HomeMy WebLinkAbout05-19-14 (2) 'J 1505680143
REV-1500 EX(0140) 4{�{
PA Department of Revenue /Syl OFFICIAL USE ONLY
pennsytvania cav:dr Catl= Y. Fa=Numb3
Bureau of Individual Taxes
PO BOX.280MI INHERITANCE TAX RETURN 21 13 0408
Harrisburg.PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Soda[Security Number Date of Death Date of Birth
04 02 2013 02 02 1927
Decedent's Last Name Suffbc Decedent's First Name N9 -
POWELL JAMES O
Of Applicable)Enter Surviving Spouse's IMonnation Below
Spouse's Last Name Suffoc Spouse's First Name Ml
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
I. Original Realm Z Supplanenfal Rehon Q I Remainder Return(date of death
prior to 12-134M
El4" Lintel Estate ❑ 4.(dare a Frruxe xy��tr S. Federal Estate Tax Retain Required
rtlrgfi aRg S2-12S2)
6_ (qa Copy�1A5 N LJI 7' t aN y B" Total Number Sere Deposit Boxes L&+g Tw
® 9. Legation Proceeds RemrM 10.X1231 -ice d 11 Election to tax under Sec 9113(A)
(At ach Sri.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Da me Telephone phone Number
RICHARD L WEBBER JR ESQU 717 532 7388 v � �
C
- REGISTERAF WILLS US,dNLY�) O j
First line of address.
Fri
126 EAST KING STREET i> c CD °
LL7 �.� Tti f---) • o
Second line of address c:> `I
r ....
City or Post Office 47tIE FLED r i
_ State ZIP Code - -
SHIPPENSBURG PA 17257
Corresponderd'se-mauaddress; rwebber@weigleassociates.com
Under penalties of perjury,1 declare that I have a ingd this return indudog ao o panpng schedules and statements,and to the best of my ImwAedge and belief,
it is true,correct and complete=Declaration of preparer Other than the persinal repnserrtaWe is based on all intonation of which -
preparerhas arty Imowledga
SIGNA7 P ON RESPONS FOR IDNG � DATE
/�/�G{ (X(X Jo Ann Littlefield X f/ /C;Lo/
ADDREss
512 Indian Lane,Salisbury,MD 21801
SKMTIBiE OF PREPARER OTRER T REPRESENTAT DATE _
ft/ -------- Richard L.Webber,Jr.,Esquire
aoDRESS
126 East 10ng Street,Shippensburg,PA 17257
Side 1
L 1505610143 1505610143
Q-�
i
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF . FILE NUMBER
Powell,James O. 21-13-0408
Under penalties of pedwy,l 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 preparar other than the personal representative is based on all
information of which preparer has a knowledge_
Signature#2
Name Dennis J.Po ll
Addressl 7 Vaughn Road
Address2
City State,Zip Newville,PA 17241
Date
1505610243
REV-1500 EX
Decedent's Social Security Number
D_s .n:sName Powell,James O.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 128,400 . 00
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. -
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 28,237. 81
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous I nn,-Probate Property
(Schedule G) L J Separate Billing Requested............ .7.
8. Total Gross Assets(total Lines 1-7)..................................................................... 8. 156, 637. 81
9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 32,395.24
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1).............................. 10. 3, 466. 78
11. Total Deductions(total Lines 9&10)................................................................... 11. 35, 862 . 02
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 120, 775. 79
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tax(line 12 minus Line 13)............................................... 14. 120, 775. 79
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sea 9116
(a)(1.2)X.00 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 120,775. 79 16. 5,434. 91
17. Amount of Line 14 taxable
at sibling rate X.12 0. 00 17. 0. 00
18. Amount of Line 14 taxable
at collateral rate X.15 0. 0 0 18. 0 .00
19. Tax Due.................................................................................................................. 19. 5,434 . 91
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 Fite Number 21-13-0408
Decedent's Complete Address:
DECEDENT'S NAME
Powell,James O.
