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HomeMy WebLinkAbout10-15-13 (4) 15�5610143 � 00 �(°2-��� �` OFFICIAI USE ONLY REV��� C�riy C,� y�r File Nurt� pp pepartrnent of Revenue ���va��ia Bw+eau of indiv�dual Taxes �NNERtTANCE TAX R NTRN 21 13 0 618 PO BOX.280601 Harrisburg,PA 1 7 1 2 8-0 6�1 R E S I D E h 1 T D E C E D E ENTER DECEDENT INFORIIA�►TION BELO Date of Death Date of Bi�th Social SecuritY Number O l 0 4 19 62 Ol 14 2013 �t Suffix Dec�edenYs First Name E peoedent's t.ast Name Cp�tQL�N STRUDWICK (ff APPricable)Er�tsr Surviving Spouse's InfcNmation Below MI g� Spouse's First Naare Spouse's La�Name SpoUSe's�oaal SecuritY Numbe� THIS RETURN MUST BE FItED fN DUPi-NCATE WITH THE REGISTER 4F WILLS FILI.IN APPROPRIATE OVAI.S BELOW �Retum � 3. ����(Date ai Death a ,.fkiyin�R� ❑ 2. Supple�l� � 5. Fedc�ral Esta�e Tauc Re�um ReqWred a 4.L�d� ❑ 48.��� 2_,2-82� a uvi�D Tn,� � S. Totai Numbef of Safe�ePosit Bo�a� 6 pec�l�'�t pied Testate � 7. �I���oMy�� ❑ (q�,�opy°1V�i1 11.E�to t�cu��6eC.�113� �p�t� ❑ Sctfed �ute u}, � :� 10.��p�-t 1�9.5�� � w C'�1 � 9. ,:�,Pt�oo�R� ❑ T0: TION .TH1S SECT1dN MIUST BE COMPI.ETE�•Au-GORRESPONOENCE ANO CONFIOENTIAI-T � ""-- :� NT � N�ne 71,� 5�6� 3g-3:8 � � � �:_ �y. cn � �' JEFFR�Y I4I MO'r�'ERN ts'� '""',, �g�9'�:..�3F M�I�S 115�C�.Y � r..�.., :.....� �7 . ;,;;_p F---+ :,., �,r„I . i.,,... First Line c�f A�r� � � � � "Tt �� r� 2 8 E MAI� ST Secand Line of Addr� � B��, $7 DATE FIIED Stabe ZlP Code City or Post Of�ice p� 3,7 0 3 6 g�LSTCn� correspon�t's e-maNi adaress: sc�,ead�,,es a�rd m the r�est o�t�ffi�w��t�. t hsve�amir�d this�m,a�din9 ao��9����i�n�xn���which� Utbar �p�l�Y���'��,�d����parer otlter lttan 1t►e Pe�'�+�ry�F�'� D/tTE It(s tiv��'�' �R��,iG �Q �'c"" Jeffrey M Mo�tern,Es uire no 28 E ain S� Hummelstown PA '�7036 a► SIGNA OF PREPARER THER THAN REPRESENTATNE ES l!11'@ � �" Jeffrey M Mottern� Q 28 E M�in St,Hummelstown,PA 17036 Side 1 1 50561�143 � � 15t]5b10143 � � 150561�243 � REV-1500 EX Decedent's Social Security Number 209 50 9416 �a�m•5 Na�: Strudwick, Carolyn E RECAPITULATION 35� 928 80 ........................................... 1. 1. Real Estate(Schedule A)............................................ 3 �397 _ 92 2. Stocks and Bonds(Schedule B)............................................................................. 2. . 3. 3. Closely Held Corporation,Partnership or Sole-Propnetorship(Schedule C)....-.-•• 4. 4. MoRgages&Notes Receivable(Schedule D)........................................................ 9� 6 g g. 4 5 5. Cash,Bank Deposits&Miscellaneous Personal Properry(Schedule E).....•••.••.••• 5. Schedule� ❑ Separate Biilin9 Requested..........