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Home My WebLink About10-05-12 (3)1505611185 REV-1500 EX (02-11) (FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 21 12 0 0 4 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1,68-24-391,2 0],062012 0801,1,925 Decedent's Last Name Suffix Decedent's First Name M I PETRY ROBERT H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach SclZe~ule O) "_.~' ~ ... CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIOI~F~.1LD BE DI~'CTEDi~O.• ~-~ Name Daytime Telephon~trcbber ~ .. ~~?;? ~"~ ~,. ~ - I ~~ HOWELL C - f1ETTE, ESQUIRE 717-232-0' t -'~~= J . REGISTER WILLS USE QTLY "'~ ~~ f--`, C7 C~ : " First Line of Address _Ce ~ - " ~ .~ fy ~ ~ ` r, CJ1 `~ O L~ ~~ 340], NORTH FRONT STREET Second Line of Address PO BOX 5950 City or Post Office State ZIP Code HARRISBURG PA 171,1,00950 Correspondent's a-mail address: H C M E T T E- C O M 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 'nformation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~.. 4 AT WILLIAM S - PETRY e~~~-~-~'~~-~~ _~ -- ~ ~ ~ ~. 7-~' ADDRESS 4 STEPHEN TERRACE CAMP HILL, PA 701,1, SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~ ,; , DATE t ~1ETTE, EVANS ~ WOODSIDE •~ ~ ~ 1 ~_ ADDRESS 3401 N - FRONT STREET, PO BOX 5950 HARRISBURG, PA 1711,D-095 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 ~~ J 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 1,68-24-3912 Decedents Name P E T R Y R O B E R T H RECAPITULATION 1. Real Estate (Schedule A) - 1. 16 8 , 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) . 2 1, 0 8 4 , 7 8 0 •71, 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. Q . Q Q 4. Mortgages and Notes Receivable (Schedule D) 4. 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 12 2 , 8 6 2.6 3 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 71, , 2 41 • 71, 8. Total Gross Assets (total Lines 1 through 7) g. 1, , 4 4 6 , 8 8 5.0 5 9. Funeral Expenses and Administrative Costs (Schedule H). g. 51, , 015.9 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 21, 4 21.5 8 11. Total Deductions (total Lines 9 and 10) , 11. 7 2 , 4 3 7 • 5 2 12. Net Value of Estate (Line 8 minus Line 11) 12. 1 ~ 3 7 4 , 4 4 7.5 3 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) _ 14_ 1, , 3 7 4 , 4 4 7.5 3 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.2) x .o - 0. 0 0 15. 0. 0 0 16. Amount of Line 14 t xable 4~ at linealratex.o 1„374,447.52 1s. 61„850.1,4 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 Q• Q Q 1 g 0. 0 0 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM4648 3.000 61,850.14 J REV-1500 EX (FI) Page 3 rlnrn~lnnt'c ~`mm~lntn Arlrlrncc• File Number al. l.a I1f144 DECEDENTS NAME PETRY ROBERT H STREET ADDRESS CU~1BERLAND COUNTY CITY CA~1P HILL STATE PA ZIP 17011- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 5 8, 0 0 0. 0 0 B. Discount 3 , 0 5 2.6 3 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1> 61, 850.14 61, 052.63 (3) 0 •0 0 0.00 (5) 7 9 7.51 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 0 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 ^ 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? . " " ^ or payable-upon-death bank account or security at his or her death? in trust for 3. Did decedent own an 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. 391 16 (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. 39116 (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. 