HomeMy WebLinkAbout08-28-13 � Lsos�loz4�
REV-1500 EX,°z," �,
PA De ar.ment of Revenue y OFFICIAI.U5E ONLY
P ETBti(15 IY2tii8 County Gotle Year Fie Nuent�er
Boreau of Individuai Taxes '�'""TM�*"°�Re"�
ao eox.zsosoi INHERITANCE TAX RETURN 21 13 0756
Harrisburq, PA 17128-D601 RESIDENT DECEDENT
EN7ER OECEDENT INFORMATION BEL6W
Sociai Security Number Date of Death Date of Bidh
os �a 2p13 0� zo 1919
Decedent's�asi Name Suffi.x DeCedent's First Name MI
GALLINA RICHARD F
{tf Appiicable)Enter Surviving Spouse'S InformaGtln Below
SPOUSe's Last Name Su�x Spouse's First Name MI
SROUSe's Soc'sai 5ecurity Number
THIS RETURN MUST BE FILED CN 6UPLICATE WITH THE
REGISTER dF WILLS
FIL�IN APPftOPRiATE pVALS BELCtW
� t. Ongir,ai Retsm � a. Suppiementai Retum r� 3. Remaindar Retum{Date at Cheafn
PAOr t0 7Z-73$2}
� 4. Limitetl Estate � qa,Fuwre mteres�comprom�se � 5. Fetlerel Estate Tax Retum Required
(tlate M tleath aher 1242-82)
1-7 g �er,eCent Dietl T>stste t � 'j LticetleN Main�ainetl a Livirg Tru9 1' __ g_ TO;dI Numbe[Of S2fe De 5it Boxes
L�.a (Attsch(:ppyofWill) LJ " (AttachCOpyNTmsi} �
� 9. LitigdYlOn ProCeetlS RECZived � 10.beNieeniyv�rt��rae d�Da�S�f Death r, ��,EIECiiDn t0[az IJtitl2f 52C.9113(A)
� {Attach Schedule 0)
CORRESPONDEN7-THIS SEC710N MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFI�ENTIAL TAX MFORMATION SHOULO BE DIRECTE�TO:
Name Daytime c7�elephone Number
.7EBTPIIE'ER B HIPP 717cf�7 $7� �:T m
� c>
,n
�' ,. ,
� REGIS�FF�OF�yY'ILLSl�SE C1f�L1`,.-,
A i 7�.) . i .:i
r'" '- � - .
First Line of Address � `f} �` � �
. . aC'; r:,
1 WEST MAIN STREET y " ? - r
KS �-- .. —
�J C c,>
5ecood line of Add�ess . --��� � ;,�
"U —f C_
p„ C.'T Cn O
�
DATE FILE�
City or Post Office Sfate ZIP Code
SHIF;EMA23STOWN PA 1'7011
CarrespandenYs e-ma+E address: lhipp�bogarlaW.COrrt
Under penaRips of perjury,I d9clare that I have euamined this return,including aceampanying schedules antl statements,and to t�e best af my knowiedge and beiief,
it is Mue,correot and wmpl9te.Declaretipn of preparer qther than the personal representative is based on all inPormation of which preparer has any knowledge.
S��/IG}NATUREOFP SONRESGONSIBLEf ftFILIN�6/RE7URN QATE
C�'lt,� '�',��� d;,� Ypi/k.�. . Ailce Jane Galtina �'!�?1 f�
AGGRESS �,,,
434 Spriog Hause 12aad. Camp Hill,PA 17411
SI(iNAT� E OP FR6PA ft bi'HERTHAN REr^R£SENTATNG DATE
� Jennifer B. Hipp .�.
A R S
1 st Main S#reet,Shiremanstown,PA 17011
Side 1
� 15�561�143 150563I]I,43 �
�"_
J 1505610243
REV-1500 EX
Decedent's Social Security Number
oe=ede^�'��ame Gallina, Richard F.
RECAPITULATION
1. RealEState(ScheduleA)._....._......_......._..........._...._....._.................................. 1.
2. StocksandBondsiScheduleB)................___....................................................._ 2. 5. , 074 . 88
3. Closely Held Corperation, Partnership or Sole-Proprietorship(Schedule C)_....... 3.
4. Mortgages 8 Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E).._........._ 5. 13 , 52 9 . 87
6. Jointly Chvned Property(Scheduie F) ❑ Separate Billing Requested............ 6. 160 � 0 67 . 81
7. Inter-Vivos Transfers&Miscellaneous Naq-Probate Property
(Schedule G) L� Separate Billing Requested............ 7. 4O2 � 714 . 81
g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 577 , 387 . 37
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 9� 6S0 . 18
1D. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)................_....._... 10.
