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Home My WebLink About11-08-13 • � 1505610143 REV-1500 EX`oZ_„> � OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes �PpRTMEMOFREVENUE PO Box.2sosoi INHERITANCE TAX RETURN 21 11 1244 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 199 16 8252 11 14 2011 05 26 1927 DecedenYs Last Name Suffix DecedenYs First Name M� HOLLI JIM W (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WIL�S FILL IN APPROPRIATE OVALS BELOW � 1, Original Retum � 2. Supplemental Return � 3, Remainder Retu�(Date of Death Priorto 12-13-82 q, Limited Estate 4a.Future interest Compromise � 5, Federal Estate Tax Retum Required ❑ ❑ (date of death after 12-12-82) O 6 Decedent Died Testate � 7• qnacdhBCopy�of T ust)a Living Trust 1 g, Total Number of Safe Deposit Boxes (Attach Copy of Will) � g, Litigation Proceeds Received � 1�•belween12�31�J1 a d't�Da95�f Deatn � 11,Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nurtvlber � LEO E GRIBBIN 717�854 95`� rn � REGI�R'"�F�/ILL�SE�L� � y�. r mm r-- � m oo �s cs First Line of Address � N � p C7 138 EAST MARKET STREET a � o � � � Second Line of Address C� � �V t'"" 1'�1 . f... .-� � O �DATE FILE4^�V � City or Post Office State ZIP Code ypgg PA 17401 CorrespondenYs e-mail address: Lg�lbbin@gOldfei111aW.COm Under penalties of perjury,I declare that I have examined this retum,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. SIGN . OF PERSON RESP NSIBLE FOR FILING RETU DATE ��,Q�,( Richard D. Holiingworth,Jr. O ADDRESS 103 Linden Avenue Red L'on PA 17356 SIGNATURE OF PR RER OTH R THA PRESENTATIVE DATE �: r M Leo E. Gribbin r� l S �� 3 ADDRESS 138 East Market Street,York, PA Side 1 � 1505610143 1505610143 J ' � 1505610243 REV-1500 EX DecedenYs Social Security Number DecedenYsName: HOII1� Jlm WilliamS 199 16 8252 RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)........................ ......................... 2. 3 97 , 91�. . 19 ............................ 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. 1.8 9, 198 . 13 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous�nn;Probate Property (Schedule G) U Separate Billing Requested............ 7. g, Total Gross Assets(total Lines 1 through 7)........................................................ g. 587 , 10 9 . 32 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 60 , 97� . 8 7 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 6,3 0 5 . 5� 11. Total Deductions(total Lines 9 and 10)................................................................ ��. 67 ,2 7 6. 3 7 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 519, 832 . 95 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 2 8 , 7 4 0 . 0 8 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 4 91 , �92 . 8 7 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �5 O . 0 0 (a)(1.2)X.00 16. Amount of Line 14 taxable 0 . Q Q 16. 0 . �� at lineal rate X .045 17. Amount of Line 14 taxable $ � Q 0 0 . 0 0 ��. 9 6 0 . �� at sibling rate X.12 18. AmountofLinel4taxable 483 , 092 . 87 �s. 72 , 463 . 93 at collateral rate X.15 19. TAX DUE................................ 19. 73 , 423 . 93 ................................................................................ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-11-1244 Decedent's Complete Address: DECEDENT'S NAME Holli,Jim Williams STREET ADDRESS 101 Green Ridge Lane CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 73,423.93 2. Credits/Payments A. Prior Payments 25,000.00 B. Discount 1,315.79 Total Credits(A +B) (2) 26,315.79 3. Interest (3) 1,742.15 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) 4$,$rJ�.29 Make Check Payable to REGISTER OF WILLS, AGENT �� r � � � � � �,..