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HomeMy WebLinkAbout06-06-14 J 1505610105 REV-1500 EX(02-11)IN) PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX28o6oi INHERITANCE TAX RETURN Harrisburg,PA 19128-o6oi RESIDENT DECEDENT of 3 yc-S LP ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01/10/2013 08/24/1939 Decedent's Last Name Suffix Decedent's First Name MI Salkeld Victoria W (If Applicable)Enter Surviving Spouse's Information Below - Spouse's Last Name Suffix Spouse's First Name MI n/a Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return OD 2.Supplemental Return t= 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) p 6.Decedent Died Testate l7 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Paul L. Zeigler, Esquire (717) 920-8420 v n ° ::a REGISTER•OPAVILLS USFLONLY r'1 C-) R7 S n Z V1 � First Line of Address "TJ - CJ) rri 300 Bridge Street ? ca C3 Second Line of Address ,.�� p _n � _ -D 4 2nd Floor, P.O. Box B f� i� M `DATE FILED O City or Post Once Stale ZIP Code t11 -n New Cumberland PA 17070 Correspondent's e-mail address:paul @piZpc.Com 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 parer other than the personal representative is based on all information of which preparer has any knowledge. SIG RE OF PE SON I#SPON IBL FOR FILING RETURN 6/5/14DATE ADDR SS V I—L//JI JC, f, 29 S Andlelliq Foad, Severna Park, MD 21146 SIGN E F E RER OTHER THAN REPRESENTATIVE DATE ADDR SS 300 ridge t, P.O. Box B, New Cumberland, PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Victoria W. Salkeld RECAPITULATION 1. Real Estate(Schedule A). . .. ...... .. .. .. .. ... .... .. .. ........ ... .. .. . 1. 209,000.00 2. Stocks and Bonds(Schedule B) ... .. ....:.. .. .. .. .... .. .... .. ... ...... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .... . 3. 4. Mortgages and Notes Receivable(Schedule D). . .. ....... ..... ... .. ..... . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. 122,495.91 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .. ... 6. 7. Inter-VNos Transfers&Miscellaneous Non-Probate Property, (Schedule G) O Separate Billing Requested.... . ... 7. 8. Total Gross Assets total Lines 1 through 7 8. 331,495.91 9. Funeral Expenses and Administrative Costs(Schedule H)... ... ... .. .. ...... 9. 51,063.73 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).......... ..... 10. 11. Total Deductions(total Lines 9 and 10). .... .. .. .. .. ..... ..... ... ....... 11. 51,063.73 12. Net Value of Estate(Line 8 minus Line 11) . . .. .. .... ..... ... ... ......... 12. 280,432.18 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. 280,432.18 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 45 280,432.18 16. 12,619.45 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable' at collateral rate X.15 18. 19. TAX DUE . .. ... .. ... ...... ..... .. .. .... .... .. .. .. ... .... .. ... .. ... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Cal) Side 2 L 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: ENAME E Salkeld S e STATE ZIP urg PA 17050 Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 12,619.45 2. Credits/Payments A.Prior Payments 13,931.12 B.Discount Total Credits(A+B) (2) 13,931.12 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 1,311.67 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 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.......................................................................................... ❑ E b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0 c. retain a reversionary interest .............................