HomeMy WebLinkAbout04-11-13 1 1505610105
-./ REV-1500 EX(m-n)(Fl)
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes """"`""`""`»` County Code Year File Number
PO BOX 28tt INHERITANCE TAX RETURN d✓ i
Harrisburg.PA 17n&o6oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION 11ELOW
08124/2012 06/09/1916
Decedent's Last Name Suffix Decedent's First Name MI
Hare L.Clyde
(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
(XD 1.Original Return C) 2.Supplemental Return C=) 1 Remainder Return(Date of Death
Prior to 12-13-82)
C1 4.Limited Estate Cl 4a.Future Interest Compromise(date of tC 5. Federal Estate Tax Return Required
death after 12-12-82)
(W 8.Decedent Died Testate O 7,Decedent Maintained a living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received C) 10.Spousal Poverty Credit(Date of Death C1 11. Election to Tax under See.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
James A. Smiley,Asst VP (71740-4505
Eft OF NM US
iss: .v -v
First Line of address
2W t-A f'T f rf
M&T Bank i �' M
C> Q
o ca
Second Line of Address c> p � --n
One West High Street ry r= rrn
DATE o r-
City or Post Office State ZIP Code
Carlisle PA 17013
Correspondent's e-mail address;jsmiteyQmth.COm
Under penalties of periury,I declare that I have examined this return,Including accompanying schedules and statements,and to the best of my knowledge and belief,
It is trim.correct and complete.Declaration of preparer other than the personal representative is teased on as information of which preparer has arty knowledge.
Sit A RE OF PERSON NS E F ING RETURN DATE
04/12/2013
W. I-1!G'�l 5 r. Ci9�f'C i,Sc, /'�i4 7ctt3
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
J 1505610205
REV-1500 EX(Fl)
RECAPITULATION
1. Real Estate(Schedule A). .... ..... .............. .... ..... .... ....... . 1. 80,165.03
2. Stocks and Bonds(Schedule B) . ..................... . ... ....... .. .... 2. 265,270.94
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00
4. Mortgages and Notes Receivable(Schedule D).... ....... ................ 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)...... . 5. 18,492.62
6. Jointly Owned Property(Schedule F) C=D Separate Billing Requested . ..... . 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. ...... 7. 91,540.06
8. Total Gross Assets(total Lines 1 through 7)..... ............. ........... 8. 462,475.42
9. Funeral Expenses and Administrative Costs(Schedule H)... ....... ....... .. 9. 39,333.11
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). ....... ....... 10. 3,654.40
11. Total Deductions total Lines 9 and 10 ............ ....... .............. 11. 41,987.51 N 4 ._
( )
12. Net Value of Estate(Line 8 minus Line 11).... ....... ....... ............ 12. 420,487.91
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ....... .. ............... 13. 288,951.70
14. Net Value Subject to Tax(Line 12 minus Line 13) .. ............. ......... 14. 131,638.21
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- 15.
16. Amount of Line 14 taxable
-°
at lineal rate X.0 4E 124,264.44 16. 5,591.90
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 7,271.77 18. 1,090.77
19. TAX DUE . . . .......... . .............. ......... ..... ............. .. 19. 6,662.67
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610205 1505610205
' REV-1500 EX(Fi) Page 3 Fife Number
Decedent's Complete Address:
DECEDENTS NAME
L.Clyde Hare
STREET ADDRESS
37 High Street
CITE STATE ZIP
Boiling Springs PA 17007
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 6,682.67
2. Credits/Payments
A.Prior Payments 3,800.00
B.Discount 200.00
Total Credits(A+B) (2) 4,000.00
3. Interest
(3)
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. (4)
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,682.67
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.......................................................................................... ❑ N
b. retain the right to designate who shall use the property transferred or its inane.._........................................ El
c. retain a reversionary interest.............................................................................................................................. ❑ N
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ M
2. if death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ E
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
containsa 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)(1)].
