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Home My WebLink About03-23-15 � � � 1505610101 REV-1500 Ex`°1_1°, . OFFICIA�USE ONLY PA Department of Revenue Pennsytvania County Code Year File Number BureauofIndividualTaxes � ��NHERITANCE TAX RETURN � `� � � t� � � PO BOX 280601 ` � � � � �`� a 3� � Harrisburg,PA i�iz8-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY �y �� .: �a ��' � �� g t� 5"�r� �{ �..FQ � P.3� (�� / 49 y��3, 3� `� � , � , , � ,� �� . �,��v� DecedenYs Last Name� � Su�x DecedenYs First Name MI , � ~r � a � �� W � �{ � D E��t k � � -zT�� k � ` „ � ��V�`$ .. ' '� . n: '^.�s. .. . �_a.+�t. .,.v�u�, � •.sw ..., n� ... U ..-` ' � � (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse s First Name MI . �, �R� ,�� ,� � .k��,�,� ; �� , �� r � � � � " „ � r � � � � > � � ? ,. � a�- �.....��,� � . � �w��a„ �� d� . _��. - � � � _ � .._ Spouse's Social Security Number . THIS RETURN MUST BE FILED IN DUPLICATE WITH THE � �� REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW p 1. Original Return p 2. Supplemental Return O 3. Remainder Return(date of death prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) p 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number �,,�� ,� -� c� � � r� � r� � y �� r � t�� 3�:� �� , REGISLER�WILLS US ONLY ' -:i � �� N First line of address 1 G� `• �. ,3 d 53 5 (� I T � 5 7" --�, � �� _, Second line of address � , i•� �- - _. �� , < 3 r �i City or Post Office State ZIP Code DATE FILED �,�; C /�- R L l S l-- � ; � t� 1 ? � t 3 � CorrespondenYs e-mail address: /v�� Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPON IBLE FOR FILING RETURN DATE � _ ,,�� :� l ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � L 1505610101 15�5610101 J v � ...rr��l►. � 15056101�5 REV-1500 EX DecedenYs Social Security Number DecedenYs Name: �' - RECAPITULATION 1. Real Estate(Schedule A). .. .. . .. .. . .... .. .. .. .. .. . ...... .. .. ... .. .... 1. (� ,� ,.t, 2. Stocks and Bonds(Schedule B) .. ... .. .. .. ..... .. .... .. .. ..... .. .. .. .. 2. ' '�i, .� 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. .. 3. ,,' � * 4. Mortgages and Notes Receivable(Schedule D) . . .. .. .. . .. .. .. .. .. . .. .. .. . 4. � � � ; � �''s ;; �� . 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . .. . 5. �, (� � '7� �� ' �,_" r�� .2 , a. �f � _ �, ,,_ 6. Jointly Owned Property(Schedule F) p Separate Billing Requested .. .. .. . 6. _ '0�� , 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property a� (Schedule G) p Separate Billing Requested.. .. . . . . 7. � �:(J y� � � 8. Total Gross Assets total Lines 1 throu h 7 � �� `I � � 9 ). . . . . . . . . . . .. . . .. . . . . . .. . . .. . 8. � �P��-� irZ � 9. Funeral Expenses and Administrative Costs(Schedule H). .. .. . . . . . . . . . .. . . . 9. � � ;�%�`�� ,(� �� =�� w:��`�,,�^ m 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . .. .. . . . . . . . 10. � �� ('j'� ��j _� � ; ,= � ^.; �� . �� 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . .. . . . . . . . .. . . . . . . . . 11. ;'� ��(^� � ��C✓ i � � � �„ a � �� ; 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . 12. � '. � ; �5� � 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which � �� '�� ` . E � �. an election to tax has not been made(Schedule J) . . . . . . . . .. . . . . . . . . . . . . . . 13. �� , �,� � �� . r , r_ . � 14. Net Value Subjecf to Tax(Line 12 minus Line 13) . . . . .. .. . . . . . . . . . . . . . . . . 14. ��= � �� rt � (�� ,� 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 ` ��- ' r: 16. Amount of Line 14 taxable � _�'-�" ��-� � �� y, � � . � � �� ; at lineal rate X A_ 16 � � � � � � � 17. Amount of Line 14 taxable � � � �� r�, � ;: � ��,,,�� at sibling rate X.12 � �iw � 17 � �� ' � `" � �� r" 18. AlllOUflt Of LinB 14 i8X8ble - " "�''� �' '-�"�`"` �- �-�+`�`^��i'`��; �'�a�;� `�' ,�a`�,�.., � at collateral rate X.15 "" �'�� 18 � � � ; � ,� � � � ; � �. � , r< 4 ,� y5 . .. �� 'a'� '�rv� '#a".7�,N wR' �s.��,e ��.{.e�,W� '.e ,, �" f � tr J: �S r,��. 19. TAX DUE . . .. . . . . . . . . . . . .. . . . . . .. . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . .. 19. � � � � � � � � � . w � _.�E _ -��-r 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 L 1505610105 15056101D5 J REV-1500 EX Page 3 File Number r��`)Wd�� Decedent's Complete Address: � DECEDENT'S NAME _�c;�,�_�1c_�� _ -- ----- -- — - - STREET ADDRESS i 1 �+ _ —. _� �i�'�.t'-V lrl 1.1.1 J�� — — - - – -- -- CITY STATE�� ZIP C�.� ('i �le. i 7� � �� Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) �� d 2. Credits/Payments A.Prior Payments — -.-- - B.Discount —-- — Total Credits(A+B) (2) 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) �) Make check payable to: REGISTER OF WILLS, AGENT d�w-: ��* ��..- '+�`9 �'�!�� 'v a�"^s r�F,�a F: '��'�`� :��'«- C m' � �� y��a�.,��:`��a"��.�5 .,�Y'* x�'M" p�°- _ ��'�4M°� '�'i�u'iitK�..�, o .. '��'��aa�;.- ��=.��E, -�d ,��.��mue�a `,`s��".� .�� ..-.�.,�'� r .,.� ,� �tw„�� . ��,. €�- u-�� . . _ .�-� , ...ua „�r . 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 transferretl:.......................................................................................... ❑ �] b. retain the right to designate who shall use the property transferred or its income:............................................ ❑ � 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,tlitl decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or 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. � �� -`.�`��"��..°��,ss k,�.�'��.��"��.;'�,g�'�'�r.� , $�*.'�"4`��'.x r.,,� ,� �', � �..,, �"+`��c �r.4:��k�w4'� ..