Ortrtracc•
File Number
1, , ~ ~ ~ rr
~+ .Y ~I L J D
DECEDENTS NAME
W TH R JO N
STREET ADDRESS
R
CITY STATE ZIP
MECHANICSBURG PA 17050-
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments ~ • 0
B: Discount ~ , ~ ~
3. Interest
!1) _ 20, 315.00
Total Credits (A + B) (2)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT
Fill in box on Page 2, Line 20 to request a refund.
O.Oo
(3) _ 0.00
(a) _ 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ 2 0 , 315 • 0 0
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 ^ ^X
b. retain the right to designate who shall use the property transferred or its income ^ ^X
c. retain a reversionary interest ^
d. receive the promise for life of either payments, benefits or care? ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . ^
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ^
4. Did decedent own an individual retirement account, annuity, or other non-probate property, which
contains a beneficiary designation? ® ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the usf; 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 rE;quirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary,
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adaptive parent or a stepparent of the child is 0 percent (72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. 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.
OM4671 2.000
REV-1502~EX + (01-10)
pennsylvania
DEPARTA~ENTOF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF:
FILE NUMBER:
John S. Wetherell 21 11 1256
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is iiehned es 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 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 DESCRIPTION OF DEATH
~. 6386 Galleon Drive, Mechanicsburg, PA
Condominium 186,600
Valued using assessment and CI,R
swasss z.ooo
TOTAL (Also enter on Line 1, Recapitulation.) I S 166 , 600
If more space is needed, use additional sheets of paper of the same size.
REV-1503 EX + (6-96)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE: NUMBER
John S. Wetherell 21 11 1256
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION
OF DEATH
.Treasury Direct - US Savings Bonds 2,424
2 E-Trade Brokerage 147,320
3 E-Trade Global Trading 14,129
TOTAL (Also enter on line 2, Recapitulation) I $ 163, 873
3W4696 '1.000 (If more space is needed, insert additional sheets of the same size)
REV-1507 ~X + (6-96)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES 8 NOTES
_ RECENABLE
ESTATE OF FILE: NUMBER
John S. Wetherell 21 11 1256
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM I VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
None
3W46AC 7.000
TOTAL (Also enter on line A, Recapitulation) $
(If more space is needed, insert additional sheets of same size)
0
REV-1508 EX+ (11.10)
Pennsylvania SCHEDULE E
DEPARTkENrOFREVENUE CASH, BANK DEPOSITS
& MISC.
INHERITANCE TAX RETURN
RESIDENrDECEDENT ,
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
John S. Wetherell 21 11 1256
Include the proceeds of litigation and the date the proceeds were received by the estate.
'
All property
ointl owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
t. Members First Chg 128
2 Members First Svg 5
3 PSECU Checking 20,795
4 PSECU Savings 102
5 PSECU Money Market 20,061
6 Household Items 15,000
7 PSECU CDs 54,224
8 Coins in safe deposit box 100
9 2003 Toyota Matrix 5,000
TOTAL (Also enter on line 5, Recapitulation) b ~ 115 , 415
owasAD 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-151Q EX + (08-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
w I w I c yr FILE NUMBER
John S . Wetherell 2:1 11 1256
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes,
ITEM
NUMBE DESCRIP110N OF PROPERTY
IMLlDET1EµeMEOFTFETRANSFEREE, THEIRRELATIONSMPTOOECEDEMAND
TFEOrUEOF1RAt~ER.ATTACHAC.OPyOFTFEOEEDFORREALE57ATE.
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST
E~:CLUSION
IFAPPUCABLE)
TAXABLE
VALUE
~• PA Employee Deferred Comp 203,315 100.0000 0 203,315
2 PSERS Pension -Nontaxable 0 100.0000 0 0
3 E-trade IRA 8,596 100.0000 0 8,596
TOTAL (Also enter on line 7, Recapitulation) $
211,911
If more space is needed, use additional sheets of paper of the same size.
