HomeMy WebLinkAbout11-14-13 (3) EEJ pennsylvenla 1505610143
DEVARTMEM OF REVENUE EX(06-13)
REV-1500
OFFICIAL Cod USE ONLY
county ty Code ear File Number
Bureau of Individual Taxes
PO SOX.280601 INHERITANCE TAX RETURN 21 13 0257
Harrisburg PA 17128_-0_601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
02 16 2013 11 04 1949
Decedent's Last Name Suffix Decedent's First Name MI
BO%10N JOHN E
(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
0 1, Original Return ❑ 2. Supplemental Return ❑ 3' prior to der Return) (Date of Death
❑ 4. Limited Estate ❑ 4a,Future Interest Compromise ❑ 6, Federal Estate Tax Return Required
(date of death after 2-12.82)
® g, Deoedent Dled Teatate ❑ 7. PAl�eche�opylof<Tiust)a Living Twat 8, Total Number of Safe Deposit Boxes
(Attaoh Copy of Will)
❑. 8. Litigation Proceeds Received ❑ 10,detWeen,gyygt��an�tlOae�)fDeaih ❑ 11.Election to tax under Sec,9113(A)
(Attach Schedule O)
CORRESPONDENT•THIS SECTION MUST BE COMPLETED,ALL CORRI5SPON13ENCE AND CONFIDENTIAL TAX INFORMATION SHOUI-D BE DIRECTED TO:
Name Daytime Telephone Number
ROBERT C SAIDIS 717 243 6222
First Line of Address
26 W HIGH STREET
Second Line of Address O rr1
tit c G7
rn c: Cr)
City or Post Office State ZIP Code D ►--► r-j r tl
rn
CARLISLE PA 17 013
mlkTp F WIL-*UsE L-ry
REGISTER OF WILLS USE ONLY C`) :3
.I ! D Y Y .Y TI -� v C>
cn
Correspondent's e-mail address: rsaldis ssr-attorne s.com DATE FILED STAMP
Under penalties of perjury I declare that.I have examined thls reium including accompanying schedules an 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.
SIGNATURE F PERSON REV NSIBLE FO FILING RETURN DATE
�,� $usan L Muccio
ADDRESS
694 Wamer Road Brookfield, OH 44403
SIGNATURE OF PREPARER 9TH THAN REPRESENTATIVE DATE
Robert C.Saidis 1
ADDRESS'
26 W High Street, Carlisle, PA
Side 1
1505614143 1545610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Bowman, John E.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 247 , 900 . 00
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 185 , 724 . 82
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate, Property
(Schedule G) u Separate Billing Requested............ 7, 278 , 927 . 49
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 712 ,552 . 31_
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 81 , 056.22
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 50,454 . 90
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 131 ,511 . 12
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 581 , 041 . 19
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. 581 ,041 . 19
TAX COMPUTATION-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.00 15. 0. 00
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 00 16. 0 . 00
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 581, 041 . 19 18. 87 , 156. 18
19. TAX DUE................................................................................................................ 19. 87 , 156. 18
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21-13-0257
Decedent's Complete Address:
DECEDENT'S NAME
Bowman,John E.
STREET ADDRESS
5430 Bonnyrigg Court
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 87,156.18
2. Credits/Payments
A. Prior Payments 75,000.00
B. Discount 3,947.37
Total Credits(A +B) (2) 78,947.37
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) 8,208,81
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑
3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which El
abeneficiary designation?.................................................................................................................. x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1502 EX+(01-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate situate at 5430 Bonnyrigg Court,Mechanicsburg, PA-See attached copy of HUD 247,900.00
-1
TOTAL(Also enter on Line 1, Recapitulation) 247,900.00
(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)
OMB Approval No.2502.0265
k� A. Settlement Statement (HUD-1)
B.Typo of Loan
1.Q FHA 2. RHS 3.Q Corn Unins. 6. F6e Number. 7.Loan Number. & Mortgage Insurance Case Number:
4. VA 5. Corn Ins. 13103 0214532327
C. Note: This form Is famished to gAe you a statement of actual settlement costs Amounts pad to and by the settlement aged are shown.
