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HomeMy WebLinkAbout02-21-13 y5056~0105 J txc~u,tFn ~, REV-1500 „~ BureauD~~ al Ta~oes ~ NHERITANCE TAX RETURN Po Box 28°6°1 RESIDENT DECEDENT Harris PA 1 1 ENTER DECEDENT INFORMATION BELOW ~ ~~ ~~~ Date of Birth Social SecurilY Number ~ ~~~n..R763 05125/2010 05/26/1946 Decedent's Last Name FRAKER MI~DYYYY Suffix pecc~errcs r~ rran~ WILLIAM (ff pppiiicable) inter Survivipg SPX's Information Below Spcwse's First Name Spouse's Last Name Suffix MI L M1 Spouse's social Security Number THIS RETURN MUST BE FlLED IN DUPLICATE WITH THE REGISTER 4F WILLS FILL, IN gppROpR1ATE OVALS BELOW O 3. Remainder Return (Date of Death t~ 1. Original Return O ~~! Return 2. Supple prior to 12-13-82) Future Interest Compromise (date of O 5• Federal Estate Tax Return Required 4a O 4. Limited Estate O . death after 12-12-82) Tea! Number of Safe Deposit Boxes 8 O 6. Dec~r-t Died Testate O . 7 (Attac~r SPY ~ Trust.) ~~ Trust ( SPY of wi} to of Death O 11. Election to Tax under Sec. 9113(A) ouse! Poverty Credit (Da S 10 O g Litigation proceeds Received O p . (Attach Schedule O) Between 12 31-91 and 1-1-95) N MUST BE Ct'NIFLEfED. ALL Cp~ESPONDENCE AND (:OIi- TAX tNFpttMAT~N SHOULD BE DIRECTED T0: b CORRESI'ON~NT -THIS SECTIO er Daytbne T~ephone Num Name SALLY J. WINDER, ESQUIRE (:~S'rER ~ MML ONri m ~o w ~ rn ~ ~ O ~ r rt ~ ~ ~ n CID t!3 ~ First Line of Address rte- ~'' r ~ -~-~ a err., ~, second Line of Address ~ ~ O ~ a° ~ ~~ P.Q. BOX 341 c~ G7 ~ DATE `~'~ City or Post Office State ZIP Code ~ ~ ~j ~ t'r'! NEVWILLE PA 17241 b c ~ ~ ~ Correspondent's e-mail address: and belief, taws retwn, icxwud~g z,ccorr~anying s~eduies and , and to the best of my Iawwled8e Under penalties of PAY I declare that I have exam~ad ~ ~d an ad information of which WeP~' ha~.s ~Y . it is true, corrpd ayd c~nplete• Dedan~bon of preparer other than the persona! rE:pKeser>tative DAT~ . ,~ L 1505610105 o usE tkuv County Code Year Fie Number ~I II ~~ Side 1 1505610105 J ~~ J 1505610205 REV 15~ ~ (Fl) Decedents Social Security Number peceden~s hlaame: VINLLIAM L FRAKER RECAPITULATION 1 65,000.00 1. Real Estate (Schedule A) ....................................... . 2. Stocks and Bonds (Schedule B) - - • • . .................................. 2 3. Closely Held Corporation, Partnership or Sde-Proprietacsh~P (Schedule C) ..... 3. and Notes Receivable (Schedule D} . ................... 4' 4. Mortgages ....... (Sc~~edule E}.. 5. 86,996.19 5. Cash, Bank Deposits and (Miscellaneous P~ Ptopedy .... . 6. Jointly Owned Property (Sc~eduls F) O Separate Billing Requested ....... 8• 7. Inter-Vivos Transfers 8 M'~aneous Non-Probate PranPertY 7. (Schedule G} O Separate BSing Requested....... . ~. 151,996.19 8. Total Gross Assets (total Lines 1 through 7} ............................ . e 45,476.38 9. Funeral Exl and Administrative Costs (Schedule H) ................. . . 10. 1,077.02 10. Debts of Decedent 11Aort9age Liabilities and Uens (Sd~edufe 1) .............. . 11. ~,~.~ 11. Total Deductions (total Lines 9 and 10) .... . ........................... . 12_ 105,442.70 12. Net value of Estate (Line 8 minus Line 11 } ..... - - - - • - • . . . .............. . 13. Charitable and Governmental BequeststSec 9113 Trusts for which an election fiD tax has not been made {Sole J) ... . ........... . . . . • - ... 13. . 14. 