HomeMy WebLinkAbout01-23-15 r
pennsylvania 1505614105
oev�mrivroF�veue EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT I114-1
� I 149 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
u -� 1 01072014 10061932
�Decedent's Last Name Suffix Decedent's First Name_ MI
Wesser � Kenneth [D]
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name _ MI
I__r _
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C§D 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of C 5.Future Interest Compromise(date of C 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
CM 7. Decedent Died Testate p 8.Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
(Edward G Roman, Jr _ 1(217)82..1-9978
I
First Line of Address
701 Walnut Bottom Road
Second Line of Address
City or Post Office State ZIP,'ode
Carlisle__ T I 17013
PA
Correspondent's email address: revyroman@gmail.comrrI
r,
C' Q.
REGIS*EW WILLS!!�f ON6V Gj
REGISTER OF WILLS USE ONLY { C7
DATEFILFIL MMDDYYYY .M
r CD -,I
c --� _T1
-DATE:FILEO STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505614105
1505614205
REV-1500 EX(FI)
Decedent's Social Security_Number
Decedent's Name: Kenneth D. Wesser [
1
RECAPITULATION
1. Real Estate(Schedule A). ................. ........................... 1.
2. Stocks and Bonds(Schedule B) ................... .................... 2. 272,377.20
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. 280,520.24
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7)....................... ...... 8. 552,897.44
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 28,868.94
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 3,726.81
11. Total Deductions(total Lines 9 and 10)................................. 11. 32,595.75
12. Net Value of Estate(Line 8 minus Line 11) .......................I...... 12. 520,301.69
13. Charitable and Governmental Bequests/Sec.9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13. 520,301.69
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 0.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 --- ----- -- ---- ---
(a)(1.2)X.0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0_ 16.
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable j
at collateral rate X.15 18.
19. TAX DUE ......................................... ............... . 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Under penalties of perjury,I declare 1 have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete. D 'oa-ofpreparer other than the person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNAWU SON RESPONSIBLE FOR FILING RET DATE
01/23/2015
ADDRESS 3
SI NATURE OF PREPARE OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
ADDRESS
Side 2 J
1505614205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Kenneth D. Wesser
STREET ADDRESS
1 Longsdorf Way
Unit#8
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to:REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred............:............................................................................. ❑ ■
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 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?................................................................................................................. ❑ E
3. Did decedent own an"in trust for"or payable-uponAeath 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 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 step-parent 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.
PremiumMoney Market Statement '� • PNCBANK
PNC Bank 40
Primary account number:50-0569 8922
Ir Pa e 1 of 3
For dto period 01/11/2014 to 02/11/2014 Ad Number of enclosures:0 /
000433 15 D
KENNETH D WESSER DECD For 24-hour banking,and transaction or
interest rate information,sign on to
CUMBERLAND CROSSING RETIREMENT PNC Bank Online Banking at pnc.com.
1 LONGSDORF WAY UNIT 8 'a For customer service call 1-888-PNC-BANK
CARLISLE PA 17015-6900 Monday-Friday:7AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espafiol,1-866-HOLA-PNC
MovW97 Please contact us at 1-886-PNC-BANK
®Write to:Customer Service
PO Box 609
Pittsburgh PA 15230-9738
Visit us at PNC.com
Barbara Miller,Relationship Manager ® TDD terminal:1-800-531-1648
Private Client Group Forhearin
1-717-240-0059 barbara.miller@pnc.com gidairedclients only
PremiMiiltlt Money Market Account Summary Kenneth D Wesser Decd
Account number: 50-0569-8922
Overdraft Coverage-Your account is currentlyOpted-Out.
You or your joint owner may revoke your opt-in or opt-out choice at any time.
To learn more about PNC Overdraft Solutions visit us online at pnc.com/overdraftsolutions.
Call 1-877-588-3805,visit any branch,or Sign on to PNC Online Banking,and select the"Overdraft
Solutions"link underthe Account Services section to manage both your Overdraft Coverage and Overdraft
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
24,723.94 .00 24,723.94 .00
Average monthly Charges
balance and fees
12,361.97 .00
Transaction Summary
Checks paid/ Check Card POS Check Card/Bankcard
withdrawals signed transactions POS PIN transactions
1 0 0
Total ATM PNC Bank 'Other Bank
transactions ATM transactions ATM transactions
0 0 0
interest Summary As of 02/11,a total of$126 in interest was
Annual Percentage Number of days Average collected Interest Paid paid this year.