Items marled'(PoLa)'were paid outside the dosM,•lhey are shown two 16r 6r1ormatfonalpurposes and are not inducted br the totals
D. Name and Address of Borrower: E. Name and Address of Seller. F. Name and Address of Lender.
Virginia D.Johns Estate of John Bowman Members 1st FCU
,Jeffrey F.Johns Susan L Muccio,Executrix P.O.Box 40
Mechanicsburg,PA 17055
G Property Location: H. SettiamentAgent 1. Settlement Date:
5430 Bonnyrigg Court Keystone Central Settlement Company LLC
Mechanicsburg,PA 17050 2595 Interstate Drive,Buie 105 July 18,2013
Cumberland County,Pennsyhrania Harrisburg,PA 17110 Ph. (717)909.1400
Place of Settlement:
2595 Interstate Drive,Suite 105
Harrisburg,PA17110
J.summary of Borrower's transaction K. Summary of Setter's transaction
100. GrossAmount Due from Borrower. 400.QossAmount Due to Seller:
101. Contract sates rice 247 900.00 401. Contract sales prim 247 900.00
102. Personal property 402. Personal property
103. Settlement Charges to Borrower Lie 1400 7,695.83 95.83 403.
104. 404.
105. 405,
Adjustments for Items paid by Seller in advance Adjustments for items paid by Seller in advance
106,CWTown Taxes to 406.Cityfrown Taxes to
107. County Taxes 07/19/13 to 01101/14 31929 407.County Taxes 07/19113 to 01/01114 31929
108. School Taxes 07/19/13 to 07/01/14 2339.88 408.School Taxes 07119/13 to 07/01/14 2,339.98
109. HOAAnnual Dues 07/19/13 to 10/01/13 1 1521 409.HOAAnnual Dues 07119/13 to 10/01/13 1521
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 258,270.21 420.Gross Amount Due to Seller 250,574.38
200. Amounts Paid by or In Behalf of Borrower 500. Reductions in Amount Due Seger.
201. Deposit or earnest money 6,000.00 501. Excess see instructions
202. Principal amount of new bens 198 320.00 502. Settlement charges to Seer ne 1400 20 614.60
203. Ex1jhg bans taken subjed to jAdjustments bans taken sub to
204. Appraisal Fee Credit 425.00 Payoff First Mo 20 PNC'Axantl0000677341 33,350.69
205. eoond Mo a e
206.
207. De os@ dLsb.as proceeds)
208. SaltersASSlstance 1,000.00 Sel�rsASSistance 1000.00
209.
Adjustments for items unpaid b Seller stments for items un id b Seller
210. C' /Town Taxes to C frown Taxes to
211. Coun Taxes to Cou Tams to
212. S chool Taxes to School Taxes to
213.214.215.216.
217. 517.
218. 518.
219. 519. ----------t 220.Total Paid b/for Borrower 205,745.00 520.Total Reduction Amount Due Seller 54,965.49
300.Cash at Settlement from/to Borrower 600. Cash at sattlern toffrom Seller
301. Grass amount due from Borrower(kn 120) 1 258,270.21 601. Gross amount due to Seller line 420 250.574.38
302 Less amount id by/for Borrower(fete 220 ( 205,745.00 602. Less reductions due Seller(fine 520) ( 54,965.49
303. Cash XE From [] To Borrower 52,52521 603. Cash a To Ej From Seiler 195,608.89
.PaoatamddoeirogW bm (B),sdlep.I WWW,asirtpeVn
The undersigned hereby ac!nowledge receipt of corn feted w of this statement&arry attachments referred to herein
Borrower ania Johns Seller
Estate of John Bowman Susan L Mua�,Emaitrix
ug ,It /
BYU'L��
�
Susan M�fmxah�' Seel
L ' traE eta
Johns
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Hs fam,v1-Itd-Plarro aanwey vWOOMSa Vd anion.No CWM-1WtY is.-t Ha dedeuaek Mlgy.TNeI do17mbprudetin pwto baRESH4oaeretl 9wsedimWHcsvma6on Qibg ftsaEwmrt
Pr_
Page 1 of 3 HJD-1
(13103.PFD/13103/19)
L Seftlemertt Charges
700.Total Real Estate Broker Fees $14,874.00 Paid From Paid From
Division of communion(pne 700)as follows,• Borrowers sews
.00 to Keller Willisms of Central PA Funds at Funds at
702.$ 7 437.00 to Keller Williams of Central PA East Setoemati Settlement
703.Commission paid at setfleme 14 874.00
704.Transaction Fee to Keller W76ams of Central PA 300.00
705.
800.Items ble In Connection with Loan
801.Our or Nation cha e $ 455.00 from GFE
802.Your credit or charge points for the specific Interest rate chosen $ (from GFE tit)
893.Your ad" d origination charges from GFE#A 495.00
804.Appralsel fee to Members 1st Federal Credit Union from GFE#3 425.00
805.Credit Report to from GFE#3 :N
806.Tax service to from GFE#3
807.Flood certification to from GFE#3
808. from GFE#3
809. from GFE#3 an _
819. from GFE#3 :.
