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Home My WebLink About07-02-13 (2) ,P...Y. �.. ,,m� �.�.� ��,� �, �� ti54sb�o�,4� REV��OO �X(02-11)� OFFiCIAL USE ONLY PA Deparbnent of Revenue pennsylvania couny code vear Fi�e Mumt�r 6ureau of Individual Taxes ��a Po BoX.z8oeol INHERITANCE 7AX R�TURN 2x 13 0317 Harrisburg,PA 9712&0601 RESIDEN7 D�C�pEN7 . ENTEF2[�CEDENT INFORMATION HELOW � Social Securiry Number Date of Deaib Date of Birth � 10 06 2012 04 14 1958 , Decedent's Last Name Sufftx DecedenYs Firat Name MI � BOYD MICHAEL W (If AppllcaWe�E►�ter 8urvlving$pouse's Informatlon Below ' Spouse's Last Name Sufflx Spouse's Ftrsf Name MI 5pouse's Soctal Security Number THIS RETURN MUST BE FtLED IN DUPLICATE WITH TH� � REGISTER OF WILLS . FILL IN APPROPRIATE OVALS BELOW � 1. Original Fteium � 2. Supplemental Retum � 3. Remalnder Ratum{pate of Dsath Prbr to 12-13-82) � 4. Llmited�state � qa,Future pxereat Compromise ' � 6, Federal 6state"fax Retum Requlred I {date ai death after 12-iz-ez) � g. DeoadeM pled Teateta � �, D�er�o�lat�11�e8 ya Living Trwt 8. Total Number of Sa(e Deposit 9oxes � (AtMchCopyafWiln {/� f • � 6. l.l0gadon Proceeds Recelved � 10.��P��,�o�a�� ❑ 11.��dule O}�9113{A) � CORRESPONDENT•THt3 SECTION MU8T BE COMPLHTED.ALL CORRESPQND�NC�AND CONFIPENTIAL TAX INFQRMA7ION SHOULD BE DIRECTED 70: Name Daytlrne Telephone Nurnber SEAN M SHULTZ 71.7 243 5222 � �� REGI37lEK(�F WILLS ll�i.'ONI� 'r �I _�� ' f � � c�-� _' � Ftrst Lfne of Atidress t'*7 � �; �fi` `'g � 26 W HIGH STREET � � r �' . r-� -� r�-� � '� � � p�. �.:W � Second Line of Address � ` � � �' ";c � c� � � � � �,-> .�, � :_i + City or Post OfHce State ZIP Code � FILED F'"' �= i � � —i t'� CARLIS�E PA 17013 � -� U' � cn , CorrespondenNs e-mail address: ditock�nberry@ssr-attorneys.com � Under penaldes of peijury,I declare tl�at I have examined this retum,Inctudtng aCCOmpen ng�dules end stetements,and to.ths best of m knowledge and pelief, H Is Uue,correcS and complete.Uecleratlon oi preparer oih than the personal represent�hre is based on all infarnalbn of which preparer ha�arry krro,Medge. SI A E OF PERSON RES NSI61.E FO FILING RETUR DATE She ti B. Heard ° �� •� DRE � 3252 Twinflower Lane,Virpinla Beach,VA 23453 SI RE OF PREPARER�RT E$ENTA'fIV� � pqT'E } a�---� � Sean M.Shultz � Z�(� 1 AP�RESs 26 W.High Street,Carlfsie,PA 17013 � Side 1 I � � 1505610b43 1SOS61Ub4� � � � � 1 ' � ► � �,.� �,�.��,� : �,,:,,.��.�.�:�._��w� �,.� .�.�„�,.� .z�:. 1 1505610243 �J REV-1500 EX DecedenYs Social Security Number DecedenYsName: BO�/C�, Michael Wendell RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)...................................................................:......... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash, Bank Deposits&Miscelianeous Personal Property(Schedule E)............... 5. 71 , 8 6 6 . 7 7 6. Jointly Owned Property(Schedule F) L� Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous�nq Probate Property (Schedule G) U Separate Billing Requested............ 7. g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 71 , 8 6 6 . 7 7 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 17 , 64 0 . 2$ 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 7 , 7�0 . 91 11. Total Deductions(total Lines 9 and 10)................................................................ �� 25 , 341 . 