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12-31-13
1505610105 REV-1500°`(02-73'tFI' ff PA Department of Revenue pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes ° County Code Year File Number- PO BOXz8o6o1 INHERITANCE TAX RETURN ----- Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT 21 j 2013 ` 00856 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _._..._.....__.---------._....._...._..--...__..__............_................................_....: ..._...-......__.._..--..........._..........-....------ - .... _.........__......................................................_..__....................._ . 07/21/2013 1 12/30/1921 Decedent's Last Name Suffix Decedent's First Name MI I BOSTIC ! NELSON __........- ...___.._._..........._.........._.._._......._................. � L _.__._...__....._._ . . _1 L.__...,----..............._.........: .................................---....._........._.........._...._......._......__......__........---.......__._......._..........: -- .. (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI _..............._........._.--............_...._..........._.............__........................_...__.._._. __......._.._..._...__......__._.......; ................................... ....--.......__.........._........._........_........._..........................._..........._.._....---...._..............---.... - j ............................_........... ; Spouse's Social Security Number __....__.........._..._._....___....__....._..........................._..... ..___.....___..., THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 1 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW QD. 1.Original Return O 2.Supplemental Return O 4 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telrtphone Number —.... ----...___......_....._......................................................................__.....__..._..........__.............._........................_......__..__._........._.._......................_.._.._._._................... E; JOHN M. EAKIN � c� C .-........_._.......__......................................_..........................................................................._........_................._....................................... -.._...._.._._......_.......___._........_................................. W .�. cr) :;a RE T O ILLUE ONLIV r rT First Line of Address CD .._............_.._._.__......_..............._........_..................................................._._..........._.........._.__.............._..._.............--....................................................................._........... . MARKET SQUARE BUILDING o rt ---........_............_..........................._.............._....__...._._......_._...._.__.........._._.....__._........................._._.......................__..__......._...._....._..................__......_.__._....... o t Second Line of Address = -:--t rV rte. rr _..__......- ...._._._.......---......................-._............__.............._.........__......----......._._._......__.............._.............._............_.._........ 1 WEST MAIN STREET ctll _........................................_.........------------_......._._................_...._..._......-.............__............_._........................_..._......._..._......_......._._._..._...---......._...........i DATE FILED City or Post Office - State ZIP Code MECHANISBURG._._...._-...... _...._^_...__ ... ---_�_..T.'..—_-.J �_..._PA..._' 17055.._............_............................._..............__.........._..........._ ._—.! 1.............................................-.....................__....._...._..........._.................._I Correspondent's e-mail address: 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. SIGNATURJE PF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNATU E OF PREPARER O?TLIER THAN REPRESENTATIVE DATE A I!Z SS " PLEASE USE ORIG AL FORM ONLY r Side 1 1505610105 1505610105 t 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: NELSON L. BOSTIC RECAPITULATION -........................_.............._...__._....._.._.._......._._.......-........... _.....--_...._.._..... 1. Real Estate(Schedule A). ............................................ 1. 148,250.00 i t 2. Stocks and Bonds(Schedule B) ....................................... 2.1 i 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 4. Mortgages and Notes Receivable(Schedule D)........................... 