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HomeMy WebLinkAbout05-23-14 J 1505610105 REV-1500 EX�02_��,�FI, .� OFFICIAL USE ONLY PA Department of Revenue pennsylvania Counry Code Year File Number BureauofIndividualTaxes p�NHERITANCE TAX RETURN �1 �/� �/� PO BOX 280601 RESIDENT DECEDENT v/ Harrisburg PA 1'7128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05/09/2007 07/26/1948 DecedenYs Last Name Suffix DecedenYs First Name MI Culley Robert H (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 � 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) p 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- TNIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number � William S. Daniels (717)243�831 � � � ;� � REGISI�{2 WILLS USE;ONL�-j � � �.y -�C ._ 7 First Line of Address � ?� �� N � V,. rV' '� _t 1 West High Street - ` ' r r;> �:� � , ',� Second Line of Address `��' �=' `�� � �� ;:y � � :.7 N i.-° Suite 205 ' State ZIP Code a D TE FILED �� City or Post Office � "ri Carlisle PA 17013 CorrespondenYs e-maii address:humeranddaniels OUtI00k.COfT1 _ Under penaities of perjury,I declare that I have examined this retum,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. SIGNATURE OF PERSON RESPONSIBIE FOR FILING RETURN DATE ADDRESS Katrina M. a d Jessica L. Cul -4711 Cedar Ave,Apt 1 R, Philadelphia, PA 19143 � SIC,�NATUR PREPARER OT EPRESENTATIVE.�� DATE � 05/22/2014 �.r,/�,. ' t-c� ADDRESS Humer and Daniels Law O�ce, 1 W. High Street, Suite 205, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610105 1505610105 � � 1505610205 REV-1500 EX(FI) DecedenYs Social Security Number �ecedent's Name: Robert H. Culley 195-38-7744 RECAPITULATION 1. Real Estate(Schedule A). ....... . . . . ..... .. . . . . . . .... . . . ............ . 1. 0.00 2. Stocks and Bonds(Schedule B 0.00 ) ................... ...... .. . . . . . . ...... 2. 3. Closel Held Cor oration,Partnershi or Sole-Pro rietorshi Schedule C 3. 0.00 Y P P P P� ) .... . 4. Mort a es and Notes Receivable Schedule D 4. 0.00 9 9 ( ).... . . . .. .................. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)...... . 5. 2,633.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . .. ... 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 547.00 (Schedule G) O Separate Billing Requested.. . . . . . . 7. 8. Total Gross Assets total Lines 1 throu h 7 . ......... . . . 8. 3,180.00 � 9 ).. . . . . .. ... .. . . . 9. Funeral Ex enses and Administrative Costs Schedule H 9• 2�878��$ P ( )... ....... . . .. . . . . . 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 65,871.21 11. Total Deductions(total Lines 9 and 10)... ........... . . . . ........ . . . .. . . 11. 68,749.39 12. Net Value of Estate(Line 8 minus Line 11) .. .. .. . . . . . ...... . . . . . . . ...... 12. 0.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ... . . ..... ... . . . . . . ..... 13. 0.00 14. Net Value Sub'ect to Tax Line 12 minus Line 13 . ............ 14. 0.00 J � ) . . ......... TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Li�e 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 6 16. 0.00 17. Amount of Line 14 taxable at sibling rate X.12 ��• 18. Amount of Line 14 taxable at collateral rate X.15 �$• 19. TAX DUE .... . . . .. . . . . ........ . ......... . . . . . ..... . . . . . . .... ... . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 L 1505610205 150561�205 ,J REV-1500 EX(FI) Page 3 File Number �/— D � — O L) � Z ✓ Decedent's Complete Address: DECEDENTS NAME Robert H. Culley STREETADDRESS 123 November Drive Apartment 4 CITY STATE Z�P Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. CreditslPayments A.Prior Payments B.Discount Total Credits(A+g) (2) 0.00 3. Interest (3) 0.00 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) 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.......................................................................................... ❑ � 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?...................................................................... � � 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 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? ........................................................................................................................ � ❑ 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 suNiving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax retum 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 decedenYs 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-15o8 EX+(o8-u) � pennsytvania SCNEDULE E f��� DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX REfURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert H. Culiey 21-07-0513 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 �, Tangible Personal Properly 233.00 2. Southwest Trailer 1,200.00 3, 1996 Dodge 1,200.00 TOTAL(Also enter on Line 5, Recapitulation) $ 2,633.00 If more space is needed, use additional sheets of paper of the same size. .. __ _ _ _ _ _ ____._.__>____.._.._.___,_. - �/ c�'�.��i�' �-,,.� --____ /oZ.3 �-r�-z,�.-���L,�.� '�� "�i��j� .s-z.�-f� �'� �-� ` -=: ��� �, � �__ �""�?���� �/i����c���?�%����'�.A�-L-. 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' ' ��September 16, 2003 � �� � ���i� � -�... 1��.58 ,_.. �� - E, ,.. � � � VEHICI,E IDENTIPICAT�ON NO. � YEAR ��AKE � �: 5KWT�1,�2$3D0002�6 2003 �� _ U�I��ED ��„�� � �+ I BODYTYPE � � �� i ��:, SHIFPING WEIGHT � TRAILER �� " ' � � ���i 2640# � ��� i / H.P.(S:A.E) G.V.W.R. % NO GY�S, SERIES OR MODEL �� ' � � r Y� . . � � .:�� � 1 �. . w °� 7000# ' U8.516TA�,5 � y,: � �Y � � • � . � , � � � a� ��8!� � � '°w u,,�� — � �� , ° �� a. � � � , d or oration narhed.balow, Fierebr certi- � I,�the undersigned authorized representative of the company,firm or c p Y fy\that the new vehicle described above is the property of the said company,firm or corporation and is trans-� �ferre�on the abov,e date and under th�Invoice N�mber indicated to the following distributo�r or:�ealer. , • NAME OF DISTRkBUTOR,DEAIER,ETC. � I ; , ��i �_ � � � ii'. i, _. a � ; � iil � ! IIII�� � � � � d, i 6 u �i�� � WHOLESAL�AUTO � � ' ' , �,; ��:; �� � , . '� „ . "'' ° - ;°��� - �'�7551 aLLENTOWM BL��� "���' � � � ��� � u'�� HARRIS�URG, P�17112 � �� �� �����,������'�� � ��� � ��'�t����`� � � C J � �� ��� � � / I y - � ��; ; .. , tt � _ ;, ., .