i t. Total Deductions(total Lines 9 and 10).._........................._............_................._ ��. 9, 650 . 18
12. Net Value of Estate(Line 8 minus Line 1'I).......................................................... 12. S Fi 7 , 7 37 . 19
�3. Charitable and Governmentai Bequests/Sec 9113 Tmsts for which
an election to tax has not been made(Schedule J)....._......_.._.........._..._........... 13. 1 � �0� . ��
14. Net Value Subject to Tax(line 12 minus Line 13)............................................... iq. S 66, 737 . 19
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 15 � _ 00
(a)(12)X.00
16. AmountotLine 14taxable 566 � 737 . 19 �s. 25 � 503 _ 17
at iineal rate X .045
17. Amount of Line 14 taxable 0 . �Q 17. � . ��
at sibiing rate X.12
� 18. Amount of Line 14�taxable 0 . �Q 18. � . ��
at collateral rate X.15
19. TAX DUE 19. 2$ � 503 . 17
_.......__.........._..................................._......................._........_...............
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 15�561�243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0756
DecedenYs Complete Address:
DECEDENT'S NAME
Gailina, Richard F. _ �
STREETADDRESS
430 Spring House Road
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 25,503.17
2. Credits/Payments
A. Prior Payments
B. Discount 1,275.16
Total Credits(A +B) (2) 1,275.16
3. Interest �3) —
q. If Line 2 is greaterthan 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) Qt1�2Q$.Q�
Make Check Payable to. REGISTER OF WILLS, AGENT.
< ,� �,s� �. �����. k���:' s$r` " � r>�.-r
<.,��� .. . <� „ ��, ;. ��'��� 4����'��. ���'`.; �.:,:
: 3 M .
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',........_..............__...... � �
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. 72, 1982, did decedeM 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?....... 0 ❑
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.
a. r>-: . * <"�.�ta��:�st _. � .�� . ��� h�N- �� x x. `'�t n M� :_ x��s ,.
Por dates of death on or after�July 1 1994 and before Jan. 1, 1995,the taz 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 taz rate imposed on the net value of transfers 10 or for the use of the surviving spouse is 0 percent
[72 P.S. §9716(a)(t1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets antl fiing 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)(12)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenPs 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 decedenfs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A
sibiing is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
1 48500041046
_„J REV-485 EX(OS-04) �
SAFE DEPOSIT
BOXINVENTORY
PF�eoarlmentofRevenue PLEASE USE ORIGINAL FORM ONLY
Social Security or Deathi CeAifcate Number Date of Death Counry Code Year Flle Number
358-10-7288 05/28/2013 21 13 0756
Der.eden�'s Last Name Suffix First Name MI
G a 1 1 i. n a R i c h a r d F
�AODRESS OF DECE�ENT STREET: CITY:� � STATE: ZIP CODE:
430 Spring House Road Ca[� ELi1_1 PA 17011
NAME AN�ADDRESS OF PERSON REqUESTING THE OPENING OF THE SAFE�EPOSIT BOX
NAME: �1CP- �J�3I12 C�LLSI13
_.__—.__—_.—...__—_____ ____.—____.
S TA�DR�SS' GIN' STATE'. ZIPCODE'.
��� Spr�ng House Road Ca� Ili.il PA 17011
� NAME,ADDRESS AND RELATIONSHIP(IF ANV)TO DECEDENT,OF PERSON(S)PRESENTAT THE BOX OPENING �(/�J
a. NPME:: RELATIONSHIP:
STREETADDRESS: CIN: STATE: �ZIP CODE'
_"— _.__.._— __..._ '""_'__— — ____
b. NAMEe � RELATIONSHIP'
STREETADORESS: CITV: S7ATE ZIPCODE:
a NAME: � RELATIONSHIP:
STREETAD�RESS: GTV: STATE ZIPCODE:
NAME AN�AD�RESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED '
NAME
M6eT B3nk
STREETAD�RESS: CITV: STATE ZIPCODE:
3805 Trindle Road Aill PA 17011
NAME OF PERSON MAKING LAST ENTRY � J OATE AND TIME OP LAST ENTRY � (I�
ru d�.�r �
: DATE OF CONTRACT Tp RENT BOX ' NUMBER OF396 I TITLE UNDER WHICH 80%IS REqUESTE� Q,, (�
�f�\ �V
NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX
a. NAME: b. NAME �
STREETAODRE53: STREETADDRESS: �
CITV: � STATE: ZIP CODE' GTV: � STFTE ZIP CO�E:
NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY - r—
''�12�;:. �les}� - S�„,o� �elle�
WAS A WILL IN THE BOX7 ❑ YES NO If yes, a. Date o(wilL .
b. Name and address of personai representative,if nametl in ehe wlll
NAME:
STREETAODRE55: CIN: � S'ATE: ZIPCODE'
c. Name and address of attorney,if any
NAME:
STREETADDRESS: CITY: SATE: ZIPGO�E
� 485�0041046 48500041046 �
RE�-485EX SAFE DEPOSIT BOX INVENTORY P�ge _ af
� WSTRUCTIONS __
I� (i) Caah: Report total only.
