HomeMy WebLinkAbout08-09-13 �
� 1505610143
���-���� EX(02-11} ���
OFFICIAL USE ONLY
PA Depa�#men#of Revenue pennsylvania co�r,ty code Year File tVumber
Bureau of individual Taxes �P�TMENTOFRtNENUE
Pt?BOX.2806p1 INHERITANGE TAX RETURN 21 12 1247
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATtON BELOW
Sociai Security Number Date of Death Date of Birth
11 10 2t}12 08 11 1931
Decedent's�.ast Name Suffix Decedent's First Name MI
FERRAIt�L(J ��iNNN W
(if Applicabie�Enter Surviv�ng Spouse's Informatian Belaw
Spouse's Last Name Suffix Spouse's Firs#Name Mi
Spouse's Sacial Security Number THIS RETURN MUST BE F1LED IN DUPLiCATE WITH THE
REGISTER t�F WI�LS
F1L�IN APPRCIPRIATE QVALS BELC?W
X� i. Originai Retum � �, Suppiemental Retum � g, Remainder Fteturn(date of Death
Priar to 12-13-82)
� 4, Limited Estate � 4� Future Interest Compromise � �. �ederai Estate Tax Return Required
(date of death after 12-12-82}
� s' A�t ach C py of W fQ tg ❑ �• (Attac.dheCapy of Tnus�a Living Trust g, Total Number of Safe Deposit Boxes
� 9. L.itigation Proceeds Received � 10•betweenP2 31�31�ndit(Dag5�f Death � 11 B�Oction ta tax undeF$ec.9113(A)
T �Etac�h�Schedule� � ^�rj
.�
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENGE AND CONFIDENTIAL T FQ MATION�,�._, UL(�'�E'�RECTED TO:
Name Dayi�e-"T�Id�hon�Cuml� :,;�
?�, �'�.~ � ,�.
MICHAEL z B�xGS ��;� ��m �lo f, ��;;
�."` r �..,�.w P"4✓ y,"�
� �"ll�,� �",-' F"'w'A
�r���oF 1P�LS U8E`�VLY
� :� �--.� ,. . ��
First Line of Address � `"'� � u;.,,,,m;� t����
�" u� �
429 SC►LTTFI 1$TH STREET � ..,�,
Second Line af Address
Ci or Post Office DATE FILED
tY State ZIP Code
GAMP HILL PA 17011
. correspondent°s e-mait adaress: mikebangs��verizon.net
Under penalties af perjury,1 declare that I have examined this return,including accompanying schedules and statements,and to the best af my knowledge and belief,
it is true,correct and complete.{}eclaration of preparer ather than the personal representa#'ive�s based on al!informatian o#which preparer has any knawledge,
SIGNAT E OF PERSON RESPONSIBLE FILING RETURN DATE
, James D. Le ett !
DRESS
6411 Glenwood Street, Mechanicsburq, PA 1?050
SI NATURE OF PREP RER OThiER T REPR SEN7ATIVE DATE
�, Michael �. Bangs
ADDRESS
429 Sauth '18th Street,Camp Hitl, PA 17a11
Side 1
� 1505610143 150561a143 �
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of
my knowledge and belief,it is true,correct and complete.Declaration of preparer other than the personal representative is based on all
information of which preparer any knowle
Signature#2
Name n L.Hawkes
Address1 95 Holl Lane
Address2
Clty,State,Zlp Etters PA 17319
Date � d �3
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
Decedenrs Name: Ferraiolo, Ann W.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 32 5,4 64 . 2 0
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 232 ,350 . 00
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 183, 165 . 87
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers 8 Miscellaneous I�aq Probate Property
(Schedule G) U Separate Billing Requested............ 7. 41 O , 7 5 7 . 7 9
g. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 1 , 151, 7 3 7 . 8 6
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 2 7 ,4 65 . 23
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 1�8,5 7 4 . 65
11. Total Deductions(total Lines 9 and 10)................................................................ ��. 13 6, 0 3 9. 8 8
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1 ,015, 697 . 98
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. 1, �15 , 697 . 98
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 �5 O . 0 0
(a)(1.2)X.00
16. Amount of Line 14 taxable 1 , 015, 6 9 7 . 9 8 �s. 4 5, 7 0 6. 41
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 � . �� 17. � . ��
18. Amount of Line 14 taxable
at collateral rate X.15 0 . �� 18. 0 . 0�
19. TAX DUE................................................................................................................ 19. 4 5, 7�6. 41
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑X
Side 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-12-1247
Decedent's Complete Address:
DECEDENT'S NAME
Ferraiolo,Ann W.
STREET ADDRESS
303 Founders Way
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 45,706.41
2. Credits/Payments
A. Prior Payments 50,000.00
B. Discount 2,285.32
Total Credits(A +B) (2) 52,285.32
3. Interest �3�
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 6,578.91
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)
Make Check Pa able to: REGISTER OF WILLS, AGENT.
- :�
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfe�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 ❑ ❑
receivingadequate consideration?....................................................................................................................
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)(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 decedent's 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 decedent's siblings is 12 percent[72 P.S.§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.
Rev-1502 EX+(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
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 knowfedge of the relevant facts.
Reai 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
Include a copy of the deed showing decedenYs interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate-303 Founders Way,Silver Spring Township,Tax Parcel No.38-23-0571-001. 196,296.20
Sold on 7/3/13(see HUD attached)
2 Real Estate-1525 North Front Street, Harrisburg, PA(Tax Parcel 12-013-050). Assessed 129,168.00
value$93,600.00 times common level ratio factor of 1.38.
TOTAL(Also enter on Line 1, Recapitulation) 325,464.20
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule A(Rev.01-10)
Rev-1504 EX+(6-98)
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
COMMONWEALTH OF PENNSYLVANIA SO LE-P RO P R I ETO RS H I P
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
Schedule C-1 or C-2(Including ali supporting information)must be attached for each closely-held corporation/partnership interest of the decedent,other than
a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships.
' ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 701 E. Locust Street Associates, LLC-Decedent owned a 50°/a interest in a limited liability 232.350.00
company named 701 East Locust Street Associates, LLC. Attached is a copy of the LLC
agreement. The LLC was formed for purposes of purchasing real estate and was comprised
solely of a parcel of real estate known as 701 East Locust Street,Mechanicsburg(Tax Parcel
No.10-23-0563-012). The assessed value for the real estate was$464,700.00;the common
level ratio factor in Cumberland County is 1.0.
TOTAL(Also enter on Line 3,Recapitulation) 232,350.00
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule C(Rev.6-98)
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
Include 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 First Clearing, LLC 93.36
2 ING -Annuity payment 1,556.65
3 Metro Bank-Checking Account 16.233.97
4 Refund from Comcast Cable 115.76
5 Refund from Highmark-premium refund 133.37
6 Refund from Phillips Lifeline 35.07
7 Sale of automobile 15,000.00
8 Wells Fargo-Individual Account 6822-8141 (made up of cash and Franklin Income Fund C 19,654.87
(FCISX)).