�`�, x��`a��'g�'f�,��r��.��su��s�°�'�� A a �� ,�.��.��,,��..,�.,�„. ��a�..''��:��„��.',�!��e��°�y��.�,��.��„�, � 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:............................................................................... ❑ � b. retain the right to designate who shall use the property transferred or its income:.................................. O � 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 O ❑ receivingadequate consideration?.................................................................................................................... x 3. Did decedent own an°in trust for" or payable upon death bank account or security at his or her death?....... ❑ �x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑ containsa beneficiary designation?.................................................................................................................. X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ��,�.'E��v��::��,�s��.,�. �_.,,.�.'�� a�.r��;a.,.��.��:�`��x�a�.ix'�,.�ar��•�.<.,��;f`,..�2�`�s�.�is�.. ��...��.�,��.�"�`� ��.��,;��,.��r:�,��''.. � �.,,F,� `:; 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 decedenYs 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-1503EX+(6-88) gCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSVLVANIA INHERITANCE TAX RETURN RESIDENTDECEDENT ESTATE OF FILE NUMBER Holli,Jim Williams 21-11-1244 All property jointly-owned with right of survivorship must be disclosed on Schedule F. iTEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH � N.Y. Life Annuity-Janet Pastorius, Niece-No.51-156-185 48,815.44 2 N.Y. Life Annuity-Margaret Conners, Niece-No.51-128-307 35,728.90 3 N.Y.Life Annuity-Shawn Conners, Nephew-No.74-009-920 35,946.65 4 U.S.Savings Bonds,Series I-See Attached List 251,420.20 5 U.S. Savings Bonds,Series II -See Attached List 26,000.00 TOTAL(Also enter on Line 2,Recapitulation) 397,911.19 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.6-98) U. S. Savings Bonds—Series I Barbara J. Barrett Serial Number Denomination Issue Date Issue Price DOD Value V001211227I 5,000.00 03/2001 5,000.00 9,320.00 V001590169I 5,000.00 03/2003 5,000.00 7,210.00 16,530.00 Thomas K. Barrett Serial Number Denomination Issue Date Issue Price DOD Value D003339992I 500.00 12/2003 500.00 674.20 M005381400I 1,000.00 12/3003 1,000.00 1,348.40 M005381401I 1,000.00 12/3003 1,000.00 1,348.40 M006235079I 1,000.00 09/2004 1,000.00 1,306.80 M006235080I 1,000.00 09/2004 1,000.00 1,306.80 V001030585I 5,000.00 12/1998 5,000.00 10,608.00 16,592.60 William M. Barrett Serial Number Denomination Issue Date Issue Price DOD Value D003339993I 500.00 12/2003 500.00 674.20 M005381398I 1,000.00 12/2003 1,000.00 1,348.40 M005381399I 1,000.00 12/2003 1,000.00 1,348.40 M006235081I 1,000.00 09/2004 1,000.00 1,306.80 M006235082I 1,000.00 09/2004 1,000.00 1,306.80 V001030584I 5,000.00 12/2011 5,000.00 10,608.00 16,592.60 Catherine M. Connors Serial Number Denomination Issue Date Issue Price DOD Value V001054506I 5,000.00 12/1999 5,000.00 10,198.00 V002040054I 5,000.00 12/2003 5,000.00 6,742.00 16,940.00 Ellen G. Connors Serial Number Denomination Issue Date Issue Price DOD Value V001152086I 5,000.00 07/2000 5,000.00 10,000.00 V001241283I 5,000.00 02/2001 5,000.00 9,382.00 19,382.00 Matthew N. Connors Serial Number Denomination