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)(11)(fi)].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:
e The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
e The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent[72 RS.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
LASTVILL AND TESTAMENT
OF
L.CL=HARE
I,L.CLYDE HARE,of Boiling Springs,Cumberland County,Pennsylvania,being of sound
and disposing mind,memory and understanding,do hereby make,publish and declare this as and for
my Last Will and Testament,hereby revoking all other wills and codicils heretofore made by me.
FIRST: I direct that all my just debts and fumeral expenses,including my grave
marker,shall be paid from the assets of my estate as soon as practicable after my decease.
SECOND: I give and bequeath all ofmy watches and my grandfather clock,to my
grandson,BRIAN MENTZER.
THIRD: I give and bequeath my Christmas cactus plant,the bird and squirrel
feeders,all bird feed on my back porch and the small desk with glass door(secretary)located in the
2°s floor hallway to my caregiver,.CATHERINE.HELLER.
FOURTH: Igive,deviseand bequeath the residue ofmy estate of every nature and
wherever situate as follows:
A) 20% thereof to St. John's Lutheran Evangelical Church of.Boiling Springs,
Pennsylvania;and
B) 45%thereof to the American Cancer Society in memory of my late daughter,LOIS
ANN MENTZER;and
C) 5%thereof to the Salvation Army of Carlisle,Pennsylvania;and
D) 30°lo thereof to my grandson,BRIAN MENTZER,
FIFTH: I direct that all taxes that may be assessed in consequence of my death,
of whatever nature and by whatever jurisdiction imposed,shall be paid from my residuary estate as a
part of the expense of the administration of my estate.
SIXTH: I nominate, constitute and appoint MANUFACTURERS &
TRADERS TRUST COMPANY(M&T BANK),of Carlisle,Pennsylvania,Executor of this my
Last Will and Testament.
REV-1502 EX+(12-12)
�pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
L. Clyde Hare 2112-0977
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 ALL THAT CERTAIN hous and lot of ground,situated in the Village of Boiling Springs,South
Middleton Township,Cumberland County,Pennsylvania,having thereon erected a residential
dwelling known and numbered as 37 High Street,Baling Springs,PA 17007
See Deed Book:U,Vol.13 P.315
Net proceeds from sale 80,165.03
(see settlement sheet attached)
TOTAL(Also enter on Line 1, Recapitulation,) 80,165.03
If more space is needed,use additional sheets of paper of the same size.
• A. Settlement Statement U,S.DepaMlentof Housft arid Urban Development
B.Type of Loan OMB Anomal No.25122.0285
1. OFHA 2. OFmHA 3. OComr Unk%. S.File Nub T Loan Number 8.Mortgage Insurance Cane Number
4, VA v.lns. 13.18
C.Nafa: wma mrww"1pu.cp.«svraaawar�o.hDMRRnae(omwmPWaManaonMY.IbE.e Mr W, TIIIaExpI6a8 Sa5lBRlaRt Sya�m
WARNII1O:E b A nbeb maw pM btlMUMIM aMlr cn etw at-Ynlrr ft.,PwlYwMlepn 13aft5:595DC
camidbn nn ub•alA ew wldrws Tar is U 1011 .3 Boom.tot
D.NAME OF BORROWER: Randy A.E 7*and Tracy L,Eamret
ADDRESS: 12 Jum Ddys.BoRkm Wqa PA 17007
E.NAME OF SELLER: Eslats of L.Clyde Have
F.NAME OF LENDER:
ADDRESS:
G.PROPERTY ADDRESS: 37 High 80*K Boiling Spriryp,PA 17007
BOA Middlidon Town"
H.SETTLEMENT AGENT: The Law ME of Andrew H.Shaw,PC,Telephone:717.207135
LACE aF MENT: 200 S Gardefl 11 PA 11013
I.SETTLEMENTDA � 0TM 8
J. N:
100L GROSS AMOUNT DUE FROM BORRROWER 400 GROSS AMOUNT DUE TO
101. Conined sails gogg MOWN 401. Cwbvd ashm pOw 6500000
102. Personal 402. al
103. SeMement chames to borrower(Ime 14001 Z141l.50 403.
104. 404.
