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HomeMy WebLinkAbout09-24-14 1505610140 REV-1500 EX (0241)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 1 3 2 9 Harrisburg,PA 17128-6601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 1 2 1 5 2 0 1 3 0 8 2 0 1 9 4 6 Decedent's Last Name Suffix Decedents Fret Name MI TENEYCK DOROTHY M (N 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 ' 0 1.Original Return 2,Supplemental Return 3.Remainder Return(Date of Death Prior to 12-13.82) 4.Limited Estate 4a.Future Interest Compromise(date of 5.Federal Estate Tax Return Required death after 12-12-82) ® 6.Decedent Died Testate 0 7.Decedent Maintained a Living Trust 0 B.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) El 9.Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death 0 11.Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ry SUSAN H CON FAI R 7177633 , O 1 REGISTE WILLS US60NL First Line of Address p,-_ Fn—0 • _.c �; t t 2 3 3 1 MARKET STREET _Z1 Second Line of Address ma ems_-. '� "3 --5 7 rt} f ,fry yI City or Past Office State ZIP Code OATS Fg-E Cn - CAMP H I L L P A 1 7 0 1 1 correspondent's e-mail address: SCONFAIRaREAGERADLERPC.COM under penanres of perjury,t declare that I have examined this rearm,indudtna acompanying acheduiac and epk3mems.and to the beet of my kruMedge and asset, it is true,mrteN and complete.peels of preparar carer than m al represented"is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON P B F ILIM1IG N /j _�D '� ADDRESS W t 350 YORK STREET MANCHESTER PA 17345 SIGNATURE OF PREPARER 0 R RESENTATIVE - /OAS„- ,� ADDRESS ,1J(/ .�f `_+—�)_'r� 2331 MARKET STREET CAMP HILL PA 17011 PLEASE USE ORIGINAL FORM ONLY Side,1 1505610140 1505610140 1505610240 REV-1500 FX(FI) RECAPITULATION - I. Real Estate(Schedule A) 2 6 9 9 0 0. 0 0 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. 2 7 0 3. 9 1 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested ....... 6. 5 9 8 1 . 2 2 7. Inter-Vivos Transfers&Miscellaneous N120-probate Property E](Schedule G) Separate Billing Requested ....... 7. 8. Total Gross Assets(total Lines 1 through 7) 8. 2 7 8 5 8 5 . 1 3 9. Funeral Expenses and Administrative Costs(Schedule H) ................... 9. 2 3 2 9 5. 5 0 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ... .......... 10. 1 3 3 8 2 8 . 2 4 11. Total Deductions(total Lines 9 and 10) ............. .................. 11. 1 5 7 1 2 3 . 7 4 12. Net Value of Estate(Line 8 minus Line 11) ........ .................... 12. 1 2 1 4 6 1 . 3 9 13. Charitable and Governmental Bequests/See 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 1 2 1 4 6 1 . 3 9 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATE'S 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 _ 0 . 0 0 t5. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.045 1 2 1 4 6 1 . 3 9 16. 5 4 6 5 . 7 6 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 tit. 0. 0 0 19. TAX DUE ...................... ................................ . 19. 5 4 6 5 . 7 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 1505610240 J REV-1500 EX(Fq Page 3 Fite Number Decedent's Complete Address: 21 13 1329 DECEDENTS NA E DOROTHY M.TENEYCK _ STREET ADDRESS 1665 REVERE DRIVE CITY ��— STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 5,465.76 2. CreditstPayni" A.Prior Payments 7,351.47 0.Discount 273.29 Total Credits(A+8) (2) 7,624.76 3. Interest (3) 4. 0 Line 2 is greater than Une 1+Line 3,enter the difference,This is the OVERPAYMENT. Fill In oval on Page Y,Line 20 to request a refund, (4) 2,15900 5. if Une 1+Une 3 is greater than tine 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT h 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. It deem occurred after December 12,1982,did decedent trier property within one year of death rv� without receiving adequate oonsideratton? ...........................................--............... ........................ ❑ 3, Did decedent own an'in trust for'or payable-upon-death bank account or security at his or her death? ......... ❑ fX 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?..........................................—..................................................... ❑ nx 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.11,1995,the tax rate imposed on the net value of transfers to or far the use of the surviving spouse is 0 percent [72 R&§9116(a)(1.1)Cg)].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 benefich". For dates of death on or after July 1,2000: • The tats 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(9}(1.2}]. • The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent,except as noted in[72 P.&§9715(a)(1)). • The tax rate Imposed on the net value of transfers to or for the use of the decedents 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. r • 4 ' @SEt Et tS � ;tr2s'tbt1A J39i�mt1� PYrebnaet3 w };UYVii', i ?AN9TC AO(l' r~ r ;ai�bol:� tans �frt�mvit! x�T (b-A)WSI:1 fefoT t[3 _. __� __r !L13MYA`tA3'✓D( ¢ e/tt dr'1te 'O sAl I.tI ..._ __«_._�..... ...,.,.� .�i 314 XA1'^M9014i i CJmWS ve1F@LY+IC wd1.2°tlt "�Y^�,. .itrj - T 0^ fy f r 'ryr'y-t�•� .ry` 07t-r ♦ e ,rte ,.+A `c'it;rUSr3 37A?R�iORRiA 9:3T tit4"X"'vfA r�it;:A.:�Y�24?Ol;2?U'3 cZ,tt3Y4b.}K'??�tiT 9�Y+?'vt�i 32A,�.14 NO may brS F.'Y•:USY h7F:T.«n�.'.CC�� ' P, ylrrxrq., 1 pC.c n �. u6;Yn6Nn C LW � ....H. •,••.. ......'.• .., nra`.. p.�i�''...Mn„w9G'�"d�:.fitb$'ii{e�t.;e:.:� G £;t�rt;r4:wMW :r 3e3. .O i_tF7Y1!^�'Jrk.0 t"* ( 4-._l it ❑ ., pSrl:”.A'r;?{t02^Kr+'r.Ce:j.'N7:.'tL?0.X>'N'"t+f AC:T"^-tErs'.f,:.n ,'lc'ravU_��•w nrm':ttbYli, t',7 _fi Lt . . ,•• •.• an>ett2n u pxms t'.,cas t^9^13nt9t:¢ObNItvP +6 nan��.ttJ`n'a?: k (X n .. .. ..... . ... .� ... _ .. ......,. «rilG:,c �jl°b4liutY!ctie r.'h',n� •tdAUi3:t IST gQ GRAS ZA 12 Ul OVA 0 3JUG` K-,OT3AMOO VIM UCY,aJ Y 2S Ub'JIT23!!0 3VCttA V1 :O YNA OT F3L'2NA 3NT�fI 2 it is eel V, ie ^c,3V?m;t'C Oul-1v i5!V,arB no Cs*_og t)tvw IM%t,.'',(t(3t r 414t 9101W Ll(Ib,k:C`r ilu6 rs'it w%f't59b to_eteb 17A lot 0.t)(c)atf4i 8C;.1111,bgCig tt:esl�-g Of WV'-W ttmvimJ po b suu tot ao1 to of e*,:SEC^t'33 vt,,6 r to^:8 nb t+&-iigl ,.,ar mf a<tt,titer t ,nrt r3ss•o m1w,tc3 wt Or'CX21ur7"e1 S(wt$G alt bm y:l fW14OtJC)4 uR.1'fller,6 ct v7.FxGt.a t.—'-Otl IG,2+7t:10,44*9 OAT.(',4(1 f)(s)"d!'9K Z.q S7 .Y°Aclft%ml YIAO wi$i 04ijam a qwjw. lm wli ma£n'.'M. J.tW rt!VIC,OU33 X61 C CrO 0912,t'(41MA 10 ro Nseb TC ta"b w7 ;77 Si..° q tm!r'.tt&!o isU 9++ V,M:H rrs:;b 13 M(VIGO'(4O 914c 10 vs9i i bFbbazwAl a mat,e131Z'6U1;5,,*hip t!10 t izogrv-etbl x5)eAT SC tfr+ot O dt us Sa ctit'r.'frr.Gqg to s w tna:>a sw gots yrYp)2r rCg 2.4 s't)�d t+a'.cn Ee fgextj Jmx g 2.A ti r,'Kc�6enx+f�nnit z tn�bs •or�+':,. 0 r?' .,1 c•ct aatzcrG`«t?a au:sr ttm 9�J nop,ergme.atct zst ef,T ^,b9nitO pr.r0;.r1 Z"qti q t C Maq St pi eplo'ta Z,)no6-,4eni t;9ei15•$N+!w M F WIZ^,'r1i 7;304V t'Sr 1'rrC no Lrzo fLs W61 ALI9dt s „ rCK'I?)rrrt ifl t%?6S C>♦'f.M.�`«t7ttN.1.?.1�''9�'C.'19t`!?tf'Wn':11irv9!'i?'t5scl�tttlrYF,SI:u Y.nr:Ott•.t%'t�tJrt}(:i r1r3 CS aE1i�t;fM.ra9Z��9`k ` r , REV-1502 EX•(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT - ESTATE OF: DOROTHY M. TENEYCK FILE NUMBER: 21 13 1329 All real Property owned solely or as a tenant In common must he 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 bal Deco led M bu ar sell,both having Reel properl that is tolntly ewsad va right of aurvivorehip mast he disclopad on$ah$chedub pkn g®of the rsisvrml fasts. ITEM Attach a copy of the setdsment sheaf If the property has been sold. NUMBER Include a copy of the deed show ng decedents interest If awned as tenant in common. VALUE AT DATE DESCRIPTION OF DEATH 1665 REVERE DRIVE MECHANICSBURG, PA 17050(SEE SETTLEMENT SHEET ATTACHED) 269,900.00 TOTAL(Also enter on Une 1,Recapitulation.) $ 269 900.00 If mole sfleee is Readed,use addWonal shaeis of paparof ft came aixa. REV-1508 EX.