39116(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. 39116(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. 39116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + B) (2) OM4671 2.000 REV-1502 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: Robert H Petry 21 12 0044 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. swasss 2.000 If more space is needed, use additional sheets of paper of the same size. REV~1503 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Robert H Petry 21 12 0044 _ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. The following securities were held in Janney Montgomery Scott Brokerage Account #6589-4950: 10,000 Par Allegheny Cnty PA Residential Dtd:09/15/2002; Mat:05/Ol/2033; 5.2~ CUSIP: 017350W39 10,000 at $100.344 Interest accrued to 1/6/2012 2 600 Shares Allied Irish Banks CUSIP: 019228402 600 shares at $0.695 per share 3 300 Shares Altria Group, Inc. CUSIP: 02209S103 300 shares at $28.715 per share Dividend accrued on 1/6/2012 4 600 Shares Amerigas Partners LP CUSIP: APU 600 shares at $44.935 per share 5 300 Shares AT&T, Inc. CUSIP: 002068102 6 200 Shares BP Prudoe Bay Royalty Trust CUSIP: 055630107 200 shares at $117.24 per share 7 300 Shares Bristol Myers Squibb Co. CUSIP: 110122108 300 shares at $34.2575 per share Dividend accrued on 1/6/2012 Total from continuation schedules . VALUE AT DATE OF DEATH 10,034.40 93.89 417.00 8,614.50 123.00 26,961.00 9,085.50 T/'1TA1 /Alen cn4cr nn lint 7 Rnranifiilatinnl ~ 23,448.00 10,277.25 102.00 995,624.17 1,084,780.71 3W4698 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Robert H. Petry Schedule B (Page 2) Item No. Description 8 10,000 Par Chambersburg PA Area Sch Dist Dtd:07/27/2011; Mat:02/Ol/2034; 4.65 CUSIP: 157882NC1 10,000 at $105.067 Interest accrued to 1/6/2012 9 100 Shares Chevron Corp. CUSIP: 166764100 100 shares at $108.85 per share 10 200 Shares Clorox Company CUSIP: 189054109 200 shares at $66.88 per share 11 403 Shares Coastal Caribbean Oils & Minerals Ltd. CUSIP: 190432203 403 shares at $0.052 per share 12 150 Shares ConocoPhillips CUSIP: 208250104 150 shares at $73.045 per share 13 600 Shares Consolidated Edison, Inc. CUSIP: 209115104 600 shares at $59.45 per share 14 484 Shares Dominion Resources, Inc. CUSIP: 257460109 484 shares at $51.68 per share 15 600 Shares Duke Energy Corp. CUSIP: 264399106 600 shares at $21.51 per share 16 300 Shares Eli Lilly & Company CUSIP: 532457108 300 shares at $40.01 per share 21 12 0044 Value at Date of Death 10,506.70 205.38 10,885.00 13,376.00 20.96 10,956.75 35,670.00 25,013.12 12,906.00 12,003.00 Total (Carry forward to main schedule) 131,542.91 Estate of: Robert H. Petry Schedule B (Page 3) Item No. Description 17 300 Shares Exelon Corp. CUSIP: 30161N101 300 shares at $41.14 per share 18 2,100 Shares Exxon Mobil Corp. CUSIP: 302316102 2,100 shares at $85.555 per share 19 25,000 Par Fedl Home Loan Mtg Corp Remic Ser 2949 Mat:10/15/2034; 5.25$ CUSIP: 31395PZ88 Interest accrued to 1/6/2012 20 312.779 Shares First Eagle Gold Fund Cl A CUSIP: SGGDX 312.779 shares at $29.96 per share 21 300 Shares First Trust Energy Income & Growth Fund CUSIP: 292697109 300 shares at $29.06 per share 22 545 Shares Frontier Communications Corp. CUSIP: 35906A108 545 shares at $5.115 per share 23 100,000 Par Govt Natl Mtg Assn Remic Ser 2011-129 Mat:09/20/2040; 4.0~ CUSIP: 38376LT74 Interest accrued to 1/6/2012 24 25,000 Par Govt Natl Mtg Assn Remic Ser 2009-93 