HomeMy WebLinkAbout12-11-14 J 1505610101
REV-1500 EX�o�.�o, �
PA Department of Revenue pennsytvania
OFFICIA�USE ONLY
Bureau of Individual Taxes "`A`"`"° ""° County Code Year File Number
POBoxzso6oi INHERITANCE TAX RETURN
Harrisburg,PA i'7i28-0601 RESIDENT DECEDENT 21 14 1062
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
184-36-6731 10/31/2014 01/27/1926
Name Suffix DecedenPs First Name M�
' MOYER ANN F
(If Applicable)Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name M�
Spouse's Sociai Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
' REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return p 2. Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
O 4. Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 8, Totai Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9.Litigation Proceeds Received O 10.Spousai Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95j (Attach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
THOMAS E. FLOWER (717) 243-5513
REGISTER OF WILLS USfiSi1NLY
t:.�
C7 � � M '
First line of address ;
C � � � �
FLOWER LAW, LLC c.� :7 � � �
r�� --- c-� M„� ,�
��� ;> r_ r--� tn r�
Second line of address r� � i�t f,_,. � � f
10 W. HIGH STREET = � �' ; 3 ��, � `
State ZIP Code 4A'T�F� � _�7 � �
r,:. ,•-3 c�7 p � �
City or Post Office �� `� ;
, CARLISLE PA 17013 � =i w r" M
_�i t_
� c.� �n a
�.- � !
CorrespondenYs e-maii address: TOM@FLOWER-LAW.COM :
Under penalties of per' ,I declar that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, �
it is true,co ct nd mplet ecl ati pf preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT E P E FOR FILING E RN DATE
ADDRESS r �
ALEXANDER P. SP UE, 1590 BOILING SPRGS RD, BOILING SPRINGS, PA 17007
SIGN PREPA N REPRESENTATIVE E
ADDRESS �Z � (
FLOWER LAW, LLC; 10 W. HIGH STREET; CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L„� 15056101�1, 150561�],01 J
J 1505610105
REV-1500 EX
DecedenYs Social Security Number
�ecedenYs Name: ' ',
RECAPITULATION
1. Real Estate(Schedule A). . . .. . . . . .. . . . . .. . . . .... . . .. . .. . . . . . . .. . . . .. . 1. 0.00 '
2. Stocks and Bonds(Schedule B) 2. 683,973.08
.. . ... . .. .. . .. .. . . . . . .. . .. .. .. . .. . .. . . .
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. . . . 3. 0.00
4. Mortgages and Notes Receivabie(Schedule D) . . . .. . . .. . .. . . . .. . . . . . . . . . . 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personai Property(Schedule E).. . .. . . 5. 20,903.55
6. Jointly Owned Property{Schedule F) O Separate Biliing Requested .. . . . . . 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. ... . .. 7. 138,015.00 '
8. Total Gross Assets(total Lines 1 through 7).... .. ... .. ... .. .. ... .. .. ... . 8. ' 842,891.63 '
9. Funeral Expenses and Administrative Costs(Schedule H)... .. . .. . .... ... . . . 9. ' 32,916.34
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) ... . . . .. . .... . 10. 3,312.52
11. Total Deductions(totaf Lines 9 and 10). .. . .. ...... .. . .. . .. .. .... . .. . . .. 11. 36,228.86
12. Net Value of Estate(Line 8 minus Line 11} .. . .. . ... .. ... . .. . .. .. . ..... . . 12. 806,662.77
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 Subject to Tax(Line 12 minus Line 13) .. .. .. . .. .. . .. . .. ... . . . . 14. 806,662.77
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxabie
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X A_ 15.