(08-12) - OF RE pennsyvania DsoueTasRT SCHEDULE E V8Nt1E iNHWANCE TAX RETURN CASH, BANK DEPOSITS & MISC, RESIDEW DECEDENr PERSONAL PROPERTY ESTATE OF: DOROTHY M. TENEYCK BILE IIUMq; Include the protmede of I(tipation and the da the __ 21 13 1329 All PAGPOKY Jointly owned with right-,ouwhrerill m�be dIseloeetl en edu�R. ITEM NUMBER 1• PER$ONALPROPE�Ty DESCRIPTION VALUE ATOATE OF DEATH 1,@00.00 2• TAX/HOMEOWNER'S ASSOCIATION/SEWER/TRASH PRO RATION FROM SALE OF 1665 REVERE DRIVE, MECHANICSBURG, PA 17050 1,203.91 TOTAL(Also enter on Une 5,Recapitulation) E If moto apa0e is Hooded,use add@ional eheote of paper of the same size. 2 703.91 REV-1509 EX«(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMURT DOROTHY M. TENEYCK 21 13 1329 If an assetwas made jointly owned whin one year of the docedem's dale of deafly It must be reported on Schedule 0. SURVIVING JOINT TENANTS)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.CHRISTOPHER T. TENEYCK 350 YORK STREET SON MANCHESTER, PA 17345 a. I, C. JOINTLY4MED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND SANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDEN IFYINGRUMBER ATTACH DEED FORJOINTLY-HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 7112 CITIZENS BANK-CHECKING ACCOUNT 5,254.24 50. 2,627.12 ONE CITIZENS DRIVE RIVERSIDE, RI 02915 2. A. 7/12 CITIZEN BANK-CHECKING 6,706.19 50. 3,354.10 ONE CITIZENS DRIVE RIVERSIDE, RI 02915 TOTAL(Also enter on Une 6,Recapiwlallon) $ 5,98t22 22 If more space is neadod,use additwl sheets of paw of the acme size. ' �A�4t35lS Q3i�tY!�7-Y�,�tUl � ,� •,,, `�F ! � ••�. . ux= gar. w • �--�- =-» -�.r -s�:-.:r-r—,._._.»._._s-sue-.-._,ssmc- ..�arr_-Tr_..=• -:;.�?..—,::.._a:-.�ss.r-;�. .c�.�:. �r_x- ..._.. l:!uf.•rS_2 no hchrjr.ya v '+h F dN".C!t b L'13xJ!'1M.+7+:'v.' ^+Tl iO IrAY 41;?f �Meh CPV XW^t AS ' u,.T�t^Eip'.rt.,?(If __ .�._..._....+_ _ ,._ F.1.9C�Cit_... -..- _.._�.»�211Ct.1N 11)T,+/314`!T r''• ___ }�,0 Qc'� `t Y3:te 1 LA.°i• Aa .ylsTc:JN"klAM i � } ♦ 1 s !x.CAN"Celia►lO-fJDA" !SAQ 0.L A.Si!!a7.4 lY!"S'x{ .9 3'i —Ar/1--Y' Pi :`I'm st •SE,S # r^" PS.Pt"S.t! TrAJO0f3A,'DW >'D3V^ 41>ririY4tOITIO� mr t ��..r 2.,I iXrrto�'Mo .ry...i, G" .QS �,�.,t• $Qi H t c4tl.>'•�=•.i"C�• VNAf# -1St7'..:# 2S_' !St 3 '^. N31ri5T j t ! � i s i • y{{/{}1 {� f f 1 ,,. z 2 t,JCS�a'w•:*"�'.E s;Tit m;x ro'it;t' ,RT.�7 •1.2 C.:Afi4. 4 :.�i•',: -�^4:.-E"� '.C'NSia.ri.�°M'R REV-tali EX+(08.13) Pennsylvania SCHEDULE H WARTMar OF REVSWE FUNERAL EXPENSES AND 1NHEMTANMrAXrtEnft ADMINISTRATIVE COSTS REVIEW DECEDEM ESTATE OF FN E iiUfdRBR i DOROTHY M.TENEYCK 21 13 1329 DenedWs debte most be repotted on Sabedok 1. - ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. NEIL FUNERAL HOME. INC. 4,369.00 2. BAUGHMAN MEMORIAL WORKS, INC. 2,748.00 3. DILLSBURG CEMETERY ASSOCATION 1,250.00 I B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Natne(s)ofpatsanalRaPmntative(s) CHRISTOPHER TENEYCK 9,520.00 SbeatAddm" 350 YORK STREET Ctty MANCHESTER State PA zip 17345 veers)Cemmisslon Pala: 2014 2. Aftm Fes: READER&ADLER, PC 5.000.00 1 parity ExW*n:(If dwWenYS address is W ft SOM as deimants,attach exptanatian.) Claimant Street Address CRY State Zip Relationship at Claimant tD Decadent 4. probate Few. CUMBERLAND COUNTY REGISTER OF WILLS 408.50 5. AcawntamPees: 8. Tax Rmum Preparer Fee: 7. TOTAL(Also enter on Line 9,Recapitulation) S 23 295.50 9 r wm is needed,m add Dow arwa 0i paper of tie ON eiaa. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, VINMANM TAXRTUR+ MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY M.TENEYCK 21 13 1329 ROW delta fecund by the deeedaM prior to death that remahted unpaid at the data of death,Inducting unrelmhumed madlaal en anew ITEM VALUE AT DATE NU48ER OESCRPTION OF DEATH 1. CiTtZENS MORTGAGE PAYMENTS 3,468.27 2. CITIZENS MORTGAGE PAYOFF FROM SALE OF PROPERTY 76,158.31 AT 1665 REVERE DRIVE, MECHANICSBURG, PA 17050 3. SELLER ASSISTANCE FROM SALE OF PROPERTY AT 11,000.00 1665 REVERE DRIVE, MECHANICSBURG, PA 17050 4. COMMISSION/EARNEST MONEY DEPOSIT FROM SALE OF PROPERTY AT 16,4%00 1686 REVERE DRIVE,MECHANICSBURG, PA 17050 5. 