Mat:10/20/2039; 5.0~ CUSIP: 38376KGV7 Interest accrued to 1/6/2012 21 12 0044 Value at Date of Death 12,342.00 179,665.50 204.13 0.99 9,370.86 8,718.00 2,787.68 99,789.88 388.78 28,548.52 121.53 Total (Carry forward to main schedule) 341,937.87 Estate of: Robert H. Petry Schedule B (Page 4) Item No. Description 25 20,000 Par Govt Natl Mtg Assn Remic Ser 2005-74 Mat:09/16/2035; 5.0~ CUSIP: 38374L5Q0 Interest accrued to 1/6/2012 26 250,000 Par Govt Natl Mtg Assn Remic Ser 2003-91 Mat:10/20/2033; 5.5~ CUSIP: 38374CUZ2 Interest accrued to 1/6/2012 27 8,000 Par Govt Natl Mtg Assn Remic Ser 2005-92 Mat:01/20/2032; 5.0$ CUSIP: 38374MUU1 Interest accrued to 1/6/2012 28 4,000 Par Govt Natl Mtg Assn Remic Ser 2005-55 Mat:06/20/2031; 5.O~k CUSIP: 38374LZY0 Interest accrued to 1/6/2012 29 300 Shares H J Heinz Company CUSIP: 423074103 300 shares at $53.09855 per share Dividend accrued on 1/6/2012 30 300 Shares Intel Corp. CUSIP: 458140100 300 shares at $25.205 per share 31 200 Shares Kimberly Clark Corp. CUSIP: 494368103 200 shares at $72.66 per share 32 300 Shares Kinder Morgan Energy Partners LP 300 shares at $83.665 per share 21 12 0044 Value at Date of Death 22,870.98 97.22 6,399.63 32.10 1,722.98 7.67 252.11 1.10 15,929.57 144.00 7,561.50 14,532.00 25,099.50 Total (Carry forward to main schedule) 94,650.36 Estate of: Robert H. Petry Schedule B (Page 5) Item No. Description 33 300 Shares Merck & Co., Inc. 300 shares at $38.59 per share 34 600 Shares Penn Virginia Resource Partners LP CUSIP: PVR 600 shares at $26.245 per share 35 5,000 Par Penns Hsg Fin Agy Singl Dtd:03/29/2007; Mat:10/01/2037; 4.7~ CUSIP: 708796EX1 5,000 at $100.35 Interest accrued to 1/6/2012 36 10,000 Par Penna Hsg Fin Agy Singl Dtd:10/14/2010; Mat:10/01/2039; 4.75$ CUSIP: 708796WP8 10,000 at $101.805 Interest accrued to 1/6/2012 37 20,000 Par Penns Hsg Fin Agy Dtd:03/29/2006; Mat:04/01/2031; 4.75 CUSIP: 708793NC4 20,000 at $99.619 Interest accrued to 1/6/2012 38 25,000 Par Penns St Tpk Commn Oil Dtd:08/Ol/1998; Mat:12/O1/2027; 4.75 CUSIP: 709221JY2 25,000 at $100.038 Interest accrued to 1/6/2012 39 50,000 Par Penns St Tpk Commn Rev Dtd:01/22/2009; Mat:06/Ol/2039; 5~ CUSIP: 709223VW8 50,000 at $104.258 Interest accrued to 1/6/2012 40 600 Shares Pepco Holdings, Inc. CUSIP: 713291102 600 shares at $20.19 per share 21 12 0044 Value at Date of Death 11,577.00 15,747.00 5,017.50 62.01 10,180.50 125.35 19,923.80 250.69 25,009.50 115.45 52,129.00 243.06 12,114.00 Total (Carry forward to main schedule) 152,494.86 Estate of: Robert H. Petry Schedule B (Page 6) Item No. Description 41 10,000 Par Philadelphia PA Arpt Rev Dtd:08/16/2007; Mat:06/15/2018; 5~ CUSIP: 717817JZ4 10,000 at $108.434 Interest accrued to 1/6/2012 42 300 Shares Philip Morris International, Inc. CUSIP: 718172109 300 shares at $77.23 per share Dividend accrued on 1/6/2012 43 5,000 Par Pittsburgh PA Wtr & Swr Auth W Dtd:03/02/1998; Mat:09/Ol/2027; 0~ CUSIP: 725304QH5 5,000 at $58.57 44 30,000 Par Pittsburgh PA Wtr & Swr Auth W Dtd:03/02/1998; Mat:09/O1/2027; 0$ CUSIP: 725304QM4 30,000 at $44.943 45 300 Shares Plum Creek Timber Company, Inc. CUSIP: 729251108 300 shares at $37.40 per share 46 600 Shares PNC Financial Services Group, Inc. CUSIP: 693475105 600 shares at $59.37 per share 47 1,500 Shares PPL Corp. CUSIP: 693517106 1,500 shares at $28.57 per share 48 200 Shares Procter & Gamble Company CUSIP: 742718109 200 shares at $66.28 per share 49 300 Shares Southern Company CUSIP: 