HomeMy WebLinkAbout11-22-13 (2) J 1505610105
REV-1500 EX(02-11)(FI)E7 a
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of Individuat Taxes NHERITANCETAXRETURN County Code Year File Number
PO BOX 28o6o1
Harrisbur ,PA 1 128-0601 RESIDENT DECEDENT °� ) i 3 075_
ENTER DECEDENT INFORMATION BELOW
IF
11/06/1933
i"
+. Decedent's Last Name Suffix
__ _ Decedent's First Name
MI Mary Ellen
C
(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
C D 1. Original Return O 2.Supplemental Return
O 1 Remainder Return(Date of Death
O 4. Limited Estate Prior to 12-13-82)
O 4a. Future Interest Compromise(date of O 5, Federal Estate Tax Return Required
death after 12-12-82)
m 6. Decedent Died Testate O 7. Decedent Maintained a Livin Trust
(Attach Copy of Will) 9(Attach Copy of Trust.) 8. Total Number of Safe Deposit Boxes
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit Date of Death
l O 11. Election to Tax under Sec. 9713(A)
Between 12-31-91 and 1-1-95) ( ach Schedule+ �
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA t&OIJL0 BE D'IRECTE6IT@�
Name
-- Daytime ltone Nura`Ger
Andrew C. Sheely, Esquire 717 67P � —mot o
r\3 rn M
� zM ry 70 o
TREMr.[S ILLS USEONLND
First Line of Address 127 South Market Street tv r'-Second Line of Address _ - - - - - - N � -�rl
C.11
P.O. Box 95
City or Post Office
-- -- - State ZIP Code DATE FILED
Mechanicsburg 17055
Correspondent's e-mail address:andrewc.sheely @verizon.net
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.
SIQVATURE OF PERSON RESPONSIBLE FOR FI/LING RETURN
pnnarSC mot/ ZI-/F----r--�—_-
Russell T Werner, Jr., Executor, 1779 Spring Willow Drive, Mechanicsburg, PA 17055
SIGNAT OF PREP ER T ER T ESEN TIVE
AT
�r `
Andrew C. Sheely, Esquire, 127 Sou et Street, P.O. Box 95, Mechanicsburg, PA 1705
PLEASE USE ORIGINAL FORM ONLY -
L_ Side 1
1505610105
1505610105
1505610205
REV-1500 EX(FI)
D,,.d,,t'.N,.: Werner, Mary Ellen
RECAPITULATION
1. Real Estate(Schedule A). ... .. ... . .. .. . .. .... ........... ...... 1 $393,000.00
Z Stocks and Bonds(Schedule B) .......... 2.
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. $49,250.91
6. Jointly Owned Prop"(Schedule F) <= Separate Billing Requested ... 6.
7, inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) C=) Separate Billing Requested... . . .. . 7. $298,682.92
tl. Total Gross Assets(total Lines I through 7).... .. .. .... . S. $740,933.83,
9. Funeral Expenses and Administrative Costs(Schedule H).... ............... 9. 19,955.25
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).. . .. .. . . 10, 8,120.57;
11. Total Deductions(total Lines 9 and 10) ................... 11 28,075.82
12, Net Value of Estate(Line 8 minus Line 11) . . .. . . . . . . . . . ... . . . ... . . .... . . 12. 712,858.01
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . ....... . .. ......... 13.
14, Not Value Subject to Tax(Line 12 minus Line 13) .. ...... .. ... .. ...... ... 14. 712,858.01
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers undo.qec.9116
(a)(12)X.0 15.
16. Amount of Line 14 f—ible
at lineal rate X o45 712,858�01 16 $32,078,61
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- $32,078.61
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610205 1505610205
REV-1500 EX(Ff) Page 3 File Number
Decedent's Complete Address:
7�DECEDENT'S NAME
Mary Ellen Werner
qTPFrTAnDRF.SS
311 Candlelight Drive
STATE
Mechanicsburg i ZIP
1 17055
Tax Payments and Credits:
1, Tax Due(Page 2,Line 19) $32,078.61
2. Credits/Payments
A.Prior Payments $30,000,00
B.Discount $1,578.90 T otal Credits(A+El (2) $31,578.90
3, Interest
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. (M
5. If Line I+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) $499.71
_
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 .........................................._................................... 1_1
b. retain the right to designate who shall use the property transferred or its income ................__............... 1:1
c. retain a reversionary interest .........___..........-..................................................... ................. .........
d. receive the promise for life of either payments,benefits or care?............-........ .......I—.......