4.1 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5.1 1,434.08 i 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 4,806.46 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8, Total Gross Assets.(total Lines 1 through 7)............................. 8. I 154,490.54 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 45,921.25 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10.1 3,425.55 11. Total Deductions(total Lines 9 and 10)................................. 11.' 49,346.80 i 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 105,143.74 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which j an election to tax has not been made(Schedule J) ........................ 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. -� 105,143.74 { TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfersunder Sec.9116 r"°`"----_.._-.. ..---_...................__..........__......................._.-_ _.i f_.._.......___-.......__.-.-._-....__......__.__..__._._.._..__._...___._...-_..� (a)(1.2)X.0- I 15.j 16. Amount of Line 14 taxable at lineal rate x.0 45 16. 4,731.47 j 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......................................................... 19.1 4,731.47 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 L 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME NELSON L. BOSTIC -......I. .. ..._... STREETADDRESS _... .._. __........... - -...... ___-............ 43 BAYBERRY DRIVE -----....-----------------.......-------------....__._.._ - ..— -- - -- CITY STATE - ---__.._ _ � ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 4,731.47 2. Credits/Payments A.Prior Payments S.Discount Total Credits(A+B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 4,731.47 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.......................................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income............................................ ❑ c. retain a reversionary interest.............................................................................................................................. ❑ ■ d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa beneficiary designation? ............................................................................................. 1:1........................... 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)(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+ (12-12) i pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NELSON L. BOSTIC 2013-00856 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. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 RESIDENCE 43 BAYBERRY STREET,MECHANICSBURG,PENNSYLVANIA 148,250.00 TAX PARCEL NO.38-22-0144-148 RECORDED IN DEED BOOK"0"VOL.33,PAGE 612 SEE AGREEMENT OF SALE AND SELLERS COST SHEET-ATTACHED SALE PRICE REPORTED SEE SCHEDULE H,ITEM 9 TOTAL(Also enter on Line 1, Recapitulation.) $ 148,250.00 If more space is needed,use additional sheets of paper of the same size. - y STANDARD AGREEMENT FOR THE SALE OF REAL ESTATE ASR 7bia form reetnuivaded tad appeored for,but not rear ued to au by,the members of the Ptanaylvante Association Of RnALTORS®(PAR), PARTIES BUYERS):Patricia A. AePaw SELLER(S)t Estate of Nelson L Sostia BUYER'S MAILING ADDRESS; SELLER'S MAILING ADDRESS: 616 Copper Cirale Lewisberryr PA 17338 PROPERTY PROPERTYADDRBSS 43 Bayberry Dr, Maohanioeburg , ZIP 17050 , in the municipality of Silver Spring ,County of Cumberland , in the School DIstrict of Cumberland Valley ,In the Commonwealth of Pennsylvania. Identification(e g..Tax ID#;P=oI#;Lot,Block;Deed Book,Page,Recording Date):30220144148 BUYER'S RELATIONSHIP WITH PA LICENSED BROKER ❑No Buslness-Relationship(Buyer is not represented by a broker) Broker(Company)RQMax Realty Assooiatee Lieensee(s)(Narne)Dava Jones Company Address 3425 ldarkat St, Camp Hill, PA 17011 DirectPhone(s) (717)441-5619 Cell phones) Company Phone (717)761 6300 Fax (717)364-3565 Company Fax (717)761 1.455 Emall dava.joneaftemax.not Broker's: Licensee(s)is: M Buyer Agent(Broker represents Buyer only) ®Buyer Agent with.Designated Agency ❑Dual Agent(See Dual and/or Designated Agent box below) ❑Buyer Agent without Designated Agency ' ❑Dual Agent(See Dual and/or Designated Agent box below) Q Transaction Licensee(Broker and Licensee(s)provide real estate services but do not represent Buyer) SELLER'S RELATIONSHIP WITH PA LICENSED BROKER ❑No'Business Relationship(Seller is notrepresented by a broker) Broker(Company)Howard Hanna Licensees)(Name)Bob Stammal Company Address 8137 Davonahira Rd, Itarrieburq, PA DirectPhone(s) CdlPhone(s) 5717)315-0201 Company Phone Fax Company Fax Small bobstammol.