HomeMy WebLinkAbout09-20-13 1 1505610105
J REV-1500 EX(a2-af)(FI)i
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes ' County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN
Harrisburg,PA 17128-o6oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04/12/2012 05/31/1915
Decedent's Last Name Suffix Decedent's First Name MI
GARRETT RAYMOND J
(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
CD 1. Original Return O 2. Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
Gil 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10, Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
THOMAS E. FLOWER (717) 243-5513
REGISTER OF WILLS USE,ONLY
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CD ry1
First Line of Address C
FLOWER LAW, LLC
Second Line of Address
J
10 W. HIGH ST
City or Post Office State ZIP Code ' C DATE FILED
CARLISLE PA 17013 Cn c <�
o
Correspondent's e-mail address:TOM @FLOWER-LAW.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,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI ATUREAF PERSON R O, E FOR�IG�ETURN D AT
& d 671
aa�i3
ADDRESS
PRISCILLA DUNKLEBERGER, EXECUTRI , 25 GOBIN DRIVE, CARLISLE, PA 17013
SI F PRZ9ARUk6 THAN REPRESENTATIVE ATE
ADDRESS
FLOWER LAW, LLC; 10 W. HIGH ST., CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
J 1505610205
REV-1500 EX(Fl)
Decedent's Social Security Number
Decedent's Name: RAYMOND J. GARRETT
RECAPITULATION
I. Real Estate(Schedule A). .. . . . . .. . . . ..... .. . ... ... ..... ... . . ... . . 1.
2. Stocks and Bonds(Schedule B) . . .... . .. .. ... .. . ... .. . .. . .. . .. .. .. .. . . 2. 7,685.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3.
4. Mortgages and Notes Receivable(Schedule D).. . .. . ... . .. ... . ... . ... . .. . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. . .... 5. 221,087.00 .
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. . . . 6. 69,241.00
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) C=) Separate Billing Requested... . . . .. 7.
8. Total Gross Assets(total Lines 1 through 7).. . . .. . ... . .. . .. . . .. . .. .. . .. . 8. 297,953.00
9. Funeral Expenses and Administrative Costs(Schedule H)... ... . ... . .. . .. .. . 9. 28,052.21
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). ... . .. . .... .. . 10. 1,817.00
11, Total Deductions(total Lines 9 and 10). . . .. . .. . . .. . . .. . . .. .. . ... . .... . . 11. 29,869.21
12. Net Value of Estate(Line 8 minus Line 11) . . . .. . ... .. ..... . .. . .. . ... . .. 12. 268,083.79
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. 268,083.79
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0 45 268,083.79 16. 12,063.77
17. Amount of Line 14 taxable
at sibling rate X.12 17,
18. Amount of Line 14 taxable
at collateral rate X.15 18,
19, TAX DUE ... ..... .. ... . . ...... . ..... . .... . ... . .. .... ... . ... . .. .. . . 19. 12,063.77
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 7
DECEDENT'S NAME
RAYMOND J. GARETT
STREET ADDRESS - - -- - --- -------
25 GOBIN DRIVE
CITY - - - - -- --- --- - -- - i-STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 12,063.77
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 12,063.77
3. Interest
(3) 248.29
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 12,312.06
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.......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest .............................................................................................................................. ❑ ■
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate 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
contains a beneficiary designation? ........................................................................................................................ ❑ N
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 Jan. 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)(11)(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.iso;EX.(8-%z)
'yJ' pennsylvania SCHEDULE B
DEPARTMENTDFREVENUE p
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Raymond J Garrett
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Old National BAncorp 185.197shrs 2,446.00
2 American Electric Pourer 13.447713shr 595.00
3 Comcast Corporation-claim 100698490 from Pa Treasury unclaimed property payment 4,644.00
TOTAL(Also enter on Line 2, Recapitulation) $ 7,685.00
If more space is needed,Insert additional sheets of the same size
. 020008
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(812) 464-1296 - (800) 677-1749
RAYMOND J GARRETT ESTATE 31933
PRISCILLA G DUNKLEBERGER EXECUTRIX
25 GOBIN DR
CARLISLE PA 17013
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06/11/13 185 . 197 $13 .4082* 1
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$2, 483 . 16* $27. 78* $2, 446 . 121
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BROKER COMMISSION
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$9 . 26*
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DON'T DELAY: CALCULATE YOUR COST BASIS NOW! j
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Remittance Advice 000078 85 68121162
Pennsylvania Treasury - Bureau of Unclaimed Property Payment
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CLAIM # 100698490
________________________________________________________________________________
Property ID Holder Name Description Amount
11516635 COMCAST CORPORATION DIVIDENDS 206.33
11516636 COMCAST CORPORATION UNDERLYING 4,437.45
Total: 4,643.78 !
i
o PAYEE INFORMATION: NOTE: Direct payment inquiries to:
GARRETT RAYMOND J ESTATE OF PA Unclaimed Property 1.800 222.2046
25 GOBIN DR P.O. Box 1837
CARLISLE PA 17013 Harrisburg, PA 17105-1837
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REV-iSoe EX+(oa-tz)
j7 pennsytvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Raymond J Garrett
include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Janney Montgomery Scott Acct 3553.7303 44,727.00
2 2005 Saturn 61473550202 5,000.00
3 Cash-Return of Diakon Entrance Fee for right to occupy cottage unit 86 171,360.00
TOTAL(Also enter on tine 5,Recapitulation) $ 221,087.00
If more space is needed,use additional sheets of paper of the same size.