9 Wells Fargo Home Mortgage-Payment of escrow 157.23
10 ING Annuity-Contract 90390185;estate is the beneficiary of 46%of this annuity;total date 130,185.59
of death value$283,012.16.
TOTAL(Also enter on Line 5, Recapitulation) 183,165.87
(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)
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
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 DATE OF DEATH °�OF DECD�s EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.SATTACH A CO Y OF T�HE DEED F�OREREAL ESTATE. VALUE OF ASSET �NTEREST (IF APPLICABLE) VALUE
1 ING Annuity-Contract No.90390185;Jan L. Hawkes 38.206.64 100.000% 0.00 38,206.64
is the beneficiary of 13.5%of this annuity or
$38,206.64;total date of death value$283,012.16.
2 ING Annuity-Contract No.90390185; Ernest W. 38,206.64 100.000% 0.00 38,206.64
Leggett is the beneficiary of 13.5%of this annuity or
$38,206.64;total date of death value$283,012.16.
3 ING Annuity-Contract No.90390185;James D. 38,206.64 100.000% 0.00 38,206.64
Leggett is the beneficiary of 13.5%of this annuity or
$38,206.64;date of death value$283,012.16.
4 ING Annuity-Contract No.90390185; Donald B. 38,206.64 100.000% 0.00 38,206.64
Leggett is the beneficiary of 13.5%of this annuity or
$38,206.64;total date of death value$283,012.16.
5 Interest-Ann W. Ferraiolo,the decedent was the 0.000% 0.00
beneficiary from her late husband under the Joseph P.
Ferraiolo Credit Shelter Trust. He died on July 1,2006
and elected to defer the payment inheritance tax until
the death of his spouse. The date of death value for
the Trust was$257,931.21 which is divided among the
named beneficiaries listed below. Attached to the
return is a copy of the Trust.
Total of Continuation Schedules See attached
a es
TOTAL(Also enter on Line 7, Recapitulation) 410,757.79
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
��IIIIIII���'
Rev-1510 EX+(OS-09j
SCHEDULE G
pennsylvania 1NTER-VIVOS TRANSFERS AND
DEPARTMENT OF F2EVENUE �+�a
INHERITANCE7AXRETURN Ml�ti.r. NON-PROBATE PRCJPERTY
RESIDENT DECEDENT
cantinued
ESTATE OF FILE NUMBER
Ferraiola,Ann W. 21-12-1247
ITEM DESCRIPTtON OF PROPERTY DATE OF DEATH °h OF DECD�s EXCLUSION TAXABLE
; NUMBER T�E DATE OF TR�ANSFERSATTAC{i A CO�Y OF TNE DEED FoR R��EsTaTE. VALUE C}F ASSET ��TEREST {IF APPLICABLE} VALUE
6 lnterest in Joseph P.Ferraiolo Credit Shelter T�rust- 18,423.66 100.000% 0.00 18,423.66
Kenneth Ferraiola is the beneficiary of 117th share of
54°!�of this asset ar$1$,423.66, Total date of death
value$25T,931.21.
7 Interest in Joseph P. Ferraiolo Credit Shelter trust- 32,241.41 100.000% 0.00 32,241.41
. Jan�.Hawkes is the beneficiary of 114th share of 54°l0
of this asset or$32,241.40. Totai date of death value
$257,931.21.
8 Interest in Joseph P. Ferraiola Credit Sheiter Trust- 32,241.40 180.000% 8•Oa 32,241.4�
Ernest W.Leggett is the beneficiary of 1/4th share of
! 50%of this asset ar$32,241.40. Total date of death
value$257,931.29.
9 tnterest in Joseph P.Ferraiota Credit Shelter Trust- 32.24�1.40 100.000°IQ ���� 32,241.40
James D.Leggett is the beneficiary of 1/4th share of
58%of this asset or$32,241.40. Total date of death
value$257,931.21.
10 Interest in Joseph P.Ferraiola Credit Shelter Trust- 32,241.40 'tOQ.000°l0 ���� 32,241.A�Q
Donald B. Leggett is the beneficiary of 1/4th share of
50°l�af this asset or$32,2A�1.4Q. Total date of death
value$257,931.21.
11 (nterest in Joseph P.Ferraiolo Cred�t Shelter Trust- 18,423.6s 10p.000% +�•�0 18,423,66
Joseph Ferraiolo,Jr.is the beneficiary of 1/7th af 50°/4
of th�s asset or$18,423.66. Total date o#death value
$257,931.21.
9 2 Interest in Joseph P.Ferraiolo Credit Shelter Trust- 18,4Z3.66 100.000% n�00 18�423.66
Brian K.Ferraiola is the beneficiary a#117th share af
50%of this asset ar$18,423.66. Total date of death
vaiue$257,931.21.
Capyright(c)2009 farm software only The Lackner Group,Inc. Farm PA-150Q Schedule G(Rev.08-09)
Rev»1510 EX+(08-09}
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENT 4F REVENUE
' INHERITANCE TAX RETURN MISC. NON-PROBATE PRl'�PERTY
RESIDENT DECEQENT
continued
ESTATE OF FILE NUMBER
Ferraiola,Ann W. 21-12-1247
ITEM DESCRIPTiON(�F PROPERTY DATE QF DEATH °ia OF DECD�s �XCLUSION TAXABLE
NUMBER '�E DATE QF ZRANSFERSATTAGN A CO Y OF T�HE QE�E[}FOR REAL ESTATE. VALUE C}F ASSET �NTEREST ��F RPPLlCABLE} VALUE
93 Interest in Joseph P.Ferraiolo Credit Shelter Trust- 18,423.66 100.000°/a 0.00 18,423.66
Holty C.Ferraiolo is the beneficiary of�117th share of
50%of this asset or$18,423.66. Tota!date of death
value$257,931.2�1.
14 Interest in Joseph P. Ferraiolo Credit�helter Trust- 18,423.66 100.000% �.n� 18,423.66
Vanessa M.Ferraialo is the benefciary af 117th share
of 50%of this asset or$18,423.66. Total date of death
value$257,931.21.
15 Interest in Joseph P. Ferraiola Credit Sheiter Trust- 18,423.66 180.080% �.08 18,423.66
Michaei D.Ferraioto is the beneficiary of 1!?th share
of 50%of this asset or$18,423.66. Total date of death
value$257,931.21.
16 Interest in Joseph P.Ferraiolo Gredit Shelter Trust- 18.A�23.66 10�.008°la ���� 18,423.66
Erica L.Ferraialo is the beneficiary of 1/7th share of
' 50°/0 of this asset or$18,423.6fi. Total date af death
value$257,931.21.
T{3TA�(Also enter on�ine 7,Recapitulation) 410,757.79
' Copyright(c)2009 farm software only The Lackner Graup,Inc. Farm PA-1500 Schedule G(Rev.08-q9)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
RESIDENTDEC DENT uRN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
q, FUNERAL EXPENSES:
See continuation schedule(s) attached 4,848.96
6. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
James D. Leggett Jan L. Hawkes
Street Address 6411 Glenwood Street
ciry Mechanicsburg state PA zia 17050
Year(s)Commission Paid 10,000.00
2. Attornev's Fees MIChBeI L. Bangs 10,000.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zi�
Relationshin of Claimant to Decedent
4. Probate Fees 388.50
5. AccountanYs Fees 1,000.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs �'227'77
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 27,465.23
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
■i���.
