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HomeMy WebLinkAbout01-07-13 (2)1505610105 J REV-1500IX(a=-u)(FI)~ PA Department of Revenue pennsylvaMa OFFICIAL USE ONLY Bureau of Individual Taxes "`" Cpunly Cade Year File Number Po Box zso6ot INHERITANCE TAX RETURN ~y ~ Harrisburg, PA 19128-o6oi RESIDENT DECEDENT p7 ~ ~ ~. - ~ `-I ~--1 ENTER DECEDENT INFORMATION BELOW Social Secudty Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _._ 09/2012 05/27/1934 Decedent's Last Name Suffix Decedent's First Name MI CONNOLLY JAMES H (N Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name S_ uffix Spouse's First Name MI DECEASED Spouse's Social Secudty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return O 2. Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12$2) t3D 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) O 3. Remainder Retum (Date of Death Prior to 12-13$2) O 5. Federal Estate Taz Retum Required O CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAT Sft ULD BE D~lECTED;TO: ;;.~~. Name Daytime pTlfin~lumber ; , ~, s' s ri PAUL L. ZEIGLER, ESQ. (717) 9~Q-~r+ ~ ,., ., First Line of Address 300 BRIDGE STREET Second Line of Address 2ND FLOOR, P.O. BOX B City orPOSt Office NEW CUMBERLAND State ZIP Code PA 17070 Correspondents a-mail address: PaUl(~pIZpC.COm Under penaldas of pedury, I tleclare that 1 have examirred this relum, including accomPanying schedules and statements, and to the best of my knowledge and Belief, R is true, uronect and complete. Dederetion of preperer oNer than the personal represenfetWe is based on all information of which preparer has any knowledge. SIGN.aTURE OF PERSON,RESP.ONSIBLE FOR FILING RETURN n ., ., DATE 1 1 05 H ther Road, Elizabethtown, PA 17022 SI REPARER OTHER THAN REPRESENTATIVE DATE/ r~~ i_ l- - '7~LC r~rr rzSC~ t / 7 ~20 i 3 300 Bridge Street, 2nd Floor, P.O. Box B, New Cumberland, PA 17070 PLEASE USE ORIGINAL FORM ONLY REGI EttUI~YWILLS,UtjE ONLY -, ., I. . :~ t ;..:r _' 1 -J DATE FILED B. Total Number of Safe Deposit Boxes -jJ 11. Elllgicn to Tax under-Sec. (A43G1LFphedule Q_ G"u r„7 ~~ Side 7 L 1505610105 1505610105 J J Lsas61o2os REV-1500 EX (FI) Decedent's Social Secudty Number Decedent's Name: JAMES H. CONNOLLY RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 212,000.00 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. 309,645.25 6. JoinBy Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Properly (Schedule G) O Separate Billing Requested........ 7. B. Total Gross Assata (total Lines 1 through 7) ............................. 8. 521,645.25 9. Funeral Expenses and AdminisVative Costs (Schedule H) ............. ...... 9. 70,317.61 __ _.___ 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. 7,276.32 11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. 77,593.83 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 444,051.32 13. Chadtable and Governmental Bequests/Sec 9113 Trusls for which ~ ~ ~ -- an election to tax has not been made (Schedule J) .................. ...... 13. 14. Net Value Subjeet to Tax (Line 12 minus Line 13) .. ......... .... ...... 14. 444,051.32 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_ 16. Amount of Line 14 taxable - - -- _ ~ ~~ at lineal rate X .0 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 1 s, 444, 051.32 17. 18. _. _._._. 1s. TAxDUE.. 1g. 19,982.31 ..................................................... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV4500 EX (FI) Pege 3 Decedent's Complete Address: Fil• Number DECEDENTS NAME JAMES H. CONNOLLY STREET ADDRESS 253 DEERFIELD ROAD CITY CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _ B. Discount 3. Interest 4. If Line 2 is greater Man Line i + Line 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Paga 2, Line 20 to request a refund. Total Credits (A+ B) (2) (3) (4) (t) 19,982.31 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .................................................................................... ...... ^ b. retain the dght to designate who shall use Me property trensfemed or its income ...................................... ...... ^ c. retain a reversionary interest ........................................................................................................................ ...... ^ d. receive Me promise for life of either payments, benefits or pre? ................................................................ ...... ^ 2. If death occurred after Dec. 12, 1982, did depdent transfer property within one year of deaM without repiving adequate considaration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust far" 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? .................................................................................................................. ...... ^ 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 Me surviving spouse is 0 percent [72 P.S. §9116 (a) (1.t) (ii)]. The statute does not exempt a hansfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are sdll applicable even if the surviving spouse is Me 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 adopfive 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 beneficiades is 4.5 peroent, except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for Me use of Me decedents siblings is 12 percent [72 P.S. §91t6(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with Me decedent, whether by blood or adoption. `~ =.=~ ~~ ~ TT LAST WILL AND TESTAMENT a ~ , ~ , r ~ - _ •: ~~ o OF " Y ' o° " : CONNOLLY JAMES H ~ c=am ~-_ ~ . D , ~,~ c~ p 4: `Si I JAMES H. CONNOLLY, of 253 Deerfield Road, Camp Hill, Pennsylvania 17011, County of Cumberland, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking and annulling any and all Wills by me heretofore made. ARTICLE 1: I direct that all my legal debts and administration and funeral expenses, as well as all taxes payable by reason of my death, be paid out of my residue as soon after my death as practicable. ARTICLE II: I give, devise and bequeath all of my Estate, real, personal and mixed, of whatever nature and wherever situate, to GWENDOLYN W. CONNOLLY, my wife, if she survives me for a period of thirty (30) days. ARTICLE III: In the event that my wife GWENDOLYN W. CONNOLLY fails to survive me for thirty (30) days, I give, devise, and bequeath all of my estate of every nature, to be divided equally between my children who are the following: VALERIE C. LAIR, New Cumberland, Pennsylvania, PATRICIA COURTOIS, of Landisville, Pennsylvania, KATHLEEN MATESEVAC, of Elizabethtown, Pennsylvania, CHRISTOPHER S. CASSELL, of Duncannon, Pennsylvania, KENNETH M. CASSELL, of Harrisburg, Pennsylvania, and MAUREEN DANKS, of Leesport, Pennsylvania. In the event that any of my six children are not living in my death, if those children had issue at Page 1 of 5 my death, then that deceased child's share shall be divided equally between the issues of that child. If any of my children are not living at my death and did not have issue, then that deceased child's share shall be divided equally among the remaining five children. ARTICLE IV: I appoint GWENDOLYN W. CONNOLLY to be Executrix of this, my Last Will and Testament. Should GWENDOLYN W. CONNOLLY my wife, fail to qualify for any