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S_A',M061NTr "Q15GOUNP: . NETAMOUNT -:
31213 03/12/13 ENTRANCE FEE RE 171360.00 0.001 171360.00
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DL4NONLUTHERANSOCL4L M'IMSTRIES
67096 ESTATE OF RAYMOND J GARRETT 26096 1 03/27/13
INVOICE DAT,E, ..: .tN,Vti10E:tTESCRi;FiION��,:. %15JUHr::. .. DISCOUNT NETAMOUNi_
31213 03/12/13 ENTRANCE FEE RE 171360.00 .0.00 171360.00
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, ..-.: . .a..:. -.:.'_ . .x,.x:v.ra.:aa.::.^:._wiew•:m:t::,.. rr;•:a.:.rc:n:��s�..ay, _ _ . .
THE FACE OF THIS DOCUMENT NAS A COLORED BACKGROUND ON WHIM PAPER
DL4KONLUTHERANSOCL4L MIMSTRI'E~S MaTBANK
960 CENTURY DRIVE zass so oueen St i3
MECHANICSBURG PA 17055 YOk PA 17403
313
.... ., , i
03/27/13 26096 *171,360.00'
i
ONE HUNDRED SEVENTY-ONE THOUSAND THREE HUNDRED SIXTY AND 001100--=
Vold after tea days
1
PAY ESTATE OF RAYMOND J GARRETr 67046
TO THE C/O PRISCILLA DUNKLEBERGER. '
ORDER 25 GOBIN DRIVE
CARLISLE PA 17013
I'm S teoLdmd EN 000 an
THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK—1O D AT AN ANGLE TO VIEW
000260960• 1.0.3 1 30 29 5 51.984899619611' j
REV-1509 E%+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT TAX RETURN JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
If an asset became jointly owned within one year of the decedent's date of death,It must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.Priscilla G Dunkleberger 25 Gobin Dr. daughter
Carlisle, Pa 17013
E,
C
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '%OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK AMOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER,ATTACH OEED FOR JOINTLY NEW REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
L A. 11106105 Orlstown acid 143000513 chkg 8,576.15 50 4,288.00
2 A 11/06105 Orrstown Aoct 743000203 svgs 937.86 50 470.00
3 A 11106/05 Onstown CD 400D039140 21,719.00 50 10,860.00
4 A 11106/05 Onslown CD 4000038775 5,065.00 50 2,533.00
5 A 11106105 Sovereign Acct 41250208 Chkg 1,077.00 50 539.00
6 A 1110M Sovereign Acct 1694061256MMK 7,143.00 50 3,521.00
7 A 11/06/05 Sovereign Aoct 8331394603 Svgs 212.00 50 106.00
8 A 11106105 Sovereign Acd 1695542496 CO 18,101.00 50 9,050.00
9 A 11106/05 Janney Montgomery Scott Acct 3553-7301 75,748.00 50 37,874.00
TOTAL(Also enter on Line 6, Recapitulation) $ 69,241.00
If more space is needed,use additional sheets of paper of the same size.
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Printmail Group
Date 4/13112 Page 1 — — -Primary Account 143000513
Enclosures
�4-a
Raymond I Garrett
Priscilla G Dunkleberger
86 Schimmel Way
Carlisle PA 17015-7620
a
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ACCOUNT SUMMARY I!
Account Number Account Title Current Balance Enclosures I.
