HomeMy WebLinkAbout09-13-13 J 1505610143
REV-1500 Ex(D2-"'
PA Department of Revenue OFFICIAL USE ONLY
P Pennsylvania county coca Year File Number
Bureau of Individual Taxes °s°°"*"s"*or aEVe"!E -
PO BOX.280601 INHERITANCE TAX RETURN 21 13 0667
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 07 2013 01 08 1916
Decedent's Last Name - Suffix Decedent's First Name MI
TOMLINSON RHODA I
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW -
X❑ 1. Original Return 2, Supplemental Return 3. Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise
(date of death after 12-12-82) F 5. Federal Estate Tax Returni Required
6 Decadent Died Testate 7 Decaedte&Mpy i�aroe_d a Living Trust D 8. Total Number of Safe Deposit Boxes
(Attach Copyof Wilp c
9. Litigation Proceeds Received to,SPousal POVedV Credit{Date of Death 11_Election to tax under Sec.9113(A)
between l2-31-yi and -1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JAMES D BOGAR (717) 737 8761
R)=GIBER OF WILLS l9SE,O�JLY
First Line of Address _Z3 r� J
ONE WEST MAIN STREET cn F f 1
>a C, W
Second Line of Address CD _o --r.)
--i DATE FILED— 1Y7
City or Post Office State ZIP Code
SHIREMANSTOWN PA 17011
Correspondent's e-mail address: jbogar @bogarlaw.com
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,
A it is true,correct and complete.Declaration of preparer other than the personal representative Is based on all information of which preparer has any k owledge.
SIGNATURE OF P SON ESP SIB E FOR FI RET RNV DATE .��/�
�r✓' Richard W. Tomlinson /Z
ADDRESS
899 Hawthorn Avenue, Mechanicsburg, PA 17055
SIGNATU PREPARE THER THAN REPRESENTATIVE DATE
James D. Bogar R k2A3
ADDRESS
One West Main Street, Shiremanstown, PA 17011
Side 1
L 1505610143 1505610143 J `
J 1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name. Tomlinson, Rhoda 1.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 42 , 712 . 00
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 222 , 084 . 28
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous N Probate Property
(Schedule G) u Separate Billing Requested............ 7. 459, 766 . 22
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 724 , 562 . 50
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 20 , 995 . 00
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10.
11. Total Deductions(total Lines 9 and 10)................................................................ 11, 20 , 995 . 00
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 703 ,567 . 50
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. 703, 567 . 50
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 15 0 . 00 -
(a)(1.2)X.00
16. Amount of Line 14 taxable 703 , 567 . 50 16. 31, 660 . 54
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable 0 . 00
at collateral rate X.15 0 . 00 18.
19. TAX DUE.............................. ................................................................................. 19. 31 , 660 . 54
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0667
Decedent's Complete Address:
DECEDENT'S NAME
Tomlinson, Rhoda I.
STREETADDRESS
100 Mt.Allen Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 31,660.54
2. Credits/Payments -
A. Prior Payments 30,077.51
B. Discount 1,583.03
Total Credits(A +B) (2) 31,660.54
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) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.....................................................................*......... x
b. retain the right to designate who shall use the property transferred or its income;....................... ......... x
c. retain a reversionary interest;or............................................................................................................... x
d. receive the promise for life of either payments,benefits or care?............................................................ x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receivingadequate 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. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?.................................................................................................................. ❑x ❑
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-1503 EX+(6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Tomlinson, Rhoda I. 21-13-0667
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 U.S.Savings Bonds-Three Series EE Bonds. Date of death 42,712.00
value$42,712.00.