(2) Stocks: List in de[ail every common or preferred certifcate, warran�or other rights found in box. Stocks are to be designated by
� name of coinpany,certifca[e number, date of certificate,name in which stock is registered,and number of shares and class of stock_
(3) Obligations oF U.S. Government Number of items, date of issue, face value, names in which registered and type of ownership,
I i.e.,jointly held, payable on death, etc.
(4) Bonds: Deslgnate by name,amount, serial number, or other designaCion_(8earer Bondsl
i (5) Bank and Savings and Loan Passbooks: State name of depositor,number of book, last date appearing in book.name o!bank
anc branch. and balance. �
(6� Jewelry, Coins, Stamps, Manuscripts,etc: Lis�and describe as fully as possible.
(7) Deeds, Mortgages,Current Insurance Policies or other evidenres of indebtedness: Lis�and describe as fWly as possible.
(B) All other contents.
(9) Retum completed form to: DEPARTMENT OP REVENUE
INHERITANCE TAX OIVISION
- DEPT.280601
HARRISBURG,PA 17�2&06�1
ITEiN �—
NO. ITEM GE'aCRIPTIQN
_--" ._.---_ '._
_—_ —___—_____ "__"_
_,� �i�!drv�'c(cr�_[__ l�w��`�evn en fi �n�ncP�� �/ oo c _ f�,_�/rt�cc_��' l,'� �
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.CL��e.� C'/os a e� ) — -
----- ---- -__. .._.__....---
�_ I/Gus�. __c�!eecl- �1�0 Sp^�"�n /�Uc�s-� �e/- �'� �n f;/,=1��.__P� (7c7��
- - -- -----
� TreG,$C�� 0 2=� rc,�a� /7�/arch 3 i -� �� �r - C/_os<�G�
__L�e��'_r�4 i f'�ss��c/ l��� � o� l�'h, /a - c�cc '" �cs • ao�r�3�
C� cfe r���--L���H�e �/1' �S' <��?��'s G �F'c ^ �e c� �, e iY
_�(1�`.,c� - ct�eceasecf �f��?c�/ao�e� �'3c7o - varu .z�
,-�c�C(�Q h 7�C< ( �.�-R'- ��q 5�ct i"YA n c.G -�o r' ��.c e._ '�'�t'I`�`/� Cti /i u�'n .
/� �� �1Y1_�5 3 a ) .��r � ( �,- �1 e��;�c��
— — _— -- - ---------------
�,C!�_�Is�-� ; �� ,/Y�� ` c, c , 'ce� -1 �,�a c� —__
_ �' czcc_�L�C�b<_"3 �t/y 9C� ��� c o �d
I CERTIFY UNDER PENALN OF PERJURV THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF Y KNOWLEDGE(aND BELIEF. SAFE DEPOSIT BOX INVENTORY:
SIGNATURE , ��/�,�y�� SIGNATURE
_��.. `�� ���a-i`„'r � ___._— _.__
_' --—____._._... _.__. .-__
�RINTNP.ME / � PRINTNAMEAN�CHECKAPPROPRIATEBO%BE!OW�.
� '� ce __�a!� e.- �'a//�'r� w --- —
PRINTTITLE DATE CHECKAPPROP4IATEBOX:
L^^\'/' / ,�//y, µ[ry�, �/ /� �e,acom�l�en) ❑nam�n�s+amqmx)
n e L�.l[ If�� V� /��^' �Es�aee Representailva ❑Jolm owner of sa(a depwu Cox
NOTE: Attach additional 8'I="x 11"sheet(s) if necessary or use duplicates of this page of form.
The Depenmenl is authonzed by lew,42 US.C.§405(c�(2)(C)(i),to requlre disclosure of Sociol Secunry num6ers In connecNon with administering state tax laws.The DeparUnent uses the
Social Securiry number ro Iden6fy the oecedent and personal representafives of the estate.The Commonwealth nay also use Ihe loformation In exchzoge o`�ax Informatioo agreements
i with Federal aed loczl taxino authontles.The siate law prohibits Ihe Commonwealih's personael fmm disclosing rAn9aen�'al tax Informatlon excapt(or oRGa�purposes.
Rev-1503 EX��6-98)
� SCHEDULE B
�
STOCKS 8� BONDS
LOMMON W EALTH OF PENNSVLVANIA
INHERITANCE TM RETURN
RESIpENT OECE�ENT
ESTATE OF FILE NUMBER
Gallina, Richard F. 21-13-0756
All property jointly-ownetl wi[h right of survivorship must be disclosetl on Schetlule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 25 shares of MetLife 42.995 1,074.88
TOTAL(Also enter on Line 2. Recapitulationl 1,074.88
pf more space is neetled,atlditional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev. 6-98)
MctLife :: Tnvestor Relarions :: Historical Price Lookup Page 1 of 2
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Historical Price Lookup
Symbol
MET (Common Stock)
Select D�te
May � 28 � 2013 v Look Up Price
Results
Date Requested OS/28/13 $42.995 Me.dian Price
Closing Price $43.240 -
X 25 Shares
Volume 7,287,200 51,074.87 Date of Death Value
Split AdjustmenY Factor 1:1
Open $42.730
Day's High $43370
Day's Low $42.620
Copyngh��J 2008 Mar6zi W amh,Inc.AII righcs vescrved.Plexse see our Tcnns ot Lsc.
