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HomeMy WebLinkAbout05-08-121505610101 OFFICIiAL USE ONLY ~ REV-1500 ~`°''°' PA Department of Revenue pennsylvanfa Counh Code Year File Number Bureau oflndividualTaxes ~~ ~ jNHERITANCE TAX RETURN Po sox zlio6ot 2 / /2 O~ Z Harrisbum PA L9126-0607 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMODYYYY 186-26-9712 ' 02/25/2012 11/23/1926 Decedent's Last Name Suix Decedent's First Name MI LILLICH JR DAVID O (If Applicable) Eller Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's first Name MI LILLICH BARBARA G B spouse's Social security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE gases-5302 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW l~ 1. Original Return' O 2. Supplemental Return O 3. Remainder Retum (date of tleath prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Relum Required death after 12-12.82) ~ 6. Decedent Died Testate O 7. Decedent Meinlainetl a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceetls Received O 10. Spousal Poverty Credit (date of death O 1 t. Election to tax under Sec. 9713(A) between 12-37-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT- TNIS SEOTION MUST BE COMPLETED. All CORRESPONDENCE AND CONFIDENTIAL TAXINFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number -.,, THOMAS E. FLOWER (717;1 243-5513~j N REGISTER OF'$fl USE ON~ _T~_7 ~ --t First line of address - R7 ~ Sl ~ ~~ ~ ~ 1 ~ FLOWER LAW, LLC n 7C~ ~ T Sewnd line of atldress U n n 10 W. HIGH ST. ~ St t ZlP C d DATEFVLED ~~ City Or POSt Office a e o e CARLISLE PA 17013 Correspondent's e-mail address: rn "J ti~ ~°, O t'-; r~ ~ : ,-.i ! C7 -z~' ~- r;=r ~~ Under penakies of perjury, I declare that I have examined Mis return, Including accompanying schedules antl statements, sill to the best of my knowledge and Deliet, a is eras, woect arW complete. Oadaratbn of preparer otner then Me personal repraseMarrve 15 based on all Information o(which Oreperer has any knowletdge. S).egIATU'FytO'F~PER~ ON RE~ONSI~ FOf} FII~I a O O iRA D.) DS~/ wI 7 2 Barbara G. B. Lillich, 225 N. Dickinson Schoo{ Rd., Cadisle, PA 17015 {I A~iE OF PR ER THAN REPRESENTATIVE Flower Law, LLC; 10 W. High Street; Car4isle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15U5610101 15l]5610101 J ~~ J 1505610105 REV-1500 EX Dec:edent's Social Secudty Number Decedenes Nama: DAVID O. LILLICH, Jr. ' lE16-26-9712 RECAPRULATION 1. Real Estate (Schedule A)......... _ .................................. L ' .584,400.00 2. Stocks and Bonds (Schedule B) ...... ...... 2 1,264,604.78 3. Cbsely Held Corporation, Partnership or SolaPropdelorship (Schedule C) ..... 3. ', 4. Mortgages and Notes Receivable (Schedule D) ...... .......... ....... 4 ,_ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5 134,985.04 ', 6. Jointly Awned Property (Schedule F) O Separate Billing Requested ....... 6. ' 7. Inter-Vrvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7 67,740.90 ' 8. Total Gross Assets (total Lines 1 through 7) ............................. 6. 2,051,737.72 9. Funeral Expenses and Administrative Costs (Schedule H) ..............:.... 9. 22,645.70 10. Debts of Decedent, Mortgage liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 22,645.70 12. Net Value of Estate (Line 8 minus Line 11) ................... . ......, .... 12. ', .2,029,086.02 13. Chadtable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ... ....... : ........ 13. 1,661,345.12 -14. Net Value Subject to Tax (Line 12 minus Line 13) :........ ..... ............ 14. 147,740.90 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a>(,.z> x .o 0 67,7aoso 16. Amount of Line 14 taxable at lineal rate x .0 45 80,000.00 17. Amount of Line 14 taxable at sibling rate X .12 1 B. Amount of Line 14 taxable at collateral rate X .15 15. ...0.00 16 __. .. _.... ......3,600.00', 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 3,600.00 O Side 2 L 1505610105 1f~05610105 REV-7500 EX Page 3 Flla Number Decedent's compte'<e Aaaress: DAVID O. LILLICH, JR. -. STREET ADDRESS _..... 225 N. DICKINSON SCHOOL RD DICKINSON TOWNSHIP ____ cICARLISLE srtiTePA ziP17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 3,600.00 2. CreditclPaymants 3,410.53 A Prior Payments -- - ----- B. Dispunt 179.50. 