��m.+.`�i�., . �� _ , �e .. -. ..,. 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 or 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 appiicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: . The tax rate imposetl on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as notetl in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)). . The tax rate imposetl on the net value of transfers to or for the use of the decetlent'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 tlecedent,whether by blood or adoption. / 1 p� � "'_!� �Cxl��j� IN'vENTOR'S� � ;'",� _ �;-_ ; >;;,f i COUNTY,PENNSYLVANIA REGISTER OF WILLS OF �---�` �� s � �S� 4� �� ` ri COb[MONWEALTH OF PENNSYLVANIA 1 SS FileNumber •,,,�,.~�-��.j�"�% "` �f'`� �1 COUNTY OF j .,'f.; ;;, ,, r _ Personal Representative(s)of the Estate of -��• deceased,depose(s)and say(s)that the itcros appearing in the following'inventory include all of the personal assets wherever situate and all of the real estate in the Cominonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I verify that the statements made in this Inven- � ." _ `4�, , .;- � � tory are true and correct. I understand that false state- � � ments herein are made subject to the penalties of � - �-t � == _ ° ' , 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Attome ame (Supreme Court I.D.No.) Y-- lN I � (Address) (Telephone) _._._._. --� _.— DECEdENPS SOC.SEC.NO. DATE OF OEATH tAS'f RESIOENCE . ., � i : .. , � f .J,.. : �_� . j . . - 'y J�.,.r � .. f�l 1/i lF `7 .-a�-i.�5 _._5 l� �.. v�,,..�..�;iz�� `.�� _�.i i i J �%C- . FIGURES MUST BE TOTALED � .� � . :. , .-, - --; � , , . �_ . . , � . , . , , n t,,- -t � , ,. - , � ;_, -r.,�.. 3 , , , , , , F. - +-.� 51 >�� 1 f � ' • _ -�... .� � A.,' _' a_. - ` �� e ,. t ..=; � __ i ' �.i C.?. j�1 i j.''�'�� r 1 _.. . _. . .. t",..i J`� 1: , -. . ,.,j .._..i .�,...�- `, � _- ` � '_ . '� ' �.��_t1�.. , ,�� ' 7,'I�f.t-- ` .. . } .'`y� {;�,�i ;., .. (Attacli additional sheets as needed) _ TOTAL: ��' `� 1 „�. ,� O.00 NOTE: The Memoranctum of reai estate outs�de the Comnwnweatth of PennsYlvania maY+at the eleetion of the personai representative ineiude the vatue of eac item,but such Fgures should not be extended into the total of the Inventory. (See 20 Pa C.S.§3301(bJ) Form RW-09 rev.l0./3.06 , b��y> II1V�AtOTy��O�lYl F..A��1 :�.�f`i - _S�- 7�.�� 3t1t}kc�Se headboard bed 8c mat�ss � > �<��' �' 4 draw�er small dres�r >aIl used�ainted bI�ue to naatch �_ 3 draw�er s�nall ciresser > -r; ,,�: s ,��:� 2 iamps Bedroom G�as� �,� 2 door TV cabinet tused) � Ties,Belts ��a �.2"fla.t screen TV Clothing,shces, PP�� gracking chair �;lothing in dresser drawers �� WaIlc,er on wheels j�" Wrist BP monitor I�.� Iron Tabletop ironing board �� Utility heater � �;� Pachet watch ��.. r�� Windowfan �� Cane �,,�, -, ._�`� 3 Pc suitcase sst :'-:-i,� 2 sh�t Sets �"' 2 pillows _, s� Blaurtket ��-� 2 Bedspreads � Clothes tree T.i�R�OIII G'�086� ,�,� ��} ;'f� Coat 8z Jacicet ;-;•�> Reeliner .:� �.Tmbr�lla j� F.n.d table '; Vacuum cleaner �;�= 2 fishing rods ;�. a laxnps , - :�C ,� Computer(wuidows 98)w/]ke:y�oard,mouse, � �= F'�.shing Vest � : , `�.Speatker,monitor,printer t�ught or given,all used) i��Tackle box .�`� Computer desk&chair(u�ed) ,-� Floor steamer �� 2-drawer file cabinet 4� Ixawn.ehair ,,�;c Tv stand(used) ,�j�' 22"flat SCP�ri 1V SBth� �� Combo DVD,VCR tape player �.�� Towels&washcloths i�,_� 3-ahelf holder for DVD's&Tapes v /.� Coffee table(used) %� Haircutting Ki# ,1, �; _ � , �� .� ,�t�t' i;� Wall mirnor � 1� Wall clock �._=> Scale ��' Phone set '� Shower curtain&hooks r � Chess game set ..`� TY table he painted squares to be the chessboard ;��' May�lovver madel he built `� Standing Bear(3 ft.) ,�i; DVD's&VCR tapes �.{� GD's&portable player �,:> CD Player i �; Utility heater j.._ . .�"<, ��s, � iYnientory of John F.Alden ,�-�s�- ��-- 7�,�� 1t en �� ' ��' Small patio table&s chairs �/ ;.� Small tile top table w/2 chairs .:'7�, 7 WalllamP �=; Wall clock ,� elec.Chain saw R' s�`� crowave `'"� S� - 3�; Ml `i Weed trimmer � 1K'icwrowave table .�, Rake 8r shovei r�> Wi+LL�4i +�� I�nb loPPers �� Teak+ettle �.c I)ish set of 4 . e:_5 3�e�mugss ,_�; t�asses set of�(box) ,'�� Eating utensils for 8 S Steak lcnife set t8) � 1.5 Knife set ,.�..� �,11 outdoor storage unit �� -� i v Pots 8z pans set � Hand g,a►rden�ls&g�oves � Toaster �z.c 3maIl charco g� �7 Blender 5`C Push Lawn mower wJcatcher ,� Fdecbric mixer �� gpr�ader � R�aster pan wJrack �.� Pasta coo�ing Pot � F1�ri.c bean.pot 5� a pc.Canister set � 3 pc.P`last�c mixin8 bowls � Me�asuring�Ps��02� �'e �' �� ,��"` Utensil holder w/utensils �' Sm,aIl r.eramic Chri.s�a�s�ree ,� Various storage contai�ners N,/li�� ;�. Salt Sc Pepper shake� �;;Zc3 Assorted decorations � ,� �J�.11C@ 1"dC�W�Sj�1CPS `��, ��t �' !��n' ,,z Breadbox �� opy&s#akes r� Bread machine tused) � Tent&tent stakes �� Wall phone ;r� Sleeping b� .� Iamp (used) �� Small battery lantern i,�. Window fan j Dish drain tc;tehe�Cia� �----- `�a Mop 8tic bmom �� .7 Hand�saw -�� Tool chest 8�tools - -- j C��',� � � _- � � � �q Metro Bank 3801 Paxton Street - Hatrisburg PA 17111-1418 �aNK mY�9��, >04704 3282401 001 092140 JOHN F ALDEN 103 WALNUT STREET CARLISLE PA 17013 We're here 7'daya a week,24 hours a day at 9-88&937-0004. � 50 PLUS CHECKING 05367qa802 �� Statetnen�t�lan�o as pf,04lQSt13 - �� ::�� ' � „� 04 � #�lua '1 ,t�pasits a�d Dt�et�tadita s v �� i1,x041. � Lpss 22 Gheck�an�t��eMt� ` �� .1 S , � � �u� ��, lnte�es#�Padd t ; � ■ = � ��- , \ ` ' oH% i. .x r� z�.v m��.zE>_��sV._.