106,
ustments for ions paid by seller in advance Aclusbrients for lama paid by Belo In advance
106. CkyApwn Wass 405, Ckytogn UM
107. County jazes 02M9n3tg12131tl3 2K07 407, County III= 02MGM302131113 2807
106. School tm 02M9M3 DOW M3 300.E 408, $ctW taxes 02119M3b06111=3 390.59
109. 408.
110. 410.
111. 411.
112. 1
120,GROSS AMOM DUE fR=BORROWER 87 16 424 DUE TO SELLER $5.1574.1116
200.AMOUNTS PAID BY OR ON BEHALF OF BOR R 500.REDUCTUM IN AMOUNT DUE TO SELLER
201. DepaskarearremEmm 1000.00 501
202. PrImclowl arnoung of row loans 1400 5 .68
203. Exieft s taken Subject ta 503. to
504 Payoff of First
505.
207. 607.
.
2D9. W9
Adhadmards for items unpaid sNiar Adiusbrods for item unoold bv se0er
M. CkyAqwn have 510
211. Couritv butes 511. Cou
212 SOW laxse 512.
21,3. 513,
214. 114.
215. 515.
216. 516,
217. 517,
218. 518.
219. 519
220.TOTAL FND BYIFOR BORROWER 1 1000.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 1 5.5119A
300,CASH AT SETTLEINT FROM OR TO BORROWER 600 AT sErnium TO OR FR=SELLER
301, Grow wraaddus from line 1201 87 16 601. 420 6706
Lass arr ouMS Dine 220 1000.00 602, Leamduclicnamiggintdueseferfline5M) 5,509.63
303.CASH FROM BORROWER 86,824.16 GO&CASH TO SELLER 80165.03
SUS STITUIEFONMIOMISELLENSTATEW-Wi nOW4m&MCWMMNCIW1aih WlpaWl bx MelreMlM nW bMMq NMNndMaakWIUIRWNw
.rMibwlw l�xaMtlw..iaMel.a e.MnpoMw a1}W Mew rm a+�aaW be�NPNYC M w a�Rb Ityou YAfgW�pb1M Brehm
Mm aUew yr armtorMw
you es e+a ralwbprwlOr oM aaMrM pweYIqq(FM.Tm 1O Ne:761Wreeb)wph ywroonW aa,L IMIWMeWn mmen.Syou aD rot poy)W Yaacvnc[ 10rmeclMbrl
nunaw,)p1 m7 a aaJbGtb W8nrolmMW Pndwi( obY W.UMr PMUNwKdPNMY.i niwYTMen rvm4YrrnoM anCY wbmet b nr1 Wlewtlm4RW�ibn tMiaf.
SELLEFES)SIGNATURE(&): /
SELLER(8}NEW MAiLWaADOREES:
SFU-ER(S)PHONE NUMBERS: __ (H) M71
U,a.uGr-MCiY 1 U rMxMxws PAU UMOM UtvtLV'MtN 1 Hie Number 13.15 PAGE 2
SETTLEMENT STATEMENT TitleExpress Seftment System S 013at15:5 SDC
L. SETTLEMENT CHARDS PAID FROM PAID FROM
700.TOTAL SALE"ROKER'S COMMISSION based on .00 fk 5.000 M .00 BORROWER'S SELLER'S
Division of commission(Line 700 as follow, FUNDS AT FUNDS AT
7 125.00 to 8 R*dWs SETTLEMENT SETTLEMENT
702. 2125.00 to PnadwitW HomnW*8wvk=Grou
763, Commission pW at 6efilwngm 4,250.00
704. Broker Fee to Pru *AW Homaals Sanicos Group 295.00
800.BENS PAYABLE IN CONNECTION WITH LOAN
1. Loan Od'aeon Fee %
Loin Df unt %
A Fee
Credit RePW
Tax swm
806. Flood ceri fixation
10.
1.
