HomeMy WebLinkAbout06-11-14 (2) 1
�1 REV-1500 Ext°=_„'IFI'; 1505610105 d
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes E,`" County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN n I 5 r l
Harrisburg,PA 17128-0601 RESIDENT DECEDENT 94 H `l n q
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04/1412013 01114/1954
Decedent's Last Name _ _ Suffix Decedent's First Name MI
Dell Larry R
(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
O@D 1.Original Return O 2.Supplemental Return O 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)
OD 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 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
Thomas P. Gleason
REGISTER OrWILLS USE ONL'L -7
CD l n
]J C_ ) U
First Line of Address
t- F
49 West Orange Street
Second Line of Address
City or Post Office _ _ State ZIP Code DAfe FEED m
Shippensburg PA 17257 j —f o N oT
w
Correspondent's e-mail address:tomgleason @tomgleasonlaw.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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI YIATUR&0F PE ON S SPO SIBL FOR FILING RETURN
,
DATE
A RE'$bS FOOD-n' ri (-12S 1
SIGNATURE O
OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
1505610205
REV-1500 EX(A)
Decedent's Social Security Number
Decedent's Name: Larry R. Dell
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. j 170,000.00
2. Stocks and Bonds'(Schedule B) ....................................... 2. 0.00 j
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00
4. Mortgages and Notes Receivable(Schedule D) ........................... 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 33,019.09
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property , w
(Schedule G) O Separate Billing Requested........ 7. 0.00
B. Total Gross Assets(total Lines 1 through 7)............................. 8. 203,019.09
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. ) 20,498.90
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 107,07627
11. Total Deductions(total Lines 9 and 10)................................. 11. 127,575.17
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 75,443.90
13. Charitable and Governmental Bequests/Sec,9113 Trusts for which
an election to tax has not been de(Schedule J) ........................ 13. 0.00 !
made
14. Net Value Subject to Tax(Line 12 minus Line 13) ....... .............14. I 75'443.90
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 0.00----�
at lineal Amount
rate X.0 45 75,443.90 I 76 0.00
16. Amount of line 14 taxable
3,394.53
17. Amount of Line 14 taxable
at sibling rate X.12 0.00 17. 0.00
16 at Amount of Line collateral ratel Xt 15 taxable
- 0.00 18 0.00
19. TAX DUE......:.................................................. 19.L
3,394.53
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
1505610205 1505610205
REV-15DD EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Larry R. Dell
STREET ADDRESS - -
96 Independence Drive
CITY STATE ZIP
Shippensburg PA 1 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 3,394.53
2. Credits/Payments
A.Prior Payments ____ 0.00
B.Discount 0.00
Total Credits(A+B) (2) 0.00
3. Interest
(3) 40.50
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) 3,435.03
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.............................................................................................................................. ❑
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 secudty at his or her death?.............. ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ 0
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 E%+(12-12)
i pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Larry R. Dell
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' 96 Independence Drive,Shippensburg,PA 17257 170,000.00
TOTAL(Also enter on Line 1, Recapitulation.) $ 170,000.00
If more space is needed,use additional sheets of paper of the same size.
OMB Approaai No.2502-0265
Q0.. Settlement Statement HUD-1
�*ii1_ )
"•,
• .- .
1.❑FHA 2.❑RHS 3.❑X Conv.Unins. 8.File Number: 7.Loan Number: 6,Mortgage Insurance Case Number:
13-86 000008512
4.❑VA 5.❑Cony.Ins.
C.Note:This foot is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown items marked
"(Ao.c)r were paid outside the dos&1g,May am shusm here for informational purposes and am not included in the farms.
