HomeMy WebLinkAbout02-10-14 (2) REV-1500 Ex(et-re) 1 1505610101
OFFICIAL USE ONLY
PA Department of Revenue p?nnsytvanla
Bureau of Individual Taxes ""'--- County Code Year File Number
PO BOX28o6oi INHERITANCE TAX RETURN Z 1 13 /5/0
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
12/05/2013 07/09/1917
Decedent's Last Name Suffix Decedent's First Name _MI
WEINSTEIN ROBERT J
(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
fMD 1.Original Return p 2. Supplemental Return O 3. Remainder Return(date of death
prior to 12-13.82)
C=) 4.Limited Estate p 48.Future Interest Compromise(date of C> 5. Federal Estate Tax Return Required
death after 12-12-82)
OD 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)
I
O 9"Litigation Proceeds Received C1 10.Spousal Poverty Credit(date of death C> 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1"1-95) (Attach Soh.O) `,.:_.: �z
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMIC08HOULD BMRECTEDTQ7>
Name Daytimsi Whone Nu�4r
THOMAS E. FLOWER (717)I'�43 3 II-1 M
(t1 IVEi WILLS USE&&!$ ,
First line of address 9 C= -rt
� w r m
FLOWER LAW, LLC o
_ ._
Second line of address =DATrFILED 10 W. HIGH ST City or Post Office State ZIP Code
CARLISLE PA 17013-0922
Correspondent's e•maii address: Torn "FIOWer-18W.Conin
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 mapper has any knowledge,
SIGNATtJf E OF PER�(3N[3FSPO I LE FO FILING PATE
ADDRESS G'(p �++•(yVY�! !! caJr-try ySl1/
ALVIN H. BLITZ, EXECUTOR; 802 WELLINGTON DRIVE, CARLISLE, PA 17013 7
. \Z7_U F` =F ER THAN REPRESENTATIVE
ADDRESS
FLOWER LAW, LLC; 10 W. HIGH STREET; CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101
1505610105
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A). .. .. . . . .. .. . .. . . ... . . . . .. . . 1. 0.00
2. Stocks and Bonds(Schedule B) ... .. . . .. . . . .. . .... .. . . .. . .. ... 3,109,629.95
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 0.00
4. Mortgages and Notes Receivable(Schedule D).. . .. . .. . ... . ... . ... . .... . . 4. 0.00
S. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . . .. 5, 93,903.05
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .. . .. 6. 0.00
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. .. . . .. 7. 0.00
8. Total Gross Assets(total Lines 1 through 7).. . . .. . ... . .. . .. . . .. . .. .. . . . . 8. 3,203,533.00
9. Funeral Expenses and Administrative Costs(Schedule H)... . .. . . .. . .. .. . .. . 9. 251,611.83
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) .... . . . . . . ... . 10. 2,365.09
11, Total Deductions(total Lines 9 and 10). . . .. . . . . .. .. . .. . .. . .. . . ... . 253,976.92
12, Net Value of Estate(Line 8 minus Line 11) . . ... . ... .. . . .. . .. . . . ... . 12. 2,949,556.08
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which -
an election to tax has not been made(Schedule J) . . . . _ . .. . .. . .. . .. .. . . 13. 2,889,556.08
14. Net Value Subject to Tax(Line 12 minus Line 13) ... . .. . .. . . . . . ... . ... . . . 14. 60,000.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 -
(a)(1.2)X.0-
15.
16. Amount of Line 14 taxable
at lineal rate X.0_ 16
17. Amount of Line 14 taxable "- -
at sibling rate X.12 17
18. Amount of Line 14 taxable
at collateral rate x.15 60,000.00 18 9,000.00
19. TAX DUE ... .... . .. .. . . . . ... . . . ... .. . ... . . . .. . .. . .. . . . . . ... . .. .. . . 19. .. .. 9,000.00
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
O
L Side 2
1505610105 1505610105
REV-1500 EX Page a file Number
Decedent's Complete Address:
DECEDENTS NAME
ROBERT J.WEINSTEIN
STREET ADDRESS .. ._ .
332 WALNUT BOTTOM ROAD
APT.#1-10
CITY CARLISLE STATE ZIP
PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 9,000.00
2. Cfedits/Payments 6,550.00
A.Poor Payments .... _ _ _ .