800.11TEMS REt1U W BY LENDER TO BE PAID IN ADVANCE
901. Interest From to as
9M MCKWIN in for R10*4
Hazard InsumnGs Ranium for Yom to
1000.RESERVES DEPOSM WITH LENDER FOR
IOQI.Mond imuffange 2 mo.A$ tmo
1002.Maiden Insurwoe 2 mo. Imo
1 Tax 2
1004.County Tax 2 mo. Ma
1 2
1 Arm1
100 0.00
1i00.fiRLE GES
1101,SeBemerda Closind Fee
1102.Abstad or TWe Search
11 03.TNa Eyminson
1104.
1105.Document The Law Offka of Andrew H.Ow.PC 100.00
1166. Sarah D.DWdrman 25.00 16.06
11 fees
fingkft above am No:
1108.Thle Inwance to Law Of s of A.H.ShowWOCOS 817.50
No:
1109.Lander's Policy
1110. 85,000.00 -817.50
1111.TaxCert.Fee io Low Offka of Andrew H,Shaw Tax Aceould 5.00
1112.
1113.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1, Fees 82.00 62.00
1 2. 00 850.00
1203.SMTWAWW 00 850100
1204.UFq Fee Deed
i
1000.ADDRM&SETTLEMENT CHARGES
1301.sulm
1302.2013 CojjWTvm Taxes to Robert Caims 328.13
13D4.FlnW Wslacrgsw to &M.T.MA 66.50
1100.TOTAL SETTLEMENT CHARGES Bower on lines 103 502 Seclon Ki Z1140.50 63
HUD CERTFICATM OF BUYER AND eELIER
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UA.CODE SECMN 10M AND ,o,a
sErn.EMENr AQENT DA
REV-t5o3 EX+(8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
L. Clyde Hare 2112-0977
All property jointly owned with right of survivorship must be disclased on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIF RON OF DEATH
L 1,265.856 units Federated Strategic Value Div,CL I Fund 6,481.18
2 2,832.593 units PIMCO Total Return CL I Fund 32,404.86
3 8,482,59 units Federated Total Return Bond CL I Fund 97,889.09
4 3,723.744 units Vanguard Long-Term Inv Grade CL INV 40,551.57
5 5,232.462 units Ridgeworth Seix Floating Rate Hi Income Fd 1 46,307.29
6 2,167.176 units Vanguard Short-Term Bond Index CL SGNL 23,080.42
7 794.372 urn Vanguard Index SGGNL 18,556.53
TOTAL(Also enter on Line 2, Recapitulation) 265,270.94
If more space is needed, insert additional sheets of the same size
Estate Valuation - Hare, L. Clyde
Date of Death: 08/24/2012 Estate of: L. Clyde Hare ImA
valuation Date: 08/24/2012
Processing Date: 09111/2012 Account: 1020690 Report Type: Date of Death
Number of Securities: 9
File ID: L. Clyde Hare 1020690 Estate Val
Shares Security Mean and/or Div and Int Securit y
or par Description High/ASk Lew/Bid Adjustments Accruals Value
1) 8193.95 Cash (CASH)(ARINC.lAA-) 8,193.95
2) 1177.82 Cash (CASH) (1NC,4n'1E', 1,177.82
3) 8482.59 FEDERATED TOTAL RETURN SERB (31428Q101)
TOIL RET INSTL
Mutual Fund (86 quoted by NASDAQ)
08/24/2012 11.54000 Mkt
11.540000 97,889.09
4) 2832.593 PIMCO FDS pAC INYT MW SER (693390700)
TOTAL RETRN PT
Mutual Fund (as quoted by NASDAQ)
08/24/2012 11.44000 Mkt
11.440000 32,404.86
5) 5232.462 RIDGEMORTH FDS (766287678)
SEIX FLRT HI I
Mutual Fund (as quoted by NASDAQ)
08/24/2012 8.85000 Nkt
8.850000 46,307.29
6) 3723.744 VANGUARD FIXED INCOME SECS FD (922031109)
L TRM INVGRD I
Mutual Fund (as quoted by NASDAQ)
08/24/2012 10.89000 Mkt
10.890000 40,551.57
