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HomeMy WebLinkAbout07-12-12 (2)1505610140 REV-1500 EX (°'-'°' OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2aosol INHERITANCE TAX RETURN n Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~~ ~ / ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 9 2 1 6 0 3 9 4 1 2 2 4 2 0 1 1 1 0 0 7 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name MI RYAN DOL ORES M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate ^X 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust _ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) State ZIP Code CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number R MARK THOMAS, ESQUI RE 71 7 796 21 00 e-..p First line of address 1 0 1 S OU T H Second line of address MARKET S T R E E T City or Post Office M E C H A N I C S B U R G 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) REGISTE `E.l~IILLS USFtGt+ILY ~ V i..r C ~ .. rTl T ~. f"' i ~C ~ N ©~. ..o T,, ~ - .~.:- f ~ ..{ CI1 ~ ~7E FILED P A 1 7 0 5 5 Correspondent's a-mail address: rmarkthOmaSCc~gmalLCOm ~~ ;'+'t ~-_, +'~;, 6 1"'~ "'i c«: "i"f 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. SIGN U E OF PER ON PON E FOR FILING RETURN !~ PATE 10~ LQNG LANE TIVE 101 SOUTH MARKET STREET NEWVILLE I MECHANICSBURG PA 17241 fyATE / A 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 ~~ REV-1500 EX 1505610240 Decedent's Social Security Number Decedent's Name: DOLORES M. RYAN 1 9 2 1 6 0 3 9 4 RE CAPITULATION 1. Real Estate (Schedule A) ......................................... .. 1. 1 2 7 9 8 3. 6 0 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. 5 3 9 8 7. 8 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested ..... .. 7. 2 6 1 8 9 3, 6 4 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 4 4 3 8 6 5 , 0 9 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. 2 4 0 0 7. 0 7 5 6 3. 4 0 2 4 5 7 0. 4 7 4 1 9 2 9 4. 6 2 4 1 9 2 9 4. 6 2 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. 16. Amount of Line 14 taxable at lineal rate X .045 4 1 9 2 9 4. 6 2 1s. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 1 g. 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 0. 0 0 1 8 8 6 8. 2 6 0. 0 0 0. 0 0 1 8 8 6 8. 2 6 1505610240 J REV-150b EX Page 3 Decedent's Complete Address: File Number 0 0 DECEDENT'S NAME DOLORES M. RYAN STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 15,000.00 B. Discount 750.00 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. (1) 18,868.26 Total Credits (A + B) (2) 15,750.00 (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,118.26 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; or .......................................................................................... ...... ^ 0 d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ X^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... ^ ^X 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? .... ..... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ............................................................................................. ..... ^X ^ 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(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-1502 EX+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DOLORES M. RYAN 0 0 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property 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 DESCRIPTION 1. Diakon Lutheran Social Ministries- paid to the Estate of Delores M. Ryan- NET VALUE 127,983.60 960 Century Drive, Mechanicsburg, PA 17055 Cottage owned by Delores Ryan- Unit 43- @ Cumberland Crossings- Carlisle PA TOTAL (Also enter on Line 1, Recapitulation.) I $ 127,983.60 If more space is needed, use additional sheets of paper of the same size. REV-1548 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DENTEDECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER DOLORES M. RYAN 0 0 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SOVEREIGN BANK CHECKING ACCOUNT NO. 16710047401 22,614.93 2. SOVEREIGN BANK MONEY MARKET ACCOUNT NO. 1671014405 23,893.97 3. SOVEREIGN BANK CD ACCOUNT NO. 1675546681 5,338.76 4. PERSONAL FURNISHINGS 418.50 5. COINS SOLD TO D&S COINS 521.28 224 FOURTH STREET NEW CUMBERLAND, PA 17070 6. GOLD WATCH 820.00 7. UGI REFUND 116.58 8. INSURANCE PAYMENT FOR TOWING WRECKED CAR -STATE FARM 380M28542 195.00 9. STATE FARM INSURANCE CREDIT ACCT 0040701213 60.86 10. STATE FARM INSURANCE CREDIT -CLOSE PAYMENT PLAN 7.97 TOTAL (Also enter on line 5, Recapitulation) I $ 53,987. (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER DOLORES M. RYAN 0 0 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 TO 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 pr APa~~cna~e) TAXABLE VALUE 1. SOVEREIGN BANK IRA ACCOUNT NO. 1678179910 1,309.16 100.00 1,309.16 BENEFICIARY- EILEEN DIRIENZO-DAUGHTER 2. SOVEREIGN BANK IRA ACCOUNT NO. 1678179928 1,103.10 100.00 1,103.10 BENEFICIARY- EILEEN DIRIENZO-DAUGHTER 3. SOVEREIGN BANK IRA ACCOUNT NO. 1678246586 2,689.60 100.00 2,689.60 BENEFICIARY- EILEEN DIRIENZO-DAUGHTER 4. REASSURE AMERICA LIFE INSURANCE COMPANY 71,145.64 100.00 71,145.64 ANNUITY # 0006543690 5. WESTERN NATIONAL LIFE INSURANCE 140,487.89 100.00 140,487.89 ANNUITY- VT 220839 PO BOX 871, AMARILLO, TX 79105-0871 6. WESTERN NATIONAL LIFE INSURANCE 45,158.25 100.00 45,158.25 ANNUITY- VT 2174187 PO BOX 871, AMARILLO, TX 79105-0871 TOTAL (Also enter on Line 7, Recapitulation) I $ 261, 893.64 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DOLORES M. RYAN 0 0 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMANN-ROTH FUNERAL HOME 11,070.16 2. FUNERAL MEAL- THE COUNTRY BUTCHER SHOP 190.41 B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2, AttomeyFees: R. MARK THOMAS, ESQUIRE 9,115.49 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 400.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: 170.00 7. HOFFMAN-ROTH -FUNERAL PORTRAIT 390.00 8. APPRAISAL- GOLD WATCH 84.80 9. AUCTIONEER- ROWES 146.47 10. AUCTIONEER- HAULING FEE 45.00 11. NEWSPAPER Patriot News 137.24 12 SOVEREIGN BANK DOD BALANCE FEE 20.00 13. NEWSPAPER -Cumberland Law Journal 75.00 14. Carlisle Memorial Service- Headstone 2,162.00 TOTAL (Also enter on Line 9, Recapitulation) $ 24.007.07 If more space is needed, use additional sheets of paper of the same size REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE( DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER DOLORES M. RYAN 0 0 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 1. (CONTINUED CARE RX 2. CUMBERLAND CROSSING 12/23-24/11 ROOM & BOARD, PHONE 3. CUMBERLAND CROSSING -REMAINING BALANCE TOTAL (Also enter on Line 10, Recapitulation) I $ If more space is needed, insert additional sheets of the same size. 106.71 259.83 196.86 563.40 REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DOLORES M. RYAN n n 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).] 1. EILEEN F. DIRIENZO Lineal 967 ROUGH DIAMOND DRIVE PRESCOTT, AZ 86301-5894 2. DONALD J. RYAN Lineal 79 MARE ROAD CARLISLE, PA 17013 3. GERALD M. RYAN Lineal 112 INVERNESS COURT SUMMERVILLE, SC 29483-1718 4. JAMES J. RYAN Lineal 339 GREASON ROAD CARLISLE, PA 17013 5. KENNETH P. RYAN Lineal 102 LONG LANE ROAD NEWVILLE, PA 17241 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 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. REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 15.000.00 Discount: 750.00 Interest Table Year Days Delinquent this time period Balance Due this year Interest this period Before 1981 1982 1983 1984 1985 1986 1987 1988 throw h 1991 1992 1993 throw h 1994 1995 throw h 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: ,~ _ , .. -_ _ ; T. , r _, _ _. -! .- - r l !~-.. ~ .. :~, :. } _ _ _ _ , .._ ~ t- 'v f i I ~ ~ j i i'!~ '. i _ 1 -.:. ' - 1= f i ' 1 ' ~ y ` _ _ _ _ _: _.f Li, r ;, i _ . 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T_._t--"'-.~ '- :,--..-,:: ~:: _ ~!_.?'- ,!tip. ~.~ t4 ~ .-____ _ !. ____.__. ~ - ca.i :!'='=i+ - ~ - L:_ __ _. _._. :..~ __ __._-- r.=.= N~ ~ I1.:1t_~ ilil ~j lj _.~~.+ i11N!TI'_i~~'9 `.i 1rt ~' -~- r;?s'";~_~'=~„ J2'i 1.= L j-i ~a r•''. C J jet trr~ G- j' t'~ ~ /<_% g .) 1 //11 f ~ i ~ 1~~e1 J r.,,- - , DI,9KONLUTHERANSOCIAL MINISTRIES Tl T TT 347749 03/29/12 0.70 V.J t.J 1ri1P~~d'~"'uv •u IN~T~fC.E'I~~JMBEFt ' ~ , ;: _ .. _ •+•• IN~JE3lCE:t7ATE,-; . 1(Ii@QFCE=CESCRIFTIO[~' ... .. Gft{?SS ~NTEFUNT '~' _ ~' E]ISGOVN7 . C1~f+tU(OUtJ7 31912 03/19/12 REF ENT FEE 127983.60 0.00 127983.60 127983.60 0.00 127983.60 DL-~KONLUTHERANSOCIAL MTYISTRIES 3a7749 03/29/12 a:~ov~ u.~lri~ v_ ,~.JL...ti... IIJ?!C~[GE T{!.'?dBER " . ..~.... INVUIGE CNTE _.-_ . ISVGLiC~ CE3CPIPTi~[J _ _GFtflSS'FfV1CtJNT . . QISGOUNT NE'FAPiQEJN'f 31912 03/19/12 REF ENT FEE 127983.60 0.00 127983.60 127983.60 0.00 127983.60 DIAXON L UTHERAN SOCIAL MINISTRIES 9bU CErVTURYDRIVE rLtECHANICSBURG PA 1705.1 WACHOViA BANK 3-50 310 a=.C,~`E .- EGK?NG `" _ Aht£~UNT ::__.._.03;29/12 :547749 "127,983.60'` ONE HUNDRED T~1~lENTY-SEVEN THOUSAND NINE HUNDRED EIGHTY-THREE AND 60/100- CC'rY PAY ESTATE OF DCLORES RYAN 65603 "VOID'" VOID 'VOID " Tcr-.~ C'0 KENNETH RYAN °'~~`~ 102 LONG LA; IE RD ,_--- , _ . ~;,GTIABLE '<~x ti,='v''!`~ILLE P,~ 172^^-.1 Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Dolores M. Rvan 192-16-03 94 December 24, 2011 Account #: 1671004701 Type: Checking Open date.: 3/1/1988 In the name of: Dolores M Ryan Date of Death Balance: Int.(YTD) from 1/1/2011 Accrued interest to date of death: Other Info: i r :I I $22,614.93 to 12/23/2011 $0.00 $21.38 Account #: 1671014405 Type: Money Market Open date: 10/2/1997 In the name of: Dolores M Ryan Date of Death Balance: $23,893.97 Int.