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HomeMy WebLinkAbout06-28-12],505610101 Ex (ot-io) • REV-1500 .l OFFICIAL USE ONLY PA Department of Revenue Pennsylvania ~,~. ,.,E~.~FH,~~~„= County Code Year Fi{e Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX ~8o6oi ~, I 7 Harrisburg PA 1'7128-0601 RESIDENT DECEDENT o2 I 1 C 55 ENTER DECEDENT INFORMATION BELOW Socia4 Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~,r ~~ _~ 7 ,_ ~'~} ~`' 04/28/2012 10/07/1916 Decedent's Last Name Suffix Decedent's First Name MI Yovan Doris K (tf Applicabie) 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 FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL 1N APPROPRIATE'. OVALS BELOW ® 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate C~ 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will} (Attach Copy of Trust) O 9. Litigation Proceeds Received C~ 10. Spousal Poverty Credit (dale of death O 11. Election to tax under :sec. 9113(A) between 12-31-91 and 1-1-95} (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Andrew C. Sheely, Esquire 717-697-7050 First line of address 127 South Market Street Second line of address P.O. Box 95 City or Post Office State ZIP Code Mechanicsburg PA 17055 Correspondent's a-mail address:andreWC:.Sheely@verizon.net REGISTER OF USE ONLK..~ ~- - A' fem.. ~. u7 - , f"-t - - ' _~_ .. - rti l ~> C`::! ` C~ . -r _-~ DATE LED .. ~ ']-! ~1 r' f-1 t~ .ri_ l . ~ r „~.: f ~ ~ -, - C 1 w: r•t't ~-- ~.rr C~ ..~.~ 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 inforrnation of which preparer has any knowledge. SIGN URE OF PERSON f2ESPONSIBLE FQR FILING RETURN t1ATC AnryrzFSG __-_-C~, Ginny ilbur, Executrix, 212 Hempt FZoad, Mechanicsburg, PA 17050 SIG RE OF E EI A REPRESENTATIVE ¢rlfl{7FCC Andrew C. Sheely, E=squi 15056],0101 S. Market St., P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056],010], J 1505610105 REV-1500 EX Decedent's Name: Doris Yovan, aka Doris k. Yovan RECAPITULATION Decedent's Social Security Number l Q~ ~~ 7 - ~~ ~~%/ 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. 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. 8. Total Gross Assets (total Lines 1 through 7) ........... ................. 8 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................ . ................ 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 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. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers und~~ sec. 9116 (a)(1.2} X .0. 15. 16. Amount of Line 14 +~~able at lineal rate X .0 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable 396 983.93 , at collateral rate X .15 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT $99,421.44 $6, 259.00 $300,580.15 $406,260.59 8,392.10 884.56 9,276.66 396,983.93 396,983.93 $59,547.59 O Side 2 1505610],05 ],5056101D5 REV-1500 EX Page 3 Decedent's Comulete Address: File Number Doris Yovan STDCC7 Af1r1D000. _... _. ___.. _. __. __.~. 20 North 12th Street Apartment 120 CIT\/ Lemoyne ___ _ _ , STAT~A __ __ zIf17043 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 56,570.30 B. Discount 2977.29 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. $59,547.59 Total Credits (A + B) (2} (3) (`1) (5) $59,547.59 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; or ........................................................................................................................ ^ 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 berefciary designation? ........................................................................................................................ ^ lF 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 dtisclosure 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 io 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. 