3,590.03 _.._..... __ -- Total Credits (A+B) (2) 3. Interest 0.00 (3) 4. If Line 2 Ls greater Oran Line 1 + Line 3, enter Ore difference. This is the OVERPAYMENL 0.00 Flll in oval on Page 2, Llne 20 to request a refund. l4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 9.97 Make check payable to: REGISTER OF WILLS, AGENT rRV ,~ 4"'> ~ b irv, 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 Uansferred :.............................................:......_.................,.................. ^ b. retain the fight ro designate who shall use the property trensfened or its income :..............................:..........._ ^ X^ -c: retain a reversionary interest; or ...................................:......................:.:.:....::...................:....:............................ ^ 0 d. receive the promise for life of either payments, benefits or pre? ............................................................_....._. ^ 2. If death occurred after Dec. 12, 1962, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ X^ 3. Did depdent own an "intrust for" or payable-upon-death bank account or security ai his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or oihernon-probate property, which centains 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.. , ~~~~~5~ih`T~*.. k.i'IH'~.. ~ .. -ia~m,~ .. -, ~d ~,.rzrE jkaS 5 >: ;Y~;.i ,': For dales 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 lax 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 lax, and the statutory requirements for disclosure of assets and filing a tax velum are still applipble even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rete imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. RE'V-1502 E%+ (ll.-OB) ~ Pennsylvania DEPARTMENT pF PEVENUE INHERRANCE TA% RETURN RE51DENi DECEDENT SCHEDULER REAL ESTATE ESTATE OF FILE NUMBER DAVID 0. LILLICH, JR 21-12-0262 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 6e exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of [he 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 DESCRIP'ftON 1 ONE-HALF INTEREST AS TENANT IN COMMON,139 ACRE FARM WITH IMPROVEMENTS, DICKINSON TWP, CUMBERLAND COUNTY TAX PARCEL 08110292015,112 assessed value 371,250.00 2. ONE-HALF INTEREST AS TENANT IN COMMON, 98 ACRE FARM WITH IMPROVEMENTS, DICKINSON TWP, CUMBERLAND COUNTY TAX PARCEL 08110292016,112 assessed value 213,150.00 TOTAL (Also enter on Line 1, Recapitulation.) ; 584,400.00 If more space is needed, insert additional sheets of the same size. ' LYN R MCOUILLEN, TAX COLLECTOR Office Hours: MAR-OCT MON 8.9PM TUES 9-1:Z NOON Bill No: 1288 1044 PINE ROAD APR 25 &8PM BIII Date: 311/12 CARLISLE, PA 170159373 NOV-FEB BY APPT ONLY NO SAT, SUN OR Control No:088000785 HOLIDAYS MAP NO 08-11-0282-018. Dees: 222 NORTH DICKINSON SCHOOL Acres 98.1 LIIIA~~NDAPPROXII9~~SII'''A'IICRES I~~~~Y8~~8~~gAlfd 51.00 FEE FOR ADDITIONAL RECEIPTS Tax Payer. LYLDH, BARBARA G B b DAVID LRLICH JR 275NORiH rACIBHSDH SCHODL RD CARLISLE, PA 170,5-815/ Assessed Value: Preferred Land: 82,500 Improvement 3x33,800 Total: 426,300 Dlacoum Penalty County RE 1.902 $794.80 $810.82 $891.90 County Llb .143 $59.74 580.98 $87.00 ffroProtc 0.084 $35.09 535.81 $39:39 TAX AMOUNT DUE If Dats Of Payment le On 5889.43 5807.69 3/1 /12 thn, 4/30/12 5/1 /12 thru 6/30112 5988.38 7/1/12 a Later TAXPAYER'S COPY -KEEP tHIS PORTION FOR YOUR RECORDS P o: AROLYN R MCQUiLLEN, TAX COLLECTOR PINE ROAD CARLISLE, PA 17015-0373 PH E-X237}4 MAP NO: -11-0292-016. ~Dex: 225 NORTH DICKINSON SCHOO .. Acres 139.48 APPROX 139 AC~pRES " '~ $1.00 FEEFORADOITIONAL RECEIPTS ~:. ' Tax Paysr. LR1ICH, DAVIbJR . bBARB.ViAGBLbLICH ~' 715 NGRRi DICgNSON SCHOOL RD CARLISLE, PA 1]015.6159 OtBee Houre: MAR-OCT MON 8.9PM TUES 9-12 NOON BIII No: 1287 APR 25 8-BPM ~ BIII Deta: 3!1N2 NOV-FEB BY APPT ONLY NO SAT, SUN OR Contrd No:088000784 HOLIDAYS ~'-'-"~~ Assessed Vstus: Preferred Land: 96,900. - Improvement: 643,80 Trial: 74$500 ~ ( Dlecdunt , _ Face Penalty ~: County RE 1.902 $1,384.00 $1,412.24. $1,553.48=~ County.Lib ' .143. $104.06 $tO8it8 $116. Flre Protc 0.084 $81.12 $62.37 $88.61 ' ~ TAX AMOUNT DUE ', If Date Of Payment is ~On 51,848.18. _ ' St,860.79 3/1112 thru 4/30112 5/1 /12 thru6/30/12'' ~ 31,738.87 7/1/12 bt Later TAXPAYER'S COPY - KEEP'THIS PORTION FOR YOUR RECORDS