811. (from GFE#3) KIF(y4•M,
900.Items Required by Lender to Be Paid In Advance
901.Dally Interest charges from 07/18H3 to 08701/13 14 $21.980500/ from GFE#10 307.73
902.Mortgage Insurance premium for months to from GFE#3
903,Homeowner's Insurance for 1.0 from GFE#11 697.84 r. 1'c $_ >A
904. from GFE#11)
905. from GFE#11 ",Alt rf"q 0!t ui
1000.Reserves Deposited with Lender
1001.Initial deposit for ur escrow account (from GFE#9) 643.55
1002.Homeowners Insurance 3.000 months (dj $ 58,15 per month "'
$ 4.45 1; ,"" !; ;
� ;,
1003.Mort
-gage insurance r month
A.�..
months
1004-Property taxes $ IN
a ar =A41 _
County 't:pi, my
T
Axes
m month
School Taxes m month
1006.CountyTax 6.000 months $ 58.50 month $ 351.00 �,' T ,:,j<w.er9 :.r,
1007.School Tax 2.000 months $ 205.11 month $ 41022
1008. $ �i e y �r,d r ran
1009.Aggregate Ad"ustment $ -292.12 X , F � aye M
1100.Title Charges $' i
1101. Title services and lender's title Insurance from GFE#4 1,752.00 250.00
1102. Settlement dosl fee
1103.Owner' insurance to Old Re NaBonal TRIe Insuran (from GFE#51 245.00
1104. Lendee Otle insurance to Old Re ub6c National TAIe Ins n Com 1,595.00 RR,
1105. Lender's tilts policy lim 198 320.00
1106. Owner's t Ile po14 trnti $ 247 900.00 °$i 9
1107. A ent s Portion of the total tale insurance remium one Central Se Coma U 1564.00 ti Ir r,'. 4 M-
1108. Underwriter's Portion of the total We Insurance premium to Old Re ubrce National Title Insurance Com $ 276.00
1109. $
1110.
1111. $
1112. $
1113. $
1200.Government Recording and Transfer Charges
1201.Government record' charges to Cumberland Countv Recorder of Deeds from GFE 166,00 .1',"a i�§'p,'_�
1202 Deed 62.00 Idortoacre 104.00 Releases Other '
1203,Transfer taxes „`
to Cumberland County Recorder of
Deeds from GFE#8 2 479.00 '';_• .
1204.C /Coun teWstam 2 479.00 Mo a e e"
1205.State tawstam s Deed$ 2,479.00 Mort a a$ iM"'ff
1206. ,; 2.479.00
1207.
1300.Additional Settlement Charges
1301.Required services that you can shop for from GFE V e
tl
1302.Home Warran to American Home Shield $ 520.00
1303.Sewerfrrash to Ha den Township Sewer/Trash $ 124.71 30.34
1305.
1304.2013 School Taxes to Michael Langan,Treasurer $ 10.15-1281-022 2,461,26
$
1306. Resale Certificate to Fairwinds Homeowner Association $ 10000
1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K) 7,695.83 20,614.
Paid atsieb ddad,y by bmmw(a),salw(s),w4kLd,a ef'"art m
�'+!TiaO De9etcrass sttanes,an eip�rbas arhpWer�er®Ipt aracanpkred«PY dpeps28L30fW59raepq.9 MmerL
Keystone Central Settlement Gofnpany,LLC,Settlement Agent
Page 2 of 3 HUD-1
(13103.PFDM3103/19)
Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1
Charges That Cannot Increase KUD-1 Line Number
Our or inathn charge #801 455.00 455.00
Your a*sted origination charges #803 455.00 455.00
Transfer taxes #1203 2,479.00 2,479.00
Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1
Government recording charges #1201 238.00 166.00
Appraisal fee #804 425.00 425.00
Title services and lendees title insurance #1101 2,098.75 1,752.00
Owner's ti0s insurance to Old Republic National Title Insurance Cor #1103 247.90 245.00
Total 3,009.65 2,588.00
Increase between GFE and HUD-1 Charges $ -421.65 or -14.01°
Charges That Can Change Good Faith Estimate HUD-1
Inklai deposit for your escrow account #1001 708.34 643.55
Daly Interest charges #901 $ 21.980500/day 303.51 307.73
Homeowner's Insurance #903 750.00 697.54
Loan Terms
Your Initial loan amount Is $198,320.00
Your loan tens Is 30.00 years
Your initial Interest rate Is 3.9900%
Your Initial monthly amount owed for principal,interest and $945.67 includes
any mortgage Insurance is FX� Prindpal
FXJ Interest
❑ Mortgage insurance
Can your interest rate rise? ❑X No ❑ Yes,R can rise to a maxsnum of %.The first
change A be on and can change again every_months after
Every change date,your interest rate can increase or decrease
by %. Over the life of the loan,your interest rate is guaranteed
to never ba lower than %or higher than %.
