HomeMy WebLinkAbout08-09-07
J 15056051058
REV-1500 EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes Coun Code Year File Number
ry
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PAt7128-0601 RESIDENT DECEDENT 21 ' 06 0803
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
160-07-1995 10/10/2004 04/05/1918
Decedent's Last Name Suffix Decedent's First Name MI
_ .
'Keefer Frances
J
(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 OVALS BELOW
~~ 1. Original Return ~..°' 2. Supplemental Return ~ ::3 3. Remainder Return (date of death
prior to 12-13-82)
"n~ 4. Limited Estate ., ~ 4a_ Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
~~~ 6. Decedent Died Testate ~a:~ 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 t:: ~~ 10. Spousal Poverty Credit (date of death c „"" 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
Stacy B. Wolf, Esquire (717) 241-4436
Firm Name (If Applicable)
_ REGISTER OF WILLS USE ONLY.
Wolf & Wolf ~-, -~
:-a
__ ~
First line of address _
rv? `',
10 West High Street ' , =~ ~' '
,
-i I ,
Second line of address ~ ~ ~~
i _'
_
_
~
-~ ~ i
City or Post Office State ZIP Code DATE, Fft.EO v
..
Carlisle PA 17013
c
~.
Corespondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, including
it isrtrugr correct and complete. Declaration of preparer other than the person
SIGJJ,9Yl1/YE2 F pEfRF~S~N~SII~ FOR FILING RETURN
600 Yorktown Drive, Leesburg, Florida 34748
iIGNATlJF,2E= OF PREPARER OTHER THAN REPRESENTATIVE
10 West I-lifjh Street, Carlisle
15056051058
17013
Q
--~-~-~~TE 1
PLEASE U8E ORIGINAL FORM ONLY
Side 1
schedules and statements, and to the best of my knowledge and belief,
a is based on all information of which preparer has any knowledge.
d ~ ) O
15056051058
J
15056052059
REV-1500 EX
Decedent's Social Security Number
~eoedeoes Name. Frances J Keefer
_~ ~ _rv......, _
_ 160-07-1995
RE _~.
_ _.. ~ .~ ~ ___ _
CAPITULATION _ .~M w ....._w _ _ __~
1. Real estate (Schedule A) .......................................... ... L ' 102,000.00 ',
2. Stocks and Bonds (Schedule B) .................................... ... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. ',
4. Mortgages 8 Notes Receivable (Schedule D) .......................... ... 4.
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ..... ... 5. ', 779.60
6. Jointly Owned Property (Schedule F) r,',;;°',;:~ Separate Billing Requested .... ... 6. 4,101.64
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) +i:'::J Separate Billing Requested...... .. 7.
8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ', 106,881.24
9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ', 12,337.37
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 12,678.00
11. Total Deductions (total Lines 9 & 10) ................................. 11.' 25,015.37 I
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12 81,865.87
13. Charitable and Governmental BequestslSec 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. ', 81,865.87
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 -
(a)(1.2) X .0_ 15.
16. Amount of Line l4 taxable °-
at lineal rate X .i) 45 81,865.87 16. ' 3,683.96
17. Amount of Line l4 taxable
at sibling rate X .12 1 ~ ',
18. Amount of Line l4 taxable
at collateral rate X .15 1 g. ',
19. TAX DUE .........................................................19..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
3,683.96
15056052059 Side 2
15056052059
REV-1500 EX Page 3 File Number
Decedent's Complete Address: ~ 21 ~° 06 ' oao3
DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER
Frances J Keefer
-- -- 160-07-1995
STREETADDRESS - - - -
1718 Locust Street
CITY STATE _
N
C
b
l
d ~ ZIP
ew
um
er
an
PA ~ 17070
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 3
683
96
2. Credits/Payments ,
.