19 12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2. 4 6, 52 5 . 5 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 4 6, 525 . 58 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 0 . 0 0 16. Amount of Line 14 taxable at�inealratex .oa5 46 , 525 . 58 16. 2 , 093 . 65 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE................................................................................................................ 19. 2 , 0 93 . 6 'Jr 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 1505610243 � .., -,ri �.�.�-��..�.� . �,.�.�»��„-�,.�.�� .��...�,K�_.,r�,.� . ., ., �.. ,� w�.,�,,r REV-1500 EX Page 3 File Number 21-13-0317 Decedent's Complete Address: DECEDENT'S NAME Boyd, Michael Wendell STREET ADDRESS — ---- - - _ _ ___ 225 North Bedford Street ---__ - _ - - —_-- -_ _- -- ---__ -_ CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 2,093.65 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +g� (2) 0.00 3. Interest �3� 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �4� Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 2,093.6rJ Make Check Payable to: REGISTER OF WILLS, AGENT. : . , � � . , � , e �, . .. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred:............................................................................... � � b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ � c. retain a reversionary interest;or............................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?............................................................ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without � n receiving adequate consideration?...................................._... . .._..........................__...................................... ' '' ,X 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... x ', �' 4. Don aens a be ef cian Idesi dnationtirement account, annuity,or other non-probate property which ` ,I rY 9 , x j IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. a, . -�;�a m �� '�. � � ��s�° ��- _�i��- .,w�;�.,�ei�r'�n- y IP4' �,r,�� r�.��n�u `;�mr�� ,�r�N��.ouw� � �hi �° � 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 January 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)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in [72 P.S. §9116(a)(1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)J 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. . . ..� � � .F.�..-�.�-��,�,:��„ �, _, � Rev-1508 EX+(��_10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Bo d, Michael Wendell 21-13-0317 Includa the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 401(k)with Wells Fargo-See attached Estate Valuation Report 43,120.32 2 Payment from insurance company for totaled 2004 Chevrolet Tahoe 12,213.11 3 Penn National Death Burial Insurance Policy 2,500.00 4 Wells Fargo Checking Account#2771 -See attached Date of Date Balance Request 14,033.34 Response Form TOTAL(Also enter on Line 5, Recapitulation) 71,866.77 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) , � Uti`�. �.n. LU I L � %iiF'�'ri 't'�Fn ��. �:1 �. [i�� .i,�_vt`� .'�'�� 1 'a . . . .. ��KK3 1 �s��.t� �a��.�.tx��. �.epor� j ., _. � ; � Prepared for the accounts of MiCHAEL W BOYD 4 � ` F'Jhail�iat'/��f�[sor .lAM�B LINSENMAI'''�R ' Wg(1�Fa�go lkdvisors 15251N W T H�f�R1S BLVtS 3R��L GH�qRLITTE,N�282F� i 1 � , . i�i i � � �%'b��Y TN��a��'F�° �' �` . "(,a ,wN._. �,,.'