� ., :. ,! ' V � '� � :� `" f - It is further o�rtified that thi �vvas the first transfer of such new vehicle in�ordinary trada and commerce. .L. � p����Illf�i , �� � �Illu d�V�� ���:h . , t�� . � ����, ' ' , ,,,'�,, UNITED�iIIII�EXPRESSLINE, IM��;� � � ,�� �. � � � --�-- � . � , ''' I � / �;,, �,,i� � ����' . � . .. _ � � 3 ,r. �"�� � � � �, � Bv: • � , ,. . T AGEN �\ (SIGNATURE OF AUT�{QPIZED REPRE$ENTATIVE) _ ( ) '• � � �_�0 0 0 8�8 7�6� ��� . � �,,, ;�-, � � �..�. � 3 : � � � � � BRISTOL,IN 46507 �� � j � /'. � CITY•STATE��:� '�� `���• � r � ,' .. . . 1 � J -.... _... . � � � �� I � �.. � � . S �_•. � � ._ ..--....... . ..._........ . ..._ . _. . _ ... . � . . 0 / * i� � �SS��'l�� . CUMBEALAND YALLEY MOtOAS USED CAR APPRAISAL S `�i^.p� _ Sales Rep.��—'�t�2��fti7P"� Date /�� / Registered Owner � `�'�i t t'anPT+r vF , /�!b c''"T /-{-�'k//<� ��, Address .�-!`s---��s � �' City G�/•��N� �A l�G� zip Home Phone Bus. Phone Vehicle Interested Stock No. �ru� Bo�v Po� YEAR �9�'24- MAKE O C M rJ[L r'( '��?TI'��Y�y Total Miles �37QO� — Ser.# s� ��� �4,37���,,.� � 1 Tag# Exp.Date Title# Ext.Coior `�� Int.Color � -- C❑ V❑ L❑ Engine Tran. ��4 WD Tilt Wheel�- Power Steering� Brakes ❑ Air Cond. ❑ Cruise Control ❑ Pwr. Windows ❑ Rear Defroster ❑ P. Locks ❑ Radio Tires Roof Wheels St. Insp. Other 1st Owner ❑ Paint/Body Work❑ Ext Wauanly ❑ Seiviced �l Leased ❑ Purchased ❑ Leinholdei _ Odnmete�� ❑ RepairedlReplaced at ___------ miles Exceeds Mech l�mits ❑ Condition Deduction Engine&Train ��-�"����C������ S Body /�1�-/ae �c.�ic�z��,L 4,�'d���� _ s _------- /�_`�---- — �' --�kf //� —_ - c, --___ Tires LF❑ RF❑ LR❑ RR� S —___—_-___ Interior ----- Gf�`rTi�G�c�K"P��°''"'—°�- S ----- Other _— - - -- --- ------- Total Ded tio S --------- ACV _ �d�d ��- —ApPraiser __ Retail❑ Auction❑ Wholesale to — S�les Manage White Copy-File Yellow Copy- anams n •�-eoo-sazd�++ . . � rpi. .'.� p // .� �rp ' /� //�%i C , !� // 7%�i.����. !i�/!,���.� /������i%%���i�� �/ ���� i//%�� ia�/� i i / � i//.�r�//� i / ���/i���%���'ri � //� i/����j�%�%i/%i �!"/%����%�.�Q/�f�TM���Q����r�'�' //rr ri/% ////� /�i � i / i// / /� i� l /� / / , %/// � /�� % �/� %���� ��-/// a%�+ �.i /��+ / � / � �� i � %�/j�%�. i�%���,����71.1��/� S/P'�����i ��/i i ! ..� �/� �� i i%i�/�j�%/ �/��%ii� �in,.�jy'-7�"r'Fnw^-�- . � n-r.K:YrT/�"yiJ"�j+�j m7�`l�'»��� /pi/ /i// /' ��!'Y�����i///�%�i���/i���%r /���i/�iij��i// / � //�p�%/������//ir� 'ii ��; �%� i�%/ ///�// �/�� � %%/ �/i// �.� � i U//i%r���j� � . i/� i �i// j i/// %/ �i �i�/ �� �� / �� . i �i i. � / / �//i�!�/�i/ ///ly/�/ � r �i� � ./�i i/// i� �i �j i � ��/�, ., .�� 3 �� i / i///r �ii i,i r %��1 � �'���� .�/� �ii�// �<�A"j-��r� � > , .. /� /, /r�/ �✓i�� ii . i i� i !�/�%„i� /j/i%/ii j�j�ir% , � � /! /pi i�� . � , � �96 � DCI�G�'� � ; ,�;��� 'e"'�l�r �Clf j���/ ��,���� �;����,, r"° ��%i ���1�la r /� / � ��/ �/ii � �g��} BER, , � ��YEAq � ,1AAK6�FVEHIG�.F� ,. � ��_��i �i, SI BER .j;�/ri�/�/ii� ��� ii� ` � l : .,;�� � ,�, ��, , ,i, , �� „ ��Q'�/9b� 0���� , %��j,�i�%��%���j� '/i�� i / r� i %/i i�� �/��%�� {{�JJ�%/ �8�T(7AP �� � PRIOR TITLE¢TATE �.,� ODOM;BR0��=0ATe O�OA�i���% 0D�7�d�S7ATUS � .. �i����j//�%��:/.�//�/.. �/ ��� , i . . , , /i / �// � i/ ' ,%� '%;'; ;, , � ''� �,��96 ,4��iJ�3� 6����� �,�� ti /i % r/r / ,, . � � � � . � i/r��. ///.// �� / /r / i/�/ /� / io ¢ �.� p, � � � � UNIADEN WEIGHT i � //� � /oii' S �� � ����� q� / �//��i/�nd(S�U� / i��� o//�� /% � ���i� I /,'1%/i//�� ,/�i�'i�/��/i/ / /% / �� / c i �� /��/ //� /i /�ii h�/y� ��/��//%ir�r %�/..