7) 2167.176 VANGUARD BD INDEX FD INC (921937850)
SHTRM BDIDX SI
Mutual Fund (as quoted by NASDAQ)
08/24/2012 10.65000 Mkt
10.650000 23,080.42
8) 1265.856 FEDERATED EQUITY FDS (314172560)
STRG VAL DV INST
Mutual Fund (as quoted by NASDAQ)
08/24/2012 5.12000 Mkt
5.120000 6,481.18
9) 794.372 VANGUARD INDEX PDS (922908462)
VALU IDX SIGHL
Mutual Fund (as quoted by NASDAQ)
08/24/2012 23.36000 mkt
23.360000 18,556.53
Total Value:
Total Accrual: $0.00 $274,642.71
Total: $274,642.71
Page 1
This report was produced with EstateVal, a product of Estate Valuations E Pricing Systems, Inc. If you have questions,
please contact Evp Systems at (818) 313-6300 or www.evpays.com. (Revision 7.1.1)
REV-1508 EX+(o8-12)
pennsytvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
L.Clyde Hare 2112-0977
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. Cash Balance Transfer from L.Clyde Hare IMA 1020690(Principal) 8,193.95
2. Cash Balance Transfer from L.Clyde Hare IMA 1020690(Income) 1,177 82
3. Cash Receipt-Refund from Humana,Inc.for Insurance Premium 152.40
4. Cash Receipt -Refund from Diakon Lutheran Social Ministries(Cumberland Crossings) 1,759.70
5. Cash Receipt-Refund from Travelers Insurance Co,Cancellation of Policy#0057763231 614.00
6. Sale Proceeds-Personal Property 5,655.25
7. Cash Receipt-Refund from The Sentinel 42.44
8, Cash Receipt-Refund from Capital Blue Cross 204.16
9. Pocket Watch Assembly-Appraisal Attached 28.00
10. Grandfather's Clock-Appraisal Attached 400.00
11. Oak Secretary Desk-Appraisal Attached 265.00
TOTAL(Also enter on Line 5, Recapitulation) $ 18,492.62
If more space is needed,use additional sheets of paper of the same size.
i
4
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
L. Clyde Hare 2112-0977
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 DESCRIPTION OF PROPERTY
INauDE THE N�OF THE Tom,THE REIAnaI V TO DEUDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OFinaKSFSLATIACH AODPrOF THE DEED FOR Rex ESTATE. VALUE OF ASSET INTEREST (IF APPUCA E) VALUE
1• MdT Bank Checking Account,held in Joint Tenants with Right of Survivorship 10,006.77 100 3,000.00 7,006.77
with Catherine Heller,a non-related person,created on 7/23/2012
2 Transamerica Annuity No.02TCBO13136 84,533,29 100 0.00 84,533.29
Created 1/16/2007
Transferees:
American Cancer Society: 45%
Salvation Army of Carlisle: 5%
St.John's Evangelical Lutheran Church: 20%
Brian Mentzer,Grandson: 30%
TOTAL(Also enter on Line 7, Recapitulation) $ 91,540.06
If more space is needed,use additional sheets of paper of the same size.
M&T Bank
1 West High Street,Carlisle,PA 17013
717 240 4572 -717 240 4518
September 11,2012
To whom it may concern:
Per your request, please find the Date of Death Values:
Account Number Balance Accrued Interest Total
1. 711764 $10,006.73 .04 $10,006.77
This account remains in an active status,owned jointly by L.Clyde Hare(deceased) and/or Catherine
Heller.
Let me know if there's anything else you need.