STREETADDRESS
CITY STATE ZIP
PA
Tax Payments and Credits:
1. Tax Due(Page 2,line 19) (1) 5,434.91
2. Credb Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. interest (3)
4. If Line 2 is greater than Line I+Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) $,434.91
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;................................................................ R x
b, retain the right to designate who shall use the propedy transferred or its Income;....-......-....................
aretain a reversionary interest or............................................................................................................... )UPI x
d. receive the promise for life of either payments,benefits or care?..................................._.._ ...... x
2, if death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?.....—................._.........._.........................--.......-.........._............_......_.... ❑
3. Did decedent own an 5n trust form or payable upon death bank account or security at his or her death?....... ❑ Q
4. Did decedent own an individual Retirement Account annuity,or otter non-probate property which
contains a beneficiary designation?..........--..........................................................................---.........
....... ❑ n
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)(t1){)).
For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§91 t6(a)(t.1) a). The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and filing a fair return are still applicable even tithe surviving spouse is the only beneficiary.
For dates of death on or afterJuty 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 172 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 1.2)(72 P.S.§9116(a)(1)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.
Revii02IX•(itAej
SCHEDULE A
REAL ESTATE
cor✓UO�o=pr-l.asrtw.ulh
ae¢xrt�.aw Twc nEivaN
ESTATE OF FILE NUMBER
Powell,James O. Y1.13-0408
Aftrestproperty awned soietyuaaatenant kh cammon must bo mpaMtlsit iairmadu#vatne.Faamadfet vain¢isd 2=d axihe price atwhich Pmp_nYwozmbe
axdtartged bsMeen aapring buyer arzd a w7f<ng leper,rcMherbamg mnpaliedto buy arses,boUn havingp reasonable b1pMadgeof fhe reiwanf fads.
Real propertywhtuh is jofnityewnad with right oraurvhorship must be disGaxetl on schedule F.
Attach a copy of the seW mw t stmat if the property hasbean soM
Mcf.d.a wry of tee deed showing decedents intero sit it owned as tenant In common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real estate,together with improvements thereon situate In Hopewell Township,Cumberland 128,400.00
County,Pennsylvania containing 0.46 acre,known as 14 Turnpike Road,Newburg,PA 17240,
valued at Cumberland County assessed value($128,400.00)multiplied by Cumberland
County Common Level ratio factor(1.0)
I
TOTAL(Also enter on Line i,Recapitulation) 128,400.00
(if more space is needed,adds ional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Fonn PA-1600 Schedule A(Rev. 11-08)
R"4508 EXF(a-9sj
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
wluarnruF._u_rao=e-avmvixv,
iu'ERruh�rix aerutw
IxFSm=rrr o=_c=o=xr
ESTATE OF (FILE NUMBER
Powel! James O 21-13-0408
Include tha praxes orlRigstion end the da:a the proceeds v.m a received by -elate.
All propertlIjoimfyo ed vdth the right of survivorship most be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Capital One -Credit card refund 11.27
2 Jewelry
600.00
3 Nationwide-Refund for auto insurance 155.74
4 Patriot Federal Credit Union Prime Share Account#208224 17.432.80
5 Summit Health-Refund
30.00
6 U.S.Treasury -Refund for 2012 federal income tax 903.00
7 Chevrolet Malibu Motor Vehicle 7,600.00
8 Household Furnishings 1,505.00
TOTAL(Also enter on Line 5,Recapitulation) 28,237,81
(t more spare is needed,additonal pages of the same size)
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1 S00 Schedule E(Rev.6-98)
aEWttbi EX.(10-00) Al
SCHEDULE H
E _11f6M,ww FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Powell,James O. 21143-0408
Debts of decedent must be reported on Schedule I.
rFEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 11,582.82
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Reprewntative(s)
Street Address
City State Zio
Year(s)Commission paid
2. Attnmev's Fees Weigle&Associates,P.C. 6,000.00
3. Family Exemption: (if decedents address is not the same as claimants,attach explanation)
Claimant
Street Address
City State MD
Relationship of Claimant to Decedent
4. Probate Fees 363.50
5. Accountant's Fees
6. Tax Return Preparees Fees
7. OtherAdministrative Costs 14,446.92
See continuation schedule(s)attached '
TOTAL(Also enter on line 9,Recapitulation) 32,395.24
Copyright(c)2009 form software only The Lackner Group,Inc, Form PA-1500 Schedule H(Rev.1006)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Powell,James O. 21-130408
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Foaelsanger Bricker Funeral Home 11,582.82
H-A 11,582.82
Mer Administrative Costs
2 Advanced Disposal 246,00
3 CenturyLink 503.88
4 Chubb Insurance- Homeowners insurance 11020.00
5 Cumberland County Recorder of Deeds-estimated realty transfer tax 1,284.00
5 Cumberland Landfill 70.00
7 Cumberland Law Journal-Legal Advertisement 75.00
8 Middle Spring Storage 110.00
4 Nationwide-homeowners insurance 150.71
10 Nationwide- homeowners insurance 173.74
ti Nationwide- homeowners insurance 704.70
12 Nationwide Insurance-homeowners insurance 112.30
13 Newburg-Hopewell Joint Authority-Sewer 512.00
14 News Chronicle-Legal Advertisement 88.25
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Powell,James O. 21-13-0408
ITEM
NUMBER DESCRIPTION AMOUNT
15 Penelec
698.76
16 Repairs -estimated for house to prepare to sell 5,000.00
17 Sollenbergers-Transferfeeformotorvehicle 52.50
18 Timmons-Fuel Oil
682.44
19 Timmons-Fuel Oil
651.63
20 Timmons-Fuel Oil
661.44
21 Timmons-Fuel Oil
651.57
22 Water softener-Estimated cost to replace 1,000.00
H-B7 14,448.92
Copyright(c)2002 forth software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-15f2IX«(12.d6)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
csnnover�anioFpxrnvuca
pce�rtue:�tix aenms
n�so�rn?csaE.rz
ESTATE OF FILE NUMBER
Powell,James O. 21-13-0408
Repart debla Inarted by de,demedCd pdorto der9i Met remained unpaid et Me date or death,Inciudina unrtlmbutzed medial expenses
NUMB ER DESCRIPTION vAOF DEATH
1 Salhard Internal Medicine 20.00
2 Chambersburg imagery 7.31
3 Health Network Lab 5.71
4 Health Network Lab 16.15
5 Kuhn Communications 37.53
6 Penelec 85.99
7 Prescription-Reimbursement to Gerald Powell 198.65
8 Prescription bill-Reimbursement to Gerald Powell 86.88
9 Shippensburg Area EMS 200.00
10 Shippensburg Area EMS-Ambulance 1,429.50
11 Shippensburg Health Care Center 376.04
12 Shfppensburg Healthcare Center 520.00
13 Spirit Physician Services 29.14
14 Summit Physicians Services 70.00
15. Trinity Pharmacy 197.08
16 Trinity pharmacy 26.07
17 West Shore EMS-Ambulance 160.73
TOTAL(Also enter on Line 10,Recapitulation) 3,466.78
(If mm space is needed,additional pages of the dame size)
Copyright(c)2009 form software only The Lackner Group,Inc, Forth PA-1500 Schedule I(Rev. 12-08)
REV-0513 IX+(11-081 .