Even K you make payments on time,,can your loan balance rise? ❑X No ❑ Yes,k can rlse to a maximum of s
Even If you inake payments on time,can your mbnthly ❑X No ❑ Yes,the first increase can be on and the monthly
amount owed forprincipal,interest,and mortgage Insurance rise? amount owed can rise to$
The maximum it can ever rise to is$
Does your loan have a prepayment penalty? ❑X No ❑ Yes,your maximum prepayment penalty s$ .
Does your loan have a balloon payment? ❑ No ❑ Yes,you have a balloon payment of$
due In_years on
Total monthly amount owed Including escrow account payments ❑ You do not have a monthly escrow payment for items,such as property
taxes and homeowners insurance. You must pay Dress Rams directly
yourself.
Q You have an additional monthly escrow payment of$321.76 that results
in a total initial monthly amount owed of$1,267.43.This Indudes
principal,idarsst,any mortgage insurance and any hems checked below:
❑ Property taxes X❑ Homeowner's insurance
❑ Flood Insurance ❑
❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms Rsted on this form,please contact your lender.
Page 3 of 3 HUD-1
(13103.PFD/13103119)
HUD-1 Attachment
Borrowel(s):Virginia D.Johns and Jeffrey F.Johns Selle(s): Estate of John Bowman Susan L.
Muccio,Executrix
Lender:Members 1 st FCU
settlement Agent Keystone Central Settlement Company,LLC
(717)909-1400
Place of Settlement 2595 Interstate Drive,Suite 105
Harrisburg,PA 17110
Settlement Date:July 18,2013
Property Location:5430 Bonnyrigg Court
Mechanicsburg,PA17050
Cumberland County,Pennsylvania
Additional Adjustments For Items Paid By Seiler In Advance(Borrower Debit)
Description Amount From/Through Prorated Amount
HOAAnnual Dues 75.00 10101/12 through09/30/13 15.21
Total Line 1091409 15.21
Seller Loan Payoff Details
Payoff First Mortgage to PNC' Re:Loan 90000677341
Loan Payoff 33,276.16 As of 07/18/13
Total Additional Interest days @ 5.430000 Per Diem
Total Loan Payoff 33,350.89
Adjusted Origination Charge Details
Origination Charge
Origination Fee 455.00
to Members 1st Federal Credit Union
Total $ 455.00
Origination Credit/Charge(points)for the specific Interest rate chosen
Total $
Adjusted Origination Charges $ 455.00
Reserves Deposited with Lender
Homeowner's insurance 174.45
3.000 at 58.15 per month
County Tax 351.00
6.000 at 58.50 per month
School Tax 410.22
2.000 at 205.11 per month
Aggregate Adjustment -292.12
Total $ 643.55
Title Services and Lenders Title Insurance Details BORROWER SELLER
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can
Include a fine and Imprisonment. For details see:Tdie 18 U.S.Code Section 1001 and Section 1010.
(13103.PFD/13103/19)
HUD-1 Attachment- Continued
Courier Fee 40.00
. to Keystone Central Settlement Company,LLC
Incoming Wire Fee 12.00
to Keystone Central Settlement Company,LLC
Tax Certification Fee 20.00
to Keystone Central Settlement Company,LLC
Deed Preparation 115.00
to David R.Breschi
Closing Service Letter 75.00
. to Old Republic National Title Insurance Company
Notary Fee 30.00
to Anne E.Houser
Deed Preparation 115.00
to David R.Breschi,Esq.c(o Pinnacle Land
Lender's title insurance 1,595.00
to Old Republic National Title Insurance Company
Total $ 1.752.00 $ 250.00
Owner's Title Insurance BORROWER SELLER
Owner's Policy Premium 245.00
to Old Republic National Title Insurance Company
Total $ 245.00 $ 0.00
Lender's Title Insurance BORROWER SELLER
`fees also shown above in Title Services and Lenders Title Insurance Details
Lender's Policy Premium 1,395.00
to Old Republic National Title Insurance Company
Lender's Endorsement Charges 200.00
Endorsement Endorsement Charge
ALTA Endorsement Form 5.1 (Planned Unit 50.00
Development)
ALTA Endorsement Form 8.1 (Environmental Protection 50.00
Lien)
Endorsement 100 50.00
Endorsement 300 50.00
Total $ 1,595.00 $ 0.00
V AFiNINQ It Is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can
include a fine and imprisonment. For details see:Title 18 U.S.Code Section 1001 and Section 1010.