16. Amount of Line 14 taxable
at lineai rate x A_ 806,662.77 �g. 36,299.82 '
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxabie
at coilateral rate X.15 �g. ,
19. TAX DUE ........ .. ... .. .... . .. .. . .. . ... . .. .. . .. ....... .. ... .. ... . 19. 36,299.82 '
20. FILL IN 7HE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
� 15056101�5 15�561,0105 J
REV-1500 EX Page 3 File Number 21-14-1062
Decedent's Complete Address:
DECEDENT'S NAME
ANN F. MOYER
_STREETADORESS __
1590 BOILING SPRINGS ROAD
CITY_ _ _. __ __ __ STATE ' ZIP
BOILING SPRINGS PA 17007
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 36,299.82
2. Credits(Payments
A.Prior Payments 34,484.83
--
---
B.Discount 1,814.94
Total Credits(A+B) �Zj 36,299.77
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 2Q 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:.......................................................................................... ❑ x0
b. retain the right to designate who shali use the property transferred or its income:............................................ ❑ 0
c. retain a reversionary interest;or.......................................................................................................................... ❑ �
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. Ditl decedent own an"in trust for"or payable-upon-tleath bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ....................... ......,,. ❑ �
......................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART QF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate impnsed 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, antl the statutory requirements for tlisclosure 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 tleceasetl 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 decedenYs lineai beneficiaries is 4.5 percent, except as noted in
72 P.S.§9116(12}(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 sibiing 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-i5o3 EX+(7-ii)
;. � ;' pennsylvania SCHEDULE B
� DEPAflTMENT OF REVENUE
INHERITANCETAXRETURN STOCKS & B4NDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANN F. MOYER 21-14-1062
All praperty jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' 400 shares AT&T INC NEW("T")@ 34.715 13,886.00
2 150 shares AMERICAN EXPRESS CO("AXP")@ 89.985 13,497.75
g 200 shares COCA COLA CO("KO")@ 41.645 8,329.00
q 120 shares EXXON MOBIL CORP("XOM")@ 95.6 11,472.00
5 890 shares GENERAL ELECTRIC CO("GE")@ 25.8 22,962.00
g 100 shares INT'L BUSINESS MACHINES("IBM")@ 164.605 16,460.50
7 450 shares MERCK&CO INC NEW("MRK")@ 57.895 26,052.75
g 450 shares MICROSOFT CORP("MSFT")@ 46.225 20,801.25
g 170 shares NEXTERA ENERGY INC("NEE")@ 99.96 16,993.20
10 800 shares PFIZER INC("PFE")@ 30.005 24,004.00
11 200 shares PRAXAIR INC("PX")@ 124.645 24,929.00
12 268 shares PROCTER&GAMBLE("PG")@ 87.035 23,325.38
13 200 shares QUALCOMM INC("QCOM")@ 78.11 15,622.00
14 500 shares VERIZON("VZ")@ 50.285 25,142.50
15 400 shares ISHARES S&P EURO 350 ETF("IEV")@ 43.93 17,572.00
16 150 shares ISHARES S&P 500 VALUE EFT("IVE")@ 91.475 13,721.25
17 575 shares ISHARES TR BOND ETF("CSJ")@ 105.43 60,622.25
�g 500 shares ISHARES TR COHEN&STEER ETF("ICF")@ 93.265 46,632.50
�g 300 shares ISHARES TR FUSSELL 1000 ETF("IWB")@ 112.325 33,697.50
20 ,1,070 shares IBOXX$HIGH YIELD CORP BOND ETF("HYG")@ 92.655 99,140.85
21 $50,000 US TREASURY NOTE @ 0.375%DUE 06/30115 50,093.75
22 $50,000 US TREASURY NOTE @ 1.375%DUE 06130118 50,218.75
23 $50,000 US TREASURY NOTE @ 1.25%DUE 02129120 48,796.90
TOTAL(Alsa enter on Line 2, Recapitulation) $ 683,973.08
If more space is needed,insert additional sheets of the same size
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REV-i5o8 EX+(11-10)
� ; pennsylvania SCNEDULE E
�����DEPARTMENTOFREVENUE CASH� BANK DEPOSITS & MISC.
INHERRANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANN F. MOYER 21-14-1062
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properky jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�, F&M TRUST CO3 CHECKING ACCT#3322793 18,905.52
2. RETURN OF UNUSED LTC INS PREMIUM,METLIFE 1,998.03
TOTAL(Aiso enter on Line 5, Recapitulation) $ �Q�qQ 3,��
If more space is needed, use additionai sheets of paper of the same size.
20 Souch Main Street
Tp� �17- Po Box 6010
1 1"l�,J�71 Chambersburg,PA 7?201
Last statement: October 04,2014 Page 1 of 2
This statement: November 04,2014 0003322793
Total days in statement period: 31 (5)
}t*��•��••*""AUTO'"3-DIGIT 170 Direct inquiries to:
2454 0.9900 AB 0.406 10 1 29 717 241-4131
lu�i�ll�lir���i9�',�I�'�Il�����rvll�ll��l��hi���i��d(Ilufl F&M Trust
ANN F MOYER 3 East First Street
1590 BOILING SPRINGS RD Boiling Springs PA 17007
BOILING SPRGS PA 17007-9690
Go Club Checking With Interest
Account number 0003322793 Beginning balance $18,237.01
Enclosures 5 Total additions 6,500.81
Low balance $18,035.32 Total subtractions 831.49
Average balance $19,118.62 Ending balance $23,906.33
Avg collected balance �19,118
Interest paid year to date $8.57
CHECKS
Number Date Amo�int Number Dxte Amo�nt
---------------------------- --....._.._...