Desi6mdandpoweadbylhw-JO�c�CI�umCOl �
Intraday dam provfded by In�e�active 1]e1e Reul'fii ic�Scrcicc.nnd subjut m the]ams of I�x
Ivtradey dala is at least 2C-minu[es delayed.All[unes are E'L
Hismncul and curren�end-oGday data pmvided by Inmra.th�c Da�x Priune��nd Refo�en.r{)3 .
� RSS Feeds I L Financial Tear Slteet
http://u2vestor.metlife.com/phoenix.zhtml?c=121171&p=irol-stocklookup&t=HistQuote 8/21/2013
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Metl.if e �omputershare
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PO Boa 43006
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RICHARD GALLWA
430 SPRING HOUSE RD
CAMP HILL PA 17011-1452
� The IRS requires that we report lhe cost 6asis o(certain shares
acquired after January 1, 1011 and ihen sold. Shares
trarrsfirred oul of an a¢ouM will be done usiig our dehuft cost
6�is calculaCron d frsi in,frst ovt(FIPO)unless olherwise
iirsWCted. Please visN our websile,review ihe encbsed FAO,
w consutt your tax advisw i(you oeed additional infortnalion
aboN cosl basis.
Dear Holder.
Re: RICHARD GALLINA
Company Name:MetLife,Inc. Account Number:0018593556
DRS book-entry shares:0 Certificated Shares: 0
Policyholder Trust book-entry shares:25
As requested,enclosed are the fortns and instructions needed to transfer the decedenPs stock to a new account or another hoidec We have also enclosed
answers to Frequently Asked Questions(FAQs)to assist you with completing the form and ro answer transfer related questions you may have.You can find
additional helpful informa6on in the"Help"section of our website, www.computershare.com(nvestor.
To request the transfer,you will need to complete the following steps:
Step 1: Transfer Request form—Complete the enclosed fonn.All surviving registered holders('rf applicable) or a legally authorized representative must sign
the"Authorized Signatures'section(section 7),with a Medallion Signature Guarantee for each signature.M individual signing on behalf of the current
registered holder must indicate his or her capacity next to the signature on the form(e.g.John Smith, Exewtor or John Smith,Custodian).See the
enclosed FAQ document tor additional informa6on.
Ii the decedent held any cedificated shares,you must include the original stock cefifcale(s)along with the Transfer Request form.If a certifcate is
lost,please wntact us at the customer servica number listed oo the top right comer oi this letter to f nd out fhe cost and process for reques6ng a
cerfifificate replacement.Lost certifirates must 6e replaced prior to transfemng the shares.
Step 2: Form W-9,tax ceAification—The new holder should sign and dale section 9 of the enclosed Transfer Request form.If ihe new holder is unable to
provide tax certification at fhis fime,we will send him or her a Form W-9(Requesl for Taxpayer ldentification Number and Cefification)once the
Vansfer request is processed.Computershare will be required to withhold taxes on any dividends or other cash distributions until tax certificafion is
received by us.
Step 3: Sales instrucfions—If the new owner wishes to sell the shares as a result of this transfer andlor from an existing account,the New Account Owner's
Sale Insiructions in Section 10 must be completed and signed.
Step 4: Additional tax documentation—Obtain either(a)or(b),as applicable:
(a) If the decedent resided in a state in which an inheritance tax waiver is required,an Inhentance Tax Waiver fortn.
(b) If the decedent did not reside in a state in which an inhentance tax waiver is required,either(i)a Notanzed Affidavit of Domicile(blank fortn
enclosed),or(ii)an Inheritance Tax Waiver stamp atfixed next to the signature on ihe Transfer Request form.
See the last page of the enclosed FAQ document for additional infortna6on on these items and how to oblain them.
Step 4: Send all required document�outlined above to:
Regular mail: OvemighUcefifed/registered delivery:
Computershare Computershare
PO Box 43006 250 Royall Street
Providence, RI 02940-3006 Canton,MA 02021
nnIC50003.d.i.mu.043MP dc9]x�n�19J'p6615"1 atKJ2A
Rev-1508 E%i�11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
°EPART"EN'°FRE�EN�E pERSONAL PROPERTY
INHERITANCE TAX RETUNN
RESI�ENT DECF_DENT
ESTATE OF FILE NUMBER
Gallina Richard F 21-13-0756
Inclutle Ne pmceetls of li�iqation and ihe tlate the proceetls were receivetl by[he estate.
All propertyjoin[ly-ownetl wiM[he right of survivorship mus[be tlisclosed on schetlule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 M&T Bank-Checking Account No.491225. Principal balance at date of death $4,886.71; 4.886.73
accrued interest$0.02.