2. If death occurred after Dec,12,1992,did decedent transfer property within one year of death
without receiving adequate c onsideration?.........._...................................-.......................____....................... 171
1 Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. 11
4, Did decedent own an individual retirement account,annuity or other non-probate property,which
containsa 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)(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)(!1)),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 F2 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.
COMMONWEALTH OF PENNSYLVANIA
I
DEPARTMENT OF REVENUE REV-1 162 EX(l 1-96S
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 018235
WERNER RUSSELL T JR
1779 SPRING WILLOW DRIVE
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 $30,000.00
ESTATE INFORMATION:
FILE NUMBER: 2113-0785
DECEDENT NAME: WERNER MARY ELLEN
DATE OF PAYMENT: 10/10/2013
POSTMARK DATE: 10/10/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 07/15/2013
TOTAL AMOUNT PAID: $30,000.00
REMARKS: RECEIPT TO ATTY
CHECK# 112
INITIALS: HMW
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
REV-1502:X+(11-08)
�r
pennsylvania L CHEDULE A
DEPARTMENT r REVENUE INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF
Mary Ellen Werner FILE NUMBER
21-13-0785
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=sold.ITEM Include a copy of the deed showing decedent's interest if owned amon.
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1 Decedent's residence at 311 Candlelight Drive, Mechanicsburg, Upper Allen Township,PA, $393,000.00
17055.Tax Darrel#42-28-2417-142. Per attached aareement of sale.
TOTAL(Also enter on Line 1, Recapitulation.) $ $393,000.00
If more space is needed, insert addit!onai sheets of the same size.
RESIDENTIAL REAL ESTATE AGREEMENT OF SALT
THIS AGREEMENT, made and entered into this Zl�,4 day of September, 2013, by
and between: Estate of Mary Ellen Werner, late of the Township of Upper Alien, Cumberland
County, Pennsylvania, by Russell T. Werner, Jr., Executor, Party of the First Part, hereinafter
called the "Seller",
AND
Kenneth R. Spidle,Jr. and Haddiee V. Spidle, husband and wife, of 488 Seedling Court,
Mechanicsburg, Upper Allen Township, Mechanicsburg, PA 17055, Party of the Second Part,
hereinafter collectively called the "Purchaser";
IN CONSIDERATION OF THE MUTUAL COVENANTS AND AGREEMENTS
HEREINAFTER CONTAINED, IT IS AGREED BY AND BETWEEN SELLER AND
PURCHASER AS FOLLOWS:
1. Premises. Seller agrees to sell to Purchaser, and Purchaser agrees to purchase and
accept the conveyance of the following residential property with improvements located at
311 Candlelight Drive, Mechanicsburg, Upper Allen Township, PA 17055, described as follows:
ALL THAT CERTAIN piece or parcel of land situate in Upper Allen Township, Cumberland
County, Pennsylvania, bounded and described as follows, to wit:
BEGINNING at point on the southern dedicated right-of-way line of Candlelight Drive, said
point being on the boundary line between Lot Nos. 37 and 42 on the hereinafter mentioned Plan
of Lots; thence along said boundary line North 42 degrees 32 minutes 39 seconds East, one
hundred twenty-five and zero one-hundredths (125.00)feet to a point;thence South 47 degrees
27 minutes 31 seconds East, one hundred sixty and zero one-hundredths(160.00) feet to a point;
thence South 42 degrees 32 minutes 39 seconds West, one hundred twenty-five and zero one-
hundredths (I25.00) feet to a point on the dividing line between Lot Nos. 37 and 42 on the
hereinafter mentioned Plan of Lots: thence along said dividing line North 47 degrees 27 minutes
31 seconds West, one hundred sixty and zero one-hundredths 9160.00)feet to a point on the
southern dedicated right-of-way line of Candlelight Drive, the place of BEGINNING.