9W46AF 2.000
REV-1511 E%~ (10.09)
pennsylvania SCHEDULE H
DEPARTMEM'OF REVENUE FUNERAL EXPENSES AN D
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FIt.E NUMBER
John S. Wetherell 21 11 1256
Decedents debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~. Longsdorf Cemetary 1,375
2 Musselmans Funeral Home 10,553
Total from continuation schedules 330
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State ZIP
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Donegal Insurance
Insurnace on condo TPP
TOTAL (Also enter on Line 9, Recapi
swasnc z.ooo If more space is needed, use additional sheets of paper of the same size.
5,000
605
159
18,022
Estate of: John S. Wetherell 21 11 1256
Schedule H Part 1 (Page 2)
Item
No. Description Amount
3 Pastor David Schreffler 100
4 Luncheon
230
Total (Carry forward to main schedule) 330
REV-1512 EX+(12-08)
' Pennsylvania SCHEDULE I
DEPARTMENiOF REVENUE DEBTS OF DECEDENT
RESIDENT DECE ENTTURN ,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
John S. Wetherell 21 11 1256
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM ,
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
~• Wells Fargo Mortgage
143,840
2 E trade Margin Debt
74,225
3 Citi Card
476
4 PPL
87
5 UGI
239
6 Pa Water
51
7 Verizon
464
8 Discover
149
9 Condo Property Management Fees 300
10 Sewer/Trash Fee
171
TOTAL (Also enter on Line 10 Recapitulation) ~; 220 , 0
BW46AH 2.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10) SCHEDULE J
pennsylvania
DEPARTMENrOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
John S. Wetherell 21 11 1256
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).j
1. Marion Wetherell
All of Residue: 434,775 Mother 434,775
2 Lance Miller
General Bequests: 5,000 None 5,000
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER :iHEET. I $ 0
swasAi z.ooo If more space is needed, use additional sheets of paper of the same size.
C~ o0p~
~cfll,~~ V'V' Illlll ~1,Il'11Q~L ~(~~~cEl1,]C]Y11~7CIL~
OF
JOHN S. WETHERELL
I, JOHN S. WETHERELL, of Hampden Township, Cumberland County,
Pennsylvania, do make, publish and declare this to be my Last 'Will and Testament,
hereby revoking all Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate
taxes becoming due by reason of my death, whether such taxes :may be payable by my
estate or by any recipient of any property, shall be paid by the Executor out of the
property passing out of the residue of this Will, as an expense and cost of
administration of my estate. The Executor shall have no duty or obligation to obtain
reimbursement for any such tax so paid, even though property not passing under this
Will.
ITEM II: I direct the Executor to pay the expenses
of my last illness and funeral expenses from the property passing under this Will as
an expense and cost of administration of my estate.
ITEM III: I give the sum of FivE: Thousand ($5,000)
Dollars to LANCE MILLER, to be deposited into an IRC §529 account for his benefit.
ITEM N: I give, devise and bequeath all the rest,
residue and remainder of my estate to my mother, MARION E. ~JVETHERELL.
ITEM V: In the settlement of my estate, the
Executor shall possess, among others, the following powers:
Page 1 c~-
(a) To retain any investments I may have at m~.y death,
including specifically those consisting of stock of any bank even if I have
named such bank as the Executor herein, as long as the Executor may
deem it advisable to my estate so to do.
(b) To vary investments, when deemed desirable by the
Executor, and to invest in such bonds, stocks, notes, real estate
mortgages or other securities or in such other property, ~°eal or personal,
as the Executor shall deem wise, without being restricted to so-called
"legal investments", and without being limited by any statute or rule of
law regarding investments by fiduciaries.
(c) To sell either at public or private sale and upon such terms
and conditions as the Executor may deem advantageous i;o the estate,
any or all real or personal estate or interest therein owned by the estate
severally or in conjunction with other persons or acquired after my
death by the Executor, and to consummate said sale or s~~les by
sufficient deeds or other instruments to the purchaser or purchasers,
conveying a fee simple title, free and clear of all trust and. without
obligation or liability of the purchaser or purchasers to sere to the
application of the purchase money or to make inquiry into the validity
of said sale or sales; also, to make, execute, acknowledge and deliver any
and all deeds, assignments, options or other writings which may be
necessary or desirable in carrying out any of the powers conferred upon
the Executor in this paragraph or elsewhere in my Will.