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ E 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ N 4. Did decedent own an individual retirement account,annuity or other 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)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) Iffpennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Victoria W. Salkeld 46-6739847 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 224 Fox Drive, Mechanicsburg, PA 17055-2515 209,000.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 209,000.00 If more space is needed, use additional sheets of paper of the same size. :III'll�'r. OMB Approval No.2502-0265 A. Settlement Statement (HUD-1) B. Type al Lean e.Fee Number, 7.Iten Number: a.Mortgage Insuraxe Case Number. 1. ®FHA 2. ❑RHS 3. ❑Conv.Unlns. 2014-011-Fide2ity 551567 446-2062925 703 r 4. ❑VA 5. ❑Conv.Ins. C.Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.Items marked '(p.o.c)'were paid outside the closing;they are shown here for informational purposes and are not Induced In the totals. p,Name 6 Address of Banswer: E.Name 6 Address of Setler. F.Name a Address of Lender Chad M.Lauro Estate or V/chmm W.Salford,Bred J. Members 1st FCU, 228 Fox Drive Sa/ko/d,Executor 5000 Louise Drive Mechanicsburg,PA 17050 224 Fox Drive Mechanicsburg,PA 17055 Tabltho Lauro Mechanicsburg,PA 17050 228 Fox Ddve Mechanicsburg,PA 17050 G.Property Location: H.Settlement Agent: 1.Screamenl Date: 224 Fox Drive DETHLEFS-PYKOSH LAW GROUP,LLC, 0413012014 Mechanicsburg,PA 17050 - 0 Darrell C.Deth/efa,Esquire Phone Number:(717)9759446 Cumbedand County PA tre 1701'11 Place of Settlement: 2132 Market Street,Camp Hill,PA 17011 Disbursement Oale:04 130/2014 J. Summary of Borrowers Transaction K.Summary of Sellers Transaction 100.Gross Amount Due From Borrower 400. Gross Amount Due To Sailer 101.Contract sales price $209,000.00 401.Contract sales price $209,000.00 102.Personal property 402.Personal property 103.Settlement charges to borrower(line 1400) $11,634.69 403. 104. 404. 105. 405. Adjustments for Items paid by seller in advance Adjustments for Items paid by seller In advance 106.CO AOwn taxes io 406.Cltyrtown taxes to 107.County taxes 0413012014 to $426.15 407.County taxes 0413012014 to $126.15 108.Assessments 0413012014 to $365.71 408.Assessments 0413012014 to $365.71 109.Hunicipal: 413012014 - 6/30/2014 $]05.64 409.21unicifeel: 4/30/2014 - 6/30/2014 $105.64 110. 410. 111. - 411. - - - 112. 412. 120.Gross Amount Due From Borrower $221,532.19 420.Gross Amount Due To Seller S209,897.50 200.Amounts Paid By Or In Behalf 0,1 Borrower 500.Reductions In Amount Due To Seller 201.Deposit or earnest money $2,100.00 501.Excess deposit(see Instructions) 202.Principal amount of new loan s) $205,224.00 502.Settlement Charges to seller line 1400) $11,382.34 203.Existing loan(s)taken subject to 503.Existing loans)taken subject to 204. Appraisal Fee Credit - $475.00 504.Payoff of first mortgage ban 205. 505.Payoff of second mortgage loan 206. Seller Assistance w/Closing Costs $9,000.00 506.SO110r Asaiatence v/Clpaing Coats $9,000.00 207. 507. 208. 508. 209. 509. Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller 210.Cit rtown taxes to 510.Cil hewn taxes to 211.County taxes a 511.County taxes la 212.Assessments to 512.Assessments to 71-3- 214. 1 514. 71-5- 216. 516, 217. 517. 218. see. 218. $19. 220.Total Paid By/Far Borrower $216,769.00 520.Total Reduction Amount Due Seller $20,3a2.34 100.Cash Al Settlement F7orrlrTe Borrower 600.Cash At Settlement TolFrom Seller 301.Grass amount due Iron borrower(One 120) $221,531.19 601.Gross amount due le Seller(line 420) 5209"'97 302.Less amounts pap by/for borrower(line 220 ( 52]6 769.00 602.less reductions in amt.due seller(line 520) $20,382.34 303.Cash ® From ❑To Borrower $4,743.19 603 Cash - ®To ❑From Seller I $189,513.16 The public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not collect this information,and you are not required to complete this form,unless,it displays a currently valid OMB control number.No Confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. Previous editions are obsolete Page i of 3 HUD-1 L. Settlement Charges 700.Total Real Estate Broker Fees $8,495.00 Pair From Paid From Division of Commission(line 700)as follows: Borrowers sellers 701.