��///%�r /� � ',/j/// ir"�w /� �� % i % / ���i�//� �i�/j .r �/i /�/ � �/ � � �/%/��?� i ..��A3 '�.� ��, � %� / i i // ��� // i i / i i / / �� i ..���i'/� //j�i %�>/��, � r /irrr � � � �, /ji� �j ,. � /� � / / //r�i,i� i / . rr��. r /i %/� CHANICAL �/%�ii��j/i��r i/��j/%i�i ; �r/ �%/�� �/ �/ ///�i'✓,/.� %/ �ii��' � ���% �///S Y: ..�. //i,%����,.�= �� ' , � ., / . �i/% � / , �i/o/�� � ,� � .� .7HE +9DCi�ET�R � -r �ia :� 1'7QT � . � �j�/�i� .,.,�'�4s-::. � _,:. '�>. , , v, . ., �E�'�,n+y.'��,� }�' ?�rra � 34„r» ,rV ,�"''E1�El�E�1 .,/ ���4'�U�`' ! i // , � ' ,.�. .r. .. , � i� i r;, �� � � � ��r . �� `'TtTLEB �ir :; �. �� / DOWNER($1. �. : t�xn a,��?y .r �.� �r A'+Ap71pUEY5111CLE� i ,i i ij i,� R�`:=�'��L.EY'JR � � e,.aqU.�Ta0sF�e�C��vOeU�� ���, - � / ._._. .--_J.. ' ' - fl�O�il01�MFO�D f6H � '/�� " L�NGS' GAP' RD as�euna+ � , , ; / . �. H AOWCIN.TURN-'VEHGLE � ,?�/ ISLf �PA��17Db3 � � � ' - � � ��� Fpi1MERlY A POIICE /Li �// - 1 �.' t % � . .. � . . �- R�P�ECONSTRUQTKO \ �. • i�v%i/�" . . . � 8�9TFIE�T�ROD � ;-. ����i' . � �� � g T.'.REWVEREDTi1E , ��. � �i � / . •"��.�,. . � . . .. ., . . �� ' . , . V�VEFYCLE CONTAINS ISSUED V1N � %.��/� . � . � � W�FLOOD VEHIQLE i /%�. . . '�-•, - %�FORMEPo.Y A �,���ii;. FAVOFi OF: � �� � � .. '. . 3ECOND�NPAVOROF: i; n �/// �/ � , �� � '����i y � a i// � . . �, . . � � ��i%� \ � � : ,. .. .. ..,.. . . . • l�� . . -. � . .. If a aecorHl lienhokler-la Uated,upoP eatlefecHon of the ltrat Ilen,the, . ��'/;j��� � . _.Ilenholder Tuet�f4�waM thia 7itle to-tta Bureeu�Mota.Yehkiea • ;���/� � � ��gpproPdeta Wrm end fe6. R�LEASED� :1" � . .%i �� ' . . � � /=' , �. -. �..� �i// I . ; . � . . 1., i i i�i�/. � � . SE �Qy , lJ�i^^"^""."' i�j� �/���! ' BY '� / ,? / // ./%//// �// �� /,/;;�. MNLING ADDRE3S . ... •� py i ii .��i�i i�•// ..i , 2�3a�� � „�, � , � �/�i��%i i��/%/i ROBERT H CULLEY JR � � ; ���� ���,,��,� � � � ,��� �ii��;� � � ,ii� ! � ,, � y i � iii�/�/ i�� � , 375 LO�1GS 6AP RD ; , �%,� „/;/;,,,;%r ,,,/ • CARLISIE PA 3�?D3�3 x , �,% �i� �j� '%��%%'� . /;, �r �,/ir/� �i//„�,�,ii, .: ii �/% �/ i�l � • � :� / / j i �%�%/��i��/i�%i !�� /�/s / /' �i�// �/�����.. i ��,. ,� / j//i/ ,� ��/� i : i /��/i�� /////���%ri . �� //���.� / : � � i�<���}`�� �. %�//� i ��/ 4� �aw � � ///i // �� i/! // � i�� � �,. � / // .� / / ;��l /%_ /� �i� �/ yy- �/� i m / �./�/ „ �UL��� iiio � iii iq i i// i� . �r. i , iii / �r`i ii i i . ... � r i /i / % �/ /��/ � �� .aa �7a 9��.��pd�g�L��nem�edhere�iNst�helawtl'1eua�nL.'';�/�� �/ j� :/�i��7/i�% /j . ,1' � 1 � �i91 � % , // _J_,i'i/r , � ,i ��� ,ii,, , �„�,�j �ii ,.���5, ,�„ation ,✓, /.. i��/� �: �/{/, .;%. � �:o. �,.. , � .• .�. .,� �� � � �� � � ��/ . ��� %� ii ���/i%�ii .. � i �//ir� � �i �� � �of� % ii / i / r �i i r r/ � � . �� �i . � ��/ i��i��/�/ �i/ / ` i � �i i, i . �oes �// � / ///�r/ / i/ jrr / / , i/� % . � � /� � �'"" / � !ii// �� / a � i i o�v ea+ �. � qwl�qr} � � �i/� � � � i � i //%/i�%/'%%��'/%i//�j%/i/��/,i///� ' � /�i a��ls -.ne��Y�� �/�r�'��j�o�e` i %�ii.�i/i// // � /..i � / PoN(i0A7H � . . i/ //�ii/ //�� /�/�����i/ �. N / ' � i.' � /i ////i�/ jj ��j / i%/ / r Bf�X ��/ //���///� �� ���/ /�/%/�%�/��/ /; �T�l�;, //G /� / / a// /// /��� �i�G �4 / %�.