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HomeMy WebLinkAbout10-09-12 (3)' 1505610140 RE~~-1500 Ex (01-10) PA Department of Revenue Bureau of individual Taxes County Code Year File Number PO Box ~~8oso1 INHERITANCE TAX RETURN 2 1 1 2 0 3 2 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 6 B 5 0 6 5 6 8 0 1 D 6 2 0 1 2 0 3 0 9 1 9 5 5 Decedent's Last Name Suffix Decedent's First Name MI M c A F 0 0 S C A R O L D I A N 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 FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OPALS BELOW 0 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach Copy of 11`Ji'I) 9. Litigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 0 (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 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) CORRESPONDENT -THIS :SECTION MUST BE COMPLETED. ALL GORKESPUNUtNGt ANU GUNfIUtN I IAL I A1C INf VKMHI IVIV JIIVULU tst ulrct~ i to i v: Name Daytime Telephone Number D A V I D H S T O N E E S Q U I R E ? 1 7 7 7 4 7 4 3 5 First line of address 4 1 4 B R I D G E S T R E E T Second line of address City or Post Office N E W C U M B E R L A N D Correspondent's a-mail actdress: D S T O N E a~ S T O N E L A W• N E T Under penalties of perjury, I de~la:e 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. t;aclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OE f~ERSON RESF'ONSIB FOR FILING RETURN DATE ADDRESS. _ 603 EAST KE LE(~ ST MECHANICSBURG PA 17055 SI R E U rH R T REPRESENTATIVE DATE A DRESS ~ ~_ 414"'B'R~ STREET _NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY REGISTER ILLS USE ONLY r i i `.~ y .~ , (~ ,t ~ I ,- W.. J i i ~ ~._.J ,, ri . _ -,~ _._ 13~E ILED ~' , , State ZIP Code ~ ~ T' ~_ _~ c t P A 1 7 0 7 0 Side 1 ~ \~ 15056~~0140 1505610140 ~ ' ,~ J 1,50561,0240 REV-1500 FX Decedent's Social Security Number DecedenYsName: C~`~ROL DIANE McAF00S 1 6 0 5 0 6 5 6 8 RECAPITULATION 1. ........................................... Real Estate (Schedule A) 1 ~ • 2 1, 3 1, 6 L . 0 1, 2. ...................................... Stocks and Bonds (Schedule B) ~ 3. Closely Held Corporat,on, Partnership or Sole-Proprietorship (Schedule C) ..... 3. - 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. • 7 6 2 4 5 . 6 5 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Proper~y (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers `~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. • 8. Total Gross Assets ,total Lines 1 through 7) ........................... 8. 8 9 4 0 6 . 6 6 9. Funeral Expenses and Administrative Costs (Schedule H) .... ..... ......... 9. 4 2 8 0 4 . ? 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ......... 10. 4 7 • ~ 0 11. Total Deductions (total Lines 9 and 10) ................. ..... ......... 11. 4 2 8 5 2 . 0 9 12. Net Value of Estate ;Line 8 minus Line 11) .............. ..... ......... 12• 4 6 5 5 4 . 5 7 13. Charitable and Gover imental Bequests/Sec 9113 Trusts for whi ch an election to tax has not been made (Schedule J) ........ ..... ......... 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ ..... ......... 14. 4 6 5 5 4 . 5 7 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. 0. 0 0 16. Amount of Line 14 to :able at lineal rate X • ~ _ ~ ~ ~ 16. 0 ' ~ ~ 17. Amount of Line 14 ta;.able 0 0 0 17 0. 0 ^ at sibling rate X .12 . 18. Amount of Line 14 taxable 4 6 5 5 4 5 7 1 g 6 9 8 3. 1 9 at collateral rate X .15 . 19. ........................................ TAX DUE ..... ........ .19. 