.�.�� =� J.+.� . .._. .. . ... .. �: . . �': �'` �. 1: � . . __ ..a,., _,�.,�.r� ,�,�� „� �, �.�� ,�n�.4�,. �.,,w.� ��,� : �. W_.� _ ��.__._____.__.__._____._._ .____..__ _._.____...______________. _......___.______.._. _..... ... �____.____...... _. ... _._. ._._... _._... ____ __...... I , tiOV: ?^ �r,,2 ! ;f,�:;F°P�9 WfA ��0, 2�2 F. �/5 � , T�;e s�:c4az:?�?,,�rz"e'�'.�zs an��aise in:�ox�t�e:•i.c�ht tc tsa,u;z2s Accruals are si."riply cas�.owe�to tnc decedent the day he�i,ed. �ra�e:`?3�a:�ct:�?�. Therefare,if you ze-evaluate the value of this cnsh six mont-is la*.er,it will still be worth the same smount.7}�e value o£accruals , The g:oss estata inc?udes aL assets owi:ed at dcath.This includes: as unchanged betw�en thz Date of Death and t�:e.Aher:�ate � assets:�eld in irdividu8l namcs,ch�apFropriate share cf assets Valuatia�Date. � o��aed s�c�n�nts ia cam:non,p.ze•l��lf of the jointly held prope;ty � � nt r��t�;e jnint tFS;tiarta are hu�h�aze?znd wii�,�:�al?s�f jtrirt?�- In�estmc?nt iC�rns that do not regresen*:ash,howec�e;,ar? r�ic�rererty w'r!er�jc�itu t<=r>asi*s 3:e nut ni:arri�c to e�.ch oth�r re-valued or.the Altert�te Date b�cause Ck�eir wcrth rr_ay - .!'aj��cr.t�a r�sk stri�:vir.g ttna,e's�tl�ilxr✓t�s r.:ra��e.c�e�ctik�;�tiqt'� haue cl�anged.Stocl�,kor instvnce,can char�ge in vs.lue with ;��hr•�ti�reF:asc:�f th��rz�;'rt`.!.Life iz�su.r�.:�ce�t:�th btia2i��iCS s3TV the fortunes of the company and couId pocentially be worh i c:l•s�i�r�in che�~ass est�tt:i{C��e insured t,aa.1:3�1Ufl�Y 4i 2�'lta sonneehing mueh different six r.nonchs laYer.It is,therefo:=,r=- pe:icy or if ti�e death benefit was payable to t�:e estatE of evA�uutEd For the Alter�zate Valuat;iQn D:�te_ tne it,su:cd. T•Bi11S,E and E£Bonds Ax�:bought at a discaunt ar�d rise c3uring The Ests;e Valuati�n Repoit provides the value of assecs the coutse of theiz'lif�time to their face value,xhis incrnsse is scluclir_g=Eysities,NIunicij al�3ar.ds,Mutual FLnds,Savin;�s ste�dy,piedictable,and repYesents aCCrued intFrest The:efere, Bunds,Corp�arate c►nd Govemrnent Bond:,GNMAs,FNMP,s, Alternate Valuation D�te reports will show t6e same vaiue fcr FHI.M.Cs,CMCs,Unit Inves;ment Trusts([TlTs),li.S.1'reasuties thes�secuxiti�s as Date of Deeth:eports. and S�v.n�;s Bonds(E,��,H and Hf-�. ..'v"nt�:;r�•c�,rc�ir.g i,i:t.arn�kt�.'�..�kzE?ian L'at�: 'Z'erzxxinolo� r�11 assets�:e included in tlse gross e�*aee at their"fair msrke2 i?ate of Death:If that date falls on a holiday or wne�.er�d,Lhea �aiue"or,the Date oE Death or if the e:tacucor elects,thei:vqlue the previous and followi�ag market dates are aeed in determining sis monti�s after dsSe of aeat�i,which is referr�d to as the Alternate �alue in tlie estace. . Valuation Date.1 ne Q�ecti�n between the Date of Deati:and tne Alternate�raivatioz�IJat�ea:ists tu allaw t'tie tax burden en an Vs�uatxon Date:Date of the b:storicEl quo2es reques-ed,usaally a�:are to raFiect the Value o:that estate as a�eurately as passible, th�same as the date oi death, For Fh�rnple>;he value of an estate can change dramaticaily durin� a�:x-monell pariod of time depenc'iin�or stock market conditions. Alternate Valustion Uate:Date six mcnths after tne date of This flu.ctuatio�car�clrar:natically a={ect ihe ar.-�ount uf esta�e death.Can on?yLe used if estat=Cax burdeia is recuced ta.