2 NCFCU -Savings Account No.54720-St. Date of death balance$4,224.13. 4,224.13
3 NCFCU-Checking Account No. 54720-S4. Date of death balance$1,744.32. 1,744.32
4 NCFCU-Money Market Account No. 54720-S3. Date of death balance$1,246.00. 1,246.00
5 Personal PropertylHousehold Contents -sold at private sale 500.00
6 AARP-2 checks totaling$1.69-reimbursement for medical expenses. The Decedent had 1.69
these checks in his possession,but had not yet cashed them.
7 Commonwealth of Pennsylvania-2012 Personal Income Tax Refund 187.00
8 Kinkora Pythian Home-Refund 740.00
TOTAL(Also enter on Line 5, Recapitulation) 13,529.87
Qf more space is neetled,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Ina Form PA-1500 Schedule E(Rev. 11-10)
Q M�s�
499 Mitchell Road,Millsboro_DE 19966 Adjustment Services
Phone 888502-1349
F ax (302)934-2955
Juty 1$2013
James D. Bogar
Attorney at Law
Oue West Main Street
Shiremanstown,PA 170ll
Re: Estate of Richard F. Gallina
Social Securitv: 358-]0-7288
Date of Death: Mav 28,2013
Dear Sir or Madam:
Per your inquiry on July O8,2013,please be advised that at the time of death,the above-named decedent had on
deposit with this bank the following:
1. TypeofAccount CheckingAccounl
AccountNumber q91225
Ownership(Names oJJ Alice J. Galdina(POA)
RichardF. Gallina
Opening Date 06/07/1971
Badance on Date ofDeath $4,886.71
Accrued[nterest $ 02
_.
Total $Q 886J3 .
2. Tvpe of Account Safe Deposit Bax
Box Number/Location 396/Trind[e Road
Ownership(Names o� Richard F. Callina
Opening Date 70/09/2008
For any additional infnrmation on(hc above accoun[s,induding owncrship and any changes,closures and/nr rcimbnrsemem oCfunds,
pleasc call thc Trindle Rond at 717-737-23118.
We werc unable[o bcate any safe deposit box for the above-mentiooed dccedenl.
7�his lettcr dces not iocludc any accoun[s in which the dece•rsed may have been listed as Power of Attorney,Cusrodian nf Oniform Trans(crs,
RepresentAfivc Payec,or Trustee under a N'ritten Agrrement
.S'It]COTP,�y,
Valarie Mercer
Adjustment Services
New Cumberland Federal Credit Union
Your Comneunity Credit Dnion
P.O.Box 658,New Cumberland,PA 17070-0658
Phonc: (717)774-7706 • I-800-716-2328 •Fax: (717)774-7996 •Web: www.nefcuonline.or�
Julv 16. 2013
James D. Bogar �
Attorney at Law
One West Main Street
Shiremansl:own, PA 17011
RE',: The Estate of Richard F. Gallina
Dear Ms. Hipp,
Pursuant to your letter dated July 16, 2013,in regards to EstaYe of Richard F.
Galiina the information is as follows:
Account Number: 54720
Owner(s) on Account: Richard F. Gallina
Jeanette Gallina
Date acct opened: O1/03/1994
Date ofDeath Balances: Sl (Savings) $4,224.13
S4 (Checking) $1,744.32
S3 (MoneyMarket) $1,246.00
Dividends as 4/30/13: $3.27
If you need anything additional in regards to this information,please feel free to
contact me directly.
Sinc �ely,
f �
Barbra Wright
Branch Manager
Enclosure
Revd509 EX*�01d0)
pennsylvania SCHEDULE F
oEPr,RTMeNTOFRe�ENOe JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT OECE�ENT
ESTATE OF FILE NUMBER
Gallina Richard F 21-13-0756
If an asse[was matle joint wit�in one year of the tleretlenYS tlate of tlea[h,it mus[be reported on schetlule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Alice J. Gallina 430 Spring House Road Daughter
Camp Hili, PA 17011
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY a�o OF DATE OF DEATH
ITEM LETTER DATE INCLODE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT DATE OF DEATH DECD'S DECEDENPS NTEREST
NUMBER FOR JOIN MADE NUMBER OR SIMILAR IDENTIFVING NUMBER.ATfACH DEED FOR VALUE OF ASSE INTEREST
TENANT JOINT JOINTLY-HEL�REAL ESTATE.
7 A 05111/2010 Members 7st Federel Credit Union-Regular 25.606.04 50.000% 12,803.02
Savings Account No. 384898-00. Principal
balance at date of death$25,603.20;accrued
interest$2.84.
2 A 0511112010 Members 1st Federal Credit Union -Checki�g 93,736.12 50.000°/a 46,868.06
Account No.364898-11. Principal balance at
date of death$93,732.47;accrued interest
$3.65.
3 A 01/28/2011 Members 1st Federal Credit Union- �76,867.76 50.000% 88,433.88
Investment Savings Account-Principal
balance at date of death$176,828.52.