A. Spousal Poverty Credit
- --
B. Prior Payments
C. Discount
- Total Credits (A + B + C) (2)
3. InteresUPenalty if applicable
D. Interest 525.09
E. Penalty
Total InteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 525.09
Fill in oval 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. (5) 4,209.05
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4,209.05
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 December 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 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)j.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (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 twenty-one 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 zero (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 four and one-half (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 twelve (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+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
prances J. Keefer 21-06-0803
All real property awned 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 fads.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
t,lAtt °r FILE NUMBER
Frances J_ Keefer 21-06-0803
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properly jointly-owned with right of survivorshio must be disclosed on Schndula F
~u nwie space is neeaea, Insen a0muonal sheets of the same size)
REV-1509 EX+ (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Frances J. Keefer 21-06-0803
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A• Richard G. Keefer 1718 Locust Street, New Cumberland, PA 17070 Son
6.
C.
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JDINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTRUTIDN AND BANK ACCOUNT NUMBER DR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE GF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE DF
DECEDENTS INTEREST
t' A. 10120/97 FNC Bank (5140033261-Checking) 5,161.39 50 2,580.70
2• A. 10/20197 PNC Bank (5130077383- Savings) 3,041.87 50 1,520.94
TOTAL (Also enter on line 6, Recapitulation) I S 4,101.64
(If more space is needed, insert addAional sheets of the same size)
REV-1511 EX+ (12-99)
SC4IEDULE N
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Frances J. Keefer 21-06-0803
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
AMOUNT
A.
t. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 11, 500.00
3. Family Exemption: (If 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 260.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
~• The Sentinel- Legal Advertising 202.37
B. Cumberland Law Journal- Legal Advertising 75.00
s. Appraisal Fees- Diversified Appraisal Services 300.00
TOTAL (Also enter on line 9, Recapitulation) I $ 12,337.37
(If more space is needed, insert additional sheets of the same size)
REV•1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Frances J. Keefer 21-06-0803
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEF{CIARIES
ESTATE OF FILE NUMBER
Frances J. Keefer 21-06-0803
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
f TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Robert K. Keefer Son 50%
2 Richard G. Keefer Son 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-150D COVER SHEET
tt 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 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I =
(If mare space is needed, insert additional sheets of the same size)
Practitioner Portal
Penalty and Interest Calculations
CALCULATION DATES-
7/10/2005 TO 8/10/2007
TAX DEFICIENCY $ 3,683.96
CALCULATED INTEREST $ 525.09
BALANCE AS OF 8/10/2007 $ 4,209.05
Start Over
hops://vvww.doreservices.state.pa.us/pitservices/Default.aspx
Page 1 of 1
8/1/2007
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SUMMARY OF IMPORTANT FACTS AND CONCLUSIONS
i !1(' A TTGIT~T•
LV V't ill •\.
TAX PARCEL NUMBER:
1MPROVEMBNTS:
PROPERTY RIGHTS:
1 ! 14 LaV11J• 4CI lreV4
New Cumberland, Pennsylvania
26-23-0543-242
One-story detached single-family dwelling.
Fee simple interest. '
OWNERSHIP HISTORY: The subject properly is owned by Frances J. Keefer. The
property was purchased on December 14, 1955 for a
rv°°pviied ~i~iil$iderativil of $13,2JV ^und Ti vriler$hIp
transferred on deed reference 16-X-206.
SCOPE OF THE ASSIGNMENT: The scope of the assignment included an analysis of the
subject's area, an inspection of the subject property, an
estimation of the nrnperty's highest and hest use;
consideration of all three approaches to value, and the
application of those relevant to the valuation of the
subject.
OBJECTIVE: To estimate the market value of the subject property as
unencumbered.
EFFECTIVE DATE: October 10, 2004.
HIGHEST AND BEST USE: Continued use as asingle-family residence.
rneT nnpvnn~u.
~VUl !11 1\VA~11. I`Y.A.
SALES APPROACH: $102,000
INCOME APPROACH: ~r N.A.
L'TT.~AT •7 AT TTC CVNCLV.IiOi~v: $iv2,CvV
1 11'1 A,L Vl11iVl.