6.Discount 450.00
Total Credits(A+6) (2) 9,000.00
3. Interest
4. if tine 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (3) 0.00
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS,AGENT:
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred:............—...................-..................................................... ❑ []x
b. retain the right to designate who shall use the property transferred or its income;..........__...........___.......... ❑ 9
c. retain a reversionary interest;or....................................................................................---............................- ❑ I�
d. receive the promise for life of either payments,benefits or care?........................................__.......................... ❑
2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................. .......—.....................-....--....—......--...... ❑ 0
3. Did decedent own an 1ri Trust for"or payable-upon-death bank account or security at his or her death?............- ❑ E
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? .....................—.......................................... .................................................. E3 Q
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 t0 or for the use of the surviving spouse is
3 percent(72 P.S.§9116(a)(1.1)(7).
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) (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 lax 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 PS.§9116(12)[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 172 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-1503 EX+(7-v)
i' pennsytvania SCHEDULE B
PUVA TM ENT OF XEVENVE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROBERT J. WEINSTEIN 21-13-1310
All property jointly owned with right Of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 19,200 shares Pfizer Inc.@ 31.465
604,128.00
2 1,000 shares 3M Co.@ 128.325 128,325.00
3 381 shares Allstate Corp.@ 54.205 20,652.10
4 405.79 Vanguard Morgan Grown Fund Investor Shares @ 25.99 10,546.48
5 Charles W.Schwab"Schwab One"Acct, No.3080-4511 (see attached list of stock holdings) 2,345,978.37
TOTAL(Also enter on Line 2, Recapitulation) $ 3,109,629.95
If more space is needed,insert additional sheets of the same size
&mputershare +
Computershare Trust Company,N.A. ,
PO Box 43078
Providence,Al 02940-3078 1
Within USA,US territories 6 Canada 800 733 9393 i
Outside USA,US territories 8 Canada 781 5754591
000165 v .computershare.com<nvestor
IIIIII'11111 1111'ills'IIlIIIIIIIII'111111ll'li""lill"I"tili'i
Pfizer Inc.is incorporated underthe lawsof hofDE.
ALVIN H BLITZ EX EST ROBERT J WEINSTEIN
802 WELLINGTON DR
CARLISLE PA 17013 Holder Account Number
C0005978998
III II I� I)II VIII VIII III I III IIII II II III I IIII IIII IIII j
Company ID PFE
SSN/TINCenified Yes
.Pfizer Inc. - Direct Registration (DRS) Advice i
1
Transaction(§)
Total Class
ShareslUnits
Date I Transaction Description I I CUSIP I Description
03 Jan 2014 Transfer 16,130.000000 717081103 Common Stock
03 Jan 2014 - Plan Deposit -16,130.000000 717081103 Common Stock
Account Information: Date: 03 Jan 2014(Excludes transactions pending settlement)
Current Current Total
Dividend I Direct I Shares/I Price Value($) CUSIP I Class
Reinvestment Registration Per Share Description
Balance Balance Units
16,130.000000 0.000000 16,130.0000017 30.520000 492,287.60 717081103 Common Stock
IMPORTANT INFORMATION—RETAIN FOR YOUR RECORDS.
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4 0 U D R P F E
OOIC50003.d.zmia.031058 aa3YMl65N00536
IM Company " weua Fargo sank N.A. Payable Date 17-1
�OmmonStock Disbursing Agent 12/2712013 1249138 910
Payable al:
Wells Fargo Bank,NA,
One Hundred Thirty E_fight Thousand Seven Hundred Ninety Six&001100 U.S. Dollars AMOUNT OF CHECK
***$138,796.00*
'AY TO THE ORDER OF .
Void after 180 days
ALVIN H BLITZ EX
EST ROBERT J WEINSTEIN
WELLINGTON DR
CARLISLE PA 17013-3560 WMM0112UB
1I
Auth Ized Signature 124
----J Slgnatum Mey Be Computer Generated 1249138 1
II' i24913811• I:09i0000L91: 000075393411•
December 27,2013
3M Company
Common Stock
IMPORTANT:Retain this document for your investment,tax, and cost-basis records.
See reverse for information about online account access.