reason or cease to act as Executrix, or not be living at the time of my death, I appoint KATHLEEN MATESEVAC as my "Successor Executrix". I direct that my said Executrix and Successor Executrix shall not be required to enter bond or furnish surety in any jurisdiction. ARTICLE V: I authorize my Executrix and Successor Executrix to exercise the following powers in addition to those given bylaw, to be exercised in their- sole discretion: (a) To retain any or all assets of my Estate, real, personal or mixed, without regard to any principle of diversification, risk or productivity. b) To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries or executors. (c) To sell at public or private sale, to exchange, mortgage or lease for any period of time, and to repair, alter or improve any real or personal property, and to give options for sales, exchanges, or leases, for such prices and upon such terms and conditions as they deem proper. (d) To compromise any claim or controversy. ~- Page 2 of 5 (e) To make distribution hereunder in cash, in kind, or partly in cash and partly in kind. (f) To make any distribution hereunder for the benefit of minor beneficiaries or others, who in their opinion, are incapacitated through illness, age, or other cause, directly to the beneficiary thereof, to the natural or legal guardian or the person who has custody of such beneficiary, or to apply any such distribution directly to the benefit of such beneficiary. The receipt of such persons to whom payment is made or entrusted shall be a complete discharge of the fiduciary in respect thereof. (g) In general, to exercise all powers in the management of any funds which any individual could exercise in the management of similar property owned in their own right upon such terms and conditions as to them may seem best, and to execute and deliver all instruments and to do all acts which they deem necessary or proper to carry out the purpose of this Will. ARTICLE VI: I wish Musselman's Funeral Home to be my Funeral Director and I wish that my remains be cremated. Page 3 of 5 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of four (4) typewritten pages, this ~© day of November 2003. AL) We, the undersigned, hereby certify that foregoing Will was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. ~~~~~ (SEAL) ~- JGLe1t„ i~~ie,~Gh f (SEAL) l (_ l . ~.FotCa Gb4G. Residing at:~~gl~ Kaol i~ ~e i~/ C~~6ev-1 ~L~A~i 7~' ~~ Residing at: K~4 LOGU~.c-L ~~ ~A'rn'tt?~{~ IAA- i~td1Q Page 4 of 5 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: Subscribed, swom to and acknowledged before me by the Testator, and subscribed and swom to before me by Q~ ~ / ~9-~P//~~ and PGL~ ~• /~G~~ ,witnesses, this day of ~IC~J , 2003. (.~ ~ ~ ~~ Notary Public My Commission Expires: NOTARIAL SEIV. EI.ILIBEIH M. MAIdJ, Nobly Pu6Me Nsw CumberYnd Boro, CunbaNnd Co. MY Camnia~on E~fret Oac 31,2006 Page 5 of 5 REV-1502 EX+ (12-12) ~pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERRANCE TA% RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JAMES H. CONNOLLY nlr rear property owned solely or as a tenant rn common mart be reported rt 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 the! 