2
APPRAISAL CERTIFICATION
1 hereby ce°t Gil;' tl:ut apace appiieuti~in fcr vaiuatic:: by:
THE ESTATE OF FRANCES J. KEEFER
the undersigned personally inspected the following described property:
!`111 thµt Vel talll p1eV1~.+ Vr p1.l l~yel Vf 1N.nd, l'Y ltll the 111 pl ~/Y~e 11e11~J lhel \°. Vyl ~°.r °vV N°,.d, SILNULV°
in New Cumberland, Cumberland County, Pennsylvania, bounded and described as follows:
Beginning at a point on the westerly line of Locust Street 169.4 feet south of the
southwest corner of the northerly intersection of Locust Street and Sherwood Road; thence
southwestwardly along the southerly line of T.ot Nn. 20; Rlock "R" 109.27 feet to a noint;
thence southeastwardly along the easterly line of Lot No. 14, Block "B", 54.39 feet to a point;
thence northeastwardly along the northerly line of Lot No. 22, Block "B" 110 feet to a point on
the westerly line of Locust Street; thence along Locust Street northwardly at right angles 25.62
feet to a point; thence continuing along said line of Locust Street by a curve to the left having a
radius of 671.3 feet 34.38 feet to the place of beginning.
To the best of my knowledge and belief the statements contained in this report are true
and correct, and that neither the employment to make this appraisal nor the compensation is
contingent upon the value reported, and that in my opinion the Market Value as of October 10,
2004 is:
ONE HUNDRED TWO THOUSAND DOLLARS
$102,000
The property was appraised as a whole, subject to the contingent and limiting conditions
outlined herein.
~~~~
Larry E. Foote
Certified General Appraiser
GA-000014-L
3
Settlement Statement
Transactions without Sellers
U.S. Department of Housing
end Urban Development
OM8 Approval No. 2502-0491
Name & Address of Borrower:
Richard G. Haefer
1718 Locust Street
New C>.ssN~arland, PR 17070
Property Location: (if different from
1718 Locust Street
New Cumberland, PA 27070
Name 8 Address of Lender.
PNC Mortgage, LLC
2720 5th Avenues South
Minneapolis, MN 55408
Settlement Agent
Lam Offices of Darre22 C. Dethlefs
riace or aeniemenr.
2232 MarXet Street, Camp Hill, PR 17011
Loan Number: ~
0076757996 Settlement Date:
07/24/2007 Rescission Date:
07/27/2007
L. Settlement Charges 1300. Additional Settlement Charges
600. Items Payable in Connection with Loan 1301. Surve to:
801. Loan Origination fee 0 % to PxC Mortgage, LLC 1302. pest ins ection to
802. Loan discount 1.5 % tp PNC Mortgage, LLC I 050. 00 1303 Overnight Fee to Law ofc DcD (UPSJ $18.00
803. Appraisal fee to PEES valssation $335.00 1304Law Office of DCD (email Doc Fee) 525.00
804. Credit report to RELS Reporting $36.00 1305Lax Office Of DCD (Tax Cert Raimb) $5.00
805. Inspection fee t0 PNC Mortgage, LLC 1306 Robin Gas eratti Tax Co21
(07-OB
ch) $976. SZ
806. Mortgage insurance application fee t0 PNC Mortgage, LLC 1307Robin Gas eratti Tax Co21 (07Co/ orc) 5544.28
807. Mortgage broker fee [o PNC Mortgage, LLC 1400. Total Settlement Charges (line 1602) S4, 969. 4a
808. Flood Life o£ Zoan Fea to TOFFS $19.00 M. Disbursement to Others
809. Processing Fee to PNC Mortgage, LLC $400.00 1501. Stacy WOIf Esq-Benefit-RKeafer
$44,586.00
810. Tax Ser'viCe Fee to WFRETS $80.00
811. 1502.
812.
813. 1503. MetteEVans6WOOdsideClien tEscrow $12,678.00
814_
815. 1504.
816.