�:es awed Se�urity Description:Is�uer n�me,CUSIP�:umber,and o�ez Tf ths�?Iternate Vah:atio�a Date is elected,�ssets are rev�lued as of information��mQSSages x�latiag�o ehe holdiag. trat cfatc.l�ssecs sold or distributed during the six-month period betwecn�he Dste vf Death snd Alternate Dats are valu�d�t the CUSIP Number:Uz�ique identifiers as�ignsd co evEry publicly date of the salz oz dsstributian.I�ssets re:�.aining are v'alued on the traded security in North America.Whi'_e such identifiers as datm six months sfter the Date nf Death.The Altexnate Valua�ian ticker symboEa C�n be Cup�.Gated across aL*fere^t exCh�r,ges Date csn orzly b�used if it results in a rc�duced tax burden on and cklange with a company's name,CU'SIPs rhange much en estate. less frequently and their re•usp is tightly�ont:vlled by sttict rules.The word"CY3S:P"comes from the name cf the grup ' '.Nhcr:ceque:st:ag an Altern�te Date c-��uation,it is posriblc thaC tnat er�oted thezn,the CotxsznittEe for Unifcnn Secu:�ties n�c all nf the asst't valucs heve cl:anged,and ycu 1vii1 no�ic�that Tdentification Procedure,a eommittee o�tr�Arnexiean ar,cnials do not continue to aerumizlrtte afcer th�Date of D�a*.li. Esr.king Association. l�ccording to I�.S�egu:ation 202fl32•1,any item in an estare th.at � can change in v�IuA for�ny rer�s�n other thar.the simple passar�e Shares or Fax: �Qr stxks,the numbcr of shsrrs or unit,kPIcZ. ; of tiir.e can be re•e�ziluated on the:Altema�e Valuation�ate. For nGnds,the fac:e�3mount(par).If the quantity is tm�v�;lable., �','' AnJthing elsc�—accn��is,far examp�e,which would only chang� ihc�inforznazion urovided is based upon one sh.are of stock oz :: $t,OAQ ar#or bor.ds. �` ��ecause mnr�tirnc h�s el�psed—kecp their Daee�f Death value. F � tiG'J. 1�� 2U;2 1 : ��!�M VJ�A N0. 2�2 � P, 4/� :rla;�'n j1��fz.Low/?id>I'�fenn:I':ic:r�:��;,priae is i:�alcu�atr�d as ar, ' , , . . a �;�ra�t��>c�:�.h�c,ta a:ac:l�w an rkae�raluu+aon clste �h�c at�ail�b'te. '��iis$b�at@�'altt8�b:i Re�3d��Zavi+�'�s;, . � , '. . ir cl��e pr:�:s ae�nert�e=�ai9..qbl�;;su��t�s on hrl�t3ay�ai�w;�eak�:�ds, � c��-r �;ar., c�:ia clt�i�•�v�rc€�?y ti��;ar�htca:l av�:tar��of th�hign�r.� . �:35'�or�Cal se��x,Ti�i�s�Z9t��zxg F�S o��.�5��1.k%ar' � 1<,�ar�thC:��:i*�:t txa�.�a�r�:��x�:�befJrra�,n�aftEar,;wl:e�n�;�:se��rrces Da'�C�7?�.2,fi�f1,�Gd'�1ieh yau�aS?'e Sp�C�7E!t�., .. <�r{��vailabi�n�itri»c�n�+rmck of�h�s^�l�ciaz�d�tc.If�e:tual;r��r�er �el�s FArg�z.��'i�oxy��'A�t��i't�x3�9'C�is � ai�c not avsiiaole:,t7e nearest oid and ask prices 8re sub3:ituted. �j��X��atg�PQZ�T,�','�,at��g�ti��4c5'i}� ', • � Secuxities traded on a Canadisn�xchange are zeported with ar�d prieXttg 53rstetMa,IT.2e,��4x.tipal�.y.�.o� : , � Canawian prices and an cxc.�uinge rate.Th�value�f the secuixry is �,��atQ.��a��,��i�tuz�ct�m,p3��'s this; zepoticd ir.U.S.Dollars. ; ar�forrxaa�inn#zom a�i�r��b�'�f souxc�s.�T��1�e,.• � �w�d�em this infozxz��t;or.t�be reli�,1�1�,�►e � Security Value:For steck.4,ch�i�umber af shares times the mean � ptice.For bonds>the Far va�ue times the mean price,divided by 100, (��'nOt�7'a�xr�t'l'Ly+��''�Ltai�D't�e i�s"a�CU�"act� V�1�,.�ssYt�es np respa�xsibili�'.��th� � _ Accrued Dividend:If an equiy is ex-c?ividend for a cash ��¢t�r8��or��s�iplex�n�s��t''1e,iTa�dY�.'X�f1Cr�f7.•� : ' cisCributior;on or be;ore ths valuarion$ate but is of recuxc�after y.