HomeMy WebLinkAbout03-23-05 (2)
JAN L. BROWN, ESOUIRE'
JACOUELlNE A. KELLY, ESOUIRE
"ADMIITED IN PA AND DISTRICT OF COLUMBIA
JAN 1. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
OLOE ENGLISH GAP
845 S,R THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
EMAIL: jlbassoc@verizon.net
TELEPHONE (717) 541-5550
FACSIMILE (717) 541-9223
BRENDA F. KEPHART, LEGAL ASSISTANT
PAULA K. WHITE, LEGAL ASSlSTANT
JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT
March 11,2005
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Jean R. Trayer
File No. 2005-00036
Gentlemen or Ladies:
Enclosed please find the following items for filing with the Register of Wills:
1. Inventory.
2. An original and one copy of the Inheritance Tax Return.
3. Check 992 payable to Register of Wills in the amount of30 for the filing fees.
4. Check 993 payable to Register of Wills, Agent in the amount of$I 17.49 for the tax shown
to be due.
Please time stamp and return our file copies of these documents. A return envelope is
provided.
If you have any questions, feel free to contact this office.
sincerll~ ~
Jan LO":n
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Enclosure
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REV-1500 EX + (f}{lO)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
(J,A.P D,
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21-050036
"COUNT'iCci6E ---VEAR- - - 'imMBER- -
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl)
Tra er Jean R
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
196-14-3134
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
12/18/2004 07/18/1924
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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00 1. Original Return
D 4. Limited Estate
00 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of dealh prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AttachSchO)
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THIS SECTION. MUST BE COMPLETED. ALLColiRESPOtilbENCEANb CONFIOEIolTlAL,TAX IIolFORMATiON,SHO(JLOBE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Jan L Brown
FIRM NAME (If Applicable)
Jan L Brown & Associates 845 Sir Thomas Ct Ste 12
TELEPHONE NUMBER
717-541-5550 Harrisbur PA 17109
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non~Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
g. Funeral Expenses & Administrative Costs (Schedule H) (g)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
3,757.041
OFFICIA~ ~SE ONLY
I
53.61,
3.161711 . -' .
(8)
6,972.36
3,810.65
413.50
(11)
(12)
(13)
4,224.15
2,748.21
(14)
2,748.21
0,00 X _(15) 0.00
2,748.21 X .045 (16) 123.67
0.00 X ,12 (17) 0.00
0,00 X .15 (18) 0.00
(19) 123.67
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
201 Hiah Street, PO Box 215
South Middleton Townshio
CITY I STATE I ZIP
Boiling Springs PA 17007
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
123.67
618
Total Credits (A + 8 +C)
(2)
6.18
3. InteresVPenalty if applicable
D. Interest
E. Penalty
T otallnteresVPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 hine 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
117 .49
117.49
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; ........................................................................... D [2SJ
b. retain the right to designate who shall use the property transferred or its income; ........................................ D [2SJ
c. retain a reversionary interest; or "".................................................................................................. 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. D [2SJ
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?........ ..................... ................. ........................... ..................... D [2SJ
3. Did decedent own an 'in trustfo~ or payable upon death bank account or security at his or her death? ................. D [2SJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D [2SJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and 10 the best of my knowledge and belief, il is true, correct
and complete,
Declaration of preparer other than !he personal representative is based on all information of which preparer has any knowledge.
DATE
. -0'1 -05
ADDRESS
845 ir omas Ct Ste 12
Harrisbur!:j
PA 17109
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)l.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot 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 twenty-one 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% [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%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)].
The tax rate imposed on the net value ottransfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A siblin9 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 + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Traver Jean R
FILE NUMBER
21 05
All property jointly-owned with right of sUNlvorshlp must be disclosed on Schedule F.
0036
ITEM
NUMBER
1.
OESCRIPTION
Prudential Financiallnc (PRU); 46 shs @ $54.12/sh
VALUE AT DATE
OF DEATH
2,489.52
2
MetLife (MET); 32 shs @ $39.61/sh
1,267.52
TOTAL (Also enteron line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3 757.04
REV-1508 EX + (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Traver Jean R
FILE NUMBER
21 05
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.