817. 1505.
818.
81 9. 1506.
820.
900. Items Required by Lender to be Paid in Advance 1507.
901. Int. from 07/30/2007 to 08/01/2007 $25.90
@ $ 512.9500 per day 1508.
902. Mortgage insurance premium for O months to
1509.
903. Hazard Insurance premium for O year(s) to
1510.
904.
1D00. Reserves Deposited with Lender 1511.
1001. Hazard insurance 3.00 mos. @ $ 539.75 per mo. 5119.25
1002. Mortgage insurance o. 00 mos. @ $ per mo. 1512.
1003. City property taxes o. 00 mos. oQ $ per mo.
1004. Cnty property taxes 8. 00 mos. @-$ 541.23 per mo. 5329. B4 1513.
1005. Annual assessments 0. 00 mos. @ $ per mo.
1006. Flood Insurance O. 0o mos. @ $ per mo. 1514.
1007. SChcol Taxes 2.00 mos. @ $ $83.04 per mo. 5166.08
1008. 0.00 mos. @ $ per mo. 1515.
1009. Aggregate Accounting Escrow Adjustment ~ - (5287. 13)
'1100. Title Charges 1520. TOTAL DISBURSED 557,264.00
110E Settlement or closing fee to Law office of narre2l C. (enter on line 1603)
1102. Abstract or title search to N. NET SETTLEMENT
1103. Title examination to 1600. Loan Amount 570, 000. 00
1104. Title insurance binder to
1105. Document preparation to Stacy Wv2f, Esquire 8150.00 1601. Plus Cash/Check from Borrower
1106. Notary fee t0 Lax office cf Darrell. c. Da thlafs 520.00
1107. Attorneys' fees to
(includes above item numbers ) 1602. Minus Total Settlement Charges
(line 1400) S4, 969.48
1108. Title insurance tmawyers Ti tZ a/Law office of Dar:
(includes above item numbers Hasic - 3 Snd. ) 5828.75 1603. Minus Total Disbursement to Others
(line 1520) 557,264.00
1109. Lenders coverage $ 570, 000.00 ( $70, 000.00 ) 1804. Equals Total Disbursement to Borrower 57, 766.52
1110. Owners coverage $ ( (after ex iration oP an a
p y ppllcable
1111. Closing service Latter Fee to Lawyers Ti tie $35. 0o rescission period required by law)
1112.
1 1 13. Borrower(s)
SigaaatUre(s):
1200. Government Recording and Transfer Charges .
//
1201. Recording fees: $70.50 X
1202. City/county tax/stamp: Ai chard G. Keefer
1203. State tax/stamp: X
42
50
1204. Recording Fee for Dead .
5
1205.
form HUp-1A (2/94) ref. RESPA
I, RICHARD G. KEEFER, hereby acknowledge receipt of the following motor vehicles which I purchases
from the Estate of Frances L Keefer, deceased, on June 20, 2007, for the total sum of Five Hundred Dollars
($500.00):
1. 1981 Pontiac Bonneville, VIN 2G2AR37S4B1718052, fair condition, 100,000 miles;
2. 1986 Ford Econoline van, VIN 1FTEE24Y6GHA79981, poor condition, high mileage, will not
pass state inspection; and
3. 1974 AMC Jeep Wagoneer, VIN J9A15NN075915, poor condition, high mileage, will not pass
state inspection.
/ ,
4~5909v1
RICHARD G. KEEFER
',~ .,
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ChevronTexaco Corporation
HR Service Center -Survivor Support Services
P. O. Box 455
Little Falis, NJ D7424
1-877-259-8786
Richard Keefer
1718 Locust Street
New Cumberlin, PA 17070
Dear Mr. Keefer:
ChevronTexaco
November 8, 2004
Social Security Number: *"*-"•-1995
On behalf of the ChevronTexaco Human Resources (HR) Service Center, I would like to extend my
sincere sympathy to you on the recent loss of Frances J. Keefer,
My name is Donald Armstrong. I will be your contact for any questions you may have related to
ChevronTexaco benefits. This letter Includes important information about those benefits.