�,,�pra�t>i�l�d,�,n�ttdimg' '�.e D��b��e�t�..' ihe v�ua:ion c�atF,the dividend is inclutled in the valuatiot�report �j�'j��y�e�kfi�g��n}��ai�e.'u'alti�rl, . � and is added to the security value.If tha date of de�th is on o:after ��Xl typi��be��sets i.�rl��tec�ia� .. � ' th�:ecor:l dgte ai�d t�ie di�ridend is pa�able after that dr;te,the � � ' a t�ie es'Ca�e$o�le�al?grt�b�.'t�ox't.a�pur�ac�ses> . ;: accruec dividend is listacl separately on�he report and added to tl:e • �• , .. � , oortiolio's total value. w�'s9.C�x sY'�L3d�13�'te+�on't��pmLt.T�5 , - ;; ' ser�i,C�is not ir�te�t��d t�r�a�i$�itu�e 1��x10� • � ��d�ice. lr�r�x ski�t��d ro�z��zlt wxtl��u'r't� � Accrued Interest:Tneerest is accrued for bonds ft'om anct � � ir:c!udinr�tl:e iast payable dste ue to bu:not including the date of p�'c�ssia��ans�a�t�zne�tc�discttss es�C�xte �, ' � c�e=th. Ir,terest accr�als are ealeulated on a 3Q/360-�y basis fcr ��j�ZiYS�it�i,[��jr.�L>��L17att�.�'S. . � corporate,qoverriment ageucy,snd municipsl bonds.An actual day , ,� ' � � . �' (:asis is us�d for U.S.Tre�sury Bor1s ax�d Nc:es.It is assumed thst � ' ' , �' t� lnt�rest is pa:d semi-anr_ually and coupon dates fall at six-mcnth �' inCervals cvrrESpcndiu�to the maturiry 3at�. ` �' ; Stock Divider�d(T?iv)Aates:"E"denot�s the date the dividEnd w�s decla:ed,"R�'mpresents tnc date of record."P":s the payablc daC?. t Eond Interest(Int.)Dates:"F"denotes che date^_urreut ge.+od inte-�st�•eg��aec:t:ing and"T"the date to v,r�ich intere.t due has bpen caiculated. � � � 1�IV�$T�i`NTA4D IMStIRAf3{EPRQDUCfS, �� NpTINSURF05YFDiC NOBANK6UARAMEE h1AYLO5EVA(ll@ .1e'si:ti';.r;ao Advsnre is G}5(�tIN:�C TiAIII@ tt}i,y�J'7 2W.^,•epara;c�,t�?ia�eced bro4;er-�]�cde7a:W4US F:�[gn A[IViSOt�+I.i.0 t3nd Wel�"Furgo Finahc»I Networls,ld,C, ^6er�rn;s 5':?C.,r.nn-bsqk s`(:lia:ea o�U�ells Fh�g�B CGmp�ny. • YJ�'1�3 F;3f{�('t1:t��iyor;eloes r�ot pr:rvidc t:4X OS lf�yid�7�VICC:- PI!'OSQ C{�Y1R11I(W1TF1 ynur dvrn t.ax�u;�1{��'.�:It1Y76C7L Jf1�:�re tnkinp any ectiantiv�.t wcn;ld l:av�iaa��r ta��l cnnre�uences. ^7,%;'u^W:,i e F<icqo,4t1L��,�s.i..LC,A)4;ighls reacivECl, r;C��-i3614� Ca.iGG414 58G:?:30£�00 N�i�: i�. 2�:�12 1 ;��'F�1 +tr'FA t�C, 232 P. �/�j - EstAt.e Nalvation ►+li,chgel W. Hoyfl paee of neath: 10/06/2012 Estata o£: Micl3ael W. Boyd waluation Date: SO/06/2012 Aecout�t: 2593-9682 - mdividua7. Proces8ing Date: 11/13/2012 Repatt Type: Fate OE Death Number O� SecutiEiea: 7, � File ip� Bayd, Michatal 2593-968z � s Sherea SecUxity Masn and/or Secuzity Div and Iat + Identifier or par poscription Xigh/Ask LeW/Hid 2Adjust�Ptits Vs��te Attsuals � ( 1) CA.SH 43120.32 Cash �3,120.�2 ` k Total Va].uo: SA3,x2o.32 y�,on Total I�ccrual: Toesl: $43,120.32 F: �: i �; i; �� # �'.: S f tr Pa�a 1 � I This seport was groduced witH Esta�e'�a1� L Prodvat of EstBko ValuAtioas 6 8rleS.ag 3yatbms, Inc. I£ Xou have questions, (, pless8 contact SVP SysLe�ae at (816) 313-6300 ox �nrK.evpsys.cam. 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REV-1511 EX+��O-09) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND RESIDENT DECE ENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Boyd, Michael Wendell 21-13-0317 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT MBER q. FUNERAL EXPENSES: See continuation schedule(s) attached 11,901.