143000513 50+ Interest Checking 8,576.15
743000203 Statement Savings 937.86
CHECKING AC COUNTS
Account Title Raymond 3 Garrett
Priscilla G Dunkleberger
50+ Interest Checking Check Safekeeping
Account Number 143000513 Statement Dates 3/16/12 thru 4/15/12 I
Previous Balance 1,009.14 Days In The Statement Period 31
1 Deposits/Credits 8,000.00 Average Ledger 1,902.46
3 Checks/Debits 433.00 Average Collected 1,902.46
Service Fee .00 Interest Earned 01
Interest Paid .01 Annual Percentage Yield Earned 0.01%
Current Balance 8,576.15 2012 interest Paid .03
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Deposits and Additions
Date Description Amount
4/12 Deposit 8,000.00
4/15 Interest Deposit .01
Electronic Debits and Withdrawals
Date Description Amount
4/12 8007467287 CVS CAREMARK 8.00-
CHECK# 1192
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Printed 4/13/2012 Printmail Group=Page 1 of 3
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Date 4/13/12 Page 2
Primary Account 143000513
Enclosures
Raymond J Garrett
Priscilla G Dunkleberger '
86 Schimmel Way
Carlisle PA 17013
50+ Interest Checking 143000513 (Continued)
—CHECK SUMMARY--
Date Check No Amount Date Check No Amount
4/03 1191 300.00 4/13 1193 125.00
4/12 1192 -See above-
*Denotes missing check numbers
Daily Balance Information
Date Balance Date Balance Date Balance ,
3/16 1,009.14 4/12 8,701.14 4/15 8,576.15
4/03 709.14 4/13 8,576.14
Interest Rate Summary '
3/15 0.010000% '
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SAVINGS ACCOUNTS
AccountTitle Raymond 3 Garrett
Priscilla G Dunkleberger I
Statement Savings 0
Account Number 743000203 Statement Dates 3/16/12 thru 4/15/12
Previous Balance 8,936.45 Days In The Statement Period 31
Deposits/Credits 00 Average Ledger 7,904.82
1 Checks/Deblts 8,000.00 Average Collected 7,904.82
Service Charge .00 Interest Earned 1.01 .
Interest Paid 1.41 Annual Percentage Yield Earned 0.15%
Ending Balance 937.86 2012 Interest Paid 1.41
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Date 4/13/12 Page 3
Primary Account 143000513
Enclosures
Raymond I Garrett
Priscilla G Dunldeberger
86 Schimmel Way
Carlisle PA 17013
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Statement Savings 743000203 (Continued)
Detail Transactions By Date
Date Description Amount Balance
4/01 Interest Deposit 1.41 8,937.86
4/12 Regular Withdrawal 8,000.00- 937.86 ;
Interest Rate Summary
3/15 0.150000%
THANK YOU FOR BANKING WITH ORRSTOWN BANK
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CIF# G024327
Orrstown Bank ACCOUNT
North Middleton Branch NUMBER 743000203
2250 Spring Rd STATEMENT SAVINGS
Carlisle, PA 17013 ACCOUNT OWNER(S)NAME&ADDRESS
(866) 624-4229
Sr: 43 RAYMOND J GARRETT
OWNERSHIP OF ACCOUNT -PERSONAL PURPOSE PRISCILLA G DUNKLEBERGER
❑ INDIVIDUAL ❑ 790 BUCK RUN ROAD
® JOINT-WITH SURVIVORSHIP lend not as tenants In common) EAST FALLOWFIELD PA 19320
r
❑ JOINT-NO SURVIVORSHIP tea tenants In common) "
❑ TRUST-SEPARATE AGREEMENT:
I
❑ REVOCABLE TRUST DESIGNATION AS DEFINED IN THIS AGREEMENT
Name and Address of Beneficiaries:
® NEW ❑ EXISTING
TYPE OF ❑.CHECKING - ® SAVINGS
ACCOUNT ❑ MONEY MARKET ❑ CERTIFICATE OF DEPOSIT
❑ NOW ❑
t This is your (check one):
® Permanent ❑ Temporary account agreement.
Number of signatures required for withdrawal 1
OWNERSHIP OF ACCOUNT-BUSINESS PURPOSE FACSIMILE SIGNATURE(S)ALLOWED? ❑ YES ® NO
❑ SOLE PROPRIETORSHIP
• CORPORATION: ❑ FOR PROFIT ❑ NOT FOR PROFIT '
• PARTNERSHIP X
❑ -- SIGNATURES)-The undersigned agree to the terms Stated on every
BUSINESS: page of this form and acknowledge receipt of a completed copy. The
COUNTY&STATE �-' undersigned further authorize the financial institution to verify credit
OF ORGANIZ iS and employment history and/or have a credit reporting agency
AUTHO ATION DATED: prepare a credit report on the undersigned, as individuals. The
undersigned also acknowledge the receipt of a copy and agree to the
terms of the following disclosure(s):
DAT OPENED 11/17/04 By HEAT •R A WILFO G ® Deposit Account ® Funds Availability ® Truth in Savings
INITI L DEPOSIT$ 16, 916.15 ® Electronic Fund Transfers ® Privacy ❑ Substitute Checks
❑CASH ❑ CHECK ❑ ❑
(610) 384-
HOME TELEPHONE#
BUSINESS PHONE #
DRIVER'S LICENSE #
E-MAIL RAYMOND J GARRETT
EMPLOYERRETIRED I.D. # 176-07-1783 D.O.B. 05/31/15
MOTHER'S MAIDEN NAME RAY
Name and address of someone who will always know your location:
121: X i KSe ll.�(il/ i
PRISCILLA G DUNKLEBERGER -
I.O. # 167-30-4535 D.O.B. 10/1:2/37
BACKUP WITHHOLDING CERTIFICATIONS
TIN: 176-07-1783 ,
]
® 131:TAXPAYER I.D. NUMBER - The Taxpayer Identification X ,
Number shown above (TIN) is my correct taxpayer identification -
number.