(13103.PFDP13103119)
Rev-1$08 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 2011 LST Refund 50.00
2 2012 IRS Tax Refund 79.00
3 2012 State Income Tax Refund 44.00
4 Capital BlueCross-Insurance check for refund of Hampden Township Ambulance invoice 812.50
5 Capital BlueCross-Insurance check for refund of West Shore Ambulance invoice 1,721.39.
6 Capital BlueCross monthly pension 1,775.97
7 Hampden Township-Refund for sewer/trash 155.05
8 Members 1st FCU Checking Account No. 112652-11 -See attached letter dated March 22, 468.34
2013 from Members 1st Federal Credit Union
9 Members 1st FCU Investment Savings Account No. 112652-05-See attached letter dated 148,135.51
March 22,2013 from Members 1st Federal Credit Union
10 Members 1st FCU Regular Savings Account No. 112652-00-See attached letter dated March 72.39
22,2013 from Members 1st Federal Credit Union
11 Members 1st FCU Regular Savings Account No. 357520-00-See attached letter dated March 19.82
22, 2013 from Members 1st Federal Credit Union
12 PA Treasury Department-Pennsylvania State Employees' Retirement System monthly 256.97
pension
13 Personal Property-estimated value-See attached Inventory List 3,140.00
14 Proceeds from Sale of 2004 Acura 91500.00
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 5, Recapitulation) 185,724.82
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
15 Refund from Erie Insurance-Car Insurance 35.50
16 Refund from homeowners insurance 275.00
17 Refund from Keystone Collections Group-LST Refund 22.00
18 Refund from PNC Mortgage-Reimbursement of Escrows 3,801.83
19 Refund from UGI Utilities, Inc. 14.42
20 Refund from Verizon 6.59
21 Refund from Visa Card 24.04
22 Reimbursement for Deed preparation mistakenly billed on HUD-1 230.00
23 Reimbursement for HOA Dues 15.21
24 Reimbursement of 2013 County/Township taxes 319.29
25 Sale Proceeds from 2004 BMW 14,750.00
TOTAL(Also enter on Line 5, Recapitulation) 185,724.82
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10)
.2-2013 11:30 FrowMEMBERS 1ST FCU 7177955176 To:7172436510 P.2/2
St
•
MEMBM I"
IMEMCRSDRUMON
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 112652-00.
Date Account Established 01/13/1:190
Balance at Date of Death $72.39
Balance Date account closed $329.36
::.?,',{ 1 •3.1, F,
6-K11WO ACCOUNfi:
Account Number/Suffix 112652.11
Date Account Established 01/25/1590
Balance at Date of Death $468.34
--- Balance-Date-account-closed - -
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 112652.05
Date Account Established 03/24/11.194
Balance at Date of Death $148,135.61
BIce Fate=Acca0�9t,Caosed;: $147,849.99
RCGUi:,AR•SAVINGS.ACCOUNT:
Amok nt Nu[rlberlS x 357520-00
Qate-Accourtt Establim red:t a 05/28/2009
_ B.ala de at,Date of_Death,;r $19.82 �3 n� ,�=:►A_�r�
a3atatjoe t7ataccit (used $19.82
VISA CRE6&-1&AR6:AC_COUNT
Account lumber,; 4672090000054924"
Date ApcoUnt Established 06/03/2009
Balance at Date of Death $634.25
Balance Date-Account.Closed, $0.00 Paid in full from account funds
*Conteactuel°Piedge of Shares
.. ...... .•ice •.. ...: .. ...». ._..
MEMBERS 1ST FEDERAL CREDIT UNION
�i Tessa L Klugh
Lending Insurance Support Specialist
March 22,2013
Instate:o;•,_JOHN_IB DQWRAAN.
