HomeMy WebLinkAbout05-08-13 (2) �t"t,',j - GY`� ;�
FAMILY SETTLEMENT AND FINAL RELEASE -` a
ESTATE OF RICHARD F, ANDERSON �? �^ '.,��', �
c.o �' �., ;.�� �:r
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1' -�! Pri ':..� � r
KNOW ALL MEN BY TNESE PRESENTB, tha# Richard F:'.Pa�c�tson lat� o�
� ,-, -,� .., _.,,
South Middleton Township, Cumberland County, Pennsylvania, decaase�� died testate
,,
an June 8, 2012, having first made his Last Wil! and Testament, v�hich was �ul�t
,_.� :a
executed on June 7, 2012 and probated in the Office of the Register oflNills 3�
Gumberland County, on January 14, 2413 and entered as file number 23-13-Q452.
WHEREAS, the said Richard F. Anderson, by #he aforesaid Last Will and
Testament, named Carale A. Anderson as Executrix of said Last Wiii and Testamet�t;
WHEREAS, Letters 7estamentary an the Estate of the said decedent were duly
issued by #he Register of Wills of Cumberland Gaunty, Pennsyivania, ta the said
Executor, hereinafter calied personal representative;
WHEREAS, the persanal representative has gathered the assets of the Estate af
the said decedent and the assets consis# of persanal and real praperiy with the total
value of $58,296.43 as set far#h in E�chibit "`A", which is a copy af the Pennsylvania
Inheritance Tax Return filed and approved by said personal representative, and which is
attached hereto and made a part hereof, and marked Exhibi# "A";
WHEREAS, the debts and deductians, including the payment of inheritance tax
in the said Estate, which have now been paid, leave a balance for distributian af
$37,751.49, also as set forth in the statement of said personal represen#ative, which is
attached hereto and marked Exhibit"B";
WHEREAS, the balance for distribu#ion as shown in the said sta#ement marked
Exhibit "B° has been reduc�d ta cash and has been distrit�uted as herein indicated in
accordance with the #erms of the Last Will and Testament of the said Decedent;
NOW, THEREFORE, Carol�A. Andersan, being the sole heir under the �ast Will
and Testament of the said decedent, and being that person entitled to inherit under said
�ast Will and Testament, does herQby acknowledge #hat she has #his day had and
received from the afaresaid personal representative, in full satisfaction and payment of
a11 sums af maney, Isgacies, bequssts, and devises as are given, devised and
bequeathed ta her by the said Last Will and Testament, the amount due her under said
�
Last Will and Testament, which amount she has received this day or priar to this day;
and, she does hereby stipulate that in order to avoid the expense and time invatved in
the filing of a formal account and schedule af distribution, she agrees that no account is
necessary and she dc�s hereby agree and cansents to distribution being made without
the filing of an accaunt and schedule of distribution, the same to be with the same force
and effect as if they had been filed and canfirmed by the C}rphan's Court Division of the
Court of Common Pleas of Cumberland Cqunty, Pennsylvania.
THEREFOFtE, she does hereby remise, release, quitclaim and fiorever discharge
the said personal representative, her heirs, executors, administrators and assigns, of
and from the said esta#e and from aiC actions, suits, payments, accounts, reckonings,
claims, and demands whatsoever for or by reason thereof, or for any other use, matter,
cause or thing whatsaever, touching upan fhe Estate af the said decedent, and she
does further hereby covenant and agree that should any liability come due to the estate
af the said decedent after the signing of this Agreement, she d�s hereby covenartt and
agree that she will satisfy any and all claims, demands, suits or causes of action which
may be successfully prosecuted against the said Es#a#e ar the afaresaid personal
representative after the signing, sealing and delivery of this Family Settlement
Agreernent and Final Release.