The above described lot of ground being Lot No. 42, in Section 11, Phase III, Final Subdivision
Plan of Meadowview Estates, said Plan being recorded in the Cumberland County Recorder of
Deeds Office in Plan Book 72, Page 52. Being known and numbered as 311 Candlelight Drive,
Mechanicsburg, PA 17055
See Exhibit"A" Tax Parcel # 42-25-2417-142
2. Pa meet of Purchase Price. Seller and Purchaser agree that the Purchase Price shall
be THREE HUNDRED NINETY-THREE THOUSAND DOLLARS ($393,000.00).
Purchaser shall pay the sum of ONE THOUSAND DOLLARS ($1,000.00) (the "Deposit") in
cash or check to Seller within five(5) days of the date of execution of this Agreement to be held in
the escrow account of the attorney for Seller, Andrew C. Sheely,Esquire("Escrow Agent"), for
delivery to the party entitled at Closing or upon termination of this Agreement. The balance of the
OMB N0.2502.0265
A. B. TYPE OF LOAN:
U.S.DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT 1.[]FHA 2.QFMHA 3.❑CONV.UNINS. 4.[]VA 5.❑CONV.INS.
S. FILE NUMBER: 7. LOAN NUMBER:
SETTLEMENT STATEMENT SPI150-13
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked"(FOCI"were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
Is 3198 (SPitSd-18PFWSPn50-1
D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
KENNETH R.SPIDLE,JR.and ESTATE OF MARY ELLEN WERNER CASH
HADDIEL V,SPIDLE 311 CANDLELIGHT DRIVE
488 SEEDLING COURT MECHANICSBURG.PA 17055
MECHANICSBURG,PA 17055
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 1. SETTLEMENT DATE:
311 CANDLELIGHT DRIVE ANDREW C.SHEELY,ESQ.
MECHANICSBURG,PA 17455 October 16,2013
CUMBERLAND County,Pennsylvania PLACE OF SETTLEMENT
171 SOUTH MARKET STREET
MECHANICSBURG,PA 17055
J.SUMMARY OF BUYER'S TRANSACTION K.SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 1 393,000.00 401, Contract Sales Price 393,000.00
102. Personal Property 402. Personal Property
103. Settlement Charges to Buyer(Line 1400 4 002.00 403,
104. 404.
105. 405,
Adjustments For Items Paid By Setter in advances Ad'usfinents For Items Paid By Seller in advance
106. City/Town Taxes 10/16113 to 01/01114 1 323.95 406. City/Town Taxes 10116/13 to 01/01114 1 323.95
10T Coun Taxes l0 407. County Taxes to
108. SCHOOL TAX 10116113 to 07/01/14 3,305.59 408. SCHOOL TAX 10/16/13 to 07101114 3,305.59
109. SEWER OCT-DEC 10116113 to 01101/14 93.74 409.SEWER OCT-DEC 10116113 to 01101114 93.74
110. 410.
411.
112 412.
120. GROSS AMOUNT DUE FROM BUYER 400,725.28 420. GROSS AMOUNT DUE TO SELLER 396,723.28
200- AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 1,000.00 501. Excess Deposit See Instructions
202. Principal Amount of New Loans 502. Settlement Charge to Seller Line 1400 4,179.00
203. Existin bans taken subject to 503. Existing loan(s)taken subject to
204. 504. Payoff of first Mortgage
205. 5 5. Payoff of second Mortgage
206. 506.
207, 507. (Deposit disb.as proceeds)
208. 508.
209. 509.
Adjustments For Items Unpaid By Seller Atflustments For Items Unpaid By Setter
210. City/Town Taxes to 510. C' /Town Taxes to
211 County Taxes to 511. County Taxes to
212. SCHOOLTAX to 512.SCHOOL TAX to
213. 513.
214. 514.
215. 515,
216. 516.
21T 517.
218. 518-
219. 519.
220. TOTAL PAID BY/FOR BUYER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 4,179.00
300. CASH AT SETTLEMENT FROMffO BUYER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301, Gross Amount Due From B Line 120 400,725.28 601. Gross Amount Due To Seller Line 420 396,723.28
302. Less Amount Paid By/For Buyer(Line 220) ( 1,000.00 602. Less Reductions Due Seller(Line 520) ( 4,179.00
303 CASH(X FROM)( TO)BUYER 399,72528 603 CASH(X TO)( FROM)SELLER 392,544.28
The undersigned hereby acknowledge receipt of a completed copy of pages 182 of this statement 8 any attachments referred to herein.