•• 6• 34, 924_37 6. Jointly Owned Property( �robate Property 62 ,343 _83 7. Inter-vvos Transfers&Miscellaneous� Separate Bilim9 Requested.-..•-••••-• 7• (Schedule G) 14 6,2 8 4 .3 7 ......................... s. 8. Total Gross Assets(total Lines 1 through 7)............................... 21,142 _23 9. g. Funeral Expenses and Administrative Costs(Schedule H).........-.••••••••••••••••••••-•••• 8 �396. 66 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)...-••.•.•••-••••••••••••••• ��' 29�538 . 89 .... 11. 11. Total Deductions(totat Lines 9 and 10)............................................................ 116,7 4 5 . 4 8 . .... ....................... 12. .. . . 12. Net Value of Estate(Line S minus Line 11 •••••••-•••••••-•-•••'-'�'' 13. Charitable and Govemmental BequestslSec 9113 Trusts for which 13. an election to tax has not been made(Schedule J)••••••••�•••-•••-• •�- ],16,7 45 . 48 . ....................... 14. 14. Net Value Subject to Tax(Line 12 minus Line 13)........................ TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable Q . 0 0 at the spousal tax rate,or �5 transfers under Sec.9116 (a?(�.2)x.o0 5,253 . 55 16. Amount of Line 14 taxable 116,7 45. 48 16• at lineal rate X .�5 0 .0 0 �7, Amount of Line 14 taxable 0 . 00 ��• at sibling rate X.12 0 . 0 0 18. Amount of Line 14 taxable 0 . 0 0 �8• at collateral rate X.15 5,2 5 3 .5 5 19. TAX DUE.................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 1 1505610243 J � 1505610243 REV-1500 EX Page 3 File Number 21-13-0618 Decedent's Complete Address: PDECEDENrSNAME k, Carolyn E meadow Street STATE 21P sburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 5,253.55 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4. if Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund ° 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 55 2553.5555 Make Check Payable to: REGISTER OF WELLS, 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?............................................................ 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?.................................................................................................................. ❑ 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)(1)]. 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)1. • 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 172 P.S.§9116(a)(1)]. •The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent(72 P.S.§9116(a)(1.3)]. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev-1502 EX.