(d) To pay all costs, taxes, expenses and charges in connection
with the administration of my estate.
Page 2 ~~~/
r
(e) To make distributions of income and of principal to the
proper beneficiaries thereof, during the administration of my estate,
with or without court order, in such manner and in such amounts as my
Executor deems prudent and appropriate.
(f) To vote any shares of stock which form a part of the estate,
and otherwise to exercise all the powers incident to the c-wnership of
such stock.
(g) In the discretion of the Executor, to unite v~~ith other
owners of similar property in carrying out any plans for i,he
reorganization of any corporation or company whose secia.rities form a
part of the estate.
(h) To disclaim any interest in property which would devolve
to me or my estate by whatever means, including but not limited to the
following means: as beneficiary under a will, as an appointee under the
exercise of a power of appointment, as a person entitled to take by
intestacy, as a donee of an inter vivos transfer, and as a donee under a
third-party beneficiary contract.
(i) To do all other acts in the Executor's judgment deemed
necessary or desirable for the proper and advantageous rr.~anagement,
investment and distribution of the estate.
ITEM VI: Any person who shall. have died at the
same time as I shall have, or in a common disaster with me, or under such
circumstances that the order of our deaths cannot be establisheci by proof, or within
thirty (30) days of my death, shall be deemed to have predeceased me.
Page 3 g/ ~. -'
ITEM VII: I hereby nominate, constitute and appoint
my mother, MARION E. WETHERELL, to be the Executrix, herein referred to as
"Executor". In the event that she is unable or unwilling to serve, I appoint my aunt,
DARLENE TRONDSON, to be the Executrix. The Executor is specifically relieved
from the duty or obligation of filing any bond or other security.
IN WITNESS WHEREOF, I have set my hand and seal to this, my .Last
Will and Testament, consisting of this and the preceding three (3) pages, at the end of
each page of which I have also set my initials for greater securit;y and better
identification this~~~ day of December, 2010.
`~~ (SEAL)
JOH ~ S. WETHERELL
Page 4 ~~'~~
We, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published and declared by the above named Testator as and for his Last Will
and Testament, in the presence of us, who, at his request and i.n for presence and in
the presence of each other, have hereunto set our hands and sE:als the day and year
first above written, and we certify that at the time of the execution thereof, the said
Testator was of sound and disposing mind and memory.
i ~ ~'
/.
`z' a' (SEAL) Residin at ~0 ~ ~~~ -
-, ,~
EAL) Residing at ~ y~ G~ ~~~ci~i ~~~~ ~~
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS.:
COUNTY OF CG~e~~~ .
I, JOHN S. WETHERELL, Testator, whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed and executed the instrument as my Last Will and
Testament; that I signed it willingly; and that I signed it as my free and voluntary act
for the purposes therein expressed.
:~~ ~/~~f~+~~~._ (SEAL
JO~T~Cf S. WETHERELL
Sworn to and subscribed before
me this' day of December,
2010.
otary Public
My Commission Expires~~ U -I /~°~~ `~ P~ ~,3
(SEAL COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
:luUa A. Wleman, Notary Public
Silver Spring Twp., Cumberland County
My Commfsslor- Aup. 28, 2013
Mem!~er, W!nnsvivenl~ Aa~claHcm Af Notarl9s
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
SS.:
COUNTY OF ~L
/.~,
We, ~ ~1 ,,,~ J~'1'~.a.~v and -~1y~.~7' /^/ ~ (`~ ' ~ ,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
JOHN S. WETHERELL sign and execute the instrument as hi:~ Last Will and
Testament; that Testator sigzzed willingly and that he executed. the Will as his free
and voluntary act for the purposes therein expressed; that each. of us in the hearing
and sight of Testator signed the Will as Witnesses; and that to t;he best of our
knowledge Testator was at that time eighteen (18) or more yeaJ°s of age, of sound
mind and under no constraint or undue influence.
.~
Witness
~~
r ~~ 1 Gi%C~~
~ ~ Witness
Sworn to an~subscribed before
me this day of
December, 2010.