I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF,IT IS A TRUE AND
ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY
THAT(HAVE RECEIVED A OPY OF THE HUD-1 L/EMENT STATEMENT.
Buyer 1 �IWr ESTATE OF MARY ELLEN WERNER
K NETH R.SPIDLE, R. Y'- fin.- ,7 i✓-�.� 2
u�nniC it en�ni� �+a�t!.t=!-• ..
L.SETTLEMENT CHARGES page
700.TOTAL COMMISSION Based on Price $ @ % PAID FROM PAID FROM
Division of Commission Line 700 as Follows: surses sm-. Frs
701.$ to FUNDS AT FUNDS AT
702, to SErrLEMENT SETtREMENT
703.Commission Paid at Settlement
7D4. TRANSACTION FEE to
i 500.ITEMS PAYABLE IN CONNECTION WITH LOAN
801.Loan Origination Fee % to
802.Loan Discount % to
803.Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Mort a lns. .Fee to
807. Assumption Fee to
808.
809.
810.
811.
800.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901.Interest From to @ $ /day ( days %)
902. MIP Totlns.for LtfeOfLOan for months to
903.Hazard Insurance Premium for 1.0 years to
904.
908.
1000.RESERVES DEPOSITED WITH LENDER
1001,Hazard Insurance months @ $ per month
1002.Mortgage Insurance months @ $ per month
1003.CilyTown Taxes months @ $ per month
1004. County Taxes months @ $ per month
1005. SCHOOL TAX months @ $ per momh
1006. months @ $ per month
1007. months @ $ per month
1008.AGGREGATE ESCROW ADJUSTME months 0 $ per month
1100.TITLE CHARGES
1101. Settlement or Closing Fee to
1102. CLOSING PROTECTION LETTER to FIRST AMERICAN TITLE INSURANCE COMPANY
1103. Title Examination to
1104. RE-IMBUSREMENT FOR TAX CERT to TRI-COUNTY ABSTRACT SERVICE 15.44
1105, Document Preparation to
1106. Notary Fees to CASH 5.00 10.00
1107. Attorneys Fees to ANDREW C.SHEELY,ESQ. POC
includes above item numbers:
110&Title Insurance to TRI-COUNTY ABSTRACT SERvICEIAGENT FOR IST AMERICA
includes above item numbers:
1109.Lender's Coverage $
1110,Owner's Coverage
1111. ENDORSEMENTS
1112.
1113,
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.Recording Fees: Deed $ 67.00;Mortgage $ Reteases $ 6704
1202.CityfCounty TaxBtam s:Dead 3,930.00 Mortgage 3,930.00
1203.State Tax/Stamps: Revenue Stamps 3,930.00;Mortgage 3 930.00
1204.
1205.
130D.ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection_ to
1303. SEWER JULY-DECEMBER to UPPER ALLEN TOWNSHIP 224.00
1304.
1305.
1400.TOTAL SETTLEMENT CHARGES Enter on Lines 103 Section J and$02,Section 4,002.001 4,17900
By signing page's of this staMmam,Me sigigmadDS aclmoWadge receipt of a completed copy or page 2 of thq Me page statement
ANDREW C.S EL- ,ESQ.
Settlement Agent
Certified to be a true copy.
REV-iSO8 Ex+(ii-so)
Pennsylvania
SCHEDULE E
DEPARTMENT OF R EVE NUE CASH, BANK DEPOSITS & MISC.