SCHEDt�1LE H
FUNER►AL EXPENSE� AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
ITEM
NU(UIBER DESCRIPTlON AMOUNT
Funeral��e ses
1 Altland Hause Catering-funeral luncheon 1,144.80
2 An C11de Tawne Florist&Greenery 9�.10
3 BJ's Whalesale Club-miscellaneous items for funeral luncheon 24.97
4 Gingrich Memarials 165.00
5 PA Wine&Spirits-Wine for funeral luncheon 57.21
fi Parthemore Funeral Home&Gremation Services,Inc. 3,066.88
7 Traditions of America-rental af ctubhause for funeral luncheon 300,00
H-A 4,848.96
Pers�nal Re�resentative Commissions
8 James D.Leggett 5,000.00
9 Jan M.Hawkes 5,000.00
H-B'1 'i Ci,088.00
. O�jer Administrative Costs
10 Cumberland�aw.)ournai-estate advertisement 7�•0�
11 James D.Leggett-reimbursement for costs associated with sale of automobile 84.39
12 Jennifer Stark-cleaning services �75.q�
Copyright{c)2Q42 form software only The Lackner Graup,Inc. Form PA-1500 Schedule H(Rev.6-98)
i�i i u��
scHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ferraioto,Ann W, 21-12-1247
ITEM
NUMBER DESCRIPTION AMOUNT
13 Kimberly Leggett-reimbursement for work done at candominium unit by plumber 150.00
'14 Leggett,inc.-Repair done to condominium unit per home inspection 455A0
15 MarQC Organizing Service-Cleanout of house 1'!5.00
16 The Patriat News-estate advertisement 4 23.38
H-B7 1,227.77
Copyright(c)2002 farm software only The Lackner Graup,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
Report debts incurred by the decedent prior to death that remai�ed unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cardmember Services 1,071.31
2 DCM Services-GE Capital card 2,176.01
3 Erie Insurance-monthly installment for homeowners insurance(1/5/13) 290.00
4 Erie Insurance-(monthly installment of homeowners insurance 1/25/13) 290.00
5 H&R Block-preparation of 2012 income tax returns for decedent 226.00
6 Hetrick Construction-work done at decedent's residence 234.00
7 Leggett,Inc.-work done at decedent's residence 325.00
8 Pinnacle Health Medical Group,Inc. 216.00
9 PP8�L Electric-11/2/12 to 12/4/12 118.85
10 PP&L Electric-12/4/12 to 1/4/13 42.49
11 PP8�L Electric-1/4/13 to 2/4/13 55.30
12 PP&L Electric-2/4/13 to 3/4/13 60.33
13 PP&L Electric-3/4/13 to 4/4113 49.78
14 PP&L Electric-4/5/13 to 5/4/13 38.93
15 PP&L Electric-5/6/13 to 6/5/13 29.89
16 PP�L Electric-July 2013 41.34
17 Publishers Clearing House 81.90
Total of Continuation Schedules See attached
pages
TOTAL(Also enter on Line 10, Recapitulation) 108,574.65
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
18 Publishers Clearing House 30.71
19 Shepherdstown Family Practice 216.00
20 Silver Spring Condominium Association 197.00
21 Silver Spring Condominium Association-6/6/13 197.00
22 Silver Spring Township 107.00
23 Silver Spring Township Authority-4/17/13 107.00
24 Traditions of America-2 months of association dues 370.00
25 Traditions of America-February payment 185.00
26 Traditions of America-(2 months payment) 394.00
27 Traditions of America-Balance due on account 24.00
28 UGI-10/22/12 to 11/20/12 84.65
29 UGI-1/15/13 63.65
30 UGI-2/13/13 136.18
31 UGI-3/11/13 142.36
32 UGI-4/17/13 115.88
33 UGI-5/6/13 85'92
34 UGI-6/6/13 14.19
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
: 35 UGI-July 2013 11.51
36 United States Treasury-Tax due on 2012 federal income tax return 398.00
37 United Water-10/1/12 to 11/1/12 40.72
38 United Water-(1/18/13) 11.28
39 United Water-2/13/13 11.28
40 United Water-3/11/13 11.28
41 United Water-4/17/13 11.32
42 United Water-5/16/13 11.32
43 United Water-6/6/13 11.32
44 United Water -July 2013 11.36
45 Verizon-(1118/13) 37.16
46 Wells Fargo-Mortgage Account#0266770734. Covers property located at 1525 North Front 100,190.43
Street,Harrisburg, Pennsylvania.(balance as of 12/31/12)
TOTAL(Also enter on Line 10, Recapitulation) 108.574.65
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferraiolo,Ann W. 21-12-1247
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSONISI RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions,and transfers
under Sec.9116 a 1.2
See attached schedule
Total 1,015,697.96
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
�
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
SCHEDULE J
BENEFICIARIES
(Part I,Taxable Distributions)
ESTATE OF:
Ann W. Ferraiolo 11/10/2012 169-24-1755
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
1 Brian K.Ferraiolo Stepchild 1/7th share of 50%of 31,024.86
140 N. Franklin Street value of Wells Fargo
Orwigsburg, PA 17961 Account 8767-9579;
one-ninth of rest,
residue and remainder
2 David E. Ferraiolo Stepchild one-ninth of rest, 12,601.20
400 Malones Road residue and remainder
Ashland, PA 17921
3 Erica L. Ferraiolo Granddaughter Specific bequest plus 28,423.66
400 Malones Road 1/7th share of 50%of
Ashland, PA 17921 Wells Fargo Account
8767-9579
4 Holly C. Ferraiolo Granddaughter Specific bequest plus 28,423.66
104 Quarry Drive 1/7th share of 50%of
Catawissa, PA 17820 Wells Fargo Account
8767-9579.
5 Joseph Ferraiolo,Jr. Stepchild 1/7th share of 50%of 31,024.86
P.O. Box 436 Wells Fargo Account
Schuylkill Haven, PA 17972 8767-9579;one-ninth of
rest,residue and
remainder
6 Kenneth Ferraiolo Stepchild 1/7th share of 50%of 31,024.86
711 North Warren Street Wells Fargo Account
Orwigsburg, PA 17961 8767-9579;one-ninth of
rest,residue and
remainder
7 Mark A. Ferraiolo Stepchild one-ninth of rest, 12,601.20
104 Quarry Drive residue and remainder
Catawissa,PA 17820
1
�
SCHEDUI.E J
BENEFICIARIES
(Part 1,Taxable Distributions�
ESTATE OF:
Ann W. Ferraiolo 11/10/2012 1fi9-24-1755
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relatianship (Words) {$$$�
,, 8 Michael D.Ferraiolo Grandson Specific bequest plus 28,423.6fi
104 Quarry Drive 1/7th share of 50°/a af
Catawissa,PA 17820 We11s Fargo Accaunt
8767-9579
9 Vanessa M.Ferraialo Granddaughter Specific bequest pius 28.423.66
400 Malones Raad 1/7th share of 50°la of
; Ashland,PA 17921 Wells Farga Account
8767-9579
1Q Jan L.Hawkes Daughter 1/4th share of 50%af 83,060.59
95 Holly Lane Wells Fargo Account
Etters, PA 17319 8767-9579; 13.5%of
iNG Annuity;one-ninth
of rest,residue and
remainder
11 Lexy A.Hawkes Granddaugh#er 10.000.00
: 95 Holly Lane
Etters,PA 17319
12 Anna M.Leggett Granddaughter '{0,000.00
2T27 S. Rosegarden Bivd.