{YTD) from 1/1/2011 to 12/23/2011 $59.66 Accrued interest to date of death: $0.00 Other Info: Account #: 1675546681 Type: In the name of: Dolores M Rvan Date of Death Balance: Int.(YTD) from 1/1/2011 Accrued interest to date of death: Other Info: to __ 11/30/2011 $1.78 Open date: 11/17/2008 $58.75 ~ Account #: 1678179910 Type: IRA Open date: 1/7/1988 In the name of: Dolores M Ryan Date of Death Balance: $1,309.16 Int.(YTD) from 1/1/2011 to 7/7/2011 $11.78 Accrued interest to date of death: $ i .86 Other Info: Primary beneficiary:Vincent Rvan-husband 100% Contingent: Eileen Dirienzo-daix~hl~. Account #: 1678179928 Type: IRA Open date: 1/7/1988 In the name of: Dolores M Ryan Date of Death Balance: $1.103.10 Int.(YTD fram 1/1/2011 to 7r7I2011 7.15 Accrued interest to date of death: 1.56 Other info: Pri~r~a~- beneficiary: V"incept Rvan-husband 100% Continent: Eileen Dirienzo-da ~,~''~~ ~~'-' CD $5.338.76 Pace 1 of 2 Sovereibn Bank ESTATE OF Dolores M. Ryan SOCIAL SECURITY #: 192-16-0394 DATE OF DEATH: December 24, 2011 Gi Account #: 1678246586 Type: IRA Open date: 10/9/2008 In the name of: Dolores M Rvan Date of Death Balance: $2,689.60 Int.(YTD) from 1/1/2011 to 11/30/2011 $5.00 Accrued interest to date of death: $0.30 Other Info: Primary beneficiary: Vincent Ryan-husband 100% Contingent: Eileen Dirienzo-dau~-~. Account #: 1675548505 Type: CD Open date: 4/29/2009 In the name of: Dolores M Ryan Date of Death Balance: Account closed prior to death Int.(YTD) from to Accrued interest to date of death: Other Info: Account closed on 07/l~/2010. Account #: 167545204 Type: In the name of: Dolores M Ryan Date of Death Balance: Account closed Int.(YTD) from to _ Accrued interest to date of death: Other Infio: Account closed on 07`15/2010. CD Open date: 7/16/2008 or PG,e 2 of 2 ,, ,..ua~.: r.~c,-.yin Ur ru^av Jl'LVA:'JIA D EPART<viENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HAP.RIS3URG. PA 1 7 1 28-0601 DECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THOMAS R MARK 101 S .MARKET STREET MECHANICSBURG, PA 17055-3851 ------- fold ESTATE INFGRMATION: ssN: 192-is-oas~ FILE NUMBER: 21 1 1 - 1 383 ~!! DECEDENT NAME: RYAN DOLORES M '~ DATE OF PAYMENT: I 03/ 1 5/201 2 POSTMARK DATE: 03/1 5/201 2 couNTY: CUMBERLAND ~'! DATE OF DEATH: 1 2/24/201 1 AMOUNT ACN ASSESSMENT CONTROL NUMBER 101 ~ S 15,000.00 TOTAL AMOUNT PAID: REMARKS: RECEIPT TO ATTY CHECK# 3238' SEAL $15,000.00 INITIALS: HMW RECEIVED EY: GLENDA EARNER STRASBAUGH REGISTCR OF 'vV1LLS REV-iiE2 EX(11-56) NO. CD 015706 RECEIPT FOR PAYMENT GLENDP_ FP_RNER STRASBAUGH Cumberland County - Register Of 4~iills Cne Co~.~rthcuse Square Carlisle, PA 17613 RYAN DOLORES M Estate File No.: 2011-01383 Paid By Remarks: R MARK THOMAS WZ Receipt Distribution Receipt Date: 6/01/2012 Receipt Time: 11:07:37 Receipt No.: 1070089 Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 4.00 CUMBERLAND COUNTY GENERP_L FUN ---------------- Check~ 3697 4.00 Total Received......... 4.00 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Regis ter Of Wills Receipt Date: 12/30/2011 One Courthouse Square Recei t Time• p 11:53: ~ Carlisle, PA 17613 Recei t No. P - 1068222 RYAN DOLORES MAE --- Estate File No:: 2011.