842587107 21 12 0044 Value at Date of Death 10,843.40 29.17 23,169.00 231.00 2,928.50 13,482.90 11,220.00 35,622.00 42,855.00 13,256.00 13,411.50 Total (Carry forward to main schedule) 167,048.47 Estate of: Robert H. Petry Schedule B (Page 7) Item No. Description 300 shares at $44.705 per share 50 20,000 Par State Pub Sch Bldg Auth PA Dtd:06/15/2003; Mat:05/01/2021; 4~ CUSIP: 857322NU1 20,000 at $101.977 Interest accrued to 1/6/2012 51 600 Units Tortoise Energy Infrastructure Corp. CUSIP: 89147L100 600 shares at $42.59 per share 52 1,500 Shares Verizon Communications, Inc. CUSIP: 92343V104 1,500 shares at $38.85 per share 53 300 Shares Windstream Corp. CUSIP: 97381W104 300 shares at $11.6862 per share Dividend accrued on 1/6/2012 21 12 0044 Value at Date of Death 20,395.40 144.44 25,554.00 58,275.00 3,505.86 75.00 Total (Carry forward to main schedule) 107,949.70 REV-1508 EX+ (11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENTTURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Robert H Petry 21 12 0044 Include the proceeds of litigation and the date the proceeds were received by the estate. All grogertv jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1971 Pontiac LeMans sedan, 124,000 miles 8,000.00 2 2002 Buick sedan - poor condition 500.00 3 AARP - refund, unearned membership dues 37.01 4 Bank of America - credit balance on VISA account 31.49 5 Household goods and furnishing and miscellaneous personal effects 1,500.00 6 Janney Montgomery Scott Money Market Account #6589-4950 79,261.08 7 M&T Bank Checking Account #68571887 16,466.80 8 MetLife Insurance - refund of unearned premium for long term care insurance 954.14 9 PNC Bank Checking Account #51-4001-3017 16,024.11 10 Refund of unearned insurance premium 88.00 TOTAL (Also enter on line 5, Recapitulation) $ ~ 122 , 8 62.63 owa6aD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (08-09) pen nsylvan is DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Robert H. Petry __ 21 12 0044 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBE DESCRIPTION OF PROPERTY INCLLOE THE NMAE OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRAIJSFER. ATTACHAC,OPY OF TFIE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPtJCABLE TAXABLE VALUE 1• Individual Retirement Account, held in Janney Montgomery Scott Account #6589-5355 71,241.71 100.0000 0.00 71,241.71 Beneficiaries are decedent's three children in equal shares See attached for date of death valuation TOTAL (Also enter on line 7, Recapitulation) $ 71,241.71 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES A N D INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert H. Petry 21 12 0044 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Parthemore Funeral Home & Cremation Services 11,752.67 B. 1 Total from continuation schedules ~ 2,932.12 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: 2. Attorney Fees: 8 0 0 0. 0 0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5. 6. 7. 