1127 10-10 98.87 1131 10-24 3.69
1129` 10-24 65.00 1133' 10-21 450.00
1130 10-24 3.69 •skip in check sequence
DEBITS
Date Description Subtractions
10-14 ' Electronified Check 102.82
WELLSFARGO CARD CHECKPAYMT 141014
1128
10-20 ' Preauthorized Wd 107.42
CARDMEMBER SERV ELECT PYMT 14'1020
CREDITS
Date Description Additions
10-15 ' Preauthorized Credit 1,500.00
SCHWAB BROKERAGE MONEYLINK 141015
11-03 ' Preauthorized Credit 5,000.00
SCHWAB BROKERAGE MONEYLINK 1411�3
11-04 ' Interest Credit 0.81
1
�
I
20 South Main Screet
� �Y�` PO Box 6010
1 RVa7 1 Chambersburg,PA 17201
ANN F MOYER Page 2 of 2
November 04,2014 0003322793
DAILY BALANCES
Date Amount Date Amount Date Amount
10-04 18,237.01 10-15 19,535.32 10-24 18,905.52
— ---__-------- -----------
10-10 18,138.14 10-20 19,427.90 11-03 _ 23,905.52
10-14 18,035.32 10-21 18,977.90 11-04 23,906.33
INTEREST INFORMATION
Annual percentage yield earned 0.05%
Interest-bearing days 31
Average balance for APY $19,118.62
Interest earned $0.81
OVERDRAFT/RETURN ITEM FEES
Total for Total
this period year-to-date
Totai Overdraft Fees $0.00 $0.00
Total Returned Item Fees $Q.G� $0.�0
Thank you for banking with F&M Trust
Member FDIC
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THIS IS YOUR RECEIPT.DEPOSITS MAY NOT BE AVAILABLE FOR IMMEDIATE WITHDRAWAL.BANK SYMBOL,TRANSACTION NUMBER AND AMOUNT OF
DEPOSIT ARE SHOWN ABOVE.WIl@fl fTlfl{(Illg d CIePOSIt,always obtain an official receipt.Checks and other items are received for
deposit subject to the provisions of the Uniform Commercial Code or any applicable collection agreement.
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RE�--1.51.0 EX r (08-09j
��������;' pennsylvania SCHEDULE G
� DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OP PILE NUMBER
ANN F. MOYER 21-14-1062
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 °!o OF DECD'S EXCLUSION TAXABLE
ITEM INCLUDE THE NAME OF THE fRANSfEREE,iF+EIR REIAIlONSHiP TO DKEDENT 4ND
NUMBER THE DATE OF TfiANSfER. A17ACH A COPY OF THE DEED FOR RFAL E.STP7E. VALUE OF ASSET INTEREST (?f APFtICABLEj VALUE
1• Patricia Sprague,daughter,cash gifts November&December 2013 5,100.00 100 3,000.00 2,100.00
2 Patricia Sprague,daughter,cash gifts January-October 2014 43,115.00 100 3,000.00 40,115.00
3 Clark Sprague,son,cash gifts November&December 2013 12,000.00 100 3,000.00 9,000.00
4 Clark Sprague,son,cash gifts January-October 2014 57,500.00 100 3,000.00 54,500.00
5 Oren Sprague,son,cash gifts January-October 2014 10,000.00 100 3,000.00 7,000.00
6 Alex Sprague,son,cash gifts January-October 2014 10,000.00 100 3,000.00 7,000.00
� Ann Sprague,daughter-in-law,cash gifts January-October 2014 10,000.00 100 3,000.00 7,000.00
$ Anna Sprague,granddaughter,cash gifts November&December 2013 100.00 100 3,000.00 0.00
9 Peter Sprague,grandson,cash gifts November&December 2013 100.00 100 3,000.00 0.00
10 Gretchen Sprague,granddaughter,cash gifts November&December 2013 100.00 100 3,000.00 0.00
11 Brenna Sprague,granddaughter,cash gifts November&December 2013 200.00 100 3,000.00 0.00
12 Peter Sprague,grandson,cash gifts January-October 2014 5,100.00 100 3,000.00 2,100.00
13 Gretchen Sprague,granddaughter,cash gifts January-October 2014 5,100.00 100 3,000.00 2,100.00
14 Anna Sprague,granddaughter,cash gifts January-October 2014 10,100.00 100 3,000.00 7,100.00
TOTAL(Also enter on Line 7, Recapitulation) $ 138,015.00
If more space is needed,use additional sheets of paper of the same size.
��v-is��Ex+(�n-a�;
������ ;: pennsylvania SCHEDULE H
DEPARTMENT OF REV[NUE FUNERAL EXPENSES AND
INHERTTANCE TAX RETURN ADM IN ISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANN F. MOYER 21-14-1062
Decedent's debts must be reparted on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' EWING BROTHERS FUNERAL HOME,INC.,PROFESSIONAL SERVICES 1,850.00
2. TRANSPORT VEHICLE USE 445.00
3. CREMATION URN 275.00
a. OBITUARY, DEATH CERTIFICATES&CREMATORIUM FEE 714.45
B. ADMINISTRATIVE COSTS:
1. Personai Representative Commissions:
Name(s)of Personal Representative(s) _ __ _
Street Address __ __ _
City . State _ ZIP _
Year(s)Commission Paid: _ _
25,072.29
2. Attorney Fees:
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation.) 3,500.00
Ciaimant ALEXANDER P. SPRAGUE
Street Address 1590 BOILIING SPRINGS ROAD _
__.
City BOILING SPRINGS State PA ZIp 17007
Relationship of Claimant to Decedent SON _
4. Probate Fees:
710.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7� PUBLICATION OF ESTATE NOTICES 302.45
8. POSTAL CONNECTIONS,POSTAGE 13.50
s. CHECK PRINTING FEE 33.15
TOTAL(Also enter on Line 9, Recapitulation} $ 32,916.34
If more space is needed,use additional sheets of paper of the same size.