IN WITNESS WHEREOF, she has hereunta set her hand and seal the day and
year nated below.
j �G� �
� - g- �a �3 ������
Date itness Carole A. Anderson
NOTICE OF INHERITANCE TAX � pennsylvania
SUREAU OF ZNDZYZDUAI TAXES APPRAISEMENT, ALLdWANCE OR DISALLOWANCE pEPARTMENTOFftEY£NUE
iNxE2tTawce rar orvtsioN �F DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 IX AfP co3-is7
PO Btl% 280601
IWRRIS9URG PA 17128-0601
DATE 04-24-2023
ESTA7E OF ANDERSON RICHARD F
DATE pF DEATN 06-08-2012
FIIE NUNBER 21 13-0052
COUNTY CUMBERIAND
JAMES M ROBINSON q�N 101 �
129 S PITT ST APPEAL DATE: 06-28-2013
CARGISLE PA 17D13-3425 (SeereversesideunderObjeGions)
Asount Remitted� �
MAKE CHECK PAYABLE AND REMIT PAYMHNT 70:
RE6ISTER OF WIlLS
1 COURTHUUSE SQUARE
CARLISLE PA 17013
. CUT AL4N6 7NIS LINE _ � RETAIN �OWER PORTIQN F'dR YOUR REGORDS �
___..,,---"'--"'»»'--` --"^^'--""'-""----""_---"'---"•'----"_--""'--"-'_'-
REY-1547 EX AFP CO2-33) N072CE OF INNERTTANCE TAX APPRASSEMENT, AIZOWANCE 4R
DISALLOWANCE OF DEDUCTIONS ANG ASSESSMENT OF TAX
ESTATE OFs � pNDERSON � RICHARD' � FFILE �Nd. :21 13-0052� ACN: 101 � DATE: 04-24-2013
TAX RE7URH WAS: f X 3 ACCEPTED AS FZ�ED C } CHAflSED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
3. Ranl Estate CSChetlule A) (1} .00 NOTE: To onsure proper
2. SYOeks anfl Bonds tSehedula B} (2} .00 cradit te Yaur account,
.00 suhmit tha upper partion ��
S. Closr�ly Haltl Stock/Pa�#nersh3p Interest CSchedule C) C3) of this form with Your �
� 4. Mortya8es/NOtas Receivable CSehedule D) C4) •�� tax paymenk.
5. CashfBaok Dapos3tslMisc. Psrsnnsl Proaerty {Sehadula E} t5} �:338.11
6. Jo3ntly Owned property LSchedule F} ib) '��
7. Transfars CSchedule G) �» 52�957.92
8. Tatal Assats t8) 5$.246.�3
APPROVED DEDUCTIONS AND-EXEMPTSONS:
9. Funeral Expenses/Adm. Costs/Mixc. Expenses (Sehetlule H) �9� . 17.729.51
10. Dabts/Mnrt9a9m L1abilStieslLiens CScAeduln 2J (10) Z.r311.77
2s. rotai Detluctions cii� 20,241.28
12. Net Value ot Tsx Returo �ly� 3$r054.75
13. CAariteble/GOVernmantal Hequestsp Non-eleGted 9113 Trusts (SChodule J3 �13� •Ob
14. Net Value of Estate SUb�ect to Tsx t74� 38r054.75
NOTEs If en assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 will
reflect fi{tures that Snolude tha total of all returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of line 16 at sAOUSai rsta {19} 34.43�.75 X 00 .(10
Lb. Amount af Line 14 Yaza6Ye at 1#noal rate C15] �'•�AO.�n. .X 045 � 103.01
. 17. Amount ot Line 14 at sfbl3o8 rate C173 -�0 X 12 .40
16. Amaunt of lina 74 taxabla at collateral rate {18} 1.335.00 X 15 ' 200.25
19. Principal Tax Due ti9)= 303.26
TAX CREDITS:
PAYMENT RECEIPS DISCOUN7 {+7 AMOUNT PAID
DATE NUMFER SNTEREST/PEN PAIA f-3
03- -201 017292 .00 .26
� �XFIIBIT TOTAL 7AX PAYMENT 303.26
`� „ BAIANCE OF TAX DUE -����. .00
� � + INTEREST AND PEN. _A .00
� TOTAL DUE .Op
� IF PAiD AFTER DATE INDICATED� SEE REV£RSE IF TpTAL DUE IS REFIECTED AS A CREDI7 CCR}, Y6U MAY BE DUE
FOR CALCULATfON OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.