Mechanicsburg,PA 17055
13 Ashley S. l.eggett Granddaughter 10,000.{}0
243 N.27th Street
Camp Nill,PA 17011
14 Brandan C. Leggett Grandsan 10,008.t10
243 N.27th Street
. Camp Hill, PA 17011
15 Catherine E,Leggett Granddaughter 10,OOO.QO
2727 S. Rosegarden Blvd.
Mechanicsburg,PA 17055
2
SCHEDULE J
BENEFICIARIES
(Part I,Taxable Distributions)
ESTATE OF:
Ann W. Ferraiolo 11/10/2012 169-24-1755
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
16 Donald B. Leggett Son Property at 1525 North 444,567.25
1525 N. Front Street Front Street,
Harrisburg, PA 17102 Harrisburg,
Pennsylvania; Interest
in 701 East Locust
Street Associates, LLC;
one-ninth of rest,
residue and remainder;
1/4th share of 50%of
Wells Fargo Account
8767-9579; 13.5%of
ING Annuity
17 Ernest W. Leggett Son 1/4th share of 50%of 83,049.25
243 N.27th Street Wells Fargo Account
Camp Hill, PA 17011 8767-9579; 13.5%of
ING Annuity;one-ninth
of rest, residue and
remainder
18 James D. Leggett Son 1/4th share of 50%of 83,049.25
6411 Glenwood Street Wells Fargo Account
Mechanicsburg,PA 17050 8767-9579; 13.5%of
ING Annuity; one-ninth
of rest, residue and
remainder
19 Jessica S.Leggett Granddaughter 10,000.00
330 Bain Bridge Street
Apt. 18
Philadelphia,PA 19147
20 Justin J.Leggett Grandson 10,000.00
6411 Glenwood Street
Mechanicsburg,PA 17050
3
SCHEDULE J
BENEFICIARIES
(Part I,Taxable Distributions)
ESTATE OF:
Ann W. Ferraiolo 11/10/2012 169-24-1755
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
21 Matthew E.Leggett Grandson 10,000.00
243 N.27th Street
Camp Hill, PA 17011
22 Michael C. Leggett Grandson 10,000.00
6411 Glenwood Street
Mechanicsburg, PA 17050
Tota I 1.015.697.96
4
p•�''ye�'°'�,t OMB Approval No.2502-0265
�• •� A. Settlement Statement (HUD-1) FINAL
b`' �
�k Otv4�
1.Q FHA 2.❑RHS 3.Q Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
13-1113GC
4.Q VA 5.Q Corn.Ins.
C.Note:This form is fumished to give you a statement of adual settlement costs.Amounts paid to and by the settlement agents are shown.items marked
"(p.o.c)"were paid outside the Gosing;they are shown here for informational purposes and are not inGuded in the totals.
D.Name&Address of Borrower. E.Name&Address of Selier: F.Name&Address of Lender:
Peter E.Dunning,Helen Carol Dunning James D.Leggett,Jan L.Hawkes,Co-Executors of the
232 Newport Court,Voorheesviile,NY 12186 Estate of Ann W.Ferraiolo
G.Property Location: H.Settlement Agent: I.Settlement Date:07/1?J2013
303 Founders Way Guardian Transfer Corporation Disbursement Date:07/12/2013
Mechanicsburg,PA 17050 4075 Ma�lcet St.,Camp Hill,PA 17011
Silver Spring Township
717-909-4700
Place of Settlement: TitleF�cpress
4075 Market Street,Camp Hill,PA 17011 Printed 07/1'V2013 at 10:22 am
by SLC
. :. . . .
�, ,w�,<Y _ t- .�,_>.� -v s;. - -� -
• M<' �,
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.. ,- .�..
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.-.,. _.__.__. _.-:......_ , . _..�._ a�_ ,,. ,. . ... _ _ . , . . . . -
�Q�. Ci0I1tf2Ct S2�8S PfICB 28�,�.� 40�. CiOtttl2C�S�2S pfICB 28�,�Q.�
102. Personal 402. Persaial
103. Settlement charges to borrower(line 1400) 5,383.00 403.
1 Q4. 404.
105. 405.
Ad ustrr�enb for itema b selkr in advance Ad uatments for items aid b seller in advance
106. Cityltown taxes to 406. Cityltown taxes to
107. County taxes 07/12l2013 to 12131/2013 443.57 407. County taxes 0711?12013 to 1213112013 443.57
108. School taxes to 408. Schooi taxes to
109. July HOA dues 07112/2013 to 07131I2013 127.10 409. July HOA dues 07/12/2013 to 07I312013 127.10
110. 410.
111. 411.
112. 412.
12�• Grosa Amount Due firom Borrow�er 286,953.67 420. Grosa Amount Due to Seller 281,5l0.67
ry^T . ...y ��...: �e.x,.?;� . �, ,:�.�-._ _ �ay,,,,�II� ,�y� ♦;��fF _ ... . _. . .
.LW. ;� ��I�. . �� �c.��. *�..,,,/tll�.yII,IL_��'1Q'��7L11� -
201. Deposit or earnest money 3,000.00 ,501. Excess deposit(see instructions)
202. Prinapal amount of new loan(s) 502. Settlement charges to selier(line 1400) 22,070.50
203. Exisan loa s taken su ' to 503. ExisGn loa s taken sub'ect to
204, 504. Payoff of first matgage loan#4003048114267704 to 63,124.13
PNC Bank Consumer Loan Center
205. 505. Payo(f of second matgage loan
206. 506.
207. 507.
208. 508•
209. 509.
Ad ustmenb for ite�m un b seller Ad ustme�s for items un id b seUer
210. CityRown taxes to 510. Cityltovm taxes to
211. County taxes to 511. County taxes to
212. School taxes 07l01/2013 to 07112/2013 79.84 512. School taxes 07101/2013 to 07/12/2013 79.84
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid b or Bortpw�er 3,079.84 520. Total Reduction Amount Due Seller 85,274.47
..._ , ...; T.<� �. . .� .� - _
3� a
Sy g'i
.�............t....�. � ��... �.r. , n.�.e .,..r..�.. ..�.��s... ., � . •�. � .. �...,.n�.w ..a.......... .� ��
301, Gross amouM due from borrower(line 1ZO) �286,953.67 yfip�. Gr�s amount due to selier(line 420) 281,570.67
302, less amounts p�d by/fnr borrower(line 220) 3,079.84 602. �����5 in amount due seller(line 520) 85,274.47
303. Caah [�X From ❑ To Borrower 183,�T3.83 603. Cs�h XQ To ❑ From Seiler 196,296.20
a
pW brm,wNN N �anNAly vWd OA�tontrW nun�.No CadNwMiWlY b atuiM:qib dbdoa��b nr�d�lOry.Thb k O�NpnW b Prmtl�tM DrM�s lo a RESPA oovM�d Vam�dbn wllh YNOirt+�don duMq 1M
�. �Nq�nt P�oa�a
Previous editions are obsolete Page 1 of 4 HUD-i
.
i� � '_ -e- ;`� .;�.� ,.,'h7���,� �. �. ��- '��� � x "����,�zs �P�'fif�f�or��:
;D�rls�iat„o�"eAm�uiV' . �l�t '�-f�11ct�.�:� q , ': ;;, - Ba�,c�n�� SelfeT's
���� : :., . .