-01383 - _ _ --- Paid By Remarks: R MARK THOMAS HEP_ '-.-"--'----------------- Receipt Distribution -------- ------ ___ -------- Fee/Tax Description Fayment P_mount Payee Name- PETITION LTRS TEST WILL 310.00 CUMBERLAND COUNTY GENERAL FUN HORT CERTIFICATE 15.0 0 28 00 CUMBERLAND COtTiv-TY GENERAL FTJN ACS FEE F_U'i OMP_TION FEE . 23.50 CUMBERLP~~L COUNTY BUREAU OF RECEIPTS GENERAL & CNTR MLD -- 5 . 0 0 ------ CUMBERLP VD COUNTY GENERAL FUN Check# 346 ------- $381 50 - Total Received......... . $381.50 Reassure America Life Insurance Company """^'w'P.O. Box 9004 CoppelL TX 75019-9004 Phone 800-792-4368 Fax 803-333-4935 Visit us at www.insurance-servicina.com February 7, 2012 R MARK THOMAS ATTORNEY AT LAW 101 SOUTH MARKET STREET MECHAMCSBURG, PA 170»-3851 Insured Name: DOLORES M RYAN Policy Number: 0006543690 Correspondence Number: 09580015 - Dear Mr. Thomas: This letter is in response to your inquiry regarding the above referenced insured under the above referenced policy number. In your letter you requested the date of death value of this annuity policy in order to have an adequate estate value. The annuity value as of the insured's date of death of L-24-2011 was $71,145.64. It is a pleasure to be of service and if you have any questions, please call the Client Service Center at 800-792-4368, Monday through Friday from 7:3G Aryl to 4:30 PM Central Standard Time. Sincerely, S. Wolf Claims Services ORES M RYAN EST VINCEN ICc # PO NUM[iER INV DATE T J RYAN GROSS - AMOUNT 102 LONG DISCOUNT AMOUNT LANE RED ~N NET AMOUNTI PAID EWVILLt NA 7 /L4l INVOICE # PO NUMBER INV DATE ' GROSS -. AMOUNT - DISCOUNT AMOUNT NET AMOUNT PAID 2580293 i 01/25/12 116.58 0.00 116.58 UNDS21377214201643 BU LOCK CIR ` ~' ~ ~e~U~~~/~I i ~p f~ ~ ', . . - ~ - - i - ! i e ~ I f ~ ` - s~a, ! ~ I - i ~ ~ _ , ~ ~ ~ ~ ~ =c' Inauines to: Accounts Payable Dept., PO Box 13578, Reading, PA 19612-3578 TGTALS I >>s.sa o.oo »6sa e ~~~~ ~~ ~~~ ,r,~ ~~~ ",~,~ c ~~ ,=~,~RnTlON fie` r~;•~,..J li= C'OC~.,_i~IT h_J JG THi - - ,_~ .__ -- _~...p .~. _ ~_.. _ - _ . __ _ .....,.~.----~-- _ _ __ . _.._ ._.T__ . .__ ~ _~ ~.~.__~__ ~ j .~ zY ~ „r ~ . ~ t g~, d<<. ~ k; ~ ~ .4. ~ ~ . _ _ ~ t 2627/F382 RYAN, DOLORES M. 43 BULLOCK CIR CARLISLE PA 17015-7616 .~ ~- G,S'~l'l~ ~~ G ~~ JAN 11, 2012 RE: Account Number: 0040701213 Refund Amount: *~-~*****7•97 1'' ~~v I„ AGENT John Zampelli Jr 717-249-1582 The attached refund is a result of your request to close your payment plan account. 'f you have any questions, please contact your State Farm agent. State Farm Payment Plan -1-4398 a.i (o1b010ba) Rev. 02-24-2004 90M11 a a .u... • d a 2 a .w f j+~; w+ ) '~.i { • e 1 ..... ..x 'nw+` e + {+r? t...•' ~' / „~„ ,,,~„ State Farm Mutual Automobile Insurance Company ~~ ,,,,,,,,,,,~o PO 80X 830854 Birmingham AL 35283-0854 2627/F382 RYAN, DOLORES M. 43 BULLOCK CIR CARLISLE PA 17015-7616 AGENT John Zampelli Jr 717-249-1582 JAN 04, 2012 RE: Account Number: 0040701213 Refund Amount: ******"60.86 The attached refund is a result of your latest policy transaction. You have credit of *"'`""'"`60.86. If you have any questions, please contact your State Farm agent. State Farm Payment Plan 9RD04 134-4393 a.1 (o1b010ba) Rev. 02-24-2004 i 1_ PAYMI•NT NO 1 13 193393 J CLAIM No 38-OM28-542 PAYMENT AMOUNT 5195.00 LOSS DATE 12-05-2011 155UE DATE 01-31-2012 _ POLICY No 6025-504-38H AUTHORIZED BY MOSCHETTA, BETSY INSURED RYAN, DOLORES M PHONE (888) 713-4694 ES M. RYAN --1~ ~j S' I~ I/(,~' /J G C~ - Gty n'1 ~ ~'1 ~ ~O / N e DOLOR /~ / 43 BULLOCK CIR ~ s' ~~ to / . CARLISLE PA 17015-7616 1-O L ~O Cl/ I /'' ~ ~`j/1 s 1?