Q �
--� REV�"{5aa�`t0i�t°� '�50661014$
PA DepadmeM M Revenua p���� �����'���Y
BureaU ot II1diV�duBI T8Xe8 ��M+�rwimveae CoCe vear Number
PO sOxzeoeo� INHERITANCE TAX RETURN 2 S i 3 a o o s a
H°m°�'rp'PA �7�2&0801 RESIDENT DECEDENT
EN7ER DECEDENT INFORMATION BELOW
06 QS 2012 d7 09 1943
DecedenPs last Neme SuffGc Decedenta Fkst Name MI
ANDEASON RTGBARD F
(HApptleably EMer SurvW(ng Sppuse's infortnation Belpw
Spouse's Laat Neme SuR& Spouse'a First Meme Mi
AND&RSBN C]IROLE A
Spouse's Socia!5ecurity Number
TMS RETURN MtJ3T 8E FH.E�IN Dt1P'LIGATE WITtf TF�
RE�iSTER OF WII.1..3
FILL IN pPPROPRtATE OVALS 9ELOW �
� t. oripina�ttemm ❑ z. suPptememsi ste#um p s. [�wr{���a� �
pdor to 12-79•82)
❑ 4. Limi�ed Eatate � 48.Fuwre inam�cqnPromlee (� 5. Fed9fel Ebtete TgX RNUm Required
tmw.w,as�,aw,a,z�exr
� 8, o.cer.MIXnrrea�ue � �. flw.m�iramnmxu.t�grnat � a rotaiwwriteras�eoepoette� � .
tama,copyav� t� omr�T�+�J --- � �
❑ 9. tin�on Pro�eas axstvea ❑ io.���f e��a{��' ❑ 71.�s �nder sac.911s{q) .
CORRESPWIOEkT-7HI88ECTIpN MU8T BE COMPLETED.ALL CORR@8PpND@NCE AND CONPWEPITIA4 TAX INFORNATION BFIOIA.O BE WR4CTED TQ:
Name Daydme TeMphane Num6ar
JAMES bI ROSINSON 717 245 9688
wao�rat oF ani�s us�g�v
c Q � �
Fln�t iine W address m � � !'? o
� �o C r �
129 $OIITH PITT STRBET � a r ��t m
� � � -� �� o
Secona R�ai�uktveas z V_' �c o c�
C1 n o 'TJ 'R ^�5
� p _ � ";,3
Ctiy or P�t OMtce � ��od� o c Dl�'1'E PILED � �
CARLISLE PA 1T813 `° � r--= iis o
�' c„a "*i
com.pmwsnrse-m�addres,: JrobEoson�turolaw.com
ftts�h�ro,artaa;teautd��pkte.��ofP���atl�ihm�m�iB�pe���� erepr�eame tiBvbh ��af� '���ProPare�ira�ertY�6apef,
�
Garole A Andaraao -1� '�/ �3
A�OREfi6
8 E.Firat Streat,Boiling SprMgs,PA 170d7
n�oF arne an�
7'? _ James AA Rotrlr�san ?�, 7
1 South Pitt ,CaHisie,PA 17013
Side 7
� 1545610143 1545610143 �
6 y
J 11505610243
REV-1500 EX
RECAPITULATION �
t. Reat Estate(Scheda�A}_.................................................................._........_..__.... i.
2. SYocks and 9ontls(SChedule B)............................................................................... 2.
3. Gasely ti�d Carporatioo,PaRnersi�a�Sote-ProprietoBtNp(Schedute C}.......... 3.
4. Mo�agee 8 Notes Recefvable(Schedule D).......................................................... 4.
s. Ca�.a�k s t�i�n�s Persanai€+rape,ty(sc�u�e e}..._........... 5. 5 , 3 S 8 . 11
8. JoinUy Ownetl PropeAy(Schedule F) ❑ Separate Billing Requeated............. B.
7. lnter-Vivoa Transfers&Miscellaneoua Non-Probate Pre erty
{sc�reau�e�} p s�arade�iiimg Requesrod............. 7, 5 2 , 4 5 7 . 9 2
$. ToGI Groas Aaafs(tWel Lines 1-'�....................................................................... 8. S B , 2 9 6 . 0 3
9. Fu�E�enaes 8�'ai ' Costs(Sdfeduk H}......................................... 9. 2 7 , ?2 9 . 51 . -
10. Debta of DecedeM,Martgage LlebiUdes.&Lien�s(Schedule p..............._............... 10. 2 , 511 . 7 7 ..: .
�f. rars�ae�,cncns�unes s s,1a}............................._... ��. 2 Q ,2 41 . 2 8 '
....................................