1 %TRANSFER TAX FROM SALE OF PROPERTY AT 2,699.00 1665 REVERE DRIVE, MECHANICSBURG, PA 17050 6. ESCROW FEE/NOTARY FEE/TAX CERT/POSTAGE/OVERNIGHT/MTG. RELEASE 1,480.45 TRACKING&SEARCH FEE/RESALE CERT./PAST DUE AND APRIL HOA FEES/ 2014 COUNTY/TOWNSHIP TAXES/S EWER/TRASH FROM SALE OF PROPERTY 7. HAMPDEN TOWNSHP-SEWER 155.05 8. PPL-ELECTRIC 256.89 9. UGI-GAS 312.13 10. BON TON-CREDIT CARD 396.93 11. VERIZON-PHONE 67.91 12. LOFT-CREDIT CARD 1,474.98 13. WELLS FARGO FINANCIAL NATIONAL BANK-CREDIT CARD 3,161.50 14. RBS CITIZENS, N.A.-CREDIT CARD 3,612.04 15. HOLY SPIRIT HOSPITAL#42890608-MEDICAL BILL 42.50 TOTAL(Also enter on Une 10,Recaphuldon) $ 133 828.24 If more spew is Raadad,inaen additional aheets of the same else. � 1 :�.1t�Ci3��� ' b.Fta'Jl��ft'.d�tit3tj rIf1�VJJ3tt T'� .)'I'�l�f .fr ',Z*' 's+»tllil:k4'iG �. ..........:.l YCiw:e.+Y....i�Lyy:��- )�"• _.� :.S-'i^—.n.:C2�TJt.:�^-._. ._.._..:T."-� ......� .^_.—"S'w_:^"_-.:a. :.:35-4">-]Cry3'i♦tiiy�L�� g7A:;lw4,ftkb >`.t:3.V}LbH4•wU Wnlvo1!A&R1wvitb'Th '.:c48^k 4101'tt ao t'.1::"".0 - "�.ddP t' j+ 4THlMYA 37AL)rp q t°IA2%"aI!? lip :T c`73';OF', IU BJA '1K)gl Y'VYAq EK 3 r l'IM PV%-17:i t3' _ CdO%t A'l jPU820-a AHO'Itil l' -,C Eri::`I/3;- �odr TAI �9.CC l iAYTA i9t):W! :V1:U'+r AG I T'i , ;2f%.:',,3131.13 ' F. { J?�'�t A� ,�..-vFiC;�:ivS.•1HJ3�d 73VIPG :334'3V79'�Jui . y'r %+ 7A Y7N34C}Si4a(}'J:A2 ir.C)9i Tr:'.1U3 Y :a."j.} T2Jl.-9,A 7:1Jr" k AAt7;� A t *U'71 &O t i C ! { TA YTSi2q;}y:"1?.o IA,'',', }itJtc i hAT 59 1a211A8'r UJ't Aq A)AL!F?vI:,AF VAM 3Vi33G iR f;Ft'2AAt1 �x tr.> I 3RA313fl =>?;v1 -j HOlVAaV(113 Aiv4%T,R?:1 (A'aa'1*f5TN Oe '-ll V10,712-il C f 12334 t)H JTFIqA 014A 3UQ 1 E:f,Rt.TAF^ 3J.^Z3 A 1314? "C'R B? I t-i 4 JA;'I' YTASgf)P? iG 31A2 MOP., HaART1513',' 3?ra3AA i qttk:f,'.Xv tVf 1-1lt f;3 htttSj t7 t'c> i fl 1Rry$.` H'?'Wr'u' , WIr-,RQh� t �' ± f i €t.SlE l i F,t?971 (I.SA)ilQ3f41-VJT 008 0(; r iL 4.Gr19 Ualtq?V PI' 8R ACA } 01AaTiQ4'.a-7'1=:"1f St r j- - 0? t31 ; t ` ^3?r 7,(1=11' IN�7 FP.ih i'/� 1hr JZ1 •trii t7F3`+,i i 8, 317tr £C f S'O€ I t"•,A7T,+l:I?.i • /x.11 .53�i7t:: GUSI MC F 1 1 t U2SA J3=''3JAIIQ3Rr u1L^coaAY„ .rr�+t.nH 'ft4ilcY.irI. dP' -:-:nsmA) MAIM r _ . .. ._....... ..... . ..w _......�.��2 i.mtfid Ja!K sR': ;ltt1:.:..41:�i-W'M 7:IrA9f•1.M.:>J�174 N It . .—.,....— _.�—.�.,_.. _.._..._. ».�.� Continuation of REV-1500 Inheritance Tax Return Resident Decedent DOROTHY M.TENEYCK Oecedenrs Name Page 1 21 13 1329 File Number Fw- Schedule I-Debts of Decedent, Mortgage Liabilities,&Liens ITEM NUMBER 16. HOLY SPIRIT HOSPITAL #46462067_MEDICAL BILL AMOUNT 9327 17• HOLY SPIRIT HOSPITAL#46702577-MEDICAL BILL 50.00 18. PINNACLE HEALTH MEDICAL GROUP n028246-MEDICAL BILL 15.00 19. HOLY SPIRIT HOSPITAL#46690244-MEDICAL BILL 295.80 20. DISCOVER CARD ENDING#4391 -CREDIT CARD BILL 3,680.47 21. EAST PENNSBORO AMBULANCE SERVICES 855.80 22. CAPITAL ONE, N.A. RE: KOHL'S DEPARTMENT STORES, INC. -CREDIT CARP 869.60 23. PENNSYLVANIA AMERICAN WATER 23.75 24• IRS-2011 INCOME TAX 2,840.59 25. IRS-2013 INCOME TAX 4,699.00 SUBTOTAL SCHEDULE 13,423.28 GRAND TOTAL SCHEDULE ; 133,828.24 REV-1513 E%+(01-10) pennsyivania SGHEDUL.E ,J DEPAATkfF T0FREVE19Ne BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECUM SSTATE OF: 6iLE NUM", DOROTHY M. TENEYCK 21 13 1 29 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY 00 Not List TTUstas(s) OF ESTATE ! TAXABLEDISTRIBUTI4NS (IRdudes hlspoussiQatRSulidas baft*mundsr Sae.�1f@{a}(t.2).) 