D,Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender:
Jill L.Dell The Estate of Larry R.Dell Ormlown Bank
961ndepandence Drive,Shippensburg,PA 17257 96 Independence Drive,Shippensburg,PA 17257 2695 Philadelphia Avenue,Chambereburg,PA
17201
G.Property Location: H.Settlement Agent: I.Settlement Date:12/04/2013
96 Independence Drive A One Settlement Services,LLC Disbursement Date:1210412013
Shippensburg,PA 17257 19 S.Hanover Street,Ste 105,Carlisle,PA 17013
Southampton Township
717-249-0020
Place of Settlement: TitleExpress
Lett Office of Thanes P Giessen,49 West Orange Strcek,
Grilipperseturg,PA 17257
100. Gloss Amatmt Duefrom Bandwer 400, Crass Amount Omito Seiler
-_. _
101. Contract sates price - 176,000.O3 407. Contract sales price 170,000.06
102. Femoral property 402. Personal property
103. Settlement charges to boamer(line 1400) 3,818.44 403.
104. 404.
105, 405.
Adjustments for Items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes to 406. Cllyhown taxes to
107. County taxes 1210412013 to 1273112013 .28.19 407. Couotytaxes 12104013101213112013 28,19 r
108. Schad taxes 12104/2013 to 06OSS2014 9:76.93 408. School Was 1 210 412 013 to 0613012014 906.93
109. 409,
110. 410,
M. 411.
112, 412.
120. Gross Amount Due from Borrower 174,753.36 420. Gross Amount Due to Seller 170,935.12
200. Amounts Paid by or in Behalf of Borrower 500. Reductions In Amount Due to Seller
201. Depositor earnest money 501. Excess deposit(see Instructions)
202. Principal amount of new bart(s) 93,500,00 502. Betterment charges to seller(she 1400) 5,534.57
203. Existing leas taken subect to 503. Existing loo s taken subject to
204, 504. Payoff of first mortgage loan#0117675595 to Wells 90,481.07
Fred
205. Appraisal Fee Refund 25.00 505. Payoff of second mortgage loan
205. Executrix Equity 35,000.00 506, Exceeds Equity 35,00000
207. 507,
208. 508.
209. 509.
Adjustments for items unpaid by sailer Ad esin a for items un aid h seller
210. Citynown loxes to 510. Cllyltowntaxes to
211. County taxes to 511. County taxes to
211 School tares to 512. School taxes to
213. 513.
214. 514.
215, 515,
216. 516.
217 517.
218. 518,
219. 519.
220. Total Paidb/for Borrower 1 128,525.00 1 520. Total Reduction Amount Due Seller 131,015.64
300- Cash at Sufffle cerrt frori Borrower 600. Cash at Settlement toffrom Salter
301. Gross ama:mi due from b robu r(line 120) 174,753.36 601. Gross amount due to seller(line 420) 170,935.12
302. Less amounts paid byKor bonower(Iine 220) 128,525.00 602. Leas reductions In amount clue sellutr(Ilne 520) 131,015.84
303. CasM1 „%❑ From ❑To Borrower 46,22(1.36 603. Cash 0 To ❑ From Seller 39,919.48
,e;.w,..`,.x,°axamur.+c�.. ..x+oa�immw, ..rm m.wmaram.eua.w.. ,:=a A.wmrcarre,e=°.", ,,,r w.IN°gym.." O.",
Previous editions are obsolete Page i of 4 HUD-1
700. Total Real Estate Broker Fees Paid From Paid From
Uivision of commission line 700 as follows: Borrower's Seller's
701, $0.00 to _ Funds at Funds at
702 $0.00 ro Settlement Settlement
703. Commission paid at se0lement
000. Items Payable in Connection with Loan
601. Our odginntien chazge (Includes Origination Point 0000%or$775.00) $775.00 (from GFE#1)
002. Yew creolf or charge(ptinls)f&7ths sostdk intaesf tale chosen $ (from GFE 42)
803. Your adjusted origination charges (from GFE A) 175.00
804. Appraisal fee to Ausherman Bros.Real Eats $375.00 P.O.C.B'(from GFE#3)
605. Credit repod to CBC lnnovis,Inc. (from GFE#3) 27.70
806. Tax service to (!mm GFE#3
807. Flood cetiitica0on to CBC lunions,Inc. (from GFE 43) 10.00
006. to
" hems Required by Lender to he Paid in Advance
PDaily lrlereit Margosftom from 12RWt2013 to 01/0112014 @$11.21001day (from GFE#10) 31188
902, tiorgi insurance foormurn I months to jIlorn GFE if