~~
Notary Public
My Commission Expires:C~~G~~~ ~~ ~D l3
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
Plotarlal Seal
Jolla A. Wlemen, Notary Public
SINer Spring Twp., Cumberland County
My CommLsslon Expkes Aug. 28, 2013
Member. Pennsvlvrnl3 ASSOdaNd1 Af Nogrlea
19879v1
TaxDB Result Details
Page 1 of 1
Detailed Results for Parcel 10-18-1323-001.-U9 in the 2010 Tax assessment Database
DistrictNo 10
Parcel ID 10-18-1323-001.-U9
MapSuffix
HouseNo 6386
Direction
Street GALLEON DRIVE
Ownerl WETHERELL, JOHN S
C/O
PropType R
PropDesc
LivArea 2112
CurLandVal 0
CurImpVal 186600
CurTotVal 186600
CurPrefVal
Acreage .00
C1GrnStat
TaxEx 1
SaleAmt 204900
SaleMo 12
SaleDa 04
SaleCe 20
SaleYr 07
DeedBlcPage 200745057
YearBlt 2007
HF File Date 01/22/2008
HF Approval_Status A
1~~~~~~
~ ~,vo
~~ ~ ~ ~ V
F/w~
http://taxdb.ccpa.net/details.asp?id=10-18-1323-001.-U9&dbselect=l 1/26/2012
St Send Inquires to:
5000 Loulse Drlve
PO Boz 40
Mechanicsburg, PA 17055
www.memberstst.org
MalaSwltchboard: (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TDD: (717) 697-5312 or (800) 283-2328 ezl. 5312
® TeleBranch: (800) 237-7288
MEMBERS 1St
FEDERAL CREDIT UNION
5713 1 AV 0.340 11425-5713
o I~~~III~~~III~~„I,I~II~~~~~I~II~I~~~I~~II~I~~I~~I~,II~~I,I~~I
JOHN S WETHERELL
N 6386 GALLEON DRIVE
o,~ MECHANICSBURG PA 17050
~_
o_
* _
Statement of Accounts
Oct 25, 2011 thru Nov 24, 2011
Account Number: 37052
Balances at a Glance:
Checking: 0.00
Savings : 0.00
Certificates : 0.00
Loans: 0.00
Money Management : 0.00
Swipe 5 YTD Reward : 0.00
Page: 1 of 2
.Your aggregate balance as of November 1st is $133.41.
An aggregate balance of $2,500 and having 3 products
will place you in the Silver MLR level.
• Enter for your chance to win PENN STATE sporting event tickets!
Visit any branch location or www.members1st.org to enter.
CHECKING ACCOUNTS
0011 -CHECKING
Date Transaction Descri tion
Oct ~ Balance Forward Additions Subtractions Ba an
Nov 08 Withdrawal 128
40
CHECK/NG Closed ' .
128.40-
""fig is fhe lira/ statement presenting /nfom-ation on this product"'
"'
P/ease retaa~ this flna/ statement for tax reporting pur
os
• • •
p
es
SAVINGS ACCOUNTS. ~ -
0000 -REGULAR SAVINGS -
,_
Date
...
v
Transaction Description ' `: - °'
'
~
Oct 2B"'"
Nov O8 ` ?
' Additions
- Balance Ic'oiwart9 __ ~ ~ ~_- ~ .