®howardhanna.com Brokeris:' Licensee(s)Is: - ®Seller Agent(Brokerrepresimts Seller only) ®Seller Agent with'Designated Agency ❑Dual Agent(Sec Dust and/or Designated Agent box below) [j Seller Agent without Designated Agency ❑Dual Agent(See Dual and/or Designated Agent box below) Q Transaction Licensea(Broker and Ilcensoe(s)provide real estate services but do not represcut Seller) DUAL ANDIOR DESIGNATED AGENCY A Broker Is a Dual Agent when a Broker represents both Buyer and Seller in the same transaction, A Licensee Is a Dual Agent when a Licensee represents Buyer and Seller In the same transaction:'All of.Broker's ilecusces are also Dual Agents UNLESS there are separate Designated Agents forBuyer and Seller.If the saran Licertsce is dcslgnated for Buyer and Sel(ce,tho Licensee is a Dual AgenL By signing.ft ARVA=ent,Buyer and Seller each acknowledge having been previously informed of,and consented to,dual agency, if applicable. Buyer IDlllah, / ASR Page i of 11 Seller Intttall; ,� Penrrsylvanla association of REALTORS' RedLsed 9113 copymoHT PBNNSYLYANU ASSOCIATION OF RMTOBS 02011 9/13 RFJMAXRa1tyA:r odatea-Corporafg112f34dtetStrsettamp�aI1RA17011 Pbw4717761.aW ran 717441-0481 r,MekAapew DM job" ... .,AodivWyAhslPFu WWA*I$0'laflReeabtos Road.Frasar.Wft=48=6 IEOECEGtptmbt,com By this Agreement, dated December 1, 2013 , 2 Seller hereby agrees to sell and convey to Buyer,who agrees to purchase,the identified Property. 3 2. PURCHASE PRICE AND DEPOSITS(1-10) 4 (A) Purchase Price$ $148,250:00 5 One Hundred Forty--Eight Thousand, Two Hundred Fifty 6 U.S.Dollars),to be paid by Buyer as follows: 7 1. Deposit at signing of this Agreement: $ 8 2. Deposit within 1 days of the Execution Date of this Agreement: $ 2,500.05 9 3, $ 10 4. Remaining balance will be paid at settlement. 1 1 .(B) All funds paid by Buyer, including deposits,will be paid by check, cashier's check or wired funds.All funds paid by Buyer 12 within 30 DAYS of settlement, including funds paid at settlement, will be by cashier's check or wired funds,but not by per- 13 sonar check. 14 (C) Deposits, regardless of the form of payment and the person designated as payee, will be paid in U.S. Dollars to Broker for Seller 15 (unless otherwise stated here: ), 16 who will retain deposits in an escrow account in conformity with all applicable laws and regulations until consummation or ter- l7 minadon of this Agreement. Only real estate brokers are required to hold deposits in accordance with the rules•.and regulations of 18 the State Real Estate Commission. Checks tendered as deposit monies may be held uncashed pending the execution of this . 19 Agreement. 20 3. SELLER ASSIST(If Applicable)(1-10) .21 Seller will pay$ or %of Purchase Price(0 if not specified)toward 22 Buyer's costs, us permitted by the mortgage lender, if any. Seller is only obligated to pay up to the amount or percentage which is 23 approved by mortgage lender. 24 4. SETTLEMENT AND POSSESSION(1-10) 25 (A) Settlement Date is January 10, 2014 ,or before if Buyer and Seller agree.. 26 (B) Settlement will occur in the county where the Property is located or in an adjacent county, during normal business hours, unless 27 Buyer and Seller agree otherwise. 28 (C) At time of settlement, the following will be pro-rated on a daily basis between Buyer and Seller,.reimbursing where applicable: 29 current taxes (see Notice Regarding Real Estate Taxes); rents; interest on mortgage assumptions; condominium fees and home- 30 owner association fees; water and/or sewer fees, together with any other lienable municipal service fees. All charges will be pro- 31 rated for the period(s) covered. Seller will pay up to and including the date of settlement and Buyer will pay for all days follow- 32 ing•settlement,unless otherwise stated here: 33 34 (D) Conveyance from Seller will be by fee simple deed of special warranty unless otherwise stated here: 35 36 (E) Payment of transfer taxes will be divided equally between Buyer and Seller unless otherwise stated here: 37 38 (F) Possession is to be delivered by deed, existing keys and physical possession to a vacant Property free of debris, with all structures 39 broom-clean, at day and time of settlement, unless Seller, before signing this Agreement, has identified in writing that the Property 40 is subject to a lease. .41 (G) If Seller has identified in writing that the Property is subject to a lease, possession is to be delivered by deed, existing keys and 42 assignment of existing leases for the Property,together with security deposits and interest,if any,at day and time of settlement. Seller 43 will not enter into any new leases, nor extend existing leases, for the Property without the written consent of Buyer. Buyer will 44 acknowledge existing lease(s)by initialing the lease(s)at the execution of this Agreement,unless otherwise stated in this Agreement. 