(01-10) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Strudwick,Carolyn E 21-13-0618 AN teal property owmed solehy or asatanaat in common must be ropdttod at{air nlErket value.FaM matKet vahte isdelinecasthole at which propettyvrouid bo ex�d+arigatl beivreen a willing buyer arei a willing seller,neither being compelled to buy or sell,both having reasonable knoxle0go of the relevant tads. Real property that is iotndyawrted wfth right of suMvorship must be disclosed m schedule F. Attach a copy of the sedlement sheet if the property has bean sold Include a copy of the deed shoving decedenrs Interest if coned as tenets in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Edge Avenue&Canoe Road, Bensalem,Bensalem Township,Bucks County,tax parcel nos.: 35,928.80 02-056-036 and 02-056-007, tax assessment$3,880.00 times CLR of 9.26 TOTAL(Also enter on Line 1,Recapitulation) 35,926.80 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10) Rev-1583 E%+(6-98) SCHEDULE B STOCKS & BONDS CCMMONWMA 10FPENW6 VANIA INHERITANCETA%nETURN RE91DEN1"DC-CE1'EM ESTATE OF FILE NUMBER Strudwick,Carolyn E 2143-0618 AN property jointlyawned vAM right of survivorship must be disclosed w ScheEute F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 Series EE savings bonds-see attached list 3,397.92 TOTAL(Also enter on Line 2,Recapitulation) 1397.92 (R more space is needed,addigonal pages of the same size) Copyright(c)2002 form software only The Lackner Group,Inc. 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'.. �._. a ��a` - j �, : . : �� �� J� 3 '� ..�_ E i� ��4�`�.� � � 4 1�!ct. i^�g 4'r W�` �s:f F � �,��e 1� r .��:T�yi' �tl � (� �i t L:..,�� ������,�� k . \� � ;� �. .��` � ,h � 6 ,1 � ��` \ �1T'��'� � � , ' . '. . \ h� �C ' t I � � Y� � 7�� . ~��\��`��iA �d ����.y. ��}.�L N N' ��� 1��" ~7 t . , . . �: � 1.�3.��L�A� `C.?'`?c.'.�5� I ��: � R� � .. ... � - � . , . �., t ` � ` y�' '�� �� � � 2 8Aig � � �j{ N �2 - . . . i" `t ,,. . � ..�y;� . ' ..�� � ' ` . 2 ��i•�.. t- ��� "��� ` !!� � � f �{ ' Z . .. ��`�. 2 • : ` �-' �v1.. C!K '� �� ��` .$! . . � - , . .... � \ `�,•.- �2. : . ��. �. .' . .:� �\. :. ��.`v�;k���a �1�$\� �..:. . . . . � ; ��a�'� � `* `°;` �°.� ���`��� ` � . - ,. .s "`t- . _ , ''„ � , t ., .� ., "�- �,,�v.,� �°���� ��. � ��� ��� ���y� `�.`��� � A ���.�`c s��=-� ��� �f'� �, ::�` ,.. \�,1 ,` ��?S`'\ ``,-V�>...�^V 7a�,c sa����s�„<:����:&�� an�$ \�?3. C. \R.��"��Y� f�. . � � , R'"-,�°``",-,°, SCHEDULE E pennsyivania CASH, BANK DEPOSiTS, &MtSC. �"�,�"'TO�RE"E""E pERSONAL PR4PERTY INHERRANCE TAX REl'URN RES�NT DECEDEMT F1LE NUMBER ESTATE OF 21-13-0f 18 Strudwick,Caro n E k,�,d,y��of Hqgaaa,ffi,a the d�de tl,e aooaed$were recei+rea br�ne�. pN��perly joinqy�oMn�ed wttl�1M ri9ht of s��P�b�disclos�d o�s�d�°F. VAUJE AkT DATE ITEM DESCRIPTION ��� NUMBER � 2.845.tI0 1 Gash on hand at time o#deatfi . 2 1st Ba�k Sea Isle City,checki�g account�umbered 175'90�10647 81.64 . 