$ 11,405.00 to Re/Max 1st Advantage, Inc. ({$125-BrkrFee) Funds at Funds at 702.$ to settlement settlement 703.Commission paitl at Settlement $8,485.00 704. Broker Fee to Re/Max Is[ Advantage, Znc. ( PD.C.by ) $125.00 800.Items Payable In Connection With Loan 801.Our origination charge Members 1st FCD $550.00 (from GFE Your credit or charge(paints)for the specific interest rate chosen $ (from GFE#2) 603.Your adjusted origination charges (from GFE A) $550.00 804.Appraisal fee to Msmbera oat F t no.c.b, ) (from GFE#3) $425.00 805.Credit report to Members let FC0 ( PO a by ) (from GFE $13.50 806.Tax service to t a.oc by ) (from GFE#3) BDT Flood certification Members Sat FCG ( P.o c ey ) (from GFE#3) $12.50 808. 809. 810. 811, 812. 900.Items Required By Lender To Be Paid In Advance 901.Daily interest charges from 0413012014 t0 0510112034 @$24.2267 /day(from GFE#10) $24.23 902.Mortgage Insurance Premium for; months. (from GFE#3)1 $3,529.49 to FHA =1, 903.Homeowner's insurance for 1.00 years. $1,030.19 (from GFE#11) $1,030.19 to GSAA 904. - years. to 905. 1000.Reserves Deposited With Lender 1001.Initial deposit fOryour escrow account (from GFE#9) $1,975.28 1002.Homeowners insurance 2.00 months @$85.65 per month $171.70 1003.Mortgage insurance months @$225.16 per month $ 1004.Property taxes - 3.00 months @$52.69 per month $358.07 1005.School Taxes 11.00 months @SI83.07 per month $2,013.77 1006 months @$ per month $ 1 DD7.Aggregate Adjustment - -$ 466.26 1100.Title Charges 1101.Title services and lender's title insurance (from GFE#4J $2,727.00 1102.Settlement or closing fee $ 1103.Owner's title insurance - (from GFE#5) $15.00 1104.Lender's title insurance isaued ttnu Fidelity National Title $ 1105.Lenders title policy limit$205,'214.00 1106.Owner's title policy limit$209,000.00 1107.Agents portion of the total title insurance premium Dethle£s-Pykosh Law Group $1,355.75 1108.Underwriter's portion of the total title insurance premium Fidelity National Title $239.25 1109. (Sale Rate - said. 300, 300, 900) 1110. Fidelity National Title' (CPL Fee) $75.00 1111, carrell C. Dethlefe (Ndtary Fee) $25.00 $10.00 1112, Dethlefa-Pykoah Lev Group (Tax Cert Reimburaeme t) $10.00 1113. 1114. 1115. 1200.Government Recording and Transfer Charges 1201. Cumberland County Recorder Government recording charges: (from GFE#7) $217.50 1202.Deed$67.00 - Mortgage$95.00 Releases$ 1203.Transfer taxes Cumberlentl^county Recorder (from GFE#8) $2,090.00 $2,090.00 1204.City/County tax/stamps: - Deed S 2,090.00 Mortgage $ 1205.State tax)stamps: Deed$2,090.00 Mortgage $ 1206 Recozdin9 Fee: Assi9 ent of Mortgage $55.50 1207. $ 1208. $ 1209. $ 1300.Additional Settlement Charges 1301.Required services that you can shop for (from GFE#6) 1302. $ 1303. $ 1304. 1305. 1306. MvQ+ael Langan, Treasufez (2014 Co/Twp Taxes) $632.29 1307. Hampden Township `seveYlrzaah: 2nd Qtr 411114-6130114) $155.05 1308. 1309. 1400.Total Settlement Charges(enter on lines 103,Section J and 602,Section K) $11,634.69 $11,382.34 Previous editions are obsolete Page 2 of 3 HUD-1 Comparison of Good Faith Estimate(GFE)and HUD-?Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Our origination charge 9601 $595.00 $550.00 ' Your credit or charge(points)for the specific interest rate chosen #802 50.00 $0.00 Your adjusted origination Charges #B00 $395.00 $550.00 Transfer taxes a 1203 $2,090.00 $2,090.00 Charges That in Total Cannot Increase More Than 10% Good Faith Estimate MUD-1 Government recording charges #1201 $266.50 $117.50 A11.1.e2 Fee #904 $475.00 $125.00 Credit Report Fee 0805 $13.50 $1J.50 FIOOd Cert Fee - 0607 $12.50 $12.50 HIP/PM2 #902 $3,591.25 $3,529.49 # $0.00 $0.00 II a $0.00 $0.00 N $0.00 $0.00 a $0.00 If $0.00 a so.505050 20 $0.00 # $0.00 $0.00 Total $1,358.75 $1,197.99 * Increase between GFE and HUD-1 Charges S -160.76 or -3.69% Charges That Can Change Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 $7.31 $1,675.28 Deity interest charges #901 $24.2267 /day $671.27 $21.2J Homeowners insurance 4903 $0.00 $1,030.19 71t1a Sarvlees/Lender•. role S....... 42101 $1,909.75 $1,717.00 O e..C.. rill. Ineurenee 41103 $10.93 $15.00 Al $0.00 $0.00 At $0.00 $0.00 # $0.00 $0.00 # $0.00 $0.00 # $0.00 $0.00 Loan Terms Your initial loan amount Is S 205,214.00 Your loan term Is 30 years Your initial interest rate is 4.25 • Your initial monthly amount owed for principal.interest,and $ 1,294.69 Includes and any mortgage insurance is" ®Principal ®Interest ®Mongage Insurance Can your interest rate rise? ®No.❑Yes,It can rise to a maximum of %.The first change will be on and can change again every after Every Change date.your Interest rate can increase or decrease by %.Over the life of the loan,your interest rate is • gueranteedtoneverbe tower than %or higher than %. Even if you make payments on tine,can your loan balance rise? ®No.❑Yes,it can rise to a maximum of S Even H you make payments on time,ran your monthly ®No.❑Yes.the first increase can be on amount ovrctl for principal,Interest,and mortgage insurance rise?? and the monthly amount owe0 con rise to It The maximum it con ever rise to is S Does your loan have a prepayment penalty? ®No.C1 Yes.your maximum prepayment penalty Is S Does your loan have a balloon payment? ®No.❑Yes,you have a balloon payment of S due in years on Total monthly amount owed Including escrow account payments ❑You do not have a monthly escrow payment for Items,such as property taxes and homeowners Insurance.You must pay these items directly yourself. ®You have an additional monthly escrow payment of$ 322.62 that results In a total Initial monthly amount owed of$1,556.30.This includes principal.interest,any mortgage Insurance and any Items checked below: ®Property taxes ®Homeowners Insurance ❑Flood Insurance ®School Fore. Note: If you have any questions-about the Settlement Charges and Loan Terms listed on this form,please contact your tender. Previous editions are obsolete Page 3 of 3 HUD-1 Certification (continued from HUD-1) I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify,that I have received a copy of the HUD-1 Settlement Statement. C.� Seller or AA Borrower: ate: 3Q I Agent: ,(/j ny>/ Date: Chad M. auro J Br t t .Sal Estate of Victoria W.Salkeld 228 Fox Drive 224 Fox Drive Mechanicsburg, PA 17050 Mechanicsburg, PA 17050 Seller or Borrower. Date: Agent: Date: Tabitha Lauro 228 Fox Drive Mechanicsburg,PA 17050 The HUD-1 Settlement which I have prepared is a true and accurate account of this t n action. I have caused or will cause the funds to be disbursed in accordance with this statement. '7 / Date: Settlement Agent: Date: Darrel ethlefs, Esquire WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see:Title 18 U.S. Code Section 1001 and Section 1010. REV-i5o$EX+(cg-i2) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL. PROPERTY RES{DENT DECEDENT ESTATE OF: FILE NUMBER: Victoria W. Salkeld 46-6739847 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2003 Ford Focus 6,000.00 2, Antiques 1,000.00 3. Rings&Jewelry 500.00 4. Accounts-Sovereign Bank Account No.xxxxxxx3047 11,392.85 Account No. xxxiaxx8288 845.21 5. American Funds 102,757.85 Inheritance Tax Paid by three lineal beneficiary's of decedent.