903. Homeowner's insurance for 1 yearstoStateFam $53400 P.O.C.B'(from GFE#11)
904, months to from GFE#11
1000.Rese s RMIted with Lender
1001.Initial deposit for your escrow accou:t (from GFE#9) 05166
1002.Homeowners Insurance 3 months @$ 4450/month $133.50
1003. Mundane Insurance months P$ I month
1004.Probably taxes months @$ }month
1005.Counly taxes 11 rnonths @$ 32.40meeontn MEAO
1006.Schoul taxes 7 months $ 135.33/month $947.31
1007,Aggregate Adjustment $465.55
N00.TRk Char s
1101.Mservksas�d tend is title insurance from GFE A, 1,575.00
1102.Settlement or closing fee to $
1103.Owners title insurance from GFE#5
1104.Lenders title Insurance $770.00
1105.Lenders rtto policyimli$93,500BO Lenders PoVy
1106.Owners title policy limn$170,00400 Damer's Policy
1107.Agents portion of the total title insurance premium $478.75
to A One Settlement Services,LLC
1100-Undenttitor's potion of She rotal Wee insurarax premium $29125
to First Amarl Title Insurance Company
11D9.Attomey's pinion of title insurance premlunto Thomas P.Gleason $510.00
1110 Doc Prep Fee to A One Settlements $100,00
1111.Tte Search to ABA Abstract $95.W
1112.Email Fee to A One Settlements $50.00
1113. Notary Fee to Kelly Baker $30.00 20.00
1114. Overnight Mail Fee to A One Settlements $20.00 10.00
1115.Wire Transfer Fee(Payoff} to A On Sol0omentsfOrrstovn$ 20,00
1200.Government Rewriting and Transfer Charges
1201.Government retarding charges $ (from GFE#7) 165.00
1202. Dead$68,00 Mortgage$97.00 Release$
1203.Transfer taxes If (from GFE#8)
1204.Chyrounly,to isesups peed$ Marasco$
1205. Stale Tadstamps Dead$ mortgage$
1206. Deed$ Mona $$
1300.Additional Settlement Charges
1301.Required services that you can shop for (from GFE#5)
1302. 2013 Gounty/fwp.taxes to Vivian F.Coy,Tax Collector $301.07
1303, 2013-14 School taxes to Vivian F.Coy,Tax Collector $1,591.48
1304.Tax cell reimbursement to A One Settlements 7.00
1305.Final Water-AM#30003D1D-0 to Boronhof su - s6sr 70.
1306.Final Hewer-Acct.#02297 to C.F.J.M.A.
1307. Deed Prep F'ee-POO by Seller to Thomas P.Gleason
1308. PA Inheritance tax escrow to One Settlement Services 5,36753
.tt - - r . r 3,81024 5,534.57
'Paid outside of closing by(B)Mrower,(S)etler,(L}ender,(pnvestor,Bro(K)er.-C o.0 by lender shown on page 1.-Credl by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-i
Comparison of Good Fab Eshmate(GFE)and HUM Changes _ Good Faih EaUmata =775.00
Char es That Connor increase HUM Lino Number
�� _ 4 601 775.011 Your credit or charge(pohds)for the specific interest rate caise g 602 0.00 chages k $03 775.00 1,703.00
Charges That In Total Cannot Increase More Then 10% Good Faith Estimate HUD-1
G%nomment MOWN charges k 1201 32100, 165m
apgsaisallee k 804 400m 375.00
Credo report a 807 62.78 27.70
�.vra
Fllaeaudin k eo7 10.00 10.00
k
k
k
k
792.70 577.70
$ -215.00 a -27.1125%
Cha ea That Can Change Good Faith Estimate HUM -
Inlsaldepo5lihN'yartescrawapbunl k 1001 1,491.65 951.66
Dailyinterestchargeshan Is 901$11.[100 190.57 313.66
Hmewrdets insuraae If 903 480.00 --� 534.00
Title seances and O WS hills plasmas It 1101 1,605.00 1,575.00
Ownees fide Insurance k 1103 160 OD 0.00
k
k
Loan Terms
Yalu Initial loan enant is $93,500.00
Your ban tea Is 30.years
Yarimtial udeashmta m 4.3750%
Your initial monthly amount ohad for principal,interest,and any mortgage $466.83 includes
insureaeis %❑principal
[XI Interest
❑Mortgage Insurance
Can yourinmerin mtertae? ONo. ❑Yealicandsetoamarimumo€ %.TheOrst charge
vnOboon t t aM can ciango agcin every yearsaimr t t . Every
mange date,your interest rate urn increase or decrease try %. Over the Igo of
the loan,your interest role Is guarantaod to never be lower than %or higher
than %.