Account Information Transaction Details Share Balances
Account Number 4003644295 Type of Transaction Sale Dividend Reinvestment Plan 0.000
Share Amount -1,000.000 Direct Registration System 0.000
ALVIN H BLITZ EX Price per Share $138.9110 Total Shares 0.000
EST ROBERT J WEINSTEIN Effective Date 121272013
802 WELLINGTON DR Gross Amount $138,911.00
CARLISLE PA 17013-3560 Service Charge $15.00
Commission $100.00
Federal Tax Withheld $0.00
NRA Tax Withheld $0.00
Stale Tax Withheld $0.00
Net Amount $138,796.00
This advice represents the most recent sale transaction processed on your account. If you requested an additional transaction(s),the
details of that transaction(s)will be mailed to you under separate cover.
The shares represented by this statement are fully paid and non-assessable. This statement is a record of addressee rights at the time of issuance.
Delivery of this statement of itself conveys no rights to the recipient.This statement is neither a negotiable instrument nor a security. A full copy of any
rights,privileges,restrictions,and conditions which may be attached to the securities covered by this statement can be obtained by writing to the Secretary
of the Company.
1
122813 IIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIN ZMM01A28I0I1I11YIYIYIY-
. . ,. A,
.}. welts t arga sanK N.A. Payable Dafe .,.1249027
S ate.
Disbursing Agent 12/27/2013 870
' • Payable et:
t Yal in hands _ welts Fargo Bank,N.A.
t7
' AMOUNT OF CHECK
Twenty Thousand Thre_a Hundred Eighty & 38/100 U.S. Dollars. ***$20,380.39***
PAY TO THE ORDER OF
ALVIN H BLITZ EX Vold after 180 days
EST ROBERT J WEINSTEIN
WELLINGTON DR
CARLISLE PA 17013-3560 wAUllzxra
AU1
! Auth ed Signature 13
Signature May Be Computer Generated 1249027
11812490270 1:0910000191: 1000075393411'
} } December 27,2013
(WA"a71 a 1 G. The Allstate Corporation
Wra In good nand& Common Stock
IMPORTANT: Retain this document for your investment,tax,and cost-basis records.
See reverse for information about online account access.
Account Information Transaction Details Share Balances
Account Number 4003644295 Type of Transaction Sale Direct Purchase Plan 0.000
Share Amount -381.000 Direct Registration System 0.000
ALVIN H BLITZ EX Price per Share _ $53.6512 Total Shares 0.000
EST ROBERT J WEINSTEIN Effective Date 12127/2013 -
802 WELLINGTON DR Gross Amount $20,441.11
CARLISLE PA 17013.3560 Service Charge $15.00
Commission $45.72
Federal Tax Withheld $0.00
NRA Tax Withheld $0.00
State Tax Withheld $0,00
NetAmount $20,380.39
This advice represents the most recent sale transaction processed on your account.if you requested an additional transaction(s),the
details of that transaction(s)will be mailed to you under separate cover.
The shares represented by this statement are fully paid and non-assessable. This statement is a record of addressee tights at the time of issuance.
Delivery of this statement of itself conveys no rights to the recipient.This statement is neither a negotiable instrument nor a security.A full copy of any
tights,privileges,restrictions,and conditions which may be attached to the securities covered by this statement can be obtained by writing to the Secretary
of the Company.
122816 ((III!IIIIIII(VIII VIII III llllll IIII VIII(till(IIII VIII VIII VIII VIII(till VIII(ill IIII -ZALL1A28101111IYIYIYIY`
January 2, 2014 Page 1 of 1
V�l�Ual'd® Vanguard Morgan Growth Fund
Investor Shares
ROBERT J WEINSTEIN 800-662-2739 - Client Services
C/O FLOWER LAW LLC (800)662-6273 - Tele-Account -
10 W HIGH ST Fund number: 26
CARLISLE PA 17013-2922 Account number: 240475
m
ACCOUNT VALUE On 1/02/2014
$0.00
Trade date Transaction Dollar amount Share price Shares transacted Total shares owned
Beginning balance 2,094.367
1/02 Transfer to 88080011743 $-53,217.87 $25.41 -2,094.367 .000
Cost basis method-AVGCOST
VANGUARD MORGAN GROWTH FUND FUND/ACCOUNT NO.
INVESTOR SHARES 0026/00000240475
•Do not alter or photocopy this Invest-By-Mail slip. ROBERT)WEINSTEIN
•Visit www.vanquard.com or call to change your address.