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Sheryll B. Heard Street Address 3252 Twinflower Lane city Virginia Beach state VA zio 23453 Year(s)Commission Paid 2013 2,200.00 2, Attornev's Fees Saidis, Sullivan & Rogers 2,500.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zip Relationshio of Claimant to Decedent 4. Probate Fees 248.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 790.78 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 17,640.28 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) .. .h��_�,.,.�.,.: ,�na.�...�, �..��.k.�..��t�,.�„�.m.�,�. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Boyd, Michael Wendell 21-13-0317 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex eR nses 1 Headstone 400.00 2 Minister 100.00 3 Oris P.Jones Funeral Establishment 10,977.00 4 Pianist 75.00 5 Shirt and tie 50.00 6 Suit for Decedent 275.00 7 Underwear,t-shirt and socks 24.00 H-A 11,901.00 Other Administrative Costs 8 Administrator's lodging cost during trip to probate estate 126.55 9 Administratar's trip to probate estate-626.54 miles 353.99 10 Cumberland Law Journal-advertise letters 75.00 11 Meals during Administrator's trip to probate estate 30.90 12 Post Office 14.80 13 The Sentinel -advertise letters 189.54 H-B7 79Q.78 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) ,. ,.t... .... .�,�.,�� .�=R,4�,w�. ...,.�_�.�4.�>�..�,.v__ �.��.��M..�.,��,�.:_,�,�.�,��._. Rev-1512 EXr(12-08) SCHEDULE 1 pennsyivania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RES�DENT DECEDENT ESTATE OF FILE NUMBER Bo d, Michaei Wendell 21-13-0317 RepoR debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTIpN QF pEATH 1 Accounts Recovery Bureau, Inc. -Account No.450903735 180.77 2 Bureau of Account Management-Account No. 28236373 287.69 3 Carlisle Regional Medical Center-Account No.9534495 1,275.98 4 Debt to Providian Bank 5,049.91 5 Pinnacle Health Hospitals-Account No.450973670 19.49 6 Pinnacle Health Medical Services-Account No.290262638 377.07 7 Pinnacie Health Medical Services-Account No. 290262638 113.97 8 Pinnacle Health Medical Services -Account No. 444276 44.00 9 Pinnacle Health Medical Services-Account No.450620030 13.33 10 Pinnacle Heaith Medical Services-Account No.450661770 152.70 11 Pinnacle Health Medical Services-Account No.451059363 186.00 T�TAL(Also enter on Line 10, Recapitulation} 7,700.91 (If more space is needed,additional pages of the same size) ?ht(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule 1(Rev. 12-08) ..cv-1513 EX*(01-10) pennsyivania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Bo d, Michaei Wendetl 21-13-0317 NAME AND ADDRESS QF RELATIONSHIP TO SHARE OF ESTATE RMOUNT OF ESTATE NUMBER PERSON(S1 RECEIVING PR�PERTY DECERENT N [L st Trustee s (WOfdS) ($$$) I� TAXABLE OISTRIBUTIQNS [indude outright spousal distributions,and transfers under Sec.9116 a 1.2 1 Mary P. Boyd Mother 23,262.79 273 Marengo Road LaCrosse,VA 23950 2 Robert E. Boyd,Sr. Father 23,262.79 273 Marengo Road LaCrosse,VA 23950 Totai 46,525.58 Enter doliar amounts for distributions shown above on Iines 15 throu h 18 on Rev 1500 cover sheet,as a rv riate. NON-TAXABLE DISTRIBUTIONS: A.SPQUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TQ TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 'ART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET �oftware only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev n+ " ��-� ��-�D