RESE RETURN
RESIDENT IDENT DECEDENT PERSONAL PROPERTY
ESTATE OF:
Mary Ellen Werner FILE NUMBER:
21-13-0785
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
NUMBER DESCRIPTION VALUE AT DATE
1. Members 18t Savings Account#406089-00,balance at date of death$5.00,accrued interest$0.00 OF DEATH
$5.00
2. Members 1st Checking Account#406089-11,balance at date of death$2,427.96,accrued interest$0.00 $2,427 96
3. Decedent's personal property -per Chuck Bricker appraisal $3,490.00
4. Merrill Lynch Account#898-67767 $28,376.00
5. Decedent's 2008 Acura TL-fair condition $14,000.00
6. Decedent's 1986 Ford F150 pick-up truck,poor condition $300.00
7. Donegal Insurance Group-Homeowner's Insurance refund $447.00
8. Verizon -refund
$135.80
9. Allied Waste-refund
$31.15
10. Traveler's Insurance-Auto insurance refund $38.00
TOTAL (Also enter on Line 5, Recapitulation) $ 49,250.91
If more space is needed, use additional sheets of paper of the same size.
St
MEMBERS 1't
FMERALCREDIT UMON
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 406089-00
Date Account Established 1 213 0/2 01 0
Principal Balance at Date of Death $5.00
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $5.00
Name of Joint,Owner None
CHECKING ACCOUNT:
Account Number/Suffix 406089-11
Date Account Established 12/30/2010
Principal Balance at Date of Death $2,427.96
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $2,427.96
Name of Joint Owner None
M`EE-//MBERS 1ST FEDERAL CREDIT UNION
Tessa L KIu�
Lending Insurance Support Specialist
July 25, 2013
Estate of: MARY ELLEN WERNER
Date of Death: 0 711 612 01 3
Socls Number: 175-26-898-'
5000 Louise Drive P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • www.memberslst.org
APPRAISAL
Personal Property of
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REV-1510 EX+(OB-09)
pennSylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE ED RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF
Mary Ellen Werner FILE NUMBER
12-13-0785
This schedule must be completed and riled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY
NUMBER tNauDE THE NAME OF THE TRANSFEREE,THEIR REUnorvsniP To DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
TIE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST nF ARPUCABIE VALUE
I. Merrill Lynch IRAAccount#898-70391 Beneficiaries: Children:Dianne T $291,541.77 100% 5291,541.77
Bassetti, Kim L. Diehl,Susan D. Bufe, Kelly L.Adams,Russell T Werner,Jr.
2. TIAAAnnuity No.Y0234701 -Beneficiaries: Children:Dianne T Bassetti,Kim $7,141.15 100% $7,141.15
L. Diehl, Susan D. Bufe, Kelly L.Adams, Russell T.Werner.Jr.
TOTAL(Also enter on Line 7, Recapitulation) $ 298,682.92
If more space is needed, use additional sheets of paper of the same size.
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REV-1511 EX+ (10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE DE E RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
Mary Ellen Werner FILE NUMBER
21-13-0785
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
Malpezzi Funeral Home
$13,487.21
2. Headstone Engraving
$300.00
3. Funeral Luncheon/flowers/misc.costs
$2,340.74
B. ADMINISTRATIVE COSTS:
I. Personal Representative commissions: $0.00
Name(s)of Personal Representative(s) Russell T Werner, Jr.
Street Address 1779 Spring Willow Drive
City_Mechanicsburg PA ZIP 17055
Year(s)Commission Paid:
z Attorney Fees: $2,550.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address_
City._ State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: $513.50
5. Accountant Fees:
6. Tax Return Preparer,Fees:
7 MISC. Postage
$13.80
B. Reserves to conclude Estate administration,final accountings, final income tax returns for 2013
$750.00
TOTAL(Also enter on Line 9, Recapitulation) $ 19,955.25
If more space is needed, use additional sheets of paper of the same size.
i mi auay, oeyien IuCI[O, [V I J I V:'I L HIVI
Malpezzl Funeral Home 7176972414
P.01
Malpezzi Funeral Home
S Market Plaza Wav
Mechanicsburg,PA 11055
(717)697-4696
Michael J.Mal ezzi,Owner,FD
Jerem J. Shartzer,FD
K le C.k
September 26,2013 e,FD
Russell Thomas Werner Jr.