6 9 8 3 1, 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1,505610240 1,50561,0240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 2L L2 0323 Tax Payments and Credits: ~. Tax Due (Page 2, Line 19) 2, Credits/Payments A. Prior Payments B, Discount 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. Total Credits (A + B) (2) (3) (4) (5) 6,983.19 o•Oo 0.OD 0.00 6, 983.1,9 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 o~ income of the property transferred; X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0 c. retain a reversionary interest; or ................................................................................................ ^ 0 d, receive the promise for life of either payments, benefits or care? ....................................................... ^ 0 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 "in trust for" orpayable-upon-death bank account or security at his or her death? ......... ^ 0 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 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 stature 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, X000: • 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 she child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net v~+iue 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 vaiue 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, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CAROL DIANE McAF00S 21, 12 0323 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH L• 93.805 shares American Funds-#58421,927-The Growth Fd 2,750.36 of America ~ $29.320 each 2 8B0.1,95 shares American Funds #84632788-The Bond Fd 10,410.65 of America-A 0 $1,2.54 each TOTAL (Also enter on line 2, Recapitulation) I $ 1, 3 ,1, 6 L • O 1, (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: CAROL DIANE ~1cAF00:o 21, 12 0323 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,• 2D04 Kia Sorento at Kelly Bluebook value 6,540.00 2 Department, of Defense-last payroll check received 576.91, 3 f1assMutual Life Ins Co-premium refund on policy 14.06 4 MassMutual Signature Care-return of premium 65,760.24 5 Members l,st FCU-Checking Acct #20870-1,1 882.02 6 Members l,st FCU-Invstmt Savings Acct #20870-D5 1,00.04 7 Members hst FCU-Savings Acct #20870-00 32.38 8 United Stat es Treasury-201,1, 1040 inlcome tax refund 2, 340 • 00 TOTAL (Also enter on Line 5, Recapitulation) I $ 7 6 , 2 4 5 • 6 5 If more space is needed, insert additional sheets of paper 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 CAROL DIANE McAF00S 21 12 0323 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 (IF APPLICABLE) TAXABLE VALUE 1, - American Equi :;y-Annuity No • 2641,65 43, 000 •00 1,00 -00 3,000.00 0 • 00 Benef - are Emily I"I • Pivovarnik, Mary Jane Oliver and Leauna Oliver 2 American Funds-CB&T Cust Roth IRA 9, 697 • 00 1,00 • 00 9,697.00 0 •00 Benef are Emily NI• Pivovarnik, Lary Jane Oliver and Leauna Oliver 3 Jackson National Life-Nonqualified 1,21„566.00 1,00.001 1,566.00 0.00 Annuity #10071,89784 Benef are Emily r1- Pivovarnik, Mary Jane Oliver and Leauna Oliver 4 John Hancock-Annuity No • 2751,601, 75, 433 • 00 100 • 00 5,433 •o0 0.00 Benef are Emily P1• Pivovarnik, Mary Jane Oliver and Leauna Oliver 5 Mass Mutual F i n Group • -NFS/~1TC IRA 74, 583 • 00 1,00.00 4,583.00 0 • 00 Benef are Emily Nl• Pivovarnik, Mary Jane Oliver and Leauna Oliver 6 Navy Depot-Thri f t Savings Plan 62, 947 • 00 1,00 • 00 2,947.00 0.00 Participants #8305936539490 Benef is estate ALL OF THE ABOVE ACCOUNTS WERE IRA'S OR ANNUITY ACCOUNTS W/ BENEF• DESIG- NATION AND DECEDENT WAS NOT 59 1/2 AT TIME OF DEATH WHICH WOULD HAVE CAUSED A 10~ WITHDRAWAL PENALTY. THEREFORE THE ABOVE ACCOUNTS ARE NOT INHERITANCE TAXABLE 0.00 0.00 0.00 0.00 TOTAL (Also enter on Line 7, Recapitulation) ~ $ 0 • 0 0 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER CAROL DIANE f1cAF00S 21, 1,2 0323 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSrS; 1,• Emily Pivovarnik-Reimb for funeral exp-flyers Buhrig 1,0,041,•00 2 Ayers Buhrig Funeral Home-add'1 death cert 1,48.00 B. ADMINISTRATIVE ~ OSTS; 1. Personal Representative Commissions: Name(s) of Personal Representative(s) E m i l y f1 Pivovarnik , A d m i n. 9, 5 0 0. 