09116(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. REV-i5o3 EX+ (~-ii) pennsytvania DEPARTMENT OF REVENUE INHERITANCE TAX REl"URN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Doris Yovan, aka Doris K. Yovan 21-12-0557 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUi~1BER DESCRIPTION OF DEATH Doris Yovan died on Saturday, April 28, 2012. Stock share price was determined by averaging the mean stockk value on Fridav. April 27. 2012 and the mean stock value on Mondav. April 30. 2012. Stock values based on NYSE. 1. Cytec Industries, Inc., common stock - 300 shares, $63.73/share $19,119.0() 2. AT&T, Inc. common stock -1,234 shares, $32.66Ishare $40,302.44 3. US Teasury Bills -Account 4800-872-8588, value at date of death $40,000.00 TOTAL (Also enter on Line 2, Recapitulation) I$ 99,421.44 If more space is needed, insert additional sheets of the same size TD 5777 (September 2010) Legacy Treasury Direct www.treasurydirect.gov 1-80D-722-2678 1304-480-6464 (Outside the U.S.) DORIS YOVAN ESSEX HOUSE APT 120 20 N 12TH STREET LEMOYNE PA 17043 '~ (717) 737-5339 - Confide73tia1 --- - T':;...-......---...__-.....:.. - No withholding Mailing Number 021 00 21 4 2 TREASURY RETAIL SECURITIES SITE P 0 BOX 91 SO MINNEAPOLIS MN 55480-9150 PHONE: (800) 722-2678 Payments made by direct deposit to: ORRSTOWN BANK Routing Number: 031315036 ~'=ainz-v--~i Accoum:130R;~ YOVA~ CHECKING Account Number: Confidential ~~~ ~ [~fiCOd1DfNlttl)fllbi~': 4800-872-8588 T~-t~1 Pa>r as a4~2o>'2~1~: ~~ $40_~ ACCOUNT HOLDINGS TRANSACTION HISTORY For 12!02/2011 to 04/20/2012 Begisn3mg Par Balance on: 12/02/2011 ~- $40,000 e ~. 4~ :~ ~ d ~~ ~, ~raasa>Lf'~aff~'ly~ge ~'sryme>Qr ~~en®t ~iTed vs T'at $aiaece 04/19/12 9I27955Ji6 BILL 04/19/12 Redemption -30,000 iF YOU HAVE QUESTIONS CONCERNING THIS STATEMENT, PLEASE CONTACT YOUR TREASURY RETAIL SECURITIES SITE AND PROVIDE YOUR ACCOUNT NUMBER REV-150 EX+ (6-98) COMMONWEALTH 01= PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Doris Yovan, aka Doris K. Yovan 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. FILE NUMBER 21 ~-12-0557 tir more space is needed, insert additional sheets of the same size) ~`` ~ooo S 5 7 5, 19 0, 3 2 9 ~' ~~ Check No. ~~~- ~ _ 04 25 12 ?4 SAN FRANCISCO, CA 3158 26489492 ~° 3158 26489492 20090800 I30 OYOVA AND4VERTAX REFUND '=; Pay to nl,lin,i„nll.i,i,liiiili4niitl~~~l~l~~i,li„tlnii~ii,li.iil -~ the order of DORIS K YOVAN 12/11 '~ ~~ ..: ESSEX HOUSE 20 N 12TH ST APT 120 92 ~f LEMOYNE PA 17043-1449 ~****598*00 ~~,~ h- VOID AFTER ONE YEAR REGION AL C15NISRSING OiF1CFF T rt^- y_ ,;~ ~~ ~:000ODD 5 LBO: 2648949 2?ii' D404 i 2 !=~' r- c {i:l r 1~ 1 'G i1 . ~ - !-i iAJ t' -^ i ~__ -~.__ .', ~-_ ..;, i f z i` fi...p_ .. Tin l t+{t+:~`r,.,i, Y"'~t°~+.-''"=a..`_.'='~:',.l;tj"r~E"t'.'.Li.'S~a _._)'il E' ~: '~" i. c !ii ~-' ii "~_ ~. 'r ~_..~.: ~' L%;,,; T' x S ~'~. a 'r' ,~ +...a' 1 >, : i e 1""' e-`i- i_. `v~ li 7. i•= ~ i 'fl 1 c! G~~ :i i !~7 i_t'r ~Li~.I-~c`. ,"t 3F. ~i"_-i :i.7`-Lj i"''f-}i ... ~~i1~l;.~l ~ _ ._.. i~ i t_ ., __ L ~ '. 41 7; C': j3 L_ a {:-3 1 i c. ~~ ', - 1. _.. ~. 1'1.. ._ L.. 1 ..E. d _.. '-' ~. i-i '~ ~ iJ ~" r. O'C';c't i ~- L ?~; ~' k~ l i ~ i~' ~ _. _ i~f _~'t ~~ v~~.=4r'• `, , ; N , , ~ 4~'?s~a.:_4 r-' c:~ _. c, iv L .. .... ? ri '~.; a i~ L,; ° . ~ }? ~: t-: i•' i ~ C: ~' -. - , , .L. ~ t ._ _ _ - - ~'~~ y, .__ ~ '. =4 ~ _. F' ... . ~ J'^ 1. ._ _ t-i 1Tt _} ~i ' 1 E_` %4 _.. r? :._ -- S '~. v . ,~ Li 4. ~7 (:arc.' . .. ._ ~itS.. 4E' ~4~F C~ l __ i'Ti ~~i!l u ~ ~ r`• '!' (:i *_ ~_ '_ ~ L r' _, fY; i. Y" i'"' i1 i'' r v ul _ ._'S _ ~'f: ~ ~ 5'~~ it ~ ~ _. -' yl w., ..i ct 1 ~ _ `~ - rti .l ~^ ~`i ;3 '.. .j C ~ `,-_i _~ r; ....~ iY, _. i_ .~ ~ L ~ ...` (' .C ~ L ~ i t= i i _".i '~ 'J ~. Q L =;i if i 1. ... 7. ._ ~-,.r`.. '[c+. L"J .~4'"'. v.iT{r~~, i~;it c4 ~ t'cti_~.';. .:. ~e ~{{ ~:' L a. J t _~ ;' , ~kt _ „ ~?I~S 't , ~! 4~ i. •, iL`~~. n a 1~ _ ~ 7 :, t= ., ti tt.. tt... „ .G k~! .! i~ i~ as !!)! ~~ i i{ , 4i'{ i1! ~~ n i~ Et! _ '4 -. ,-- ~ ~ L.. . a i_`t i[} 1 ~.{ . {,~i {~^.