1. CHRISTOPHER TENEYCK Lineal 83,721.30 350 YORK STREET MANCHESTER, PA 17345 2. MEGAN SACCHETTI Lineal 57,740,09 2820 NC 18 SOUTH MORGANTON, NC 28855 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-15M COVER SHEET,AS APPROPRIATE. iL NON i S if}Nffi; A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1, B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART n-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. s 1(more space is noem,use additional ahem of paper of the aamo she. t' r LPPIEstatePlannin2JCiient(reneyck/will.Dorothy f January 5,2009 - LAST WILL AND TESTAMENT OF DOROTHY M. TENEYCK 1, DOROTHY M. TENEYCK of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last I Will and Testament, hereby revoking any and all prior Wills and Codicils thereto by me at anytime heretofore made. 1. FAMILY. L I Identification of Family, I declare that I am married to THOMAS TENEYCK and that there are two(2)children of this marriage whose names are: CHRISTOPHER TENEYCK and MEGAN SACCRETTI. L2 Definition of Family Terms. As used in this Will, the term "my spouse" shall mean only THOMAS TENEYCK. As used in this Will,the terms "my child" or"my children"refers to all my natural children and adopted children. As used in this Will,the term "issue"refers to all lineal descendants of the indicated person of all generations, with the relationship of parent and child at each generation determined by the definition of"child/children"set forth in this paragraph. 2. PAYMENT OF BURIAL EXPENSES AND DEBTS. I authorize my executor to pay all the expenses of(1) a funeral or memorial service; (2)the internment of my remains,including the costs of a gravesite, if necessary; and (3) the 'installation and inscription of a suitable marker at, and perpetual care of,the gravesite. I further direct my executor to pay all of my debts that my executor in his or her sole discretion may allow as claims against my estate. 3. DISPOSITION OF TANGIBLE PERSONAL PROPERTY. 3.1 Disposition to Spouse. I give all of my tangible personal property of every kind and description, including,but not limited to,books,pictures,clothing,articles of household or personal use or adornment,household furnishings and effects,and automotive vehicles and their accessories, but excluding any money, evidences of indebtedness, documents of title, and securities and property used in connection with the operation of any trade or business,to my spouse. 12 Alternative Disposition. If my spouse does not survive me by more than sixty(60)days after the date of my death,and any of my children survive me,I direct my executor to divide my tangible personal property into two parts. The first part shall contain all items that my executor determines, to be of no present or future v lue or kise to my children. The second 1 Dorothy M. Teneyc LPP/EsiatePlanning/Clienaeneyck/W i It.Dorothy January 5,2009 - sale, abandonment, destruction, or gift to any charity or person. The proceeds of any sale shall be added to my residuary estate. All property in the second part I give to my children who survive me,in substantially equal shares,to be divided among them as they shall agree. If no agreement is reached within (60) days after my death, all property in the second part shall be divided among all my children in such manner as my executor shall direct. The decision of my executor shall be conclusive and binding on all persons interested in my estate. Any item of personalty passing to a minor under this Section 3.2 may be delivered to the minor or to any person to hold for the minor, as my Executor thinks advisable, and the receipt by any such persons, including the minor, shall constitute a full and complete discharge to my Executor. 4. DISPOSITION OF RESIDUARY ESTATE. 4,1 Disposition to Spouse. All of the rest,residue and remainder of the property that I own at the time of my death, both real and personal, and of every kind and description, wherever situated, to which I may be legally or equitably entitled at the time of my death (my "residuary estate"), I give outright and absolutely to my spouse, if he survives me. 42 In the event my spouse is not living on the sixtieth(60)day after the date of my death,I leave all the rest, residue and remainder of the property that I own at the time of my death, both real and personal, and of every kind and description, wherever situate, to which I may be legally or equitably entitled at the time of my death(my"residuary estate")in equal shares to my children, PROVIDED THAT, if any of my children shall predecease me leaving issue who survive me, then I leave the share of that deceased child to his or her issue,per stirpes. 