12. Net Value of EsfaEa(Line 8 minus Line 11)............................................................. 12. 3 B , 0 5 4 . 7 5
13. Chadtahie arni C,ovemmentei BequeatdSec 9t 13 Trusts for which
an�ectb�to tac hes nM t�m�e{Schedub J}................................................. 13.
14. Nat Value 9ubJ�et to Ta�c Nne 12 minus Line 13).........................................._..... 14. 3 8 , 0 5 4 . 7 S
TAX COl�UTATIOFf-�N1STfttICTIQD�WR APPLtrABGE RATEB
15. Amount pt Une 14 taxaMe
at the spouaal tex nEa,qr
trenefern uraler Sec.9116
{a�(t2}x.� 3� , 430 . 75 t� 0 . 40
18. Amount ot Une 14 taxabie
gt n�a��r�x .oa� a , x a 9 . a o ,s. i a s . o i
17. AmouM W Une 14 taxable
et s�aCing rete X .12 1T. -
78. Amount of Line 74 ta�cable
at conarerel ram x .ts 1 , 3 3 5 . Q 0 ��� 2 0 0 . 2 5
t9, Ta�c�s.................._....._..................................,.................................._................... ts. 303 . 26
20. �ILL IN THE OVAL�YOU ARE t�tlUEB'(Mlti A REFUND dF API 017ERPAYMEN7. �
Side 2
L 1505670243 1605618243 �
. ,
REV-1500 EX Pagm 3 Fne wumd�er 2t - 13 - Od082
DecaclenYs C�tple�Addross:
Anderson, Riahard F
^aTREETADDRESS �
8 Eaat First Streel!
CITY � STATE ZIP
Boiling Springs PA 77Q07
Tax Payments and Credlfs:
�. Ta,coue{P�ez.unet�> (t� 3U3.26
2. CredilslPayments
A. Prior Paymenfs
8. Olscourrt _�
TMai Crad�ls(A +B} (2} 0.00
3. mierest (3) 8A8
4. If Line 2 is greater than Line 1+�g 3.etrter the dlHere�ce. This is the OVERPAYMENT. (4)
Chack box on Page 2 Une 20 ta reqwst a refund
8. ff Linie t+L'me 3 ia greaterthan Lhte 2,eflter� . rn��tns ra�c�. t5t 303.28 �
Make Check Payable fo: REGIBTER 8F WILLS,AGEN7'.
PLEASE AN8INER THE FOI.LQWINti QUEST�MS BY PIACft�IG AN"X"!PE THE APPROPRFATE BLOCK8
1. pid dacedent make a frantfer and: Yes Na
a. tafeki the u�or inrwme of tt�propetty transterred�................................................_...................._......._. x
b. reiain the right M desfgnate who sha0 use the property transfened or its incame:.................................... x
G [9T8�18 � 'M............._„..........„..............._....._........._._..............................,................. Z
d. receive tM promiee for IIM M either peymaMs�bene(tts or care7.............................................................. x
z. �r esaas occu�sa ette�oec�er�a,�ea2.aa deced�u nansr�r propeny w�n�n one�er a�m«nu,«a
recefving adequate consideratfan4....................................................................................................................... ❑ �
3. Did deoedeni oxm en'in Wat fot' ar pay����ettE bank aecpunt or�xu�Uy at FNS or tmr death?......... ❑ �x]
4. Did dacetleM oxm an Individual ReNremeM Aecount,annuiry,or WNar non•probab propeAy which
coMelnsa6�eryd�ipnakion?................................................................_._.......---°.........._......................_. � ❑
IF THE AN9WER TO ANY OF'1'HE ABOVE QUESTICINS 18 VES,YOU MUST COMPLETE SCHEOU4E G AND FlLE IT AS PART OF THE RETURN.
