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Home My WebLink About06-08-121505610105 REV-1500 Ex`°z-~~"~' ~ OFFICIAL USE ONLY PA Department of Revenue P~~Ylvania County Code Year File Number Bureau of Individual Taxes oEO,a..E~,o INHERITANCE TAX RETURN PO BOX 28o6oi r'' ' L-~ -- Harrisburg, PA 1128-0601 RESIDENT DECEDENT t/~ ~ I ~ ~~ ~_`~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 03/25/2012 09/01 /1929 Decedent's Last Name Suffix Decedent's First Name MI Baker Daryl E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILE D IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) dD 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUtI TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Donald R Drumheller (937) 698-6735 First Line of Address 5845 S Wheelock Rd Second Line of Address City or Post Office West Milton State ZIP Code OH 45383 REGISTER OF WILLS USE ONLY ~ r-,~ ~.> ~ +v Cx7 ~i ~' r-r~ _Z_ (-_` ~ ~ ~ Ca :~ ~ t ~ t,n c~ c:,~ ' DA ,D -- D ~ Correspondent's a-mail address: jrumheller@woh.rr.COm r-r'I {"~ <_~'> C~ ~`, -'~ r _~, --~, }~ ~~ ~o -.r.t 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, ru correct and co claration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI NA RE OF P S SP NSIBLE F F RETURN DATE 06/07/2012 ADDRESS ~" 5845 SWheelock Rd, West Milton, OH 45383 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J (~)h 1505610205 REV-150() EX (FI) Decedent's Social Security Number Decedent's Name: Daryl E Baker RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 17,944.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 86,693.57 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 104,637.57 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 867.26 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 14,711.66 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 15,578.92 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 89,058.65 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 89,058.65 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_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 __ 1 g. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 t;3xable at collateral rate x .15 89,058.65 18 13,358.80 19. TAX DUE ....................................................... .. 19. 13,358.80 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number Daryl E Baker STREET ADDRESS 20 Blue Mountain Vista ~- - _-- -_ clTr Mechanicsburg STATE __ - -- - ~IP ~! F'A ~ 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments --- - _ - B. Discount 667.94 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE (1 } 13,358.80 Total Credits (A + g } (2) 667.94 (3) (4) (5) 12,690.86 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income ...................................... ...... ^ c. retain a reversionary interest ........................................................................................................................ ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust 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 use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are 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 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(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. REV-i5o8 EX+ (11-10) j ~ pennsylvania DEPARTMENT of REVENUEOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Daryl E Baker 2012-00395 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must t-e disclosed on Schedule F. 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Np hternet Connectivity _ i.Jp Full ~ -Yes DVD or BNi Ray Rayer ncluded -None Screen Conditbn _ (,ppd Warranty _ Fxpved _ .._-. r IP _, Fbme ~ Post an ad ~ Ask a question Feedback Bonkn~rk this sacs y' SlumbleUpon ~~ Get Your ~ FREE~2012,Credit Score NOW ~t.p~ >~+G r'~~orts t .oF ~i°,:~n . r. ,cc~ ~ Ab ~;~.n Us ~ Support ~ RF•ler sae [o friend ~ Contact Us ~ ;Ite h4ep ~ f}ivacy Pulic y ~ Terrre of Use ~ .7~saa rr~~ Powered by ~~Infinite ~a--Ave www.gadgetvalue.comlprice.aspx ~!~ RE\!-157.0 "<+ (05-;)9; Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Daryl E Baker 2012-00395 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP Tb DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD`S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1• Revocable Living Trust -Wells Fargo Bank Savings Account 7,152.05 100 7,152.0; Checking Account 721.42 100 721.4; Savings Account 1,947.07 100 1,947.Or 2 Revocable Living Trust -Janney Montgomery Scott LLC 76,873.03 100 76,873.02 TOTAL (Also enter on Line 7, Recapitulation) ~ I 86,693.57 If more space is needed, use additional sheets of paper of the same size. s r ~ U N ~ U a v ai U C ~ ~° C ~ ca ~ ~ ~ c ~ ~ cn ~ 0 a ~ O ~ O ~ O L_ L O (O C1 L u- _ _ n ~~ O U O VN' O ~ O _ a> '~ ~ ~ ~~ ,~ ~ ~ U ~ ~~ J c N _ ~ ~ Y_- Q ~ J ~ ry1 LL ~ ~ ~ ~ Q Q. 07 - Y- ~ _ N ° m e ~ Q Q ~ Ef} d7 U _ _ - c ~~ Z Z ~i~ ,~ ~ Y ~ O ~ O ~ C m ~ ~ m ~ d 0 .L . LL N N ~ ~ ~ ~ ~ >~ ~ N (~ C ~ ~ Q i~ N C c _ ~ U _Q _O ~ U ~`- ~ c 'C 0 N ~+~' 0 O O ~ O C O C O C . ~ C V '° U ~' ° ° N O a~ O O O 3 a ~ RS O~ ~ N O N O~ O cn ~, o ~ ~ d ~ ~ I- 0 0 cn >- ` O I- ~ 0 0 C~ ~ 0 0 (~ ~- O O cn >- - u. N G e o ~ ~ s ~ ~ ~ ~ ~' O O~ N -- s O c Z Y U N ~ ~ O O ` m Z o~ ~ co o N ~ - o C C ~ of O ~ ~ O ~ ~ ~ O t~ ~ ~ CO N O ~ 0~ ~ _ ~ ~ 0 0 ~ O > O > f~ > ~ > O N U w G U U .~.~ O H O r- U ~ U O~ O ~ QQfn .-2 Q r- Q ~t Q d' U ~~ Q ~~ - :°. o c u ~ _ o ~ U ~ n ~ Q ~ N ~ ~ ~ _ ~ ~ :c c U z O y ~ > ~ O ^ _ ~ O ~ ~ ~ ~ O `-° v O W ~ .a. - Q N s ~ ~ ~ ~ 'p ~ U j + -~ .y ^ ~ ~ ~ ~ C O R5 ~ C~ ~ i a m v ~ ~~ U U ~ O -- ~ ~ W y v .a - ~ Q O ~~ d m~ U ~~ -x~ U >~~ U ~, . u L . W Y W Y O W Y W O Y > u_ cf~ m Z ° o ~ ~ ~ ~ ~ m ~ ~ m U m U m O ~ m n O W Q Q~ ~ ~ , , U= ~ W U W ~ W ~ W O W c ~ -i-+ J 1 _U ~ fn ~ O } c} ~ ~ O~ ~ ~ C ~ w ~ V ~ ~ U O ~ ~ ~ Q U ~ ~, ~ Q ~ ~ o- Q U a' aQSo Q Uo Q n..o a.o ~~ ~ m U; ~ U a` ~ C O U U Q Trust Fund Values on 3/25/2012 Description Symbol Quantity Price 3/25/2012 Value 3/25/2012 Janney Advantage Insured Sweep 0.94 Janus Investment Fund Overseas Fund Class A JDIAX 268.92 29.40 7,906.10 Loomis Sayles Funds f I Invt Grade Bond Fund Class A LIGRX 771.72 12.18 9,399.54 