• I.D. # D.O.B.
® BACKUP WITHHOLDING - I am not subject to backup
withholding either because I have not been notified that I am
subject to backup withholding as a result of a failure to report all (4):
interest or dividends, or the Internal Revenue Service has notified X• .
me that I am no longer subject to backup withholding.
❑ EXEMPT RECIPIENTS - I am an exempt recipient under the I.D. # D.O.B.
Internal Revenue Service Regulations. I
❑Authorized Signer(Individual Accounts Only) '
SIGNATURE: I certify under penalties of perjury the statements checked in this IX _ '7
section and that I am a U.S.person(including a U.S.resident alien). L J
X � '
ate) I.D.# D.O.B. t
® O1g92 Bankers Systems,Inc.,St.Claud.MN Form MPSC-tAZ-PA 4/1912004 I /page 1 of 2J
A
CIF# 6024327
Orrstown Bank ACCOUNT
North Middleton Branch NUMBER 143000513
2250 Spring Rd CARRIAGE CLUB
Carlisle, PA 17013 ACCOUNT OWNER(S)NAME&ADDRESS
(866) 624-4229 Br: 43
RAYMOND J GARRETT
OWNERSHIP OF ACCOUNT-PERSONAL PURPOSE PRISCILLA G DUNKLEBERGER
❑ INDIVIDUAL ❑ 790 BUCK RUN ROAD
® JOINT-WITH SURVIVORSHIP(and not as tenants in common) EAST FALLOWFIELD PA 19320
❑ JOINT-NO SURVIVORSHIP las tenants in common) -
❑ TRUST-SEPARATE AGREEMENT:
❑ REVOCABLE TRUST DESIGNATION AS DEFINED IN THIS AGREEMENT
Name and Address of Beneficiaries:
® NEW ❑ EXISTING
TYPE OF Q CHECKING - ❑ SAVINGS
ACCOUNT ❑ MONEY MARKET ❑ CERTIFICATE OF DEPOSIT
❑ NOW ❑
This is your (check one):
® Permanent ❑ Temporary account agreement.
Number of signatures required for withdrawal 1
OWNERSHIP OF ACCOUNT -BUSINESS PURPOSE FACSIMILE SIGNATURE(S)ALLOWED? ❑ YES ® NO;
❑ SOLE PROPRIETORSHIP '
❑ CORPORATION: ❑ FOR PROFIT ❑ NOT FOR PROFIT
❑ PARTNERSHIP IX
❑ SIGNATUREIS) -The undersigned agree to the terms stated on every
BUSINESS: page of this form and acknowledge receipt of a completed copy.The
COUNTS&STATE' undersigned further authorize the financial institution to verify credit
OF ORGAI IPTION: \ and employment history and/or have a credit reporting agency
AUTHORIZATION DATED: prepare a credit report on the undersigned, as individuals. The
undersigned also acknowledge the receipt of a copy and agree to the
terms of the following disclosure(s): I
DAT OPENED 11/17/04 By HEA II[ER A WILFO G ® Deposit Account ® Funds Availability ® Truth in Savings
INITIAL`DEPOSIT$ 174, 500.00 ; 91 Electronic Fund Transfers ® Privacy 11 Substitute Checks
❑ CASH t CHECK ❑ - ❑ �+✓�ps'�'n�J/J
HOME TELEPHONE# 84-2108
BUSINESS PHONE#
111:
DRIVER'S LICENSE#
E-MAIL RAYMOND J GARRETT
EMPLOYERRETIRED I.D. # 176-07-1783 D.O.B. 05/31/15
MOTHER'S MAIDEN NAME RAY A0LWt �� ^ ^ _
Name and address of someone who will always know your location:_ (2). , I
PRISCILLA G DUNKLEBERGER .
# 167-30-4535 D.O.B. 10/12/37
BACKUP WITHHOLDING CERTIFICATIONS
TIN: 176-07-1783
131:
® TAXPAYER I.D. NUMBER - The Taxpayer Identification X
Number shown above (TIN) is my correct taxpayer identification
number. )
I.D. # D.O.B.
® BACKUP WITHHOLDING - I am not subject to backup
withholding either because I have not been notified that I am
subject to backup withholding as a result of a failure to report all (4);
interest or dividends, or the Internal Revenue Service has notified X
me that I am no longer subject to backup withholding.