Yield Earned(APYE) in Interest period balance for APYE this period
0.007 18 21,976.83 .00
Activity Detail
Other Deductions There were 2 Other Deductions totaling
on $24.723.94.
01/27 24,723.94 Withdrawal Re erence No. 05381 8
Performance Checking Statement f &VFor
b z
tt
0` 4 Far the period 02/11/2014
For 24-hour information,sign on to PNC Bank Online Banking � H D WESSER DECD
on pnc.com. 40111 G& Primary account number:50-0580 8458
Account number:50-0580-8458-continued I-P � Page 2 of 3
Dverdraft and Returned Item Fee Summary
Total for this Period total Year to Date
notal Overdraft Fees 36.00 36.00
Aictivity Detail
Deposits and Other Additions There were 4 Deposits and Other Additions
)ate Amount Description totaling$6,$48.07.
)1/13 1,411.78 Deposit Reference No. 050610539
)1/29 1,109.64 Deposit Reference No. 051336710
)1/31 3,327.33 Direct Deposit-Annuitant
PA Treasury Dept XXXXXXXXXXX5919
)2/11 .32 Interest Payment
Mocks and Substitute Checks
:heck Date Reference Check Date Reference
arrnber Amount paid number number Amount paid number
1267 244.26 01/16 085477265 3269 1,073.64 01/27 083328403
1268 513.50 01/16 085314834
'Gap in check sequence There were 3 checks listed totaling
$1,831 As.
Inline and Electronic Banking Deductions There was 1 Online or Electronic Banking
)ate Amount Description Deduction totaling$630.00.
11/21 530.90 Direct Payment-Premiums Cms Medicare 0000
tther Deductions) There were 2 Other Deductions totaling
rate Amount $70,016A0.
11/27 69 979.40 Withdrawa�Rcference Na�05381�572O
11/28 36.00 Overdraft e
taUy Balance Detail
late Balance Date Balance we Balance
11/11 69,856.28 01/21 69,979.40 01/29 .00
11/13 71,268.06 01/27 1,073.64 - 01/31 3,327.33
11/16 70,510.30 01/28 1,109.64- 02/11 3,327.65
t•�
60-1503 DATE {(/+�/�
8659
P.O. BOX 234 SHIPPENSSU80, PA 17257 13 '�+ 0
PAY DEF?OF Kenneth D blesser state
hkneten Thmmrd HiWWd 76/100 DOLLAI
it VOID AFTER 6 MONTHS",AS Fil E R'8 ( 14-,E
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Remitter _
r n°090R65ito 14*0313150361: 1e03 0046 0 IP
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AC Aadj of EVC0jkne
Stonehedge
Member F.D.I.C.
1/28/2014 10:10:00 AM
Effective Date-01/28/2014
0103 *4000 *0055
CD/!RA Withdrawal
$19,094.76 Y
Cash Amount: $0.00
Cash Back: $0.00
ALL ITEMS ARE SUBJECT 70
VERIFICATION& COLLECTION
www orrstown.com
Thank you!
Orrstow n Sank
ORRSTOWNBANK
A Tradition of Excellence
ORRS P.O.Box 250
Shippensburg,PA 17257
Temp-Return Service Requested Date 3/31/14 Page 1
Primary Account 706002970
Enclosures
�III�III�IIII�I'IIS'��I'I�Ill�lil����ilr�l�l��l��l�l�lll�llllll�'
000312 0.4500 AV 0.381 TR00001
Kenneth D Wesser
1 Longsdorf Way Unit 8
Carlisle PA 17015-7623
SA VINGS ACCOUNTS
Account Title Kenneth D Wesser
Prime Statement Savings 0
Account Number 706002970 Statement Dates 1/01/14 thru 3/31/14
Previous Balance 69,558.06 Days In The Statement Period 90
Deposits/Credits .00 Average Ledger .00
1 Checks/Debits 69,570.92 Average Collected .00
Service Charge .00 Interest Earned 12.86
Interest Paid 12.86 Annual Percentage Yield Earned 0.25%
Ending Balance .00 2014 Interest Paid 12.86
Detail Transactions By Date
Date Description Amount Balance
c 1/28 Credit to Cloed Account 12.86 69,570.92
'^ 1/28 Close Account 69,570. 92- .00
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0
12/31 0.250000%
0
0
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THANK YOU FOR BANKING WITH ORRSTOWN BANK