Ust each check $ ❑r❑❑❑r❑❑FI F1 El
separately. $ 0,0110,11110 -00 Make checks payable to:The Vanguard Group-0026
$ ❑fEl El[1rQ❑❑ •❑El
THE VANGUARD GROUP
Total amount $ ❑� 1:111 El •El[I PO BOX 13750
> > PHILADELPHIA PA 19101-9897
11111 1111111111 111
00261 00000240475 301 70 000563693 2 1 rI�f
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Attachment to Schedule B Robert J.Weinstein Estate 21-13-1310
Schwab Acct. No. 3080-4511
1,000 sh.Allstate Corp @ 54.285= $54,285.00
4,800 sh. Ball Corp @ 49.89 = $239,472.00
500 sh. Bank of America Corp @ 15.59= $7,795.00
5,000 sh. Carlisle Companies Inc @ 74.67= $373,350.00
1,000 sh. Chesapeake Energy Corp @ 2.6815= $26,815.00
500 sh. Devon Energy CP new @ 61.04= $30,520.00
720 sh. Discover Financial Svcs @ 52.735 = $37,969.20
200 sh. ConocoPhillips @ 70.84= $14,168.00
325 sh. Frontier Comm. @ 4.505= $1,464.12
1,400 sh.General Electric @ 26.83 = $37,562.00
2,694 sh. Hershey Co. @ 96.845= $260,900.43
1,300 sh. Ingredion Inc @ 69.025= $89,732.50
1,500 sh.Jardin Corp @ 57.305 = $85,957.50
1,958 sh. Kimberly-Clark Corp @ 105.165 = $205,913.07
500 sh. Marathon Pete Corp @ 86.76= $43,380.00
1,440 sh. Morgan Stanley @ 30.555= $43,999.20
1,000 sh. Neenah Paper Inc @ 42.11 = $42,110.00
1,000 sh. Pepco Holdings Inc @ 19.03 = $19,030.00
8,000 sh. Pfizer Inc @ 31.465= $251,720.00
500 sh. Phillips 66 @ 71.25= $35,625.00
1,500 sh. Raytheon Co New @ 86.53 = $129,795.00
150 sh.Schlumberger Ltd @ 88.15= $13,222.50
500 sh. United Tech. Corp @ 110.635= $55,317.50
1,354 sh.Verizon Comm @ 49.275= $66,718.35
600 sh. Wells Fargo&Co new @ 43.81 = $26,286.00
1,000 sh. 3M Co. @ 128.325 = $128,325.00
300 sh. Potash Corp Sask. Inc @ 31.82 = $9,546.00
500 sh. PPL Corp @ 30= $15,000.0 0
Schwab Account total stock value: $2,345,978.37
REVn508 EX+(u-io)
pennsytvania SCHEDULE E
DEPARTMENT of REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ROBERT J. WEINSTEIN 21-13-1310
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 VALUE AT DATE
DESCRIPTION OF DEATH
1. Wells Fargo Bank Acct.#1010080462071 54,330.31
2, Orrstown Bank Acct#106004122
26,625.34
3. M&T Bank Acct#12829268(received from PA Treasury,as previously unclaimed property) 12947.40 12,947.40
TOTAL(Also enter on Line 5, Recapitulation) $ 93,903.05
If more space is needed, use additional sheets of paper of the same size.
Primary account number:1000294663430 ■ November 8,2013-December 6,2013 ■ Page 2 of 6
•
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Summary of accounts
theckinglPrepaid and Savings
Ending balance Ending balance
Account page Accountnumber last statement thisstatement
Crown Classic Banking' —i 2 100029466343IT — 0.93 -0.05
Wells Fargo•Preferred Rate Savings 4 1010080462071 54,353.15 54,330.31
Total deposit accounts $54,354.08 $54,330.26
Crown Classic Banking®
Activity summary Account number: 1000294663430
Beginning balance on 11/8 $0.93 ROBERT J WEINSTEIN
Deposits/Additions 25.00 Pennsylvania account terms andconditions apply
Withdrawals/Subtractions - 25.93.1 For Direct Deposit and Automatic Payments use
.Ending balance on 12/6 -50.03 Routing Number(RTN): 031000503
Overdraft Protection
Your account is linked to the following for Overdraft Protection: .