+ _~a fln4~ ~. rj H ~ JG 1 a i~ }~i - E~,~?i REV-ISi~ L=X+ (08-U9; pennsylvania DEPARTMENT OP REVENUE iNNERITANCE T0.X RETURN RESIDENT DECEDENT E57ATE OF Doris Yovan, aka Doris K. Yovan SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY FILE NUMBER 21-12-0557 This schedale must be completed and filed if the answer to any of questions I through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE N4hE GF THE TRANSFEREE, T I1EIR RELATIONSHIP TO DECEDENT AND THE SATE Cf TRANSFER. ATTACH A CDRY CF THE DEED FOR REAL ESTATE, DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION i;IF APPLICAELE? TAXABLE VALUE _ I, Orrstown Bank Morley Market -account #111800186, balance as of date of $254,812.32 100% $3,000 $251,812.32 death $254,785.09, accued interest $27.23 2~ Orrstown Bank Interest Checking -account #111001292, balance as of date of $48,767.83 100% $48,767.83 death $48,766.96, accued interest $0.87 *Decedent's money market and checking account became jointly owned within one year of the Decedent's date of death. A $3,000.00 exclusion is claimed on decedent's money rnarket account as reflected in item 1. See attached letter from Orrstown Bank. TOTAL (Also enter on Line 7, Recapitulation) $ I 300,580.15 If more space is needed, use additional sheets of paper of the same size. May 16, 2012 Andrew C. `.3heeley Attorney at Law 127 S. Market Street PO Box 95 Mechanicsburg, PA 17055 Fax: 697-7065 Re: Estate of Doris K. Yovan Social Security Number 195-07-9091 Date of Death 4/28/2012 IT IS HERE',BY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE FOLLOWIPJG ACCOUNTS WITH ORRSTOWN BANK: CHECKING ACCOUNT Account No.- Account Type- Date Opene~d- Joint Account (name/date)- Balance- Accrued Interest- Account No.- Account Type- i~aiC Ol,e~~e~d- Joint Account (name/date)- Balance- Accrued Interest- 111001292 50+ Interest Checking 9/28/2007 Virginia Wilbur, 4/8/2012 $48,766.96 $0.87 111800186 Money Market ~/2o/2C07 Virginia Wilbur, 4/8/2012 $254,785.09 $27.23 Best Regards, Q l~~~L ~' ~~ Ji 1 R. Worthington Deposit Processing Clerk 2695 Philadelphia Avenue Chambersburg, P.A 17201 1.888.ORRSTOWN URRSTOWN saNx A Tradition of Excellence REV-13.I EX+ (10-U9) Pennsylvania SCHEDULE H DEPARTMENT OE REVENUE FUNERAL EXPENSES AND ~ww~ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDf_NT ESTATE OF FILE NUMBER Doris Yovan, aka Doris K. Yovan 21-12-0557 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT _ A. FUNERAL EXPENSES: I' All funeral expenses prepaid. $0.00 B. ADMINISTRATIVE COSTS: i. Personal Representative Commissions: $3,675.00 Namei;s} of Personal Representative(s) Ginny Wilbur Street Address 212 Hempt Road city Mechanicsburg state PA zIP 17050 Year(s) Commission Paid: $3,675.00 2. Attorney Fees: ~(~w ~,.5~1~~~Y t ~rjq, P~`~ C%~-I~~~~~~~" 3. Family Exemption: (If decedent's address is not the same a[[s claimant's, attach explanation.) Claimant Street Address City _ _ State ZIP Relationship of Claimant to Decedent $377.50 4. Probate Fees 5. Accountant Fees. 6. Tax Return Preparer Fees: ~. Postage, certified mail costs $41.60 a. Filing fee $15.00 s. Additional Short Certificates $8.00 ~o. Reserves to conclude Estate administration, final accounting, preparation of decedent's 2012 Federal $600.00 and state income tax returns. TOTAL (Also enter on Line 9, Recapitulation) I $ 8,392.10 If more space is needed, use additional sheets of paper of the same size. RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNEF~ STRASBAUG:H Cumberland County - Register Of Wills One Courthou~~e Square Carlisle, PA 17613 YOVAN DORIS Estate File IVo.: 2012-00557 Paid By Remarks: VIRGINIA WILBUR HMW Fee/Tax Description PETITION LTR`~ TEST WILL SHORT CERTIFICATE JCS FEE AUTOMATION FETE Check# 3652 Total Received......... Receipt Date: 5/15/2012 Receipt Time: 10:15:57 Receipt No.: 1069884 Receipt Distribution ----- -------- -------- --- Payment Amount Payee Name 310.