1779 Spring Willow Drive
Mechanicsburg,PA 17055
The Funeral Service for Mary Ellen Werner
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every
way we can. Please feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,FACILITIES,AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
L PROFESSIONAL SERVICES:
Services of Funeral Director/Staff
FUNERAL HOME SERVICE CHARGES $5,475.00
SELECTED MERCHANDISE: $5,475.00
Steel Casket
Sentinel Vault $3,150.00
Bridge of Faith Register Package $1,450.00
DVD Memorial Slideshow $195.00
THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE $40.00
THAT YOU HAVE SELECTED
AT THE TIME FUNERAL $10,310.00
ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO
OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES:
Opening Grave
Cemetery Equipment $750.00
Certified Death Certificates $200.00
Newspaper Notices-Patriot $102.00
Newspaper Notices-Allentown $317.02
Newspaper Notices-Reading $581.39
Clergy-Rev. Shane Wilson $265.00
Clergy-Rev.Bern Kefer $200.00
Soloist-Marilyn Cooker $100.00
Flowers $100.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES $561.80
CONTRACT PRICE $3,177.21
HISTORY: $13,487.21
08/08/2013 Payment Estate of Mary Ellen Werner
TOTAL AMOUNT DUE $13,487.21
$0.00
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 7/18/2013
Cumberland County - Register Of Wills e : 12 : 58 : 15
Time :Receipt T
One Courthouse Square Receipt Tim 1074904
Carlisle, PA 17613
WERNER MARY ELLEN
Estate File No. : 2013-00785 ---
Paid By Remarks : ANDREW C SHEELY
DB1
------------------------ Receipt Distribution
------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 90 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 25 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN - 15 . 00 CUMBERLAND COUNTY GENERAL FUN
Check# 4166 $193 . 50
Total Received. . . . . . . . . $193 . 50
REV-1512 EX+(12-08)
pennsy(vania
SCHEDULEI
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF
Mary Ellen Werner FILE NUMBER
21-13-0785
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical exrVA11
ITEM
NUMBER DESCRIPTION 1 Chuck Bricker,Auctioneer- personal property ap praisal .00 2. Settlement Costs,see attached settlement sheet. 00 3. Macy's credit card-final bill 80 4. Jerry Sweeten-lawn and property maintenance-final bill 94 5. Upper Allen Township•final sewer bill 00 6. Dennis Zerbe,Tax Collector-prorated real estate taxes through settlement 39
7. Hess Garage-state inspection and fires for 1986 Ford F150 pick-up truck prior to sale/transfer
$502.19
8. Harris TV&Applicance-stove repair prior to sale of real estate
$62.54
9. Sechrist Construction-garage door and frame repair prior to sale of real estate
$210.00
10. Allied Waste-final trash bill
$39.03
11 Time-Warner Pension Plan -reimbursment of overpayment of pension plan
$111.68
12. Alex Humphries-window repair to 2008 Acura TL prior to sale/transfer
$200.00
TOTAL (Also enter on Line 10, Recapitulation) $ 8,120.57
If more space is needed, insert additional sheets of the same size.
7_ A&ay JH6 x & Z
Z ±7 3. !2
a/ y £ £»»a»
y . /gip
3409 _:a::«
REV-1513 EX+(61-10)
pen nsytvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Mary Ellen Werner 21-13-0785
KELAUUNSHIP IU UtI,EUEN I AMUUIVI UK CHAKC
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).J
1. Dianne T Bassetti,30 Flint Ridge Drive,Shillington,PA 19607 Daughter 20% Rest, Residue of
P"4ta fA
2. Kim L.Diehl, 1702 North Main Street,Bethlehem,PA 18018 Daughter 20% Rest, Residue of
Estate
3. Susan D.Bufe,220 John Glenn Avenue,Reading,PA 19607 Daughter 20% Rest, Residue of
Estate
4. Kelly L.Adams,2318 Abbey Lane,Harrisburg,PA 17112 Daughter 20% Rest, Residue of
Estate
5. Russell T Werner,Jr., 1779 Spring Willow Drive,Mechanicsburg,PA 17055 Son 20% Rest, Residue of
Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IS OF REV-1500 COVER SHEET,AS APPROPRIATE,
II 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 ONLINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
OF
MARY ELLEN WERNER
I, MARY ELLEN WERNER, of 311 Candlelight Drive,
Mechanicsburg, (Upper Allen Township), Cumberland County,
Pennsylvania, make, publish and declare this as and for my Last Will and
Testament, hereby revoking all other Wills and Codicils heretofore made
by one.