■ Savings - 001010080462071
a
m
0
m
interest summary
Interest paid this statement $0.00
Average collected balance $12.49
Annual percentage yield earned 0.00%
Interest earned this statement period $0.00
Interest paid this year $0.00
r
i
ORRSTOWNBANK
A Tradition of Excellence
ORRS P.O. Box 250
Shippensburg,PA 17257
Temp-Return Service Requested Date 12/10/13 Page 1
Primary Account 106004122
Enclosures
��Irdhhd �4hh�lu�ll Jill d-111-11l,ll,nln1,ld-d-i[
000142 1.1155 AV 0.360 TR00001
Robert i Weinstein
Thornwald Home I-10
442 Walnut Bottom Rd
Carlisle PA 17013-3742
CHECKING A C C O U N T S
Account Title Robert J Weinstein -
Thornwald Home I-10
Orrstown .Bank has updated the Terms and Conditions of your deposit account.
Enclosed with your statement is the revised agreement. Please contact our
Customer Service Center at 1-888-677-7869 if you have any .questions.
50F interest Checking Check Safekeeping
Account Number 106004122 Statement Dates 11/12/13 thtu 12/10/13
Previous Balance 33, 322.15 Days In The Statement Period29
3 Deposits/Credits 7, 448. 57 Average Ledger . 29, 507.52
6 Checks/Debits 9, 537.38 Average Collected 29, 352.07
Service Fee - .00 Interest Earned 1. 17
Interest Paid - 1.17 Annual Percentage Yield Earned 0.05%
Current Balance 31,234.51 2013 Interest Paid 27.44
r
N
o Deposits and Additions
o Date Description Amount
11/29 PENSION PR NYSLRS 2, 655.47.
N PPD
.". 12/03 XXSOC SEC SSA TREAS 310 185. 10
c PPD
12/09 Deposit 4, 608.00
0 12/10 Interest Deposit 1.17 -
N
a
O
O N
O O
N
o� Electronic Debits and Withdrawals
tiDate Description Amount
° 11/15 BILL PYMT CenturyLink 53.71-
°" CHECK # 1075
LMM&TBank,
i
ACCOUNT>N0. ACCOUNT TYPE STATEMENT PERIOD PAGE.
585602 CLASSIC CHECKING DEC.22-MAR.21,2013 1 OF 1
00 0 04319H NM 017
v',{y`� 000003094 FIDS1549DO1703211303 02 000000 12484
P
ROBERT J WEINSTEIN
`f� 442 WALNUT BOTTOM RD I-10
CARLISLE PA 17013
INTEREST EARNED FOR STATEMENT PERIOD 0.00 HIGH STREET-CARLISLE
ACCOUNT SUMMARY
;:BEGINNING DEPOSITS 8 -OTHER CURRENT- ENgING
BALANCE OTHER:::ADDITIONS �> CHECKS PAID: SUBTRACTIONS ! -,INTEREST::PD :BALANCE
N0. AMOUNT. NO. AMOUNT N0. AMOUNT
12,947.40 0 0.00 1 ol 0.00 1 1 12,947.40 1 0.00 0.00
ACCOUNT ACTIVITY
:pgSTINODEPOSITSINTEREST CHECKS<;8 OTHER ;DAILB
>f DATE 7RANSABTION DESCRIPTION X18 OTHER.ADDITIONS-. SUBTRACTIONS BALANCE
12-22-12 BEGINNING BALANCE $12,947.40
03-20-13 CLOSEOUT - ESCHEAT TO STATE 12,947.40 0.00
S ENDING BALANCE . $0.00
0
LET MORE OF YOUR PERSONALITY SHOW BY ENHANCING YOUR M&T CHECK CARD WITH THE
PICTURE OR DESIGN OF YOUR CHOICE. VISIT MTB.COM/CUSTOMCARD TO VIEW OUR GALLERY,
EXPLORE OUR INTERACTIVE DEMONSTRATION TOOL, AND GET STARTED.
n USE OF THE CUSTOM CARD DESIGN SERVICE IS SUBJECT TO PROGRAM TERMS & CONDITIONS,
IMAGE GUIDELINES AND A 07.95 IMAGE SET-UP FEE FOR EACH NEWLY APPROVED CUSTOM
CARD DESIGN. FOR CARDS HAVING THE SAME NUMBER, ONE FEE WILL BE CHARGED PER
APPROVED CUSTOM DESIGN, REGARDLESS OF THE NUMBER OF CARDS ISSUED. REPLACEMENT
CARDS WILL NOT INCUR THIS FEE IF THE CUSTOM DESIGN REMAINS UNCHANGED.