45 (❑Tenant-Occupied Property Addendum(PAR Form TOP)is attached. 46 5. DATES/1'IME IS OF THE ESSENCE(1-10) 47 (A) Written acceptance of all parties will be on or before:December 3, 2013 48 (B) The Settlement Date and all other dates and times identified for the performance of any obligations of this Agreement are of the 49 essence and are binding. 50 (C) The Execution Date of this Agreement is the date when Buyer and Seller have indicated full.acceptance of this Agreement by sign- 51 ing and/or initialing it. For purposes of this Agreement, the number of days will be counted from the Execution Date, excluding 52 the day this Agreement was executed and including the lust day of the time period. All changes to this Agreement should be ini- 53 Baled and dated. - .- 54 (D) The Settlement Date is not extended by any other provision of this Agreement and may only be extended by mutual written agree- 55 ment of the parties. 56 (E) Certain terms and time periods are pre-printed in this Agreement as a convenience to the Buyer and Seller. All pre-printed terms 57 and time periods are negotiable and may be changed by striking out the pre-printed text and inserting different terms acceptable 58 to all parties. 59 6. ZONING(1.10) 60 Failure of this Agreement to contain the zoning classification (except in cases where the property {and each parcel thereof, if subdi- 61 vidable} is zoned solely or primarily to permit single-family dwellings) will render this Agreement voidable at Buyer's option, and,''if... 62 voided,any deposits tendered by the Buyer will be returned t6 the Buyer without any requirement for court action. 63 Zoning Classification: Residential 64 Buyer Initials: 1V/ ASR Page 2 oR11 Seller Initials: Revised 9113 Produced with ApForm®by ript.o&18070 Fifteen MUD Road,Fraser,M1chlaan 48026 Patricia Depew ;Ivy 604 (B) Additlonaltermst 609 , 606 607 608 609 610 611 612 613 614 615 616 617 6I8 619 620 621 Buyer and Seller acknowledge receipt of a copy of this Agreement at the time ofsigning. 622 This Agreement may be executed In one or more counterparts,each of which&hall be deemed to be an original and which coun- 623 terparts together shall constitute one and the same Agreement of the Parties, 624 NOTICE TO PARTIFSt WHEN SIGNED, THIS AGREEMENT IS A BINDING CONTRACT. Parties to this transaction are 625 advised to consult a Pennsylvania real estate attorney before signing if they desire legal advice. 626 Return of this Agreement, and any addenda and amendments,including return by electronic transmission,bearing the signatures 627 of all parties,constitutes acceptance by the parties. .628 of Buyer has received the Consumer Notice as adopted by the State Real Fstate Commission at 49 Pa.Code 629 $35336. 630 / Buyerbas received a statement of Buyer's estimated closing.costs before signing this Agreement. 631 Ab/ Buyer bas read and understands the notices and explanatory Information in ibis Agreement. 632 aD/ Buyer has received a Seller's Property Disclosure Statement before signing this Agreement, If required by law 633 (sea Information Regarding the Real Estate Seiler Disclosure Law). 634 ED/ Buyer has received the Deposit Money Notice (for cooperative sales when Broker for Seller is holding deposit 635 money)before signing this Agreement. 636 ! Buyer bas received the Lead-Based Paint Hazards Disclosure, which is attached to this Agreement of Sale, and 637 the pamphlet Proted Your Fondly from Lead in Your Home(for properties built prior to 1978). 638 BUYER � ��A.P.t� DATE j �� natrioia A. DepcM 639 BUYER DATE. 640 BUYER DATE 641 Seller has received the Consumer Notice as adapted by the State Real Estate Commission at 49 Pa.Code$35336. 642 Seller has received a statement of Seller's estimated closing costs before algning this Agreement. 643 Seller has read and understands the notices and explanatory information in this Agreement. 