�a5 ��l��*d��A�-T-frpSRh�s°f�R .k7.znh.a,Is"ti��:,.,,, v :¢, . atw„ «_� ..-�n.�,a.e .._ , . _,. .. ,..,,_.. .f;s�.. .�.a<.<..o1."h�,u£`.t..�. i.. + �� Transactions By Date Debit Credlt Balance aate Descri hon ��_ t t; ,. ,��"'�"`" , , ', � � �� t �y,�� ,• � �y � µ �. .,� ° , � � ' ,��,�:��?, r.�ret. �'�'.i�?3.�+..r..;?_ �..., .'/£�'„/'i,...*„id�': .� -'f��l..d'+�e..�::F^a^ .,N^fa7S�.:..+.Li"x .a r� 1. ..'�: . . 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P ti�`;_, � ,�u � * : �.� ��. ..n .�.� ti. ..-.� . , � �.�'��r� .�� _��.�... ,.�. �. .,. _ .��. �� _.d. . �" Fees Summary u.ao: � ees�s; �� .. so.00� ;� �� ,: � -. ,; Total Overdraft Fees Year to Dats ..�-r-.�— `—` _. ' �„ � ,.:�„��, � � �s � � �; �"�� .� �' ��.�� „.. ��+y�; . ' 50.00 ��Totai Retumed Item Fees Year to Date For your convenience,a summary of overdraft and returned ftem fees appears on yout monthly statement. Piease note that the overdraft fee summary includes non-su�cient funds fees,uncollected�ms cred ted to your ac�Counts fees. The summary dces not reflect refunded or waived Fees&Charges:To fu�ther clarify the Schedule of Service Fees and Charges effective May 5,2013;Customers will continue to receive a single copy of their statement at no charge.Additional statement copy requests,beyond the originai statement,are 55.00 each.Cash withdrawals at non-Metro Bank ATMs(over 4 qer cycle)are 32.00 each. There is no additional charge to use your Metro Bank Visa�Debit Card everywhere Visa debit cards are accepted. Spring Time is Home Equity Timei Home Equity Instaliment Loan Rates are as low as 3.24°k.Appiy today for the cash you need at your nearest Metro Bank store,online at mymetrobank.com or call Loan-by-Phone at 800.296.1015.Ask a representative for details on rates and terms.Equal Opportunity Lender. �5 c��'-'x�= �' E T RO Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 BAN K mymetrobank.com >02642 3338261 0�1 092140 JOHN F ALDEN 103 WALNUT STREET CARLISLE PA 17013 We're here 7 days a week,24 hours a day at 1-888-937-0004. � 50 PLUS CHECKING 0536704802 � . s #u h� ' � F � � a � s �. � �'�'Y+r�, � , � � :. �� '3 � ��'"��`'�,�� s��,��'�``x"'�" ��3�'�� (z�� \ 4 � "� �� Yn�� El fe,.. i . �r � yj�� y��:h� N �ii�g��'�:��4.*r '�*�,��n�`� 4 ��y,� ��.�� ,3�"��*;��:�� i��*.a•'��y�Ml7� "+ �' yAri k". !r?"*r��ri�� v :R� i '�', '� 4 -: �� i 4 � � x ~ �i�G �.�,r��e y �,�, ,� x` s"' 's .. y"t � a ��,� -- � � ,�aat .�� t�� i'��a§v ��,it.��r� � `��< y*f y 2` {��Lw s �}�*:� ,� � ��r�- �. ��'��i��i:�^:�r�'�.x�l�4�I+�Anis"�� ?,.�"��''��' Q � ��"�`4 '�'�;c��r��.�'1 s��'�,`r r ��°a '�'k S� , /�/�a � ��£*'��L:� ,,� � s'�„' .a -:. -;W,g��, "�. �.i� F":.: �.,�k ;�I � t$tk°�a `�,' � �' � �y ��ta,� ' �+�tt� �S e. ��. ��,� � �^�s�u y �p'�� }�� y ,�� :�`��?., �i�� a� ��$�,�,aA"#�'��'��g� M^;a�.� � � F#. `5 ��X� �'��.' � � ��`��C��!!'w�#��4�?f'�� 'as3��y��>��`'"�' �D:-�'.F5 �..3�.�� i �_.�.��? �j, a�"� ��, � �� s t � m ��a 1;�`a'`x` ° Q..� s'� '?� . . , ,.,,. €..: �'�'4�.� .�: .�.;-.'�`..�s,�c`,� , . _ .�, ,_. , ...�.., _.;� - . Tra�sactions By Date — __ .__ _ Balance _ ____ _ _ _ �t Cred Date Desc�i tion � _ 4 �'� r m� f � �� y.�tF 4�3�`S'4 ,S� a��$'�i ' �yy��{ � F . l`� J'�Y'�b 3 .�rw Y.�. . e S� �� y t� � �.F7SA �=� '- ..e, . .: . .,.: .... -,.�:. , , .. . ! �^'.: , rn< . �.� . . �::_ F._. .;;_.�,.. s�.___ ,..'i �. . .1�.0� 05131h3� �� DEBIT�MEMO �� _� ;1,20298 ��.�� ,-tY� �. � ��-�e ¢�CC� interest Summary ry . �� ., �a��.�r� � y. �^�.� � .�� r""y,�t��r�,��v �i . � �^��s�a N�� ,�. � ^�,�'1��} ��1� � ��`�"� ,a�'z � y `� . `�'k�� d`�'e,+, 'v � � i ��'."�k +�.�� a,� '�'��1 � �� }..�y�{ a, � a �� ky�� },''��, � � ��1��yX��r� a��,�„� �� "�� l�R`! � e�� M.J�sr G� ,y -��i£r� 4 S . !. � ?`�°�y`�F l j�4 , �Y '34„ �/�. F,(� 1� �4�g � Ns _f 3�� i^ �Far�' � �.' F ��M�X��y. ��,�'$� zi�� "SK` � ��'��x�-,H"S�,�i'i ��K �� MR��j � ��,�,�,r�-."�T'��^ vi"' d� uy`.±a.�a �. t.Yr ,��"Q f�.T . ��,,. �'�sa A'�� ,,,� . �� . ��i�a-.�Aa."�sv��§�t... . .._ , 4 3kFAo� ^' -.,y,�•• �.�� L'%.�.��4r� 't� Fees Summary � ��. -a, s r�.,. . , . ; . „ . . ,.q,. .., . � s0.00 Total OverdraR Fees Year to Date �r � . _ ; _ . . � �� :� N ;�'8 � '�"• s �50.00�. Totai Retumed Item Fees Year to Date For your convenience,a summary of overdraft and retumed item fees appears on your mw►thly statement. Please note that the overdraft fee summary inciudes non-su�cieM funds fees,uncdlected f�ed�f��Y��u�f�• T�summary does not reflect refunded or vvaived Notice:As more Customers utilize their Savings accounts to make electronic payments,we remind you it is important to track aif activity and take necessary action(make deposits or transfers)to avoid the account from becoming overdrawn and incurring potential non-sufficient funds(N5F)fees.Pre-authorized electronic fund transfers from a Savings account are limited to six(6)during a cycle period per Federal regulations;however unlimited withdrawalsitransfers at tellers or ATMs are permitted.Actively monitor your account with Metro Online Banking, Bank By Phone or with our 2417 Live Customer Service at 888.93T.0004. Sc��1e�1+,�1� � �. • RECEIPT FOR PAYMENT � GLENDA FARNER STRASBAUGH Receipt Date : 5/16/2013 Cumberland County - Register Of Wills Receipt Time : 15 :27 : 04 One Courthouse S quare Receipt No. : 1074206 Carlisle, PA 17613 ALDEN JOHN FANZLER Estate File No. : 2013-00564 Paid By Remarks : MARTHA. HARRY � Receipt Distribution ------�'-'-"--"--- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 30 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNT� GENERAL FUN SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENER.AL FUN INH TAX RETURN ---------------- Cash $113 . 