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ORRSTOWNBANK
A Tradition of Excellence
ORRS P.O.Box 250
Shippensburg,PA 17257
Temp-Return Service Requested Date 2/05/14 Page 1
Primary Account 400920
Enclosures
000062 0.4500 AV 0.381 TR00001
Kenneth D Wesser
1 Longsdorf Way Unit 8
Carlisle PA 17015-7623
CHECKING ACCO UNTS
Account Title Kenneth D Wesser
50+ Interest Checking Check Safekeeping
Account Number 400920 Statement Dates 1/06/14 thru 2/05/14
Previous Balance 225.28 Days In The Statement Period 31
Deposits/Credits .00 Average Ledger 159.87
1 Checks/Debits 225.28 Average Collected 159.87
Service Fee .00
Interest Paid .00
Current Balance .00
Electronic Debits and Withdrawals
Date Description Amount
c 1/28 Close Account 225.28-
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c Date Balance Date Balance
Cq C>
1/06 225.28 1/28 .00
C>
CD THANK YOU FOR BANKING WITH ORRSTOWN BANK
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Close Deposit Account- 202978668 Personal CD - Bank 400 Page 1 gf 1
'S-�
9:55:04 AM CDT
Wesser Kenneth D
202978668 Personal CD
Enter Activity Detail Hae Panel
Close account: Yes
Reason for Closing Account
Requested by:* Customer-pending
Reason: Death of customer
Description:
Deposit ID: 1
Disbursement Manual check
type:'
Balances
Pay accrued Yes
interest:
Available $ 0.00
principal:
Unavailable $ 27,683.27
principal:
Accrued interest: $ 230.00
Available interest: $ 1,196.04
Total $ 29;4031
Penalty: $ 0.00
Disbursement $ U.00` Transaction code:
fee:
F Waive fee
Net proceeds:
:}V
Current Calculated Amounts
Penalty: $ 235.31 /
0
rVI S 7'
IRA Election of PaymentBeneficiary F&M Trust
for Traditional, Roth, and S1MPL!y11RAs PO Box 6010
Chambersburg, PA 17201-6010
RA OWNER INFORMATION (717)264-6116
NVAX ADDRESS.CrrY,STATE AND ZEP TYPE OF DIA(SEZECr ONE):
Kenneth D Wesser 9 Traditional IRA
37 Bullock Cir 0 SIMPLE IRA
Carlisle, PA 17015-7616 0 Roth IRA
MA ACCOUNT MAM NUMBER SOCIAL SECUIUTY NUMBER(W DATE OF 1111111110 DATE OF MATH
[252978531C 1174-30-3101 10/06/1932 01/07/2014
BENEFICIARY INFORMATION
NAME,ADDRESS,CM,STATE AND ZV MA ACCOUNT MIAM NUMBER
No beneficiaries named;closeout check issued to: n/a
Kenneth D Wesser Estate; Edward G Roman A Ex TAW. AYM mVnMCATrON NuMEROM
23 Ridgeway Dr; Carlisle, PA 17015 46-7268146
DATE OF BIRTH DAYTM PHONE NUMBER I E-MAIL(OP770NAL)
1— 1(217)821-9978 1
BENEFICIARY ELECTION (Complete A, and either B. C,or D.See Additional Information included with this form.)
A. Death Occurred: 0 Before Required Beginning Date(RBD)
X On or After RBD(Roth IRA owners are treated as having died before the RBD.)
B. Total Distribution of Benericiary's Share 0
C. Designated Beneficiary[Elect one option under (1)or(2)].
(1) Spouse as Sole Beneficiary (2)Other Individuals (Includes spouse who is not sole beneficiary.)
• Single Life Expectancy* (Attained Age Method) 0 Single Life Expectancy* (Reduction Method)
• Five-Year Rule(Only if death occurred before RBD.) 0 Five-Year Rule(Only if death occurred before RBD.)
n Treat as Own
*If death occurred on or after RBD,the longer of the IRA owner's single life expectancy or the beneficiary's single life expectancy is used.
D. No Designated Beneficiary (Applies to all beneficiaries if any non-individual has assets remaining on the determination date.)
D Five-Year Rule(only if death occurred before RBD.)
10 IRA Owner's Single Life Expectancy—Reduction Method (Only if death occurred on or after RBD.)Not Applicable to Roth IRAs.