644 SELLER_ 2 s� .ti?. DATE $state of Nelson k Boatxo 645 SELLER DATE 646 SELLER DATE ASR Page 11:or 11 Revised 9113 t�rodroaowph�#ut�bYrlptodx teo�o 6Uoaood;trase, +ssa� lmmtl D PaWdaDepew y/ Net Proceeds to Seiler for 43 Bayberry Drive The following data is for information purposes only and accuracy of the figures hereinafter set forth is not guaranteed. The actual costs with respect to each trasaction will vary depending upon the circumstances. Sale Price $148,250.00 Estimated Closing Costs Present Mortgage Balance-Loan 1 $0.00 Present Mortgage Balance-Loan 2 $0.00 Broker Fee $9,120.00 Seller Discount Points $0.00 Tax Service Fee $15.00 .Notary Fee $20.00 Document&Deed Preparation $0.00 State Transfer Tax $1,482.50 Estimated Repairs $0.00 r Home Warranty $0.00 Hydraulic Load Test $0.00 Locate and Pump Septic $0.00 Private Water Testing $0.00 Resale Certification Fee $0.00 Overnight Fee $0.00 City Fees $0.00 Buyer Closing Costs Paid by Seller $0.00 Total Expenses $10,637.50 Net Proceeds to-Seller $137,612.50 THE ABOVE PROCEEDS AT SETTLEMENT DO NOT INCLUDE PRO-RATION OF REAL PROPERTY TAXES AND RENTS, MORTGAGE LIENS, MUNICIPAL ASSESSMENTS, CONDOMINIUM CHARGES OR APPLICABLE CERTIFICATION AND/OR INSPECTION FEES. THE AMOUNTS ABOVE ARE ESTIMATES.ACTUAL COSTS WILL VARY WITH EACH PROPERTY. I[We hereby acknowledge receipt of a copy of this Statement of Estimated Sellers Costs, and understand and agree to the charges indicated herein. Witness:- G I vY�• Seller • Seller Prepared 6y:CPML on December 2,2013 REV-15o8 EX+(o8-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NELSON L. BOSTIC 2013-00856 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ;HOUSEHOLD FURNISHINGS-SEE ATTACHED APPRAISAL 990.00 2,; )THE SENTINEL-REFUND OF SUBSCRIPTION 59.50 3,: REFUND OF AUTO INSURANCE PREMIUM 384.58 7. _.. -. _ TOTAL(Also enter on Line 5, Recapitulation) $ 1,434.08 If more space is needed,use additional sheets of paper of the same size. 12-10-92 01:4T' P.01 111, � •zq - Ti Qc 1 i2-10-92 0148 P.02 t'° Al qolO P . REV-i5og EX+(oi-io) i pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NELSON L. BOSTIC 2013-00856 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT ..........._.. .._.,...... ... __ .. .................. ._. ....... A TODD H.BOSTIC i43 BAYBERRY DRIVE SON r !MECHANICSBURG, PA 17055 B. I ' I ii C.: JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 05/10/88 .MEMBERS 1ST FCU-ACCOUNT 101883-SEE ATTACHED 1,411 93 50 705.97 2. A. 05/10/88 MEMBERS 1ST FCU-ACCOUNT 101883-SEE ATTACHED 8,200.98 . 50 4,100.49 TOTAL(Also enter on Line 6, Recapitulation) $ 4,806.46 If more space is needed,use additional sheets of paper of the same size. BUREAU OF INDIVIDUAL TAXES Penns Ivania Inheritance Tax pennsytvanla PO BOX 280601 Y HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE ----- REV-1543 E%DE%EL (08-12) And Taxpayer Response D- EXEC N0.21 ACN 13142217 DATE 08-06-2013 Type of Account Estate of NELSON L BOSTIC Savings SSN Checking Date of Death 07-21-2013 Trust TODD H BOSTIC County CUMBERLAND Certificate 43 BAYBERRY DR MECHANICSBURG PA 17050-3187 MEMBERS 1ST FCU provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No. 101883 Remit Payment and Forms to: Date Established 05-10-1988 REGISTER OF WILLS Account Balance $ 1,411.93 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $705.97 Tax Rate X 0.045 Potential Tax Due $31.77 NOTE': If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PA 1 RT Step 1 : Please check the appropriate boxes below. A ❑No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B F�The information is The above information is correct, no deductions are being taken, and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C F—]The tax rate is incorrect. F—] 4.5% 1 am a lineal beneficiary(parent,child,grandchild, etc.) of the deceased. (Select correct tax rate at right,and complete Part ❑ 12% 1 am a sibling of the deceased. 3 on reverse.) ❑ 15% All other relationships(including none). D ❑Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E F—]Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART Debts and Deductions r 2 Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8112"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date Line 1 account balance Line 2 , or =.:-;Z Y 9 ( ) ( ) percent taxable(Line 3), -" - please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"intrust for"another or others were 100%owned by the decedent. ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the total number of owners including the decedent. (For example:2 owners= 50%,3 owners=33.33%,4 owners =25%, etc.) b. Next,divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate,please state -Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ PAD 3. Percent Taxable 3 X 1 2 4. Amount Subject to Tax 4 $ '3 5. Debts and Deductions 5 - '4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 8. Tax Due 8 $ 7 8 9. With 5%Discount(Tax x .95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work Home Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 BUREAU INDIVIDUAL TAXES 28 PO BOX 280601 Pennsylvania Inheritance Tax '`4 pennsyLvania HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE AnJ'Taxpayer Response REV-1543 EX DocEXEL (08-12) FILE NO.21 ACN 13142218 DATE 08-06-2013 Type of Account Estate of NELSON L BOSTIC Savings SSN X Checking Date of Death 07-21-2013 Trust TODD H BOSTIC County CUMBERLAND Certificate 43 BAYBERRY DR MECHANICSBURG PA 17050-3187 MEMBERS 1ST FCU provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Account No. 101883 Remit Payment and Forms to: Date Established 05-10-1988 REGISTER OF WILLS Account Balance $8,200.98 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $4,100.49 Tax Rate X 0.045 Potential Tax Due $184.52 0.0 NOTE*: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount(Tax x 0.95) $(see NOTE*) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 A F-]No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. B F]The information is The above information is correct, no deductions are being taken, and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. C F—]The tax rate is incorrect. F—] 4.5% 1 am a lineal beneficiary(parent,child, grandchild, etc.)of the deceased. (Select correct tax rate at right,and complete Part F—] 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships (including none). D F—]Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E F—]Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. fDebts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required,you may attach 8 1/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held "in trust for"another or others were 100%owned by the decedent. ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the total number of owners including the decedent. (For example:2 owners= 50%, 3 owners=33.33%,4 owners =25%,etc.) b. Next,divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate,please state Official Use Only ❑AAF your relationship to the decedent: PA Department of Revenue 1. Date Established 1 2. Account Balance 2 $ :PAD I 3. Percent Taxable 3 X 1 4. Amount Subject to Tax 4 $ 3 5. Debts and Deductions 5 4 6. Amount Taxable 6 $ 5 7. Tax Rate 7 X 6 8. Tax Due 8 $ 7 8 9. With 5%Discount(Tax x .95) 9 X I — - Step 2: Sign and date below. Ralum TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work Home Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 REV-1511 EX+ (08-13) [ i `7 pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER NELSON L. BOSTIC 2013-00856 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MALPEZZI FUNERAL HOME 8,467.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 8,050.00 Name(s)of Personal Representative(s) TODD H. BOSTIC Street Address 43 BAYBERRY DRIVE City MECHANICSBURG State PA ZIP 17055 Year(s)Commission Paid: 2013 Z. Attorney Fees: 5,300.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 3,500.00 Claimant TODD H. BOSTIC Street Address 43 BAYBERRY STREET City MECHANICSBURG State PA ZIP 17055 Relationship of Claimant to Decedent SON 4. Probate Fees: 358.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. ROBERT BANZHOFF, REAL ESTATE APPRAISAL 350.00 8. KIM POTTEIGER, PERSONAL PROPERTY APPRAISAL 25.00 9. COST OF SELLING REAL ESTATE 9,268.25 10. 1%TRANSFER TAX 1,482.50 11. BROKER FEE 9,120.00 TOTAL(Also enter on Line 9, Recapitulation) $ 45,921.25 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER NELSON L. BOSTIC 2013-00856 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. HOLY SPIRIT HOSPITAL-MEDICAL BILL 1,087.90 2. PINNACLE HEALTH-MEDICAL BILL 49.45 3. CAMP HILL AMBULANCE-MEDICAL BILL 31.72 4. WEST SHORE EMS-MEDICAL BILL 200.29 5. DR.D.STAKEN,MD-MEDICAL BILL 24.93 6. VISA-CREDIT CARD 1,631.26 7. SCOTT BOSTIC-PAINTING BILL 400.00 TOTAL(Also enter on Line 10,Recapitulation) $ 3,425.55 If more space is needed,insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE ] DEPARTMENT Of REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NELSON