_ Subtractions Balance
~
Deposit, -
Nov 23 Withdrawal Transfer ~ 128.40
13
To JOHN S WETHEREL X) X)CXXXXXX S~iare 0000 133.41- 0,
REGULAR SAV/NGS Closed- ~ h
"' firs is the bnaf statement. prese~fing information on fhis proq'uct"'
"'
P/ease retain. this l~na/ statemerf for tax:reooiting purposes "'
LOAN ACCOUNTS ?~-_' `~'
~ U
Account 8405XXXXXX WETHERELL,JOHN S
ID DUE DATE PRINCIPAL INTEREST
-----------------------------------
Withdrawal from REGULAR SHARE
Ol 54,224.26- 0.00
-----------------------------------
Document Number: 2651687
Effect: 01/24/12 Post: 01/24/12 Tlr: .0166
FEES NEW BALANCE TRAM AMOUNT SEQ
Prev Bal: 54,224.26
0.00 0.00 54,224.26 #597964
Check Disbursed ESTATE OF JOHN S WETHERELL 54,224.26-
JOHN S WETHERELL
6386 GALLEON DR
MECHANICSBURG PA 17050-2949
www.psecu.com
800.237.7328
717.234.8484
JOHNS WETHERELL
Account 8405XXXXXX
WETHERELL,JOHN S
EFFECT: 11/28/11
POST: 11/28/11
TLR: 0484
Withdrawal from CHECKING ID 0
PREY BAL 20,79
TRAN AMOUNT 20,795.09-
NEW BALANCE 0.00
SEQ: #569629
---------------------------------------
Deposit to REGULAR SHARE ID 0
PREV BAL 101.73 ~,
TRAN AMOUNT 20,795.09
NEW BALANCE 20,896.82
SEQ: #569630
----------------------------------------
Withdrawal from MONEY MARKET
PREV BAL 20,061.14
TRAN AMOUNT 20~ 4_
NEW BALANCE 0.00
SEQ: #569631
Deposit to REGULAR SHARE ID
PREV BAL ,896 Z
TRAN AMOUNT
NEW BALANCE 4 g
SEQ: #56963
Current Holdings -Summary
Trec~su~yDrect
Current Holdings » Summary
For details about a particular security, choose a security and click Select.
Your Series I current holdings total amount is: $1,300.00
Series I Savings Bond
.Page 1 of 1.
7ahn's Account: D-313-133-071
Q IAABZ 10-01-2000 8.28% $75.00 :$150.00
~~ IAABO 08 01 `2000-, .~
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$50.00 :102.48 i
Select Cancel
https://ntprd65b.acs.bpd.treas.gov/RS/RSGatewayRW 02/10/2012
,..
.~,~ .
Great-West Retirement Services
PO Box 173764
Denver, CO 80217-3764
January 10, 2012
MERRILL LYNCH
FBO MARION E WETHERELL 87272725
214 SENATE AVE STE 501
CAMP HILL PA 17001
- -' ComrnonMenhh or
Itnnsvlvania Deferred
'
~ Compensation
, ~.~.,
~'`~ Program
Employee Name:
Plan Number:
Plan Name:
John S Wetherell
98978-01
Commonwealth of
Pennsylvania Deferred
Compensation Program
RE: Disbursement Confirmation
The details for your current distribution are summarized below. Please note that only the investment
option(s) from which funds were drawn are displayed, including the ending value.
A tax form will be mailed to you by January 31" of next year, and must be used in completing your tax
return.
SUMMARY OF TOTALS
Total Withdrawal Amount $203,315.43
Total Available to All Receivers $203,315.43
Receiver's Share of Proceeds $203,315.43 •
Check Amount $203,315.43
BEF I - 98978-01 Employee Before Tax
Investment Beginning Distribution
Option V
l UnidShare Uinits/Shures Ending Vuluc
a
ue Amount Value Distributed
Stock Index Fund $61,673.96 $61,673.96 317.970000 193.961569 $0
00
Stable Value Fund $50,624.94 $50,624.94 1.941471 ,
26,075.558172 $0
00
Aggregate Bond Index $10, 146.85 $10,146.85 10.540000 .
962.699241 $0
00
Fund ,
EAFE Equity Index Fund $20,262.88 $20,262.88 144.906000 139.834651 $O
Op
Extended Market Fund $60,606.80 $6Q606.80 236.640000 ,
256.113928 $0
00
TOTAL $203,315.43 $203,315.43 .
$0.00
Beginning Distribution Ending Value
Value Amount
GRAND TOTAL $203,315.43 $203,315.43
$0.00
• If you have any questions, please contact our Client Service Department at I-866-737-7457
(1-866-sers45,7).