Issue Date Issue Price DOD Value V002032707I 5,000.00 11/2003 5,000.00 6,774.00 V002547120I 5,000.00 03/2005 5,000.00 6,426.00 13,200.00 Donald A. Henry Serial Number Denomination Issue Date Issue Price DOD Value V001098771I 5,000.00 04/2000 5,000.00 9,932.00 V001094948I 5,000.00 07/2004 5,000.00 6,594.00 16,526.00 Ruth H. Henry Serial Number Denomination Issue Date Issue Price DOD Value V001274270I 5,000.00 OS/2001 5,000.00 8,914.00 V001311800I 5,000.00 09/2001 5,000.00 8,692.00 17,606.00 Nancy M. Hoak Serial Number Denomination Issue Date Issue Price DOD Value V0010946521I 5,000.00 07/2004 5,000.00 6,594.00 6,594.00 David R. Hollingworth Serial Number Denomination Issue Date Issue Price DOD Value D002771533I 500.00 03/2003 500.00 721.00 M004109433I 1,000.00 03/2003 1,000.00 1,442.00 M004109434I 1,000.00 03/2003 1,000.00 1,442.00 V001040064I 5,000.00 03/1999 5,000.00 10,402.00 V001040065I 5,000.00 03/1999 5,000.00 10,402.00 24,409.00 Larry N. Hollingworth Serial Number Denomination Issue Date Issue Price DOD Value D003530034I 500.00 09/2004 500.00 653.40 M005904621I 1,000.00 09/2004 1,000.00 1,306.80 M005904622I 1,000.00 09/2004 1,000.00 1,306.80 V001040066I 5,000.00 03/1999 5,000.00 10,402.00 V001040067I 5,000.00 03/1999 5,000.00 10,402.00 24,071.00 Richard D. Hollingworth Serial Number Denomination Issue Date Issue Price DOD Value D002771432I 500.00 03/2003 500.00 721.00 M004109431I 1,000.00 03/2003 1,000.00 1,442.00 M004109432I 1,000.00 03/2003 1,000.00 1,442.00 V001122834I 5,000.00 07/2000 5,000.00 10,000.00 V002034299I 5,000.00 12/2003 5,000.00 6,774.00 V002453588I 5,000.00 10/2004 5,000.00 6,504.00 V002805488I 5,000.00 09/2005 5,000.00 6,378.00 X001217992I 10,000.00 09/2001 10,000.00 17,384.00 X002268299I 10,000.00 03/2006 10,000.00 12,332.00 62,977.00 U.S. Savings Bonds—Series HH Harriett M. Barrett Serial Number Denomination Issue Date Issue Price DOD Value M9464524HH 1,000.00 OS/2004 1,000.00 1,000.00 M9464525HH 1,000.00 OS/2004 1,000.00 1,000.00 M9464526HH 1,000.00 OS/2004 1,000.00 1,000.00 V9829257HH 5,000.00 OS/2004 5,000.00 5,000.00 8,000.00 Thomas K. Barrett Serial Number Denomination Issue Date Issue Price DOD Value D6659202HH 500.00 OS/2004 500.00 500.00 M9464529HH 1,000.00 OS/2004 1,000.00 1,000.00 1,500.00 William M. Barrett Serial Number Denomination Issue Date Issue Price DOD Value D6659203HH 500.00 OS/2004 500.00 500.00 M9464530HH 1,000.00 OS/2004 1,000.00 1,000.00 1,500.00 Ruth N. Henry Serial Number Denomination Issue Date Issue Price DOD Value M9464527HH 1,000.00 OS/2004 1,000.00 1,000.00 M9464528HH 1,000.00 OS/2004 1,000.00 1,000.00 V1829258HH 5,000.00 OS/2004 5,000.00 5,000.00 7,000.00 Nancy M. Hoak Serial Number Denomination Issue Date Issue Price DOD Value M9464521HH 1,000.00 OS/2004 1,000.00 1,000.00 M9464522HH 1,000.00 OS/2004 1,000.00 1,000.00 M9464523HH 1,000.00 OS/2004 1,000.00 1,000.00 V1829256HH 5,000.00 OS/2004 5,000.00 5,000.00 8,000.00 Rev-1508 EX+(71•70) � SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OFREVENUE p E RS O NAL P RO P E RTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Holli,Jim Williams 21-11-1244 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 Certificate of Deposit,ACNB-No. 1619091 5.