2.500.00 g pecede�t's misceilaneou�personal effects t�anal,junk value ��'� 4 1990 0ldsmobile Calais,lflN-1G3NL54U7LMT$Q051,non-apera. 67.84 g Og1a5113-Pinnacle Healtfi,refu�d . 29.73 6 06/05i13-PPL Etectric,refund 80.22 7 06/05/13-Yet�zot�wireless,refund � t ee cornpensation 1.602.02 8 p6t30113-Un�ted Sta�es Postal Service,unpa d emp oY g OTM5113-U.S.Treasury,refund from decedenYs 2012 fiaderal income tax 1.40T.00 �p 08121M3-State of New Jersey,r8fund from decederrt's 2012 state income tax retum 826.00 TOTAL(Also enter on Lir�e 5.�ecap+�u�atia�l 9,689.45 (If more spaoe is needed.adaitiona�pages of the same s�ze) Copyrigirt(c)2Q10 form soflwate onty��ner Group,lnc. Form PA-1500 Sd�edule E(Rev.11-10) R•°-,�°`+��'-,°, SCHEDULE F pennsylvania - - �,�,���,,,� JOINTLY-OWNED PROPERTY �ERITlINCE TI1X� ��1DENTD��"'� FILE NUMBER EST�TE OF 21-13-0618 Stru�w�ck Caro n E �a����d��„���a���� N an ssset was made joMn�°^e Y°x AODRESS RELAT�ONSHIP TO DECEDENT SURVIVIMG JOINT TENANTtS)NAME 11Aother a ��S�dW�k 206 Longmeadaw Street Mechanicsburg,PA 17055 241�Lank Road Sister g, Artne Feathers �polino,FL 32577 311 North Edgevvood Street Brother G. pffred Strudwick A�ington,VA 22241 .lO1NTl.Y OWNED PR�ERTY: o,►�c�o�►TM DESCRIPTlOIV C�PR�F'ERTY �� viu.uE oF �E�l'ER oaTE u�x.�r�oF Fa�wcw.a�srrturiow�m ea�c ncco�vr r�►TE oF oEA-I�+ DEC��s oE�rs a��sT tTEM ��� MqpE w�o�t s����.n,r'racN o�u Fos� /�LUE QF ASS INTERE�►T NUM6ER ��T .lQIf�IT JOINRY-HELO REAt.ESTATE. ��q33.33 locatied at 206 206.600.00 16.66794 � ���C�p�E pgtQ411g�6 Re$ide�tia1 p%�Mechanicsburg,Monroe tondmea�dow ToMrnship,Cumberland County, Penr�sylvania,l�x Pa�l no.:22•24-0785-006, ta�c assessmsr�t of 5206,fi00.00 times the CLR 1.00 2 A 07126/1979 Members 1s#F�11�o nion,Savings 26.47 50.� 13.24 account numbe � A 09f2912t)10 Members 1st Federai�r�ecii�Union,checking 937.00 511.Q009�. 4�68.50 account numbered 14+448-11 a � 1 W10H 885 1�Aembers 1 st Federat Cretlit Unian,maaeY 18.60 50.00096 9.30 managemer�t accourrt numbered 14448-�5 34,924.3T TOTAL tA��o enter on Line 6.Rec�p����On) (If more spaoe is needed,�ditionai pages o�the same size) Farm PA 1500 Schedufe F(Rev.01-10) CQpY�ght(c)2010 fo+rm software only The Ladcner Group,inc. .: Jl.�1-27-2013 12:28 From: 1ST FCU � '7177955176 To:717 566 37� P.1�2 � � �E�� 1� � F�ERA�,CREDIT[)HIQN ,. V �.i�.�3-.$fl�1�L�CCQUNT: � q�y�N�� 14448-a0 ����t��� 03/�5/1973 prinGpal Balerfoa et Dete of Oeath $26.47 A+canl�d lnterest ri�D�#C C�f I�e$th �0.� Total P'�indpa!