$1,541.35 x 3=$4,624.05 TOTAL(Also enter on Line 5, Recapitulation) $ 122,495.91 If more space Is needed, use additional sheets of paper of the same size. REV-iSo9 EX+(oi-Lo) `� i lvania SCHEDULE F �Lur P enns Y INHER7MCE TAX REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Victoria W. Salkeld 46-6739847 If an asset became jointly owned within one year of the decedent's date of death,It must be reported on Schedule G. SURVIVING JOINT TENANTS)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.None B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. TOTAL(Also enter on Line 6, Recapitulation) $ 0.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) Pennsylvania SCHEDULE DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Victoria W. Salkeld 46-6739847 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Auer Cremation Services of Pennsylvania, Inc.,4100 Jonestown Road, Harrisburg, PA 17109 1,695.00 Packaging/forwarding of remains 65.00 Newspaper notices 226.23 Dauphin County Coroner fee 30.00 10 Death Certificates 60.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 10,980.00 Name(s)of Personal Representative(s) Brett J. Salkeld Street Address 29 St. Andrews Road city Severna Park State MD ZIP 21146 Year(s)Commission Paid: 2013 2. Attorney Fees: Paul L. Zeigler, P.C. 9,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)n/a Claimant Street Address city State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 463.50 5. Accountant Fees: Richard Simpson, CPA 100.00 6. Tax Return Preparer Fees: 7 Estate Notice-The Patriot News 109.52 B. 2013-2014 School Tax 2,152.95 9, 2013 County/Township Tax 616.06 TOTAL(Also enter on Line 9, Recapitulation) $ 47,615.39 If more space is needed, use additional sheets of paper of the same size. Schedule H(Continued) Estate of Victoria W.Salkeld Estate Expenses Utility Expenses $ 1,543.56 PP&L-$778.73 Hampton Twp.Sewer-$465.15 Water-$167.47 Comcast-$132.21 Medical Expense: $ 1,219.74, Meals on Wheels-$35.00 Pinnacle Health-$17.33 West Shore EMS-$976.38 Pinnacle Health-$120.03 Dr. Thackth—(co/pay) -$10.00 Manor Care Home-$18.00 Manor Care Home-$43.00 Car Transfer Expenses: $ 402.50 Sales Tax-$360.00 Registration& Plates-$42.50 Home Expenses $ 1,167.33 Barry Hake—Lawn Service-$720.80 Bank Account Maintenance Fee(checking)-$108.00 Discover Card-$21.02 American Homeshield-$48.51 Dehumidifier-$269.00 Settlement Charges $11,382.34 Seller Assistance w/closing costs $ 91000.00 Travel Expenses: $ 350.00 Personal Representative— 10 trips 100.00 miles each way—Gasoline-$350.00 $51,063.73 REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Victoria W. Salkeld 46-6739847 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. REM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None TOTAL(Also enter on Line 10, Recapitulation) $ 0.00 If more space is needed,Insert additional sheets of the same size. REV-13131x(4-10) APPLICATION FOR Pennsylvania REFUND OF official Use Only r DEPARTMENT OF REVENUE PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES INHERITANCE/ESTATE PO BOX 280601 TAX HARRISBURG, PA 17128-0601 gee Instructions on Reverse TO: PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 FROM: Official Representative Decedent Information Name Paul L.Zeigler,Esq. Name of Decedent Victoria W.Salkeld Address 300 Bridge St. 2nd FI, File Number 21-13-0436 P.O.Box B Date of Death 0111042013 New Cumberland PA 17070 Social Security Number 294-34-3191 Phone Number (717)920-6420 E-mail Address pawl @plzpc.com The undersigned requests a refund in the amount of $ 1,311.67 for the above-referenced decedent's estate. REFUND REQUESTED ON: © Original or Supplemental Joint/Trust Assets Remainder Return Estate Tax Probate Return EXPLANATION OF OVERPAYMENT Subsequent Real Estate Settlement resulted in lower asset value and higher settlement costs than estimates set forth in original return. 6 .St?Nq`' Z.rj1(� gnature Date Please allow six to eight weeks for the processing of your refund request.