FordabsMdaathanaaMrJuM 11�4mdbatoreJsn.1�t985,thet�rr�imposedm�then&vsiueaftr�s�rstowforthet�oCttresurvMinp .
apouse is 3 percent[72 P.S.§9118 ta)(t.t)(n1.
For da�s of�h on ar� 1.198b�ttre tax rab" on Hte�t value QPtrsnehrs kr ar fa�Use�es of ft�e survtvkig epouse is 0 qarcent
(72 P.3.§9118(aj(t.t)tiq]. The doea not exempt a trenater ro a surviving spauae ftom ie�c,and ihe aiptuMry reqotrema�for df�ebsure of
aeseta a�d flUng e ta�c iefum are sHll applieable aven if�fie surviving spause is tha only baneficlary.
For dates of death on or efiar Juy 1,2p00:
•The fux rate(m��d on ihe tret vaWe ot hans�rs from a dflceasad c�!21 ot�ot}�n�r at dgaih M w tor the u�of a nsturaF psrent,an
edopNve paren,t or e sleppareM of Rhe child is 0 percent[72 P.S.§9118(a)( .Z�)]
•7he tax raW impoaed on ri�e not value of Vansfars M or fortha use of ihe de+�denPS Iineal beneikiarias is 4.5 percem,except as rroted'm
]2 P.B.§9116 1.2){!2 P.S.�9716(a)(1)].
•The tex rate impoeed on the net valua of trnnsfere to or for the usa of tha decedenPS aiblinga is 12 percent p2 P.S.&8118(a)(1.3)i. A
siWing is defiired un�r Sedion 9702,as an indfiridual who hes at least one parent in common with the deeedant,wFethar by blontl or adopUon.
a s
sc�Eau�E E
CASH, BANK DEPOSITS,J�MISC.
cwn.qw�lu.n�oFrex�an.vnNw pERSONAL PROPERTY
����
��
FILE NUt11BER
8TATE OF Anderson, Richard F 21 - 13-00052
�e the of�tron and th�date Uze pr4ceeds were received by the estate.All property Jolntly-owned wlth the rigM of
urvtvarsh p must be disclosed on achedule F.
,����E� DESCRIPTION VALU DAETADHTE OF
� 1 AqeVo Benk Sevings Acct. Na.06271222587 714.11
2 200Q Ghevy 5-10 Truck-vatu�f at sa�pr�ce 1,400.40
3 Ruger Biackhawk i2evotver with Nolster-35�, Seriai 122988 425.00
As valued by Farwel!'s Gun Shop, Newville, PA
4 Thompsan Genter Muuie Laader�50 cal.witt�Ca�-Seriat 17035 424.04
As valued by FanmelPs C3un 5hop, Newville, PA
5 Ruger Mini 14,223 Csi.with Scope,SlingtCa�-Seria{ 18740555 755.00
As valued by Farvvell's Gun Shop, Nevwille, PA
B Remington 870 E�tpreas 128A with Scopi and Cese-Seria!Under Mt 57Q.00
As valued by FarwelPs Gun Shop, Newvitla, PA
7 Remington 780 wlth Scope and Case-Serial 529401 540.Od
As vaiued by FanvetPs t3un Shop, Neawilte, PA
$ R�whneU 9 Rinnln Rinnrvil�ra nn RAofal�Annn}l511v'291l�.(1vC.f11 TiItnll7rinnri 13a.��
9 Simmons 2 Single Binoculars on Metal Mount, Model 1208(25x50) 60.00
10 Ruger 204 Cai.Sing�-Shat-Seciel not evatlabie,vait�at sals prlce 700.00
TOTAI.(Also enter on Llna 5, Recapitulatiqn) 5,538.11
b s
COMMONWEALIHOFPENNSYLVANIA SCHEDULE G
INHERITANCETAXRENRN INTER VIVOS TRANSFERS &
��,'o�°EOE� MISC. NON-PROBATE PI20PEi2TY
3TATE OF Andereon, Richard F FILE NUMBER
21 13-00052
Thia schedule mwt 6e campledad antl flletl N the a�wer to any of questions 1 thmugh 4 on page 2 is yes.