Evan Y you make7,apneatson luw ran your low baancarse? [X]No. ❑Yes it pan ilia tea maxfmumd$
Even if you make payments on ame,can your monthly amount awed for ❑X No. ❑Yes the first increase can be on I I and the monthly
pdndpal,IntemsL and mortgage Insurance rise? amount owed can rise to$
The ma+dmum It can ever rise tots$
Does your ban have a prepayment pereyt E]NO, ❑Yes,your medmen plepayment Penney is
Does your loan have a balloon payment? [K No, ❑Yes,you have a balloon payment of$ due in
years on I I
Total monthly crams coed induding esrrow amount payments C)You do ran have a MM*esrnm paymeu for some.such as Mop"taxes
and horuawmers Inainerce. You must pay these items dbecily yourself.
Q You have an additional monthly escrow payment of$212.23
that results in a total Instal monthly amount awed of$679.06. This Includes principal,Interest,any
mortgage insurance ad any bens dradded baba.
❑X Present taxes Q Homrowner%insurasce
❑Hood insurance ❑
❑ ❑
Note. If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
Previous editions are obsolete Page 3 of 4 HUD-1
HUD CERTIFICATION OF BUYER AND SELLER
I have®refutly revlowed the HUDt Settlement Statement and to the beat of my knoMmits,and belief.It is a true and accurate statement of all receipts and
disbursements made on my acoount or by me In this lmnsadlen I further cerbly that I have received a copy of the HUD-1 Settlement Statement
i Jig Deli
THE/ESTATE OF LARRY R.DELL
Mf Goodall,Exeprtrix. .
,ilL W.Exealf0,
The HUD.1 Settlement Statement which I have prepared is a true and accurate account of this transaction.I have caused or Mill cause the funds to be
disburseeedtIn/Iaccordance,with thiisss statement
SETTLEMENT MEENT-AGENT DATE
WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT,FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010.
Prevfi us editions are obsolete Page 4 of 4 HUD-1
Name of Bom7eer: Name of Seller. to Number
Jill L.Deli The Estate of Larry R.Dell 13-88
TitleExpress
Prepared 12/03/2013 at 12:10 pm
Nct This page is furnished to provide an itemization of certain amounts she. on the Settlement Paid From. 'Paid From
Statement (HllD-1). This page accompanies but is not a part of the settlement statement If a gOffOWeT$ Seller's
discrepancy exists,the information rhovm on the Settlement Statement(HUD-1)applies. Funds at Funds at
Settlement Settlement
8M.' ftems is"lein Cormucli nw61%Less
801. Our origination charge (Includes Origination Point O.000Yo or$775.00) $775.tl0(from GFE 91) _
a.Tax Service Fee li 75.00
b.AopIKakim Fee _ 200.00 _
c. Doc Prep Fee 250.00
d. _
e. Underedling Fee 250.00
802. Youraedlm'charge(picunis)forme_peNttctnteres(rale chosen from GFE#2)
803. Your adjusled origination charges (from GFE A) 775.00
804. Appraisal fee to Ausherman Bros,Real Estate (from GFE 03) 375.00P
805. Credit report to CBC innovis,In (from GFE#3) 27.70
W6, Tax service, to (trmr GFE#3)
807. Flood cerlincalion to CBC innovis,Inc. from GFE#3) 10.00
808. to (from GFE#3
Name of Borrower: Name of Seller
File T'ti Jib L Oelt The Estate of Larry R.Dell
net.: This page is fu-nfy}red to give yov an ,tcnnzatian of the amovnss shown nn Lines lle1, n03 and =Fror�n , fO1104 of the Settlemem Statement (MUD ). Th is page accompanies but is not a part of the ers settlement statement,if a d,screpansy exsts the information shown an the Settlement Statement s at
(HUD i)applies ment�<
11�. TflhGltatges rA`- ; - Armsntr included II M =
1101. Title services and lenders title insurance 1,575.04
a.
b.
c.