FIRST: 1 direct that all inheritance, estate, transfer, succession
and death taxes, as well as my just debts and funeral expenses, of any kind
whatsoever, which may be payable by reason of my death, shall be paid
out of the principal of my estate as the same can conveniently be done.
SEC OND: I give, devise and bequeath all the rest, residue
and remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, as follows:
(a) Twenty percent (20 %) thereof unto my daughter,
DIANNE T. BASSETTI, of Shillington, Pennsylvania, provided. that
should DIANNE T. BASSETTI predecease me, I give and bequeath her
share unto her issue, share and share alike, and if there be a failure of
same, then I give and bequeath her share unto my surviving children as
named herein;
(b) Twenty percent. (20 %) thereof unto my daughter,
KIM L. DIEHL, of Bethlehem, Pennsylvania, provided that should KIM
L. DIEHL predecease me, I give and bequeath her share unto her issue,
share and share alike, and if there be a failure of same, then I give and
bequeath her share unto my surviving children as named herein;
(c ) Twenty percent (20%) thereof unto my daughter,
SUSAN D. HUMPHREY, of Reading, Pennsylvania, provided that
should SUSAN D. HUMPHREY predecease me, I give and bequeath her
share unto her issue, share and share alike, and if there be a failure of
same, then I give and bequeath her share unto my surviving children as
named herein.
(d) Twenty percent (20 %) thereof unto my daughter,
KELLY L. ADAMS, of Harrisburg, Pennsylvania, provided that should
KELLY L. ADAMS predecease me, I give and bequeath her share unto
her issue, share and share alike, and if there be a failure of same, then I
give and bequeath her share unto my surviving children as named herein.
(e) Twenty percent (20 %) thereof unto my son,
RUSSELL T. WERNER, JR., of Mechanicsburg, Pennsylvania, provided
that should RUSSELL T. WERNER, JR. predecease me, I give and
bequeath his share unto his issue, share and share alike, and if there be a
that
of same, then I give and bequeath his share unto my surviving
children as named herein.
THIRD: In addition to all powers granted to them by law and
by other provisions of this Will, I give the fiduciaries acting hereunder the
2
following powers, applicable to all property, exercisable without court
approval and effective until actual distribution of all property:
(A) To sell at public or private sale, or to lease, for any period
of time, any real or personal property and to give options for sales, ex-
changes or leases, for such prices and upon such terms (including credit,
with or without security) or conditions as are deemed proper. This
includes the power to give legally sufficient instruments for transfer of the
property and to receive the proceeds of any disposition.
(B) To partition, subdivide, or improve real estate and to
enter into agreements concerning the partition, subdivision, improvement,
zoning or management of real estate and to impose or extinguish restric-
tions on real estate.
(C) To compromise any claim or controversy and to abandon
any property which is of little or no value.
(D) To invest in all forms of property, including stocks,
common trust funds and mortgage investment funds, without restriction to
investments authorized for Pennsylvania fiduciaries, as are deemed proper,
without regard to any principle of diversification, risk or productivity.
4
(E) To exercise any option, right or privilege granted in
insurance policies or in other investments.
(F) To exercise any election or privilege given by the Federal
f and other tax laws, including, but not necessarily being limited to, personal
income, gift and estate or inheritance tax laws.
3
(G) To make distributions to my herein named beneficiaries
in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order to
pay debts, taxes, or estate or trust administration expenses, to protect or
improve any property held under my will, and for investment purposes.
(I) To select a mode of payment under any qualified retire-
ment plan (pension plan, profit sharing plan, employee stock ownership
plan, or any other type of qualified plan) to the extent provided for by the
plan or the law.
EO UTRTH: I nominate and appoint DIANNE T. BASSETTI
and RUSSELL T. WERNER, JR., Co-Executors, of this, my Last Will
and Testament. I direct that my Co-Executors or their successors shall not
be required to post security or a bond for the performance of their duties
in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this, my Last Will and Testament, this 4 day of September, 2003,
SEAL)
MAR EL E WERNER
4
Signed, sealed, published and declared by the above-named Testa-
tnx as and for her Last Will and Testament in our presence, who, at her
request, in her presence and in the presence of each other, have hereunto
subscribed our names as attesting witnesses.
Address ''Osr Name
Address
Name i
5