CAROLYN R MCGlUILLEN, TAX COLLECTOR 1044 PINE ROAD CARLISLE, PA 17015-9373 TEMP -RETURN SERVICE REQUESTED ~ ~ ~ . L 9 nll.1,I,IIINIIIII'Iludlll'.I.Ni,,,,4lpplll'hhdhlP1° B7„0-i26] " LILLICH, DAVID JR REZ-15x3 E%+(7-v) ~ ` Pennsylvania OEVAflTMEHi OF PEVENIIF INHERITANCE TA% RENRN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER DAVID 0. LILLICH, JR 21-12-0262 All properly jointly owned wlth right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM --___--.. nv nonTu I' Goldman Sachs Bank USA certificate of deposit, CUSIP 38143AGU3 2 8,000 shares Cadisle Companies Incorporated common stock, CUSIP 14233910 0 @ 49.51 g 500 shares Cisco Systems, CUSIP 17275R 10 0 @ 20.1675 4 4,000 shares Ford Motor Co., CUSIP 345370 86 0, @ 12.25 5 4,400 shares EXXON, CUSIP 302290101 and 30231G 10 2, @ 87.2725 g 396 shares BP AMOCO P.L.C, CUSIP 5562210 4 @ 47.505 7 4,000 shares General Electric, CUSIP 36960410 3 @ 19.1625 g 400 shares Emerson Electric Co., CUSIP 291011 10 4 @ 50.88 g 300 shares Wells Fargo & Co.; CUSIP 9497461-- @ 30.45 10 - 1,888 shares M&T Bank, CUSIP 55261E 10 4, @ 81.67.. 11 1,000 shares Microsoft, CUSIP 59491810 4 @ 31.335 ~ 2 ' 6 shares JP Morgan Chase 8 Co., CUSIP 46625H 10D @ 38.4725 13 1,500 shares Susquehanna Bankshares, Inc., CUSIP 869099101 @ 9.3075 100,773.00 396,080.00 10,083.75 49,000.00 383,999.00 18,811.98 76,650.00 20,352.00 9,135.00 154,192.96 31,335.00 230.84- 13,961.25 TOTAL (Also enter on Line 2, Recapitulation) ; 1,264,604.78 If more space is needed, insert additional sheets of the same size PMA account 8431262271 ^ February 1, 2012 -February 29, 2012 ~ Page 8 of 10 Brokerage account statement Account profile Accoun[rype: Standard Brokerage Brokerage accoun[number. 33686296 Taz status: Taxable Investmentobjective/ flick [derance: Moderate Income Cos[ basis election: First in, Firs[ out DAVID O LILLICH 225 N DICRINSON SCHOOL RD CARLISLE PA 170159154 Investment products and services are offered through Wells Fargo Advisors, LLC, brokerage account(s) carried by First Clearing, LLC. Wells Fargo Advisors, LLC and First Clearing, LLC, Member NYSF151PC are separate registered brokerdealers.and rwn-bank affiliates of Wells Fargo Company. To view yourattount information online, visit: wellsfargoadvisorz.com &okeraae d«umwat delWery status: Paper EI«tronlc Customer Service or 24 hour service:: 1-800-359-9297 Statements X Trade confirmations X Your Financial Advisor. L465 Tax documents X For more information about your account calk Sharehdder communiw[ions X JAY BAVLISH 600 PENN STREET, 2ND FLOOR This summary of your account(s) is prgvided for your convenience. You READING, PA 19602 will receive.a complete monthly s[a[elnen[ of your atcoun[(sl separately. 668-243-7422 Portfolio summa -~ ry Current asset allocation Esrimaredann Detoiprlon '.Previous value ($) Currentvalue (S) IncorrrctS) Cash and sweep balances 0.00 0.00 0' Stocks, optionsA ETFs O.W 0.00 0 ,Fixed incomesecuri[ies 101,406.00 100,773.00 2,500 Mutual funds ~ 0.00. 0.00 0 Assetvalw 5107,406.00 5100,773.00 52,500 ~... s Flied lncamesecudde;: 100% Inveatrawrst and Insurance Producb: - Are NOT insured by the FDIC or amy other federal government agency - Are NOT deposits ofaguaran[eed by the Bank or any Bank affiliate - May Lose Value 020_L4_L455 V' N M 0 0 0 a r c U N T - `o ydp^O pL,y _ C .L.. 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M O gad +O~ ~~ V o~ V ^w ~~ ~g,~ J ~ Q W •••t ••••YOAKl' TRANSFYn n-~ "~_ NEW AND BEGiST RAA BY ~ y ~~~,,J~v.~-~ ~iw-~- / "" - AUTHDRI7FD 91GNATUAE ~:. O 0 I a w 0 1_ O N a ,~ g ~ ~ ~~ YOPK1 i pN0 PEGIS~'^ ' ~ (NE`1A ~ ~~,~"`~ AU7~~~S16NATJPE z a a c ~ ~~ ffig ~- w ~~ O 4 s a~ °n m nz so 0 m i .a ¢- W~ S W6 O ¢0 ~ W< ~ n .L .,.,. ~~ W ~~~ a <:. ~~ p ~ ~ ~~ ~ Y O Y ~ 2 Z' W m W.: ~,. Z a, a; W ~~ ~~. m m W " a a C Oc o. U W f ~ 4 0 W Q R N N N k a: o ~~ _ ~~~~ Z _ ~o a ~~~ o ~ ~^~r i I u=r i I ~- M ~ O o ~~~ W~~t9 `rA I Z AQ T5 yyyyy i~ w~ O ~~ ~... W, W W Z W W a . z Q p ~a ~~ J 7 ~ r ~~ °~. W F o m mi o <O T Wf ~< S WC P p0 ~ >-~~ N ,_ __ __ D ~~ O O_ ytly m N 0 o~~¢. ~' u Y ~~ ~~ e ~~ ^^ :~.~~.. r~ rc ~~ W= YI u W J6 W m s ~~WF ~~~~ _~ (V r ~~ ~ z ~~ COUNTfiR810N6G, GENERAL ELECTRIC COMPANY, BY i TRANSFER AOENT. •~ ~. ~ a ~~ ~ ~ 1(I Y ~ U ~ F ~ m N "'I ZR J O* ~, Q U ~. W 2 :~ Q N » W.,, . _ , y o :,; ~ , z a -., . _, J ~ r~ LL ~ y • ~~~ •ra~uso aazrooNanv •rvaxeloar )006 M~i3D ~ xe .lt1V~[O~ 1S[121L AL1~LV~/I1FJ NtnJ OU[ laaa xsloaa `W {J ~W ~J Q, W C:~ O 4 .