TOTAL(Also enter on Line 2, Recapitulation) 42,712.00
(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 B(Rev.6-98)
Calculated Value of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
calculator Results for Redemption Date 06/2013
Total Price Total Value Total Interest YTD Interest
$15,000.00 $42,712.00 $27,712.00 $840.00
Bonds: 1-3 of 3
Issue Next Final Interest
Serial # Series Denom Date Accrual Maturity Issue Price interest Rate Value Note
X2391074EEj_ EE ;$10,000r01/1993_07/2013� 01/2023' $5,000:00� $8,956w00 _ 4.00%j$13�956.00:
X2188178EE EE $10,0 00:08/1992_08/2013 08/2022 $5 000 00� $9,236.00 4.0 0% $14,236.00
__
X2167458EE EE, $10,000:03/1992'09/2013 03/2022 $5 000 00; $9 520.00 4.00% $14,520.00
Totals for 3 Bonds $15,000.00:$27,712.00 $42,712.00;
Notes
NI ;Not Issued
NE ;Not eligible for payment _ _
---- --'------
PS ;Includes_3 month interest penalty
ur
MA Mated and not earnin interest
http://www.treasurydirect.govBC/SBCPrice 8/16/2013
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OR' RHODA ITOtIiiA15D7>I! X17 F"
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Rev-1506 EX-(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE p�+ p p
INHERITANCE TAX RETURN PERSONAL, PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tomlinson, Rhoda I. 21-13-0667
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 PNC Investments-Account No.004-338389. Date of death balance$221,904.58. 221.904.58
2 Comcast-Refund 20.23
3 Freedom Blue-insurance refund 159.47
TOTAL(Also enter on Line 5, Recapitulation) 222,084.28
(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)
PNC
INVESTMENTS
Member FINRA.,d Sine
August 21, 2013
James D. Bogar, Esquire
1 W. Main St. .
Shiremanstown, Pa 17011-6327
Re: Estate of Rhoda I. Tomlinson
PNCI Account#004-338389/Rhoda 1. Tomlinson Individual
Dear Mr. Bogar:
Attached please find the Date of Death valuation for the above-referenced account held with
PNC Investments for Mrs. Tomlinson. This Individual account does not name beneficiaries.
Please do not hesitate to contact me at the number listed below, should you require any
further assistance with this matter.
Sincerely,
Todd A. Perry
Financial Advisor
717-730-2289
PNC Investments LLC
Member of The PNC Financial Services Group
4242 Carlisle Pike Camp Hill Pennsylvania 17011
www.pnc.com
Important Investments Information:Brokerage and insurance products are:
Not FDIC Insured•Not Bank Guaranteed•May Lose Value
Securities and brokerage services are pmvided by PNC Investments LLC,member FlNRA and SIPS.
Annuities and other insurance products are offered by PNC Insurance Services.LLC a licensed insurance agency,
PNC
INVESTMENTS
Member FINRA and SIPC
June 19, 2013
Marian Kinter
maria n.kinter(alipnc.com
RE: 004-338389/Rhoda Tomlinson(Individual) .
Dear Marian
The value of the above-referenced account on June 7th, 2013 is as follows:
Symbo OD
Amount - "Description - - cusip "' "-Price ` DOD Valus Accruedinterest
3,994.770 FEDERATED PRIME MGMT OBLIGATIONS QPSSQ $ 1.00 $ 3,994.77
21,013.482 PIMCO LOW DURATION CLASS A PTLAX $10.37 $ 217,909.81
METLIFE INVESTORS USA INS CO
Bond $ - $
$ 221,904.58 $ -
Grand Total(Market Value ab Accrued Interest)l 1 $ 221,904.58 1• Please note the carrier must provide the date-of-death value of the annuity. PNC Investments serves only as the broker/dealer.
•Note: DOD price is based off the closing price on the day the client has passed away, if this is a non-business day the price will be
taken from the previous business day's closing price.
If you have any questions, please contact our Estate Resolution Desk at 800-622-7086.
Sincerely,
Ankit Patel
PNC Investments, LLC.
Estate Resolution Desk
The summaries, prices,quotes and/or statistics contained herein have been obtained from sources believed to be reliable
but are not necessarily complete and cannot be guaranteed.They are provided for informational purposes only.Past
performance does not guarantee future results.
PNC Investments LLC
Member of The PNC Financial Services Group
4242 Carlisle Pike Camp Hilt Pennsylvania 17011
www.pnc.com
Important Investments Information:Brokerage and insurance products are:
Not FBIr:Insuretl
it Bank Guaranteed-May Lose Value
Securities and brokerage bervmes are provided by PNC Investments LLC,member FINRA and SIPC.
Annuities and other insurance products are offered by PNC Insurance Services,LLC a licensed insurance agency,
Rev-1510 EX.(0808)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tomlinson Rhoda I. 21-13-0667
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 NAME TRANSFERS ATTACH A COPY OF THE DEIED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Ameriprise-Annuity No.93002272673 9 004. Ann L. 55.759.85 55,759.85
Timashenka and Richard W.Tomlinson are the named
beneficiaries of this account
2 MetLife-Annuity No.A2072698. Date of death value 80,769.38 80,769.38
$80,769.38. Ann L.Timashenka and Richard W.