��/i/���i� i � , ��� /,i/ //; / �� ,%i %ri/�/�// '-�%/r��iiiii/�� //, i '! %�j.!, �%�/,, ;/i,jii �/%iii� ��iii%� / / // i/ iii �i /�/, ��� � / i /i!� ��..,�%�///.�j/�i/ � - � %� �//� p%���ir�/j%iiiii/ G�i/ ,: . , ` � � !���/ � � ./ i%//.�i%q� //�O ", i/ i i�/� // /// ii/�//i ., �:. . /i /��%/� ���ii�� /% �/i��� . ���/ // �i . � � �;j%� � � ������4,F A N��'Aft1l �, ��, '; �� ��; � � � �i��i r r d i�� � ��� ��r � %/�i��i i /� �j i/� � /� � . �� rii i�i /i � .�i �/�//��/ � , i ; � �//// .r � �/ � �/r// ��%��i i/�/ �j/r��: ii ���. � i f /i i /�// � `����/�// ���%i�.���/O//��� /H���� r�� /r� � �i .// i���%%//���.�p i/ � � .. i� %i/�%i%% �iGi�o��:%� O%%�',, � �H, `. i r, ii�%%��%//r� I.1EN ; � i� / �� � �� i _ �. � " OATE.��.i,/,% �j �� ..�� {///�� . (`�BO�C � �i;i �%�//�/°�/i/� ��/ �/%//%/��// ,•. . �� N ���/����p�����a¢p����tpieeta d TItW to Me vehble described�, 9ECONP HOL�ER � %/ i i///� �� ; u / �'9�� � � , >� �o "; �, i oi %a S)r tl��cW J^sM�«m i»re. � /� � ��,i/,�vinf�o%�.>,�„ � p�ME s�, W � � , � � � � ��. � �/-/r/�G//�.p/ � '. �//, . ,. "�i STREET`;� �i /r /, /���i . / ♦� i%�i �/ � p "TM;Po,. . q G'�V� � / .L� � ..:e �.L, i'/ �.1/ � :i/ �� �� ` �.. . . . .�. �/i i��j�/ � �� � i/ /� ��� i %ji/'�iii /i/�aii i,i�i�/�/,ii „ „ ,., � �%'Ti�>%t! � �i/ �a i!��'/�i��r/���/'�'/��/��!����� �� s /,//��v,.../�„ ��i����uii+omie4s�a� �i,/ dii�r,�'�i.�;,,i, � i!,�q •r�/i���,/�,ii z�, /, • " '' � - 1 i � � �� � � . � . . , ,;�- Each unde "ned seller ceNiies to the besl of his knowledge,infortnation and belie�under penally'pf law that the vehicle is new end has n�(been registered in � this or eny s te et the tlme of delivery and the vehicle is not subject to any securiryinterests"o1h�r,than disclosed hereip and warran title to�he vehicle. FOR VAIUE RECEIVED i TRAN F THE VEHICLE DESCRIBED ON THE FACE OF 7HI$CERTIFICATE'�,TO: NAME OF ,; O �N � I"• �l w� � PURCHASEA(S) . � . Q m ADDRESS i ' - p�j I certiy to t�bes�of my k owl dge that e od et readin is_ -� �. ��No Tenths ��Z- DEAIE � BY • F Z �' DEAIE S UCENSE NUMBE �, g81n dul sWOr�l u on oath s that the statem8n set torth are - �f �' x, N�T L . We an Y�rpqt`�e bscrib y w�i to me �Dr'f 3 I � ��,�-�- tate.ot ��� �( � .` betore �g_d of Year � ��_ l � Notary Public �a ����� �� TI ONLY IF REQUIFtED IN TI ` TIO ` � Q N • rw,� PURCH�SEri S� - --- — --- � �'a m . ADDRE$.S _ o� I certify to ih�beS4of my knowledge that the odpmeter reading is � ' �� .�_ „ ' No Te�th; Z . . . .. _ ., —' .. . O f- `�DEALER � _ BY; �.. ` ?W � � NAME OF DEALERSHIP DEALER'S LICENSE NUMBER 88if1CJ dUIY�SWp m upon oath says that the/statements set torth are �p� "' h� �� true and correc'1 Subscribed aAd sw6m l6 me F� State of_ ��J � —1__�_ _ ___ __ �I ` before EhisT day of____ Year_____�__ . � �y Counry o� __"r� , .. '__\—�--�— ------I- � --- � — __..- ------Notary Public a / USE NOTARIZATION ONLY IF R€QUIRED INiTITLING JURISDICTION �'+ NAME OF ! ' ��j ry�,;v.�', I W� PURCHASE�(S) /" -- �� �,.� . � T—��-+q��?"'�S . � w� ADDRESS - ---—_—.--�t �„ .,,,, _ J W ,� o� I certfy to thE besC � kno�Madge lhat th�odome(��a�ding A ��r,�,.- ,.,,,,R.� ����- � �r��.--` : [No�enths ' T' �F: , aEQ�r.a.�..