0 0 Street Address 603 E Keller Street city f1e~.~hanicsburg state PA zIP 17070 Year(s) Cc mmission Paid: 2 01, 2 / 2 013 2. Attorney Fees: D~7Vid H Stone 21,500.00 3, Family Exemption: ~:~ decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: S E e b e l o w # 4 5 • Accountant Fees: 6 • Tax Return Preparer Fees: 7 • Kelly Fii~ancial Serv-prep of 201,1, income taxes 237 •75 2 PA Dept of Revenue-tax due on 201,1, PA40 23.00 3 Cumberla~~d Law Journal-adv grant of letters 75.00 4 Stone LaFaver & Shekletski-Reimb for probate 294.50 5 Notary f~~e on various claim forms 1,0.00 6 The Sentinel-advertising grant of letters 1,89.54 7 Register of Wills-cert copies and short certs 41,•00 8 Register of Wills-filing Petition for Guardianship 1,5.00 9 Register of Wills-filing Inh tax ret and Inventory 30.00 10 Reserve for filing First and Final Acct 500.00 1, 1, Reserve for closing expenses 200.00 TOTAL (Also enter on Line 9, Recapitulation) $ 4 2 , 8 0 4 • 7 9 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 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER CAROL DIANE f1cAF00S 21 L2 0323 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,• G.H• Harris Associates Inc-f~echanicsburg Boro per 47.30 capita tax due for 201,0 plus interest and penalty TOTAL (Also enter on Line 10, Recapitulation) I $ 4 7 • 3 0 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: CAROL DIANE McAF00S FILE NUMBER: 21, 1,2 032B 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, • WILf1IER, JAf~ES First Cousin Collateral 3,1,05.1,9 26 LEANDER ROAD ROCHESTER NY 1,461,2- 2 WILMIER, ROGER First Cousin Collateral 3,1,05.1,9 210 SOUTH PE~IDLETON ST CORTLAND NY 1,3045- 3 f10VIC, AMY First Cousin Collateral 3,1,05.1,9 1,243 PARK STREET McKEESPORT PA 1,51,32- 4 f10VIC, VICKIE L First Cousin Collateral 3,1,05.1,9 1,269 ARGONNE ROAD SOUTH EUCLID OH 441,21,- 5 WELBORN, REGINA M First Cousin Collateral 3,1,05.1,9 4600 CANAL Di~IVE SANFORD FL 32771,- 6 SUTTON, VIRGINIA A First Cousin Collateral 3,1,05.19 66 SHADY LANE INDIANA PA 1+5701,- 7 GROMLEY, CHARLES PATRICK First Cousin Collateral 3,1,05.1,9 2445 OLSON ROAD ~1ARION CENTER PA 1,5759- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBI.9TIONS; A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1, B. CHARITABLE AND GO'/ERNMENTAL DISTRIBUTIONS: L• TOTAL OF PART II - E~~TER 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. Continuation of REV-1500 Inheritance Tax Return Resident Decedent CAROL DIANE McAFOOS 21 12 0323 Decedent's Name Page 1 File Number Schedule J -Beneficiaries - 1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under I Sec. 9116 (a) (1.2).j 8 BRICKEL, WIL'_IA~1 L First Cousin Collateral 3,105.1,9 2571 PURCHASE LINE ROAD CLY~1ER PA 15728- 9 ENTY, DAVID J Child of Collateral 3,105.1,9 220 HSTINGS AVENUE First Cousin ENDICOTT NY 1,3760- 1,0 CROWE, FRANK Child of Collateral 1„033.5], 1,046 ELf1W00D AVENUE First Cousin BUFFALO NY 1,4222- 1,1, CROWE, REBECCA SUSAN Child of Collateral 1„033.51 1,2943 WEST MAIN STREET First Cousin ALDEN NY 1,40D4- 1,2 CONGDON, DIANE ELAINE Child of Collateral 1„033.5], 1,31,48 W f1AIN ST • , NO 3 First Cousin ALDEN NY 1,4Di14- 1,3 CESSNA, RICHARD B Child of Collateral 775.14 2689 f1ILL ROAD First Cousin PUNXSUTAWNEY PA 1,5767- 1,4 CESSNA, DENNIS Child of Collateral 775.14 BOX 36 First Cousin GLEN CAMPBELL PA 1,5742- 1,5 CESSNA, ROBERT D Child of Collateral 775.14 BOX 43 First Cousin GLEN CAf1PBEL!