Da#e of Deat�i O2115/Z0.13
Social` ecurity Nuiri6er:174.42-0749
5000 lbuisc give. r P. Bbx 40 • Mechanic iburg,Pennsylvania 17055 (800)283-2328 ww .mcmbuSIS org
A`13 11:49 FH0M-llUlrShHL1Nli-MUUU1U ;i30-b5L-ZUJ
INVENTORY LIST
Leather Sofa &Chair (Auctioneer said it would't go for more than$400.00) $400.00
Piano-Baldwin spinet (40 plus years old,fair condition) $250.00
Large screen N&components $500.00
2 small flat screen TV's (18" &24") $400.00
Rattan patio furniture(3 pc.) Sofa,chair,ottoman (15 years old) $100.00
Stiffle brass lamps (pair) per auctioneer-may get $30.00/pair
Day bed/trundle bed wooden frame w/mattresses(good conditi $175.00
Oak pedestal dining table w/leaf and 4 chairs $250.00
2 Bar stools w/backs(wrought iron) $50.00
Old Mediterranean style bedroom set. Dresser w/mirror,chest of drawers,2 night
stands,headboard w/frame(old mattress&springs) poor condition $100.00
Maple bedroom set,dresser w/mirror, chest of drawers,2 night stands,headboardw/frame,
decent mattress&springs) $200.00
Older small appliances,crockpot,toaster,coffee maker,etc. cookware,dishware,flatware and
assorted kitchen gadgets May be able to get at yardsale $150.00
Leaf blower(electric) & Hedge clipper(battery) $35.00
No power tools and lawn equipment(Mower or tractor,etc-)
2 walnut end tables&coffee table w/marble inset(fair condition) $100.00
Small china hutch(does not match dining table) $40.00
1 floor lamp, 2 small bedside lamps,2 large bedside lamps,desk la $80.00
Computer desk and small office chair,2 drawer file cabinet, paper shredder $80.00
Misc.items: knick knacks,books,framed poster prints(4),old bumper pool table,5 ft
aluminum step ladder, linens(heavily worn), record albums, casettes,VCR tapes. Generous
estimate $200.00
Total $3140.00
1
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE �+
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE ATE OF TROANSFER. ATRTACN A COPY OF THE EIED FOR DECEDENT EAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Vanguard 401(k)-beneficiary cousin, Chad Clark- 278,927.49 100.000% 278,927.49
See attached email dated April 24,2013 from Capital
BlueCross
TOTAL(Also enter on Line 7, Recapitulation) 278,927.49
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
Dolly Hockenberry
From: Wolfe, Michael (CBC) <Michael.Wolfe @CapBlueCross.COM>
Sent: Wednesday,April 24, 2013 4:15 PM
To: Dolly Hockenberry
Subject: RE: Estate of John E. Bowman
Sorry about the confusion. The value in the letter I sent on April 23rd was, indeed, the"current' balance. The date of
death balance is different, although it is remarkably close to the current balance. The date of death balance was: Balance
as of 2116113 $278,927.49.
Please let me know if you need any other information.
Thanks.
MICHAEL WOLFE Senior Counsel I Legal Department
CAPITAL BLUE CROSS Office: 717.541.6366 1 Fax: 717.651.4075
2500 Elmerton Avenue, Harrisburg, PA 17177-2132 1 capbluecross.com
Celebrating 75 Years of Service
From: Dolly Hockenberry [mailto:dhockenberry(aOssr-attorneys.com]
Sent: Wednesday, April 24, 2013 4:00 PM
To: Wolfe, Michael (CBC)
Subject: RE: Estate of John E. Bowman
Good Afternoon Mr.Wolfe,
Thank you for your letter of April 23, 2013. The letter states that the "current" account balance of Mr. Bowman's 401(k)
is$278,595.38. As requested in previous letters,we need a date of death balance for inheritance tax purposes. Could
you verify whether this is a date of death balance also, and if it is not, could you please provide a date of death balance?
Thank you.
Dolly
Dolly M. Hockenberry
Saidis, Sullivan & Rogers
26 West High Street
Carlisle, PA 17013
717-243-6222 - Phone
717-243-6486- Fax
i
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
R SEDENTDEC DENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 10,790.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Susan L. Muccio
Street Address 694 Warner Road
City Brookfield State OH ziD 44403
Year(s)Commission Paid 2012, 2013 25,000.00
2. Attornev's Fees Sa.idis, Sullivan & Rogers 17,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State zio
Relationship of Claimant to Decedent
4. Probate Fees 558.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 27,707.72
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 81,056.22
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Curran-Shaffer Funeral Home-Funeral Bill 7,410.00
2 Freeport Monumental Works-Monument 1,425.00
3 Pine Run Community Church 150.00
4 Reimbursement to Susan L. Muccio for Celebration of Life luncheon-Caddyshack 1,530.00
5 Reimbursement to Susan L. Muccio for Funeral Lunch 250.00
6 Reimbursement to Susan L. Muccio for organist at funeral 25.00
H-A 10,790.00
Other Administrative Costs
7 1%Transfer Tax for real estate sale 2,479.00
8 2013 School real estate taxes 121.38
9 Chris Durenleau-Power washing 120.00
10 Cumberland Law Journal-advertise letters 75.00
11 Deed preparation (mistakenly billed and later refunded) 230.00
12 Executrix's expenses-See attached explanation of expenses 4,041.94
13 Fehl Awning Company, Inc. 86.92
14 Gran-U-Lawn 75.22
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Bowman, John E. 21-13-0257
ITEM
NUMBER DESCRIPTION AMOUNT
15 Hampden Township-Final Sewer/Trash 30.34