PAYMENT INSTRUCTIONS
r. A.PAYMENT E[,XCT10N B.PAYMENT MV171111011 C.PAYMENT VETAM
1 elect my required minimum distributions to (1) 0 Mall check to me. Amount Requested $ 5,430.65
be paid in the following manner(select one): Penalties Charged 0 OM
(I)IM Immediate Distribution (2) 0 Deposited into my Administrative Fees 0 0.00
of$ 5,430.65 account at this Subtotal(anow ntjm to wmarolkling) $ 5,430.65
(2)0 Periodic Distribution flimciall organization. Federal Income Tax Withhold 0 0.00
I authorize automatic distributions of Account Type state Income Tax Withheld(ifamumbie)
$ on a LDC81 Tax Withheld 0.00
• monthly 0 annual Account Number Net Amount Paid $ 5,430.65
• quarterly 0 other Earnings paid to date not already reported to IRA
basis, starting on administration provider (optional). Include
determined by my election. (3) 0 Other this figure in the Amount Requested.
Continue periodic distributions until 1 $ 0.00
notify you in writing otherwise. Does this distribution close the IRA? 10 Yes D No
(3)D Other(including transfers)
Date of Distribution 1/28/2014
WITHHOLDING ELECTION (Not appffcable to Roth IRAs. See IRS Form W-SBEN if you are a foreign person.)
The instructions to Form W-4P(Withholding Certificate)are included in the Additional Information section of this form, Form W4P
0 1 elect not to have Federal income tax withheld from my IRA distribution. E�� T�S=
0 1 elect to have 10 percent Federal income tax withheld from my IRA distribution. OMB No.1*545-0074
1 want the following additional dollar amount($_),or additional percentage withheld from each IRA distribution.
X I elect to have$0.00 or State income tax withheld from my IRA,distribution(if applicable),
IRA Election of Payment by Beneficiary for Traditional,Roth,and SIMPLE IRAs IRACMBEPBLAZ 611/2008
Bankers SYstem;TM
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Walnut Bottom
Walnut Bottom 1166 Walnut Bottom Road
1166 Walnut Bottom Road Carlisle PA 17013
Carlisle PA 17013 Inquiries Call: 717-249-4666
Inquiries Call: 717-249-4666
Acct XXXXXXX633 WESSER,KENNETH D
Acct XXXXXXX633 WESSER,KENNETH D Eff: 01/27/14 Date: 01/27/14
Eff: 01/27/14 Date: 01127/14 Tlr: 0709 Time: 4;24pm
Tlr: 0709 Time: 4:26pm
Deposit to REGULAR SAVINGS 0000
Withdrwl from 15 MONTH CERT 0041 Prev Bal; 5.00
Prev Bal: 29,655.10 Amount: 0.00
Maturity date: 10/01/14 Now Sal; 5.00
Amount: 29,655.10 Seq: #518694
New Bal: 0.00 Deposit to 15 MONTH CERT 0041
Seq: #519249 Prev Bal: 29,639.27
Withdrwl from REGULAR SAVINGS 0000 Maturity date: 10/01/14
Prev Sal: 5.00 Amount: 15.83
Amount: 5.00 New Sal: 29,655.10
New Bal: 0.00 Seq: #516696
Seq: #519250 Comment for 15 MONTH CERT 0041
APY Earned 0.75% 01/01/14 to
01/26/14
Check Disbursed -29,660.10 d Share Dividend
ESTATE OF KENNETH D WESSER Share Dividend 15.83
Ref number: 00 883060
Authorized by
Authorized by
ID Source:
® Dry Lic ID Source:
❑ SigCard ❑ Dry Lic
Known ❑ SigCard
❑ Other ❑ Known
[]-other
VISA Balance Transfer 1.90% APR NO
balance transfer fees. Ask an associate VISA Balance Transfer 1.90% APR NO
for more details. balance transfer fees. Ask an associate
for more details.
KENNETH D WESSER
KENNETH D WESSER
Marty's Inc.
471 E. North St.
PO Box 117
Carlisle, PA 17013
1-28-14
The Value for the 2009 Honda Civic coupe vin#2HGFG12819H524704 is 9,000.00.
Based on the following items:all four wheels need refurbished 420.00, needs oil change and
Ater 39.99, inspection and emissions 60.00, replace front and rear brake pads and calipers
350.00,4 tires 400-00, mount and balance tires 100.00, detail 140-00. Paint touch up 50.00.