1102. Seltlemenlor closing fee
1103. Owner's Otte insurance --
1104. Lenders title insurance (policy) 545.00 $ 774.00
a.Endorsement 900 EPL-Residential 50.00
b.Endorsement 100(No Vialatvm) K.00
c Endorsement 306 Survey 50.00
d.Closing Service Letter 75.00
(TOta111O3+1104) $ noon
1105:Lender' r,
1106. Oimers0 ii policy limit$170,000.00 a1 k"
.1107'Aent's Mom of the total title insurance premium.' � $V478.75
1108. Underivsk'sportion of the totalt0le insurance preen. :L.291.25.c
(Toth 1107+1108)
1109. Adome s portion of ti0e insurance premium $ 510.00
1110. Doc Prep Fee $ 100.011
1111. T&le Search $ 9540
1112 =_mail Fee _ $ 5000
1113, Notary Fee $ 30.00
1114. Ovemi ht Mail Fee $ 20.00
1115. Wlre Tranbie[Fee(PayofQ t -
'.�. N. F}i'- a' ,- - a"• *a TOfal '�° SB:MMr ' iBor bftr sell N
ti W."(i C with Payee .. - x .m ��'. _ Ch .. PpCWsredit L 'LJnettet. Paid
1101. Title services and lender's OOe insurance $
1104. Lenders title insurance to First American Title/A One Settlement Sery 770.00 770.00
1109. Attorney's podion of title insurance premium to Thomas P.Gleason 510.00 510.00 _
1110. Doc Prep Fee loA One Settlements 100.00 100.04
iiti. Title search to A&A Abstract 95.00 95.W
1112. Email Fee to A One Settlements 50 00 50.00
1113. Notary Fee to Keliy Baker $0,00 30.00 20.00
1114. Ovemi m Mail Fee to A On Settlements 30.00 20.06 10.00
s .W 157,5.04 3
THE ESTATE OF LARRY R,DELL
By LL..G �41 sn _ Date X4/13 _ill ell Dale 12/4/13,,,_
J e K.Gaodhart,E' Jill elf
By Date 1214/13
Jii Doll,Executrix
REV-1508 Ex+(08-12)
U pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Larry R. Dell
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. F&M Trust checking account 3,191.11
2. 2003 Dodge Ram 1500 from Kelley Blue Book 7,720.00
3. 2003 Harley Davidson Road King Classic from NADA Price Guide 10,000.00
4_ Defense Finance&Accounting for payment for unused vacation and leave time 6,636.88
5. Miscellaneous personal effects 2,000.00
6. 2013-14 School tax prorations from sale of house 935.12
7. Donegal Insurance for homeowners insurance refund 493.00
B. M&T Bank checking account 2,042.98
TOTAL(Also enter on Line 5, Recapitulation) $ 33,019.09
If more space is needed, use additional sheets of paper of the same size.
REV-1511 Ex+(08-13)
pennsytvania SCHEDULE H
�� DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Larry R. Dell
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Fogelsanger-Bricker Funeral Home 9,953.90
2. Gordon's Memorials for grave marker and headstone. 3,450.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
Z• Attorney Fees: 3,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 3,500.00
Claimant Jill L. Dell
Street Address 96 Independence Drive
city Shippensburg State PA zip 17257
Relationship of Claimant to Decedent Daughter
4. Probate Fees: 373.50
S. Accountant Fees:
6. Tax Return Preparer Fees:
7. Cumberland Law Journal to publish estate 75.00
8. News Chronicle to publish estate 96.50
9. Register of Wills for additional probate 50.00
TOTAL(Also enter on Line 9, Recapitulation) $ 20,498.90
If more space is needed,use additional sheets of paper of the same size.