16 Hampden Township-Sewer/Trash 155.05
17 Hampden Township-Sewer/Trash 155.05
18 Home Warranty on real estate 520.00
19 Jeffrey Johns-Reimbursement for payment to fix air conditioner 72.00
20 Joseph F. Muccio-labor to clean out house 500.00
21 Keller Williams-realtors commission 14,874.00
22 Lou Solimeo-lawn care 315.00
23 Lou Solimeo-lawn care 227.00
24 Lou Solimeo-lawn care 210.00
25 Lou Solimeo-lawn care 105.00
26 PA American Water 59.71
27 PA American Water 21.24
28 PA American Water 18.05
29 PA American Water 17.12
30 PA American Water 15.26
31 Postage 22.22
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
ITEM
NUMBER DESCRIPTION AMOUNT
32 PPL Electric Utilities 33.64
33 PPL Electric Utilities 30.09
34 PPL Electric Utilities 42.56
35 PPL Electric Utilities 82.01
36 PPL Electric Utilities 137.72
37 Sellers Assistance for real estate settlement 1,000.00
38 Susan L. Muccio-Reimbursement for payment of newspaper ads for BMW 51.00
39 Susan L. Muccio-Reimbursement for dumpsters 63.50
40 Susan L. Muccio-Reimbursement for trash pick-up 288.00
41 Susan L. Muccio-Reimbursement for U-Haul to empty house 412.24
42 Susan L. Muccio-Reimbursement for hotel stays-see attached invoices 545.44
43 Tax Certification Fee 20.00
44 The Sentinel -advertise letters 200.16
45 UGI Utilities, Inc. 166.49
46 UGI Utilities, Inc. 30.15
47 UGI Utilities,Inc. 22.09
48 UGI Utilities,Inc. 14.42
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
ITEM
NUMBER DESCRIPTION AMOUNT
49 UGI Utilities,Inc. 21.71
H-67 27,707.72
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
EXPLANATION OF EXECUTRIX'S EXPENSES
Executrix traveled from her home in Brookfield, Ohio to the location of the Decedent's
home in Mechanicsburg, Pennsylvania 9 times prior to selling the property. Decedent
also made trips to Apollo, Pennsylvania, to finalize funeral arrangements, and to
Lancaster, Pennsylvania to sell Decedent's vehicle. Total approximate mileage is 5475
miles. 5475 X 56.6 cents per mile is $3,093.38.
Fuel to bring Decedent's vehicles to Ohio to sell, and fuel for U-Haul to remove house
contents totals $189.96 (not included in mileage above).
Executrix traveled the Turnpike and paid tolls for the trips listed above. Those tolls total
$399.00.
Executrix had 49 meals during the above trips. At an average of$7.34 per meal, the total
is $359.60.
Rev-1512 EX+(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
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
NUMBER DESCRIPTION OF DEATH
1 AIIStar Home Remodeling-Remodeling to Decedent's home 2,623.00
2 AIIStar Home Remodeling-Remodeling to Decedent's home 1,647.00
3 AIIStar Home Remodeling-Remodeling to Decedent's home 1,600.00
4 Balance of Mortgage due to PNC Bank at settlement-See attached HUD-1 33,350.89
5 Capital Blue Cross Retirement Plan-Repayment of Pension 1,775.97
6 Hampden Township-Ambulance Bill 812.50
7 JC Erlich Co. -pest control 50.09
8 PNC Mortgage-Loan No.0000677341 1,222.01
9 PNC Mortgage 1,222.01
10 PNC Mortgage 1,222.01
11 PNC Mortgage 1,222.01
12 PNC Mortgage 1,222.01
13 State Employees' Retirement System -Repayment of portion of February 2013 pension 119.92
14 Verizon Wireless 9.84
15 Visa-Members 1 st FCU Visa Credit Card Account No.4672090000054924 634.25
16 West Shore EMS-ALS-Ambulance Bill 1,721.39
TOTAL(Also enter on Line 10, Recapitulation) 50,454.90
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1(Rev. 12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Bowman,John E. 21-13-0257
RELATIONSHIP TO
NUMBER PERSON(S)AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSOS)RECEIVING PROPERTY
Do of List Trustee(s) (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Chad Clark Cousin Vanguard 401(k) 278,927.49
722 W. Castlebury Circle
Saline, MI 48176
Robert Louis Clark Cousin 50%residue
4978 Pintail Court
Frederick, MD 21703
Susan L. Muccio Cousin 50%residue
694 Warner Road
Brookfield,OH 44403
Total 278,927.49
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev. 01-10)
• 4
LAST WILL AND TESTAMENT
r
OF c m
Co o
JOHN E. BOWMAN m =�
rri -
ej) ;Z1
. 7: o C3
v « 'n
I, Jahn E. Bowman, of Hampden Township, Ciamber' ar, Cc&�*;y,
Pennsylvania, being of sound and disposing mind^, memo a&`-4
understanding, do hereby make, publish and declare this as and
for my Last Will and Testament, hereby 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 funeral from my estate as soon after my death a
conveniently may be done. I direct my body be interred in the
family plot at the Pine Run Reform Church, Pine Run Church Road
Apollo, Pennsylvania,
Further, I authorize my personal representative to expend
funds from my estate, in such amount as my personal representativ
shall consider necessary and desirable for the purchase, erectio
and inscription of a suitable marker for my grave,
SAMDIS
R'& SECOND
FWWIE
LTNDS.AY I give, devise and bequeath all the rest, residue and
26 Wcsr High Srreer
Carlisle,PA remainder of my estate fifty (50%) percent to my cousin, Susan
L. Muccio, per stirpes; and fifty (50%) percent to my cousin,
Robert Louis Clark, per stirpes. Provided, however, that if
t
o ti
either of the above named individuals predeceases me without
issue, then in that event, his or her share shall pass to the
remaining survivor.