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle, PA 17013
(717)243-2421
November 5, 2014
Alexander P Sprague
1590 Boiling Springs Road
Boiling Springs,PA 17007 /
Ann F. Mo er /
The Funeral Service for Y
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,FACILITIES,AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
Professional Services
Basic Services of PA L.F.D. 1,200.00
Basic Use of Facility 265.00
Documentation Prep/Recording 385.00
-----------------1,850.00---
Total Professional Services
Fyuipment
Transfer Deceased to Funeral Home 295.00
Utility Vehicle 150.00
--------------------�d��0---
Total Equipment
Merchandise
Green Cloisonne Urn 275.00
� Total Merchandise Selected
--------------------2'1��0---
�- AT THE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO
� OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE C�-IARGES.
Cash Advances
The Sentinel Obituary 214.45
Death Certificates 120.00
Crematorium Fee 380.00
Total Cash Advances
--------------------ri�d�---
SALES TAX 0.00
SUB-TOTAL 3,284.45
INITIAL PAYMENT/DISCOUNT/CREDITS 0.00
TOTAL AMOLJNT DUE 3,284.45
The unpaid balance over 30 days is subjected t�1 %service charge per month- ]2%per annum.
D �� oy, ��,
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RECEIPT FOR PAYMENT
-------------------
-------------------
LISA M. GRAYSON, ESQ. Receipt Date : 11/07/2014
Cumberland County - Register Of Wills Receipt Time : 13 : 10 : 36
One Courthouse Square Receipt No. : 1079649
Carlisle, PA 17613
MOYER ANN F
Estate File No. : 2014-01062
Paid By Remarks : ALEXANDER P SPRAGUE
DBl
------------------------ Receipt Distribution - ------------ -------- ---
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 560 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENER.AL FUN
CODICIL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D
SHORT CERTIFICATE 50 . 00 CUMBERLAND COUNTY GENERAL FUN
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 1415 $710 . 50
Total Received. . . . . . . . . $710 . 50
REv-151z Ex+{lz-o8}
�� SCHEDULE I
� pennsylvania
. DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCETAXRE7URN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANN F. MOYER 21-14-1062
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,includin9 unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• QUANTUM IMAGING&THERAPUTIC ASSOCIATES 30.96
2. 'BLUE MTN.ANESTHESIA ASSOCIATES 435.41
3. QUEST DIAGNOSTIC 2_59
4. MT.HOLLY PHARMACY 19.21
5. CARLISLE REGIONAL MEDICAL CENTER 1,400.00
6. HOSPITALISTS OF CENTRAL PA 183.86
7. CARLISLE MEDICAL PATHOLOGY,PC $.22
8. CARLISLE HMA PHYSICIAN MGT 247.61
9. ANN SHAH,MD 100.28
10. STARK&STARK,P.C.,LIFETIME LEGAL SERVICES:ESTATE PLANNING 412.40
11. CARDMEMBER SERVICES,CREDIT CARD BALANCE 251.34
12. WELLS FARGO,CREDIT CARD BALANCE 220.64
TOTAL(Also enter on Line 10, Recapitulation) $ 3,312.52
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
� � : pennsylvania SCHEDULE J
___ DEPAATMENTOFREVENUE gENEFICIARIES
INHERITANCE TAX REfURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANN F. MOYER 21-14-1062
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. Patricia Sprague,207 Vance Ct Henderson,NV 89074 DAUGHTER ��9
2. Daniel Sprague, 112 Junction Rd,Hampton,NJ 08827 GRANDSON ��9
3. Jacqueline Sprague, 112 Junction Rd, Hampton,NJ 08827 GRANDDAUGHTER ��9
4. Christa Sprague 21800 Townctr.Plza,Ste 266a,Box 220,Sterling,VA GRANDDAUGHTER 1/9
5. David Sprague,3909 Meridian Ave N,Tulalip,WA 98271 GRANDSON ��9
6. Brenna Sprague,1590 Boiling Springs Rd, Boiling Springs,PA 17007 GRANDDAUGHTER 1/9
7 Peter Sprague, 1590 Boiling Springs Rd,Boiling Springs,PA 17007 GRANDSON ��9
8 Anna Claire Sprague, 1590 Boiling Springs Rd,Boiling Springs,PA 17007 GRANDDAUGHTER ��9
9 Gretchen Sprague, 1590 Boiling Springs Rd,Boiling Springs,PA 17007 GRANDDAUGHTER 1!9
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:
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.