105,442.70 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... . TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 105,442.70 15. 4,744.93 (a~1.2) X .0 45 16. Amount of Line 14 taxable 16. at lineal rate X .0 ._ 17. Amount of Lme 14 taxable 17. at sibling rate X .12 18. Amount of Line 14 taxable 18 at collateral rate X .i5 19. TAX DUE .............................•--•-.......................19. 20. FIU_ IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610205 Side 2 15056102D5 4,744.93 O J REV-1500 EX {FQ Page 3 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditstPayments A. Prior Payrrren~ B. Discount 3. tnterest 4. If Line 2 is greater than tine 1 + Line 3, enter the di0erertce. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. F~ Number Total Credits (A + B) (2) (~ (1~ 4,744.93 (3) 284.70 (4) 5,029.63 Make check payable to: REGISTER OF WILLS, AGENT. EASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS PL 1. Did decedent make a trar~er 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 ~ its income ............................................ ^ c. retain a reversionary interest ............................................................................ ^ d. receive the promise for ~fe of either payments, benefits or qre? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property withir- are Year' of death without receiving adequate consideratiar? .............................................................................................................. ^ 3. Did decedent awn ~ "m trt~ ta" or bank account or security at his a her death? .............. ^ 4. Did decedent awn an individual retirement acaxrnt, annuityr or other non-probatie property, which contains a beneficiary designat~on? ........................••---........................................................................................... ^ ^ IF THE ANSWER TO ANY Of THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 transi~ers to a for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)J. For dates of death on a after Jan. 1, 1995, the tax rate imposed on the net value of transfers fio ~ fior the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does n~ exempt a transferto a surviving spouse from tax, and the statutory regiiirerrr~ts for disclosure of assets and filing a tax r~etum are still appfirabie even if the surviving spouse is ~ only b~~riefiaary. For dates of death on or after July 1,2000: The tax rate imposed ~ the net value of transfers fran a deceased cad 21 years of age or younger' at death to or for the use of a mural parent, an adoptive parent or a stepparent of the cthiid is 0 percent [72 P.S. §9116{a)(1.2)]. • The tax rate imposed on the net value of ~ th or~Or ~ use the deoedenYs Nr>eal beneficiaries is 4.5 percent, exc as r>~ed ~ [72 P.S. §9116(a)(1)]. The tax rate imposed on the net v~ue of transfers to or fior the use of the cit~dertt's ~ ~s 12 percent [72 P.S. §9116(a)(1.3)]. Asib~ing is defined, under Sec~iat 9102, as an ind'nridual who has at least one parent in c~rrurwn with the decedent, whether by blood or adoption. Deceden#'s Comple#e Address: REV-1502 EX+ (01-10) ~ ennsylvania SCHEDULE A DEPARTMENT OF REVENUE p REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER: ESTATE OF: 21-11-0188 WILLIAM L. FF2AKER lel or as a tenant in common must be reported at fair market oa5ee• both havingvreasonable~knowledge of the relev~antfacpts. All real property owned so y would be exchanged between a willing buyer and a willing seller, neither being compelled to uy , Real property that is joir~tly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the setNement sheet if the property has been sold. VALUE AT DATE of the deed showing decedent's interest if owned as tenant in common. OF DEATH ITEM Include a copy NUMBER DESCRIPTION 1• 1861 WALNUT BOTTOM RD., PENN TWP. CUMBERLAND CTY, PA TAX PARCEL N0. 