jTEM DESGtIPTIONOFPROPERTV ppTEOFDEATN �� F%C4USION TAXABLEVALUE
NUPABER ,,,a�ineammuaoare�r.n���aureaaearo reeiaet�. vnu�o�,�r i��y,�. �Fnw+t.�cnatc_t
� 1 FidefiryUvestmenfs-,9dvance441(k)SavingsPian �,�7.� 1�°l0 4.40 i52,957.92
SM 40472
�
TOTAL.(Aleo e�r on line 7,RecapllulaUon) 52,967.92
b �
�3i�tJL.EH
carurx.ea�moFratasnvnnu AR= ��-�'�J�/�r8e
�T� fY��,1YGVWt�7
FILE NUMBER
STA7E OF Mderson, Richard F � 21 -13-00052
Debts of decedent must be repartetl on Schadule I. _
ITEM pESCRiPT{QN AMOUNT
NUMBER FUNERALEXPENSEB:
L 1 Myers Buhrig Funeral Home&Crematory 11,092.04
2 Roliing Green Cemetery Co. 1,940.�
3 VFVN Post 8851 -Costs of post-funera!reception 248.23
B. ADMINI8TRAT111E COSTB:
t. Peraonet Rapresentat+va's Commiaelons
Na�ne ot Pers�el ReprasenlatYve(s)
StreetAddress
Ciy S�te Zip
Ya�{s)Commissian�id
z. nttor�'s r-sas Turo Rflbinson Attatteys at Law 500.Op
3. Family E�rn�ion: {it decedenPa�Iresa�r�die aame�claimanfa.attech e�Wtenavon)
Cm�,t Garole A.Andetson 3,500.Oq
Stnet Address 8 E. Fftst Stteat
ci� Boiling Springs smre PA z�, 7 70Q7
Retetiormh(p of CleimaM to Decedant Surviving Spouse
4. Prohate Fees Registe�of WfIIs 163.5Q
Cumberiand Law Joumai 75.�
The Sentinei 210.78
6. Aecountard's Fees
B. Tax Retum Preparer's Fees
7. OtMr Admin(atrative Cosis
1
TOTAL(Also enter on Itna 9,RecaplWlatlon) 17,72$.51
t s
SCHEEtULE 1
DEBT3 OF DECEQENT, MQRTGAGE
`�E��°""w LIABILITIES, & LIENS
�#��
FFLE NUIY�ER
S7ATE OF Anderson, Richard F 21 -13-00052
eporf debts incurred by the decsdent prior to death that rema�ed unpaid at the dah�of�,i�eding unreimburseti med�al experrses.
ITEM � DE3CRIPTION AMOUNT
UMBER
1 Carlisle Regiooal Mledical Center 1,176.72
2 Ho[y Spirit Haspitai 40.78
3 Pinnscie Heafth Hospftats 290.84
4 Yellow Breeches Family Practice 319.66
5 Cenkral Medical Equipment Co. 22.26
8 Pinnaciehealffi Cardiovascular ins#., tnc. 34.91
7 Cumberiand Gao�iii Fire Rescue EMS 83.68
6 Camp Hill Emergency Physicians 10.15
9 Carlisle NMA Physician Management 82.62
10 Hershey K'�tney Specialists, inc. 51.15
11 Wainut Battom Radiology LEC 25.35
12 Carlisle Medical Pathology, PC 180.97
13 Urobgy af GenVal PA 39.50
t4 Three Springs Femiiy Praetice 42.84
15 Carlisie Digestive Disease 94.03
1 B Blue Mountain AneSthesie Assoc. 16.37
TOTAL(Alsa enter on Line 10, RecapiWlaUon) � 2,517.77
187a E%+(itfilJ
scHEOU« �
co�nmr�R.�T a�s�NannA BEMEFICIARIE$
RESIOENT DECEDENT
�TaTE OF Anderson, Richard F ���E Nt11N8ER '
21 -13-00052
NAA9E AND ADDRE3S OF PERSON S RELATIONSHIP TO 3HARE OF ESTATE AMOUNT OF ESTATE
UUMBER RECEMNG PitOPERTY { � bn NDM�HeD�(si (WcrdB) {$ffi$)
i. TAXABI.E CtISTRIBUTttN4S(mt#ide auErtght i
dlshibuBons and�re
under Sec.�UB(a){1.2)7
1 Carole A.Anderson Spouse Residuary
$E. First StreSt
Boiling Springs, PA 17007
2 Aiice L.Anderson daughter Specifin Devise 2,290.00
, 1901 Clayton Avenue
� Harcisburg, PA 17109
3 Sonny J. Goodyear Daughter Speciftc Devise 0.00
31 f 1 Dickinsnn Avenue
Camp Hill, PA 17011
I
Enter dollar amounts tar distributtons shown above on�nes t$throagh i8 on Rev 15W wver ahemt,ae appropriate.