Respectfully,
Dodie Wise,CEO
Marty's Inc.
February 14, 2014
Received from Dodie Wises DBA Marty's Auto Sales the sum of Nine Thousand Dollars
($9000.00)for the sale of a 2009 Honda Civic 2-door, VIN 2HGFG12819HS24704
Belonging to Kenneth D. Wesser's.
Purchaser �Lw
Seller: Edward Roman EXTR Kenneth D. Wesser Estate
Dodie Wiise
LTL ff�
... ,
9
GLF.ANEST�Ct4.RS I3�TT~',.
rLt811 ® l'S 17 $¢3�ite3S;l �JJ4r\
117
j ;•.�,
r .+471 E.NORTH STREET,CAR�.ISi,E,PA
Bus.Phone:(717)249-5418'
www.m"sinc.com
Gerwortlh Financial 1>9
GENWORTH LIFE INS CO
LONG TERM CARE INSURANCE DIVISION
P.O.Box 40007
LYNCHBURG VA 24506-9939
000 00008n 00000000 001002 00356 INS:10
THE ESTATE OF KENNETH D WESSER
1 LONGSDORF WAY
CARLISLE PA 17015
Page 1 of 2
A355528 Claimant: KENNETH D WESSER Claims: (800)876-4582
Payment for Dec 10 2013 through Jan 7 2014: $2,400.00
Section A - Policy Details
Daily Benefit: $120.00
Deductible Period: 20 Days
Deductible Period Met: Aug 30 2013
Lifetime Max: Unlimited
Benefits Paid to Date: 117 Days .
Please detach before negotiating check
narssx��+ ,Byrn ^z2az -ra:e»a�T33 �,;rr��rx7t7�Ts�rr�sr ,. .
Genworth F nano el �;~K 2021$5262b 5' .
GD- WORTH LIFT INS CO 11;1
LONG TERM CARE(NSURANCtDIVISION DATE€F C IECIf
P.0;6=40(167 .
LYNCHBURG"506,sss9 01/22/14
PAY EXACTLY*—TWO THOUSAND FOUR HUNDRED DOLLARS AND NO CENTS
PAY TO THE ORDER OF THE ESTATE OF KENNETH D WESSER VOID AFTER 180 DAYS 8 ;
1 LONGSDORF WAY
CARLISLE PA 17015 CHECKAMOUNT
. . $2,400.00
HFN6419474 A355528
Iaaneacs NA Atlite�d89
FiA1tiFORD,6 NNECTICUT
II0202b85252011e 4Obb900445I: 000005304911'
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kenneth D. Wesser 2014-00049
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Weber Funeral Homes 502 Ridge Ave,Allentown,PA 18102 Funeral expenses:professional services 2,325.00
2. Weber Funeral Homes embalming 575.00
3. Weber Funeral Homes dressing,casketing,and cosmetology 295.00
4. Weber Funeral Homes funeral ceremony 550.00
Weber Funeral Homes transfer of remains to funeral home 410.00
Weber Funeral Homes hearse/coach and driver 250.00
Weber Funeral Homes flower van and driver 75.00 -
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 19,200.00
Name(s)of Personal Representative(s) Edward G. Roman, Jr SS#303-76-5258
Street Address 701 Walnut Bottom Rd
city Carlisle State PA ZIP 17013
Year(s)Commission Paid: 2015
2. Attorney Fees:
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
city State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 513.50
S. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 28,868.94
If more space is needed,use additional sheets of paper of the same size.
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Additional sheet
Funeral expenses cont.
Weber Funeral Homes utility vehicle and driver 75.00
Weber Funeral Homes Hartly 20GA 2345.00
Weber Funeral Homes memorial register 60.00
Greenwood Cemetery Allentown,PA gravesite services 1870.00
Weber Funeral Homes death certificates(12) 72.00
Rev. Edward Roman minister's honorarium 125.00
Allentown,PA&Carlisle, PA newspaper notices 512.67
Weber Funeral Homes discount (384.23)
REV-1512 EX+(12-12)
Iffpennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kenneth D.Wesser 2014-00049
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Diakon Luthem Services dba Cumberland Crossings residential care expense balance 1,109.64
2. AAA Financial credit card balance 5.90
3. Masland&Associates medical services balance after insurance 12.82
4. Walnut Bottom Radiology patient balance after insurance 25.00
5. Public Schools Employee Retirement Systems return prorated portion of January 2014 pension 2,293.62
6. Family Home Medical cost of walker after insurance 2.24
7. Omnicare of Prussia prescription medication through Cumberland Crossings 246.02
8. Advanced Pain Care office visit co-pay 10.00
9. Health Drive Podiatry office visit co-pay 10.00
10. Mobilex medical services balance after insurance 11.57
TOTAL(Also enter on Line 10, Recapitulation) $ 3,726.81
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Kenneth D.Wesser 2014-00049
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,
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.