701. a8 730.00 �o Coldwell Banker Hornestead Group : Fli�id��� ��;F�ll�ttks'.1t
702. ag 730.0p to �dwell Banker Hanestead Group SE�tletri�t � -Set,tl�r�lettt
703. Commission paid at settlement 300.00 17,160.00
� � �:�:'.i,.:.Y ._..�-.�.� .'..:_ a... .�.2 , �,:.; �; At_ _ . . � -. ' -... '� .
1Y �.`. .:.., -t. .;.
.
-. . _S.� � .: ...... .�.: . ..u:'.'....__.....".'� �' -�... ..'�:. _" _..:�.. . ... �.. _ . ...
801. Our origination charge (Includes Origination Pant 0.000%or$0.00) $ (from GFE#1)
802. Your cxedit or charge(points)for the speciflc interest rate chosen $ (from GFE#2)
803. Your adjusted origination charges (from GFE A)
804. aisal fee to from GFE#3
805. Credit r to � from GFE#3
806. Tan service to from GFE#3
807. Flood certification to from GFE#3
808. to
��. _ .._. ...,.. ... �,., �,.,.:..._.;.R x e.-�t ,y �,,`a 'a'k, �sx-�°'�c..�; T�,°. ,� - .
, �:.. ..., ..,, .� _
�c, 11. , tt��[IC� . , , '
901. Daily interest charges from from 07N2/2013 to 0810112013 @ 30.00/day (from GFE#10)
902. Matgage insurance premium for months to (from GFE#3)
903. Homeowners insu�ance for ��to (from GFE#11)
904. r�nths to from GFE#11
... . .:- tl\ .... .4�.�.�.:�.. . �•.�y. : ..:R" +y ' - .
�._;� ... .:. .. ��iii..0 l.t+ .w�:...: ...,. . . _
.0.'f.:�. �;n^ .
t.c,�� l. ;�.� ��:..-.
...: :, n.._..�. ,...._....: ....�.... . .. , ..... . . ...
1001.In�ial deposit for your escrow aa;ount (from GFE#9)
1002.Homeowner's insurance months 3 O.00/month 3
1003.Mortgage insurance months a O.00/month $
1004.Property taxes months S O.00/month $
1005. months a O.00/month $
1006.Assessments months $ O.00/month $
1007.Aggregate Adjustment $
. -� ; � �s �., ,�...x„ �.�� - _.
'��:�: _....:ao:-
,,.r.,. ..�..w .. ,...,. ... . .._... ... ,. . . . .. ,. . .
1101.Tttle servioes and lender's title insurance from GFE#4
1102.Settlement or dosing fee to $
1103.Owners title insurance-Title Resourc�s Guaranty Company from GFE#5 �,�5•�
1104. Lenda's title insurance-Title Resou�ces Guaranty Company S
1105.Lenders iitle policy limit 30.00 Lenders Policy
1106.Owners title policy limit s281,000.00 Ovmers Pdicy
1107.Agent's pation of the toial tide insuranc.�e p�emium $1,534.25
to Guardian Transfer ation
1108. Underv�riter's pation of the total btle insurance p�emium $270.75
to Tiae Resources Guaran Can�
1109.Notary fees to Guard'+an Transfer 5.00 15.00
1110.Couria fee-payoff to Gu�an Tr�sfe� 15.00
C
1111. Reimbursement of tax cert fee to Gu�di�Transfer ����
. _��- �:.i:� :'Sn"w�' c k T' Y . .. ' ._....
, '° ....�.�;-,n.�...`..o......., ..�.... ..�.��, .. .�. , . .. , , . ... .
1201.Govemment�eootding charge,s a . (from GFE#� 69.00
1202.pe¢d 569.00 Mort $ Release S
1203.Transfer taxes $ (frwn GFE#8) 2,810.OQ
1204.CitylCounry tax/stamps peed S2 810.00 S
1205.State Taxlstamps Deed S2 810.00 Mort 5 2,810.00
1206. Deed$ Mort �
,�o�. a
�y.w�A� _._
� :��.T,TI���.,..�.., _.._.�t.� . ..�� ° - T :» .�r . - . . .. � . ..
� �.» �.. .�:. '
._.: ..�.... .�...-_..-. �.. .. ,,........ . ,.....
..� .� �.:' ..9 .
, . ..Y.«.'....' -r....'. �.-.��._..v...,�.x..H ,_-�... . � ...:, .'. �. ,. . .
1301.Required services d�at you c�shop for (from GFE#6)
1302.2013 County/Township taxes to Debra Wiest 1,029.
1303.ReSale Cert fee to Tradi6ons of America �'
1304. Retroadive Inaease feeWuly HOA Dto Traditions of America 22�'
1305.Capital Improvement Fee to Traditions�America 3�'�
1306.Attomey's fees to B law O(fice �.
1307.Final sewer 411-7/3/13 to Silrer S ' Townshi Auth ' 110.0
:, . 5,383.00 22,0T0.50
'Paid outside of dosing by(B)orrower,(S�ile�,(L�der,(qnvestor,Bro(K�r.'��edit by lender shown on page 1."'Cred'd by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-1
z,:
�.W d.W
0.W 0.W
�.W �.W
0.00 2,810.00
0.00 69.00i
0.00 0.00
0.00 1,805.00
. 0.00 1,874.00
. � . $ 1,874.00 999.9999%
0.00 0.00
0.00 0.00
0.00 0.00
Loan Terms
a
r�
�o
a includes
❑Prinapai
❑interest
❑Mortgage Insurance
Q No. ❑Yes,it can rise to a maximum of °�. The first change
will be on I I and can change again every yea�s after I I . Every
d�ange date,your interest rate can increase or decrease by °k. Over the life of
the loan,your iMerest rate is guaranteed to neve�be lower than %a higher
Nan �.
QX No. ❑Yes,it can rise to a maximum of$ .
QX No. ❑Yes,the first inaease can be on I ! and the monthty
arnount oared c�rise to S •
The maximum it can eve�rise to is$ .
QX No, ❑Yes,Your maximum prepayment penalEy is$ .
OX No. ❑Yes,you have a bailoon payment of$ due in
years on ! I .
Q You do not have a monthly escxaw payment for items,such as p�operty taxes
and homeoMrt�s insurance. You must pay these items�recUy yoursetf.