50 Total Received. . . . . . . . . $113 . 50 \ � � ' �+r�i C ��5� ._.C��"�� 1?�- •t'ri�'' J� '�. C�t.OtiGES' Ft_[lYlERS 101-iJ:l G ST. :-y;:�;�� ` _ �'�� CARLISLE, PA 17013 }3L�1 r., ��i�9�� tr�B�� ., , i��;3 t�7-2�'.�� :��'� f�'lerne�r��t.� �er�liC'� i,ar;�,. �r.x ,.. , , �n. . ,c<•,. . .. i�i� �:, iatr: 06/13/ZU13 1rtT�iiii�il: 2 ,:;� + � �. _ ._�Z.,t.�r E':li�,:l=:i ;me: 10:30:58 AM SeS�iitn: r':+�la r ' I�i l,r f,,�,t:--- ^�;,s: � :�;��r^ , u__. �_. _. _ %' j,�-liii'��C.=�r � j _ _.,...I aY�dC NUIiI�iBl`: Zc�.y��il ��i�.� 1 i�.t'i �: 'ii��,t��`r;+,��,ir; _... T�, - �� F`r i�e �u` ' ,, Ity Gescription � : �� rLOWER ARk. $ �;'.;'� � � v .. , � - �l-r� � xc:,y� �S.�+) T,-, , ,i�i![) `�t�,>E � `j i��y� Li.'•�`) ,.T�,a,: ::,a� . ' .. ,. . Sub Total: $ 5o.`1U ?��; �: ��,��- Tax $ ' ` EY�;'IRY: x>: ,r� ,,, :��' �8�E3.> �.J� ` �:'iT�# F:1�'�:'�`; �totai Amoui�t Uue_ $ �2•�� t �• CC Tendei BJ: y �2•C11 Change Due: $ 0.00 l�l Eti1� i -,. -- '=-��+ln,i;:1`� ' ,..- �,_ . _ ?t�auk Yu�� Fo+ Your Busineus! -,+ - � it�i.if,�., �r.iiCi�c G��., �i�:��i . �� ...;'', sp �hj� ;' ,- ".�f G;.i! f�i?�r": t;�' t;t �:'"':: 'Yitlt D'atE+: U6/13/2Gl:i �y�f ti.�c'i;j;?' 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Mi ke Young. `�ta�e Manager VISA TENA 7.99 M�ke Xourx�, Store� Mlar+a9�'r � Giant Faod Sta�e #6112 *#** *,�** ***�a 59Q8 ` ui��t Food Store #6112 �g g_ Sp�r;�g Gar-den Street ACCOUNT � ' 255 S: Spr 9 ng Garderi Str�e�t Carltsle, PA iT013 ppPROVAL � 604652 C�rtisla. PA 17013 �717) 249-2323 RE� � 316000883275 - o •, t?17) 249-232c; - � Store Telephor�e: TRANS ID - 000316077946�ib85 Stor.. Te,eF�hone: ph�nac;Y Telephone: ,717) 249-8E�� VALIDATION - SBD9 Pharraar.Y Te?ePhone: <717) 249-883f, THANt YOU 4a00679�1133 TERMINALS�tRMX050306 TNAyi( Vi)t! 4��'��` 2 v 3.00 06/09/13 17�30:95 3 � 1.39 boro bag NP 6•�'�� V CD GIN aERAI.E �•i. `�.G� : TAX PAID •�'�� CHANG� DUE Q•00 3 � 64 xxx*TOTAI. 6.f�] SC BOt�JSBUY SAVINGS '1.'.3�:-t � �IT 6.C"' � ITEMS SOLD 3 Price fior 3 ti�.�5 SB PLST CUPS 6C 3•�F; x��,�x�X*X***��,�x��xr'��XX�x'CX:��%:,C�x SC BOM1S4Uv SAYINGS .;iG,_' GIRNT FOOD # 6112 255 SOUTH SPRING GhRDFN ST. 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"' Insurance $1.95 Gty,State,ZIP+4� , .. .._...-•...............•..............».......--•••-•...._..._ �ZCt.r�CSb'�1f� �-�� rl�3�a^1 Insurance Amount '13122830000038452587 Label #: ________ • Issue PVI: �26.87 .� , .o � /� � f� MA(�KSYILLE LA 71351 �2�•96 , � � . 1 1 ' Zone-6 Standard Post . � �. 19 lb. 6.4 oz. � '• ��`° � Expected Delivery: Mon 07/22i13 �- $1.95 "" Insurance � ' Insurance Amount : $50.00 N ' ? Labei #: 1312283UUUU0;33452�94_'-- . ��_ ❑Freglle Per nabie -------- � P�e� $ ❑u �ra ❑H�rao�a Issue PVI:_. $29.91 � nsurance overage: m Insurance Fce _==s��= � Total : $56.78 Q o specrai rte�dnng Fee �Yi- rho,.� _.____ _ $56.78 �ag,ro„� Persor,�.,..� tiere __-- r� � For tracking or inquiries go to m �� USPS.com or cati 1-800-222-1811. tU TotalPoslage&Fees � Yt7YYl7t'k7k1Y7Ck7KYt7CYtYC7Y7k7kYC7C7KYtYt7k:C:t�C�7CYt�7t7YYfW7Cft7KYCXX (�.� S@fltt0: . 1CItY(Yt 7t7[7tYtYt7t7C7t%7tYfXXX7fil7K7CYt'XYCICYc7�f7C1C7cYt7lYCY[YtYCXx '_� ,._ RDT.NTF�I SAMF�AI�'S MATI R�X CirP.Pt 1 nO cAY` 5 " � �c.,��r;��c.r-�"��Q.�� . m ........................_....._.................._�__...____..............__�___-__-_. � __ ____.__ __ __.__ _ � Street,Apt Na.;a PO Box No. � , �'ty��Cs�'1(r; ,L� --�i�3�j__..-----_-__._.._._._...._.... � , � i � YI t ,� i ,'.,' . . . _.. � ; � ;T+ � ; � `� i i' - j ..�;: ( I � i; i �� , � � I ' � �.. � ; '� � i ft �� ,j � � � �� ; i ' i ; r`••,.>f . 'J _j� i �.�`i i 3� ! 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' I ��f �� t: � �( =:� � U j ,` ; ( ; �,� � I'J! !__'_i__i_ '< : � �� , � �� ' , � �;� ; � --� � �� " � ' ' �� ._ �� - � i i r� -- + � :�`a ' �,, � I ,� � � J_�n , iu �i f�:r`��. _. :..� j �! i� i L> � 2 + ri�� '� ,�' — � , . :. ,� • , �. � ,-_ jL � �I)�,% i�r�� 4, E <;r�#�.�c�.cit� {� „r=�'e �7Gn�.,,.„e1 MARTHA HARRY AD NUMBER PAGE NO. 111 �lu 1 308 3.PITT STREET 421T52 1 of.1 www.cumboriiok.com CARLISLE,PA17013 �� BILL DATE SALESP,ERSON 717-2433249 08/24/13 woifc ca� s�� cainm START DATE STOP DATE 08/08/13 OSl22h 3 AD NUMBER AD DESCRIPTION CLASS LItdES qZ�� EXECUTRIX NOTiCE LETTERS TESTAMENT 10 PUBLIC NOTICES 24 * 2 cota Publication Insertions Rate Net Amount Gross Amount 3 THE SENTINEL-LEGAL 3 LGL $127.4A TOTAL AD CHARGE $127�� 3 MOBILE SITE MQB2 $2.00 PREVIOUSLY PAID �$12g�� ____ ---,-,_..........._.._..�_�..�.a_�..._.._._�___.w�., _ _ _ _ �1 f �F=�`f i v)� _ .._.._......__.__._ �. � .�.:�,�._�� g,� �.�t,�''" F�_� �4��k� _.__...__..__._.__.—__._. _., ��:r_��= !�, �___�L�_ �. � ' . __.._ __ _ _._. _ .. � � _, , ` � tp �t ru(�;i_ ��, ��'Y�i.�Q�l�� w � � 3� ___ _..____ _� �._�.... 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Deadline for c/o LEE NEW8PAPERS in-calumn legal ads is 4:00 p.m.two business days prior to PO BOX 5,40 date of insertion.For questions,call(717)240-7130. , WATERLOO IA 50704-0540 _ __ _ .____ _L8 gi _ _ _. _ _ _Retum this po�tlon wldi your payment ._ ❑ Check# ❑Credit Card Ad Number 421T52 THE SENTINEL � � � � — c!o LEE NEWSPAPERS ❑ � � � Billing Date 06124/13 PO BOX 540 Amount Due $ .00 WATERLOO IA 50704-0540 A�� E�.Date:m m � _ $ Name on credit card SlgnaWre Please ma�ce ct+ecks paYdb�e ro: THE SENTINEL 00018t THE SEN7iNEL � MARTHA HARRY clo LEE NEWSPAPERS 308 S.PITf STREET PO BOX 742548 . CARLISLE,PA 17013 ( 'N� ' �� I�� I� I I l� � �� u� � �n � u �i � � � u �� nnn n � n. 2154020p000004217520000000000D00�D000Q000D�On�00Q5 . 