� ��� ��� ���� ���
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_. - � -
' ANN F. MOYER
- �
'r= `' �ANN F.NIOYER, of Cumberland County,Pennsylvania,publish and declare this to be my
;�;a'st Wtltand Te"stainent. I revoke all of my prior Wilis and Codicils.
` -- -- �
ARTICLE ONE
TAXES AND EXPENSES
All Estate and Inheritance Taxes on all Assets includabie in my gross estate for the purposes of
those ta�ces shall be paid as an expense of administering my estate. There shall be no contribution or
reimbursement from, proration to, or apportionment against, any Beneficiary or any other Person
owning or receiving any Asset which is subject to Estate or Inheritance Ta�ces but which does not pass
under this Will. All of my funeral expenses,last illness expenses,unsatisfied charitable pledges,debts,
and estate administration expenses shall similarly be paid.
ARTICLE TWO
BEOUESTS
Section A. Personal Effects.
The term "My Personal Effects" includes all clothing, jewelry, motor vehicles, household
furniture and furnishings,household appliances,silverware,glassware,china,pets,books,pictures and
other works of art, stamp and coin collections, family memorabilia, and all other similar Assets of
personal or household use or omament, which I own at my death. That term also includes all of my
interest in casualty insurance policies insuring any of those Assets against loss or liability. I intend to
leave a memorandum(which is not a part of this Will)listing some of the items herein.described which
I wish certain persons to have and direct that my wishes as set forth in the memorandum be observed.
I leave the balance of My Personal Effects to my son,ALEXA.NDER P.SPRAGLJE.
Section B. General Provisions.
The reasonable costs of protecting,appraising,packing,storing,shipping,cleaning,delivering,
and insuring all Assets disposed of in this Article Two,inciuding costs incurred before the issuance of
letters testamentary,shall be paid as an expense of administering my estate. The Executor is authorized
to make a binding and conclusive resolution of any reasonable doubt or uncertainty as to whether the
term"My Personal Effects" includes any particular Asset or Assets.
ARTICLE THREE
RESIT�UARY ESTATE
Section A. Definition.
The term"My Residuary Estate" i�icludes all the residue of my Assets of every kind,wherever
located, which I own at my death. It includes all future interests and all Assets which I have not
othenvise effectively disposed of in this Will,either because an in!ended Beneficiary failed to survive,
or for any other reason.
Section B. Dis�osition.
I leave My Residuary Estate in equal shares to my daughter,PATRICIA SPRAGUE; and my
grandchildren, DANIEL SPRAGUE, JACQLTELINE SPRAGLTE, CHRISTA SPRAGLTE, DAVID
SPRAGUE,BRENNA SPRAGUE,PETER SPRAGLTE,ANNA CLAIRE SPRAGtTE and GRETCHEN
SPRAGLJE. If any individual does not survive me,I leave his or her share to such individual's Issue,
per stirpes. If any individual does not survive me,but has no Issue surviving him or her,such share
shall lapse.
ARTICLE FOUR
VESTING OF INTERESTS
Section A. Simultaneous Death.
If any Beneficiary dies simultaneously with me or under circumstances where there is no
sufficient evidence of the order of our deaths otherwise than simultaneously,I shall be presumed to have
survived that Beneficiary for all purposes material to this Will.
Section B. Disclaimers.
At any time before receiving any Asset under this Will, each Beneficiary is authorized to
disclaim ail or any part of that Beneficiary's interest under this Will. From time to time after receiving
any Asset under this Will,each Beneficiary is authorized to release all or any part of that Beneficiary's
remaining interest under this W ill. In addition to any other method of disclaimer or release recognized
by law,a Beneficiary may disclaim or release any interest under this Will by delivering to the Executor
an Acknowledged Instrument to that effect. The executors or administrators of a deceased Beneficiary
are authorized to similarly disclaim or release any interest of that deceased Beneficiary, without
authorization or approval by any court. After any disclaimer or release,the interest under this Will
which has been disclaimed or released shall be administered and distributed as if that Beneficiary did
not survive me.
ARTICLE FIVE
PERSONS UNDER TWENTY-ONE
Section A. Discretions.