4 A 04/11/2012 Members 7st Federal Credit Union -CD No. 5,052.99 50.000% 2,526.50
384698-45. Principal balance at date of death
$5,048.70;accrued interest$4.29.
5 q > 1 Yr. Spectra Energy Stock-602 Shares 18.872.70 50.000% 9,436.35
TOTAL(Also enter on Line 6, Recapitulationl 160,067.81
(If more space is needed,atlditional pages of ihe same size)
Copyright(c)2010 form soflware only The Lackner Group, Inc Form PA-1500 Schedule F(Rev.01-10)
St
�
REGULAR SAVINGS ACCOUNT: MEMBER st
Account Number/Suffix FEDERACCREOrr 98-00
Date Account Established OS/11/2010
Principal Balance at Date of Death $25,603.20
Accrued Interest to Date of Death $2.84
Total Principal and Accrued interest $25,606.04
Name of Joint Owner Alice Gallina
Date Joint Ownership Established 05/24l2010
CHECKING ACCOUNT:
Account Number/Suffix 384898-11
Date Account Established 05/11/2010
Principal Balance at Date of Death $93,732.47
Accrued Interes!to Date of Death $3.65
Total Principal and Accrued Interest $93,736.12
Name of Joint Owner Alice Gallina
Date Joir.;O:a�nership Es±ab!ished O5l24/2010
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 384898-OS
Date Account Established 01/28/2011
Principal Balance at Date of Death $176,828.52
Accrued Interest to Date of Death $39.24
Total Principal and Accrued Interest $176,867.76
Name of Joint Owner Alice Gallina
Date Joint Ownership Established 01/28/2011
CERTIFICATES OF DEPOSIT:
Account NumberlSuffix 384898-05
Date Account Established 04/11/2012
Principal Balance at Date of Death $5,048.70
Accrued Interest to Date of Death $4.29
Total Principal a�d Accrued Interest $5,052.99
Name ef Joint Owner Alice Gallina
Date Joint Ownership Established 04/11/2012
VISA CREDIT CARD ACCOUNT
Account Number 4672090000378687"
Date Account Established 05/19/2010
Balance at Date of Death $.00
Joint Cardholder None
'Contractual Pledge of Shares.
EMBERS 15T FEDE L CR DI NION
� ��.k� �- ���-C�
a elle A. Kline
Lending Insurance Support Specialist
July 17, 2013
Estate of: RICHARD GALLINA
Date of Death: 05/28/2013
Social Security Number: 358-10-7288
�000 Louise Drive • P.O. Box 40 • Mechanicsburg, Pennsylvania 17055 • (800) 283-2328 • wunvmembexslstorg
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',JJ.( � a 0.27(OJ5%� 4-.03PM EDT�AfierHOUrs:35.87 0.16(0.45%)4:11PM EDT ��
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May28,2013 3163 3167 3'103 31t3 2,357,600 3�.t3 ,. ,�� ..
'ClosepnceaGjuS�etlfortlividentlsanOSplRS. ' " ' `��
F�rst I Previous�Nexi I_a=_t
'�'DOwnload to Spreadsheet .
Currency in USD LOW PRICE
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$31.35 Median Frice
X 602.00 Nisnber of Shares Shop Now
$18,872.70 Diate of Death Value
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SPECTRA ENERGY CORP 06/10/2013 °
CASH DIVIDEND
SPECTRA ENERGY CORP CHECK NO. 5320316910
Share Position 602 shares GROSS AMOUNT: $183.61
Record Date O5/10/2013 BACKUP W/H: $51.41
Payable Date 06/10l2013 NRA W/H: N/A
Rate per share 0.305 NET AMOUNT: $13220
YTD AMOUNT: $367.22
=om a�e oeewn He�e rom a�e oeiecn Here
Rev4510 EX+�08�09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
°EPARTME"T°`RE�EN�E MISC. NON-PROBATE PROPERTY
INHERITANCE TAX RETURN
RESIDENT�EC!_DEN7'
ESTATE OF FILE NUMBER
Gallina Richard F 21-13-0756
This schetlule musl be completetl antl filed if the answer[o any o(qvestions 1 tM1rough 4 on page�hree oi the REV450D is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH r oF oecos exa.usioN TAXABLE
NUMBER THE OA�E OF�R�ANSFERSATTACHTA COPVEOF THE DEIED�OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Edward Jones-Account No.851-13839. The named 402,714.81 402.714.81
beneficiaries of this account are Richard A.Gallina
(25%); Elizabeth Wroga (25%);Alice J. Gallina(25%);
Joseph Gallina (12%)and Ann Gallina (13%).