��a% . � By, W �NAME OF DEALERS�iIP� DEALER S UCENSE NUMBER �$eif19 d41y 6WOR1 UpOfl 08th Sey9 IhBt th8 Sl8f8rt16�tS SBt fOrth a�e m� �i true and correct.Subscribed and swom to me �� State of + _._ _ __ be(ore this �lay of Year _ o� County o��� ____ --_-- — Notary Public a ' USE NOTAfiIZATION ONLY IF RE�UIRED IN TITLING JURISDICTION � � ¢a NAME OF � ' I J w PURCHASEA(S� :+` a m App�e� 'r • . --� � p j I c9�U(y to th�best�ot my knowledge that�he odometer reading is_ _ No�enths Z� �DEALER �u•` —}-- S Z � NAME OF DEALERSHIP DEAL£R'S LICENSE NUMBER �BBing dyly swom upon oath say�that the statementS SBl�Orth 0fe � true and�correct Subscribed and swom to me �m� State fpf � � _ before this�_day ot Year y Counry of�-- � Nolary Public �� �a b USE NOTAfiIZATION ONLY IF EQUIRED IN TITLING JURISDICTION ;. � Federai Lavl`requires you ro state the odometer mileage in conn�ction with the trans(er of ownership.Failure to complete or providing a false statement may W result in fine�and r imprisonment. I " ' ¢ - I certity to t o y knowledge that the odometer reading is the actual mileage ot the vehicle unless one ot the following statements is checked.Odometer , N� Reading � . + No Tenths.� The'mileage stated is in excess of its m�chanical limits.0�The odometer reading is not the actual mileage. . ��a � a ; �� �� WARNING ODOMETER DISCREPANCY �N•� � i� � � � Date of Statement_ � Date of sale - y��-.� Signature(s)pf Sellers(s) QW Printed Nam�9(s)of Sellers(s)___ Deale sr No _ Being duly sworn upon oath says that the statements set forth are W¢ ,,SignaWre(s)�t Purchaser(s)_ � true and correct.Subscribed and swom to me � . — -- before this� � day of_ Yeaf �� P�inted Names(s)o(Purchaser(s) __ __ _Notary Public �, Oo LL Company Nyne(it Applicable) State of - SO Adc�ress of F�rchaser(s ____ _ County of_ __ � �S USE NOTARIZATION ONI.Y IF REOUIRED IN TITLING JURISDICTIO� ¢ 1 st lien in fa�or of .Y I � whose addr�ss is . — --- . 2nd�lien in f�vor oi __�,� � Z � ?' whose addr�ss 1� � . , �,,4; � I 1 i b'� . i _ _ _ �. _ . , � . � � * REV-1510 EX+ (08-09) � pennsylvania SCHEDULE G DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERifANCE TAX REfURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OP FILE NUMBER Robert H. Culley 21-07-0513 This schedule must be compieted and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERIY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE ITEM INCLUDE 7HE NAME OF 7HE iRANSFHiff,7HEIR RELATIONSHIP TO DEC�BdT ANO NUMBER iNEDA7E0F1RWSFHt. ATfACHACOPYOFTHEDEEDF01iREALESTATE. VALUEOFASSET INTEREST tlFarvucn�) VALUE 1• Capitai Bank and Trust Company,401(k) 547.00 100 547.00 TOTAL(Also enter on Line 7, Recapitulation) $ 547.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+ (08-13) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX REiURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert H. Culley 21-07-0513 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Auer Memorial Home,Cremation 1,158.00 2. George's Flowers 106.00 s. Cumberland Valley Memorial Gardens,Burial 855.00 0.00 0.00 0.00 0.00 B, ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s)of Personal Representative(s) N/A Street Address City State ZIP Year(s)Commission Paid: 1.00 2. Attorney Fees: 3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.) 