SCHEDULE J
conuno EwF L qrF NN BENEFICIARIES
NHER AN
RESIOEN nECEO-
ESTATE OF FILE NUMBER
Powell,James O. 21-13-0408
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) (SSS)
Q.NC.Lre TNSIE9!0
TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)
Janice Caruso Daughter One-Fourth 30,193.95
743 Firehouse Road
York, PA 17404
Jo Ann Littlefield Daughter One-Fourth 30,193.95
512 Indian Lane
Salisbury,MD 21801
Dennis J.Powell Son One-Fourth 30,193.95
7 Vaughn Road
NevMlle,PA 17241
Gerald O.Powell Son One-Fourth 30,193.95
21 Turnpike Road
Newburg,PA 17240
Total 120,775.80
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TARN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev. 11-08)
LAST WILL AND TESTAMENT
OF
JAMES 0, POWELL
I, JAMS 0. POWELL, o£ Hopewell Township, Cumberland County.
Pennsylvania, being of sound mind, memory and disposition, do
hereby make, publish and declare this my Last will and Testament..,
hereby revoking and making void any and all wills, Codicil;., c_
writings in the nature thereof, by me at any time heretofore made:
YLUT—: PAYMENT OF EXPENSES - I direct that all my just debts and
funeral expenses, including my gravemarker and all expenses of my
last illness, shall, be paid from my residuary estate as soon as
practicable after my decease as a part of the administration of r,
estate.
SE,CDN_D: RESIDUE OF ESTATE - I give, devise and bequeath all the
rest, residue and remainder of my estate, be it real, persoral, or
mixed, of whatsoever kind and wheresoever situate, unto my wife,
DOROTHY M. POWELL, Provided she shall survive me by thirty (30)
days.
"e event my wife fails t:O survive me by thirty (30) days,
I then .give, devise and bequeath all the rest, residue and
remainder equally unto my children, JO ANN LITTLEFItLD, JANICE L.
CARVSO, DEN14I8 J. POWELL, and GERALD O. POWELL. Fiowevc, if aL*p,, n
does not survive me and leaves children who so surf=V`4' mR=? su"'v-,
!::
Children shall receive per stirpes, the snare my ch�18 4.ou'_z hd,va;
received had he or she so survived mt_
THIRD: TRUSTEE OF CHILDREN' S ESTATE - Any share or shares of my
estate which passes to a minor shall be placed IN TRUST with DENNIS
J. POWELL and GERALD O. POWELL as CO-TRUSTEES, to serve without
posting bond, on the following terms and conditions :
A. So long as any child or children are minors , the net
income of the Trust shall be paid to or applied for the
maintenance, education or support of any or all of the minor' s
at such time and in such proportions as my Trustee shall in
their sole discretion determine. In the event that the income
would be insufficient to provide any of the minor' s with
adequate maintenance, education and support, the Trustee shall
invade the principal for this purpose and such invasions shall
be according to the needs of the minor, rather than according
to any pro rata scheme of distribution.
B. The Trustee shall pay the child the balance of the .
Trust upon his or her attaining the age of eighteen (18)
years .
FOURTH: EXECUTOR - I appoint my wife, DOROTHY M. POWELL, Executrix
of my Will . In the event that DOROTHY M. POWELL predeceases me or
is unwilling or unable to serve as Executrix, I then appoint as Co-
Executors, my daughter, JO ANN LITTLEFIELD and my son, DENNIS J.
POWELL. If either JO ANN LITTLEFIELD or DENNIS J. POWELL
predecease me, I then appoint my son, GERALD O. POWELL as
substitute Co-Executor to take the place of the deceased child.
Neither my Executrix nor any successor shall be required to give
bond for the performance of their duties .
PAGE 2
I grant to my Executrix the power to compromise claims without
court approval and without the consent of any beneficiary.
FIFT-;T. PROTECTItc PROVISION - TO the Greatest extent permitted by
law, before actual payment to a beneficiary or to his or her
account, no interest in income or principal shall be assignable by
a beneficiary or available to anyone having a claim against a
beneficiary.