65,000.00 31-29-2524-019, SEE ATTACHED DEED COPY AND AGMT OF SALE 65,000.00 TOTAL (Also enter on line 1, Recapitulation.) $ If more space is needed, use additional sheets of paper of the same size. oMe Approval No. 2so2-o2s5 ~,~. A. Settlement Statement (HUD-1) s M«+aaee ataurar~ c~ +': 8. we tJumbee 7. loan t~ktmbe+- 1. ^ FHq 2, ^ RHS 3. ~ ~~- ~- Et30~iANT1212 8DOD0~ 4, ^ VA 5. ^ Cam. lns. ale shown-teems mattaed a mat ace~at sew ~+. Amouras Paid b and bN the sel08ma+t a11~ iw Nooe: This tam is eo !~ Y'0U ane sty here for irdammbanel PaP~ and are not i~chided in the eaais. •(p o cj' wane Paid arrlside the doait~ ~ F. Name b Addre~ of lam' E Name ~ Addn'ss ~ ~' CBC N\TIONAL BAN( D. Name 8 Address ~ t3ptt'ower WRl(AM t_ FRM~ ESTATE TIMOTHY Cx ECIWAN. ~21DA a ECIV~w 3mo Raral etw soUtf+.. std 23D, PA 17013 1861 WAL.MJT BO7Tt3fA t'iQAD, "E' ~ glp}IAi~ f TA t3A 30022 `318 WAt.MJT iAME, ~ 17241 t. SeiYement Date: 01/31/20'!3 {{. rretrt A9erd: ~ Date: 01131/'1013 G. PtapertY low= ~I REAL ESTATE SERVICES LLC 1881 WALNUT BOTfOAA ROAD Mlest Paw6etP ~ ~ ~pard~etStn:et. rimvv6le, PA 17241 fib, PA 17013 Penn Township T 717-249-2353 Faor 717-249.6354 ~~ ~ ~ 60 WestPant~etSheet Printed 01/30/2013 at 3:50 pm West Pambet Piofewioiial fig. b!t .Ilr~ Cable, PA 17013 400, ~~yapturtDt•!>pSelfat r 03,000.00 103. S d~ b baiorrer ~ 141 403. iorikws sa0eria adwaee ~ ~ b 106. CilrAam taxes b eo 407. Counryr laoaes b O1I31Q013 b O~Of?013 611.41 107. County taxes 01131f1013bO6t30f2013 611.41 408. S~pdTaores 106. Sdwd Ta>as 409 109. 410. 110. 411. 111. 412 65,611.41 112. 79,6yg6T 4l0 GeoesAmoentDosloSir 120. ~ spit Drre trove 8ono~wr 500. ~u ltaiprrit t)ue b Stier ~0, Aaeorr~ paid a is BaMai of Borrora 1,000.00 501. f~oaess dePosR (see ice) fi,2~.90 201. Deposdoreamestmon~ 5851q,Op 502. tu~ar(ine1400) ~ Pdnerrban(s) ~ tam b 203. S takes b 504. ~~ ~n 204. 505. ~~~ ban ~- ~ 3,900.00 206. 3,900.00 507. SeOerAss~t 207. Seler Assist 508. 208. 509. 209. iix iesais adan tix eeews tw seler b 510. C~ loxes b 01A1R013 b 01r31/?013 22.31 210. Ciyibam loxes 01p1Q013 b 01r3U2013 22.31 511. Counljr taaes lD 2i1. Cpaityta~es 512 Sd+colTao~ 212 SclioolTaaes b 513. 2i3. 514. 214. 515. 215. 516. 216. 517. 217. 518 218. 519. 10,19221 219. 63y4?2.31 529. Tod itedw:6oa Away Drs S~ 220. Tod Paid Borrosrw i00. Cam atS~lUwrt~ SeOer 65,611.41 ~0. ~~~~~ 70,>I90.07 601_ (;~ awoiaitdue b se0er (~+e 4201 21 10.192 ~ t~ antM~~ iom bot ~ 1~ Less wdirc9ora iu aaouM due Seler ~ 520? . . LESS anads Paid t~for bor~uoer ~ ~ ~' 63.422.31 602. ~ ~ flew SoMr X To 55,41920 7,4iTJi iis. Cak 303. ~ ~ Fr011r Q TOBoflOOef' .~nrtmwetws- .,era,waot a i •w~rdbb~e°p~NS1o~t~~arwamriw.rNidw~a~~o~ reu e~ arw ~~rm~imo.c ~a.rw~~rs°'mws wm i~e a,ram~uw~awrr•am+ir ~Cr~rtpoowa rw" HUD-1 page 1 of 4 Previous editlons are obsoleoe Paid From Paid From Borrowers Sellers Funds at Funds at 'Paid outside aFt9oainp by ( ( l~I~~ l ~~ ~ ia+der ~~ ~ P~ t "'Credd bir seler charm on papa 1. HUD-i page 2 of 4 previous editlons are obsoleoe ty ' ~!