0036
ITEM
NUMBER
1.
OESCRIPTION
Prudential Financiallnc; dividend check
2
United Health Care; benefit refund
VALUE AT DATE
OF DEATH
20.70
32.91
TOTAL (Also enter on line 5. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
53.61
REV.1509 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Traver Jean R
FILE NUMBER
21 05
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
0036
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Susan R Trayer
201 High Street, PO Box 215
Boiling Springs PA 17007
daughter
B
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JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FlNANCIAlINSTlTUT10N AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FORJOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 6/03 Citizens Bank 1,467.27 50. 733.64
Checking 610073-202-9
2 A 6/03 Citizens Bank 4,856.14 50. 2,428.07
Savings 6140-174538
TOTAL (Also enter on line 6, Recapitulation) $ 3161.71
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Traver Jean R
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule J.
FILE NUMBER
21 05
0036
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
So~al Secunty Numbe~s)IEIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees Jan L Brown & Associates 1,500.00
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) 2,183.65
Claimant Susan R Trayer ($2, 183.65 of probate assets available for exemption)
Street Address 201 HiQh Street, PO Box 215
City BoilinQ SprinQs State P A Zip 17007
RelaUonship ot Claimantto Decedent dauQhter
4. Probate Fees Register of Wills, Cumberland County 127.00
5. Accountants Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 3810.65
(If more space is needed, insert additional sheets of the same size)
ATTACHMENT TO SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Trayer, Jean R
FILE NUMBER
21-05-0036
Legal fees reflected on Schedule H were incurred in connection with the decedent. Fees
covered preparation and filing of the Inheritance Tax Return as well as work involved with post
death issues.
The attorney's fees are reasonable in amount considering the legal time required and
expense involved in these matters.
REV-1512 EX + (6-98)
*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Traver Jean R
FILE NUMBER
21 05
0036
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Humer & Daniels, Law Offices, outstanding bill for services in 2003
PAID OUT OF JOINT ACCOUNT FUNDS
VALUE AT DATE
OF DEATH
413.50
2 Department of Public Welfare; Estate Recovery Program
Restitution of medical assistance; CIS #190225216
Claim of $19,831.16; Class 3 = $13,680.13; Class 6 = $6,151.03
Amount available for payment to DPW = $0
0.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
413.50
REV_1513EX.,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Tr"vpr .lp"n R ?1 n!i nmR
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS pnclude outright spousal d~tributions, and transfers under
Sec. 9116 (a)(1.2)]
1. George W Trayer, son Lineal
1376 Boiling Springs Rd, Carlisle, PA 17013 $0 residue
2 Susan R Trayer, daughter Lineal
201 High Street, PO Box 215, Boiling Springs, PA 17007 joint funds
$0 residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
..
(If more space IS needed, insert addlhonal sheets of the same size)
LAST WILL AND TESTAMENT
OF
JEAN R. TRAYER
I, JEAN R. TRAYER, now domiciled in South Middleton Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils
that I may have previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estatlil-.Shall
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be paid by my Executor from the principal of my residuary estate as soon as pra~~ble ~mY3 8
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Article II CD
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations which exist
at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
If at the time of my decease my daughter, SUSAN R. TRAYER, shall be unmarried, I give,
devise and bequeath to my said daughter my residence in South Middleton Township, being known
as No. 201 High Street, Boiling Springs, Pennsylvania, and all of the household furniture,
furnishings, personal effects and other tangible personal property therein contained, together with
policies of insurance thereon. All the rest, residue and remainder of my estate I give, devise and
bequeath, in equal shares, to my son, GEORGE W. TRAYER, and my daughter, SUSAN R.
TRAYER, if living, and if either shall be deceased, to his or her surviving issue by representation.