�d ACCrt�ed Ir►�reSt �'26.47 Nsme of Jant Owner Ann M.Stnidwick D�JQint�wn�rship Established Ofi/2�M 9T9 CFIE �3 ACCOUNT: • . p���,� • 14448-11 D�A�oocwnt Es�b�ahed 09129J20�t0 Prit�:ip�t B�tanoe at Da�te of Death �93T.00 • � Ac:p�,Nd tnbsr�t#o t��e of De�eth �•Op Tot�1 A�indp�l snd/�oCru�d Inierest �J37.Op Name ofi JdrN Owner Ann M.Strudwidc D�te Joint�wnership�stablished 09/29/'1010 • CCOUN�'• �: � 14d48-OS ������ 10N�11985 Princ�paE�ar1GQ et DBfiC O�F D�ath $18.60 Aaxt�sd Urte�at�Dsts Of Qeath �.� Tt�Ftinc3p�t anci Aocru�d Irrterest $9 8.8Q Name df Joint t?��er J�nn M.Strudwick Date.bfnt Owne�hip EstaWished 1011a19�5 • 5000 LAui.�e IkivC • �'.(�.Hox 40 • Mec6anicxt�m'g.Pcnn,cylvan�A 1?OSS • (800)283 2328 • www.meanbr.r�t st.vrr� . . -- . __ _.. J-- --� - - --._ .. . _.. _. .. _ _ ... _... .. _ . _. JIN�l-27-2013 12:28 Fr om:l"�I'�ERS iST FCU 7177955176 Ta:717 566 3780 P•2'2 • 1R0 S�►VINt3�A�:COUN�`: . �N�n�eds� �aa4s-�o oa�e�a�ounc�e�st�e� aar�7r�� Prindprl B�C1►�t Oate of Cfeath $10,088.43 Acq�taed Interest to Oa�e of Death �0.72 Totai P�irx�pal artti AQCrued Ir�terest �10.Q67.15 Name o���ry Rnn M.Stn�dwidc tRA CLRTlEI�,�,OF OEPOSIT• AcxAt�rrt Nt�rrtberl3tJfflu 14448•45" 14448-16"" D�te A+000ur�#Established U8I1 W2Q�2 0811012011 P�d 8alarioe et Dete af Qe�th $41.665.43 x4.072.10 1�1�r�,�ed Inter+�t to D�t�of C?eath �15.a8 $0,65 Tptst P��c�ipai and Aaxued Irderest �41,�81.01 $4.072.75 IV�m�of 8cnc�iciary Ann M.Strudwic�c Ann M.Strudwidc ' `Rdlov�er trom IRA SevinQ�l�►CCOUnt 14448-10,Originalfy�s�tablished an 0?117N984. **R411vve�'frorr�IRA C�rtific�te of Deposit 14448-18.O�i�inall�t Estabtisl�d on 0110612019. VISA C�aT�,�ARI�ACC�JNT Ao�oount NUmbar 46T�09tl00049405�4'''"' Ds�e A�ounE Est�bGshed � b4/27/1999 BalanGe at D�o caf De�th �4.4Q5-57 ,loint Gerdhoider None "'^"'Contrt�l Pied�e of shar�es MEM ERS 1�FEDERA�CI�EDi UNtON ����� ' � L�igh ne Stallir�s l.end�ng insur�r�c:e S�or't Supervisor June 27,2013 �+tt�e of:Carolyn Str+udwick D�of�:01H4lx01�3 • 3oalal S�curity Nutnher:209-60 94'!� 5000 Louife Drirc • N.U.I3aoc 40 • lVECd�+nic,cburg.f'cnnsylvania l7Q55 • f!�)2�3 2328 - www.momh�cls�arg 1 Rev-�509 EX+(01-10� pe�ns�ivania SCHEDULE F ������ JOINTLY-OWNED PROPERTY '"'�'�T'"��'�" (continued) R€s�Nro�oa�r ESTATE OF FILE NUMBER �trudwick,Carol n E 21-13-0s18 If an�sat was made jd�t wtel�o�e yesr of the deced«ir:daoe of death.it mvat tie reporced Qi+schedufs G. SURVIVING JO1NT 7ENANT�S)NAA#E ADDRESS RELATlONSHIF TO DECEDENT D. John Strudwick 1337 Hainesport&M�laurel Rds. B�er M�.Laurei,NJ 08054 E. Stephen Strudwick 7652 Carlfsle Pike 6rother York Springs,PA 17372 �-'S10D```°�' sCHEDULE G pe�nnsylvania lNTER VIVOS TRANSFERS AND oEP,���,,,roF�aue ��SC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN RES�ENT DECEDENT FtLE NUMBER ESTATE OF 21-13-0818 � Strudwick Carol n E This sc�eduls must be caopleted and fited if the ar�sw�to anY d questions�tlx'�4°^P�tfx�ee of tl�e RE�I-1500�yes. OESCRIPTION OF PRCWERTY