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. REM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• 253 Deerfield Road, Camp Hill, PA 17011 HUD-1 210,000.00 2. Cemetery Lots (4) RDlling Greeen Cemetery, 1811 Carlisle Road, Camp Hill, PA 17011 ~ 2,000.00 TOTAL (Also enter on Line 1, Recapitulation.) $ 212,000.00 If more space is needed, use additional sheets of paper of the same size. U. S. DEPARTMENT OF F70U81N0 uW URBAN DEVELOPMENT OMB No. 2902-0295 SE7TLEMENf STA71?9ENT T111.EPR0 ^' Keystone Properly 8ettlemer>ts, Inc. B. TYPE OF LOAN 104 Susan Avenue 1. PHA z. RNs ^ 3. tnNV.uRNa Willow Street, PA 17584 4. VA a CONY. N8. a FILE NUMBt3t 7. LOAN NIMBER: Phony 717-484-0272 FAX 717-4645549 slat 27omse7 MDRT, INB. CAEE NO.: 101090947989 C. NOTE: T19a btm Y 3vnhhed b pM you • ehYrerm rncmal tntlbmamaottb. Amount WN m and qOm tuNanmr aemt m shown. 114nN mrNW'm.o.o•P wNe Mm owme ma do9lnp; tlteY n rtoaa htns mrhmtmrbn Ompoe4e tma wn not hoWeW h tlr btW. D. NAME AND AODREBB OF BORROWER: E. NAME ANDADOR~80F 8ELlER: F. NAAE AND ADDRESS OF (ENDER POBp M. lJlaen ESTATE OF JAMEB H. CONNOLLY OMH Moepgs ewnM, LLC NkhNN D. lawn 2782 T1911WIe Roa9 2~ OeelOeN Rob 70 Cattlptut Boabvald Etratm87bwn, Pa ti022 Catttp Hul Pa. 171111 Nttwlewn 84YMn, Pa. 1B7T3 G. PROPERTY LOCATIO2Y N. SEITLEMENTAOENT: t0yabtm Pmpaey,104 Su9an Ave. I. SETTLEAIFNf DATE: 26S DeelAaN ROae WObw SL Pa (7174940272) Dw. 21, 2012 O+mP HN, Pe 17011 FMq L9wwl AlNn TOwnhq PLACE OF 8Ef1LD,ENT: 3496 Mrkr 8tmet M90 PM CultEeemte Cau~ty, PA Came HAL Pn 17011 J. OP e0R11ow62'8772ANBACTIC 81 KSUIlMRY OP BB.L®l'e 17iANB11C710M 100. B1euaAnmmROttnFlw7nBO710M1 400.OmaeAmountDlmbarbf 101. Cot19er77414u MIOe 210.000.00 401. CatlBaf2 aeNe DAOe 210. 702. Pamaml Pmpn4y 400. Purwntl Pnlpetty 1W. BeWet7r18 Dhat92e )Ina 1400) 14,982.88 409. fo4. ~* 1os. 406. Atgmmmnb mrNama P9N In 9eu977ee M tm9ot(s) AIMb /mlmm Wm M neranm q eNW(q 109. Gy/forn urz 12?Il1M3 b 12/31/2M2 8.9/ 408. C9yrtown to 12212M2 m 121818072 8.0 107. CoNipdCly me 7781flD12 b 12A18012 ia89 407. Cw7b9Clym9 128U2012 b 72A18012 18. 108. AMaawnmW 121278012 m 127818012 7.09 40& A77eM~9Ntb 122112D12 b 17818M2 7. 109. edtoN Tn 1281 2 m 91802013 1,2M.97 409. Brmr T4N 12fN/M12 m 9790f1078 1A88. 110. m 410. b 111. OR T08ELLHt 8NM1710118Fm /N81/1072 d10 111. CR. TO SELLER BNMt//o/2BFm 12/31!!012 6.1 112. m 412 m 120, GmN Amount Ow ham Banorvar 220.271.80 420. Oeap A717oum WN b Boger 211,29{. 20D. Atnaut7b Pry ~ramsrmll Oteelroymr 990. RMuWNm mAmountOw TO aalar 201: DeP449 orsnNr money 800.00 901. Elmw eapoNt p4e hMmctlmm) ~. A9nplAmmntr717nrmN4q 219,9.00 871. 87A9Nnm4 ahNpabualer lht91400) 14.801. 208. CdWn9lonlq lrmt ate}rm 809. 6tlMYa 199nU)trunt tu0)erb 'Za. Sd. Pgeltr FM MOtt9gelnmt x69.1>q9R rSemM Mdtlptlp lam Bortowarerd Zee 4800D S1et9q'Slominr(8289.14 POC) 808. Nedmm~-T9m00e 90. 607. Amnon Home Bhhltl (Nwna v74mngQ 620. 50e. Pa NIrR(bttrytlty ll9mlm lm nrma9l9fJ 508. 8mtl DamNrNane 9nPiovnlmnb 1.878. Ad)Inetrnb mrllottn mAnN q 7WNr A~ItNneremr I47nu utlpal0 M sent 10. CMy/fom la m 610 f~dTOwn lmt m 11. CaunQAClq~lc m 671. Con101Cg1ot m 12 Aaaetmttmr6 m 612. Aaw4nm7W b 1a 8rlaol T4N m 919. 8eh09174a m 7a m s14. m 15 b 516. m fa m a7a m 17. 7bleta Avert 9,347.90 617. srln At7W 0.247. 1e. 819. 19. 519. Tad Pre 9yllor Barmwer 221.237.20 520. ToM Redtaemtln AanomtOn BNNr CA911 AT 9E'nI~NT Pmmlfo BOIBIOYYBI 900. CA911 AT BCT7LB@7T TolFrom Bm t ee 1. time mnmW Mm9a1779anotler pFM 120) 320.277.30 807. Grm4 Amoumtlua 8eMOhe 420) 271,294. Len nMttb PaN 9Y4er b4nawaf llin 230) 227.227.90 809, l.aY taeuWOn b ef7LL rAle nlm late 620) 349. . Cart^PRON ®70 Beetowar 890.00 BOa Cah®TO ^PRON 8Nbr 7ea9N /~ ~~jj I e or Si971rure Selim's SIp777dum Huo-1 BETTLEMQIT CNkN0E4 CeN 14741 700. Tad PMN 6MIe Bmbr Fee E 200.000.00 MM Prom PeW Fmm Divlebn damenlwbn Akle 700) es MBOem: SO^O'r'Ore ~~ 70,. e,ooaoo MFmtlemlY NanueM Servkes rimssa Funtls Al 702. E.9ooao m ~ Re4llyAaoNeW senNmerd ENU.n.nt 709. Comnka4mlpY0 e18M8anent 12,000.00 704. baker MS roRammc RaMryAOOdeMe roc. 906.00 800. Mrnr PgY1e N Calnee0on wM Lwn 801. W adlka8m tllerye 986.00 Mom roFE 17) 802. Yaurandflarabu0e(panM)rortllskllaaetMaahosenE MmI(~+'~ eo9. rma edJwOetl mplnetlon da^pes ro Mam R3FE Al 906.00 0. ew. AI4nMU Faa ro f0d9e kYdatka A4eade7es Mam caFE 19) n6.oo eoE. cramt wean m Ged Fiw Mam (APE+r3) 28.86 eae. r.a seluice ro Man ro~ ~ 807. Fbad aedlAOetlon ro ro~+~ 808. ro 800. ro 810. ro att. ro 872. ro 819. ro 814. ro eo0. awl.lr.yau.leyl~7berleeMPraklAae.le. 801, DdIy 60seetehn0ee Sam 127!,2012 ro 1Hf2019 OS 10.9167 Poet 01am (LIFE 110) 212.q 902. 