5�e��.ca,l� i� July 6, 2013 Martha E. Harry 308 South Pitt Street Carlisle, PA 17013 Statement of Funerai Expenses fnr: Jnhn F.Alden - Account id: 16879-120 Date of Death: May 4, 2013 PACKAGE: lmmediate Cremation $ 1,990.00 OPTION 5-Cremation Sub Total: $ 1,990.00 TOTAL FUNERAL HOME CHARGES: $ 1,990.00 CASH ADVANCES: $ 30.00 Coroner's Fee $ 150.00 Auer Cremation Services/Removal Sub Total: $ 180.00 Total Funeral Expense: $ 2,170.00 Total Payments Made: $ 2,170.00 Payments Made: i Professional Disc Discount Jun 3, 2013 1,570.00 Robert McGinnis,Jr Check 2473 Jun 20, 2013 500.00 Cumberland Cty VA Check 876063 Jul 6, 2013 100.00 Balance: $ 0.00 , , . , , . _ ,_., ,, . , , , , , . • _ , . , ;. . , : � ,_.... _ . ,�.� ,��;� �.., .� � �.� . ��,�=� -� �_ _ �_ � - .�,��.�.�u ��,�ct:u.l�1 _ � � � ,� �i�� d t3 `c�U�� 7�1�1 �� C.� �c�. Transmission of Van When I had transmission problems in April of 2oi3, John promised to put $300.0o into the cost of fixing it because he had no car and I supplied his transportation. He did things like changing the oil and washing the car a few times a year. He was listed on my car insurance as a driver because I could not drive at night and if we went anywhere he would drive after dark. He also drove me to my chemo treatments and stayed in the hospital with me during my surgery. You will find the card that he wrote for his budget of spending it. It amounted to $650.00. The rest was for a day trip we were to take in July when he received it. When I remembered that he had already filed it I called and told them that he had died and gave them the address to send it too. They sent the check to me and I deposited it in the estate account. I deducted the $300.0o from his account. He died in the middle of my chemo treatments. `�� - �'- �� . :.:..�- � � . r • �'V. • � "�#��'��°� �"��:�N�r�� . a ; �� , , : , , � - : _ — ' -- 4�l�t,^ Har�s�as�Y��'�� ---- ' — " , - ,, . - ; ' , :_;' ' ;:,��°..t:��_�, �4��` ,��R�x .t '.:�;.,. -------- - -- — �''z�� 4�..�,+9�"� ,� ;' ,._ .: , — -- 0...--_— 1 _ ;'� , .,-. . � 3 ,'„� � . . ... , '� �� DATE '-7 .. �— — NAME +� " _ --- � � ; , � _��; ;. �- � ��7 9 --- ----- . n�nr�ess �,., k`�t, . .y ';,�%� .�.� � P �� : `^ , C.�' i GTY PHONE. ., DA7F OF ORIGINAL MSTAlLAT10N .7 � �r'�... '� i ., _ ___—'_ �� ... - {.� � �'' / G..t, �AAYEE . z MO�PI,,,�"� � . .. , ._ . ; ��v ... G .�, ,. ,._.� � ,....,5 ... ' ESTIMA7E — — , .-i t .� _i. ` �",�� . : �... ., � . � t - --�� [..; WARRANTY - seaini.n oaTe aaonaisEo � ..._-- — � � � � ,J CONTRACT -- '-- —� NATURE O�SERVICE� � � � i J ` �� { . , ._. .t:�r . , � ::. . . .. _ �_. . .., ._.__. . -r � ,i �!' 0 ; ' ^ ' �� `,r � - _ , � 7: � " . , , , . ., , � . � � ;�,_ r , �".:... .::'..�� , . �.,�. .� .... ',._ . ,r �... .� .'' i.� . / , _ � (:�-."� . . , . .. . ._ . . %� __ _ j .. : . i� ; .: j .. � , � f . f ...f. . . ,< � � ,' :`� � r i:: . ` � , -- { `i j �;.. c ' , 4 — ._.... . � "�'7 t `"� f �`. � . . . . ... . . . .. . ... , , —_-----�--- � � �,�,., ..,x-.:. .. .,. . . ... �r3'�M rrm�.� �.bl.0 a..mm �M�V , -- -- —r — — - - ---__—_ -- — TOTAL MATERIALS ( ;^ f ;„,�. � � ` w TECHNICAL SERVICE T�ME: ❑ SNOP ❑ HOME E J : ` ` � t — --- --- ---- ._ I I � ❑ PICK UP OR DE�IVER ❑SERVIGE CALL CHARGE ——____ _—_�..--.�_ rEcr�taianN — _`_T------- -f I -- —�.— — -- --- —�--:-�� —""----" .—. DATE COMf'LLTE:L' �� TA�_—_" .'' '� . r ___ ` �. - � .�� r; ' __— --' ---'— —��—"-- r ON COMPLETION TOTAL ' '�� g -��' � CASH OFWORK — __ ,__. ____'�---_._ _ .__.....__..____�--- I ._.."---_—._ SIGNATURF.. TO�TAL MATERlALS ° ~ � 5�.y iture aoove c 'sl�ui,•5� t 1 3 . °I r .Yi�'.nnJi ,at.�tautnry and tt.at .qu a?m�m Y a�l:.. : .)� Guaranry on other side __ .�. _ __ __. _ ____._ _ COP __ _ _. _ __ __ ..._.._ _ __ �_ __ __ ___ __. _ __ �. __.. _., ___._ _ _ . _____ _ __ _ ... .. �. . _....._. ��1_�� s�{e� _ _ �� _ 1� �� _ _ _ _ �� °-�; __ _ �� `�-�..�� tc�.�e;� _ _ _ _ _ _ _ _ __ � G�_ _ _ _ _ . _ . � _ _ _ _ . _ � �� ,�� . � � ��,..._.._._._�___:___ _ � REV+1502 EX+ (11-08) � pennsylvania SCHEDULE A DEPAFiTMENT OF REVENUE INHERITANCE TAX REfURN REAL ESTATE RESIDENT DECEDENT ESTATE Of FILE NUMBER �Toh� � � �1�d��. �oi3-c�o� ��f All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule P. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• �U'Yl(�i TOTAL(Also enter on Line 1, Recapitulation.) $ (� If more space is needed,insert additional sheets of the same size. ' REV-1503 EX+(6-98) K r� SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF �I��,1 FILE NUMBER �C�lrl � • ��— L�G/�-�'�`� All property jointly-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM NUMBER DESCRIPTION OF DEATH 1. ��(�3r1� TOTAL(Also enter on line 2, Recapitulation) $ Q (�f more space is needed,insert additional sheets of the same size) REV-1504 EX+�,-9�, � SCNEDULE C - � � CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR IN RESIDE TED CED NTRN SOLE-PROPRIETORSHIP ESTATE OF� r FILE NUMBER _, o`�,►-, �, r�1 a�- �^� �'�- o0 5�'f Schetlule C-1 or C-2(including all supporting information)must be attached for each closely-held corporation/partnership interest of the decedent,other than a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. �c��— TOTAL(Also enter on line 3, Recapitulation) $ (� (If more space is needed,insert additional sheets of the same size) ' REV-1505 EX+(6-98) , �� SCHEDULE C-1 � CLOSELY-HELD CORPORATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN $TOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER .��hn F, r�ic�� 3- ��s�y 1. Name of Corporation �� State on Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year 3. Type of Business ProducUService 4• TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK VotinglNon-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred � Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes, provide amount of indebtedness$ 7. Was there life insurance payable to the corporation upon the death of the decedent? . . . . . ❑Yes ❑ No If yes, Cash Surrender Value$ Net proceeds payable$ Owner of the policy 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ❑Yes ❑ No If yes, ❑Transfer ❑ Sale Number of Shares Transferee or Purchaser Consideration$ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedenYs death? ....❑ Yes ❑ No If yes, provide a copy of the agreement. 10.Was the decedenYs stock sold? .......................................... .. ......... ❑Yes ❑ No If yes,provide a copy of the agreement of sale,etc. 11. Was the corporation dissolved or liquidated after the decedenYs death? ............ .. . ..... ❑Yes ❑ No If yes,provide a breakdown of distributions received by the estate, including dates and amounts received. 12.Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . ❑Yes ❑ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • • � • � � A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns(Form 1120)for the year of death and 4 preceding years. C. If the corporation owned real estate,submit a list showing the complete address/es and estimated fair market value/s.If real estate appraisals have been secured,attach copies. D. List of principal stockholders at the date of death,number of shares held and their relationship to the decedent. E. List of officers,their salaries,bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year.List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed,insert additional sheets of the same size) REV-1506 EX+(9-00) SCHEDIJLE C-Z PARTNERSHIP COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER �)��'1 n �� l�t 1�I�- �13- t�7 t75(� 1. Name of Partnership �'l� Date Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business ProducUService 4. Decedent was a ❑ General ❑ Limited partner. If decedent was a limited partner, provide initial investment$ 5. PERC�` P�t+t'�' : EALANCE�F PAR7`PIE�t NkME S?F�C�1U1� {'��WN�F�SF1iP C14PITAL 4kCC�UN't A. B. C. D. 6. Value of the decedenYs interest$ 7. Was the Partnership indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes, provide amount of indebtedness$ 8. Was there life insurance payable to the partnership upon the death of the decedent? . . . . . ❑Yes ❑ No If yes, Cash Surrender Value$ Net proceeds payable$ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ❑Yes ❑ No If yes, ❑Transfer ❑ Sale Percentage transferred/sold Transferee or Purchaser Consideration$ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedenYs death? . . . . . . ❑Yes ❑ No If yes, provide a copy of the agreement. 11. Was the decedenYs partnership interest sold? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes,provide a copy of the agreement of sale,etc. 12.Was the partnership dissolved or liquidated after the decedenYs death? . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes,provide a breakdown of distributions received by the estate,including dates and amounts received. 13.Was the decedent related to any of the partners? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑ No If yes, explain 14.Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . . . ❑Yes ❑ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • � • - • � � A. Detailed calculations used in the valuation of the decedenYs partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns(Form 1065)for the year of death and 4 preceding years. C. If the partnership owned real estate,submit a list showing the complete address/es and estimated fair market value/s.If real estate appraisals have been secured,attach copies. D. Any other information relating to the valuation of the decedenYs partnership interest. R�V-1507 EX+(1-97) Y � ►�s�, SCHEDULE D .', �� .�.- COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER ,J�vhn �. /-�Id��1 �-o►3-e�a�� All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH /t�c��e_- `�� ; ,. '�� t� • ' � _ ��.._.. . � �� , ---�--' � 7 t t i ` TOTAL(Also enter on line 4, Recapitulation) $ � (If more space is needed,insert additional sheets of the same size) REV-1508 EX+�1�97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS� a MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF r, FILE NUMBER �j�hr� �. i��c.�l� �-o ► 3-- C�v�G�� Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �. �1e.tro l3�nIL ��a��3 � -9�' 3�� ( Ptt.X�i-c� 5�-, � � �� a c� - � l �7 t�r �%i 7��3 _-__...._- j.-`Ct i r t s 6 tt�C'� � �C') / c�- GI o��`) l . �h e�.K�n ��, 0 53 f�'7t��5�.� � � �, _ � , � Re�w►�c�-�-`�rc.m {�dv�cec� P�M� ��-� `�'i�.�� . #�cc.�cle.,,:{-�.i+��,��. t'c�1i`cy �.��.��. �.�� ,s , c�= �/�Il�-YFcr�e� �ff r9�F93 ��,H��.o�, 3. 3. �,; �.� o--��--�,1��.��y ��-,�.. TOTAL(Also enter on line 5,Recapitulation) $ � �v o�7. �� (If more space is needed,insert additional sheets of the same size) , REV-1509 EX�(1-97) SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF ��j 3 -- �'7 p�(�� c��n � /�-ld�- If an asset was made joint within one year of the decedenYs date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT a. N��— B. C. JOINTLY-OWNED PROPERTY: o�oF DATE OF DEATH LETTER DATE DESCRIPTION OF PROPERTY DATE OF DEATH DECD'S VALUE OF ITEM FOR JOINT MADE Include name of firiancial institution and bank account number or similar identifying number.Att2ch VALUE OF ASSE7 INTEREST DECEDENT'S INTEREST NUMBER TENANT JOINT deed for jointly-held real estate. 