Pimco Funds Total Return Fund Class A PTTAX 846.15 11.31 9,569.93 Templeton Global Bond Fund Class A TPINX 1,086.13 12.24 13,294.22 First Eagle Funds Inc Global Fund Class A SGENX 416.52 44.54 18,551,71 Ivy Funds Inc Asset Strategy Fund Class A WASAX 790.53 22.96 18,150.59 ~ 76,873.03 REV-1511 EX+ r 1~-Q9; Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETIIRN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Daryl E Baker 2012-00395 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address __ City ___ ____ _ State ZIP Years} Commission Paid: z• Attorney Fees: 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Addmss _ City __ __, State ZIP Relationship of Claimant to Decedent 4• Probate Fees: S• Accountant Fees: 6. Tax Return Preparer Fees: ~~ Executor Expenses TOTAL (Also enter on Line 9, Recapitulation) I ~ If more space is needed, use additional sheets of paper of the same size. 261.50 258.00 347.76 867.26 a~ c~ w O Y f~ m O r.+ Q) _~ L C O Q X W Q ~ o° ~ ~ ~ N O ~ CD N ~ N ~ ~ ~ ~ ~ Z O ~ O O O O O O O O ~ O O O O ti O O O to M O O tC') O to O ¢t tf~ ~ 0 d' 0 ~ 0 ~ 0 O 0 ~ V to ' V l1' ' ~f ) L(') V ~ 0p ~ r-- N O N O N O O M ('') O r r N M r N 00 ~ ~' M i~ N ~ M ~ ~!' ~ r ~f r f~ .- ~ ~ I~ N ~ CO M Q Q N O ~ O w L ~ O O a. a. a Z ~ ~ _ O a ° a = Q Q ~ ~ = = o 0 0 O ~ ~ ~ ° ~ - ~ c ~ . ~, 0 ~ ~ ° U U U c c c Q ~ 0 m 0 m p U o il N o ~ ~ ~ m a~ m om, ... ~ c U '~ ~ ~ a~ ~ a c ~ c . . ` .N ` ~ ° .c U ~c ~c 3 3 3 v O ca o~ cif ~ n. o m o m c a t o a i i a ~ ~ ~ c L ~a CD C C O (n O M Q ~ U . • ~ ~ O ~ O ~ i ~ ~ ~ C N ~ - ~ ~ _ C 0 C 0 B O O (4 N cn C C C ~ ~ ' I `' o I L a~ +-~ C +-~ C c o ~ ~' to X m ~ m ~ a~ ~ a~ U ~ ~ = in = v~ co ~ m o c ''" ~ co = m in a~ ~ c~ ~ ~ cn c~ o ~ a~ O O cn ~ c ~ o ~ o U ° U 3 3 ~ N ~ ~ U o ~ o ° d d a c ° ~ ~ ° ° Z Z ~ U ~ o p a~ u- ~ O O O ca +" fn ~ c Y O C ca .O ;J C c~ -O o = o _ Z ~ ~ t ~ O ~ U i LL ~ a ~ L ~ Z w a L o `- ~ L ~ O ~ to c0 _ c c~ x o 0 0 _ o o m c o o 0 0 ~ ~ o c c Q o ~' o ~ ~ 0 0 0 O ~ ~ I ~ N N O O U U ~ ~ ~ _c _c O Z ..- ° ~ ~ ~ Q,1 u i N u i (0 u i f0 Y O O Q N f4 f0 (B fd N Y O Y O `~ ~ cOn `' C ~ ~ ~ ~ ~ ~ - `c `c a ~ ~ ~ v ~ ~ o 0 o a ~ .o Z w in ~' d• ~. ~ • c ~ Q ~ ~ O a~ ~n a~ u~ .~ cn c ~ ~ m ~ ° E ° ~ ~ ~n 4- r- m co ~ X .N-- Qy to fn to ~ fB <6 (0 Y N N cn O ~ ~ fSf ~ ~ ~ ~ d w ~ I~ O S C7 C~ C~ a ~ ~ ~ ti C~ C~ C~ C~ ~ a ~ u)) ci) in U U FL- _N N ~ eN- ~ ~ ~ ~ ~ N ' N N N N N N N N N N N N r O N O N O N O N O N O N O N O N O N r O N .- O N .-- O N ~ O N ~ O N r O N r O ~ O ~ O r O ~-- O .-- O X O 0 N 0 N N N N N N N N w n j S O N O O O O O O N N N N N N N N N ~t t o l n ~ N N Q ~ Q ~' Q ^^Q~ LL C ~ cc~ G CCQ L CC~ G C~ C CC~ L cc~ L L Q L Q L Q L~ Q L.. Q L Q L Q L Q L Q L~ Q L. Q L Q L Q L Q CC~ G C ~ L N ~ ~ ° N ~ ~ U O I- m F -- w w RFV-)Sig Ex+'I~ OS; pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Daryl E Baker 2012-00395 Report debts incurred by the decedent prior to death that remained unpaid at the date of APath_ ~~~I~~d~~~ ~~~.a~...ti...~ea .....a:,.,~ _..