~ r _. . _ _„ ~, 4: ~W o~ m <o ° y1F A 6~ S ~w O .D ¢b < .L m Z a r `,.c.: €y 0:-~- i dN p~ a o~ 0. ~' ,M~~ ~i sW ~~ ~~ Q Fl W Z W C7 i COUNTERSKiNED AND REDI69'EREd. 1~3E BANK OF NEW YORK (M[w1bRK1 TRANSFFF~}~t AGENT BV AND REDISTRAR ~".,a.,J-~~ AUTIORISED SIGNATURE ~\ ~`~~' ~;.y ~~ ~ ~~~ Y U O N ~ ~ `~ iZ. ) ~ ,~ O F e lO U <, ~ W b S F ~~ ~ \ 0 N W 2 N Q r Z 0 2 0 Z Q 0 a~ a; J LL, :,. ~k M a y ..~ ~z Q a -~ ~~ o ~~ v g V li '. ~. M 0 GY ",~y~Nl_IN YORIQ ~•• TRANSFER AGEM AND REGISTRAR ~.~/~ AUTHORIZED SIGNATURE 0~3 ~~ . ~ ~~~ ~ s 3 Y S U ~~_ Z. a f E 0 U W I f 0 m W Q I UI O Z .0 Z i • .. :.,;~„ O' O .~ N v O ,: ,Z $ Q ~ ~ o a 5 S 0 a 1'3 3 ~ 6 ~ S O ~ ~ ' ru > °z $ d a ~k~ ti ~ ~w ~ ~ g~ v o z • O U w COVNTEf1316NE0 M1G BEGISIFSIEB: MELLON IM/ESTON SEIIVICE9 LLO W ~ BT AND 4STggR ~O 0 ~r _ W 2 tl NfTHOR 91pNg1UgE N 4 6 W ~ ~ 0 Y O N Z O f O U IIII O 2 Q O a J 7 W V a 0 U M Y L W 0 a t a f rc a x u a rc rc W W e S u f Y 0 Q~ R 8 ffi U L ...._,. S O a O ri ¢ Q. 7 N 0 0 a a F F-I H 0 ~ V F W ~ u O o I~~ N 00 4 f ~_= e W 2 V N 4 ~ W y~ W O .!~ 4 O Y U O N W 2 H $I < a ~ 4, W 7 J f~ f ~. N. r W C Q Z N O 2 Q a J LL °"'ski K t 0 m W F O 2 ~, i ~ U 3 ~ K U o pN `. N 0 ''~Vw?~:t~; -a: ;~ c n ~. 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"m. ; o: Z 5 0 i W~ ~~//~~ V/ 3 ,~ N F d m v° ' m r n m - u r C m v N L O m t N ~ O ~? ~ J O (j r a Z ~ r _ O 0 ~ ~ t {{~ 9 ~ Q k T •• 9 V ~ ~ ~•~ Z Q a m m ~ . ~ :~ o~~. a %gm = a~ E ~~~ mom mm~ ~ L¢~ N 9~~ c om ~~o H a « ~ 1 C Tp [ oa ~ ~ m 1 ~ O~t3 ~ U m m N j 0 0= a~E a«~ C o~~ r m~~ I `n m- i° m 3 '~ r '~ ~~ o FS INC ..,~ , ~~ J N 4 d gN' ~` 8nos~5 a,,..P•• n 0 a, m N Q O O b M T O O D la o ~- 0 ~- a H ~ Vl U uu V 1~ ~ ~ -w ~~~yyy f ^ 1 ~ ~ W < <~ n ~ ~ U o d ~ ~ ~ ~ # Ri u ~ ~ ~ ~~ ~ y; , ~ W v l ~ ~ ~ ~~~11 , ? ~ M ~ ~ ~. ~ ~ ~ ~ «,- ~ e `V = M o w ~`. ca z~~ ~ * ~ z 'i- Q ~, -~ ~. -~b .ti ~ ~~ w _. v~ ~ ~. ~a ~ e . ~, a emie~ars P~NWIuY <~ v~ Rg luedy ~Byeue~l (~rvwRa~ued'unrV NNV81Sald S!l3WHVd Peuera+ewno~ w a ,. p, :: .,~~~{„QSOS nmun N ~. ftEV-1508 E%+(ff-f D) ~ ' pennsytvania SCHEDULE E OEPARPMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDEM DECEDENT ESTATE OF: FILE NUMBER: DAVID O. LILLICH, JR. 21-12-0262 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. _. 1, .WELLS FARGO CERTIFICATE OF DEPOSIT #247402093390543 2, hA&T BANK CHECKING ACCOUNT # 424935 TOTAL (Also enter on Line 5, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 50,108.16 84, 877.88 134,986.04 • AO.:' ACCOUNT TYPE :' 424935 PTHER CHECKING 00 0 04319M NM -- 4122 DAVID 0 LILLICH JR 225 NORTH DICKINSON SCHOOL RD CARLISLE PA 17015 INTEREST EARNED FOR STATEMENT PERIOD 1.29 INTEREST PAID YEAR TO DATE 8.58 4000l1NT SLIMMARV STATEMEM PERI00 PAGE FEB.18-MF~R .20,2012 1 OF 3 HIGH STREET-CARLISLE NG >: >:9ALANCE :~ ~: A TS ~R OTHER OI7'IOHS ~. ':. ~HEC'KS pATO ~ ' :::OTHER ~.::: .~UtfTRACYI0N5 RREMT IiiTERE37 PD EN.O~ NG :s BAI:'ANCE N0. AMOUNT. N0. AMOUNT N0. AMOUNT - 85,729.08 3 828.46 5 848.10 2 81 394.44 1.30 4 316.30 ACCOl1NT ACTTVTTV ROS7IHFa Dk1` YkA Ac`F'20N:OESCRYPTYON .. pOS T&;IN:ERE83 a'tl'FHE::AUOiT'~oNS >:'GHEGK& &>~:QTH R s TRACTIONS ~ AAILY;;- BALANCE :; 02-18-12 BEGINNING BALANCE L85,729. 08 02-21-12 DEPOSIT . 282.89 02-21-12 DEPOSIT '" 45.00 02-21+12 CHECK NUMBER 2184 - - - 163.10 85,893.87 02-23-12 DEPOSIT 500.57 02-23-12 BARCLAY CARD US CREDITCARD OOOODOOO.OOD2183 1,516.56.. 84,877.88 02-28-12 In Branch Transfi~r/Nithdrswal 79,877.88 5,000.00 02-29-12 CNECK NUMBER 2185 ~ ' ~ 585.00 02-29-12 CNECK NUMBER 2188 50.00 02-29-1 CNECK NUMBER 2187 25.00 02-29-12 CHECK NUMBER 2186 25.00 4,315.00 03-20-12 INTEREST PAYMENT 1.30 _ 4,316.30 ENDING BALANCE - 04,316.30 CHEsCKS PAID SUMMARY 2184 02-21-12 163:10 2185 02-29-12 585.00 2186 02-29-12 25.00- 2187 02-29-12 25.00 2188 02-29-12 50.00 ANNUAL PERCENTAGE YIELD EARNED 0.04 HARM UP WITH SPECIAL SAVINGS THIS SPRING AT POPULAR RETAILERS WHEN YOU USE YOUR N8T CHECK CARP OR MSTVISA CREDIT CARD IN STORES, ON THE WEB AND OVER THE PHONE. VISIT MTB.COM/SHOPPING TO TAKE. ADVANTAGE OF GREAT DEALS ON SPRING SAVINGS TODAY! PMA account 8431262271 ^ February 