THIRD
I direct that any and all inheritance, estate, and transfer
taxes imposed upon my estate passing under this will or
otherwise shall be paid out of the principal of my residuary
estate.
FOURTH
In addition to the powers conferred by law, I authorize any
personal representative, trustee or guardian acting under this
instrument, in their absolute discretion:
A. To retain in the form received, or to sell either at
public or private sale any real or personal property;
B. To exercise any options to subscribe for stocks,
bonds, or other investments;
C. To join in any plan of lease, mortgage,
consolidation, exchange, reorganization or foreclosure of
i
any corporation in which my estate or any trust may hold
R
SAIDIS, stocks, bonds or other securities;
LINDSAY D. To sell, transfer, convey, mortgage, pledge, lease
�rtnw
26 West High Street
Carlisle,PA or exchange any property, real or personal, which at any
time may form part of my estate, for the payment of debts
or taxes, or for any purpose of administration or
2
F' J
distribution, for such prices and upon such terms as my
personal representative, in their sole discretion, may deem
wise, and to execute and deliver deeds of conveyance or
transfer thereof;
E. To make settlements and compromises on such terms as
my personal representative in their sole discretion may
deem wise without the necessity of obtaining any court
approval thereof;
F. To make distribution hereunder either in cash or
kind, as my personal representative in their discretion may
deem wise.
FIFTH
I do hereby nominate, constitute and appoint Susan L.
Mueeio, to act as Executrix of this my Last Will and Testament.
Provided, however, that if Susan L. Muccio is unwilling or
unable to act as Executrix, I direct the duties of Executor to
be performed by Mark A. Muccio.
SIXTH
I direct that no personal representative, guardian,, trustee
SAIUIS or other fiduciary appointed under this instrument shall be
FLOAWR'&
LPQDSAY required to give bond f'or the faithful performance of their
26 War High Screen
Carlisle,PA duties in any jurisdiction.
3
IN WITNESS WHEREOF, I, John E. Bowman, have hereunto set my
hand and seal to this my Last Will and Testament, consisting of
four typewritten pages, the first three of which bear my
initials in the margin for identification, this 7th day of
December, 2009 .
Jo E Bowman
Signed, sealed, published and declared by the above-named
John E. Bowman, Testator, as and for his Last Will and Testament
in the presence of us, who have hereunto subscribed our names at
his request as witnesses thereto, in the presence of said
Testator and of each other.
ADDRESS 26 West High Street
Carlisle, PA 17013
72 ADDRESS 26 West High Street
Carlisle, PA 17013
SAMIS
FLOWER,&
LUNDSAY
U •L\W
26 West High Street
Carlisle.PA
4
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, John E. Bowman, Tanya L. Ware and Phyllis McCoy, 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 act 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
their knowledge the Testator was at the time eighteen (18) or
more years of age, of sound mind and under no constraint or
undue influence.
Jo Bowman
IY
Tanya Ware, Witness
Phy is McCoy, ness
Subscribed, sworn to and acknowledged before me by John E.
Bowman, the Testator, and subscribed to and sworn or affirmed to
before me by Tanya L. Ware and Phyllis McCoy, witnesses, this 7th
day of December, 2009.
0/'
otary Public
SAMIS, BARBARA E.STEEL,Notary Public
FW)WR & Carlisle Bor%C='berland County,PA
IINDS" My Commission Expires June 7,201!
nnyni�.r,�
26 West High Street
Carlisle,PA
5