IN WITNESS WHEREOF, I hereunto have signed my name to this, my
Last. Will and Testament, the text of which consists of three (3)
typewritten pages, this St day of 1997 .
r _
i/ai./ L; /err <'! (SEAL)
- -n.5 5 O. POWELL, Testator
In our presence, the above-named Testator signed this and
declared it to be his Will, and now, at his request and in his
presence and in the presence of each other, we sign as witnesses:
lax_
PACE 3
PA Dept. of Revenue
Safe Deposit Box Unit
P.O. Box 280601
Harrisburg, PA 17128-0601
Subject: Safe Deposit Box Inventory and Notice
To Whom It May Concern:
a. the name of estate and person entering the box-Estate of James O. Powell; ]o Ann
Littlefield And Dennis ]. Powell, Executors;
b. the name and street address of the financial institution in which the
box is located-M&T Bank, 35-39 East King Street, Shippensburg, PA 17257;
c. the date and time of entry-August 9, 2013, 9:30 am.
Regards,
Jo Ann Littlefield, Executrix
Cc: M&T Bank
i
,r1 ftEVw485 EX(05-04) 48500041046
SAFE DEPOSIT
BOXINVENTORY
PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY
Social Security or Death Certificate Number Date of Death County Code Year _ File Number
174-20-8663 04/02/2013 13
Decedent's Last Name----- Suffix - First Name �� MI
POWELL JAMES O
®ADDRESS OF DECEDENT STREET: CITY: STATE: ZIP CODE:
. 14 TURNPIKE RD NEWBURG PA 17240
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
NAME`JO ANN LITTLEFIELD
STREET ADDRESS: CITY: STATE: ZIP CODE:
12 INDIAN LANE SALISBURY MD 21801
NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING
a. NAME: RELATIONSHIP:
JO ANN LITTLEFIELD DAUGHTER
STREETADDRESS: CITY: STATE: ZIP CODE:
512 INDIAN LANE SALISBURY MD 21801
b. NAME: RELATIONSHIP:
DENNIS POWELL SON
STREETADDRESS: CITY: STATE: ZIP CODE:
7 VAUGHN RD NEWVILLE PA 17241
c. NAME: RELATIONSHIP:
' STREET AbORESS: CITY: STATE: ZIP CODE:
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
NAME:
j M&T BANK
j STREET ADDRESS: CITY: STATE: ZIP CODE:
35-39 East King Street SHiPPENSBURG PA 17257
NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY
JO ANN LITTLEFIELD AND DENNIS J. POWELL 8/9/13 9:30 am
DATE OF CONTRACT TO RENT BOX NUMBER OF BOX 1 TITLE UNDER WHICH BOX IS REQUESTED
NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX
a. NAME: b. NAME:
DENNIS J. POWELL GERALD O. POWELL
I STREETADDRESS: STREET ADDRESS:
i 7 VAUGHN RD 21 TURNPIKE RD
CITY: STATE ZIP CODE: CITY: STATE: ZIP CODE:
NEWVILLE PA 17241 NEWBURG PA 17240
NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY
NA
WAS A WILL IN THE BOX? 0 YES JE NO N yea, a.Date of will:
b. Name and address of personal representative,if named In the wlii
NAME:
STREETADDRESS: CITY: STATE: ZIP CODE:
o. Name and address of attorney,if any
NAME:
STREETADDRESS: CITY: STATE: ZIP CODE:
48500041046 48500041046
REV-485 EX SAFE DEPOSIT BOX INVENTORY Page 1 of 1
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stocks:List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by
name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock.
(3) Obligations of U.S.GovemmenL Number of Items,date of issue,face value,names in which registered and type of ownership,
i.e.,jointly held,payable on death,etc.
(4) Bonds: Designate by name,amount,serial number,or other designation.(Bearer Bonds)
(5) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing In book,name of bank
and branch,and balance.
(6) Jewelry,Coins,Stamps,Manuscripts,etc:List and describe as fully as possible.