5. POWERS OF ADMINISTRATION. 5.1. Grant of Powers. My executor, in the administration of my estate,(my "fiduciaries")shall have the powers and authorities set forth in this Article 5. These powers and authorities may be exercised by my executor and trustee in their sole and absolute discretion, without the permission or order of any court. These powers shall be supplementary to those conferred by law, including,but not limited to,those set forth in Title 20,Chapter 33,of the Pennsylvania Consolidated Statutes. 5.2. Retention of Assets. My fiduciaries shall have the power to retain any or all property of my estate, however received and acquired, for so long as they deem appropriate. This power may be exercised even though the property may not be of the type authorized by law for investment,and even though the retention may leave a disproportionately large amount of the value of my estate invested in one type of property. 53. Transfer of Assets: My fiduciaries shall have the power to sell, transfer, and convey any property,of whatever nature,including real property,and wherever situated,that I may own 2 Dorothy M, eneyck LPPfatatePlanni ng/Client/reneycW W ill.Dorothy January 5,2404 at the time of my death, or that may come into my estate or after my death. The sale, transfer, or conveyance may be by public or private sale, at such time, on such terms and conditions, including selling price and credit, in such manner, and for any reason that my fiduciaries deem appropriate, including, but not limited to, the purpose of obtaining net proceeds to be distributed to my residuary beneficiaries. 54. Investment. My fiduciaries shall have the power to invest and reinvest any property in my estate in preferred and common stocks, bonds, notes, common trust funds (including any managed by any corporate fiduciary), interests in investments, trusts, mutual funds, leases, mortgages on property wherever located,and,generally,in any property and in proportions of property as my fiduciaries deem advisable, even though the investments are not of the character or proportions authorized by applicable law for the investment of the funds. 55. Power to Borrow. My fiduciaries shall have the power to borrow money for any purpose, for any periods of time, and on any terms and conditions as they deem advisable(including the power to borrow from any corporate fiduciary), and to pledge, mortgage, or otherwise encumber any property in my estate to secure repayment of any loan,as well as the power to renew existing loans either as maker or endorser. 5.6. Power to Hold Property in Nominee Form. My fiduciaries shall have the power to hold any property in the name of a nominee or in bearer form. 53. Distribution in Cash or in Kind. My fiduciaries shall have the power to make distributions in cash or in kind,.or partly in cash, in divided or undivided interests, as amended,or other applicable law,and to determine which assets shall be sold and which shall be distributed in kind, without notice to or consent by any beneficiary, 5.8. Distribution to Minors and Persons Under Disability. My fiduciaries shall have the power to make distributions or payments to or for the benefit of any beneficiary who is a minor, an incompetent, or who in the fiduciaries' judgment is incapacitated. The distributions or payments shall be made in any one or more of the following ways: (1) directly to the beneficiary;(2)directly to the creditor in payment of the debts or expenses of the beneficiary; (3) to the guardian of the person or estate of the beneficiary; (4) to any custodial parent of a minor beneficiary; (5)to a custodian for the beneficiary under any law related to gifts to minors, including to my fiduciaries in that capacity; or (6) to any other person who shall have the care and custody of the person of the beneficiary. There shall be no duty to see to the application of funds so paid, provided due care was exercised in the selection of the person to whom the funds were paid, and the receipt of the person shall be full acquittance of the fiduciaries. 