_ PA 1,5742- 1,6 CAMERON, CINDY J Child of Collateral 775.1,4 490 CAMERON ~~OAD First Cousin ROSSITER PA ~~5772- 1,7 ETHER, ROBIN Child of Collateral 3,1,05.18 2425 ROBERT ,'TREET First Cousin STOUGHTON W~~ 53589- 1,8 CESSNA, GREGORY D Child of Collateral 1,55D•27 303 WEST COLINTRY DRIVE First Cousin JOHNS CREEK GA 30097- 1,9 RICKARD, DEBRA R Child of Collateral 1„550.27 1,73 VALLEY ROAD First Cousin INDIANA PA 1,:x701,- 20 BENYAK, BERNADETTE M Child of Collateral 620.1,1, 220 S• EDGEHILL AVENUE First Cousin YOUNGSTOWN OH 4451,5- 21, BAILEY, RICK A Child of Collateral 620 •1, 1, 4498 WARWICK DRIVE NORTH First Cousin CANFIELD OH 44406- Continuation of REV-1500 Inheritance Tax Return Resident Decedent CAROL DIANE McAFOOS 21 12 0323 Decedent's Name Page 2 File Number Schedule J -Beneficiaries - 1 NUMBER NAME AND ADDf~ESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE ~ TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 2Z BAILEY, RODNEY C Child of Collateral 620.10 461,8 WARWICK DRIVE SOUTH First Cousin CANFIELD OH 44406- 23 ~1cCUE, JULIE A Child of Collateral 620.1,0 4824 BAYFIELD ROAD First Cousin ALLISON PARK PA 151,01,- 24 SAMUEL, JUDY L Child of Collateral 620.1,0 3548 GRANDIN ROAD First Cousin CINCINNATI OH 45226- 25 ROBERT C GROP1LEY ESTATE DIED AFTER Collateral 3,1,00.53 5959 W CORTARO FARMS RD DECEDENT TUCSON, AZ 85742 First Cousin REV 1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Estate of Carol Diane McAfoos File No. 21-11-0323 Additional Information in explanation of the Attorney fee and Administratix commission: The Attorneys fee and Administratrix's commission were estimated in part on the total value of the estate (approximately $431,000) as well as the extensive amount of time the attorney invested in finding the heirs of the deceased. At the time of the decedent's death, there were no known heirs, Thy attorney through extensive investigation over 2 months time, discovered some 25 first cousins ar~d first cousins, once removed, spread across eight states related to the deceased entitled to share in her estate. Eight of the heirs had equal rights to serve as administrator and each was contacted and thoroughly briefed on the estate administration process prior to each executing a renunciation in favor of the Emily Pivovarnik. The minor beneficiaries of several of the annuities required the petition of court and appointment of a guardian to receive the property of the minors. This also necessitated the filing of status reports with the Orphans Court to ensure the proper transfer and investment of the minors' funds. Finally, it is anticipated that the estate will require a forrnal audit by the Orphans Court to be settled to the satisfaction of the heirs. 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AdvancedNtarketsSysterns.cc~rn Get started with a broker 4 7 httn•//hic7rharte m:~r)tr-tu~atrh ~nm/hiet~ri~nl/r1Pfa>>lt a~n~wmh=ahnc~xc4zelc~Senate=O1%2F0... 9/20/2012 Kelley Blue Book 1i.1•Y1~rrllr~ r ~' '' ' '' ~ :p K~«~''/ lU@ $04k The Trusted Resource'' r~ I~l +~1g~GREI.!'/l~E S • "~ The Nance Your f'riceg Too{, On{y from Progressive - .. ;~ • ;',~ .. advertisement why ads; Your Blue Booms Value 2004 Kia Sorento pr4.