(7) Deeds,Mortgages,Current Insurance Policies or other evidences of indebtedness:List and describe as fully as possible.
(8) All other contents.
(9) Return completed form to: DEPARTMENT OF REVENUE
INHERITANCE TAX DMSION
DEPT.280601
HARRISBURG,PA 17128,0601
ITEM ITEM DESCRIPTION
NO.
1 VETERANS ADMINISTRATION CERTIFICATE OF ELIGIBILITY 6597901
2 LETTER DATED 114/1945 FROM CLERK OF CUMBERLAND COUNTY
3 ADOPTION PAPERS DATED DECEMBER 1944 No.205
4 DEED DATED 31571959 NORTH HIGH ST.#60
5 HONORABLE DISCHARGE NAVY-JAMES POWELL
6 PAID MORTGAGE FOR HOME DATED 2/4/1972
7 DEED DATED 10/1/1959 LOT#7 NEWBURG
8 BUREAU OF NAVAL PERSONNEL-TRANSCRIPT OF NAVAL SERVICE
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY:
SIGNATURE SIGNATURE
PR WT NAME PRINT NAME AND CHECK APPROPRIATE SOX BELOW:
PRNT TRLE DATE CHECK APPROPRIATE SOX
❑Exerutor(irixl ❑Atlminirtrator(b4)
I]Emote RepreeentaMe I]Joint owner of safe depCAR bas
NOTE: Attach additional 811,"x 11"sheet(s) if necessary or use duplicates of this page of form.
The Departrnent is authorized by law,,42 US.C.§405(c)(2)(C)(q,to require disclosure of Social Security numbers in connection vAlh administedng state tax laws.The Deparonent uses the
Social Security number to Identify the decedent and personal representatives of the estate.The Conummalth may also use the Information in exchange of tax Information agreements
with Federal and kKal t&*g authorities.The state law proldlots the Commanveallh's personnel from dsdosInc cmlfidendal tax Information except for off dal purposes,
14 TURNPIKE PC AD
PIN:11-21-0390-021
Deed book:0019L-004452
Owner;PO'WELL,JAMES C
Land Use Code:103
Property Type: R
Acreage:0.46
Square Feet:14AO
Taxable Status:T
Clean&Green Status:
Lend Assessed Value$:35000
Building Assessed Value$:994100
Total Assessed Value$: 12wo r
Sale Price$:
Sale Date:
Year Buitt:1960 .
Municipality: HOPEWELL TOWNSHIP
Height in Stories:
Type of Dwelling: DETACH
Primary Exterior
Basement Percentage: S4
Air Conditioning;NO
Total Rooms:6
Bedrooms:3
Full Bath: i
Half Bath:
MA9 )»x(452
XAWTHE /'`s +oaf Gc ra be it the
of r Lsrd see asesod esse".6w mad fiahnina(1959) V=
j Bxrwr N Ft3STER S. EUMFRIM sad Bl MCL
MW=nM'.18a, his wlb, or
the Borough of#WW39, Lltmberlarad County. Pausylvenia,
I i
I
hareiaattar Called the - Greriwa. i
( sort VMTS O. Pf74Y=and DOROTHY POWELL, his wife.of Newtmq, Pamayl- ;
varla,
t. ,. hmeAa$er called the &a"$: i
BIVE.BalMM-D ,DOu NS}(5500,00).
a
hoot m>'°id.tL 41 s'+M++ef fe twrtbl+t�u+lw7+d W wii pear4B is h mE►MSt
' sort awe/b fie rd gr.aeea . thalr heirs and"algae,
ALL that certain Its of ground aftveto in the Borough of Newbaeg. Cumberland
a i
I Canty. 7nusylvmaJa,more fully boarded and described as follows: )
BtGnnj=m a point In the Center of Mountain$treat and the comer i
Of Lot NO. 6 Presently Owned by Omar Barnhart, sold point being
SIX Hundred Thirteen and Saven-teach.(613.7) feat North horn a
point in the center of Mountain Stunt and the Northerly side of a
(+I Twelve(12)fact after,thane along lot No, 6 South Fifty(50)
degrees Fifteen (15)minutes West Two Hundred(200) feet to i
Other land Of the Grantors herein;thence along land of the Grantors
• harm North ThIM-nine(39)dogmas Forty-H"(45)minutes Wear.