(ireal-West Retirement Sen'ices'~ refers to products and services provided by Cireal-West Life & Annuity hisurnnce Company, FASCore,
LI,C (F:1SCoro Administrators, LLC in California)
First Ci
t
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L
,
rca
-
esl
ila Rc annuity U~surnnce Company, While Plains, New York, and
their subsidiaries and aRiliales. Great-1Vesl Lita & Annuity Lisurance Company is not licensed to condu
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i
i
products and related services are sold in New York by its subsidiary. First Grcal-
and services maybe sold in New York by FASCore, LLC. c
us
ness
n New York. Insurance
West Lita Rc flnnuily Insurance Company. Other products
AO I :050510
D(>C_I'YPE: DISt3_S'rD UF,ATH M'1LB
U<X' ID: 274953329
IND ID: 3374939 ADDR-Y PNPF.NCI
F,V ID: 469)68363
REV-485~X + (3-041
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
SAFE DEPOSIT BOX
INVENTORY
Please Print or
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE FILE NUMBER SOCIAL SECURITY (Rsquirad- OR DEATH CERTIFICATE NUMBER (only if SSN is unknown)
p2a I 1 - ~ 12S (0 2 I - (I " I ?..S" IO
.DECEDENT'S NAME (LAST, FIRST, MID~LEI DATE OF DEATH
ADDRESS OF DE,CpED/ENT (ST EETI
~ (CITY) (STATE) (ZIP CODE(
Q-
6 3 O b ~J- A t.a_ E O n! M t~11 q •v ~ c.S J •~ r P (~ i~ ~'~
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE EPOSIT 80X
(NAME)
MA,Z,oN W~-~-,~,.~~ ~
(STREET ADDRESS) (CITY) (
TATE) QIP CODE)
~ 1 2~ ~ AN ~la
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NAME ,ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S- PRESENT AT THE BOX OPENIN
s. (NAME)
M A 2.t o ~~ W C..'F'41 !r f;,, ~ ~ (RELATIOIN~S~H,IP)
! ~' , o `4'L--tr
(STREET NAME( (CITY( (STATE) (ZIP CODE)
H l y y ti n ti +~ ~k ~. -~ '~~ M p ~,~, ,~ s 5 ,..,. ~ ~ a i ~ o~ O
b. INAMEI ~ (RELATIONSHIP(
(STREET NAME) (CITY) (STATE) (ZIP CODE(
c. (NAME) (RELATIONSHIP(
(STREET NAME) (CITY) (STATE) (ZIP CODE)
• NAME AND ADDRESS.OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
INAMEI ~ 1 ~ ~~
~ I
(V
~
(STREET NAME) (CITY( (STATE) (ZIP CODE)
e NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY
~oa~ w~-~,~~< <~ yligl „
DATE OF CONTRACT TO RENT BOX NUMBER OF BOX . TITLE UNDER WHICH BOX IS REQUESTED
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. WAME)
M~2~,w ~~.-~,~~~1 b. (NAME) -
(STREET ADDR
ESS
( (STREET ADDRESS)
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(CITY) (STATE) (ZIP CODE) (CITY) (STATE( (ZIP CODE)
M«~,a~~.~sb~. P~ ,~~~~
NAME AND
TI
TL
E
OF EMPLOYEE TAKING THE TORY
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1 G ~aS ~ O C I.f C S (~ I'LL ..f ~„ r,~ "' ` A ~V PE 4 C rL.
WAS A WILL IN THE BOX7 ^ YES ^ NO If ysa, a. Date of wilt:
b. Name and address of personal representative, if named in the will
(NAME)
(STREET ADDRESS( (CITY( (STATE) (ZIP CODE(
c. Name and address of attorney, if any
INAMEI
e
iSTREET ADDRESS) (CITY( (STATE( (ZIP CODE(
EFORM125600
-.~
SAFE DEPOSIT BOX INVENTORY Page of
' INSTRUCTIONS
The Department is authorized under federal law, 42 U.S.C. § 405(cl, to use the decedent's Social Security number in
administering this state tax law. The department uses Social Security numbers to establi:;h a decedent's identity and
ensure proper credit for tax payments.
11) Cash: Report total only.
(21 Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
designated by name of company, certificate-number, date of certificate, name in which stock is registered, and
number of shares and class of stock. '
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of
ownership, i.e., jointly held, payable on death, etc.
141 Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, la;.t date appearing in book,
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, .Manuscripts, etc: List and describe as fully as possible.