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 24.00 CUMBERLAND COUNTY GENERAL FUN 23.50 BUREAU OF RECEIPTS & CNTR M.D 5.00 ------------- CUMBERLAND COUNTY GENERAL FUN --- $377.50 $377.50 REV-151~ EX+ (12-08) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE Tax ReruRN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris Yovan, aka Doris K. Yovan 21-12-0557 __ Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. _ ITEM 'VALUE AT DATE NUMBER DESCRIPTION OF DEATH _ i. Chuck Bricker, Auctioneer -appraisal of personal property $85.00 2. Shelby County Retirement benefit reimbursement $44.89 3. Golden Living -final bill $30.00 4. Rowe's Auction Service -sale commission, disposal fees $334.72 5. Pinnacle Health Cardiovascular -final bill $12.64 6. Internists of Central PA -final bill $81.68 7. Spirit Physician Services -final bill $38.16 8. Carlisle Medical Group -final bill $150.38 9. Camp Hill Fire Company #1 -transportation -final bill $34.21 10. Holy Spirit Hospital -final bill $5.68 11. Kantor Tkatch Associates -final bill $67.20 TOTAL (Also enter on Line 10, Recapitulation) I $ 884.56 If more space Is needed, Insert additional sheets of the same size. STATEMEIa1T -r C~~Lt-~~. ,1-x,%2 i~,~.E~ ~~~T`/~~:'EE,~ ~3 1 ~h~t~~ .~~, TO ~ ~~ y 5 rr E ~~~ -~7-7~1j; T~ M S ,~- ~' P ~ 15 ~4L DATE ~ ~~ -1 Z-' ~ ~~. ~~ ~~ ~~~~7. 3409 MADE IN U.S.A. C~t~ ~~ ~~~L~~ ~/ ~~ ROWE'S AUCTION SERVICE (RH 79L) 2505 Ritner Highway • Carlisle, PA 17015 Bill Rowe (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L) Auction Is Action Call ``Rowe" For Satisfaction CSTA~ o~ A~Rts ~1. ~or~Rn~ SELLERS NAME C Q IKl~- GYl ~ ~U~ ~ ~ X . DATE •~ S ~ ADDRESS/•`( ff~(~7P`f Rb~lr1~H~3C--• PR (7fJ~13 PHONE C~~~. ~I~(8-j39~~. OTHER AUCTION DAT'EILOCATION AUCTIONEER % CLERK % DESCRIPTION OF MERCHANDISE hCy~ C d lDli)-v ~ t S C h ar - v r~ ~ 1 s a c ~ Ih ~ a ~ ~. iL at II f G S YL~.i S c j~ e (yi~5 ~ a'~"l , ~ .S ~ ~~ i l .l Sv ~©-=sue ~~~ i ~~~ se no ~.c ~3S- a~ I ;~ r~ e I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold is & grouped as necessary obtain bids. I certify that I am the owner or authorized represen- tative of e e ndise, goods and pr perty and have good title and the right to sell and that they are free from all ' rances. I to t ll responsibility for providing merchantable title and for delivery of title to a chaser. ee to mless the Auctioneers against any claims of the nature referred to in this a nt. S-`~ Total Sales (Clerk:ing Tickets Attached) ~ ~ C~ Less Sale Expense: ca ,- Z- ~l' %a Commission Auctioneer $ ~c~ ~ SE~LERS SIGNATURE % Commission Clerks ~ ~ ~~ OTHER: 1 {~-e-c.~i K-P~ Fi~1i ~ 3^ +J I©iS~~S,~t- ~ ~, ~~---_ -r TOTAL SALE EXPENSE DEDiJCTED ~ ~_-3 ~ ~ ~ ' SELLERS NET ~ ~ ~ 8 -, 6~~- ~~ REV-1513, EX+ (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Doris Yovan, aka Doris K. Yovan NUMBER 1 1. 2. 3. 4 5 6. II NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Ginny Wilbur, 212 Hempt Road, Mechanicsburg, PA 17055 Janet K. Glessner, Apt. 309, 5015 Santa Cruz Ave.,San Diego, CA 92107 N.Ray Yovanovich, 1505 Farmhouse Lane, Middletown, PA 17057 William Z. Yovanovich, 405 College Avenue, Elizabethtown, PA 17022 Dorothy G. Bell, 1593 Landvater Road, Hummelstown, PA 17036 N. Lorraine Basonic, 329 Baumgardner Drive, Harrisburg, PA 17112 Cousin Cousin Nephew Nephew Niece Niece 1/6th of Rest, residue of FstatP 1/6th of Rest, residue of Estate 1/6th of Rest, residue of Estate 116th of Rest, residue of Estate 116th of Rest, residue of Estate 1/6th of Rest, residue of Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUT40NS ON LINE 13 OF REV-1500 COVER SHEET I $ FILE NUMBER 21-12-0557 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF DOR.IS YOVAN I, DOR:IS YOV.AN, a resident of Shelby County, Tennessee, being of sound and disposing mind and memory and over the age of eighteen (18} years, do hereby rriake, publish and declare this instrument to be my Last Will and Testament, hereby revoking any and all wills and