j One Hundred(100) £Canto a point;thence by the mute North Fifty '
(50)degrees Mass (15)minutes Past Two Hundred(200)fast to a _
' Point in the tamer Of the mid Mountain SemOt;throe, along the
I said center line of Mountain Strout South Thirty-vane (39)degrees
I Forty-five (45)minutes East One Hundred(100)feet to a point, the
place of BEGINNING.
BEING Lot No. 7 in a Plan of Lots known as Fast"HeffelfingeNm Addition par
t survey of T. Elliott Mlddleton,B.S., made July I5, 1955.
BEING a part of a longer tract of land which Ellis E. Heffleftnger and Mary 3
Catherine HefOeflnga, his wife, by their dead dated June 7, 1955, and recorded
!' in the Office of the Recorder of Deeds in and for Cumberland County in Deed Back
014%Vol. 16, Page 305, conveyed to Faster S. Heffelfbtger, Grantor herein.
i
i BOS=TO THE FOLI.OWfNG BUILDING RESMCTIONS:
. 1. No building or any part of a building, shall be erected within fifty(50)
feet of the center line of Mountain Street. '
' 2. That no building an said lot or My hareafter emoted shall be drected
Of used far My purpose than that of a residence Md the necessary
I
i
(
outb•i_n+aws Ln caanectlm therewith. Inclu lbs;➢r1 a t+aves, aad
i
that the cost of said residence shall not be lees than$7,000.00 u
present day yricas, ,(}�L h/�'i Vie► f
G0• w1N�th�41t �lt�t edti� h6r eefd coadltlons
and restrictions shall be covenants tuning with the lend, and that I
in my dead of conveyance of said pramisas or any part thareol, to
my,person or perams, sold coadiHOns and obstrlcttoas shall be
i f fn&cipoceted in such deed or dmWae fully as the same are eontabod i
in thin indenture.
AND the aod-erode .do hereby wo mrt that they wM WARP.dNT GENERALLY
SAS property hereby eehMal.
IN WITNESS WHEREOF,said puritan Auve hermW rot their had s 'asd Sege I I
the day and your fret sbevs senttae. ,
bfpn.angles&=a to
c In ror p asserts rt eid
f
I �
a�"�taut nesore mM1M1 sweet a.+e
ihd[eerie Insda toot s...�-.-..
n�a,xo
"y,�rLl v
Stare of PENNSYLVANIA j
CUMBERLAND
I
0.(busty°f�.the (w,y day of" teCf.�.4.(/v ,IS 59,before me,
a Notary public in taut far said County and State,
the nsdenigs af& ,pertmogy appeared ,r0SM S. BEF7'ELyINGER and SECNICE
I6yyELPINGOt, his wife.
lrmum N me(or satigute a,pm)to be the Damon s-hose names aro eubteKbed to the s uh-
.in instrument,and ad ledoet that they ezended tams fer the:maps"ehere '
IN WITNESS WHEREOF.1 hemmto set my ham!mad s&W seall ft
vo.rr m►�'h"a vi t' �e
r I
(Aas67Side of 16t the RmNer -
et fled t75re sf whin Geebe is — —.
Title e/o6�csr.
C.Aw w Any.
c
Household inventory-I assigned values based on what we would get at an auction,which is the plan.