❑ EXEMPT RECIPIENTS - I am an exempt recipient under the I.D. If D.O.B.
Internal Revenue Service Regulations.
❑Authorized Signer(Individual Accounts Only) ,
SIGNATURE: I certify under penalties of perjury the statements checked in this �X
section and that I am a U.S.person(including a U.S.resident alien).
X /
Date
CA I.D.# D.O.B.
4® 01992 Bankers Systems,Inc.,SL Clwd,MN Form MPSGLAZ-PA 4/19/2004 1 (page 1 of 2)
r )
8/16/13 Time Deposit Inquiry 14 : 19 :59
Raymond J Garrett Account number: 4000039140
Redeemed Due to Death/Disability Has messages 1 of 1
Original balance: 21, 573 . 31 YTD interest : . 00
Current balance : . 00 Next pmt date : 10/09/12
1=View 6=Print T=Tset Control : From To
Opt Posted Inputsrc Rate T/C AFF Amount Balance
10/07/11 G 670 D I 5 . 35 21, 681 .42
10/07/11 G 671 C B 5 . 35 21, 686 . 77
11/09/11 G 670 D I 5 . 52 21, 686 . 77
11/09/11 G 671 C B 5 . 52 21, 692 .29
12/09/11 G 670 D I 5 . 35 21, 692 .29
12/09/11 G 671 C B 5 .35 21, 697 . 64
1/09/1'2 G 670 D I 5 . 53 21, 697 .64
1/09/12 G 671 C B 5 . 53 21, 703 .17
2/09/12 G 670 D I 5 . 51 21, 703 . 17
2/09/12 G 671 C B 5 . 51 21, 708 . 68
3/09/12 G 670 D I ' 5 . 16 21, 708 . 68
3/09/12 G 671 C B 5 . 16 21, 713 . 84
4/09/12 G 670 D I 5 . 53 21, 713 . 84
4/09/12 G 671 C B 5 . 53 21, 719 . 37
More—
F4=Redisplay F7=Scan forward F8=Scan backward F16=Sort
F17=Top F18=Bottom F20=Fold/Unfold F22=Tran Codes
8/16/13 Time Deposit Inquiry 14 :21 :51
Priscilla G Dunkleberger Account number: 40000.38775 1
Redeemed Transfer to Orrstown Bank Account _1 of
Original balance: 5, 000 . 00 YTD interest : . 00
Current balance: . 00 Next pmt date: 9/18/12
1=View 6=Print T=Tset Control : From To
Opt posted InputSrc Rate T/C AFF Amount Balance
3/16/12 G 671 C B 2 . 01 .5, 054 . 86
4/18/12 G 670 D I 2 . 14 5, 054 . 86
4/18/12 G 671 C B 2 . 14 5, 057 . 00
5/18/12 G 670 D I 2 . 07 5, 057 . 00
5/18/12 G 671 C B 2 . 07 5, 059 . 07
6/18/12 G 670 D I 2 . 14 5, 059 . 07
6/18/12 G 671 C B 2 . 14 5, 061.21
7/18/12 G 670 D I 2 . 07 5, 061 .21
7/18/12 G 671 C B 2 . 07 5, 063 .28
8/17/12 G . 350000 651 5, 063 .28
8/17/12 G 670 D I 2 . 15 5, 063 .28
8/17/12 G 671 C B 2 . 15 5, 065 .43
8/27/12 M 620 D C 5, 065 . 72 .29-
8/27/12 M 628 C C .29 . 00
Bottom
F4=Redisplay F7=Scan forward F8=Scan backward F16=Sort
F17=Top F18=Bottom F20=Fold/Unfold F22=Trad'; Codes
• ! `�'- �, 4.;_ Please read the important notice regarding overdrafts at the back of is statement _
—.. S't
Ht
000539 04132012
RAYMOND J GARRETT
PRISCILLA G DUNKLEBERGER
86 SCHIMMEL WAY
CARLISLE PA 17015-7620
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page / of = BaMSNwlswaaipnaN S.MeMre.aw 4c bpo aro rexMma4 veeemarbmsonreQn Bemi,nn.am ,41250208
„�, Wrpa Sanbrcer.$A,naeclrvnry,agNaBlbhsawC,kbraan Gl UeNM$blaaM OlMranaNler.