codicils heretofore made by me. ITEM I APPOINTMENT OF EXECUTOR I hereby appoint my niece, GINNY WILBUR, as Executrix of this Will. If GINNY WILBUR', shall at any time be or become unable or unwilling so to serve, I hereby nominate and appoint LAR_RAINE BASONICE, as successor Executor. Each Executor, individual or corporate, original or successor, shall serve ~~ithout bond and with all the rights, powers, duties, authority, discretion and other immunities as are conferred upon the original Executor without curtailment or diminution. Except where. the context otherwise indicates, all Executors, Executrices, Co-Executors and Co-Executrices, whether original or successor, shall hereafter be collectively referred to as the "Executor." M 1-B 994897 v 1 0-0 l I.rLU12U06 ITEM II BEQUESTS AND DEVISES I hereby devise and bequeath all real property and personal property including property of every kind and character and wheresoever situated to GINNY WILBER, JANET GLESSNER, LARRAINE BASONICE, DOROTHY BELL, WILLIAM YOVANOVICH AND RAY YOVANOVICH, if they survive me, to be divided into shares of substantially equal value for each surviving beneficiary. The share of any deceased beneficiary shall lapse and be' distributed to the named surviving beneficiaries. All divisions shall be made as the beneficiaries shall agree, or if they shall fail to agree within six (6) months after my death, as the Executor shal]~ determine. In default of all of the foregoing, I~ devise and bequeath the rest and residue of my estate in fee simple absolute to my heirs determined in accordance with laws of descent and distribution in effect in the State of Tennessee at the time of my death. ITEM III PROVISIONS RELATING TO THE EXECUTOR The Executor shall possess the following specific rights, powers, authority and. immunities: 1. The Executor shall pay as soon as practicable after my death all my just debts, including the costs of administration of my estate, my funeral expenses, and the expenses of my last illness. The Executor need not however pay prior to maturity any debt, secured or 2 M J-B 994897 ~~l 0-0 11/20/2006 unsecured, on property owned by me at my death, and such property may pass sut>ject to such debt. 2. The Executor may file income or gift tax returns covering any period of time permitted by law; and in connection therewith to determine whatever taxes, interest and penalties are proper and to pay the same from my estate. 3. Any and all estate, inheritance, generation-skipping and other succe~.ssion taxes, including all interest and penalties thereon, imposed by reason of my death by the United States or any other government of subdivision thereof, in respect to property subject to such taxes, passing outside this Will, by operation of law, or otherwise, shall be proportionately charged against and paid by the recipient of such property or shall be paid from such property except to the extent. that a marital, charitable or similaz deduction is allowed with. respect to such property for the purposes of such taxes. All such taxes (except for generation-skipping taxes), including all interest and penalties thereon, imposed on property passing under this Will shall be paid from the residue of my estate without charge to any legatee. 4. For the purpose of paying my debts, the costs of administration of my estate, my taxes andl'or bequests, the Executor may (a) use all or any part of the income of my estate which the Executor receives during the administration of my estate and (b) sell, encumber or otherwise lawfully dispose of such of my assets, real, personal or mixed, as may be desirable or necessary to raise the funds therefor without being required to exhaust personalty before realty. 