Item Description Est Value
Sofa Upholstered 20
Table lamps 2 10
Grandmother clock Small 200
Mantle clock 200
End table Wood 25
Floor lamp 10
Stereo console Old, not working 0
Dining room table and Wood 100
chairs
Microwave Old, large, but working 5
Microwave stand Compressed wood with laminate finish 5
Sewing machine-electric Older Kenmore 10
Refrigerator Will be sold with house
Electric Range Will be sold with house
Dishwasher Will be sold with house
Washer Will be sold with house
Dryer Will be sold with house
Desk Compressed wood with laminate finish 20
Desk Chair 10
Bookcases 2-Compressed wood with laminate finish 10
Glass door bookcase 50
Bookcase Wood SO
TV 75
Bookcase-triple Compressed wood with laminate finish 15
Sleeper sofa Upholstered 20
Record Cabinet Wood with door 20
End table with lamp 10
Table lamp 5
Floor lamp with tan shade 100
Computer table-small Compressed wood with laminate finish 5
Bedroom Suite-blond Compressed wood with veneer finish(no 25
mattress or box spring)
Wardrobe Compressed wood with laminate finish 5
Single bed Wood 25
Dresser Wood 100
N'rghtstand 10
Dresser Wood 25
Chair Upholstered 5
Bedside tables 10
Riding tractor Purchased in 1984 25
Books M isc 100
Clothing Ali has been either disposed of or donated. 0
Jewelry 600
Car Chevy Malibu Sold for 7500
Wall art Primarily family photos 0
Kitchen Pots, pans,dishes, utencils.small appliances 200
�"'�/�'f0 P.O. Box 778
a 6�6 d®t cnambenburo,3- r;zo3•o77s
717-263-4444
J IM
FedeMly Irdwed by the Nitlavl C_....Loden Adm6,i,-a'
Acct XXXXXX1390 POWELL,JAMES 0 Eff: 05/04/13 Pst: 05/04/13 Tlr: 1913
ID DUE DATE PRINCIPAL INTEREST FEES NEW BALANCE TRAM AMOUNT SEQ
Withdrwl from PRIME SHARE ACCOUNT 00 Prev Bal: 17,432 .80
00 17,427.80- 0. 00 0 .00 5.00 17 ,427.80 #208224
Comment for PRIME SHARE ACCOUNT 00
CK PAYABLE TO ESTATE PER EXECUTORS
Check Disbursed 01 52�9J7�01 THE ESTATE OF JAMES O POWELL 17 ,427 .80-
Authorized by v
We have two sweet options to get your budget back on track. A Debt Consolidatior
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MEMBER COPY
ldt.f lUl
ILYM'ML^FT 14
h 0f.I1T'a[el
UWAa -176
0171 iE 3+teeE
Check Purpose SHARE WITHDRAWAL Check# 529701 $17,427.80
Acct 0000351390 POwELL,JAMES 0 Effect: 05/04/13 Post: 05/04/13 Tlr: 1913
ID DUE DATE PRINCIPAL INTEREST PEES NEW BALANCE IRAN AMOUNT SEQ
Check Payable to:
THE ESTATE OF JAMES o POWELL
(See receipt for reference)
14 TURNPIKE ROAD
P O SOX 113
NEWBURG PA 17240-0113
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No.
PAT;
PAY
W-Q U., r '
OLLARS
RS 'NBAKK
'm ..... 4a
R
JAMES 0 POWELL ESTATE
DENNIS J POWELL EXECUTOR 105
JOANN LX"LMELM,EXFClJTPlX
74 rJRNFKE AD.
PO BOX I 13
NEWBURG.PA 17240
6�m 5
OnRSTOWNJSANK
A�,eFiAe,.
i£9 1:L+: FRY .1m.. & pl--calbw%., ffl .000000 LF.O?3,0
MES 0 POWELL ESTATE
DENNIS J POWELL EXECUTOR 103
JOANN LITTLEFIELD,EXECUTRIX
14TURNPlKE SO.
PO BOX 11 1
NEWBUAG,PA 17240
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