Carlisle Baptist Church 701 Walnut Bottom Rd,Carlisle,PA 17013 520301.69
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 520301.69
If more space is needed,use additional sheets of paper of the same size.
F,.C.0y--
Z. Executive Committee
Southern Baptist Convention
11PT S
..............
OFFICE OF BUSINESS AND FINANCE
December 15, 2010
TO WHOM IT MAY CONCERN:
This is to state that Carlisle Baptist Church of Carlisle, Pennsylvania (as
well as ministries sponsored by the same) has in time past communicated
to the Southern Baptist Convention its desire to be a missionary Baptist
church in friendly cooperation with the Southern Baptist Convention and
has demonstrated its support of Southern Baptist work in accordance with
the SBC Constitution, Article III, and is, therefore, included in the SBC's
501(c)(3) group tax exemption ruling number GEN #1674 as a
cooperating church.
Attached is a copy of the group ruling dated August 10, 1990 as well as an
updated confirmation dated December 20, 2004.
Sincerely,
Donald R. Magee
Associate Vice President for Finance
rhw
Enclosures
901 Commerce Street
Nashville,TN 37203-3699
(615)244-2355
internal Revenue Service Department of the Treasury
Returns Program Management
Staff- Taxpayer Assistance
P. 0, Box 1055 - Room 907
District 101 Marietta Street, MR
Director Atlanta: Georgia 30370
Date: AUG 1.0 198Q
Southern Baptist Convention Refer Reply to#RPM;EO:TPA
901 Commerce Street
Nashviller TN 37203-3620 Your Inquiry Datedt 7/18/90
EIMI 62-0535346
DEM: 1679
Dear Sir or - Madams
This is in response to your request for confirmation of your
exemption from Federal Income Tar;,
You were recognized as an organization exempt from Federal Income
Tax under section 501(c) (3) of the Internol' Revenue Code. by our
letter of Augusty 1969 , You were further determined not be
a private foundation within the meaning of section 509(a) of the
Code because you are an organization described in section
170(b) ( 1 ) (A) ( i) and 509(a) ( 1) :
Contributions to you are deductible as provided in. section 170 of
the Code,
The exemption letter for you and your subordinates remains in
effect until terminated: modifiedy or revoked by the Internal
Revenue Service, Any change in your purposesy character : or
method of operation must be reported to us so we may consider
the effect of the change on your exempt status, You must also
report any change- in your name and address.
Thank you for your cooperation.
.ncerely yoursr
EX PT QRGANIZATiONS/!MASTER FILE
COORDINATOR
RECEIVED JAN 012004
Internal Revenue Service
Department of the Treasury
P. O. Box 2508
Date: December 20, 2004 Cincinnati, OH 45201
Person to Contact:
EXECUTIVE COMMITTEE OF THE SOUTHERN Richard E. Owens 31-07974
BAPTIST CONVENTION Customer Service Representative
% MORRIS H CHAPMAN PRES & CHIEF EX Toll Free Telephone Number:
901 COMMERCE ST STE 750 8:00 a.m.to 6:30 p.m.EST
NASHVILLE TN 37203-3600 754 877-829-5500
Fax Number:
513-263-3756
Federal Identification Number:
62-0535346
Group Exemption Number:
1674
Dear Sir or Madam:
This is in response to your request of December 20, 2004 regarding a copy of your organization's group
exemption letter.
In August 1964 we issued a determination letter that recognized your organization as exempt from federal
income tax. Our records indicate that your organization is currently exempt under section 501(c)(3) of the
Internal Revenue Code.
Based on the information submitted, we recognized the subordinates named on the list your organization
supplied as exempt from federal income tax under section 501(c)(3)of the Code.
Our records indicate that contributions to your organization are deductible under-section 170 of the Code, and
that you are qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or
2522 of the Internal Revenue Code.
If you have any questions, please callus at the telephone number shown in the heading of this letter.
Sincerely, ,
Janna K. Skufca, Director,TE/GE
Customer Account Services