______ ,~ inure space is neeaetl, insett atlaiUOnal sheets of the same size. ~p~ning Date: February 26, 2012 - Closing Date: March 25, 2012 r--- Disaaver More Card Account Summary Cardmember since 1989 Account number ending in 9867 P~e~.~io~> Balance $81 68 Payments And Credits . Purchases - 81.68 Balance Transfers + 362.09 Cast Advances + 0.00 Fees G~arged + 0.00 Interest Charged + 0.00 New Balance + 0.00 362.09 See interest Charge Calculation section following transactions for detailed APR information Credit Line $12 500 00 Credit Line ,4vailable , . $12 "'7.00 Cash Advance Credit Line , $6 300 00 Cash Advance Credit Line Available , . $6,300.00 You may be able to avoid Interest Charge Important Informati f d s, see Additional on or etails. Cashback Bonus® Anniversary Month October Opening Cashback Bonus Balance $ 18 29 New Cashback Bonus This Period + 0.90 Cashback Bonus Balance $ 19.19 To learn more, log in al www.Discover.com 0 Transactions nnno 1 .,L A Payment Information ~~ ~. UQ v New Balance _ ~ ~/S Minimum Payment Due _. d t Z~, cad C ~ ~~$362.09 Pa ment Due Date $40.00 y ~~ y 5~2_~~,S~April 20, 2012 Late payment Warning: IF we do not receive your minimum payment by the date listed above, you may have to pay a late fee of up to $35.00 and your purchase and balance transfer APRs For new transactions may be increased up to the Penalty APR of 18.24% variable. Manage Your Account Online at www.Discover.com • Securely access statements and free online tools pay bills online and track and view all transactions simply and easi;y • Make your money worth moreSM-f;nd easy ways to earn and redeem cash rewards ' NEWT Access your account securely through your mobile phone 3 Easy Ways to Contact Us 1. Access your account securely at `^'w`^'.Discover.com 2. Call 1.800.DISCOVER (1-800-347.2683 Please have your Discover®card availab e. 3. Write to us at Discover, PO Box 30943, Salt lake City, UT 84130 (Not a payment address) For payments, please send to address on remittance or Discover, PO Box b 103, Carol Stream, IL 60 1 97-6 1 03 For TDD (telecommunications Device for the Deaf] assistance, please call 1-800-347-7449. Trans. Post Date Date Payments and Credits Mar 17 Mar 17 PAYMENT -THANK YOU Restaurants Mar 20 Gasoline Mar 20 LONGHORN STEAKHOUSE MECHANICSB $ '81.68 U Mar 1 Mar 1 GIANT 6005 MECHANICSBURGPA RGPA $ 42.41 ~ Automotive Mar 5 S Mar 5 010038 BRENNER CHRYSLER JEEP LL MECHANI 58.53 ~ upermarkets Mar 3 Mar 3 CSB MONAVIE 866.217-8455 UT URGPA 179.47 24762719 81.68 fees TOTAL FEES FOR THIS PERIOD Interest Charged $ 0.00 TOTAL INTEREST FOR THIS PERIOD 2012 Totals Year-to-Date $ 0.00 70TAL FEES CHARGED IN 2012 70TAL INTEREST CHARGED IN 2012 $ 0.00 0.00 NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION DISCOVER' MESSAGES EXPLAINED . BELOW ']ate IPatr<IPrvalMsai SerVICB DeSCrIDiIDh GPT UX I Chards 03/07/12 1 7 E Destruction Of Lesions 2- 17003 702.0 440.00 03/28/12 FREED DEDUCT Payment 03/28/12 Accept Assign Add. 03/07/12 1 7 E Shave Skin Lesion .6-1CM 11301 216.5 118.00 03/28/12 FREED DEDUCT Payment 03/28/12 Accept Assign Add. 03/07/12 1 7 L Office Visit New Level 3 99203 216.9 115.00 03/28/12 FREEDOMBLUE Payment 03/28/12 Accept Assign