�78.2$ 2 Certificate of Deposit,ACNB-No. 172577 4,448.17 3 Checking,ACNB-No.2067935 7,395.31 4 Checking, F&M Trust-No.3422410 4,160.94 5 Green Ridge Village, -Balance Due 63,000.00 6 IRA,ACNB Bank-No.300000100002-Ben.James Barrett, nephew 46,829.89 7 Money Management, F&M Trust-No.7121741 11,233.75 8 Roth IRA, F&M Trust-No.252977488-Ben.James Barrett, nephew 46,351.79 TOTAL(Also enter on Line 5, Recapitulationl 189,198.13 (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-1511 EX+��O-09) SCHEDULE H pennsylvania DEPARTMENTOFREVENUE FUNERAL EXPENSES AND R SEDENTDECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Holli,Jim Williams 21-11-1244 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT q. FUNERAL EXPENSES: AUER Cremation Services of PA, Inc. 1,595.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Richard D. Hollingworth, StreetAddress 103 Linden Avenue City Red Lion State PA Zio 17356 Year(s)Commission Paid 29,350.00 2, Attornev's Fees Leo E. Gribbin 29,350.00 3, Family Exemption: (If decedenYs address is not the same as ciaimanYs,attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 193.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. OtherAdministrative Costs 482.37 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 60,970.87 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09) _ _ SCHEDULE H FUNERAL EXPENS�S AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Holli,Jim Williams 21-11-1244 ITEM AMOUNT NUMBER DESCRIPTION Other Administrative Costs 1 Cumberland County Register of Wills-File Tax Return 10.00 2 Cumberland County Register of Wilis-Additional Letters 370.00 3 Cumberland County Register of Wills-Short Certificate 5.00 4 United States Post Office-Certified mailings to heirs 97.37 H-B7 482.37 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) � SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, OEPARTMENTOFREVENUE MORTGAGE LIABILITIES AND LIENS INHERITANCE TAX RETURN � RESIDENT DECEDENT ESTATE OF FILE NUMBER Holli,Jim Williams 21-11-1244 Report debts incurred by the decedent prlor to death that remained unpaid at the date of death,Including unreimbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1 Alexander Springs Emergency Physicians-Balance �2.�7 2 Azizkhan Internal Medicine Association-Balance 42'22 3 Blue Mountain Anesthesia -Balance 13.18 4 Bureau of Vital Records-Death Certificates 135.00 5 Carlisle HMA Physicians Manager-Balance 158.15 6 Carlisle Medical Pathology-Balance 9.17 7 Carlisle Regional Medical Center-Balance 452.80 8 Center for Kidney Disease-Balance 19.34 9 Cumberland Goodwill Fire Rescue-Balance 31.54 10 Green Ridge Village-Rent 3,037.21 11 Kuhn Communications-Balance 57.90 12 Mount Rock Inpatient Services-Balance 7$'62 13 Pinker&Associates-Balance 3'2$ 14 PP&L-a/c Electric 317.50 15 Quantum Imaging-Balance 42.84 16 Reinsel Kuntz Lesher-Accountants 750.00 17 Richard Hollingworth-Obituary and Cremation 882.05 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 10,Recapitulation) 6,305.50 (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 I(Rev. 12-08) . Rev-1512 EX+(12-OS) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Holli,Jim Williams 21-11-1244 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 18 TCM Bank 15.91 19 VISA-Balance 123.77 20 Wal-Mart Credit Card-Balance 122.25 TOTAL(Also enter on Line 10, Recapitulation) 6,305.50 Copyright(c)2008 form software oniy The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX+(9•00) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Holli,Jim Williams 21-11-1244 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 See attached schedule Tota I 491,092.87 Ente dollar am unts for di tribu ions hown a ov on line 15 throu h 18 as a r riate n R v 1500 cover sheet II� NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 28,740.08 Newville