TOTAL(Also enter on Line 7, Recapitulation) 402.714.81
(If more space is neetled,atltlitional pages of the same size)
Copyright(c)2009 furm soflware only The Lackner Group, Ina Form PA-1500 Schedule G(Rev.08-09)
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REV-1511 EX*�10�09)
pennsylvania SCHEDULE H
oEPARTMENT��FRE�EN�E FUNERAL EXPENSES AND
'""ER'T""`E-�RET°R" qDMINISTRATIVE COSTS
RESIOENT DECEDENT
ESTATE OF FILE NUMBER
Gallina, Richard F. 21-13-0756
DecedenYs debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMB R
q. FUNERAL EXPENSES:
See continuation schedule(s) attached 654.00
B. ADMINISTRATIVE COSTS:
1. PersonalRepresentative'sCommissions
Name of Personal Representative(s)
Street Address
Ciry State _ Zio
Year(s)Commission Paid
Z. Attornev's Fees Bogar and Hipp Law Offices 7,350.00
3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees 136.50
5. AccountanPs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,507.68
See continuation schedule�s) attached
TOTAL(Also enter on line 9, Recapitulation) 9,650.18
CopyrigM(c)2009 form soRware only The lackner Group, Ina Form PA-150D Schedule H (Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Gallina, Richard F. 21-13-0756
ITEM AMOUNT
NUMBER DESCRIPTION
F�neral Exoenses
1 Carraba's -funeralluncheon 277.00
2 Myers-Harner Funeral Home-Balance of funeral expenses 377.00
F{_p 654.00
Other Administrative Costs
3 Cumberland Law Journal-Executrix's Notice 75.00
4 Register of Wiils-2 Short CeRificates 10.00
5 Register of Wills-3 Short Certificates 15.00
6 RESERVES: -Costs to conclude administration of Estate, including filing PA Inheritance Tax 1,250.00
Return and Inventory,preparation and filing of final Personal Income Tax Returns and
Fiduciary Income Tax Returns
7 The Sentinel -Executrix's Notice 157.68
F{_g7 1,507.68
Copyriqht(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
REV-0513 E%+�0140)
pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
�NHER�TAN�E,�RET�RN BENEFICIARIES
RESIDENTDECEDENT �
ESTATE OF FILE NUMBER
Gallina, Richard F. 21-13-0756
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (y�ords) (5$$)
o Nol ' Trusree s
TAXABLE DISTRIBUTIONS [include outright spousal
I• d�stributions,and transfers
under Sea 9116 a 12
Alice Jane Gallina Daughter Twenty-five
430 Spring House Road percent of rest,
Camp Hill, PA 17011 residue.and
remainder
Ann M. Gallina Granddaughter Twelve and One-
6191 Haymarket Way Half Percent of
Mechanicsburg, PA 17050 Rest, Residue
and Remainder
Joseph M. Gallina Grandson Twelve and One-
975 W. Matterstown Road Half percent of
Millersburg, PA 17061 Rest, Residue
and Remainder
Richard F. Gallina Son Twenty-Five
6156 East Preston percent of Rest,
Mesa,AZ 85215 Residue and
Remainder
Elizabeth A.Wroga Daughter Twenty-Five
9803 Autumn Lane Percent of Rest,
Woodstock, IL 60098 Residue and
Remainder
Total
Enter dollar amounts for distributions shown above on lines 15 throu h 1 S on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. q.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Humane Society of Harrisburg Area, Inc. 1,000.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 1,000.00
Copyright(c)2010 form software only The Lackner Group, Inc Form PA-1500 Schedule J(Rev.01-10)
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LAST WILL AND TESTAMENTrn � :-: f-= �? ��
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RICHARD F. GALLINA � �` � �
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I , RICHARD F . GALLINA, of Camp Hill, Cum3�er�landFCount�;
�
Pennsylvania, make, publish and declare this as and for mj��Last1i
Will and Testament, hereby revoking all other Wills and Codicils
heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remai.nder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
toget.her with any insurance policies thereon, as follows :
(A) I give and bequeath the sum of One Thousand and
� No/1G0 ($1 , 000 . 00) Dollars to the HiIMANE SOCIETY OF HARRISBURG
;
AREA, INC. , of 7790 Grayson Road, Harrisburg, Pennsylvania, to be
used for general purposes as that organization deems appropriate.
�'�,\ (B) I give, devise and bequeath all that real estate
� owne� by me, same being known and numbered as 430 Spring House
Road, Camp Hill, Hampden Township, Cumberland County, Pennsylva-
nia, together with all household and personal effects and other
� -' tangible personal property of like nature (not including and
excepting, however, all cash, securities, bank accounts, certifi-
cates of deposit and like intangible personal property) together
with any existing insurance thereon, to my daughter, ALICE JANE
GALLINA. Should ALICE JANE GALLINA predecease me, I direct that
said real estate be and become a part of my residuary estate to
be distributed as set forth hereinbelow.
(C) I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment,
and together with any insurance policies thereon, as follows :
( 1) Twenty-five (25�) percent thereof
to my son, RICHARD A. GALLINA.
Should RICHARD A. GALLINA prede-
cease me, then I direct that his
__ _
_ _
share under this, my Last Will and
Testament, be divided equally
between my daughters, ELIZABETH ANN
WROGA and ALICE JANE GALLINA.