(7) Deeds Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as
possible.
(81 All other contents.
'
ITEM
N0. ITEM DESCRIPZION
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f N ~ o -~ ~1 .. .,-~-
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS
CORRECT AND COM
P
LE
T
E TO THE BEST OF MY KNOWLEDGE AND BELIEF. PERSON RECEIVING COPY OF
SAFE DEPOSIT BOX INVENTORY:
SIGNATURE ~~~ ~.~~
/
'
~
~ SI NATURE ~ ~ `, ` - "
PRINT NAME PR~NAME AND CHECK APP RIATE OX eELO `
PRINT TITLE
zAN~ ~ M ~~,~~ ~ DATE
i 6~ r 2 CH(EC~KAPPROPRIATE BOX:
LLJ Efeecutorltrix) ^ Administretor(trix)
^ Estate Reprasantative ^ Joint owner of safe deposit box
NOTE: Attach additional 8 ~" x 11 " sheet{s) if necessary or use duplicates of this page of form.
• - - -~
E~TRADE
FINANCIAL®
E*TRADE Securities LLC
PO Box 484
Jersey City, NJ 07303-0484
tel 1-800-ETRADE-1
www.etrade.com
Member FINRA/SIPC
February 2, 2012
Persun & Heim, PC
1700 Bent Creek Boulevard, Suite 160
Mechanicsburg, PA. 17055-0659
Re: Estate of John Spencer Wetherell, deceased
Date of Death Valuation as November 3,-2011
John Spencer Wetherell Account Numbers XXX~-5047, XXXX-6802, and XX~~X-8104
Dear Persun & Heim,
We would like to take this opportunity to provide the date of death value* for the above noted accounts of John .
.Spencer Wetherell as of November 3, 2011
Individual Account ending in 5047 opened on August 27, 1999
*This is not a tax document-data provided for informational purposes only. Averag~z price calculated using the
hioh and Inw vnluec nn Nnvemher 3. 2011 /Thursday)
uanti
Assets Average Price
11/03/2011 Market Value
,11/03/2011
300 ALTRIA GROUP INC.: MO - $27.385 $8,213'.50 -
100 . AMERIGAS PARTNERS LP APU $45.125 $4,512.50 .
200 APPLE INC. AAPL $399.38 $79,876.00
600 CISCO SYSTEMS INC CSCO $17.955 $10,773.00
300 GENERAL ELECTRIC COMPANY GE $16.525 $4,957.50
3 GENERAL MOTORS COMPANY GM $23.44 $70.32
200 INTEL CORPORATION 1NTC $23.755 $4,751.00
100 MICROSOFT CORPORATION MS $26.285 $2,628.50
200 SPECTRA ENERGY CORPORATION SE $28.82 $5,764.00
100 VANGUARD INTERNATIONAL E UITY INDEX VWU $41.90 $4,190.00
100 VANDGUARD SPECIALIZED FUNDS VIG $53.555 $5,355.50
300 VENTAS INC. VTR $54.58 $16,374.00
3 WTS GENERAL MOTORS COMPANY GMWSA $14.99 $44.97
3 WTS GENERAL MOTORS COMPANY GMWSB $9.05 $27.15
1;000 GENERAL MOTORS CORPORATION ESCROWED SHARES ~ $0.00 $0.00
,.4; ; - PUT VTR Ol/21/12 SOLD.SHOR - -- $0.55' -$220.00
~~
~~~
~~~
!In addition to the securities listed above, his account had a margin debt-balance_in floe a of ~73,64~"55' a ' f
;November 3; -201-1. This amount u}cludes.margin'tiebt uiterest accrued in the amount ~ $577.12, but not posfed a
the , . e of death. - - __ _ _ ' ~ ` _ ', ~ . + ~ .:?) _ ; - - i - - - _ ~ (}
Hof .. dot ,, .. ,J -
_._
s ~~ ~
~ 3' 1
.. '~ .:~
. E~TRADE
FI NAI~IC IAL°
A
E*TRADE Securities LLC
PO Box 484
Jersey City, NJ 07303-0484
tel 1-800-ETRADE-1
www. etrade. com
Member FINRA/SIPC
Roth Account ending in 6802 opened on September 28, 2008
*This is not a tax document-data provided for informationalpurposes only. Averag<>price calculated using the
hivh and Inw values nn November 3. 2011 (Thursdav)
uanti
Assets Average Price
11/03/201.1 Market Value
11/038011
50 GUGGENHEIM BRAZIL RUSSIA INDIA & CHINA ETF EEB $39.465 $1,973.25
56.5556 ISHARES TR BARCLAYS TREAS TIP) .$I 17.11 $6,623.23
~~
,~~.