Financial Summary
•• 1 1
RAYMOND J GARRETT
PRISCILLA G DUNKLEBERGER
Deposit Accounts Account Number Average Daily Balance Current Balance
_SOVEREIGN PREMIER CHECKING 41250208 $1,534.26 $�1,077.02
PREMIER MONEY MARKET SAVINGS 1694061256 $7,042.59 _ $7,043.82
STATEMENT SAVINGS ACCOUNT 8331394603 $212.21 1$212.22
Total Deposit 48,333.06
Time Deposit Accounts Account Number Maturity Date Interest Rate Current Balance
12 MONTH CD 1695542496 0227113 0.40% $8,101.30
Total $19.101.30
SOVEREIGN - •• 1 1
RAYMONDJGARRETT Account#41250208
PRISCILLA G DUNKLEBERGER
Balances
Beginning Balance $2,015.45 Current Balance $1,077.02
Deposits/Credits +S1,989.29 Average Daily Balance $1,534.26
Withdrawals/Debits - $2,927.72
Interest
Paid this Period S 0.01 Annual Percentage Yield Earned 0.01%
Earned this Period $0.01 Paid Last Year $0.50
Paid Year-To-Date $0.06 •;
'The interest earned and the interest paid may differ depending on when interest is credited to your account.
Overdraft/Returned Item Fee Summary
Fee description Total for this statement period Total yearto date
Total Overdraft Fees $0.00 '1$35.00
Total Returned Item Fees SO.001 $0.00
Checks Posted
Check It Date Paid Amount Reference Check# Date Paid Amount I Reference
_1530 03119 $80.00 981519490 1535 04106 520_00 49868P1050
1531 03119 S65.00 992617860 _ 1536 04/04 _t 590.00__986039260
1532 03/19 $200.00 992617210 1537 04/03 $77.00 977697615
1533 0321 5200.00 _982079575 E1538 04!06 510.0(_ AARP AARP
1534 0323 $100.00 982656855 1539 04/02 $85.00 j 577609015
10 Check(s)Posted=$2,427.00
An asterisk I')indicates a skip in sequential check numbers. An(E)indicates check was convened to an electronic item.
Account Activity
Date Description Additions Subtractions Balance
03-15 Beginning Balance S2,015.45
03-19 CHECK 1532 $200.00 51,815.45
03-19 CHECK 1530 S80.00 _ $1,735.45
03-19 CHECK 1531 S65.00 j 51,670.45
1
i
pure? 0/'6 I 4125020R
Account Activity (Cont.for Acct#41250208) j
Date Description Additions Subtractions Balance
03-21 CHECK 1533 $200.00 $1,470.45
03.23 CHECK 1534 $100.00 _ l $1,370.45
03-23 Centuryl-ink SPEEDPAY 120322 313868960 530.98 $1,339.47
03-26 FIRSTENERGY OPCO ACH 003284685710 $31.77 $1,307.70
03.30 USPBGC-BETHLEHEM PN PMTSBG MAR 12 $778.88 $2,086.58
1362280GH/12090
04-02 CHECK 1539 - :$85.00 $2;001.58
04-03 US TREASURY 303 XXSOC SEC 040312 $1,210.40 $3,211.98
A SSA
04-03 CHECK 1537 - $77.00 $3,134.98
04-04 CHECK 1536 $1,590.00 $1,544.98
04-05 Un@edHeafthcere PREMIUM 0095481961 . . - $257.12.•_ $1,287.86
04-05 VALUE ADDED/FSA 8002512311120404 $2.00 1 $1.285.86
3247241
0406 STATE FARM RO 27 SFPP 13 S 0340390013 -$94.47 $1,191.39
04-06 CHECK 1535 $20.00 $1,171.39
04-06 AARP AARP 040512 1538. "' $10.00 Ij W61.39-
04-12 UGI UTILITIES UGI BILL APR 12 $84.38 $1,077.01
213.772-1775-81
0413 INTEREST CREDIT - $0.01. - $1x077.02
04-15 Ending Balance $1,077.02
MONEY PREMIER - - Period • 1
RAYMOND J GARRETT Account# 16 4061256
PRISCILLA G DUNKLEBERGER I
Balances
Beginning Balance - $7,042.59 Current Balance j#7,043.a2
Deposits/Credits +$1.23 Average Daily Balance X57.042.59
WithdrawaWDebits -- $0.00 !°
Interest
Paid this Period' -$1.23 Annual Percentage Yield Earned.': - 1) 0.20%
Earned this Period $1.23 Paid Last Year $16.84
Paid Year-To-Date $4.74
'The interest earned and the interest paid may differ depending on when interest is credited to your account.
Service Fees -Itemized Date #Transactions Fee Total
MONTHLY MAINTENANCE FEE 04/13/12 . 1 10.06 $10.06.
FEESWAIVED 04113112 1 -10.00 _ -$10.00
Total $0.00
Account Activity
Date Description Additions Subtractions Balance
03-15 Beginning Balance $7,042.59
04-13 INTEREST CREDIT - $1.23 " i $7,043.82
04-15 Ending Balance $7,043.82
page 3 of 6 41150208
i
i
• _ •• � 0•
RAYMONDJGARRETT `�-:s• '�'•• •,- -." w>a. . -r .T u.r:r ., -.v.a.rb:✓..a -:•..�.curr°E'<
Account#833 394603
PRISCILLA G DUNKLEBERGER
Balances ,
Beginning Balance $212.21 Current Balance $212.22
Deposits/Credits ; a +S0.01 Average Daily Balance I $212.21
Withdrawals/Debits - $000
This balance was calculated for the period beginning"ori'03/01/12 and ending on 03/31/12 . .