Fire Department Ambulance TOTAL OF PART il -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 28 740.08 Copyright(c)2002 form software only The Lackner Group,inc. Form PA-7500 Schedule J(Rev.6-98) Schedule J—Beneficiaries 1. Barbara J. Barrett Niece $ 16,530.00 1025 Highland Street Seaside, CA 93955 2. Benjamin James Barrett Nephew $ 93,181.68 468 Oakton Road Odenton, MD 21113 3. Harriet M. Barrett Sister $ 8,000.00 1212 Odenton Road Apartment 314 Odenton, MD 21113 4. Thomas K. Barrett Nephew $ 18,092.60 288 Bloomsbury Avenue Apartment C-71 Catonsville, MD 21228 5. William M. Barrett Nephew $ 18,092.60 1000 Arion Park Road Aparhnent No. 78 Baltimore, MD 21229 6. Catherine M. Connors Niece $ 16,940.00 3709 Bluebird Way Pearland, TX 77584 7. Ellen G. Connors Niece $ 19,382.00 7510 Linden Houston, Tx 77012 8. Matthew N. Connors Nephew $ 13,200.00 625 South Quincy Street Arlington, VA 22204-1558 9. Margaret Connors Niece $ 35,728.90 222 Morton Avenue Albany,NY 12202 10. Shawn Connors Nephew $ 35,946.65 11 Vernon Boulevard Glenville,NY 12302 f 11. Donald A. Henry Nephew $ 16,526.00 108 Lone Pine Lane 137 Harrison Avenue Greensburg, PA 15601 12. Ruth H. Henry Niece $ 24,606.00 209 West Third Street Apartment 405 Greensburg, PA 15601 13. Nancy M. Hoak Niece $ 14,594.00 13916 Country Road, 123 W Odessa, TX 797655 14. David R. Hollingworth Nephew $ 24,409.00 3923 Lynner Avenue Des Moines, IA 50318 15. Larry N. Hollingworth Nephew $ 24,071.00 695 Hillside Drive St. Petersburg, FL 33705 16. Richard D. Hollingworth Nephew $ 62,977.00 103 Linden Avenue Red Lion,PA 17356 17. Janet Pastorious Niece $ 48,815.44 132 Mamont Drive Export, PA 15632 $491,092.87 P.O. Box 2588 138 East Market Street Goldfein and Joseph, P.C. York, PA 17405-2588 ��G7.� Telephone:(717)854-9506 `/ A T T O R N E Y S A T L A W Facsimile:(717)845-4931 Leo E. Gribbin Igribbin@goldfeinfaw.com November 6, 2013 r�,; Ms. Glenda Farner �c o 7 rrn � Cumberland County Register of Wills c� � a " � 1 Courthouse Square, Room 102 � a � � `� � Carlisle, PA 17013 � � � � z� � ` � o0 Re: Estate of Jim W. Holli, Deceased � ? -C-�,' � � � � Da te o f Dea t h: 1 1/1 4/2 0 1 1 � � rv 6� � Your File No. 21-11-1244 �„ N cr, o Our File No. 25-12031-11 Dear Ms. Farner: Enclosed please find the following documents: 1. Inheritance Tax Return, two copies; 2. Will (photocopy); 3. Check to you as Agent in the amount of$48,850.29; 4. Check to you, $10.00, filing Return; and 5. Check to you, $370.00, underpayment of Letters. Enclosed also is a self-addressed, stamped envelope in which we request you return the receipts for the payments. Thank you for your attention to this matter. Very truly yours, GOLDFEIN & JOSEPH , .: � ,.-1�...�t__ �`-'� Leo E. Gribbin LEG/af Enclosures PHILADELPHIA�1880 JFK Boulevard,20`h Floor,Philadelphia,PA 19103•Tel(215)979-8200•Fax(215)979-8201 NEW YORK�305 Broadway,14`h Floor,New York,NY 10007•Tel(212)791-0340•Fax(212)791-0347 DELAWARE�3513 Concord Pike,Suite 2000,Wilmington,DE 19803•Tel(302)656-3301 •Fax(302)656-0643 www.goldfeinlaw.com y O �p WNo � 10 �NN WN°o � = O7 O ��aOZa �. N � � � � O � p t` 6, Q ■� b. � M � p_� W �.� _ e^p '� . Q � �s�311Nn o o� f • r' J � f � � � � U cn � � � 0 � �, "�' ~ N � w � ¢ O r N � � � z u� � � O � N � � o ■� � eo N �O�C � � � � � o z � N zQ °' W � � w � - i � � M • I.i� � `�i = � � �� 7 - -��, c�� r� a - �= i � _ � � -C ai � � � � N 0 o �' N � � - �' � U � �- , F' - � U .- U w .:.i �v � d , � � � � � � 0 0 'c �q � w � � .W � w _ o�c �` � � � : ! � u � °, � _ u� � � � �.., . .,