Article V
If at the time of my decease my daughter, SUSAN R. TRAYER, is married, I give, devise
and bequeath to my son, GEORGE W. TRAYER, and my daughter, SUSAN R. TRAYER, such
articles of tangible personal property, excluding automobiles, having family or heirloom significance
as they shall amicably select and agree between themselves, together with policies of insurance
thereon, without requiring strict equality of distribution between them. All the rest, residue and
- 2-
remainder of my estate, real and personal, I give, devise and bequeath in equal shares to my son,
GEORGE W. TRAYER, and my daughter, SUSAN R. TRAYER, and if either be deceased to his
or her surviving issue by representation. If neither of my children nor any issue shall survive me, I
give, devise and bequeath my entire estate, real and personal, to Mt. Zion United Methodist Church,
absolutely and in fee simple.
Article VI
I nominate, constitute, and appoint my son, GEORGE W. TRAYER, and my daughter,
SUSAN R. TRAYER as Co-Executors of my Last Will and Testament. In the event of the
renunciation, death, or inability to act, for any reason whatsoever of my Co-Executors, I nominate,
constitute and appoint CITIZENS BANK, or its successor(s) as successor Executor of my Last
Will and Testament. I direct that my Co-Executors or successor Executor be permitted to serve
without bond and in addition to those powers granted by law, I grant them power to distribute in cash
or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living.
My Co-Executors or successor Executor shall receive reasonable compensation for services rendered
to my estate.
Article VII
In addition to the powers conferred by law, I authorize my Co-Executors and successor
Executor, in his/her/its absolute discretion:
- 3 -
(a) to retain in the form received and to sell either at public or private sale, any real estate or
personal property except that which I specifically bequeath herein,
(b) to manage real estate,
( c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
- 4 -
G) to receive reasonable compensation in accordance with their standard schedule of fees in
eli.let ~....... .- S"p"t I
IN WITNESS WHEREOF, I, JEAN R. TRAYER, hereby set my hand to this my Last Will
\ '\
and Testament, on '. 0 - 0
2003, at Boiling Springs, Pennsylvania.
~w~:r
R. TRA
In our presence, the above-named JEAN R. TRAYER signed this and declared this to be her
Last Will and Testament and now at her request, in her presence, and in the presence of each other,
we sign as witnesses.
Name
Address
,
~t't~cn
~.t '- ttJ< t2ad
m5 01rT!rrros (+, ~ PA 17/cq
JrsJd ~ &)~.-,j7/JO/O'1
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that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affIrmed and
acknowledged before me by
JEAN R TRAYER, the Testatrix
on ~. - L. 2003.
't\~cx\-\~
Notary Public
~~'~
JE TRAYER
~A._~
na 2007
We, the undersigned witnesses who signed the foregoing instrument, being duly qualifIed
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
:d~~/~'r]'~~,
witnesses, on L.. - \..
,2003.
~~\~jcn
W tness
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Witness
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Notary Public
J_.51
- 6 -
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of Trayer, Jean R
Jean R Trayer
, Deceased
No. 2005 00036
Date of Death 12/18/2004
Social Security No. 196143134
also known as
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. l/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Jan L Brown
Susan R Trayer
1.0. No.: 67993
Address: 845 Sir Thomas Cl Sle 12
Harrisbur~
Telephone: 717-541-5550
Dated 3/10/05
PA 17109
Description
Prudential Financiallnc (PRU); 46 shs @ $54.12/sh
Value
2,489.52
MetLife (MET); 32 shs @ $39.61/sh
1,267.52
Prudential Financial Inc; dividend check
20.70
United Health Care; benefit refund
32.91
Total
3,810.65
(Attach Additional Sheets jf necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BROWN JAN l
845 SIR THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
--------Iold
ESTATE INFORMATION: SSN: 196-14-3134
FILE NUMBER: 2105-0036
DECEDENT NAME: TRAYER JEAN R
DATE OF PAYMENT: 03/14/2005
POSTMARK DATE: 03/11/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/18/2004
NO. CD 005056
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $11 7.49
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 0993
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$117.49
GLENDA FARNER STRASBAUGH
REGISTER OF WillS