Interest
Paid this Period $0.01 Annual Percentage Yield Earned E 0.10%
Earned this,Period $0.02 Paid Last Year 1 $0.24
Paid Year-To-Date $
*The interest earned and the interest paid may differ depending'on'when interest is credited to your account.
Account Activity
Date Description Additions Subtractions Balance
03-15 Beginning-Balance - r j,
$212.21
03-30 INTERESTCREDIT $0.01 I $212.22
04-15 Ending Balance ( $21222
I.
I
I
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Statement Period 03115112 TO 04115112
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2 313 9 269 4: 0011150208.•1530 i ::2313926911: 004 1 2 50 208N 353
41250208 # 1530 03/19/12 $8000 41250208 #1531 05119/12 $65.00
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231372691. . 0011250208e 15 I ,�-_� _...-.e..•-�.-�___
41250208 #1532 03/19/12 $200 20
.00 412508 # 1533 03/21!12 $200.00
j2''�- l f R1rNOlroawRPQ** . Lm� . 1$35.> .
y 1 1tnEPCm .
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1'�aJUn1-" r 231392694: 0011250208e 153$
`f 2313126911: 004 1 2 50 208e1531
41250208 # 1534 03/23/12 $100.00 41250208_#1535_0441 /12 $2.0.00�_-
�.
''�'�"'�'� +1 wrrJpxo J.aJPPQn ° '-159!
RIYMONO 1535 'I 1 RPISCPJANKLEBEPGE ^ I
ORISa+WNxweERCEGGd 3-d$ r� i ,,,ems..�,,,,2rEe6in Utve ..x 9:�1�-- ;.
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...•.ILOGOIt�--- I!`=1313726911: 001250208 1531 r
.23 L392L9 U: " ,OON 250208e 1536 I NM _—
41250208 #1536 04104/12 $1,590.00 `41250208 # 1537 04/03/12 $77.00
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wunn r.
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1 1
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1:231372691. - ,0041250208e1539 y fj.j � I
41250208 # 1539 04/02/12 $85.00
11250208
pave 6 nl( i
REV-1511 EX+ (08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RAYMOND J. GARRETT 21-12-0456
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. WILDE FUNERAL HOME,434 MAIN ST., PARKERSBURG, PA:PROFESSIONAL SERVICES 7,330.00
2. FLOWERS 167.00
3. CLERGY HONORARIA 200.00
4. MEMORIAL DINNER 409.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 5,719.30
Name(s)of Personal Representative(s) PRISCILLA DUNKLEBERGER
Street Address 25 GOBI N DRIVE
City CARLISLE -
Year(s)Commission Paid: 2013
2. Attorney Fees: 10,115.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 3,500.00
claimant PRISCILLA DUNKLEBERGER
Street Address 25 GOBIN DRIVE
City CARLISLE state PA zip 17013
Relationship of Claimant to Decedent DAUGHTER
4. Probate Fees: 319.50
s. Accountant Fees:
6. Tax Return Preparer Fees: 150.00
7. PUBLISH ESTATE NOTICES,CLJ:$75;THE SENTINEL:$67.41 142.41
TOTAL (Also enter on Line 9, Recapitulation) $ 28,052.21
If more space is needed,use additional sheets of paper of the same size.
REV-1512 Ex+ (1242)
pennsylvania SCHEDULE I
Y.
DEPARTMENT OFREVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Raymond J Garrett
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMSER DESCRIPTION OF DEATH
1. Shirley Smith Cottage cleaning 125.00
2 Hillside Storage-unit fees 106.00
3 Diakon Lutheran Social Ministries 1,089.00
a Us Treasury-Income tax 197.00
5 Storage Disiposat fees 300.00
r
TOTAL(Also enter on Line 10,Recapitulation) $ 1,817.00
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
" pennsylvania SCHEDULE ]
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RAYMOND J. GARRETT 21-12-0456
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
I. GERALD GARRETT,4828 N.Plant.Harbor Dr,Little River,SC 29566 SON 112...LESS...$7,500
2. PRISCILLA DUNKLEBERGER,25 GOBIN DR,CARLISLE,PA 17013 DAUGHTER 1/2...PLUS...$7,500
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE,
11 NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT COPY
OF
RAYMOND J. GARRETT
I, RAYMOND J. GARRETT, of South Middleton Township, Cumberland County
Pennsylvania, being of sound and disposing mind, memory and understanding, d
hereby make, publish and declare this as and for my Last Will and Testament, hereb
revoking all other Wills and Codicils heretofore made by me.