Tomlinson were the named beneficiaries of this
account
3 Ameriprise-Mutual Fund Account No.02015414677 1 37,235.82 37,235.82
002. Anna L.Timashenka and Richard W.Tomlinson
are the named beneficiaries of this account.
4 Members 1st -Savings Account No.338008-00. 37,671.74 37,671.74
Principal balance at date of death$37,670.81; accrued
interest$0.93.
5 Members 1st -CD No.338008-48. Principal balance at 71,048.55 71,048.55
date of death$71,040.96;accrued interest$7.59.
6 Members 1st -CD No. 338008-50. Principal balance at 46,164.23 46,164.23
date of death$46,159.30;accrued interest$4.93.
7 Members 1st -CD No.338008-51. Principal balance al 81,626.65 81,626.65
date of death$81,619.27;accrued interest$7.38.
8 PNC Bank-Checking Account No.5140064519; date 3,948.69 - 3,948.69
of death value$3,948.69;accrued interest$0.00.
9 PNC Bank-Savings Account No.5002002029; date of 45,541.31 45,541.31
death value$45,541.23;accrued interest$0.08..
Total of Continuation Schedule 3ee attached page
TOTAL(Also enter on Line 7, Recapitulation) _ 459,766.22
(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)
4 £
Ameyiprise
Financial
Gccl:ouch&.4saociates
A private e'calth ii&isoi_v practice
of AmcrIprisc Financial Sm it's,Inc.
June 20, 2013 4661 1 rindle Road,Snit,MID
Camp Irill,YA17011
"Cc1:717.761.4205
'toll Frew:800.962.8694
Fa,:717.761.6282
Thomas 1'.Belthra ch,CFP
Mr. Richard W. Tomlinson ChFC`,CF-S'
899 Hawthorne Avenue - Private Werdtl dvisor
Mechanicsburg PA 17055 practitioner
rn <;tn1.P nnmau"'
> practitioner
thomas.f.benlmcichC-ampf coin
Dear Richard: William K Pressmann,ChFC'
Financial Adviu,r
_ wi lliantkpressm rum C'ainpf.com
Thank you for your recent inquiry regarding Rhoda I. Tomlinson's Julia A.Stuart
accounts. These are the values of the accounts as of 06/07/2013. Parnplanncr
Aiea.sf uart(t nmpf cons
Account Information
Mutual Funds
Account Number Ownership
02015414677 1 002 Individual - TOD
Annuities-Post 1985
Account Number Ownership
93002272673 9 004 Individual
Mutual Funds
Account Number Total Value #of shares Asset Value Per Share
020154146771002 $37,235.82 4012.481 9.280
Annuities- Post 1985
Account Number Total Value
93002272673 9 004 $55,759.85
The date of death values provided are for estate tax purposes and are not a value to be paid.
Accounts may be subject to market fluctuation as governed by each product. Please note that the
values indicated for any Life Insurance product(s) with the insured deceased reflect the gross
death benefit at date of death and not the cash value. Values indicated for Life Insurance
Products with only the owner deceased reflect the cash value as of the date of death. Values for
r any proprietary mutual funds include accrued dividends as applicable. Values provided for
brokerage products are manually calculated, and should be used as estimates only. The prices
used to provide values are estimates obtained from outside sources believed to be reliable.
Ameriprise Financial provides these values as a service to its clients. Actual values used in
preparation of tax returns or for planning purposes should be verified by your legal and
accounting advisors.
Aa Aincrease Financlal Franchise.Amenprise Financial Services,Inc.offers financial advisory sel investments,insurance and annuity products.RiverSource"and
Columbia ManagemenC products are offered by affiliates of Am=riprlse Financial Services,Inc.,Meinher RNIRA and SIPC.
We appreciate the opportunity to be of service to you. Please contact us if you have any
questions.
Sincerely,
VV
Laure E. Kane
Office Manager to Tom Benkovich, CFP®
MetLife Investors USA
P.O.Box 14593
Des Moines IA 50306-3593 e ft; e
August 27, 2013
Copy to:
JAMES BOGAR ESQUIRE PNC INVESTMENTS
TODD PERRY
1 WEST MAIN ST 4242 CARLISLE PIKE
SHIREMANSTOWN PA 17011-6327 CAMP HILL PA 17011
RE: METLIFE INVESTORS USA INSURANCE COMPANY CONTRACT A2072698
OWNER RHODA I TOMLINSON
Dear Mr. Bogar.
Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the
date of death and the account value on that date are:
Date of Death: June 7, 2013
Account Value: $80,769.38
If you have any questions, please contact your representative or call our Customer Service Center at
1-800-2844536 Monday through Friday between 8:30 a.m. and 6:30 p.m., ET.
Sincerely,
Elizabeth Theisen
Sr. Annuity Representative- Post Issue Processing
MetLife Annuity Operations and Services
Help us stay connected: Please keep us updated with respect to all who are associated with this contract,including the owner,the
annuitant,and any beneficiaries. Make sure that we have the following information for all persons or entities: name,address,
phone number,date of birth,and social security or tax identification number. Changes may be submitted to the address provided
above,by Galling our Customer Service Center at the phone number provided above,or by contacting your Representative.
St
MEMBERS V
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 338008-00
Date Account Established 08/28/2008
Principal Balance at Date of Death $37,670.81
Accrued Interest to Date of Death $0.93
Total Principal and Accrued Interest $37,671.74
Name of Beneficiary Richard Tomlinson Ann Timashenka
CERTIFICATE OF DEPOSIT:
Account Number/Suffix 388008-48
Date Account Established 04/26/2012
Principal Balance at Date of Death $71,040.96
Accrued Interest to Date of Death $7.59
Total Principal and Accrued Interest $71,048.55
Name of Beneficiary Richard Tomlinson Ann Timashenka
CERTIFICATE OF DEPOSIT:
Account Number/Suffix 388008-50
Date Account Established 04/21/2011
Principal Balance at Date of Death $46,159.30
Accrued Interest to Date of Death $4.93
Total Principal and Accrued Interest $46,164.23
Name of Beneficiary Richard Tomlinson Ann Timashenka
CERTIFICATE OF DEPOSIT:
Account Number/Suffix 388008-51
Date Account Established 05/10/2011
Principal Balance at Date of Death $81,619.27
Accrued Interest to Date of Death $7.38
Total Principal and Accrued Interest $81,626.65
Name of Beneficiary Richard Tomlinson Ann Timashenka
I��t�L�.,(,,B ER ST IFEEDEP.AL�CREDIT UNION _
Tessa L Klugh U
Lending Insurance Support Specialist
June 20, 2013'
Estate of: RHODA I TOMLINSON
Date of Death: 06/07/2013
Social Security Number: 177-10-0804
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 www.memberslst.org
1. 5. 2013 2 : 35PM PNC BaPk No. 3660 P. 1/2
R. F. `
PN
July 5, 2013
James D Bogar
Attorney At Law
One West Main St
'Shiremanstown, PA 17011
RE: Name: Rhoda I Tomlinson
SSN. 177-10-0804
DOD: 06-07-2013
Dear Sir>'IvMadam-
In response to your request for Date of Death (DOD)balances for the customer noted above, our
records show the following:
Checking Account
Account 4 5140064519 Established: 05-06-2009
RHODA I TOMLINSON ITF
RICHARD W TOMLINSON
ANN L TIMASHENKA
DOD balance: $ 3,948.69+00 accrued interest
Interest paid 01-01-2013 thm 06-071-2013 $ 0,26 YTD
Savings Account
Account.# 5002002029 Established: 05-06-2009
RHODA I TOMLINSON ITT
RICHARD W TOMLINSON
ANN L TIMASHENKA
DOD balance: $ 45,541.23 + 0.08 accrued interest
Interest paid 01-01-2013 tbru 06-07-2013 $ 25.40 YTD
Investment Account
The decedent maintained Investment Account#4338389. For further information,you may call the
Brokerage Department at 1-800-762-6111.
Page 1 of 2
Jul. 5. 2013 2: 35PM PNC Bank No. 8660 P. 2/2
Please note that this office provides date of death balances for deposit accounts(rRPs, CDs, Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these items, please call 1-SSS-PNC-BANK(1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Enter
PNC Bank,N_A_
Member FDIC
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that is privileged, confidential and exempt from disclosure under applicable law.
If the reader of this message is nor the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient,you are hereby notified that any dissemination,
distribution or copying of this communications is strictly prohibited. Ifyou have received this
communication in error,please notify me immediately by reply or by telephone at 800-762-1775 and
immediately destroy this faxed document.