❑You have an additional monthly escrow payment of$
that results in a total initi�rnonthly amount owed of$ . This indudes prinapal,inte�est,
�Y�9�insurance and any items chedced below:
�p��y�p,� ❑Homeowners insurance
�Flood insurance ❑
o a
Note: If you have any questions about the Settlement Charges and Loan Terms Nsted on this form,please contact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
.
HUD CERTtFtCAi'ION OF BUYER AND SELLER
1 haYe carefu��Y reV�wed the NUC�i Setttement Statement and to the best af my knowledge and belief,it is a true and acCUrate statement of 81t receipts and
disbursements made on my account or by me in this transadion i fuRher certlfy that!have roceived a ccpy of the HUD-i Se#tlement 5#atement
.
�..
0
Pete�E.Dunning
���-�--r��+�.
Nelen Ca�ol Qunning
�� l�� ` ��C`Ef-
Jarries .
���
Jan G , EstaGe .Ferraiob
The ilt�13^i S�iement ,` wt�t�r f t�r pr�parer�iB e Ut�e ar�tfi sCCVia�e�of tlsis tra�sadion.i have causad or wiii cause the fur�ds to be
d�Mraad in sccadanoe w�h tl�is�eM.
-1,�`—,��/.�
o T�
�iT{S A CRfME TU 14NOWINGIY MAKE FAl-SE STATEMENTS TO THE UN17ED 5 S C QE SECTION 1001 AND SECT1pN 1010N�TlES UPON
WARNiNG.
CONVICTI4N CAN iNCIUDE A'FINE ANO lMFRISONMENT.FOR DETAILS SEE TITLE 18.
HUD-1
Previous editions are absolete
Page 4 of 4
ING�
...
Dec�mber 13, 2012
BANGS LAW OFFICE
,
429 SOUTH 18'�'� ST
CAMP HILL, PA 17011
ING USA Annuity and Life Insurance Company
Decadent: Ann Ferraiolo
Contract Number: 90390185
Claim Code: 03010
Dear Mr. Bangs,
Thank you for your recent inquiry regarding the annuity contract iisted abov�. Please find
the contract information below.
Deatla Benefit V alue $283,012.16 as of 12/16/12
Cost Basis $185,396.15
Primary Beneficiary Ann Ferraiolo Estate
Primary Beneficiary Jan Hawkes
Primary Beneficiary Donald Leggett
Primary Beneficiary Jim Leggett
Primary Beneficiary Ernie Leggett
If you have questions regarding this information,please contact our Customer Contact
Cent�r, available Monday—Thursday, 8:30 a.m. to b:30 p.m., Eastern Time, and Friday,
8:30 a.m. to 5:30 p.m., Eastern Time. Ca11800-369-5303 and press 3 to identify yourself
as a bene�ciary. When prompted, enter the five digit Claim Code above and press#.
Your call will be addressed by a claims specialist.
Sincerely,
Customer Service
ING
Annuities issued by ING USA Annuity and Lije Insurance Company.
1001kb
1 N Ci :'
�,
�
December 28, 2012
BANGS LAW QFFICE r �
429 SOUTH 18� ST �
CAMP HILL PA 17011
ING USA Annuity and Life Insurance Company
Decedent: Ann Ferraiolo
Cont�act Number: 9Q390185
Claim Code: 03010
Dear iVir. Bangs,
Thanic you for your recent inquiry regarding the annuity contract listed above. Please find
the contract information below. .
Death Benefit Value $283,012.16 as of 11/16l2012
The Death Benefit Value is for the date after a Systematic Withdraw on 11/15/2012.
If you have questions regarding this information, please contact our Customer Contact
Center, available Monday—Thursday, 8:30 a.m. to 6:30 p.m., Eastern Time, and Friday,
8:30 a.m. to 5:30 p.m., Eastern Time. Call 800-369-5303 and press 3 to identify yourself
as a b�eneficiary. When prompted, enter the five digit Claim Code above and press#.
Your call will be addressed by a claims specialist.
Sincerely,
Customer Service
ING
Annuiti�s issued by ING USA Annuiry and Life/nsurance Company
1001 bm
\
� � C�arnev ��x��,urh��
� � J rh Street �
�r f� jnvestrnent Harrisburg,PA 1i103 �
� ' � —
Group �����z32-�9�� ��.
� 1-8�38-529-?973 �7,1
Qf l�<�ls Far�.n A!lz�i:orr
(71')232-6979 fn.t-
February 4, 2013
M+cha�� � Bangs, Es uire
q
B�n95 �-aw Office, LLC
429 S 1$m Streefi
Camp Nifi, PA 17Q 11
R�: Ann W. Ferraiolo
Date of Dec�th: Noveml�er 10, 2012
Accovnt Numbers: 8767-9579 and 6822-g 141
D�r Mik�:
Enclos�d you w�li find the date of death values for Ann Ferraiolo's
fn►st Ac�ount and IndivEdual AGCOUnt.
Shiou�d }�ou have any questions or concerns, please fee! welcome
to cantoqct either Qoug or !. We can be reached at 717-232-6974.
Sin��r�.
Amanda J Barnett
SR Client Associate
Enclosure
Ann W Ferraiolo
Individual Account 6822-8141
: Ccsh $93.36
. Mutuc�l Funds
Frankiin Income Fund C (FCISX)
8,891 .597 shrs @ $2.20 per shr 19 Sb 1.51
TOTAL $19,654.87
Ann W Ferraiolo � Donald Leggett, TfEE's
U/W Joseph P Ferraolo Credit Sheftered Trust
Account Number 8767-9579
Cash �1,915.81
Stocks and ETF's
American Capital LTD (ACAS)
6.656 shrs @ $1 1 .37 per shr � 75.68
Mutuai Funds
American High Income TR CI C (AHTCX)
5,537.729 shrs @ $11 .23 per shr $62,188.70
Franklin Income Fund C (FCISX)
33,431 .1 19 shrs @ $2.20 per shr $73,54$.46
Oppenheimer Rochester Nat Muns CI C (ORNCX)
5,934.137 shrs @ $7,62 per shr �45,218.12
Pioneer Global High Yield C (PGYCX)
7,461 .138 shrs @ $10.05 per shr 74 984.44
TOTAI $257,931.21
BA N K 3801 Paxton Street 888 937.0004
� Harrisburg, PA 17111 mymetrobank.com
12/13/12
Bangs Law Office, LLC
429 Sou#h 8�' St
Camp Hiil, PA 17011
RE: Estate of: Ann W. Ferraiolo
Tax Identification Number: 169-24-1755
Date of Death: November 10, 2012
To Whom It May Concern:
This letter is in reference to decedent account information you requested for the
individual listed above.
We are able to provide the following:
Account Type:CK
Account Number: 536279052
Date Opened: 08/18/2003
Date Closed: 12/3/2012
Primary Owner: Ann W. Ferraiolo
Principa{ Balance: $ 16,233.97
Accrued I nterest: $ 1.59
Date of Death Balance: $ 16,235.56
Please feel free to contact rne at (717) 412-6127 if I may be of further assistance.
Sincerely,
.