REV-1511 Ex+(10-09)
T pennsylvania SCHEDULE H
DEPARTMENT Or REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROBERT J. WEINSTEIN 21-13-1310
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROTHERS FUNERAL HOME, INC.-PROFESSIONAL SERVICES 1,825.00
2. EWING BROTHERS FUNERAL HOME,INC.-VEHICLES&EQUIPMENT 445.00
3. OBITUARY 187.32
4. HONORARIA:CLERGY,ORGANIST,SEXTANT 500.00
5. DEATH CERTIFICATES 60.00
6. ALTAR FLOWERS 65.00
7. CREMATION/CORONER FEE,etc. 360.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 160,176.65
Name(s)of Personal Representative(s) ALVIN H. BLITZ
Street Address 802 WELLINGTON DRIVE
City CARLISLE _ state PA ZIP 17013
Year(s)Commission Paid: TO BE PAID HALF IN 2014(HALF IN 2015
Z. Attorney Fees:
84,088.32
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: 1,865,00
s. Accountant Fees:
6. Tax Return Preparer Fees:
7• PUBLICATION OF ESTATE NOTICES 264.54
8. FILING FEE,FINAL ACCOUNT 1,775.00
TOTAL(Also enter on Line 9, Recapitulation) $ 251,611.83
If more space is needed,use additional sheets of paper of the same size.
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle, PA 17013
(717)243-2421
December 9, 2013
Alvin Blitz
802 Wellington Drive
Carlisle, PA 17013
The Funeral Service for Robert J. Weinstein
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.
Professional Services
Basic Services of PA L.F.D. 1,200.00
Basic Use of Facility 250.00
Documentation Prep/Recording - 375.00
Total Professional Services - 1,825A0
Equipment
Transfer Deceased to Funeral Home 295.00
Utility Vehicle 150.00
Total Equipment --------------------
44?i.UO----
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO
OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
Cash Advances
The Sentinel Obituary 187.32
Clergy Honorarium 250.00
Organist at Church 200.00
Church Sexton(Jim Olson) 50.00
Death Certificates 60.00
Flowers(Altar Flowers) 65.00
Cremation/Coroner fee etc. 360.00
Total Cash Advances -----------------J- .32-----
SALES TAX 0.00
SUB-TOTAL 3,442.32
INITIAL PAYMENT/DISCOUNT/CREDITS 100.00
TOTAL AMOUNT DUE 3,342.32
The unpaid balance over 30 days is subjected to a 1 %service charge per month- 12%per annum.
Page
REV-1512 EX+(12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROBERT J. WEINSTEIN 21-13-1310
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. Thornwald Home,room&board,prorated to date of death 2,032.89
2. West Shore EMS,ambulance/oxygen administration 286.87
3. Millenium Pharmacy Systems, Inc. 45.33
TOTAL(Also enter on Line 10, Recapitulation) $ 2,365.09
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
1+� DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ROBERT J. WEINSTEIN 21-13-1310
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not that Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).j
1. TANYA&DIRK BROWN,109 STOVER RD,MECHANICSBURG 17055 NONE 30,000
2. TINA&RICHARD WATTS,502 W Siddonsburg Rd,Dillsburg,PA 17019 NONE 30,000
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.
8, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
Corporation of Pennsylvania Epsilon,Phi Delta Theta Fraternity of Dickinson College 2,000.00
2. St.John's Episcopal Church 721,889.02
3. The Episcopal Home of Shippensburg 721,889.02
4, Dickinson College(general endowment fund) 721,889.02
I
5,6 5.Episcopal Diocese of Central Pennsylvania(12.5°/x)&6.Bosler Memorial Library(12.5%) 721,889.02
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE OISTR18UTIONS ONLINE 13 OF REV-1500 COVER SHEET. $ 2,889,556.08
If more space is needed,use additional sheets of paper of the same size.
C3 mrn
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LAST WILL AND TESTAMENT 'M c-> ��
r z rn � o
OF U- � o
C1 - ,'D _.D ° -n
n a o '
ROBERT J. WEINSTEIN ° ;:a co r- m
I, ROBERT J. WEINSTEIN, of 102 West Pomfret Street, Carlisle,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this as and for my Last Will and Testament,
hereby revoking and making void any and all former Wills, Codicils, or writings in the
nature thereof, by me at any time heretofore made.