11alye0e Yaualloe PnOrIMn far O ma8he ro VA FlMD003 F!P Man roPE 1b) B,tg0.00 803. Hwnepxrfe beumlw plembm 100 ysem roGnakOWl Me. CO.1894.00 POC'B Man (LIFE i,t) BO6. M ,000. fteevaee DpoNlWvM01lm8er 1001. Inmlde0ae2E1ryoweeaawsaant Main(BFEK) 2,723.99 0.09 1002. Naneowrfebeuenae a MOwro®s ee.so n6adh 2oE.6o ,009. MalpeOehlel8enae o k1a8MQE 13eaah 7004. P7oprbEPS „ MadM®S 27.04 14on01 907.34 1006. ammy MOe „ MPIIlneOE 42.39 RaPllm 406.89 7008. erAaolteer 7 E,adn.OS 2w.0, INaltk z,areo7 ,OW. A99m0eMAdluebwnt -89721 1,ao. t21e ,101. TOM eenlOS enl Nndefe tl0ehwnnn Man (C1FE M) 1,877.00 0. 1102. l3stlMnwd a 41aek10 M ro Ksyarons PlapeM1y BetlMmalb, Inn ,fas. tlrllereaM krlBenas rolfsJprolle Po0pa8y 8etlNnNIN,Inn Mam roFE O6) , ta. I.erIQKe me kwr.nos t,e9s.o0 ,tos. IergeYe604PelgOnl s 0,6,190.00 „a. OwIwM16tleP0poyin0 s 2,0000.00 1107. AperlTe patlm d6r,otel Etls inuanOe Plem9an 1,389.76 ,tOB. Une.nNeefsPatondnrbYEtlsfmunnnplemiUm ze6.2e 7109. ro ,,,o. ro 8.00 ,717. Navy roMerT BUger 7200. GseernmmtReom'dM1m8711mMra.rlw ,207. oewn.nmtlemranE ahenles Mom roFE 17) 147.00 Oesd S 8980 ModPpe S 8780 liecortlsr d Desde 1202 . ManroFE96) 2,00.00 ,zw. TheleMrMen clbtieullgMdeu,lP•0.ea 02,,0000 Nargp•E fMeomerdDeede 1209 . 1208. BMlatexlsMmM IMMlE2loo.ao Mabe0s9 nx0nwd0eade x.,00.00 120& is ,390. Almmra.1rm11Gl.1ee ~~~ o.oo 1901. RpWled eeMae tlMt WU pnehap Ta 1302 ro 19(13. ro ,904 ro 1906. to ,306. sLalVEF1MO Tr1A6N PA107NNU,arJtHZ ro 1907. M ' emrt m 8nss 103 Srllrolr J entl 602 Bsctlalr p ,4,882.86 14,601.00 11400. 7aW 6etllwner8 GprgM Pneb ebw Nil m MClbe evvnetl by 8r6rnmlApelbrereprbq'arh4ear6on OolYdise byaeWS M 91!09!! mar MU416eebmwn Blkbern I heue arNuky IeVMNrd Oro NUO-7 BbtlMNnl SIeYnleld end ro 6b beet d my M0eYd8e end bale[ 8 M e tme end eaaneb ebNMrleN d el maeMM end dMbu /gJMe m,/mY~emoUm by meln OdsbeneNab INMxesmyMetlhe~w naeNedampy dtb~eJNW~, SatlMmem Sbbmeld. t C~ ~ ~_/ ~LL~ ~1-elf/t..sL f'/'~~l.~t e,C: f~~ l~~IX ZAPIeeA BuyvM1 p4erw 6 POariz b'Mlle Nee Adtllam 4 PbOre: Tle MIDI BWIe111e1e &ebnvllefikb I neR Aeerea be Nr 9110 eomlW eaaneelNberwolbn. I NM GYOed arraeive Ne4rdeb G dbbllred b eOOtIdNGbtll aY0 Mmra _"~ 1`~Ctl~Cl~i'~ ~2-~a~~lz BMMnreA2r4 Deb W11nUm0: eb •almebbrwepb Wlrnmlblo U 81eI~m We ernq Mnev bm. MnYIIS Upon oomielm em bMUtlee Nrend enPlemmK POrdebib eR T1e 1e U.6 Cede eeEBen 1001 ene Setlbn 1O efnoad FYtlt Ebtlmab entl HU0.1 Oootl Fa9h [Mlnlete 1810.7 Cko6w tMM7brmot lttmeaee XD0.t LW HUmbr LowN ineN p47 Our oti6Mt4ew olatpe Ye01 a 888.00 S 688.00 Vwrerodpkhar6e (poMe)tortlm nrb ahopn NB02 S .00 S .W Vow egwlW OtlpMbn dwipa NBOS S 860.00 S B68.B0 7mrokrisow N1209 a 8100.06 6 ;7wA0 .. tlrt aemotbwrawe mon tlNtr lD% naotl Falnt8Wma7e HW1 Olwanansnt t1tODIN616 tlnt6w N 1201 a 180.06 i 7NA0 Appm4M Fw 804 f 480.00 8 /78A0 t]etlk Xeport BOS S 80.06 a x.x Bletmpe Mrouwlw promlum 902 8 B,g0.00 S B,N0.x o s .a6 s .ao o s .ao a .x o s .ao s .ao o s .ao s m o .ao .w 6 .m .a6 6 .00 .00 o .oo .6M ioW S 7,80.06 S 7,674.p Ntawwe Oalteaan t7FE utd XIN-7 e11ar8ee S 3.18 OX ,.01 % Wtwrt DeoB Fanll Gtltrnle XW-1 IttmltlspwkforywreeuoW wwunl