5.4. Continuation or Liquidation of Business. My fiduciaries shall have the power to continue or to permit the continuation of any business,incorporated or unincorporated,in which I may have any interest at the time of my death for any period of time,or to liquidate the business on any terms as they deem appropriate. This powe includes, but is not li i ed to (1) the 3 Dorothy M. eneyck UP/EstatePlanninp/Clienvreneyck/W ill,Dorothy January 5.2009 power to invest additional sums in any business, even to the extent that my estate may be invested largely or entirely in the business, without liability for any loss resulting from lack of diversification; (2) the power to act as or to select other persons to act as directors, officers,or employees of any business,to be compensated without regard to being a fiduciary wider this Will; and(3)the power to make any other arrangements in regard to any business as my fiduciaries shall deem proper. 5.10. Employment of Agents. My fiduciaries shall have the power to employ and pay the 4 compensation of any and all'attorneys, agents, custodians, attorneys-in-fact, experts, investment counsel,accountants,bookkeepers,or other agents or providers of services as my fiduciaries deem advisable in the administration of my estate. 5.I1. Commissions. My fiduciaries shall have the power to take reasonable commissions on account at any time during the administration of my estate without the approval of any beneficiary or of the court,but subject to allowance or disallowance on the settlement of the final accounts of my fiduciaries, 5.12. Third Party Reliance. No person or corporation dealing with my executor shall be required to see to the application of any property paid or delivered to my executor,or to inquire into either the authority of my executor to enter into any transaction or the expediency or propriety of any transaction entered into by my executor. 5,13 Charitable Donations. In the event that any of my tangible personal property is donated to a charitable organization(s)then my fiduciary is instructed to use the value of said donation(s) as an inheritance tax deduction.for any inheritance tax return which may be required to be filed as a consequence of my death. 6. PAYMENT OF DEATH TAXES. 6.1 Payment of Estate Taxes. I direct that all federal and Pennsylvania estate taxes payable as a result of taxes assessed on property passing under this Will shall be paid from my residuary estate as a part of the expenses of the administration of the estate. 62 Inheritance Tax. I direct that the Pennsylvania inheritance taxes payable as a result of my death, limited to taxes assessed on property passing under this Will,shall be paid out of my residuary estate and shall not be deducted or collected from any beneficiary under this Will or other transferee. 7. EXECUTOR. 7.1 Appointment. I name, constitute, and appoint my spouse, THOMAS TENEYCK, as executor of my estate. If my spouse shall not survive me,shall not serve as executor for any reason, or shall cease to serve as executor for any reason after appointment, CHRISTOPHER TENEYCK shall act as executor in his place. r 4 Dorothy M.Z�eneyck LPPI EStatePlanning)Clienllreneyck/W ill.Dorothy January 5,2W9 7.2 Bond Not Required. None of the individuals named in Section 7.1 shall be required to furnish a bond for the faithful performance of his or her duties as executor. S. PRESUMPTION IN CASE OF SIMULTANEOUS DEATH. For the purposes of this Will,in determining whether a person has survived me or another person,(1) my spouse shall be deemed to have predeceased me unless it unmistakably appears by proof that he survived me; and(2)in all other cases,a person shall not be deemed to have survived me or another person if he or she dies within sixty(60)days of my death or of the death of the other person. 