1. A. TOTAL(Also enter on line 6,Recapitulation) $ � (If more space is needed,insert additional sheets of the same size) REV-1510 EX+ (08-09) � pennsylvania SCHEDULE G � DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT FILE NUMBER ESTATE OF �v�n F� �ld�,�- �-v 1 �� c�C��(n� This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE ITEM INCWDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSH[P TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLiCABLEj VALUE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1. /l�C'�'1'�-. TOTAL(Also enter on Line 7, Recapitulation) $ � If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-06) � � SCHEDULE H COMMONWEAISH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF `, � �� FILE NUMBER � hn �, �1 �3� � �-- c� �;��y� Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: �,,�" � � �']p.�L� �- 1. ��G��'rYl�-�'�C)t r� �-u.YZ��Gi.� ��►'�Lt�O t"y{�Gl[� , �.. �rm�r.� Fi4 h e r c�-l' ?-�t'�� '-- ��'c 1-4-I�I�;,rtau.,r+�e n�e-,.Xi-t�er-v�c.� 3v�c�o �L, �. i�'�.U. �hc�ro�,;n l-�a-Id��n,�.,,�n %...f�:ov 3 . �. G rG�E Z.I:�M C,Y'NUX�Q�' ZL5�c''�c.,�t�,rCQ.-t �rc�c`+G�. �D.�O b `t• � �,� a �ic"61'��- � �y�;�C�� 'vv1u..5+C-�'�'S�t`�ItC� �.Q .GtU � • �, <S�Y'Je.rS`c`�-� � � �� .�'C.��l�S�C��rS-r(� '_ ` �, Jc�n'.-{�r szfi'� :�t7: au c�. 7, Ft��r,�e��5 ��. z''� 7' s,�. GGd.e-��" ��K � ,i�l,e �� .�-�'�/ 3. �' �T'�1� l.�Gt;c"<<S�� S�<l�'iYl�t "��iif.S < � � c�- !T- ��T r i. �! � �cc�� nc't c f� /C? e. i� ��!jp f0, �fo ��S�s�-F-�l�.�aly-�'A:�-R�"l-+.ucrKo-� CGtrcf� �IC��.'�- 5.(c.,7� ��, g. ja• ADMINTSTRATIVE COSTS: t3�!�� —}�� Q��1'' �a� r�, �rG�.s h S �. Personal Representative'sCommissionsZSKe{'re 7rne.-�S�orc��trG{'gd�,� he1p. (��QyS) �,l�� c ' Name of Personal Representative(s) _ ��11�[�'1� �"�G�.�'y`_�_ ��'��`� f�� -- - - -- `�' Street Atldress ��_ :S_ ��-{�-__�}", '-'��`�� City�?c'�`C'�i�,�P .— State�Zip �_7D_l_ 3 Year(s)Commission Paid: �C'i� _ __ ___ ___ -- -- -- 2. Attomey Fees 3. Family Exemption:(If tlecedenPs adtlress is not the same as claimanYs,attach explanation) Claimant _ __ _ _- _ Street Address -- - — -- — — City State Zip __ __ ___ __ Relationship of Claimant to Decedent _ _____ __ -- - -- -- --- 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. TOTAL(Also enter on line 9, Recapitulation) $ " ^ q � ��-�j (If more space is needed,insert additional sheets of the same size) REV-1512 EX+ (12-08) � pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF �., p FILE NUMBER :�C=�31�'1 �� 1 �G13" GU�� Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH i. Q Q,.�td.�.r I—�n t`, ! 7.7 O � . �F Pf_ ��-�=`�`"<<= �� •��... �,�, E1l�.� �0�99 V tt CV�#�e��.;,�s�Fa;rs) 7`�,q� �' '� �ct�i�-C'.�J act�fC C t3l�t'i r� C��/8'. FS�' �fi� co��e�� c �i�.�z��-r� r �' � �° ��' Se ru'�cE 5 � �c� �,r f�C�11 � �Joh�`� sh�..�--e_�'�sr,�rssr�-+b;��) 3�n- 7r �1GC1�'�'t'dGC �Gt.��u" TOTAL(Also enter on Line 10, Recapitulation) $ v!�--v � � � If more space is needed, insert additional sheets of the same size. RE�-1513 EX+ (11-OS) � pennsylvania SCHEDULE � DEPARTMENT OFREVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT � ESTATE OF FILE NUMBER �C�r��, l��c�P..�v�. RELATIONSHIPTO 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. 2116(a) (1.2).] 1. 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 2113 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, insert additional sheets of the same size. REV-1514 EX+(12-03) SCHEDULE K . LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA & TERM CERTAIN INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4 on REV-1500 Cover Sheet ESTATE OF FILE NUMBER ,�'�h� � �(d�- �-c� � 3 -- c3v.s�y This schedule is to be used for all single life,joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ❑ Will ❑ Intervivos Deed of Trust ❑ Other • NAME(S)OP LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE iS PAYABLE ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interest table rate—❑ 3 1/2% ❑6% ❑ 10% ❑ Variable Rate % 3. Value of life estate(Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ • NAME{S)OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABLE ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding (number) . . . . . . . . . . . . . . . . . . . . . . . . . . Frequency of payout—❑ Weekly(52) ❑ Bi-weekly(26) ❑ Monthly(12) ❑ Quarterly(4) ❑ Semi-annually(2) ❑ Annually(1) ❑ Other( ) 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Annuity Factor(see instructions) Interest table rate—❑ 3 1/2% ❑ 6% ❑ 10% ❑Variable Rate % 6. Adjustment Factor(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity— If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period,calculation is: (Line 4 x Line 5 x Line 6)+ Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ NOTE:The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return.The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed,insert additional sheets of the same size) REV-1644EX+�3-oa� INHERITANCE TAX -. SCNEDIJLE L COMMONWEALTH OF PENNSYIVANIA REMAINDER PREPAYMENT `/ IN RESIDE TEDE EDENTRN OR INVASION OF TRUST PRINCIPAL FILE NUMBER e�-t'j�'Cj C?J��T I. ESTATE OF �i �1'l.. �}1vl • (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II, REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on _ (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Stocks and Bonds . . . . . . . . . . . . . . . . . . . . . . . . . .$ 3. Closely Held Stock/Partnership . . . . . . . . . . . . . . .$ 4. Mortgages and Notes . . . . . . . . . . . . . . . . . . . . . . .$ 5. Cash/Misc. Personal Property . . . . . . . . . . . . . . . .