OATE OF aEATH %oF oECO�s ��us� TAXABLE �M ��N�� 'fHEIR R5IATIONSHIP T4 DECEDENT MIO ���T IF APPL,ICABLE) VAI_UE NUMBER �p��o��wsf�����T�°E�F��'��A�. VAIUE OF ASSET 10.067.15 1 M�bers 1st Federal Credit Union,iRA savings 10.067.15 100.000% account numbered 14445-10,beneficiary,mother,Ann Strudwick 2 Members 1�t Federail Gr�it Un'ron,IRA certificat,e of 41,681.01 100.0{f4� 41,681.01 depasit accour�t n�mbered 14448-15,beneficiary, mathe�',Ann Strudwick 3 Members 4st Federat Credit Union, iRA certificat�e of 4,0�2.75 100.0009�. 4,072.T5 �it accourtt numbered 14�4�4$-16,beneficiary, mo�ther,Ann Strudwick 4 �gpS Thri�t Savings Retirement Plan,beneficiary, 6,52Z.92 6,522.92 niother,Ann StrudwiCk , 62,343.83 TOTAL(Also enter on Line 7.Recap�l��ationl (If mae spaoe is needed,additiona�Pa9es of the same size) Copyrigfit{c)2009 form soflware oniy T he Ladcner Group,inc. Fomn PA 1500 Schedule G(Rev.08-09) `�"-161°```,°�09, S�HEDULE H pennsylvania o�,►��roF�uE FUNERAL EXPENSES AND �"'�T^"'�"'�'' ADMtt�ISTRaTIVE COSTS �s�Hr o�o� FILE NUMBER ESTATE OF 21-13-06'!8 Strudwick,Caro n E Oecedent's debts must be reported on Schedule 1. ITEM DESCRIPTIDN AMOUNT q, FUNERAL EXPENSES: See corrtinuat�on schedule(sj attached 6,142.� g, AD�MIISTRATIVE COSTS: 1. Pe�onal R�e�ttative's Cammissions Nam�of Perscfnai Representative(s) ' ,Jeff�ey M Mot#ern, s�,�,,� 28 E Main St �;�y Humm�istown state PA z'ro '17036 13,85t1.00 Year(s)Commis�sion Paid 2. Attomev's Fees 3, Fam�y Ex,em(�ion: (ff deoeden#'s address is not the same as daunant's,attach e�lanation)� (�a�n2tirt Street Addce�ss ;� Stat@ _____,_ ZiD Rela�onshio of Claimarrt to Deoedent 2G8.50 4. Probate Fees 5. Acx�ourttarrt's Fees fi. Tauc Retum Preparers Fees 881.73 7. Crttter Administratn�e Costs ' See con�inuation schedule4s}attached . TOTAL(Also enter on line 9,Recapitulation) 21,142.23 �PY�9�(�)�form software oniy The Ladcner Group► Inc. FoRn RA-1500 Sehedule H(Rev.10-09) SCHEDULE H FUNERAL EXPENSES AND ADMiNlSTRATIVE COSTS continued ESTATE OF FILE NUAABER StrudwiCk Caro n E �1-13-0618 �M DESCRIPTION ��� NUMBER Fungr�l E cnense� 6,142.00 1 07/15/13-Malpezzi Funera�Home H_q 6.142.00 2 05102113-S�rage UePot,rent for storage unit 202.96 2$.83 3 05149t13-A11sta�e Msurance � 4 p6�/03/13-Storage D+�pot,rent for storage unit �75'� 5 p6/�q113.Cumberland County Bar Association,Estate Notices 75.00 6 p6126/13-Regis�er of Wiils,Bucks County,fiting fee for flting of exemplified record 30.00 136.44 7 Q7f15/13-TMe Sen�i�el,Estate Notices rerrt for stcra unit ���� 8 07�10113-storage oepot, 9� g 08/21113-Ph��adeiphia County Court,fee to obtain copy of divorce decree 41.58 H-B7 881.73 Cop,yright(c)2002 form softwra�only The Ladcne�Group, inc. Fomn PA-1500 Sd�edule H(Rev.6-98) R`"-'S,Z°`'"z.