N7007 2 1,769.K S 7,7x]8 Dally hBeteN oMCBaa N BDi S 10.9187 lday S 786.74 S Y17AT Honam6tlef4lwuanw N 809 S tl8.0e 8 864.00 TON ean4m and brkafe the Inwttrxe 1101 S 7,180.N a 1,A7.00 oewr.w.lrouwiw ttaa S x4.47 a .w e a .ao s .w o .ao .w 0 m .06 0 m m 6 m .oo Win Tum6 ro~rbnlr bw amwmb a 216ADOm Yowlwn Mmb x Yeaw Yow mitlal Ydetast m7e b 1.76 % VwrMdtltM nantltly amend ovwtlfar S 9w.OB Intludw pOncIFN, INereel eM am/ motbe6e O PrMttlPai Ineteenn b: Q tmatwt MaM6apelrourmw Cen ywrYNenel Metlwi x w,nwn Metoamedmum d0 %.7M 1kH tlmt9e tvn w on mtl aw onan6e e6ain evwy elbr . 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Mieeee wtletl Your bnd.r ~Pmrbue adNaw ete aMtlate Pepe 9 oT9 NU61 Closing Statement Continuation -Line 1100 Section Tdle Fees Detail Barto.ar. lanon, POpO 31. S.IMr. Conmxy Esltle, KeNxKIn P~op.M1y. OrAIW Rd 25.9, L.naM.r Imunr.Old R.pWieT3N.n.n Ckrpp O.b 1221/!012 710x. T0b CMry.s D.W for Md Amin, Ihw. 7101 -1110 8anawr B.Ax 1101. 11x.6.r.kN.rxl llr.l.1. TMAe h1e11rnW (PmmfiFl6q S1A77.00 .p0 .) Al.un gi.oi .03 b e1.y A. ewp.r a) a.mgxtw(pawp.) 31aoo .oo b F.IMfel~ c) YW. A'.. (0lmmeg) 317.OD AO b 11.Y.1mw Prgnrq~8.ltl.m.lm.. hie. 0) Claeeq Pr.uakn t.wrsr 37x.00 .w b ONI RbpuWk s) Doomnent PmpnMm 3136.00 .p0 b I(.~gbM PrgNllly i.tllxnw~b. lna. ~ t.xe .06 b 9) 3.00 .00 b h) a00 .00 b p Tad Sam A.hro 1103 (b.l.w) ' 3.00 D To1.10om LYw 1104 NMOM N~63a00 Nei 6.WnlrurlA nf.l0.I11p AM b I6YIMmentwdo.Inpfw P74q.) 3.00 .Op 11~. Owuh 011e ln.uwiq. m IFrvm OFL6q 3.e6 .00 110a 1..11e.y. tltl.lner~i.. 31,e3a0o .~ e) LMdBM1 PIYOMIm (100IJOW8.1) 31,e3a00 .~ b x'spbn. Pr.p.r0r 9.M.mmb. ma b) aw .ao b d 3.00 .00 b a) 3.66 .a6 b a00 .) .00 b Noa ~wnM/. 31N POIWY xm6 33u,330 Noa w.r.r.6a.6•xep6wn 33+aao6 11m. ~ wrlxn oA1M bal ew eruren.. Pmnlue 31Aw.7e 11aa une.rwrxev. Partlen a<tlr AOW w.eri.ene. prmeum 337e.u 1100. b ~~ AD 1710, b 3A0 ~ 1111. A1o1.ry b el.ry Burps 3.00 a00 1 REV-i5o8 EX+(o8-u) SCMEp11LE E Pennsylvania OEPARTMENTOFREVENUE CASH, BANK DEPOSITS Ft MISC. INHERRANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JAMES H. CONNOLLY Include the proceeds of litigation and the date the proceeds were received by the estate. All property iointly owned with right of survivonhtp must be disclosed on lkhedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Metro Bank -Account No. 513247601 88,164.08 2. U.S. Treasury Bonds 1,417.36 3, Metro Bank -Certificate of Deposit No. 26449 6,928.99 No. xxx-235 4,076.08 No. xxx-236 4,076.08 No. zxx-049 6,902.78 No. xxx-280 3,752.76 4. Cash 140.20 5, Morgan Stanley Smith Bamey -Deposit 7/30/12 $16,288.27 -Deposit 11119112 $49,759.10 - 183,698.66 Deposit 11115/12 $140,501.21 -Deposit 11/20/12 $64.28 g, HomeFumishings 1,194.00 7, 1996 Honda Accord 3,800.00 g. AT&T Pension Payment 2,898.95 g. Refunds from u81i8es & etc. Patriot News 45.30 Comcast 7.55 Hartford Car Insurance Refund 666.00 Holy Spirit Hospital 146.65 Vedzon 4.40 PPL 60.00 10, Proceeds from Consignment Sales ($584.25 + $261.30 + $513.75 +106.75) 1,466.05 11. Interest received on McVo Bank CD's 199.36 TOTAL (Also enter on Line 5, Recapitulation) $ 309,645.25 214 Senate Ave 7th Floot Camp Hill, PA 17011 direct 717 730 1800 fax 717 730 1894 toll free 800 237 1700 James H. Connolly Date of Death values: 04-09-2012 i7 ~s ; r ~.r7 ,~t ~ ~ c~, l , '70 MorganStanley SmithBarney Description American Intl Growth/Income 5 hn.rz5 .~r'~i :<' Price 28.99 dJ~.h-2_. ~ ©l3+ot~ Blackrock Equity Dividend 9 ,;~ ~ 19.29 7 !o$S • `/a EV Global Macro Ab Return 7 y!7+ 10.03 "7 597.35 FidelityAdvNewlnsight 37/• [7G,a 22.48 ~ 3~/' `/7 Fidelity Floating Rate ~7~a5•• 177 9.82 7 ~ ~ ~• First Eagle Global q~• 95~, 47.84 /~ p ~[ (y .3 pr3 {, Forward Tactical Growth ~ $ 3. SC•S 26.45 '7 SoU,a 9 ING Global '~{~ ~ •3~3 16.34 7S •33 Invesco Balanced Risk / /3 J, O(o~ 12.37 /~f DtoS• S/ Loomis Sayles Strategic J Q ~. 