The Executor is granted absolute discretion to distribute any Asset left to a Beneficiary who has
not attained the age of twenty-one (21) to the Beneficiary; to the Beneficiary's natural, general, or
testamentary guardian;or to a custodian for the Beneficiary under the Uniform Gifts to Minors Act of
either the State in which the Beneficiary or custodian resides, or any other State of competent
jurisdiction. The Executor is authorized to permit any Beneficiary who has not attained the age of
twenty-one(21)to have the possession of any of My Persona!Effects left to that Beneficiary,without
bond or sureTy. Additionally,the Executor is granted absolute discretion to retain any Asset left to a
Beneficiary who has not attained the age of twenty-one(21),until the Beneficiary attains that age or
dies,whichever occurs first. While holding any retained Asset,the Executor is authorized to exercise
all Rights and Discretions over it which are granted elsewhere in this Will. The Executor is granted
further absolute discretion, at any time or times, to distribute any part or all of the net income and
principal of any retained Asset to the Beneficiary, which is advisable in the Executor's absolute
discretion for the Beneficiary's best interests and general welfare, ignoring all income and other
resources available to the Beneficiary. The Rights and Discretions granted in this Section A shall be
exercisable even though a Beneficiary who has not attained the age of twenty-one(21)may be legally
regarded as an adult.
Section B. Distribution.
When the Beneficiary attains the age of twenty-one(21),the Executor shall distribute all retained
Assets, as then constituted, to the Beneficiary. If the Beneficiary dies before attaining the age of
-2-
twenty-one(21),the Executor shall distribute ail retained Assets,as then constituted,to the Beneficiary's
executors or administrators. The receipt of the Beneficiary,of any such guardian or custodian,or of the
Beneficiary's executors or administrators, or evidence of any such distribution, shall completely
discharge the Executor from all further accountability and liability for that distribution.
ARTICLE SIX
FIDUCIARIES
Section A. Anpointment of Executor.
1. ^Initial Appointment. ALEXANDER P. SPRAGLTE shall be the Executor of this Will.
2. Successor Executors. IfALEXANDER P.SPRAGLTE fails to qualify or ceases to act as
an Executor for any reason,the following shall serve,in the order named,as successor Executor to fill
the vacancy occurring in the office of Executor:
First,PATRICIA A. SPRAGUE;then
Second,CLARK M. SPRAGLTE.
I request that my Executor consult with ALVIN BLITZ as an advisor to the Executor in administering
my Estate.
Section B. Resienations.
Each Executor and successor Executor is authorized to resign from that office at any time,
without any reason, by an Acknowledged Instrument to that effect filed in a court of competent
jurisdiction.' '
Section C. Powers of Successor Executors.
Each successor Executor shail have all Rights and Discretions which are granted to the Executor �
who preceded that successor,except those which are specifically denied irrthis Will.
Section D. Waiver of Bond.
No Executor or successor Executor shail be required to give any bond or security in any court
or jurisdiction for acting as such.
ARTICLE SEVEN
EXECUTOR'S POWERS AND PROVISIONS
I grant unto my Executors(including any substitute or successor personal representative)the
following powers, in addition to (except as hereinbelow modified) those powers from time to time
granted by the laws of Pennsylvania to Executors of Pennsylvania residents during the course of
administration of my estate, the same to be exercised in such manner as the exercise of reasonable
discretion may deem advisable, and to be applicable to all property, real and personal, at any time
forming part of my estate:
1. To retain,temporarily or permanently,any or all properiy owned by me at the time of my
death in the form in which it then exists; acquire by purchase, exchange or otherwise, and retain,
temporarily or permanently, any kind of realty and personalty, including stocks and unsecured
obligations,undivided interests,interests in investment trusts,mutual funds,common trust funds,leases,
and property which is outside of my domicile,all without being under any duty to diversify the property
and without being limited to investments authorized by law for such funds(including the discretion to
retain as an investment any obligation or obligations owing to me by any corporation in which I have
a stock interest at the time of my death);and hold funds uninvested,or deposit any monies of my estate
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(or of any trust hereby created)in one or more savings or other banks(including the fiduciary)in any
form of account whether or not interest-bearing;
2. To vote through its officers, employees or agents, in person or by general, limited or
discretionary proxy, or give its consent for any purpose, in respect of any stocks or other securities
constituting assets of my estate; exercise or sell any rights of subscription or other rights in respect
thereof;
3. Unless inconsistent with other provisions of this instrument,to hold two or more funds
in one or more consolidated funds, in which the separate fund or funds shall have undivided interests;
4. To sell, exchange or otherwise dispose of realty and personalty publicly or privately,
wholly or partly on credit or for any consideration, including stocks, bonds or other corporate
obligations,grant options for the purchase,exchange or other disposition of any such property;
5. To pay general legacies,establish trusts,and divide or distribute principal,in kind or in
money,or partly in each,or by way of undivided interests;
6. To delegate discretionary powers to agents,remunerate them, and pay their expenses;
employ and pay the compensation of accountants, custodians, legal and investment counsel without
diminution of any Executor's commissions;
7. To renew,assign,alter, extend,compromise,release,with or without consideration,or
submit to arbitration,obligations or claims,including taxes,held by or asserted against it or which affect
estate assets,
8. To hold property in its own name or in the name of nominees;
9. To borrow money from itself or others and pledge or mortgage any property, for the
payment of taxes,debts, legacies or expenses or any other purpose which in its opinion will facilitate
the administration of my estate;
10. To exercise any election or option that may be available to it under the Internal Revenue
Code;but if Federal Estate Taxes are increased because my Executor in the exercise of such an option
claim administration or other expenses or losses as deductions on income tax returns,the corpus of My
Residuary Estate shall not be reimbursed out of the income thereof because of such increase;and in no
case shall any adjustment be made in the interests of the beneficiaries under this Will because of my
Executor's exercise of any election or option available under the Code;
1 l. To manage,retain,insure,improve,alter,subdivide,dedicate to public use or lease real
property or grant easements with respect thereto for periods to begin presently or in the future without
regard to statutory restrictions on leasing and even though any such period may extend beyond the term
of any Trust;
12. To consent to and participate in any plan for the liquidation,reorganization,consolidation
or merger of any corporation any security of which is held in my estate;
13. To abandon,in any way,property which it determines not to be worth protecting;
14. To deposit funds in the savings department of any bank without limit as to duration or
amount;
15. To sell or exercise any"rights"issued on any securities held in my estate;and
16. Unless inconsistent with other provisions of this instrument, all dividends payable in
stock,all dividends in liquidation and all"rights"issued on securities shall be allocated to principal,and
a11 other dividends received (except those declared and payable as to a "record date" preceding my
death,which shall be treated as principal)shall be allocated to income.