~ d ~ =y -.. TAX PARCEL NO. THIS DEED, ~E this ~ ! day of January, 2013 , Salisbury, as Adm~°~ of the Estate of William BETWEEN Jenne 1L Fraker and Deanna - - - - - - - - - - - - - - of Penn Township, Cumb~l~ County, P~nsylvania - - - - - L. Fralcer, late ------------------------------------GRANTOR - - - - A,. Eclanan, husband and wife, of Cumberland County, AND Timothy G. Eckman and Meluida - - - - - - - - - - - p lvania,astenantsbYthee~1tireties--------------------- ennsy - - - GRANTEES died May 25, 2010, intErstaxe, a domiciliary of Penn y~EP~S, William L. Fraker lv seized of the real estate hexer described' and Township, Cumberland CiDUn~'' Pe°nsy ania, vvas duly probated by the Register of Wills for WHEP,EAS, decedents e:~tate d is recorded at the Office of the Register of Wills for Cumberland County, Pennsylvania, an Fraker and lvania, as Estate No. 21-11-0188 where~ua Jenne R- Cumberland County, Peery were appointed as Administrators of his estate, and Deanna Salisbury d Deanna Salisbury duly, qualifies as Administrators of ~EE17~EAS, Jew R. Fraker an f Administi'ation were granted on February 11, 2011, and decedent's estate and I.e~ters o e inheritance and estate taxes have been or will be paid ~~VHEREAS~ ~ federal and slat 'ens u n the real estate herein conveyed; neither sha11 and will not be permitted ~ become li Po ' n the real estate herein conveyed as a result of the cantor permit any lien to exist or remain upo •a ent of Welfare F~tate Recovery Program, and Pennsylvam I~ e real estate herein conveyed was not specifically devised. WHEP'~S~ ~ SSETS, that for and in considerate°n of Sixty-five NOW, TgERETORE, VVI~I['NE 000,00 Dollars, in hand paid the receipt whereof is hereby Thousand and No Hundredths ($65, ) ~ Administrators as aforesaid, does hereby grant and convey acknowledged, the said Grantors, in fee simple unto said Crrantees: e of Centerville, Penn Township, ~,I, that certain lot or l of land situate in the Villag and plan p ly~,ia,l~unded and described in accordance with a survey Cumberland County, ennsY stered Spey©r~ ~~ Jay 15,1970, as follows: thereof by Noel B. Smith, Regi- line of Walnut Bottom Road, (Pa- Route 174), said point BEGfNNIlVG at a point on the northern bong the northern line of 112.35 feet W~ of the renter line of Penn Avenue; thence ~~ ~ 15 minutes West b6.75 feet to a corner of lanwd not 143.99 Walnut Bottom Road South 6 demos said land North 24 degrees 54 minutes fornoerly of Andrew Galbraith; thence along North 66 degt~s 15 minutes thence along said alley . ~~ bong said land feet to the southern line of a public alleyformerl of Ronald Shug~a~, East 66 5 feet to a corner of land now or y East 144 feet to the point and place of BEG~!jN~G- South 25 degrees frame dweller ~ other improvements- Havingthereon erected a two-story ew and Aloma L. Handshew, his wife, by BEING the same pn~~ which Robert E. Y.[a order of Deeds Office ~ ~d for deed dated August i4, 1970 and r~~,orded vn ~ e 3b9, granted and conveyed to William L. Cumberland County Deed $OO Volume P~ ' Arlene M_ Frake1 died October 1 ~ 2009 ~~ vesting fee Fraker and Arlene M. Fraker, his wife- L. Fraker died May 25, 2010. In use, Willia~rn L. Fraker. William simple title in her surviving spo Salisbury were ~~.