/j,,~G/1~~ li G-~G, START OATt 01-31-2012 REMAR~~ reimbursement for towing COVEftA~E DESCRIPTION ON BEHALF OF AMOUNT EMERGEN4Y ROAD SERVICE RYAN, DOLORES M 195.00 _- __ __ __. - - CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 May 18, 2012 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. T0: R. Mark Thomas, Esquire RE: Dolores M. Ryan Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: May 4, May 11, and May 18, 2012 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received ~ 75.00 ~~ti!~y N. Morgentf~al, Excutive ~irs-,~ ;r ~~-~- a ~-~ot-News Co. - echnology Pkwy ' Suite 300 ~; ~echanicsburg, PA 17050 `Inquiries - 717-255-8213 ~: R. MARK THOMAS 101 SOUTH MARKET STREET MECHANICSBURG PA 17055 c~he~tatriot•News Now you know STATEMENT ALL CHARGES ARE NET ~CCT # NAME AD ORDER # DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT 35242 R. MARK THOMAS 0002205293 04/27/12 METRO WEST BASIC AD CHARGE 544.08 35242 R. MARK THOMAS 0002205293 051G4l12 METRO WEST BASIC AD CHARGE 544.08 :;5242 R. MARK THOMAS 0002205293 05/11/12 METRO WEST BASIC AD CHARGE $44.08 AFFIDAVIT CHARGE 55.00 TOTAL: X137.24 This is not an invoice. Please do not remit payment from this Statement. An ire>>cice will be generated at the end of the month. --Than"A you. NOTE: This SiGt~ment replaces the Order Confirmation which we previously sent with Proofs of Publication /~ ~ G ~ t ~i' 1 ~ ~. ~ - The .Country. Butcher Shop, Inc. CARLISLE, PA 17015 ~- 286 MCALLISTER.CHURCH ROAD, PHONE.: 249-4691 (~ - ~ - ~. y~ ~ ~ ~ Date ~ ~ Name ~/ \ /~ i- Address f_ !`:, -. City ; --- ......,,,,r ~ NET: 7 DAYS: A finance charge of 1 1/2% per month will be charged on all accounts ever 7 days. This is an annual percentage rate of 18°-°. ~; a 1 ;y 1 i r~, ~~ ;'~ FUNERAL HOME & CREMATORY, INC. 219 North Hanover Street Carlisle, Pennsylvania 17013 717.243.4511 toll free 1.866.451.451 1 fax 717.243.3723 ww„v.hoffrrprxoth.com infcC ~offmarroth.can January 25, 2012 Kenneth Ryan 102 Longlane Road Newville, PA 17241 Statement of Funeral Expenses for: Dolores Mae Ryan Date of Death: December 24, 2011 Account Id: 16418-276 PACKAGE: Traditional Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 4,650.00 Sub Total: $ 4,650.00 MERCHANDISE: Casket: Christian II $ 3,060.00 Outer Container: Monarch -Concrete Vault $ 1,420.00 Sub Total: $ 4,480.00 TOTAL FUNERAL HOME CHARGES: CASH ADVANCES: $ 9,130.00 St. Patrick Catholic Church Cemetery $ 1,000.00 18 Certified Death Certificates at $ 6.00 each $ 108.00 Newspaper Notice -Sentinel $ 138.16 Clergy $ 250.00 Flowers $ 159.00 Cantor $ 75.00 Organist $ 150.00 Altar Servers $ 60.00 Sub Total: $ 1,940.16 Total Funeral Expense: $ 11,070.16 Tota! Payments Made: $ 11,070.16 Payments Made: Kenneth Ryan Check 1069 Jan 5, 