3 M 1-B 994897 v l 0-0 11120/2006 5. As soon as the Executor is able to arrange adequate cash funds for the purposes of paying my debts, the costs of administration of my estate, my taxes and bequests, fhe Executor shall pay the bequests provided herein. In the interim, the Executor may without order or license of court advance from the' date of my death to my legatees any sums out of my estate during the administration of my estate necessary for the comfortable maintenance, support and health of my legatees. 6. The Executor shall not be required to file any inventory or any annual, period or final accounting or settlement with any court unless specifically required in writing by any beneficiary under this Will. 7. The Executor at any time or from time to time may exercise without the necessity of procuring any judicial authorization therefor, or approval thereof, in addition to those fiduciary :powers now or hereafter conferred by law or in equity, all of the fiduciary powers specifically enumerated iri Tennessee Code Annotated Section 35-50-110 as in effect as of the date hereof, it being my intention pursuant to the authority of Tennessee Code Annotated Section 35-50-109 to incorporate herein by reference all of the provisions of Tennessee Code Annotated Section 35-50-110 as completely as if set out verbatim herein. ITEM IV GENERAL PROVISIONS If there are insurance policies on my life owned by me at the time of my death which may are payable to specifically named beneficiaries, it is not my intention to change the !beneficiary 4 M J-B 994897 v 1 0-0 1 1 /20!2006 designation therein in any way, and the proceeds thereof shall pass to the beneficiary therein designated. If any policies are made payable to my estate, it is my intention that t:he Executor may use the proceeds thereof for the purposes of paying the costs of administration of my estate, my taxes and bequests if the Executor in the Executor's sole and absolute discretion shall deem it necessary therefor. Any remaining balance of such proceeds shall become a part of my residuary estate and pass as hereinbefore provided. WITNESS MY HAND this 24th day of November, 2006. ~n ` DORIS YOVA SIGNED AND PtJBLISHED BY Doris Yovan, as and for her Last Will and Testament, she signing and publishing the same in our presence and we signing the same as attesting witnesses at her request and in her presence and in the presence of each other, this 20th day of November, 2006. ,-, ~~/ ~~-~, ? WITNE'S//S ~ /~ G`i~/ ~• WI ESS WITNESS M J-B 994897 vl 0-0 11 /20/2006 STATE OF TENNESSEE COUNT.' OF SHELBY Before me, the undersigned authority, on this day personally appeared ~~t't Ko ~~ ~'S/~~/J f' ~-f'.~ f~Gr~ and ~~wtes w.~~~-{ ~~~`~E-~ ,known to me to be the witnesses whose names are subscribed to the annexed or foregoing instrument, and all of said persons being by me duly sworn, each on his oath stated to me that he witnessed the execution of the attached or foregoing will of DORIS YOVAN, on the 20th day of November, 2006; that the testatrix had declared to them that said instrument is her last will .and testament, and that she executed same as such in their presence and at the time of making such subscription requested that each of them sign it as a witness; and upon their oaths, each witness stated further that they did, at the request of the testatrix, sign the same as witnesses in the presence of the said testatrix and in the presence of each other; that the testatrix at: the time of the execution of such will was in all respects competent to make a will and not under any restraint; that the testatrix and each of said witnesses was then at least eiighteen (18) years of age and of sound mind; and that they are making this affidavit, at the request of the testator, in. accordance with Chapter 568 of the Tennessee Public Acts of 1972. I ~~ ~~ WITNESS WI ESS ~ WETNESS M J-B 994897 v 1 0-0 1 I /202006 SEVERALLY SUBSCRIBED AND SWORN TO before me this the 20th day of November, 2006. ~ ~~ ~c/~ Notary Public ,o~B. s(/,gHs My ~ rr~n~~>r ~ Pt1~.. ~,° ~ ~ _~~ _~ F~~r ~ ~~ ~ ~~~~ des April 10, 2007 M J-B 994897 v 1 0-0 11202006