~ A ' ' rs of the ~ Fe~bruarY 2012, Jenni Fraker ~ Dean~la of William L• Fraker. ar the rights, li-~berti~~ Pn~~~' h~ents and TOGE~R ~'i'H all and ~~ wise appeing, and the reversions, a ~~~ v~~tsoever thereunto belonging or in any PP fits thereof, and all of the estate, right, title, interest, prop~y rents, i:>sues and pro said decedent ax and immlY before the time of her claim and demand v~vliatsoever of the decease, in law or equity, of, in, to or out of the same. ~ said ~~ Preis by the said Grantees, their hens TO HAVE A1vD To HOLD and assigns, forever. d , Salisbury, as Administrators as aforesaid, for AND the said Jeniu R. Fraker an • 'strators, do covenant, Promise and agree to and themselves, their heirs, executors, and admnu _2- d assi by ~~ ~~ that may, the said with the said Crrantee~ ~~ heirs an ~ fore done or committed ~y ~~ ~~ or thing A ors as aforesaid, have not hereto thereof, is, ~~ or shall or may be hereby g~~ or any paw ~;~y~~tsoever whereby ~e pn~miseS c e, estate or otherwise howsoever- ~~ by im hed, charged or encumbe1ed m tztte, 've an cleans or any liability thax Ynight be made agate this deed waz y accepting and the Grantor as a result of any envirommentat actions. ~~ ~ GauSed this moment to be duly executed ~ F, the Cn~an the day and year above written. Witness: ~ ~ (SEAL) -, strator of the >; J ~ F er, as Admini r Estate of William L- Fraker ... '~ ~, (SEAL) ' ~'~"~~" or of the ~ -~ ~~ bury, as Admin~ Estate of William L. Fraker -3- STATE OF PENNSYLVANIA ~ COITNTY OF CUiVl~ERLAND 201, before me, the undersigned officer, personauY - ~ ~~ da of cld l'ul On this y ~~,, known to me to be the persons whose names -appeared Je»ni R Fraker and ~ t and acknowledged that they executes the sa~oae in the en are subscribed to the ~~ i therein stated and for the pmpo•~ therein contained. capac ty •tness wher~f, I hereunto set my band ~ official seal- In w~ . _ ~ ~ Nohp~y lic s~-Y ~ wig ~?~ ~ ~4,~s~~ ~ ~ CERT~F~~~ OFRESIDENCE • that the precise residence of the within G`rrant~ees is: I hereby GAY /I fP~//!~~ ~ l~/~ ~ ~ ~ ~~ ~ S~~ ~ h/r~~ud' ~ 'ou't r j,~ .~- oZa13 m hand on this 3 ~ day ofc.~ 2'~ Wrtncss y a ~~ c , _~ -4- REV-cos a+ (il-1o) SCNEpt1LE E ~~~} $ 86,996.19 TOTAL (Also enter on Une 5, Recapitu _--- If more space is needed, use addfionai sheets of Paper ~ Lim same sae. pennsylvarna ~, BANK DEPOSITS ~ MISS. DEPARTMENT OP REVENUE ~~~ P~OPGRT mHeurar~ ~ Gs` FILE NUMBER: RESroc-~r 21-11-0188 ESTATE OF: WILLIAM L. FRAKER the estate. include the proceeds of litigation and the date the pri ~Sm~ ~ d ~ ~ p. Ali proPertY lam °~~ v~itlti ~~ ~ ~ P V OF DEATN~ rrEM ~~~~ 65,755.46 NUMBER 1. FIDELITY, BALANCE OF IRA ACCT PAYABLE TO ESTATE 19,182.37 2 ARL.ENE FRAKER ESTATE, DISTRIBUTIVE SHARE 1,408.36 E FCU, ACCT 188-071N DECEDENT'S NAIWE. DATE OF DEAD BALANCE 3 CORNERSTON 650.00 4 2000 CHEVROLET S-10 PICK UP TRUCK ti_i ''^'' ~}t'v4~ ~2E~ li t_:;T ~ Pennsylvania DEPARTMENT OF REVENUE rNH~tITANCf TAX RE'r1iRN SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ru~+rr °~~ FILE NUMBER ESTATE OF 21-11-0188 1MLLIAM L. FRAKER Decedent's debfis must be reported on Schedule I. AMOUNT ITEM DESCRIPTION NUMBER A, FUNERAL fxpENSES: 5,188.73 1• Hpu.