2012 1,940.16 Estate Of Doris Ryan Jan 25, 2012 9,130.00 Balance: $ 0.00 Please return this portion with your Remittance. g Amount Enclossd Do3cras ^11Ge Ryan SERVi`1G OUR COMt~~1Ul~lITY SINCE 1 907 ~' ~~rWS~~ ~-~ ~ - ;i ;f FUNERAL HOME ~ CREMA?ORY, INC. William E. Hoffman -President Christopher H. Hoffman-Owner RobertA Filbum III-Supervisor Adam G.Shaffer-Funeral Director 219 North Hanover Street Ccriis;e, Pennsylvcnia 17013 717.243.4511 toll free 1.866.451.4511 fax 717.243.3723 The first print and frame are courtesy of Hoffman-Roth Funeral Home and Crematory. Memorial Portra« Order Form Name of person in picture Name of person ordering ~~~ Telephone Number ~ ~ `~ -' ~ `~ ~ `'~ Address (optional) It Quantit ~~ Price em 8 x 10 framed ---- -----~--45------------ --•--------------- •-----------------•------ ----•--•----$ :.:._. .., ;.. 11-x_14-- . -----------framed-------------~--65------------ ------------------ ------------------------- '. -------•---- -. 1 i` 16-x-20- ------------framed--•----• -85------------ ------~- -- ---------------- ------------------------- ~° .r ------------ Y - / ~3 a 8-x_10--- ------------no:frame.---- -----~--30------------ ------------------------ ------------------ ---- 11- x-14 - ' ------------!~-~ _fra me----- ------ -- 50 S 16-x_2rJ- ------------!i-o=frame----- ------~--~~-•--------- ------------------- ------------------------ -------------5 ~ /, `r/ J ,f' ~G c / '!'i~ i,1 fit, n brir~ ~ , J .',' ~~~" ~.. onetime charge of $5~ per picfur~ do t}~e above prices. ®SEPh JAMES ~EWELERS >~:.4 301 E. MAIN STREET RECEIPT MEC{fANICSI)URf~~ PA 17053 WWW.JOSEpI1JAMESJEWELERS.COM 00'1-32369 # 1 jJJ EW E~ER52@COMCAST. NET 7 X 111111111111111 iil Ili I111I i1i~111 717.795.9224 2/25/2012 11:58 AM Joseph James Jewelers (717)795-9224 You were assisted by Sold To: _#001-11699 Ellen Augusterfer (#6) ~' Kenneth and Linda Ryan ~ j 102 Longlane Road ', Newville, PA 17241 I USA 717-448-7747 32340-001 62205 -Gold Pocket watch. Tasks:Written !IIV1!I!I!li!IIIIIIIIIII!ICllillll!li appraisal for the es tate of Dolores Ryan. Repair Pickup Price... $80.00 Less previous payments... $0.00 Due at pickup... $80.00 $80.00 --- ----- SubTotal... $80.00 Pennsylvania Sales Tax... $4.80 Total... $84.80 __ --- - --- -__ __--- Check #1003 Tendered... 584.80 cor~Tlr~ul~~ c~a~E ~x ~~ 5 s~C~,~~~ ~T NELJPO~tT P~, 17474 S S T r; T y i'! ~ i~ T -~ ~- sir r-'~~~1417t ~../~V~. 12J ,~ilii 1'`c: L~~. L Account #: ldddb4l^ ~,~tLu's~c ~-~ i~'v Aiv ~ i ,~ ~ ~ -~ ~.~ C~J~'1?~y~:L~,~ly CRO~SIi~iG~ ~~ 1 L~;N~~~L~DPt= WAY ~~ CAuLI L~, PA 17d1~ ~Q ~ a f' ~- ~~~ C~ ~~ df~ ~~n~~~rrt • ~• --~____1 _ ,y._rY..,___.___---~ ----.________.....__._ _ __..._ 1 4. 6i 1 ~l,~ f / 1 R"~ ~ ~~ ~ ~•' ~~=v~ T ;-TIJP I t~iG-~,CTB~ i d~-~~ T ~~l 3. d3 11;_'1!1.1 R r;== o~'~'- ~;3~ i'~-~kL-SSIiVG C4-ifi t~1,''~HLt;~Pi; s ,-„ ~ -~ ,4.~-~_ NLPAPIrd 1ddU1ML 5110!`';L SY ~ ~. 75 •-~ ' ~+ -' ' ~ 7. ^: X =-: ~ ~ ~ 1 ;j=r U 1-~1'~(L l=s ;! [ 17 ~i is n e l t~ I=' ~, ~ ~ 15 d C.~ T f~ ;~ d i _ ~J iLJ G, r ~, dd CJr'~~ a -. -. ,, ; -,.,.. ,-,,~,~_;- _~ cIr-~;~~=L~xACIr`t ti dd~i~~ TA~~ ii^t' cif=?"C ~a~.~ ,13.5 alii%~SJit -'--._._._.__ _ i~.}~~.,. % 1 :alTi? % c c Past ~. __. G ~_ ; rent ~s i -dC d a j.