0.00 Claimant N/A Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 43.00 5. Accountant Fees: 0.00 6. Tax Return Preparer Fees: 0.00 �• Patriot News,obituary 2�.62 s. Cumberland Law Journal,ads 75.00 s. The Sentinel,legal 182.56 �o. Auctioneer,appraisal 35.00 ��. Register of Wills,filing fee 45.00 �2. Reserve 350.00 TOTAL(Also enter on Line 9, Recapitulation) $ 2,878.18 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12-12) �� pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCE TAX REfURN MORTGAGE LIABILITIES &LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert H. Culley 21-07-0513 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� PP&L,electricity 115.12 2. Penn DOT,trailer registration and tax 243.00 3. Comcast,cable 14.94 4. Morgan Properties,utilities 68.36 5. Vontage Phone,telephone 39.99 6. Lowes,paint for apartment 21�99 7. Wellspan Heaith,York Hospitai 63,359.81 8. Cardiac Diagnostic Associates 378.00 9 West York Ambulance 1,630.00 TOTAL(Also enter on Line 10, Recapitulation) $ 65,871.21 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(O1-10) � �- pennsylvania SCHEDULE � �����,� DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert H. Culley 21-07-0513 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. Katrina M.Cuiley,4711 CedarAve,Apt 1R,Philadelphia,PA 19143 Daughter 1/2 2. Jessica L.Culley,4711 Cedar Ave,Apt 1 R,Philadelphia,PA 19143 Daughter 1/2 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: l. � B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 0 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. CERTIFIED COPY �O�T, DUFFIE, STEWART c£3 WEIDNER �� ATTORNEYS AT LAW ��$�""' LEMOYNE. PENNSYLVANIA ATTORN£Y FOR ���t �fl�ill �n� ���t�.m�nt OF � � RUBIIZT H. Q1LI�Y I, ROBERT H. CULLEY, of the Township of North Middleton, County of G'�m�berland and Cariunonwealth of Pennsylvania, bei.ng of sowzd and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills heretofore made by me. AR�.ICLE I I direct the paym�nt of my legal debts and the expen.ses of my last illness and the disposition of my remains from my estate as soon aftex my death as conveniently may be done. Al1 of the foregoing shall be considered expenses of the achninistration of my estate. ARTIC[.E II I bequeath all of my tangible personal property (excluding cash or secu-rities) , togeu`�er with any �isti.r�g insurance thereo:�, to my �iauc�ters, JES�ICA L. �.Y and KPi'atIl� M. cULr�.v, in as nearly equal shares as possible. ARTIC[.E III I devise and bequeath all of the residue of my estate to my daughters, JESSICA L. C�LiEY and KA`Q2Il� M. CUL�'v, in equal shares. � � �� � 4 k r f ��' � � �Y i �Y��.�t� d �(� � �;� � 'E�y'��TY^y�w��� ��C�AS��: � 4i ��� � �i I apnoznt � � , � � its C.arlisle deposit office� c�' � � �„ +ei. � under this Will or othe�rs.ri�, to a �r � �.� � 'tQ �d3 � a� � authorized to a�oint a g�i ian and ha�re nat cx�en ��se s�ecifically rlc�e sc�. Provided that this appointment of a guardian shall nat a�Iy to property distributable to a minor for wham I have otherwi.se made special provision, and provided further that this appoinisnent of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. S�ich guardian shall have the pawer to use principal as well as income from time to time for the minor's suppart or education (including college education, bath graduate and undergraduate) , and to make