1, 2012 -February 29, 2012 ~ Page 5 of 10 Certificates of Deposit Summary of Cartificatas of Deposit No. Accountnumber Originalissue dare Odginol value ierm Matudry date Current balance 1 247402093347611 3!22/08 $60,000.00 60 months 3/22/13 $60,000.00 2 247402093390943 5/13/08 $50,000.00 60 months 5/13/13 $50,000.00 3 2474020933905 73 9/73/06 $43,000.00 60 months 9/13/13 $43,000.00 $193,000.00 ~ Certificate of Deposit #1 Account summary Original value ~ 560,000.00 Currenr: value Sfi0,000.00 Original Issue date 3/22/08 Current issue date 3/22/08 Ma[udty date 3/22/13 Term 60 months Account number: 247402093347011 DAVID O UUJCH JR BARBARA G B UUJCN Wells Fargo Bank NA., ,vennrylvania (Member FDIQ Questions about your account: 1-800-742-4932 IntarQSt you'v'z ealre6ad intarostwkhh~ld . Interest rate ~ 4.16% Total interest withheld in 2011 $U.00 ~ ' Annual perce!htageyield 429% Interest accrued but not paid $6.84 ~. ' ~ InteresC paid this year $410.98 Interest paid in 3011 $2,900.79 Activity d6ltail Interest Paid 198.63 Interest Distributions 198.63 Current bdenco 560,000.00 ~ 3 c~uc. ~uAt tt/~ ~~' C ~ot,~i~t (~ k.eS / ~~~ ~, ~` ~ . Z w<c N.. ~~.aQ~.c~rs ~ ~ssr I I~~III~I ~~~ ~I~~I ~~II~ ~+~~~ III~I ~I~~~ I~~I~ (~I~I ~~I~I ~I~~I ~I~~I ~~~I~ ~~~~~ I~~II ~~~~~ I~~~ I~~I 'P, 973,29~OC9,7a~e3w9ia0iaa~ PMA account 8431262271 ^ February 1, 2012 -February 29, 2012 ~ Page 6 of 10 CERTIFICATES OF DEPOSIT (CONTINUED) ~ Certificate of (Deposit #2 Account summary Original value $50,000.00 Curren[value $50,000.00 Original issue date S/13/08 Current issue date 5/13/08 Maturity date 5/13/13 Term 60 months Interest you've earned Interest tale 4.64% Annual percentage yield 4.75% Interest accrued but not paid $108.16 Interest paid [his year $394.84 Interest paid in 7011 $2,324.34 Account number: 24402093390543 DAVID O LILLICH 3R Wells Forgo Bank NA, Pennsylvania (Member FDIQ Questions about your account. 1.800-742-4932 Intarast withhold Total interest withheld in 71111 $0.00 Activity datafl Interest PaGd ~ 197.42 Interes[Oistribu[ions 197.42 - Curr4mt balan<ar 550,000.00 - 445558 PMA account 8431262271 ^ February 1, 2012 ~ February 29, 2012 ~ Page 7 of 10 i CERTIFICATES OF DEPOSIT (CONTINUED) ~ Certificate df Deposit #3 Account summary Account number: 247402093390573 Odginal value $43,000.00 DAVIDOLILLICH IR Current value $43,000.00 BARBARAGBLILLICN Original issue date 5/13/06 Wells Fargo Bank NA,.°ennsylvonio (MemberFDlQ Cunenr. issue date 5/13/08 Questlons about your accoune 1-800-742-4932 Maturity date 5/13/13 Term 60 months Intorost you've oarnotl Interest rate 4.fi4% Annual percentage yield 4.75% InteresC ac[rued but no[ paid $93.03 InteresC paid this year $339.55 InteresC paid in 2011 $1,998.94 Intorost withhold Total interest withheld in 2011 50.00 Activity detail InteresC Paid 169.77 Interest Distributions 169.77 Currant balance $g3,000.OD C~ Asa I I~~~I~~~ ~~I ~~~~I ~III~ I~~~~ I~~~I (~~I~ I~~~I ~~I~I ~II~I ~~~~I ~II~I I~~I~ I~~~~ ~~~I~ ~~~II ~~~) I~~~ ~P,573II91045, ~aioaro5lololeia• REV-1510 E%+ (00-09) ~ pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND mMERITANCE rAx RETURN MISC. NON-PROBATE PROPERTY RESIDENT DE(FDENi ESTATE FILE NUMBER DAVID O. LILLICH 21-12-0262 This schedule must be completed and Flied if the answer to any of questions l through 4 on page three of the REV-1500 is yes. TAM NUMBER DESCRIPTION OF PROPERTY mauDE tNE wolf of mETaeisR~zff, INaR REUnoNSwP To oECtaFm AnD niE OAhaawwsre~. ATrADiAmPr orn+E Dan wR Rr~x ESrare. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION RrRVUrwF TAXABLE VALUE 1. IRA atx:ount at Orrstown Bank, PAYABLE TO SURVIVING SPOUSE, 67,740.90. 100 67,740.9( BARBARA G.B. LILLICH TOTAL (Also enter on Line 7, Recapitulation) ; I 67,740.90 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (30-09) SCHEDULE H ~ Pennsylvania DEPARTMENT OF REVENUE INiNERRANCE TA%RETURN RESIDENT DECEDENT FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DAVID O. LILLICH, JR 21-12-0262 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPf10N AMOUNT A. FUNERAL EXPENSES: t' HOFFMAN-ROTFN FUNERAL HOME, TRADITIONAL SERVICE PACKAGE 4,650.00 2. CASKET (2,945)14ND OUTER CONTAINER (1,620) 4,565.00 3. MT. HOLLY SPR~,S. CEMETERY, INTERMENT 700.00 a. DEATH CERTIFICATES 180.00 5. OBITUARIES, S~NTINEL (194.68) AND PATRIOT NEWS (333.87) 528.55 s. FLOWERS 99.11 B. ADMINISTRATIVE 00575: 1. Personal Represen(ative Commissions: Name(s) of personal Representative(s) _.. _. _.. __ _,.. Street Addrdss _. „.. City _.