What you need to do
1. Carefully review the information in this letter.
2. Mail a photocopy of Ms, Keefer's death certificate to the HR Service Center in the enclosed envelope.
3. Save this letter for your records,
Important information
Our records show Ms. Keefer's last payable annuity check was dated October 29, 2004. It was in the net
amount of $160,59.
Also payable to the estate is $58.74, which represents the total amount of Ms. Keefer's
November and December quarterly supplements to the annuity.
If you have questions
Please call Survivor Support Services toll-free at 1-877-259-8788. My direct extension is 32982. Survivor
Support Services hours are 6 a.m, to 5 p,m. Pacific Time, Monday through Friday, excluding holidays.
Sincerely,
Donald rmstrong
Case Specialist -Survivor Support Services
~/. VV4/UUU
V4/LV/GVVr rsci tt: s~ run
PAYER'S Name, Streel Atldress, City, Slate, end ZIP cotle
JOHN HANCDCK LIFE INS. CD.
G,S.F.P. T-24 TEl 1-800-624-5155
JOHN HANCDCK PLACE, PO BOX 111
BOSTON, MA 02117-0111
RECIPIENT'S Name and Address
OOS0789 O1 A7 0.292 +,AUTO T1 3 0562 17070- OB99-
I,,,III,,,III,,,L,dlh,,,,tIlrl,rhLLl,rl,[r,lll„I,L161
FRANCES J KEEPER
1718 LOCUST ST
NEW CUMBERLAND, PA 17070-1458
CU'stdtner Idanlifiaatron numbet t. .
7676 10661 8566'6721 401 0465
FORM 1099-8
PAYER'S Neme, Streel Address, City, Stale, and ZIP code
JOHN HANCDCK LIFE INS. CO.
G.S.F.P. T-24 TEL 1-800-624-5155
JDHN HANCDCK PLACE, PD BOX 111
BOSTON, MA 02117-0111
RECIPIENT'S Name and Address
FRANCES J KEEPER
1718 LOCUST ST
NEW CUMBERLAND, PA 17070-1458
Cu'slame[ rdantd~etwn nltrtibe~ '.~~
7076 10601 '8565b7~1 401 `0465
FORM 1099-R
PAYER'S Name, Street Atldress, Gily, State, and ZIP code
JOHN HANCDCK LIFE INS. CO.
G.S.F.P. T-24 TEL 1-8D0-624-5155
JOHN HANCDCK PLACE, PD BOX 111
BOSTON: MA 02117-0111
RECIPIENT'S Name and Adtlress
FRANCES J KEEPER
1718 LOCUST ST
NEW CUMBERLAND, PA 17070-1458
Cu§iomer rdemrGCti(ron numli$i,
. , ;: ;.:,
7676 10601 85056721 461 0465
FDRM 1099-R
1401
7703
14D1
7703
1401
7703
r~ uvui vuo
Depanment of the Treasury -Internal Revenue Service
i Grtiss distnbuhon ; ; ;=a TaxsDle"amount ? OMB No. 1545-0119
g 6D2.70 $ 602.70 2004,
2b':Taxable amount :Total
rfbt deterfniiSetl ^ ;didiabUbbn :;^
I Form 1099-R:
DlsMibutions
3 Capaal ggars :'
- .
A Fedaral tricoma tax From Pensions,
Annuities
;(Includetl fn
bpx 2a)
,.. ~; Withheld ";
,
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Retlrementor
g 0,00 ~ 0.00 Profit-Sharing
Plans
IRAs
st=mpta ee cbdtirdurions
y G Not nroalizea appr¢oidiljiti :-
,~ ,
,
Insurance
'ait msurenEe; p`te~nvums ,; p:>in emplGy6,YS SacunlldS~;~ ;' Contracts, etc.
D
D D This intormalion Is holn_qq
furnished to the Internal
. Revenue ervi e
7•.Dddebuhhp,~s~p 80
Q ttiet _,_ ,.