�' SCHEDULE 1 penn�ylvania DEBTS OF DECEDENT, °E�"`�''"�OFf�""E MORTCAGE LIABILITIES AND LIENS a�rn��Ax� � �sroENr oEC�o� FILE NUMBER ESTATE OF 21-13-0618 Strudwick,Caro n E R.porc d.as i�unra ay u»e.o.d«rt prio��d�u�ac remain.a unpva se�►e daa of d�aa�.��w�n�d n�ica�.x�• VALUE AT DATE �M DESCRIPTiON '���� NUMBER 4,405.57 � M�mhers 1st Federal credit union,NiSA credit card account numbered 4G72090000494454 2 prthapec{ic Institube of Pennsylvania,medical claim unpaid by decedent at time of death 137.38 9 u� id b decederrt a��me of 1.120.83 3 C�W Perfamance,automobile towin and service charges P�► Y death 4 Heaith South Rehabilitation,medica!ciaim u�paid by decedent at time of death 116.16 5 gerics Credit CoNection,inc.,nnedical claim for Quan#um Imaging u�paid by decede+'rt at tim�e 17.10 of d�#h 6 ghepherdstown Family Practice,medical ciaim unpaid by decederrt at tirne of death 433.20 7 g�qu�nna yailey Pain Management,medical claim unpaid by decede�t at time of death 391.90 8 a1p�p�1�P�S Credit Services,inc.,medical claims for Heritage Medica►t�rouP,unpaid 23.94 t�y deceder�aEt�me af death g ���3����11,�ction Services,medicai claim for Gtuest Diagnostics unpaid by 59.27 decedent at tinne of death 10 01120/13-Pinnacie Health Hospitals,medica�ciaim unpaid by d�cedent at tim�of death 300.00 11 011�1/13-Verizon Wir'eless.invoice for cell phone se�'vicE'-unpaid by deceder�t at time of 17Z.79 de�ath 12 10/01t13-Pennsytvania DePar�men#of Revenue,decedent's 2012 State income tax abligation 1,218.52 TOTAL(Also enter on Line 10,Recapi�tation) 8�3�•� (If mone spa�oe is needed.add'�iOnai pa�ges�tl�e same size) �pY�Pub(c)20(�8�orm software oniy The Ladcner Group,ina Forrn PA 1500 Sd�edule�(Rev.12-06) �v-�s�s oc«�o�.�o� pennsyivania SCHEDUL� J ������ MIHER�TANCE TAX RETURN BEN EFIC IARIES �S���� ES7ATE OF FILE NUMBER Strudwick,Caro n E 21-13-0618 RELATIONSHfP TO NANIE AND ADDRESS OF SHARE OF ESTATE NT OF ESTATE NUMB�R PERSON(S)RECEtVtNC PROPERTY DECEDENT �o�� ���� � T/1XA6LE DISTRIBUTIONS jindude outri�htspousaf • distribt�tic�ns,and transfers under Sec.911 a 1.2 Ann M Strvdwick Mother One-hwtdred 24fi l.�ott�ne�r�tdaw Street (1 pp9�)per�csnt N�echanicseurg,PA 17055 residuary Tot�al Etat,er dolt�r amainnts frx c!'�utions shown above on lines 15 th h 18 on Rev 15QfJ cover s �s " . t�(�-TA�(ABLE aISTR16Ul1t�N�: �• A.�POUSAL DiSTRfBIJTiONS UNDER�ECTION 9113 FOR VlI�IICH AN ELECTION TO TAX iS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRlBUTIONS TOTAL UF PART 11-ENTER TOTAL NON TAXABL.E DtSTRIBUTIONS ON ItNE 13 OF REV:1�04 COVER SHE Copyrigfit{c)2010 fonm soflwane o�ly The Lackner Group,inc. Fortn PA-4500 Sd�edule J(Rev.01-10)