__-,____... .____._. ________ -. State_____. ZIP. ________._ Year(s) Commission Paid: 2. Attorney fees: 7, 500.00 3. Family Exemptiom'~,(If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 Claimant BARBARA G. B. LILLICH Street Addrt{ss 225 N_ DICKINSON SCHOOL RD city CAF~ISLE _ state PA ZIP 1!015 Retationship',of Claimant to Decedent SPOUSE 4. I Probate Fees: 5. ~ Accountant Fees: 6. Tax Return Prepargr Fees: ~ ADDITIONAL SHbRT CERTIFICATES e. DEED RECORDING FEES s. PUBLISH ESTAT~ NOTICES; LAW JOURNAL ($75) AND THE SENTINEL ($189.54) TOTAL (Also enter on Line 9, Recapitulation) ~ $ 508.50 24.00 126.00 264.54 22,645.70 If more space is needed, use additional sheets of paper of the same size. . ~; 219 North Hanover Sheet Carlisle, Pennsylvania 17013 717.243.4511 - -~ -~ toll free 1.866.451.451 1 ,,~,~ i' ~~/]-`'~~.-~ i 2 .~Y~~j~//j~~ 1 ~r/ fax 717.243.3723 t.~I' (,~(J~ ~ i~'I'rla.4~l' Z~'" cam.: - C.~~f~7i li w~.wv.hoffmonroth.com !FUNERAL ROME b2 CREMATOR:Y, INC. info@hottrrarroth.com May 3, 2012 Mrs. Barbara G. B. Lillich 225 N. Dickinson School Road Carlisle, PA 17015 Statement of Funeral Expenses for: David O. Lillich, Jr. Date of Death: February 25, 2012 Account Id: 16488-055 PACKAGE: Traditional Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 4,650.00 Sub Total: $ 4,850.00 MERCHANDISE: Casket: Daniel Casket Outer Container: Monticello $ 2,945.00 $ 1,620.00 Sub Total: $ 4,565.00 TOTAL FUNERAL HOME CHARGES: $ 9,215.00 CASH ADVANCES: Mt. Holly Springs Cemetery $ 700.00 30 Certified Death Certificates at $ 6.00 each $ 180.00 _ Newspaper Notice -Sentinel $ 194.68 Newspaper Notice -Patriot $ 333.87 Rowes $ 99.11 Sub Total: $ 1,507.66 Total Funeral Expense: $ 10,722.86 Total Payments Made: $ 10,722.88 Payments Made: Barbara Lillich Check 98 Mar 18, 2012 1,408.55 Barbara Lillich Check 302 Mar 22, 2012 9,314.11 Refund To Barbara Lillich Apr 12, 2012 (100.00) Cumberland Cty VA Check 841782 Apr 12, 2012 100.00 Balance: Please return this portion with your Remittance. $ Amount Enclosed David O. Lillich, Jr. Service ID#: 18488-055 SERVING OUR COMMUNITY SINCE 1907 REV-1513 EX+ (O1-10) ~ Pennsylvania DEPAPTMENT OF NEVENUE INHERITANCE TAX RETURN RESIDEM DEfFDENi SCHEDULE ] BENEFICIARIES ESTATE OF: FILE NUMBER: DAVID O. LILLICH, JR 21-12-0262 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMOER NAME AND ADDRESS OF PERSON(S) RECENtNG PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [[ndude outdght spousal distributions and trensfers under Sec. 9116 (a) (1.2).] 1. DAVID 0. LILLICH,111;13660 BALMORAL GREENS AVE, CLIFTON, VA SON 50,000 2. JOAN E. LIILICH,13660 BALMORAL GREENS AV, CLIFTON, VA 20124 DAUGHTER-IN-LAW 10,000 3. LINDSAY ALEXANDER LILLICH,13660 BAL. GR. AVE, CLIFTON, VA GRANDDAUGHTER 20,000 4. BARBARA G. B. LILLICH, 225 N. DICKINSON SCHOOL RD 17015 SPOUSE 67,740.90 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IB OF REV-1500 COVER SHEET, AS APPROPRIATE. - NON-TAXABLE DISTRIBUTONS A. SPOUSAL DISTRIBUTIONS UNDER SECIION 91 t3 FOR WNICH AN ELECTION TO TAX IS NOT TAKEN: ~ - 1• BARBARA G. B. LILLICH TRUST UIW DAVID 0. LILLICH, JR 1,881,345.12 B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COZIER SHEET. I S 1,881,345.12 If more space is needed, use additional sheets of paper of the same size. ~~c~t i11 ~.n~ C~Te~~~zmaertt o~ DAVID O. LILLICH, JR. I, DAVID`O: LILLICH, JR., Dickinson Township; Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and form foIlowing; FIRST: I hereby expressly revoke all Wills,and Codicils heretofore made by me. i , SECOND: ? I hereby direct niy Exeeeitrix; to pay all- my just debts, .funeral. and administrative expenses out of my estate; as soon as prccticahle after. my death.. ` THIRD:. I direct that all tares which may ba assessed in consequence. of :my death, i)f whatever nature and by whatever jurisdiction imposed, shall. he paid out of my ' est'ateas a p:~rrt of the administration of my est{tte. 