ARTICLE EIGHT
CONSTRUCTION PROVISIONS
Section A. Executor.
The term "Executor" includes any personal representative, successor Executor, preliminary
Executor, and any administrator with the Will annexed. It also includes the terms "Executors" and
"Executrix"whenever the facts and context require.
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�_. _ _ __ _._ __
Section B. Children.
The terms"Child"and"Children"mean descendants in the first degree of the designated parent,
who are living at the date of execution of this Will, and those who are born thereafter. Those terms
include Persons who are tegally adopted by the designated parent only before that adopted Person attains
the age of majority. Those terms do not include a stepchild, a foster child, or a grandchild or more
remote legitimate descendant. At the time of the execution of this Will,I have four(4)living Children:
CLARK M. SPRAGUE, OREN D. SPRAGLTE, ALEXANDER P. SPRAGUE and PATRICIA A.
SPRAGUE.
Section C. Issue.
The tercn"Issue"includes Children and more remote descendants ofthe designated ancestor,who
are living at the date of execution of this Wili,and those who are born thereafter. That term includes
Persons who are legally adopted by the designated ancestor or by any descendant of the designated
ancestor only before that adopted Person attains the age of majority. That term also includes all
Children and Issue,whether natural or legally adopted before attaining that age,of any adopted Person,
to the same extent as if each Person legally adopted before attaining that age had been the adoptive
parent's natural Child.
�_
IN WITNESS Wf3EREOF,I have signed my name to this Will on this 1� day of
�=..�r., � ,2014.
� �.
i '1r 5,: � �_:>� - -
ANN F.MOYER ��-; __-� ..
This instrument, consisting of six (6) pages, was on the above date, signed, published. and
declared by the Testator to be her Will, in the presence of each of us, and at the same time we,at her
request,in her presence,and in the presence of each other signed our names as attesting witnesses.
� '��'- residing at ����` r =i;.' ���'.
i i �
-�`��-�� � [-(-. }-t�i!� I-,, r
residing at � "�-�7 S �� _
-5-
COMMONWEALTH OF PEi�1NSYLVANIA )
,-, : SS.
COLJNTY OF ! ..{.:%; i:��� a �
I,ANN F.MOYER,the Testator,sign my name to this instrument this �"� �— day of
�-`�''� � ,2014,and being duly sworn,do hereby declare to the undersigned
authority that I sign and execute this instrument as my Last Will and that I sign it willingly(or willingly
direct another to sign for me),that I execute it as my free and voluntary act for the purposes therein
expressed,and that I am eighteen years of age or older,of sound mind,and under no constraint or undue
influence.
.i _`; '
�'J%%'` - `C';�.s..c.,-
ANN F.MOYER - =_-�_-,---`-
�
We, �; �� _ ���,',���. and tcv; ,� c`�, ;rtr���, - ,the
Witnesses, sign our names to this instrument, and, being duly sworn, do hereby declare to the
undersigned authority that the Testator signs and esecutes this instrument as his or her Last Will and
that he or she signs it willingly(or willingly directs another to sign for him or her,as the case may be),
and that each of us,in the presence and hearing of the Testator,hereby signs this Will as witness to the
T'estator's signing,and that to the best of our knowledge,the Testator is eighteen years of age or older,
of sound mind,and under no constraint or undue influence.