�___--
Jennifer Jacobs �
Research Associate
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I,ANN W. FERRAIt3LtJ, of Siiver Spring Tawnship, �umberiand County,
Pennsylvania,declare this to be my last will and revo�.e any will previously made by rne.
ITEM I. I direct that ali my just debts and fi:�neral expenses, includi�g my gravenciarker
and aIl ex�enses of my Iast illness shall be paid fram my residu�ary estate as soon as practicabie
aft�r my death as a part of the expense of the administration of my estate.
ITEM II. AlI estate, inher�t�unce and other death t�es{including interest and penalties�
payable by reason of my death shall be apportioned among, charged to and paid by the recipients
and beneficiaries Qf the property ar interests included in the measure of the tax in the proportion
that the net arnaunt of such property ar interest bears to the amount c�f my net estate. In
determining the allocation of the ta��, the property or interest included in the measure of a
particular ta�shall be reduced by an�deduction specifically attributable to that property or
interest with resp►ect ta that ta�. The terna"net estate" shall mean rny grt�ss est�te as tlefir�ed fo�
puur�poses of a particular tax Iess any deductions (other than the unified credit}altowabie for the
Pwrposes c�f that tax.
ITEM III. I hereby make a specific bequest to my son DCtNAL� B. LEGGETT
pxavided he survives my death by th.irty (30}days of the property I aum and identified as tlnit
1�1, 1525 North Front Street,Harrisburg,Pennsylvania. i currently have a mort�age on this
property and my son Danald is required as part of this bequest ta pay off that mortgage�r
otherwise have it ref�nanced so that it is no longer a debt of my estate. In the event that he
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cannot pay off or refinance that mortgage,then th�.property should be sold and he shall be
entitled to retain all of the proceeds from the sale. My son, DONALD B. LEGGETT, shall be
responsible and required to pay any and a11 inheritance taxes due or which result from this
: specific bequest.
ITEM IV. I hereby make a specific bequest to my son DONALD B. LEGGETT of my
ownership interest in 701 East Locust Street Associates, LLC which essentially is an interest in
real estate at 701 East Locust Street, Mechanicsburg. In conjunction with my purchase of the
interest in 701 East Locust Street Associates, LLC, I took out a home equity loan with PNC
Bank which currently is a lien on my home at 303 Founders Way, Mechanicsburg, Pennsylvania.
If the home equity line owed to PNC Bank has not been paid in full as of the time of my death,
then my son DONALD B. LEGGETT sha11 be responsible to pay the outstanding balance of the
home equity loan or otherwise have it paid so that it is not a debt to my estate. The debt may be
repaid frorn any share that he is to receive from my estate. However, should Donald B. Leggett
not receive sufficient funds from my estate to pay this debt or is unable to otherwise refinance
the debt,then my interest in 701 East Locust Street Associates, LLC, must be sold and the home
eguity loan with PNC Bank must be paid in full. All proceeds in excess of the outstanding
balance of the home equity loan sha11 be given to Donald B. Leggett.
ITEM V. I give and bequeath one (1%}percent of my estate or Ten Thousand and
00/100($10,000.00) Dollars, wluchever is less,to each of my grandchildren and step-
grandchildren who survive my death by thirty (30) days.
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ITEM VI. I give and bequeath all my ho�ehald goods, autornabiles,jewetry and all
other articles of household and personal use, equipment and ornarnent, tagether with all
insurance thereon and relating thereto, in equa.I shares to my children JAMES D. LEG�ETT,
D4NALD B. LE�GETT, EkNEST W. LEGC�ETT and JAIrt M. HAWI�.ES who survive my
death by t�urty{3Q) days. In the event that any of my children fail to survive my death by t�urty
(30}days,then their share shall gc�to their issue.
ITEM VII. I give, devise and bequeath a11 the rest, residue and remainder of my
possessit�ns and estate of every nature and wherever situate in equal shares to my natural
children 31�►��IES D. LEGGETT, DONALD B. LECi�ETT,�RS�IEST W. LEGGETT and JAN M.
HA'�JI�.ES and my stepchildren MA►RK FERF�AI(JLO,JOSEPH FER.RAIOLO, DAVID
FER.RAIOLp, BRIAN FER,RAIC�LQ and I�E1�bNETH FER.RAIOLC7. In the event that any of
my natural children or stepchildren fail ta survive my death by thirty {3�}} days, then the�share
sha11 go to their issue per stirpes. Shauld they not have any issue,then their share shall be
divided evenly among those beneficiaries designated in this paragraph who do survive my death
by�hirry (�a}days.
ITEM VIII, Should any beneficiary entitled to a share of my estate not�ave att.ained the
age c�f tw�nty-ane{�1} years at the time far distributian to him or her, I devise and bequeath the
share of such beneficiary to my hereinafter narned trustee, IN SEPA�.R,ATE TRUSTS,to hold,
manage, invest, and re-invest,the shares so received, and the accumulation of income thereon,
. and to use and apply frt�m ti�.me t�time such portion af income and principal thereof as my
trustee thinks praper for the comfartable support, maintenance, health, welfare, and education af
the beneficiary ar to make payment for such purposes,without fiu�kher responsibility, direc�ly to
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such beneficiary, or directly to any person taking�.are of such beneficiary., Any principal or
income not so applied shall be distributed to such beneficiary when he or she attains 'the age of
twenty-one(21)years, or if he or she dies prior thereto,to his or her personal representa.tive.
ITEM IX. I appoint my son DONALD B. LEGGETT trustee of the trust or trusts
created by this my last will. Should my son Donald predecease me or otherwise fail to qualify or
cease to serve as trustee, I appoint my son JAMES D. LEGGETT trustee. In addition to the
other powers and authorities granted to my trustee by Pennsylvania Law and by the preceding
paragraph of this my last will, I hereby give my trustee the following special powers and
authorities:
A. To retain any or all of the assets of my estate, real or personal
(including any stock or securities of any corporate fiduciaries), without any regard
to any principle of diversification,risk, or productivity;
B. To invest and re-invest in a11 fonns of property without restriction to
in�estments authorized for Pennsylvania Fiduciaries, as my trustee deems proper,
without regard to any principle of diversification, risk or productivity;
C. To sell at public or private sale,to exchange or to lease, for any period
of time, any real or personal property and to give options for sales, exchanges, or
leases, for such prices and upon such terms or conditions as my trustee deems
proper and in the best interest of the beneficiary or beneficiaries of sa.id trusts;
D. To allocate receipts and expenses to principal or income or partly to
each as my trustee from time to time deems proper in its sole discretion;
E. To compromise any claim or controversy;
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F. To exercise any option, right, c�privile�e gr�nted in insurance palicies
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or in any c�ther investments;
G. My trustee may accumulate the income from this trust during the tern�
thereof but may, from time ta time, distribute from current income ar from
accu��nulated income or from prin�igal such amounts as my trustee, in its sole
discretion,deems advisable for the education,welfare, and cc�mfort af the trust
beneficiary.
ITEM�. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or ta volunt��ry or involur�tary ali�nation nor shall they be subject ta any executian or
attachment.
ITEM XI. I appoint my sc�n D{�NALD B. LEGGETT executor of this my last will.