REV-1512 Ex+(12-12)
i pennsylvania SCHEDULE I
'� DEPARTMEW OF REVENUE DEBTS OF DECEDENT,
INHERrTANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Larry R. Dell
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
I. Wells Fargo Home Mortgage payoff mortgage Loan No.0177675595 for 96 Independence Drive. 90,481.07
2. Wells Fargo Home Mortgage for payment between date of death and selllment on 96 Independence Dr. 3,627.38
3. Chambersburg Hospital final medical bills 1,024.28
4. MB Financial Bank for payoff for Harley Davidson motorcycle 6,153.27
5. F&M Trust Co.for payoff of personal loan 3,734.75
6. 2013-14 School taxes on 96 Independence Drive,Shippensburg,PA 1,591.48
7. Rider Insurance for insurance on motorcycle 187.00
8. Commonwealth of Pennsylvania motorcycle license renewal 18.00
9. Miscellaneous settlement casts associated with sale of 96 Independence Drive real estate 57.00
10. Morehouse Family Dentistry final bill 92.00
11. Borough of Shippensburg for final water bill 70.52
12. C.F.J.M.A.for final sewer bill 39.52
TOTAL(Also enter on Line 10, Recapitulation) $ 107,076.27
If more space is needed,Insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J REVENUE
�i INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Larry R. Dell
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
I. Julie K.Goodhart Daughter 50%
2. Jill L.Dell Daughter 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
11 NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
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,use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
I, LARRY R DELL, presently residing at 96 Independence Drive, Shippensburg,
Cumberland County, Pennsylvania 17257 being of sound mind, memory and disposition, do
hereby make,.publish and declare this my Last Will and Testament, hereby revoking and malting
void all Wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and
funeral expenses as soon as may be convenient after my decease.
SECOND. I give, devise and bequeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate, to my beloved daughters, JULIE K GOODHART and
JILL L. DELL, it being my specific intent and desire to omit my son, MATTHEW R. DELL
and my daughter, KATELYN M. DELL from any distribution whatsoever under this my Last
Will and Testament. In the event that either of my daughters predecease me, the share of any
deceased daughter shall pass to the survivor of the said JULIE K GOODHART and JILL L.
DELL.
THIRD. I nominate, constitute and appoint my daughters, JULIE K GOODHART
and JILL L. DELL, or the survivor thereof to be the Co-Executrices of this my Last Will and
Testament.
FOURTH. I direct that my personal representatives shall not be required to give bond
for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, LARRY R. DELL, have hereunto set my hand and seal to
this my Last Will and Testament, written on one page this day of
7 l 12009.
(SEAL)
WEIGLE 6 ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SMIPPENSBURG. PA 17257-1397
This instrument was by the Testator, on the date hereof, signed, published and declared by him to
be his Last Will and Testament, in our presence, who at his request and in the presence of each
other, we believing him to be of sound and disposing mind and memory, have hereunto subscribed
our names as witnesses. �f.
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
I, LARRY R DELL, the person whose name is signed to the foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed the instrument
as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
LAI Y R. ELL
Sworn or affirmed to and acknowledged before
me by LARRY R DELL,the stator,
this day of 2009.
_ NOTARIALS�y
"Jerry A Weigh,Not Public
:Shippensburg,PA Cumberland County
My Commission Expires October 7,2010
WEIGLE 6 ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND f
We,= kA.vLYtsA `*J - V.2�-# Q S t llI PA
and k,q ri cl 1 f the witnesses whose names are signed to the
foregoing instrument, being duly qualified according to law, do depose and say that we were
present and saw LARRY R DELL,the Testator, sign and execute the instrument as his Last Will;
that he signed willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator, signed the Will as
witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more
years of age and of sound mind and under no constraint or undue influence.
Sworn or a£&rmed to and subscribed before me
by j�W/.t.�',.A1
and rtrtC. A l- rip V
esses, thisay of 12009.
J�.:: ry Pubic
x.t w'= berla
,Cumnd County
t Shippe'° ber7,2010
Cola r^Pi es Octo
r
WEIGIE S ASSOCIATES, P.C. - ATTORNEYS AT !AW - 126 EAST KING STREET - SHIPPENSBVRG, PA 17257.1397