1, ;�^ :�-::�,�i.�`^�
Witness
1
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�'�•�
Witrless
The Commonwealth of Pennsylvania
County of�',• '- ' .y_
l.;.�,c;C.;_;�:.�,,
Subscribed,sworn to and acknowledged before me by ANN F.MOYER,the Testator and subscribed
�. _
and sworn to before me by �� �r•,.;, %�• � .�•:'?r� and % �* � �� i i� . •�,-f,-n�,-
Witnesses,this 1 ��`' day of ;"���r; I ,2014.
r
i
COMMONWEAL7H CF PENNSYLVANIA `G� , / ' �
Notadal5eal ';7G'�,'�.G[lii�. /,�'�,., i���i..;�.'�,,'/
Barbara M.Minrier,NoWry Pubiic �
South MlQdte[on Twp.,Cumberland Counry NO.%tARY PUBLIC
hfy Commission 6cpires March 22,2015 .
MEM6ER,PENNSYIVANiA ASSOQATION OF NOTAR[ES
-6-
..- ._
F'IRST CODICIL TO
a � �
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I,ANN F.MOYER,a resident of Cumberland County,Pennsylvania,declare this to be a First Codicil
to the Last Will and Testzunent executed by me on April 10,2014 in the presence of Jean L.Smith and Kevin
M. Stoner,as Witnesses.
1. I revise Section A of Article Six of my I,ast Will and Testament in its entirety to read as
follows:
"ARTICLE SI�
FIDUCIARIES
Section A. Apnointment of Executor.
i. Initial Ap�ointment. ALEXANDER P.SYR�1Gi1E shall be the Executorofthis
Will.
2. Successor Executors. IfALEXANDER Y.SPRt1GUE fails to qualify or ceases
to act as an Executor for any reason,the following shall sei�-e,in the order narned,as successor
Executor to fill the vacancy occurring in the office of Executor:
First,CLARK M. SPRAGUE;then
Seccnd, F&M TRUST COMPANY of Chambersburg,
Pennsylvania."
2. In all other respects, I ratify and confirm all of the provisions of my said Last Wil] and
Testament dated Aprii 1 U,2014.
IN WITNESS WHF.REOF,I subscribe my name to this First Codicil to my Last Will and Testamr..�l*,,this
I ��`� day of__�t�r,G _,20l 4.
i�' ��
. �.
��� i C�� �:.t.�
ANN F.MOYER ----� --- _ "
/
This instrument,consistin�of two(2)typewritten pages was signed,and published and declared by ANN
F. MOYER,the Testator,to be the First Co3icil to her I,ast Will and Testament,in our presence,and we at
her request and in her presence and in;he p:es�nce of each other have hereunto subscribed our names as
attesting witnesses.
— residing at���°�-5�.�t ��
residing at ��i I�n 9� 5�ri P�}
i � n4 .
COMMONWEALTH OF PENNSYLVANIA:
: SS.
COiJNTYOF Li,�,,���t:-(c�r,�
I,ANN F.MOYER,the Testator,sign my name to this instrument this I``�' day of �� =t%'� E-
2014, and being duly sworn, do hereby declare to the undersigned authority that I sign and execute this
instrument as the First Codicil to my Last Will and Testament and that I had signed willingly and that I
executed it as my free and voluntary act for the purposes therein expressed,and that I am eighteen year�of
age or oider,of sound mind,and under no constraint or undue influence.
��r�-t/ ';� '' �i''J ce:�.-�:c:
ANN F. MOYER —�---�-�'
/
We (�f� ��� i1� �__4i,;�Er and
, K��=��-� i'��il;.S�}�
the Witnesses,respectively,whose names are signed to the attached instrument,being first duly sworn,do
hereby declare to the undersigned authority that the Testator signed and executed the instrument as the
Testator's First Codicil to the Testator's Last Will and Testament and that the Testator had signed willingly
and that the Testator executed it as the Testator's free and voluntary act for the purposes iherein expressed;
and that each Witness states that he or she signed the Codicil as Witnesses in the presence and hearing of the
Testator,and that to the best of his or her knowledge the Testator was at the time eighteen(18)years of age
or older,of sound mind,and under no constraint or undue influence.
/
Wit ess
.//VInQ i�r�v-�
Witness
Commonwealth of Pennsylvania
County of ��x�n��k;-��t���
Subscribed,sworn to and acknowledged before me by ANN F.MOYER,the Testator and subscribed and
swomtobeforemeby �tv�i� j11 S-}-ci�t.r and �r'rs�n �`c�{�iyc�:^
>
Witnesses,this ���'' day of ��1 i,�„� ,2014.
/�
'� {'�k .
COMMONWEALTH OF PENNSYLYANIA —�—I C�'-rC�i�a•.� fl�• 1+�-i'9-;i Ck-�;
Notartal Seat NOTARY PUBLIC
Barbara M.Minnier,Notary PuWk
South Middle[on Twp.,Cuml�erland County
My Commisslon Expires March 22,2015
MEMBER,PENNMVANU ASSOQA71Crv OF MOTARIES
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