Sincerely,
Tammy Spencer
Adjustment Services,M&T Bank-MB 50
Phone: 302-934-2267
Fax: 302-934-2610
Email:tsoencer@mtb.com
M&T Bank-"Building Bridges by Strengthening Communications and Teamwork"
i t
TRANSAMERICA 433 3 Edge wo od Road
NE
® LIFE INSURANCE COMPANY Cedar Rapids,IA 52499
www rrancamericaannuities com
ST JOHNS EVANGELICAL LUTHERAN CHURCH
C/O M AND T SECURITIES INC
ATTN: SHAWNEE E SMITH
1 W HIGH ST
CARLISLE PA .17013
RE: Annuity Number s) 02TC3013136
L Clyde Hare - Deceaeed
Dear Claimant:
We have received notification of the death of L Clyde Hare. We extend
our sincere condolences to you for your loss. The information in this
letter is being provided to assist you in submitting death claim
paperwork. Our records reflect the following information regarding
this annuity:
Annuitant: L Clyde Hare
Owner: L Clyde Hare
Claimant: St Johns Evangelical Lutheran Church 20%
Annuity value: $84, 533 .29 as of 08/24/2012
Annuity type: Non-Qualified
Tax information
This letter includes general tax information that should not be relied
upon for personal tax planning. Transamerica Life Insurance Company
does not give legal, tax, or accounting advice. You may want to
consult your attorney, tax advisor, or accountant with questions
regarding the direct tax consequences when selecting an option.
General Information
The financial professional of record will remain on this annuity
unless we are notified of a change in writing.
Please be advised automatic operations such as Systematic Payouts and
Automatic Payments have been stopped.
an AEOON company
BRANS A MERICA Administrative Office.
4333 Edgewood Road
NE
a LIFE INSURANCE COMPANY Cedar Rapids,IA 52499
ww.,,tra=mericaannuities com
BRIAN E MENTZER
C/O M AND T SECURITIES INC
ATTN: SHAWNEE E SMITH
1 W HIGH ST
CARLISLE PA 17013
RL: Annuity Number(s) 02TC2013136
Dear Claimant:
We have received notification of the death of L Clyde Hare. We extend
our sincere condolences to you for your loss . The information in this
letter is being provided to assist you in submitting death claim
paperwork. Our records reflect the following information regarding
this annuity:
Annuitant: L Clyde Hare
Owner: L Clyde Hare
Claimant: Brian E Mentzer 30%
Annuity value: $84, 533 .29 as of 08/24/2012
Annuity type: Non-Qualified
Tax Information
This letter includes general tax information that should not be relied
upon for personal tax planning. Transamerica Life Insurance Company
does not give legal, tax, or accounting advice. You may want to
consult your attorney, tax advisor, or accountant with questions
regarding the direct tax consequences when selecting an option.
General Information
The financial professional of record will remain on this annuity
unless we are notified of a change in writing.
Please be advised automatic operations such as Systematic Payouts and
Automatic Payments have been stopped.
an AEGON company
Administrative Office.
kMEFJCA 4333 Edgewood Road NE
to IFE INSURANCE COMPANY Cedar Rapids,IA 52499
SALVATION ARMY OF CARLISLE
ATTN: SHAWNEE E SMITH
I W HIGH ST
CARLISLE PA 17013
RE: Annuity Number(s) 02TCB013136
L Clyde Rare - Deceased
Dear Claimant:
We have received notification of the death of L Clyde Hare. We extend
our sincere condolences to you for your loss. The information in this
letter is being provided to assist you in submitting death claim
paperwork. Our records reflect the following information regarding
this annuity:
Annuitant: L Clyde Hare
Owner: L Clyde Hare
Claimant: Salvation Army Of Carlisle 5%
Annuity value: $84, 533 .29 as of 08/24/2012
Annuity type: Non-Qualified
Tax Xnformation
This letter includes general tax information that should not be relied
upon for personal tax planning. Transamerica Life Insurance Company
does not give legal, tax, or accounting advice. You may want to
consult your attorney, tax advisor, or accountant with questions
regarding the direct tax consequences when selecting an option.
General information
/
The financial professional of record will remain on this annuity
unless we are notified of a change in writing.