- Styte: LX Sport Utility 4D . ~" ~~~ - -~~ Mileage: 51000 i;~k ' t~ Private Party `/alue Excellent $6,990 1 Very Good ` 3 E $6,690 £ b Good $ 6, 540 i Fair $5,840 '.. v. v~ ~ ,,,~ ~, ,,, b~.~.,,,~,.~„ .,..,~ Vehicle Highlights Page 1 of 2 MPG: City 14/Hwy 18 Doors: 4 Drivetrain: 4WD EPA Class: Sport Utility Vehicles Country of Origin: - Max Seating: 5 Engine: V6, 3.5 Liter Transmission: Automatic Body Style: Sport Utility Country of Assembly: - __ ._. Your Configur~:d Options Our pre-selected options, based on typical equipment for this car. / Options that you added while configuring this car. Engine Comfort and Convenience Safety and Security V6, 3.5 Liter Air Conditioning Dual Air Bags Transmission Power Windows F&R Side Air Bags Automatic Power Door Locks Roof and Glass Drivetrain Cruise Control Privacy Glass 4WD Steering Wheels and Tires Power Steering Steel Wheels Tilt Wheel Entertainment and Instrumentation AM/FM Stereo CD (Single Disc) New Cars Yo~,l IVlight Like ~~ 201 ~ 'ia Sorento http://www.kbb.con,'.cia/sorento/2004-kia-sorento/lx-sport-utility-4d/?vehicleid=2867&int... 9/19/2012 Kelley Blue Book :~~+:-~, ,~;, ,, 2013 Chevrolet Equinox .~ y ;,,,,~ 2013 Mazda CX-5 :~.* Glossary of Terms Kelley Blue Book® Trade-in Value -This is the amount you can expel to receive when you trade in your car to a dealer. This value is determined based on the style, condition, mileage and options indicated. Kelley Blue Bookp Private Party Value -This is the starting point for negotiation of a used-car sale between a private buyer and seller. This is an "as is" value that does not include any warranties. The final price depends on the car's actual condition and local market factors. Excellent Condition: 3% of all cars we value meet this criteria. This car looks new and is in excellent mechanical condition. It has never had paint or bodywork and has an interior and body free of wear and visible defects. The car is rust-free and does not need reconditioning. Its clean engine compartment is free of fluid leaks. It also has a clean title history, has complete and verifiable service records and will pass safety and smog inspection. Very Good Condition: 23% of all cars we value meet this criteria. This car has minor wear or visible defects on the body and interior but is in excellent mechanical condition, requiring only minimal reconditioning. It has little to no paint and bodywork and is free of rust. Its clean engine compartment is free of fluid leaks. The tires match and have 75% or more of tread. It also has a clean title history, with most service records available, and will pass safety and smog inspection. Good Condition: 54% of all cars we value meet this criteria. This car is free of major mechanical problems but may need some reconditioning. Its paint and bodywork may require minor touch-ups, with repairable cosmetic defects, and its engine compartment may have minor leaks. There are minor body scratches or dings and minor interior blemishes, but no rust. The tires match and have 50% or more of tread. It also has a clean title history, with some service records available, and will pass safety and smog inspection. Fair Condition: 18% of all cars we value meet this criteria. This car has some mechanical or cosmetic defects and needs servicing, but is still in safe running condition and has a clean title history. The paint, body and/or interior may need professional servicing. The tires may need replacing and there may be some repairable rust damage. © 1995-2012 Kelley Blue Book Co. ,Inc. All rights reserved. ~c~ 20t2 Xeltey Glue Aonk L"n., Ins. All rights reserved. 9,~I~1/2022-9/20/. 