Page 2 of 2
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Tomlinson, Rhoda I. 21-13-0667
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 1,441.23
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2. Attorney's Fees Bogar& Hipp Law Offices 7,350.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State - Zio
Relationship of Claimant to Decedent
4. Probate Fees 613.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 11,590.27
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 20,995.00
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Tomlinson, Rhoda I. 21-13-0667
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Exoenses
1 Gingrich Memorials-fee to add date to memorial 165.00
2 Myers Harner Funeral Home-balance of funeral bill 1,142.55
3 Richard W. Tomlinson-reimbursement for funeral luncheon 133.68
H-A 1,441.23
Other Administrative Costs
4 Alert Pharmacy Services, Inc. - 178.96
5 Messiah Lifeways-May/June bills 9,446.31
6 Messiah Lifeways-final bill for Medicare co-insurance payments 435.00
7 Paul D. Dalby, DPM -podiatry bill 30.00
8 RESERVES:-Costs to conclude administration of estate, including preparation and filing of 1,500.00
final personal income tax returns and fiduciary income tax returns
H-137 11,590.27
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
REV-1513 E%+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE p �+
INHERITANCE TAX RETURN _ BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tomlinson, Rhoda I. 21-13-0667
RELATIONSHIP TO
NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List TrusteeW I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers -
under Sec.9116(a)(1.2)] -
Ann L.Timashenka Daughter One-half of rest,
4 Jamestown Square residue and
Mechanicsburg, PA 17055 remainder
Richard W.Tomlinson Son One-half of rest,
899 Hawthorn Avenue residue and
Mechanicsburg, PA 17055 remainder
Total
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet,as appropriate.
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)
LAST WILL AND TESTAMENT
OF
RHODA I . TOMLINSON
I , RHODA I. TOMLINSON, of Borough of Camp Hill , Cumberland
County, Pennsylvania, declare this to be my Last Will and
Testament, hereby revoking any will previously made by me.
I . I bequeath certain items of my tangible personal
property in accordance with a written list made by me in my
lifetime . In absence of a list or designation on the list,
then I bequeath my tangible personal property to my son,
RICHARD W. TOMLINSON and ANN L.TIMASHENKA to be divided between
them as they mutually agree .
II . All the rest residue and remainder of my estate of
whatever nature and wherever situate, I devise and bequeath
unto my children, RICHARD W. TOMLINSON and ANN L. TIMASHENKA,
in equal shares, per stirpes .
III . I appoint my son, RICHARD W. TOMLINSON, Executor of
SAIDIS,
FLOWER & this my Last Will and Testament . Should my son fail to qualify
LINDSAY
2109 Market Street or cease to act as such then I appoint my daughter, ANN L.
-
Camp Hill,PA
TIMASHENKA to act in this capacity. Neither of my personal
representatives shall be required to post bond in this or any
jurisdiction. /
c�
IN WITNESS WHEREOF, I have hereunto set my hand and seal
on this, the day of 2009 .
c';2ja.,.-2 - SD t. (SEAL)
RHODA I. TOMLINSON
Signed, sealed, published and declared by RHODA I . TOMLINSON
herein named, on this and one (1) other sheet of paper as and
for her Last Will and Testament, in our presence, who, in. her
presence, at her request, and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
Ortt— r<�
\ Name Address
t / p
Name Address'
SAMIS,
FLOWER &
LINDSAY
.u'mwuarsrtruw
2109 Market Street
Camp Hill,PA
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF CUMBERLAND }
WE, the undersigned, the Testatrix and the witnesses,
respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed
the instrument as her Last Will and Testament and that she
signed willingly (or willingly directed another to sign for
her) , and that she executed it as her free will and voluntary
act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix signed
the will as witnesses and that to the best of their knowledge
the Testatrix was at that time eighteen years of age or older,
of sound mind, and under no constraint or undue influence.
R DA I . TOMLIIJSON, Testatrix
P ,
Witness
Witness
Subscribed, sworn to and acknowledged before me by the
Testatrix, and subscribed and sworn before me by both
witnesses, this tkN day of ��grti, 2009 .
T--p- �
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
SAMIS' Yvonne Sersch,Notary Public
Camp Hill Soro,Cumberland County
FLOWER & _ Mycommission Expires Feb.1.2012
LINDSAY Member.PennrtA,,sn;n Assaciatlon of Notaries
arm�-e-uW
2109 Marker Street
Camp Hill,PA