FIRST
I direct the payment of my just debts and expenses of my last illness and funera
from my estate as soon after my death as conveniently may be done. If there be.n
cemetery lot available for my interment owned by me at the time of my death,
authorize my personal representative to purchase such cemetery lot with a contract fo
perpetual care, using therefor funds from my estate in such amount as ;she .shal
consider necessary and desirable, and I authorize my personal representative to caus
title to or ownership of such lot so purchased to be vested in such person as m
personal representative shall designate.
Further, I authorize my personal representative to expend funds from my estate
it such amount as my personal representative shall consider necessary and desirabl
for the purchase, erection and inscription of a suitable marker for my grave.
�
R� SECOND
I IlVDSAY
My son, Gerald R. Garrett, has borrowed from me the sum of Fifteen Thousan
2109 Market Stmet -
Camp Hill,PA
($15,000.00) Dollars, which amount shall be treated as an advangement of-is share,o
my estate. 0� z L s
cn� Co ;? r-
.y
THIRD
I give, devise and bequeath all the rest, residue and remainder of my estate i
equal shares unto my children, PRISCILLA G. DUNKLEBERGER, and GERALD R
GARRETT, per stirpes.
FOURTH
In the event that any beneficiary shall contest this my will, said beneficiary'
share of my estate shall be reduced to one ($1) dollar.
FIFTH
In addition to the powers conferred by law, I authorize any persona
representative acting under this instrument, in her absolute discretion:
A. To retain in the form received, or to sell either at public or private sat
any real or personal property;
B. To exercise any options to subscribe for stocks, bonds, or othe
investments, .
C. To join in any plan of lease, mortgage, consolidation, exchange
reorganization or foreclosure of any corporation tin :which my estate or any trus
may hold stocks, bonds or other securities;
D. To sell, transfer, corivey; mortgage, pledge, !ease or e=hange an
property, real or personal, which at any time may form part of my estate, for the
LO of debts or taxes, or for an p
LOWER � payment y pur ose of administration or distribution, fo
LINDSAY
u o9 Ma<>=s¢ea
such prices and upon such terms as my personal representative, in her sole
Camp Hill,PA
discretion, may deem wise, and to execute and deliver deeds of conveyance o
transfer thereof;
z
E. To make settlements and compromises on such terms as my persona
representative in her sole discretion may deem wise without the necessity o
obtaining any court approval thereof;
F. To make distribution hereunder either in cash or kind, as my persona
representative in her discretion may deem wise.
SIXTH
I do hereby nominate, constitute and appoint my daughter, PRISCILLA G.
DUNKLEBERGER, of Carlisle, Pennsylvania, to act as Executrix of this my Last Will
and Testament.
SEVENTH
I direct that my'personal representative shall not be required to give bond for the
faithful performance of her duties in any jurisdiction.
IN WITNESS WHEREOF, I, RAYMOND J.. GA'RRETT, have hereunto set.°my
hand and seal to this my Last Will and Testament, consisting of three (3) typewritten.
pages, the first two (2) of which bear my signature in the;margin for identification, this
day of`V 0!7 , 2009.
RA OND J. ARRETT
SAMIS,
FLOWER &
LUNDSAY
Nrom+eysnruw
2109 Market Street
Camp Hill,PA
3
Signed, sealed, published and declared by the above-named RAYMOND J
GARRETT, Testator, as and for his Last Will and Testament in the presence of us, wild
have hereunto subscribed our names at his request as witnesses thereto, in th
presence of said Testator and of each other.
ADDRESS 2� 1J .
ADDRESS
I p
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, RAYMOND J. GARRETT, - NPvm4s E• � tvuC_�'and �¢ �Q c°
the Testator and witnesses, respectively whose names are signed to the foregoing or
attached instrument, being first duly sworn, do hereby declare"to the undersigned -'
authority that the Testator signed and executed the instrument as his' Last Will and
Testament and that he signed willingly and that executed as his free and voluntary ac '
for the purposes therein expressed, and that each of the witnesses; in the presence
and hearing of the Testator signed the Will as witnesses and that to the 'best of thei
knowledge the Testator was at the time eighteen (18) or more years of f b soon
mind and under no constraint or undue influence.
If��� .
YMON RRETT
it,,'o
Witnes
A R� Subscribed, sworn to and acknowledged before me by RAYMOND J. GARRETT,
LINDSAY the Testator, and subscribed to and sworn or affirmed to before me by
1t3�4 and `j_ny rfl
.I Q4 Mazket Serest — .L i I(� f{1 , Wltne5S6S> this
c�r,P Hiu,PA day of tt E , 2009.
Notary Public
BARBARA S STEEL,Notary Public
Cullsle Borg Combcrisad Coo*,PA
4 M Commission Ex irce Jnna 7,pit