'FOURTH: i give ti) my son; DAVID'i?. LILLICH, 111, the sum of Fifty Thousand : i ($50,000.00) Dollars. FIFTH: I give to my gr<tnddziughter, LINDSAY ALEXANDER LILLICH, the. sum of Twenty Thousand ($20,000,00) Dollars but should she not have attained the age of 28, her parents shall-hold the same In Trust for her until she reaches the age of 28 years. SIXTH: I give to JOAN ALEXANDER LILLICH the sum of $1(1,000.00. SEVENTH: Provided my wife, BARBARA G. B. LILLICH, survives me, I give to the Trustees hereinafter named, an amount equal to the Federal Tax Exemption Equivalent in _ .r~. ~~ ,._l' ~ 111018 force and ,applicable to my estate at the time of my death, In Trust, nevertheless, upon the following terms and conditions: A. The Trustee shall invest and reinvest the principal and pay the net income arising'from the principal of this Trust in a monthly or quarterly installments to my wife, BAiRBARA G. B. LILLICH, during her life; B. If in any year my wife, BARBARA G. B. LILLICEI, makes request of the Trustee, th~lere shall be distributed to her from the principal of this Trust in such year such anuipnt as she may in writing request, prttyided, however, that the total of . said Burn-sb'-distributed in any calendar yeahshallnotexceed the greater of.-five. p'ercerif (5%) of the value of the Trust-principal (determined at the beginning of such tni5t' year) or :Five Thousand ($5;000,(10) =Dollars annually. Thi right shall. be exebresable only by my wife personally and shall be nonacannulative; C. QI}~tin the death trf nay'wife, the Trust shall terminate,and the Trustee shall distribu[f; 'the principal and •accumulated income to my son, DAVID 0. LILLICH, I[I;, D. Should my song DAVID O. LILLICH, III pre-decease my wife, I direct that distrihutichn be made to his issue, in equal shares. Should any such issue be under the age of 23 at the date of the life beneficiary, then the Trustee shall hold the interest of such issue in Trust until he or she attains the age of 213 at which time such issue shall be entitled to receive his or her appropriate share of principal and interest; E. Trustees shall have the power: ~,- 1,,, f ~~n~aiA (1) To lend to and buy property from my estate or the estate of my wife, for the purpose of facilitdting settlement of my estate by advancing funds for payment of taxes or administration expenses or for amp other reason which may seem advantageous to my estate; (2) To apply income to which the beneficiary is entitled directly for her comfort, maintenance and support. should she dee:m such beneficiary incapalble of receiving the same by reasomof age, illness or any infirmity or incapacity; ,_> (3) Tn do all -itther acts in its judgment deemed necessary or desirable for-the proper-and advantageaus?management, investment and , distribution of a Trust; F. Any realized cilliital gain received by the Trustees in any one year, as weal as any stock'divideiitts'of ten liercent { 10%) or ess, may be-considered by. the Trustees u~ be income; in the st>Le discretion of the corporate 'Trustee. G. This Trust may be funded by property from the estate in kind or in cash. H. If at any time any minor child shall he entitled to receive any funds pursuant to the foregoing subsection D. I. I appoint FINANCIAL TRUST SERVICES COMPANY, of Carlisle, Pennsylvania,,and my son, DAVID LILLICH, III, to he Co-Trustees of the foregoing Trust. ...J \ V I:1~f iSl EIGHTH: All the rest, residue and remainder of my estate:, I give, devise and bequeath to my wife, BARBARA G. B. LILLICH. NINTH: In the event my wife, BARBARA G. B. LILLICH„ fails to survive me, I give my entire estate to my son, DAVID O. LILLICH, III, or to his issue, subject to the bequests to my granddaughter and daughter-in-law. TENTH: I nominate, constitute and appoint my wife, BARBARA G. B. LILLICH, to be the Executrix df this my Last Will and Testament. Should my wife he unable to act as such Executrix for any reason, I appoint my son, DAVID O. LILLICH, III to act.. as Execufor in' her place and stead. Should neither my wife. nor son he able to so act,.I appoint 1FINANCIAL TRUST SERVICES .C011IPANY ;of Carlisle, Cumberland County, Pennsylvania to be the Executor. IN WITNESS WIIEREOP', L_hereunto set my hand and seal his c~_~ ~ ~~ day of _ -''t.-~.. ~ _ _; 1.99?.. .... ~~ .. -.G ...... ~ ~ r ~._....~ ..`.