Add. 03/07/12 1 7 E Destruction Of Premalig L 17000 702.0 85.00 03/28/12 FREED DEDUCT Payment 03/28/12 Accept Assign Add. 03/28/12 Accept Assign Add. 03/15/12 1 2 E Surgical Pathology Level 88305 216.5 105.00 03/28/12 FREED DEDUCT Payment 03/28/12 Accept Assign Add. 0.00 -365.20 74.80'' 0.00 -29.55 88.45 86.23 -13.77 15.00 0.00 -38.23 -8.54 38.23* 0.00 -5.99 99.01* ~ E-This bill applied against your deductible. You are responsible to pay us. L-The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment. DATE LAST PAID AMOUNT • ~ • • ~ • ' ~ • ~ ' 00/00/00 0.00 315.49 0.00 0.00 0.00 0.00 0.00 0.00 315.49 CRUMAY PARNES ASSOCIATES, INC ~ MAKE 104 ERFORD ROAD CHECK PAYABLE TO: CAMP HILL, PA 17011 315.49~~ Ph:(717)-763-7685 PAT~~ 1-DARYL E BAKER PRV~~ 2-ORMAN, STEVEN K., M.D. Acct~~: 80087 PRV~~ 7-FOGELBERG, ANNELI C., M. Date: 03/30/12 Page 1 of 1 i~il ~ wi .. ~-l/% ~~> ~i Tll Au[o Finance is committed to providing Legendary customer service..~c one of North America's top bank-owned auto-I`mance companies, we look forward to continuing to make your automotive tutancing experience worry-tree and easy, now and in the future. ~-Manage your account online. • Make payments ~ ~„~Y~'. r • View and print w, }~ ~ "~ billing statements :~ ,,_"` t • Receive monthly ~ ~ `' ~;, payment reminders <; ,. ~:. ^f~ ~., ~..Y._____ " - ~,~ ~. x .:.., .. _ ' ~ff~' c. t~~a+,. t (hu eBill service gives you all the same features as mailed billing statements with the convenience of un.line payment. We'II send you reminders when your monthly billing statement is ready and belore your payment is duo. You crut also choose to have us send your eBill directly to yotu email box. Sign up online at www.tdautofmance.com Keep 1 TD Auto finance ,~. '; Account Number 1026887859 ~'elucle Descripuo° 2008 CHRYSLEK 3000 HE:~II Vehicle Idantificauo^ Numbar 2C3KA63HG8H177416 Contnict Date 09/23/"1008 Statement Data 04/09.2012 Payments Made 42 Estimated PayoffAmount* St4 pq;_27 •YayoJj"dmor+nr as ofsratemeni dare. See reve rse far details. „~~„ ~ ~ . F' I .~ Rate llescrlptiouofActlvlty Amount 03/l9/2012 P~n•mentReceired -77iank 3%r~ $105 00 04/28%2012 Current Amount Due , 5505 00 04/28/2012 'Total Amouut I)ue 5505 00 Payments receiv ed afaerstaiement dare are nrr reflected. . Please see reverse side Cor important information on c4ecl conversion" t'ta ~yeb Address WautoQuauce.com Y'isit ins online ro rep-iex~ your a ccount, make your payment or update vour personal infonnadnn. . Customer Service Center 1-800-556-8172 Hours of Operation Mon -Fri 7 am ul l0 pm (L"f) SatBamtilCpm(ET) Yaymeui Malllng Address P O BOX 900192 I LOUISVILLE, KY 402 90-1 92 1 6 REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: Daryl E Baker SCHEDULE BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ Donald R Drumheller 5845 S Wheelock Rd West Milton, OH 45383 RELATIONSHIP TO DECEDENT Do Not list Trustee(s) Brother-in-law 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 SHEET ~ ~ If more space is needed, use additional sheets of paper of the same size. FILE NUMBER: 2012-00395 AMOUNT OR SHARE OE ESTATE 100