$ 6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 3. Value of Unincludable Assets . . . . . . . . . . . . . . . . .$ 4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ E. Total Value of trust assets (Line C-6 minus Line D-4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$ F. Remainder factor(see Table I or Table II in Instruction Booktet) . . . . . . . . . . . . . . . . . . . . . . . . . G. Taxable Remainder value (Line E x Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of corpus (Month, Day,Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed • � � � - � � � � � ' '� D. Remainder factor(see Table I or Table II in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . . . E. Taxable value of corpus consumed (Line C x Line D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) � PEV-16d5 EX+ ��-85� INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH Of PENNSYLVANIA REMAINDER PREPAYMENT ELECTION '/ INHERITANCE TAX RETURN FILE NUMBER ��'��`��"�5�7' RESIDENT DECEDENT -ASSETS— I. Estate of �� Q �� Last Name) (First Name) (Middle Initial) II. Item No. Description Value A. Real Estate (please describe) Total value of real estate $ .� (include on Section II, Line C-1 on Schedule L) - B. Stocks and Bonds (please list) Total value of stocks and bonds $ ,.� (include on Section II, Line C-2 on Schedule L) C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ ,� (include on Section II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (pleose list) Total value of Cash/Mist. Pers. Property $ (include on Sedion II, Line C-5 on Schedule L) 111. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $ (If more space is needed, attach additional 8'/s x 11 sheets.) REV-1646 EX+ (3-84) INHERITANCE TAX � SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION IN RESIDENTED CEDENTRN —CREDITS— FILE NUMBER �U i3—UG�SG�� I. Estate of �'C� F�iv'�- cT�� ` (Last Name) �First Name) (Middle Initial) II. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities S (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests S (include on Section II, Line D-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets S (include on Section II, Line D-3 on Schedule L) ��, TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ (If more space is needed, attach additional 8'/z x 1 1 sheets.) REV-1647 EX+(9-00) SCHEDULE M - FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4a on Rev-1500 Cover Sheet FILE NUMBER ESTATE OF � r3�'.�_��.�� ,�,,� � A-l��.�. This Schedule is appropriate only for estates of decedents dying after December 12,1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. � W�� ❑ Trust ❑ Other I. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedenYs death,check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ❑ Unlimited right of withdrawal ❑ Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Value of Line 1 exempt from tax as amount passing to charities,etc. (also include as part of total shown on Line 13 of Cover Sheet) . . . . . .$ 3. Value of Line 1 passing to spouse at appropriate tax rate $ CheckOne ❑ 6%, ❑ 3%, ❑ 0% • • • • • • • • • • • (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ❑ 6%, ❑ 4.5% . . . . . . . . . . . . . . . . . . . . . . . . . . .$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate(12%) (also include as part of total shown on Line 17 of Cover Sheet) . . . . . .$ 6. Value of Line 1 taxable at collateral rate(15%) (also include as part of total shown on Line 18 of Cover Sheet) . . . . . .$ 7. Total value of Future Interest(sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . .$ (If more space is needed,insert additional sheets of the same size) V 1649 EX+(08-09) �� pennsylvania SCHEDULE O .� DEPARTMENT OF REVENUE ELECTION UNDER SEC.2ii3(A) INHERITANCE TAXES RETURN ($pOUSAL DISTRIBUTIONS) RESIDENT DECEDENT FILE NUMBER ESTATE OF r n��ry,�, �'n � 3'� Q��4' �p�� '� of the Inheritance and Do not complete this schedule unless the estate is making the election to tax assets under Section 2113(A) Estate Tax Act. ass,Unified Credit,etc.). Trust(marital,residual A,B,by-p If the election to more than one trust or similar arrangement,a separate form must be filed for eac trus , This election applies to the If a trust or similar arrangement meets the requirements of Section 2113(A)and: a.The trust or similar arrangement is listed on Schedule 0 and ional ortion or percentage)to be included in the election to ha d as a taxable translfer on per- b.The value of the trust or similar arrangement i fractered p whole or in part as an asset on Schedule 0,then the transferor's personal represen a- tive may specifically identify the trust(all or a is include ty treated as a taxable transfer in this estate.If less than the entire value of the trust or similar property' t of the trust or similar arrangement included as a taxable asset on Schedule 0.The denomi- Schedule 0,the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangemen . The numerator of this fraction is equal to the amoun nator is equal to the total value of the trust or similar arrangement. r the description and value of all interests, both taxable a Samilar arrabgeme�ntrdless of location, which pass to the PART A:Ente trust o Value decedent's surviving spouse under a Section 2113(A) Description Part A Total $ � : Enter the description and value of all interests included in Part A for which the Section 2113(A) election to tax is PART B va�ue being made. Description part B Total $ � If more space is needed, use additional sheets of paper of the same size.