-NGER FUNERAL HOME, FUNERAL ACCOUNT 4,381.00 BAUGHMAN MEM~t1ALS, GRAVEMARKER g, 1, ADMINISTRATIVE COSTS: Personal Representative Commissions: 7,599.00 Name(s) of Personal Representative(s) Street Address state uP Year(s) Commission Paid: 1,750.00 2. Attorney Fees: 3. Fatuity Exem~ion: (If decedent"s address is not the same as claimant's, attach explanation.) gaimant Street Address State ZIP ~Y Relationship of Claimant to Decedent 500.00 4. Probate Fees: 5. Acxountarst Fees: 6. Tax Return Preparer Fees: 75.00 ~. CUMBERLAND LAW JOURNAL, ADVERTISE LETTERS 4,173.00 g. SALZMANN HU(~-IES. P.C., ATTORNEY FEES ~ 50.00 9. ANDREWS ~ JOHNS~V, ATT~NEY FEES 271.19 ~o. 11. MABLE STITT, 2010 CTY TWP REAL- ESTATE TAXES DF~-NNA SALISBURY, REIMBURSE MISC. ESTATE EXPENSES 1,147.57 13.95 12. DELUXE, ESTATE CHECK FEE TOTAL {Also enter on Line 9, Recapitulation) ~ 45,476.38 er ~ me same sae. a f p P If more space is needed, use additior~l sheets o SCHEDULE H - CU D SES AND ADMINISTRATE COSTS FUNERAL EXPEN FRAKER ESTATE, 21-11-0188 IAM L _ WILL $5.00 13. MEMBERS FIRST F.C.U., account fee 14. DISH NETWORK, HI'S to return receiver and remotes $12.51 Dec 2012 ECTRIC UTILITIES, through $1139.58 15. PPL EL UMBERLAND CTY TAX CLAIM BUREAU 2010 R/E taxes $1827.00 16. C 17. WEST SHORE EMS, CARLISLE, ambulance account balance $1850.16 $369.64 18. WALMART, Chevy truck fire service tic inspection and pump 19. ROSENBERRY' S SEPTIC SERVICES, sep $620.00 20. DEANNA SALISBURY, LAWN CARE 6/1.1-9/11 $390.00 BERLAND CTY TAX CLAIM BUREAU, 2011 RIE taxes $1915.10 21. CUM JAMES SALISBURY, lawn care 1861 Walnut Bottom Rd $350.00 22. 23. SUBURBAN fuel oil for 1861 Walnut Bottom Rd. $968.38 $1625.69 24. MABLE STITT, 2012 SCHOOL R/E taxes LER' S ASSIST CLOSING COST CREDIT $3900.00 25. SEL $650.00 26. RECORDER OF DEEDS, R/E transfer tax 27. J. SPENCER, trash hauling and removal $300.00 11/10 and 10/11) 28.OHI0 CASUALTY, homeowners insurance $2255.50 DIVERSIFIED APPRAISAL, real estate appraisal $350.00 29. $840.78 30. CURT BEAR, home repairs $380.00 31. IESI WASTE MANAGEMENT $338.00 32. Home Maintenance ~~~;-~~~~ ~~:-~- ~~~-~vj SCHEDULE I ~ Pennsylvania o~.~ of p~oEt~rr, DEPARTMENT DF REVENUE ILI'RES ~ LIENS MORTGAGE LIAB ~~~ FILE NUMBER 21-11-0188 ESTATE OF WILLIAM L. FRAKER that remai~ud unpaid at the date of death, tndudm9 i to ~' unreimbursed ~ ALUE A. Repo or rt debts Incurred by the decedent pr OF DEATH ITEM DESCRIPTION 750.87 NUMBER 1. OCM SERVICES, CREDIT CARD BALANCE 93.51 pPL ELECTRIC UTILITIES, JUNE gILUNG 45.74 2. AMERICAN HpMEPATIENT, MEDICAL EQUIPMF..NT 50.00 3. CUMBERLAND GOOOwILI- ~' AMBULANCE SERVICE, 5118110 50.00 4. yE~OW BREECHES EMS, 413/10 AMBULANCE SERVICE 30.69 5 ACCOUNT BALANCE ~RVICES LLC 6. , PR02 RESPiRp,T~tY 56.21 ORNERSTONE FCU. VISA BALANCE 7, C 1,077.02 TOTAL (Also enter on txte ail, Recap~lation) ~ If more space is needed, insert additional sheets of the same size. REV-15.3 pC+ (01-10) ~ Pennsylvania DEPARTMENT OF REVENUE INFIERITANCE TAX RETURN RESIDHYT DES SCHEDULE ~ BENEFICIARIES :STA OF: WIL IAM L. FRAKER NUM NAME AND ADDRESS OF PERSONS} RECEMNG PROPERTY I TAXABLE DISTRIBUTIONS [Indude outright spousal o~ and trdttsf+ers ocular Sec. 9116 (a} (1.2).] 1 1. DEANNA SALISBURY, 4029 CARLISLE RD, GARDNERS, PA { JENNI R. FRAKER, 6 FOX HOLLOW LANE, CARLISLE, PA _ ELIZ4BETH QUIGLEY, MECHp-NICSBURG, PA RELATIONSHIP TO DECEDENT Do NaR List Trustee(s) DAUGHTER DAUGHTER DAUGHTER ENTER DOW1R AMOUNTS FOR pISTRIBUTIOris SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBt1TI0NS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVE~tNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 DE REV 1500 COYER SHEET. ~ ~ FILE NUMBER: 21-11-0188 AMOUNT OR SHARE OF ESTATE 1/3NET 1/3NET 1/3NET if rrwre Space is needed, use additional sheets of paper of me same size.