[r NON-TAXA9LE DIS7f216UTi�NS:
A.SPOUSAL DISTRIBU170NS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT 7AKEN
�
B.CHARI'fRBtE RNO GC}VERhlFAENTAL D1ST'RIBS)TIt7NS
!
TOTA4 OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIpNS ON LWE 13 OF REV-1500 COVER SHEET 8.00
. ,
iH}O(e(g.gg}
� scH�au�� .r
COMMpNWEAITHOFPENNB`/LVhNIA gENEFIClpRIES cantinued
iNHERi[qNGE TAX RETURM
RESIpEN70ECE�EN'('
3TA1E� Anderson, Richard F FELE t+FUMBER
21 -13-00052
NAME AND ADDRESS OF PERSON S RELATIONSHIP Tp SHARH OF ESTATE AMOUNT OF ESTATE
NUMBER RE{�iVii+�PROPERTY � � oo��Enuex.ro) M�oNa) (SS$)
�, TAXABLEDISFRIBUTIONStt��o�qM��l�
under Sac.�118(a)(12)J
4 Amy L.Zilka Daughter Speciflo Devise 4.�
13 Glendele Drive
Mechaniosburg, PA 17055
5 Oanny Gouid Friend Speciflc Deviss � 60.40
14 Springers I.ane
New Cumberiand, PA S?070
6 Brian Gouid Friend Spec'�'ic Devise 154.00
b22 N. 3econd Street
Steelton, PA 17113
7 Ma�k E. Biggs Step Son-irnlaw Speciflo Devise 425,00
12 E, Keiter Street
Mechanfcsburg, PA 17055
8 Greg Giias Friend Sp�ific Qevise 700.00
P.O, Box 251
Baiing Springs, PA t70d7
I
Page 2 of$chedule J
EXHIBIT "B"
GROSS ESTATE NET OF TAX AND
NON-PROBATE PROPERTY $ 57,992.77
LIABILITIES
A. Myers Buhrig Funeral Home & Crematory $ 11,092.00
B. Rolling Green Cemetery Co. 1,940.00
C. VFW Post 8851 — Post-Funeral Reception 248.23
D. Turo Robinson Attorneys at Law 500.00
E. Family Exemption — Carole A. Anderson 3,500.00
F. Register of Wills 163.50
G. Cumberland Law Journal 75.00
H. The Sentinel 210.78
I. Carlisle Regional Medical Center 1,176.72
J. Holy Spirit Hospital 40.76
K. Pinnacle Health Hospitals 290.84
L. Yellow Breeches Family Practice 319.66
M. Central Medical Equipment Co. 22.26
N. Pinnaclehealth Cardiovascular Inst. 34.91
O. Cumberland Goodwill Fire Rescue EMS 83.68
P. Camp Hiil Emergency Physicians 10.15
Q. Carlisle HMA Management 82.62
R. Hershey Kidney Specialists, Inc. 51.15
S. Walnut Bottom Radiology LLC 25.35
T. Carlisle Medical Pathology, PC 180.97
U. Urology of Central PA 39.50
V. Three Springs Family Practice 42.80
W. Carlisle Digestive Disease 94.03
X. Blue Mountain Anesthesia Assoc. 16.37
TOTAL LIABILITIES $ 20,241.28
AMOUNT REMAINING TO BE DISTRIBUTED $ 37,751.49
DISTRIBUTIONS:
Value of Specific Devises to
Various Beneficiaries $ 3,625.00
Carole A. Anderson 34,126.49
TOTAL DISTRIBUTIONS $ 37,751.49