Please be advised automatic operations such as Systematic Payouts and
Automatic Payments have been stopped.
an AEGON company
iTIZA AdmintarrativeOf�rce:
e LIFE INSURANCE COMPANY 4333 Edgewood Road NE
Cedar Rapids,IA 52499
mrwwtranSamericaannjjit'c9 com
AMERICAN CANCER SOCIETY
C/O M AND T SECURITIES INC
ATTN: SHAWNEE E SMITH
1 W HIGH ST
CARLISLE PA 17013
REt Annuity Number(s) 02TCB013136
L Clyde Hare - Deceased
Dear Claimant:
We have received notification of the death of L Clyde Hare. We extend
our sincere condolences to you for your loss. The information in this
letter is being provided to assist you in submitting death claim
paperwork. Our records reflect the following information regarding
this annuity:
Annuitant: L Clyde Hare
Owner: L Clyde Hare
Claimant: American Cancer Society 45%
Annuity value: $84, 533 .29 as of 08/24/2012
Annuity type: Non-Qualified
Tax Information
This letter includes general tax information that should not be relied
upon for personal tax planning. Transamerica Life Insurance Company
does not give legal, tax, or accounting advice. You may want to
consult your attorney, tax advisor, or accountant with questions
regarding the direct tax consequences when selecting an option.
General Information
The financial professional of record will remain on this annuity
unless we are notified of a change in writing.
Please be advised automatic operations such as Systematic Payouts and
Automatic Payments have been stopped.
an AEOON company
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
L. Clyde Hare 2112-0977
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman Roth Funeral Home 1,706.88
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 14 982.74
Name(s)of Personal Representative(s) Manufacturers and Traders Trust Co.
Street address One West High Street
city Carlisle State PA ZIP 17013
Year(s)Commission Paid: 2013
2. Attorney Fees: 14,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 0.00
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 415.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Ronald E.Johnson,Esq.-Reimbursement for house keys 3.97
8. S.W.Barrett-Real Estate Appraisal 375.00
9. The Sentinel-Legal Advertising 178.92
10. Hilton's Lock Service-Re-Key lock 84.80 '
11. Roy Gottshall-Auctioneer's Commission 8 Expenses 2,120.90
12. Cumberland Law Journal-Legal Advertising 75.00
TOTAL(Also enter on Line 9, Recapitulation) 33,943.71
E-
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SCHEDULE H - CONTINUED
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Total from previous page 33,943.71
13. Conservative Environmental Services—Asbestos Removal 1,575.00
14. K.M. Daugherty—Cleanout labor and 2 dumpsters 2,420.00
15. K.M. Daugherty—Reinforcement of termite damaged beam 379.40
16. Register of Wills—Filing Fee 15.00
17. Reserve for Closing&Accounting 1.000.00
TOTAL(Also enter on Line 9, Recapitulation) 39,333.11
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
L. Clyde Hare 2112-0977
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medial expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
11 Continuing Care Rx Newport-Drug expense due 525.92
2. PA Department of Revenue-State Individual Estimated Tax payments 240.00
3. Met-Ed-Electric Charges 195.25
4. Carlisle Petroleum-Furnace Service 269.90
5. Century Link-Final Phone Charges 84.14
6. Kevin Mellott-Lawn Care 125.00
7. South Middlellon Township-Water&Sewer Charges 224.64
8. Carlisle Petroleum-Fuel Oil 1,894.15
9. Les Heiler-Lawn Care 95.40
..... ..................................
TOTAL(Also enter on Line 10,Recapitulation) $ 3,654.40
If more space Is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NtM UR:
L. Clyde Hare 2112-0977
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List TnwtmKs) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Brian Mentzer-Specific Personal Property:Watch 8 Grandfather's Cthcit Grandson 428.00
2. Catherine Heiler-Specific Personal Property: Bird Feeder&Sec.Desk None 265.00
3. Brian Mentzer-30%of Residual Estate(including the amt.from Annuity) Grandson 123,836.44
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE,
u NON-TAXABLE OISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
St.John's Lutheran Evangelical Church-20%of residual estate(including the amt.from Annuity) 82,557.63
2. American Cancer Society-45%of residual estate(including the amt.from Annuity) 185,754.66
3. Salvation Army-5%of residual estate(including the amt.from Annuity) 20,639.41
TOTAL OF PART U—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. # 288,951.70
If more space is needed,use additional sheets of paper of the same size.