Should h�predecease me or otherwise fail to qua�ify ar cease ta serve a�s executar of this my last
will, I appoint my son JAMES D. LEGGETT executor of this my last will.
IT'EM XII. In addition ta the vther powers and authorities granted tc� my gersonal
represent�tives by Pennsylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effectide without caurt
approval and until actual distributivn af all property: tt�campromise any claim or contra►ver�y;
: ta make distribution in cash or in kind, ar partly in cash and partly in kind, and in such manner as
my perso�al representatives may determine and at valuations finally to be fixed by them;to
invest in�lI fon:�s af property, including any stc�ck ar other secu�ties in any carporate fiduciary
or its successor without restriction to investments authorized far Fennsyivania fiduciaries, as my
persQnal representatives deem proper,without regard to any principle of risk ox diversification;
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to retain any or all assets of my estate, real or per�nal, without regard to any principle of risk or
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diversification; to sell at public or private sa1e, to exchange, or to lease for any perioc�of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
ITEM XIII. I direct that my personal representatives and fiduciaries shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this �2 � ' 3 ' t �lay of
, 2011.
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ANN W..FERRAIOL4
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Ti�e preceding instrumenf, consisti�g of this and SIX other typewritten pages�each
identified by the signature of the testatrix was on the date thereof signed, published, and declared
by ANN W. FERRAIOLO, the testatrix therein named, as and for her last will, in the presence of
us, who at her request, in her presence, and in the presence of each other, have subscribed our
names as witnesses hereto.
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COMM01�1WEALTH OF PENNSYLVANIA _ • }
( SS:
COUNTY OF CUMBERLAND � ) '�
The undersigned,being the testatrix whose name is signed to the attached or foregoing
instrument,having been duly qualified according to law,does hereby acknowledge that I signed and
executed the foregoing instrument as my last will,that I signed it willingly; and that I signed it as my free
and voluntary�t for t�e purposes therein expressed.
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� ANN W. FERRAIOLO
_ �c!�n�x--�ffirmed to and acknowledged
befiQ+e me�y the testatrix n ed above �OMt�ONV��TM��� �'��'�'
- �s _� �ay of���� , 2011. �� �
� V4'e�dY K Sh�uti,No�Y
� ,; � ��n T�,,,p,mbe�xs OamtY
; ������40,2011
I�otary Publi ���p��ort d i+ioteries
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND )
VvE, M��.�,_ � � and L yi✓N �'11�'r�F�t.o ,the
witnesses whose names are signed to the attached or foregoing instrument,being duly qualified according
to law,do depose and say that we were present and saw the testatrix sign and execute the instrument as
her tast will;that she signed it willingly and that she executed it as her free and voluntary act for the
purposes tl�erein expressed;that each of us in the hearing and sight of the testatrix signed the will as
wimesses;and that to the best of ow knowledge,the testatrix was at that time 18 or ore ears of age,of
sound mind, and under no constraint or undue influence. �
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Sworn or af�irmed to and acknowledged
before is day of
- 2011.
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I, ANN W. FFItRAIULU, of Silver Spring Township, Cumberland County,
Pennsylvania, declare this to be my sole codicil to my last will dated March 23, 2011.
ITEM I. I hereby revoke ITEM XI of my will and in lieu thereof provide as follows:
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ITEM XI. I appoint my son JAMES D. LEGGETT and my daughter JAN �
M. HAWKES Co-Executors of this my last will. Should either or both of them
predecease me or otherwise fail to qualify or cease to serve as Co-Executors of
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this my last will. I appoint my son ERNEST W. LEGGETT Executor of this my �
last will. �
ITEM II. In all other respects, I hereby ratify, confirm and republish my last will date
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March 23, 201 I. together• v��ith this sole codicil as and for my last will. �
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IN WITNESS W�-�EREOF. I ha��e hereunto set my hand and seal this da
of � — ---- - ------� �O l 1.
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ANN W. FERRAIOLO
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Signed, published, and declared on the d�,e..hereof by the above-named testatri�c as and
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for the sole codicil to her last will dated March 23, 201 l, in the presence of us, who at her
request, in her presence, and in the presence of each other, have subscribed our names as
witnesses hereto.
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CC►�II�40NWE�I.�'H 4�p������ �.. � .
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COU►NIY OF��BII�..� )
The undersi�d. b�ng t5e�est�mc v��e u�ne is sign�d to the attached or for�egoing
instruanent ha��ing b�een dulti-quali�ed acc�orc�ng to law,doe.s hereby ackn�wledge that I si
an�d execut�d th�e for�egoin�i�neut as my sole coc�icil to my last will,that I signed it
a�llingly;a�d th,at I signed it as my free and voluntary a�c,t for the purposes therei.n expr��ssed.
ANN W. FERRAIOLO
Sworn cr affirmed to and acknowledged
be�e�ne by e te�t rix named above
this! 3ay o , 2011. oO�M�Ttt oF Y-�vnswn
. � ��ser
- 1Ma'�d�r K S�'s�b�NafarY PubNc
lowe►AOen Twp..Cariberler�d Cou�y .
Notary Publ' ���E����,��
p�BAt�syJlvBr�As��ation o�N�a�
COMMONWEALTH OF PENNSYLVANIA )
( SS.:
COUNTY OF CUMBERI.r'�ND )
WE� ��,� � L��-� � NN �N�r7��t"Z,� ,the witnesses
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whose names are signed to the attached or foregoing instrument, being duly qualified accordin
to law, do depose and say that we were present and saw the testatrix sign and execute the
instrument as her sole codicil to her last will; that she signed it willingly and that she executed t
as her free and voluntary act for the purposes therein expressed;that each of us in the hearing
and sight of the testatrix signed the codicil as witnesses; and that to the best of our knowledge,
the testatrix was at that time 18 or more years of age, of sound m�nd, and under no constraint or
undue influence. n >
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Swo�-ra or aff rmed to and a� owl ged
- b�fore:�e this �l day° of 2011.
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1NM��cly K Straub►Na1dtY Pt�1a
l.owt�Nk�n Ti�.C�t�mbeAHQ Coes�pr
tuly Qpmtt�ipn E�it�es l4Aay 10�2041
p�yh�snia Asscx�tion ot t�r�le4
��N�S I.��OF�'IC�, LLC
429 SOUTH 18TH STREET PHONE: 717-730-7310
CAMP HILL,PA 17011 FAX: 717-730-7374 ;
E-mail: mikebangsnverizon.net
MICHAEL L.BANGS,Attorney-at-Law WILLIAM E.MILLER,JR.
WENDY K.STRAUB,Paralegal Of Counsel
August 7, 2013
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Ann W. Ferraiolo
File No. 21-12-1247 .
DeaY IVIrs. Strasbaugh:
Enclosed you will find the following:
1. The original and one copy of the Pennsylvania inheritance tax return.
2. The original inventory.
I'lease file th�se documents accordingly. The estate is due a refund in the amount of$6,578.91.
Kindly send me a filing receipt in the enclosed, stamped, pre-addressed envelope.
If you require anything further, please contact me directly.
, Very truly yours, �„� � � r�
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Mr. James D. Leggett
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