payment for these purposes, without further responsibility to the minor or to any person taking care of the minor. ARTICLE V I appoint my brothex, Q2IDIN A. QIGIEY, guardian of the persons of my minor daughters. �cr� vz � I appoint my brother, Q2IDIN A. QTLT�Y, Executor of this my last Will. In the event of lzis inability or unwillingness to act or continue to act as �ecutor, I appoint �IC[�L BANK, of Harrisburg, Pennsylvania (through its Carlisle deposit office) F�cecutor. A�ICCE V I direct that my �ecutor, or his successor�, shall not be required to give ; . �� - �. #„��.,;s �.w�.� 4 ,Yi.�x3 �,t ��' . � . -��` -a '� �3 .� �` n,� �a��- € „�`�. � . bond fc� t�e �aii� �' � � Z3 � �� � ^z.t, x+" �"t x N�" � `*_�`� � �'�T � �.�2f� 1�1 � +�� a� � ������'�` k�� '�i�� °�����"�` "�v"�� `�� : � ":e, W� � �. �t � '� � ��� � � � 1� �� � ° > � �, r�.t.�� �:' .����� � t.,�.f � {��� y��Robert H. CU1.Iey Signed, sealed, published and declared by the above-named Testator as and for his Iast Will and Testament in the pre.sence of us, who, at his request, in his presence and in the presence of each other have hereunto subscribed our names as witnesses. ��� ��-� G�l�C.ll�Y �',-�-- r � °� " `� , � s ' k � ;< :�'�..`�, �, .�,��- � ,�� ,s,,,r,�. , ��� �� `��'�7��;Y. . �y;'�S �.y �' � � "��� r''g�a� �` � � . � k ' 'k"l' t5' �*'� a..�'' . �� ��.3 -�i' �i ti ba�Cr Y� -s�.� . � .. r �. � �,�,. �., d��� �.faA�> w�e ,�' .� �,' �' �,"'.r- . , � „ „� � � ":�N .G F; oot� a� . I, Robert H. Cuiiey, 'i3estator, whose name is signed to the foregoing ;n�trinnP.nt, having l�n duly qualified accordirig to law, do hereby ac.�rnawledge that I signed arxi executed the instnm�zt as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes thexein expressed. ` �t�� �� ��. �',�� �r.�� / Robert H. Culley�— ! f Sworn or affirnied to and ac,J�owledged before me, by Rabext H. CUlley, t�e } Testator, this°j ��3_t day of ��, �,��fi , 1990. � � ;� � „�, ���-,u ���,;�;�� ,r"�; � � �� � � � �� ��� �����'� � �"` �� � :�*�� �� ,��-�'�� ��� � "�',�� � � ��� E � . . .. � .:.�� '�:..� *��z�:�T ^yr" k f�Li ,.. . � �; t � „ �;.y,�. ' �, ,,� .. ,,x �s<� � �c.��. . , ��; � ��i ���x k%��� �t>> r� � + _���l+ ■ 1 #� Z p 1�����11��1���"� � #P:.. �r�� �"� 'a"�."a. � 3 xr v`�� Y+ ;.,�a.�',���Y A ?;�� s� �. dy � .:4� �,� a- �st� 5 '✓.� �' .� � . OF PIIaTSYL�iAt�IP4 � ; � �' ���' ;� � OOi.AV'I'Y OF CCIIKB�ZLAND . � � � , we, �.�/�S�l���� � �r���t�' ,�''�. 1"���,�'r.S � �� whose names are signed to the foregoirig instrument, being duly qualified acxordingly to law, do depose and say that we were present arid saw the Testator sign and execute the foregoisig instn�nent as Yii.s Last Will and �.nt; that he sigried wil�ir,c�ly and that ha executed it as hss free and vol�nt.azy act for the pt�s therein e�'essed; ��a� � �� � in ��e �r�ng arri sic�t af � ? ; 2'estator sigr�ed t�e T�?.�. � �.�� � �� � � � �� � �a��, a the 'Iiestat�r �es that t�.�e a�: �� � ��.�-s � �e, � � � constraint ar � infl�. � � i � � � �� .��r+ �� V �, i`±�'� � t""e4�� ��"� � x � � � � N k��;� r� . y .t..� �R�, X�x,�µx�.- ..r �a 1' ��" " � !� S�aorn to or affir�3 tc> aa�d ��-�� tre� � � � �d'L�r' �'. l�"�(I��'.S , witr��s, t�..s*,��;�- a�y' c� `..�`��` ,^�� � .��� ,, r"ti. W�i ^' ;� � �.��. ` �� . Notary Iic � i .