012 F_dition forVennsylvania 17070. the specific information required to determine the value for Phis p.3rtrcular vehicle was supplied ny fhe person generating this report. Vehicle vatuati°ns are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions; specifications, vehicle condition or other particular circumstances pertinent to this particular vehicle or fhe transdctiat or the parties t° the transaction. This report is intended h;r the individual use of the person generating this report only and shalt not he solJ nr transmitted t° another party. Kelley fi/ue Qook assumes no responsibility fir errors or omissions. (v.I1092) Page 2 of 2 http://www.kbb.corr?/ncia/sorento/2004-kia-sorento/lx-sport-utility-4d/?vehicleid=2867&int... 9/19/2012 Claim: 20120046 Policy: 14-14606422 MASS. MUTUAL LIFE INSURANCE CO LTC ADMINISTRATIVE OFFICE P.O. BOX 4243 WOODLAND HILLS CA 91365-4243 Policy Holder: MC AFOOS,CAROL 603 EAST KELLER STREET MECHANICSBURG PA 17055- Payee O1: EXPLANATION OF BENEFITS Agent: 115192-LANGAN, ROBERT J. (037 ) Insured: MC AFOOS,CAROL Patient: MC AFOOS,CAROL Date: 4/02/2012 ESTATE OF CAROL MC AFOOS Payee ID: 163506568 C/0 EMILY M PIVOVARNIK Check: 70014999 4/02/2012 603 EAST KELLER STREET MECHANICSBURG PA 17055- -Date of Service- # of Days Charge Eligible Ineligible Coinsurance Amount Provider/Service From To Paid Amount Amount Amount Amount Paid EMILY M PIVOVARIK RETURN OF PREMIUM, NON-FORF 3/30/12 3/30/12 Return of Premium, Survivor Benefit Payee Total For: ESTATE OF CAROL MC AFOOS 1 65760.24 65760.24 1 65760.24 65760.24 .00 .00 65760.24 .00 .00 65760.24 ~~i~l~ ~~~~~ ~t. ~~~ REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Estate of: CAROL DIANE MCAFOOS Date of Death: 01/06/2012 Social Security Number: 163-50-6568 20870-00 08/24/1978 $32.38 $0.00 $32.38 None 20870-11 12/31 /1979 $882.02 $0.00 $882.02 None 20870-05 01/20/1987 $100.04 $0.00 $100.04 None MEMBERS 1ST FEDERAL CREDIT UNION Tessa~h 9 Lending Insurance Support Specialist September 21, 2012 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org STONE LAFAVEH &SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E GERALD J. SHEKLETSKI NEW CUMBEIILAND. PA 17070 www. stonelaw.net October 5, 2012 Register of wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, P~~ 17013-3887 R~', : Estate of Carol Diane McAfoos No. 21-12-0323 Greetings: OF COUNSEL CHARLES H. STONE JON F. LAFAVER TELEPHONE (717) 774-7435 FACSIMILE (717) 774-3869 EnclosE~d please find an original and one copy of the Inheritance Tax Return and Inventory for the above mentioned estate. Please clock in the copy of the Inventory and send it back to my office along with any receipts in the enclosed stamp addressed e~~.welope. Also, Enclosed is check #1007 in the amount of $30.00 for filing the return and inventory and check #1008 in the amount of $6,983.19 for inheritance tax due. Please note the timely postmark of this correspondence. Should you have any questions, please do not hesitate to contact my ~~f f ice . Very truly yours, STON `LaF VER & SHEKLETSKI ~. ,~ ~~"Dav%~ H . Stone d '`'' .n ~+ {~ , , _ Enclosures ~ ~" L° ~ -- U `.. n ~_.- ~ _ _~, r ., C~ ~ _: ~ _ -v `I`y '~ ~.r i~"'i ~~~ T1 "'~ ly Sr fD ~ (7 ~ ~ f-' O t3' N IJ • s; (D U) v~ I-' trt' F--' tD m Z (D O ~ K ~ ~ s/ ~o ~~~r C O -' ~y m li 1V O ~ W ...I cn~ N• o°v~o ~ ~ ~ m~ n ~ i'~ r olv"C t~ , ~ m ZmN~'A cn boo-I ~ ~ w(D f~0 ~ ym~~o O I-h W ~ ~ C ~ ~ ~ ~ i--i ~ // U , mm 1V ~p ~~ ~ ~rYY ..,~N .~• ~~ "'Y~ s"~'t"~ ~ 7 i ~~ ~ °~" .~ ~µ rti,'t';~'h': k-.~ •~y;a~ ~`:~ ~'~'; '.'fir lh O N ~~Fp a 0 ~ ~ "'~ '~''' w Ti IV O cfl ~~ ~ cfl N ~'~ ~` Q-.I~y m°~~ a o ~'"~ ~ v-~~~n aN O~