FIRST: I direct that all inheritance and estate taxes becoming due by
reason of my death, whether such taxes may be payable by my estate or by any recipient
of any property, shall be paid by my Executor out of the residuary of my estate as an
expense and cost of administration of my estate. My Executor shall not seek to obtain
reimbursement for any, such tax paid by it, from any beneficiary. In the absolute
discretion of my Executor, it may pay such taxes immediately or may postpone the
payment of taxes until convenient to the administration of the estate.
SECOND: I bequeath the sum of Two Thousand ($2,000.00) Dollars to
the CORPORATION OF PENNSYLVANIA EPSILON, PHI DELTA THETA
FRATERNITY, of Dickinson College, Carlisle, Pennsylvania.
THIRD: I bequeath the sum of Thirty Thousand ($30,000.00) Dollars
to TINA and RICHARD WATTS, or the survivor, of Dillsburg, Pennsylvania.
FOURTH: I bequeath the sum of Thirty Thousand ($30,000.00) Dollars
to TANYA and DIRK BROWN, or the survivor, of Mechanicsburg, Pennsylvania_
FIFTH: I may add to this Will a list of other personal property which I
may decide from time to time should go to other individuals. i will leave any such list with
my Will and request that my Executor follows any direction set forth in any such list.
SIXTH: I bequeath all the rest, residue and remainder of my estate, of
every nature and wheresoever situate, as follows:
A. Twenty-five (25%) percent to ST. JOHN'S EPISCOPAL
CHURCH, of Carlisle, Pennsylvania, to be distributed to its unrestricted Reserve Account,
provided, however, it is my desire that the Vestry, at its discretion, consider the use of
such funds for the maintenance and upkeep of the historic fabric of the Church (such
request is intended to be precatory and not mandatory).
B. Twenty-five (25%) percent to THE EPISCOPAL HOME, of
Shippensburg, Pennsylvania;
C. Twenty-five (25%) percent to DICKINSON COLLEGE, of
Carlisle, Pennsylvania, to be added to its General Endowment Fund;
D. Twelve and one-half (12/2%) percent to the
INCORPORATED TRUSTEES OF THE EPISCOPAL DIOCESE OF CENTRAL
PENNSYLVANIA, of Harrisburg, Pennsylvania; and
E. Twelve and one-half (12 '12%) percent to the J. HERMAN
BOSLER MEMORIAL LIBRARY, of Carlisle, Pennsylvania.
LASTLY: I nominate, constitute and appoint my friend, ALVIN H.
BLITZ, ESQUIRE, to be the Executor of this my Last Will and Testament. I authorize that
he be paid five (5%) percent of the gross estate as an Executor's fee for administration of
the estate. in the event that ALVIN H. BLITZ, ESQUIRE, shall fail to qualify or cease to
2
qualify as Executor, or that his personal circumstances are such that it is impractical for
him to serve as such, I authorize him to appoint an alternate or successor Executor. If he
fails to qualify or ceases to act as Executor, and has not appointed such an alternate or
successor Executor, I direct that the alternate Executor of my estate be the ORRSTOWN
BANK, of Carlisle, Pennsylvania. I direct that all fiduciaries acting under this Will, whether
or not named herein, shall not be required to file bond for the faithful performance of their
duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
f S day of ,,, 2011.
Robert f Weinstein
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
3
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, ROBERT J. WEINSTEIN, Testator, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed. it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledged before me, by ROBERT J.
WEINSTEIN, the Testator, this 15— day of
2011.
YI tae�� 4-,.
Robert J. W instein, Testator
Notary Public
. COMMONWEALTH OF PENNByLyAH�p
N07ARWLSEAL
THOMAS E.FLOWER,Notary p�tyy�
Carlisle BOrO•.CumbedarM Coun
Commission Expires October 26,T014
4
F
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, 1141-cuef,. A FlOa-mil . Jf and
the witnesses whose names are sighed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were present and saw
Testator sign and execute the instrument as his Last Will; that he signed willingly and that
he executed it as his free and voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the
best of our knowledge the Testator was at that time 18 or more years of age, of sound
mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by s
and_ AIV 4 It LE this day of
e pr 2011.
Witness
Witness
Notary Public
coMMO►rwew�rHOF�NNSn, wrvra
N07ARU1L SEAL
THOMAS E.FLOWED,Note Public
Carlisle Boro.,Cumberland Coon(y
Commissar Expires October 26,2014
5