COPY C
,,, , _. ~stntt
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4 $ i+ For
9a ~YOUr ~pd(centage of 9 6':. Total omployee dontt111111ianS'
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Records
%s
D . DD
1DState tax withhela 7q 5tafe/Faytirs stale llti'+ 12 5tati?>d~stnbut~on; ;:.
g PAtOBD 2783 gN1A
PAYER 5 Feaer•al ID # ~:` .RECIP.IENTS Ib #
04-1414660 160-07-1995
Department of the Treasury - Intemal Revenue Service
IUYron i
602 7D ."1a T~(E6'Iti~~amdun1 '`- ;i
$ _ 602 r'o , OMB No. 1545-bt 19
2004
ndbllt rr""''ff !Jbi61 rr``~'11,
sd ~ t
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al
1 Form 1099-R:
Distributio
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uQ
.
_.
n
-
'
41:
de
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e n
From Pensions,
K
4~
e
hbom
ra
tax
wdht,eia
boi«a).- Annuities,
.,
.. .. Retirement or
0 DO g 0 00 Profit-Sharing
Plans
IRAs
fit8itr1Lt3ns;~
fitJeja'i[rrL~lr~4dap)itei~flton< ,
,
Insurance
0.00 mm~sned m ma mtemai
S q~,{~ ROVenue Service
rDrslgbuliah 8Ei' a $ Ottier -F,< ,~ :°
datlas J ,._ .,, , ~ ....... COPY 2
4 ~ A Fite this copy
3a :Your etceYila~@°rif ~ 9 Tatat eMployae conlnnubolfS' with your State,
;, ,;,:.
1t5ial ~fsirlbuilbYt ,~ - s.:. < .. ....; :<s~ City, or Local
<., , , .. Income tax return,
0 . D O when required.
s
g PA10B0 2783 gNlA
P;47ER'S Feda'ral iD # .' '` REGp1ENT'S )~# ,},
04-1414660 160-07-1995
Department of the Treasury -Internal Ravernre Service
V 4l LV/LVVI rni~ u:su rnn
JAN-21-2007 23:26 PNCBANI<
PN~BANC
January 22, 2007
Lisa J. Knode
3401 North Front Street
P.O. fox 5950
bTarrisburg, PA 17110-0950
RE: Estate of Frances J. Keefer, deceased
SSN: 160-07-1995
DOD: 10!10/2004
412 768.3458 P.01
Dear Ivls. Knode:
In response t0 youx request for,bate of Death balances for the customer noted above, our
records show the following:
Checking Account
Account #5140033261 Established 10/20/1997
FRANCES J KEEPER
RICHARD G KEEPER
DOD balance: $5,161,31 + 5,08 accrued interest
Savings Account
Account #S 130077383 Established 10/20/1997
FRANCES J KEEk'>wR
RICI3ARD G KEEPER
DOD balance: $3,041.69 + 5.18 accrued interest
The decedeni anaintained Credit Line Account (RCA #4003045004611687). For'1`urther
information, please call 1-B86-762-2265. Select option 1, then option 3, and then 0 (zero).
After pressing zero, please remain on the line to speak to a Loan Service Representative.
(We do not have access to Loan information, you mast contact the Loan Area at the
above number for further assistance).
~ uuci uuu
Page i of 2
v4i cui tour rni 1~_: yr rna
~uuoi uuu
7RN-21-2007 23 26 PNCBANK
412 768 3458 P.02
Please note that thts office only provides date of death balances for deposit accounts
(1RAs, CDs, Checking and Savings accounts). We do not process any financial
transactions or provide statements. ifyou need assistance with any of these items,
please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Sank branch
off ce,
Sinc/e'Ir/e~ly~,}p ~Q~ f ~~ ~ ~ ~~
~UU~1 UC.~CJ84 l~~.X~~'-`
Rael-elle Wells
1-800-762-1775
P7-PFSC-04-F
500 first Ave,
Pittsburgh PA 15219
Page 2 of 2
Member FDIC
TOTAL P, 02
~~K
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
December 22, 2006
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.