L.I. BOSTIC 2013-00856 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. Todd H.Bostic,43 Bay Berry Drive,Mechanicsburg,PA 17055 Son 1/6th Residue Susan Stanskas,205 Redhead Drive,Little Elm,Texas 75068 Daughter 1/6th Residue Peter N.Bostic,232 Yankee Road,Lot#217,Quakertown,PA 18951 Son 1/6th Residue Scott Bostic,1263 Greeley Avenue,Nyland,PA 18974 Son 1/6th Residue Ann Smith,8733 Cardinal Forest Circle,Laurel,MO 20723 Daughter 1/6th Residue Timothy Bostic,9224 Shirland Drive,Norfolk,VA 23505 Son 1/6th Residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 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: ...... .... .. ..._ ... _.... .. TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. -. �k .;r T.'4'"-. ^':'aYS!'xRe•'M'.".i!n,';y','.?Z°?s'p°`?'4�y.!Rr?S%tiyr'�'h�7ngsA!�1' "':y�'.<y,`r",r-.r,� •,ra+'yaa.+",�,"}p;.nevaRtYn�. e;;ttr.x;.. -.. .._ _ r' r eb / _ LAST WILL AND TESTAMENT OF NELSON L. BOSTIC I , NELSON L. BOSTIC.. of the Township of Silver Spring, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore. made, 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I gi:v& and bequeath all my personal belongings, household furnishings, including any a all the contents of my personal residence, absolutely and un- _.....__ c flsd td-©na d . , ha ta� etax ..on this b e.cue.s t.--the .aAnhe be' paid out a .my residuary estate. I direct that all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, be converted into cash, and for this purpose I authorize, empower and direct my ' personal representative, hereinafter named, to sell any and all real estate which I may own at -the time of MY decease, at either public. or private sale or sales. r l.. . f •f After my estate has thus been converted into cash, and upon the payment of all my just debts and obligations, the costs of administration of my estate, and the payment of all inheritance, estate and succession taxes, I direct my Executrix or Executor, whichever the case may be, to divide the balance of my entire estate _then,. rema ning.,. .into .six (6._)._e.qua_l share,s,., and to pay out and distribute the same as follows, to wit: (a) I give and bequeath one (1) su.eh equal share to my son, PETER BOSTIC. (b) I give and bequeath one (1) such equal share to my son, SCOTT BOSTIC. (c) I give and bequeath one (1) such equal share to my son, TODD BOSTIC. (d) . I give and bequeath one (1) such equal share to my son, TIMOTHY BOSTIC. (e ) I gave a,n' MV4"ath one .(I) such equal share to my daughter, ANN P. SMITH'. (f) I give and bequeath one, (1) such equal share to my daughter, SUSAN L. STANSKAS. ? 9;4,,,I nominate, constitute and appoint my ,Executrix of this my Last Will and - Testament, and in the de that my said �r should predecease me, or should she be unable or unwilling to serve in such capacity for r 2 r a. any reason, then in such event, I nominate, constitute and appoint my son, Psatfi. l BOSTIC, Executor of this my Last Will and Testament, in her piace 'and stead. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /t;4 day of June, A. D. , 1992. SEAL Nelson L. Bostic Signed, sealed,* published and declared by the above named, NELSON L. BOSTIC, as and for his Last Will and Testament, in the presence of us, who have subscribed our names hereto as witnesses, at the request of said testator, in his presence and in the presence of each other. lid T P � f COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, NELSON L. BOSTIC the testathr whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that T signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. Sworn and affirmed. to and acknowledged before me bX N TES© ;; ROOT_TrC! the -testator � , this day of Tune �, A. T". .,1992. N. COMMONWEALTH OF PENNSYLVANIA ) Aae SS. COUNTY OF CUMBERLAND ) We, the undersigned, J. ROBERT STA.UFFER and RUTH AJJN 'F1T1WIT)tR the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testat:oor,,:,+, _ , sign and. exe- cute the instrument as- his 'Last Will and Testament; that the said tes.ta.t ors, NELSON L. BOSTIG . _, executed it as his./ free and voluntary act for the purposes therein expressed; that each opus.,. #`ie�iearni'`s `g:re- i the Will as witnesses; and that to tie best. 6�-:our. knowledge, the testator was, at the time, eighteen: (18) or more years o.f age, - of sound mind, and under no constraint, duress or undue influence.. Sworn -and s_owibed to before me this j 5 day of Jjjne 1992. FRI MY 0"Tastp 0WWNft&.