1 City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Administration expenses incurred by Executor including postage, office supplies Total from continuation schedules . State ZIP 1,003.50 735.00 62.15 26,530.50 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 51 , 015.94 swasA~ z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: Robert H. Petry Schedule H Part 1 (Page 2) Item No. Description 2 Rolling Green Cemetery Grave opening 3 Rev. Stephen Lytch Ministerial services 4 Market Square Presbyterian Church Funeral services 5 Old Towne Florist Funeral flowers 6 Nick's Cafe Funeral luncheon 7 Food and supplies for memorial wake 8 Gingrich Memorials Inscription on grave marker Total (Carry forward to main schedule) 21 12 0044 Amount 1,395.00 150.00 400.00 92.21 315.61 554.30 25.00 2,932.12 Estate of: Robert H. Petry 21 12 0044 Schedule H Part 7 (Page 2) 2 Beth Blancher Services for staging of residence in preparation for sale 150.00 3 Camp Hill Borough Sewer utilities, January - October 465.00 4 Chestnut Court Condominium Association Monthly condo fees, February - October 3,985.00 5 Cleaning expenses for decedent's property 137.06 6 Comcast Cable/internet services 119.50 7 Estate Valuations & Pricing Systems Charges for date of death valuation of securities 93.10 8 Eugene Acri Painting contractor 1,028.00 9 Harland Clarke Check printing fees 56.39 10 John Farling Painting contractor 949.50 11 Packing and storage supplies 116.43 12 Paint, supplies and materials for repairs to residence in preparation for sale 1,724.65 13 Patrick Roth Furniture moving services 150.00 14 Petry Enterprises Labor for electrical repairs at residence 300.00 15 PPL Electric Electric utilities at residence 496.02 16 RE Leppo Replacement battery for Pontiac LeMans 68.68 Total (Carry forward to main schedule) 9,839.33 Estate of: Robert H. Petry 21 12 0044 Schedule H Part 7 (Page 3) 17 Settlement expenses Settlement expenses relative to sale of residence, including 6~ realtor's commission, 1~ realty transfer tax and miscellaneous fees (see attached) 12,240.00 18 Storage Depot Storage unit for removal and storage of decedent's personal property pending disposition 894.78 19 Tax Collector, Camp Hill Borough 2012-13 school real estate taxes 2,201.16 20 Tax Collector, Camp Hill Borough Balance, 2012 county/ township real estate taxes 28.14 21 Tax Collector, Camp Hill Borough 2012 county/township real estate taxes 889.36 22 Travelers Insurance Homeowners insurance 81.84 23 U.S. Postmaster Certified mail for income tax returns 13.00 24 Veterinary fees and supplies for care of decedent's dog 200.14 25 Yale Electric Co. Materials for electrical repairs at residence 142.75 Total (Carry forward to main schedule) 16,691.17 REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER Robert H. Petry 21 12 0044 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 8W46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Robert H . Pet 21 12 0044 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. William S. Petry 4 Stephen Terrace Camp Hill, PA 17011-1167 Individual Retirement Account, held in Janney Montgomery Scott Account #6589-5355 Inventory Value: 23,747.28 One Third of Residue: 434,401.94 Son 458,149.22 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. 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. $ 0 . 0 0 9W46A1 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Robert H. Petry Schedule J Part 1 (Page 2) Item No. Description 2 David H. Petry 673 San Pablo Avenue Orlando, FL 32707 Individual Retirement Account, held in Janney Montgomery Scott Account #6589-5355 Inventory Value: 23,747.21 One Third of Residue: 434,401.94 3 Patricia A. Petry 8585 Somersworth Drive Manassas, VA 20111 Individual Retirement Account, held in Janney Montgomery Scott Account #6589-5355 Inventory Value: 23,747.21 Son Relation 21 12 0044 Amount 458,149.15 One Third of Residue: 434,401.94 Daughter 458,149.15