(2) Twenty-five (25�) percent thereof
to my daughter, ELIZABETH ANN
WROGA. Should ELIZABETH ANN WROGA
predecease me, `h°n T_ direct that
her share or shares under this, my
Last Wi11 and Testament, pass to
her issue per stirpes by represen-
� tation.
-a
�� (3) Twenty-five (25$) percent thereof
` to my daughter, ALICE JANE GALLINA.
-�� Should ALICE JANE GALLINA prede-
``'a`' cease me, then I direct that her
w�. share or shares under this, my Last
� Will and Testament, pass to the
HUMANE SOCIETY OF HARRISBIIRG AREA,
� �"` INC. , to be used for general pur-
poses as that organization deems
appropriate.
(4) Twelve and one-half (12-1/2�)
percent thereof to my grandson,
JOSEPH M. GALLINA, son of my
deceased son, MICHAEL P. GALLINA.
Should JOSEPH M. GALLINA predecease
me, then I direct that his share,
under this my Last Wi11 and Testa-
ment, pass to my granddaughter, ANN
M. GALLINA.
(5) Twelve and one-half (12-1/2�)
percent thereof to my granddaugh-
ter, ANN M. GALLINA, daughter of my
2
deceased son, MICHAEZ, P. GALLSNA.
Should ANN M. GALLINA predecease
me, then T direct that ner share
under this rny Last Will and Testa-
ment, pasa to my grandspn, JOSEPH
M. GALLINA.
3ECOND: No pravision is made in this, my Last Wil1 and
Testamerit, £or my w�fe, JEANNEmTE M. GALLINP., not necessarily
because of any lack of affection for her, but because she is
already well provzde� far.
THTRD: I have made no provision in this, my Last Will
and Testament, for my grandchildren, THEODORE GIpLdTTI and ANGELA
GIQLOTTI . I also wish that it be known that I have had no
.� contact from my grandchildren, THEODORB GIOLOTTE and ANGELA
w
; ;
GIOLOTTI, in more than twenty-five {25} y�ars.
F URTH: In addition to all powers granted to them kry
�: '�.
law and by other provisions of tYais Will, I give the fiduciaries
"!� acting he�eunder the fallpwing powers, applicable to all prop-
� '� erty, exerczsable without court approval and effective until
� actual distribution of all praperty:
a {A) To se11 at public or private saie, or to lease,
r'�%" for any period of time, any real or personal groperty and to give
\r'�;
opti_ons for sales, exchanges ar leases, for such prices and upon
such terms (including crec3it, with o: without security} or
conditions as are c?eemed proper. This includes the power ta give
Iegally sixfficient instruments for transfer of the property and
to receiva the praceeds of any disposition of it.
(B} To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning ar management of real estate and ta
impase or extinguish restrictions on real estate.
{C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
t�3) fio invest in zll farms of propexty, including
3
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiducia-
ries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granbed
in irsurance policies or in other investments .
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limit.ed to, personal income, gift and estate or inheritance tax
laws .
(G) To make distributions to my herein named benefi-
ciaries in cash or in kind or partly in each.
� (H) To borrow money from themselves or others in order
� to pay debts, taxes , or estate or trust administration expenses,
:�
�.- to protect or improve any property held under my will, and for
,�, investment purposes .
�� (I) To select a mode of payment under any qualified
:�, retirement plan (pension plan, profit sharing plan, employee
' stock ownership plan, or any other type of qualified plan) to the
`� extent the plan or the law permits them to do so, and to exercise
y
�` ,"� any other rights which they may have under the plan, in whatever
��
manner they consider advisable.
FIFTH: I direct that all inheritance, estate,
tran�fer, successioa and c'.eath taxes, of any kind whatsoever,
whicr may be payable by reason of my death, whether or not with
respect to property passing under this Will, sha11 be paid out of
the principal of my residuary estate.
SIXTH: All interests hereunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
i�eneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
4
SEVENTA: I nominate and appoint my daughter, ALICE
JANE GALLINA, Executrix of this , my Last Will and Testament. In
the event of the death, resignation or inability to serve for any
reason whatsoever of the said ALICE JANE GALLINA, I nominate and
appoint JP.MES D. BOGAR and SENNIFER B. HIPP, as Co-Executors of
this,. my Last Will and Testament . I direct that my Executrix or
Co-Executers, as the case may be, and their successors, shall not
be required to post security or a bond for the performance of
their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this ;�� day of
�� ��.e ,�z-'7� , 2007 .
9
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� �C �-�C:�, _ � c���r��Yl _ (SEAL)
�`� RICHARD F. GALLINA
c,y.�
` :
� Signed, sealed, published and declared by the above-
' � named Testator as and for his Last Wi11 and Testament in our
-�,
;: ,r
� presence, who, at his request, in his presence and in the
��' presence of each other, have hereunto subscribed our names as
attesting witnesses .
Address
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Address ,
5