-...... ._ -DAVID O. LILLICH, JR. SIGNED, SEALED, PUBLISHED and DECLARED in th'e presence of: 4 ~-~ ~ ,.,. ' .,... uL3i. _. , COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, DAVID O. LILLICH, JR., Testator, whose name is signed to the attached or foregoing instn~ment, having been duly qualified according to law, do hereby acknowledge...: thatl signed and executed the instrugrent as nay-Last Will; that I signed it willingly; and that I signed it as my free and voluntary ac[ for the purposes therein expressed. Sworn or affirmed to and''acknowl~dged before: me, by DAVID CI. LILLICH, JR,; the, Testator, this:.: ~ ` ~ ~ day of ~ ~~ 1997. -___~~ ~. ~ ~A ~~: UAVIll O. LILLICH, JR., Testator _1 NOTANIAL SERI. t §tJSAN M. RAtrISEY, Ndary Nch9e Ctrgsle, CumUetland Cour:ty, Pe. OAy fgmrtlaebn E>q~6es September 8,1999 S COMMONWEALTH OF PENNSYLVANIA ss. COUNTY' OF CUMBERLAND We, James D. Flower and Carol J. Lindsay ,the witnesses whose names are signed to the att.tched or foregoing instrument, being duly qualified according to law, dq depose and say that we are present and saw Testator, DAVID O. LILLICH, JRy sign and execute the instrument as his Last Will, that he signed willingly and that he executed it ass his free and voluntary act for the purposes therein expressed; that each-of us' in ttie heating and sight of the Testator signed the Will as witnesses; and that to the hest of-our knowledge the Testator was at that time 18 or more years of age, of sound mired and undet no constraint or undue influence.. `Swormor affirmed to and subscribed to before me by James D: Flower and carol J. Lindsay ,witnesses this _ 23rd.. day of . 1997. `~ i :: ,. Witness i ` Wi Hess auaw ~, rinMSEr, rbmry rum . tIuNN~, Grnbwwd Cw~ly, Pe. a+F.~nesepemeere„teas C CODICIL OF DAVID O. LILLICH, JR. I, DAVID O. LILLICH, JR, the within named Testator, do hereby make and publish this Codicil of my Last Will and Testament dated Apri127, 2005. FIRST I hereby amend ARTICLE SEVENTH, Paragraph L of my said. Will to provide as follows:: II appoint my son; David O: Liliich, III, to serve as sole trustee of the. foregoing trust.. , SECOND I hereby' further amend ARTICLE :SEVENTH'of my said:will by adding thereto the , , following Paragraph J.: I direct my arastee that it is: my desiee a.nd intentomthat no interest in , . , any faun ~aihich may form apart of this trust shall. be sold during the lifetime of my surviving spouse, except in a case of strictest necessity, THIRD In ~Ib other respects I hereby ratify, confirm and republish my Last Will dated July 23, 1997, togethei with this sole Codicil as and for my LasYWill and Testament. IN !WITNESS WHEREOF, I, DAVID O. LILLICH, JR, have hereunto set my hand and seal tolthis Codicil to my Last Will and Testament this ~~ day of ~`, 2011 DAVID O. LIL ICH, JR Signed, sealed, published and declared by the above-named T<;stator, as and for a Codicil to his Last Will and Testament in the presence of us, who have hereunto subscribed our names at his request as witnesses, thereto, in the presence of said Testator and of each other. \`_C~~I ADDRESS / D W J7~ ~ ~ ~~~ni~ ~,~~ ADDRESS ~~~ _ r'a /~%3 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND V~Ve, DAVID-.:O. LILLICH, JR; ./ai~ac A. ~/ewer, 5,., and D4wN L, rI. WE.~ the -:, Testator rand witnesses; respectively whose names are sgnF;d to'the foregoing or attached instrurne$rt; being first -duly sworn; do hereby declare to the undersigned authority that -the ' Testator signed and executed the instrument aS his Codicil and t}iat he`signed willingly and that he executed as his free•and voluntary.act for the purposes therein expressed, and that each ' ofthe witnesses, in the ,,presence and hearing=of the Testator signed the Codicil as witness and that to the best of their.: knowledge the Testator was at the time 18 or more years of age; of sound mind and under no constraint or undue influence. f ~ ~p,~ DAVID O. L.IL/,LICH, JR Witness I~f~ C~ /~` Subscribbd, sworn to and acknowledged before me by DAVII) O. LILLICH, JR, the Testator,'and subscribed to and sworn or affirmed to before me by J$w.o b, ~(ua~rd, ,and D4,.,,, t.,.11'/mower > witnesses, this 16 "' day of Fc bvu4r.~_, 2011. Notary Public COMMONWEALTH OF PENNSYLVANIA NOTARWLSEAL THOMAS E. FLOWER, Notary Public Carlisle Boro., Cumberland County My Commission Expires October 26, 2014