73 15.08 S SZ~• 03 Oppenheim Develop Mkt ~3 • f 33.27 / / / Da• S~ PIMCO All Asset All Auth s, 10.53 37'7. PIMCO Unconstrained 11.10 % DS • 7 Prudentiallennison .37~. u27 16.76 (, a~1~. `•!~ ~ American Inc Fund EV Pa Mun Inc 1, P7~ • `~s ~ a' $, 79 17.09 9.12 02~ /~2r~• 7y 0~O .:ate 9 7 THE INFORMATION HEREIN HAS BEEN OBTAINED FROM SOUCES WE BELIEVE TO BE RELIABLE BUT DO NOT GUARANTEE ITS ACCURACY OR COMPLETENESS Moron $ranlev Smirh Barney LLC. Member SIPC. REV-1511 EX+ (10-09) - pennsylvania DEPARTMENT OF REVENDE INHERITANCE TAX RENRN RESIDEM DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER JAMES H. CONNOLLY Decedent's debts must be reported on Schedule I. NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Musselman Funeral Home, 324 Hummel Avenue, Lemcyne, PA 17043 2,600.00 Catholic Cemeteries (Resurrection Cemetery)116 S. Oak Grove Rd., Harrisburg, PA 17112 670.00 g. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 17,489.00 Name(s) of Personal 0.epresentative(s) Kathleen A. MatesevaC street Address 4205 Heather Road city Elizabethtown state PA ZIp 17022 Year(s) Commission Paid: N/A z. 3. Attorney Fees: Paul L. Zeigler, Esq., 300 Bridge St., 2nd FI., New Cumberland, PA 17070 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) NIA Claimant 9,750.00 Street Address City State ZIP Relationship of Claimant to Decedent 473.50 4. Probate Fees: 5. accountant fees: 6. Tax Retum Preparer Fees: John Cox, 317 Std St., New Cumberland, PA 17070 1,200.00 ~. Patriot News -Publication 109.52 g. Appraisal Fee - 253 Deefield Road, Camp Hill, PA 17011 375.00 s. Estate Checks -Harland Clark (check order) 23.85 t o. See next sheet 37,626.74 TOTAL (Also enter on Line 9, Recapitulation) ; 70,317.61 Schedule H (Continued) Estate of Jamea H. Connolly Estate Expenses Utllity Expenses $ 1,603.73 VerlZpn:($67.94 + $33.97 +$33.97 + $34.69 = $170.57) UGI: ($74.00 +$74.00 +$30.00 + $74.02 + $100.00 + $100.00 + $79.00 = $531.02) PPL: ($41.24+$32.62+$38.28+$30.20r $48.40+$61.13+$78.50+$37.81+$24.54= $392.72) PAWL: ($30.12 +$30.12 +$32.0 3+31.12 +$28.53+29.46 = $181.38 +$28.53) Lower Allen Township: ($1oa.ss+$1oa.s5=$217.so) AT&T: ($3ss2+$aass=$81x1) Medical Expense: $ 1,287.87 West Shore Pathology ($15.oa) Internists of Central PA ($s1.oa) Spirit Physician Services ($2ss.ss+$3s.s7 = $3o5.ss) Pulmonary & Critical Care Med. P.C.($a3.a3) PRISM ($7o.as) Heritage Medical Group LLP ($37.04) Camp Hill Emergency Physicians ($1s.ss> James R. Harty, M.D. ($aa.3a> Apna Healthcare ($s7.n) Quantum Imaging & Therapeutic ($31.zs) Manor Care Health Services, Camp Hill ($a2e.s1) Camp Hill Fire Company No. 1 ($3z.a7) Capital Cardiovascular Assoc. ($1s.sz) Holy Spirit Hospital ($5.se) Snoke Family Practice ($17.sz> Home Expenses $ 8,388.84 Maintenance - Ruells's Lawn Care: ($3aa.oa +$277.60 + $218.08 +$218.00 +$153.56 +$706.00 + $45.00 +$222.60 +$176.08 +$222.60 = $2,625.56) Maintenance -Goodall Pool & Spa Service: ($35a.oo+$351.00+$177.00 = $ae5.oo) Maintenance-H.B. McClure: ($saz.3a+$1as.oo=$$1,128.34)) Hartford Insurance: Homeowners ($e7z.oo+$a3.oo=$s15.oo) Merry Maids: Clean-up ($t,o3e.ao> Scott Danner Home Improvements ($a7o.oo) Household supplies: Clean-up ($3s1.oo) Pick-up fee: Consignment Sales ($2z5.oo> Stanley Steamer ($33a.1a) Estate Costs Attributable to Real Estate Sale $28,348.30 Broker Fee: ($1z,3s5.oo> Transfer Tax: ($z,loo.oo) Seller's Assistance to