~ 5 ~ 1.__________ ____.__._.___.__ __ ~,~__ dd ~~d 1 db. 71 d _ ~;~~'~ i ! u;`d~ ~~LM~~ CnLL 1-~~,~U-v~~-G~79 i•~.Y. ~° .-'irr~~ C01yTTi~lVI1`.~G CARE R~ 28 S SECOi~II~ ST idEWPORT PA i7Q7~ .. .. S T (~, T E i 1 E i~a T ?~ 5c~~~ment Dates: 12f'~ifii P_~p: 1 JJ tJLOR ~'J R~!'11~Y c~ji~~c~LAr~D cR~ssTC~~~s 1 LCih?i-SDOFZF WAY CARLISLE. PA 17Ci5 ~;~ t~mCUnt ~}~-~~ D~s~. ription ___..._....._ __ ___ --____-- j'; . ` G 1 / 1 ' _____ <;~;~ ________ r`•'47C1r"_'. = 13j`• CAY _{wlt~t,,~____-~_ a : TfiL'Iia S.lJ ~ r G=~ ~ ~• ~ CC C' C'3 COr~AY j ~ . Li [ i-~t'Y ~ _ r + ~'> `~ i f 11 c R;x~ 1=~'~r~i~ DILTIAs Ei~( CD i c;~;~.,C: C,-,~- Y 1 5 i70 Ct~PAY . 12121 l11 R ; 4 Gy~.y~~~~} ti n ~_ ~ ; .~{ if~ ~ .LI~~'Tf SF~?~,TP ~. __ {- ~ t ~ . ~ ~+ Lt ~.i _ t': ~,~i If'~~'~ ~'" '^.~^%{. '~~ t S 1'1CL ~~ 1 ~ {:.i t i'=.1_~}C': 'v l..: i~~S ..f . t . i i ~ t: '- ='~'ci'7ry-~~c ~~?~i'i~ ! ~"((a.~ Tl~ti= e!`~'i'i~:' Ti-tii ` ~t- 1~:f•21f11 ~:'~~= ~:-~,c•F,~S 'L. SODIt)i~t r~-iL G. ~r% 1i~i1Lf12fi C 1=ai t~ t~+ T f '? i / 11 1 ~' ~- _x =~ ~"~=+ r ? 53 WAR FAii I I~; S f ' U i i'~ ~~ Tt~tl.' - ~ ~ y., 4~ . ''-,~ t•....+;. ~,::,,- ~,^~1 -F y` . ,t ., ,~,. . Ai`~IT;=~tCi~~fc';iaTIG t~~ 1~.~~ { i`; tL, . i ,~_ '~ _ _ „ f i ~. ;.2: ~ l ,-.. , -r n_ ,y }. _ c c' ~L ~Y 1 • CC ~ tw7~ fzT ~ t t~' !, Zvi ~L~ I _ ~~i :i~f L}3 it G ~l~t{4f'! ~ Y 1 ice' >=. ~ , t ~ ~ ~, _.S 1 ~! ~ 1 ~ 1 1 ! 1 t, ~ I t I ~ 1T . ~ 7 .i.O ~{~ V ~ 1 } t ~ +~q~i 7 } 't L ~t`J~Gi~L { 1«.. J~L Ltw S ii'T 1! ' ~ L / ' G- t ~r G< = G. ~ 'f ~f 11 _ T. T.' I1-• LY'~~~-`~~~G~ _ r { (} t} 7''1]~lj (''$t_: ~^ C.~~ ~ L3• 41z ~`I•. ~. _'v ~~~L7'/! f 3.=L/1Tt~LJ •_J .G .s. t ~ - ~ L'V 1tt ~ , ; l . ~ 1 ~ V ~(7 ~ + G i~i'-'i fi _ r._ s . ~':.:.' oonr>_„_'!2 T :. ~.- ~ Tt;'_~`;~fc.._7a,(».r. T ~;, _ ._:~_ Frt~Tr-+ • 'if'# Ct7nti.inU~Ci a:iit it°:; +. Gct~it= ~-:} Y`j `. ~,.1 i~ , .. ..... .. ~t3~i,£?~AIt~ a^ka-=. 7c:i~iJ1~. mments ~--- - ~. - Date Description Da~~sl "Chargesl , Payments Balance - Units ' ! . {Credit) ..------- -- ---- -- -- 1 $255.00 $255.00 '23/11 -12/23/11 R&B Private Pay 1 $0.27 $255.27 X24/11 -12/24/11 Sales Tax -Phone-Basic 1 $4.56 $259.83 24/11 - 12/24/11 Phone -Monthly TOTAL BALANCE DUE: $259.83 7S~ ~3 Ch Pcf.'~ /o% "!CITY NAME RESIDENT NAPr1E DOLORES M RYAN ACCOUNT NUM6ER 20630516 `;15ERLP,ND CRCSSiNGS e•,J a 1. 1 C. 2 G 12;.1 ~ : 24 PNle63a26966 1vTay 10, 2012 Cdward Taylor Via l+acsimile: 717.243.5907 Re: ~4nnuity COl]tr~Ct: Contract Owner: Dear N1r. Taylor: Wf~ VALIC ZTP228039 anal VV217487 bolores Ryan, beccased No. 5175 fP, 2 eve2 WESTERN J NATIONAI L f f c f n s r., r C) n C c C o m ~ n n y E!U. liar, Al f rlii~siillir,~,T:Yns 701:1 {I?/i 1.Si70,~74A~~'1(1 Thank you ibr your recent inquiry regarding these a»nuity contracts. We would lilcc to take this opportunity to respond to your request. The accumulated value ol'conrract V1~228039 as of, peccmber 24, 2011, the date of doath is $140,487.89, The accumulated value of'eontract VV217487 as ofl3ecember 24, 2011 the date of death Is $45,045.03 We appreciate the opportunity tc, assist you. Should you have arm questions, please contact our Client Care Center 1t 1.800-424-4990. Sincerely, ~~~?2 Atigel.a Furlong Annuity Claims Dapartmc~it