In addition to the securities listed above, this account had a cash balance in the amount of $944.61 as of November
3, 2011. This amount included interest and dividends in the amount of $20.40, but not paid as of the date of death.
Global Trading Account ending.in 8104 opened on November 4, 2007
*This is not a tax document-data provided for informational purposes only. Averages price calculated using the
hivh and low values nn November 3. 2011 /Thursdav)
uanti
Assets Average Price
11/03/2011 Market Value
11/03/2011
100
BANK OF MONTREAL BMO
$57.66
$5,766.00 Q
Q .
100 GOLDCORP INC. GG :$51.245 $5,124.50 \
,~~
100 SUNCOR ENERGY INC. SU $32.38 $3,238.00
In addition to the securities listed above, this account had a cash balance in the amount of $456.04 as of November
3, 2011. This amount includes interest and dividends accrued in the amount of $71.12'., but not paid as of the date of
..death .. ..
- ~ In closing, we hope you find this information useful. Should you-have any: further questions, please contact a :.
;Financial Service, Associate at 1-800-387-233,1, 24 hours a.day,; seven:days a week. .. _.
~;
Don . Jo tun'
Correspond ce Specialist
E*TRADE S rarities LLC
Current Moldings -Summary
TreasuryDirect
Yage 1 of 1.
Current Holdings » Summary john's Account: D-313-133-071
For details about a particular security, choose a security and click Select.
Your Series I current holdings total amount is: $1,300.00
Series I Savings Bond
Q IAAAA 10-O1-2006 6.03% $25.00 .$30.68
Q ;.. IAABD 04"~i~003 `' '2 ~°/0y'~,, ' ~ :.~s, ~`i4:~~~,c~ ~;~-~ ~
Q
IAABM
04-01-2002
6.65%
$75 00 z ~:
$'116 91
.~ 7AABC2 10 Ol^~2001 :~ 67°/q`r
, `t ,~. ^ ~~~~$75,00 "~f~~ ~`3~ ~~.
o
Q IAABR 09-01-2001 7.67°i~ $75.00 $]'.32.87
Q IAABS .:07 01 :2001 ;6 11p/o'` ~ ' ~~ ~ '' ~~'~~~00 i r.~ 1~~ ~ 7
- - r _ ~ ~ , ~, ~ _
Q
IAABT
06-01-2001
6.11°,%0
$75.00 _
$135.06
~Q Y
IAABU i .. _.. ..
05 01 ;2001 '6 11%
'~~`'~"'"
$75 00 $135'75
Q IAABV 03-01-2001 8.08% $75.00 $142 59
Q _ IAABW '02 01=2001 " -,6.51% $75.00 $143:55
Q IAABX' 12-01-2000 6.51% $75.00 $145.08
Q IAABY 11-01-2000 ~ 6.51% ~ $75:00 $145:•86
Q IAABZ 10-01-2000 8.28% $75.00 $1!i0.00
Q.. IAABD. 08 012000 6.72% $75:00 $162:04 .
Q IAAB1 06-O1-2000 6.72% $50.00 $1(12.48
Q `IAAB2 04 Ol 2000 8:08% ^$50.00 $101:'30
Q IAA63 02-01-2000 6.51% $50.00 $102.64
Q 'IAA64 ~,12-01-1999 6:51% . $50.00 $103:74 "
Q IAABS 11-01-1999 6.51% $50.00 $104.30 '
Q IAAB6 . 09-01-1999 7.98°!0 $50 00;~ ': ;$103 42'
,~ _ mitt. - - •..~- - - r ` a'. ~. . .
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02/10/2012