Buyer ($x,347.30) Notary Fees: ($s.oo) Home Improvements: ($t,sts.oo) Home Warranty: ($5zo.oo) Termite Protection: ($s5.ao) ,626.74 REV-1512 E%+ (12-12) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS Of DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JAMES H. CONNOLLY If more space is needed, insert additional sheets of the same size. J REV348EX(03-09) 3460091[]1 ESTATE INFORMATION Pennsylvania FOR REGISTER'S OFFICE USE ONLY ue>ea.MexT Or nevexue County Code Year File Number DECEDENT INFORMATION: Enter data as k will appear on all documents submitted to the Department. _ ._._ _.; _. _ ....._ ,. Decedent's Social Security Number Date of Death Date of Birth 728-09-7333 04/09/2012 i 05/2711934 Last Name Su~x First Name MI ICONNOLLY ~ i (JAMES H TYPE FILING: Fill in oval to indicate the nature of the return to be filed with the department. m Probate Return O Joint Assets Only ONon-probate Assets Only O litigation Purposes (no other assets) LETTERS GRANTED: FlII in oval to indicate the nature of the proceedings at the Register of Wills OMce. (Attach addtional sheets if ezplanaNOn is necessary.) m Testamentary O Administration O No Letters O Other (Please Explain.) ATTORNEY/CORRESPONDENT INFORMATION: Enter all inrormatlon ror the attorney or individual to receive tax information and correspondence. Last Name Suffx Firs[ Name MI ~ZEIGLER ~ ,PAUL ~ L Supreme Coun I.D. # Telephone Number "'~ """ "- ~- ''~- -' - Attorney/ Correspondent's a-mail address: ~ 9603 1(717) 920-8420 paulQplzpc.com First Line of Address X300 BRIDGE STREET, 2ND FLOOR Second Line of Address P.O. BOX B Cdy or Post Office State ZIP Code ~iNEWCUMBERLAND { ;PA .17070-2144 PERSONAL REPRESENTATIVE INFORMATION: EMar all intormation for the personal ropresentative(s) of the estate authorized by the Register of Wills. Executor/Administrator Social Security Number Telephone Number X196-48-1647 (717)580-7068 { last Name SuF_Fx First Name MI iMATESEVAC ~ ~ KATHLEEN ,Ai First Line of Address 4205 HEATHER ROAD OFFICIAL usE oNLy Second Line of Address - TRANSACTION COUNT I City or Post Offce State ZIP Code ELIZABETHTOWN PA ' 17022-9018 Complete general estate IMormation questions and indicate additional personal representatives on reverse side. PLEASE USE ORIGINAL FORM ONLY Side 1 L 3460009101 3460009101 J J 3460009201 REV346 EX (oa-os) Decedent's Social Security Number beceoent's rvame: JAMES H. CONNOLLY ':728-09-7333 Co-Executor/Administrator Social Security Number Telephone Number Last Name Suffix First Name MI :_. ~. ...~ First Line of Address Second Line of Address City or Post Office State ZIPCode ~~ Co-Executor/Administrator Social Security Number Telephone Number ,: i last Name ~ Suffix First Name MI i i ~ Frst Line of Address Second Line of Address City or Post Offce State ZIP Code General Instructions: This form should be filed with the Register of Wills of the county of which the decedent was a resident at death. Please be aware the correspondent identified will receive all correspondence from the department. It is the responsibility of the personal representative to notify the department if [he correspondent contact information changes. The department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The department uses the Social Security number to identify the decedent and personal repre- sentatives of the estate. The commonwealth may also use the information in exchange-of-tax-information agreements with fed- e21 and local taxing authorities. State law prohibits commonwealth personnel from disclosing confidential tax information except far official purposes. Side 2 L 346009201 3460009201