TO: Vicky Ann Trimmer, Esquire
RE:
Frances J. Keefer, 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:
December 8, 15, 22, 2006
Advertising Cost 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment received $ 75.00
Total Amount Due $ 00.00
Becky H. Morgenthal, Executive Director
Diversi led Appraisal Services INVOICE
Real Estate Appraisers and Consultants
35 East High Street
Suite i 0 i
Carlisle, Pennsylvania 17013-3052 DATE: January 12, 2007
Tel: 717.249.2758
Fax: 717.258.4701
TO: The Estate of Frances J. Keefer AMOIJN'I': $300.00
FOR: Appraisal Report
1718 Locust Street
New Cumberland, Pennsylvania
Thank You,
/~ 1~~~~
t ., ~ ~,.,,.o
LNrl ~ L. L VV LV
Certified General Appraiser
GA-000014-L
TERMS: Due upon receipt Tax ID Number 206-36-6731
1\
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~ °!r.
a ,;',.
File Number: 168532113 i
Page: 1 of 7
Darelssuea: os/oi/zoo? TransUnion.
~~~ ~ ,
Personal Information~~~ ` '~ ~ "° ~ ~ ~~ ~~
v. ~1 .,.-,..~.._.-, ,..i.uhiailw~::t`x...~;~2-~.s.. 7'Li"-~e~r~.~~MSe w~.:~.~: ":~.:
Name: FRANCES 1. KEEPER
Other Names: KEFFER,FRANCES,1
KEEFER,EST,FRANCES
You have been on our files since 04/1985
SSN: XXX-XX-1995
Date of Birth: 04(1918
Telephone: 774-5024
Your SSN is partially masked foryour protection.
CURRENT ADDRESS
Address: 1718 LOCUST ST
NEW CUMBERLAND, PA 17070
Date Reported: 01 /1986
CHASE/BANK ONECARD SERV #5417122780110084
X
OK
800 BROOKSEDGE BLV Balance: $23,743 Pay Status: CHARGED OFF AS BAD DEBT<
WESTERVILLE, OH 43081 Date Updated: 04(2007 Account Type: REVOLVING ACCOUNT
(800) 945-2006 High Balance: $23,982 Responsibility: CONSUMER DECEASED
Credit Limit: $25,000 Date Open: 0611998
Loan Type: CREDIT CARD Past Due: >$23,743< Date Closed: 01/2005
Remarks: DECEASED
Estimated date that this item will be removed: 11/2011
CITIBANK CBSD NA #5424180480556627
PO BOX 6241 Balance: $12,678 Pay Status: >COLLECTION ACCOUNTc
SIOUX FALLS,SD 57117.6241 Date Updated: 03/2005 Account Type: REVOLVING ACCOUNT
(800)950-5114 CreditLimi[: $15,300 Responsibility:iNDIVIDUALA000UNT
Past Due: >$1,048< Date Open: 03/1995
Loan Type: CREDIT CARD Date Closed: 11/2004
Remarks: ACCT CLOSED BY CREDIT GRANTOR
Estimated date that this item wilt be removed: 10/2011
THE HOME DEPOTjCBSD #6035320042394666
PO BOX 6003 Balance: $30 Pay Status: rCHARGED OFFAS BAD DEBT<
HAGERSTOWN, MD 21747-6003 Date Updated: 08/2005 Account Type: REVOLVING ACCOUNT
(800)677-0232 High Balance: $2,497 Responsibility :)OINTA000UNT
Credit Limit: $7.500 Date Open: 10/1995
Loan Type: CHARGE ACCOUNT Past Due: >$30< Date Closed: 01/2005
Remarks:>PROFITAND LOSS WRITEOFR
Estimated date that this item will be removed: 12/2011
To dispute online go to: http://transunion.com/disauteonline