9. LIABILITY OF EXECUTOR. My executor shall not at any time be liable for mistake of law or of fact, or both law and fact, or errors of judgment, nor for any loss coining to any beneficiary under this Will, or to any other persons,except through actual fraud or willful misconduct on the part of the executor. My executor may, from time to time, consult with counsel with respect to the meaning, construction, and operation of this Will,particularly with respect to the appointments,allocations,and disbursements, and may act on the advice of counsel in all matters without incurring liability on account of his or her actions. Ib. INTERPRETATION. 10.1 Will Not Contractual. My spouse and I are executing Wills at approximately the same time, in which each of us is the primary beneficiary of the Will of the other. These Wills are not being executed pursuant to airy contract to make a Will or any contract not to revoke a Will. The Will of each of us is revocable at any time,whether before or after the death of the .other spouse, at the sole discretion of the spouse making the Will. 10.2 Successors of Fiduciaries. All pronouns referring to an executor and the term "executor" shall be construed to mean any person`acting as my executor, co-executor, persona representative, or administrator, as the case may be. 103 Number and Gender. If required by the context of this Will, singular language shall be construed as plural,plural language shall be construed as singular,and the gender of personal pronouns shall be construed as either masculine, feminine, or neuter. 10.4 Headings. All headings used in this Will to describe the contents of each article,paragraph, or other division are provided for convenience only and shall not be construed to be a part of this Will. 10.5 Governing Law. This Will shall be construed in conformity with the law of the Commonwealth of Pennsylvania. r $ Dorothy M. Jeneyck ! LPPt EstatePlanning/ClienVreneycktWill.norothy January 5,2009 - IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament,consisting of six(6)typewritten pages,the first five(5)of which bear my signature in the margin for the purpose of identification, this day of-- 2009. J DOROTMV M.TENEY K,TESTATRIX Signed,sealed,published and declared by the above-named Testatrix,DOROTHY M.TENEYCK, as and for her Last Will and Testament, in the sight and presence of us,who,at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. Witness Address Li za cl /✓�/ --t4l WJtness Address Ix N\1_11 6 LPP/EsmtePlanning/Clientrreneyck/W ill.Dorothy January 5,2007 COMMONWEALTH OF PENNSYLVANIA ) SS, COUNTY OF ) I, DOROTHY M.TENEYCK,THE TESTATRIX,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 AND TESTAMENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIRME] TO AND ACKNOWLEDGED BEFORE ME BY 1n± t`�1. 'Le _ IC THE TESTATRIX THIS -:5- DAY OF 4 � 2009. COMMONWEALTH 6FF @NNbYI,VANIA Notarial$a Seal DO T M.TENS CK,TESTATRIX Deborah L Brenneman,Notary Public Camp Hill eoro,Cumberland County MY Commission ExpEres Juna 18,2010 Member PennsM•»niz 4ssocla8on of Natarlas -- OTARY PUBLIC, COMMONWEALTH OF PENNSYLVANIA ). SS. COUNTY OF CUMBERLAND ) WE, �° 1-4 ` f AND THE WITNESSES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRUMENT, BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SAW THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TESTAMENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED;THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTATRIX SIGNED THE WILL AS WITNESSES;AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN (I8) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. K_ SWORN R AFFIRMED TO AND SUBSCRIBED TO BEFORE ME, THIS DAY OF 2009. 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