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Home My WebLink About06-22-15 (2) �`�` pennsylvania 15 0 5 618 4�3 � �� UEPARTMENTOFREVENI�X�03-�4� t OFFICIAL USE ONLY REV-1500 County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po gox 2soso� 2 y 15 0 319 Harrisburq PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDWYY Date of Birth MMDDYYW 02 26 2015 ❑8 31 1928 DecedenYs Last Name Suffix DecedenYs First Name MI HYKES LAURA R (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return � 2. Supplemental Return � 3. Remainder Return(date of death priorto 12-13-82) � q, Agricultural Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) � 7. Decedent Died Testate � 8. Decedent Maintained a Living Trust _ �_ 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) � 10. Litigation Proceeds Received � 11. Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) � 13. Business Assets � 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number JAMES D HUGHES ESQ 717 249 6333 First Line of Address 354 ALEXANDER SPRING RO Second Line of Address City or Post Office State ZIP Code CARLISLE PA 17015 CorrespondenYs email address: Jhuqhesna satzmannhuahes com �� (� � REGIS7�ER Q�}WILLS U�ONLY�;:y r' ;,y �- _ `,-7 REGISTER OF W ILLS USE ONLY �ry � � r,",! - C:.* � ., . i DATE FILED MMDDYYYY � ..... �� , _:.. CV �7 �, � ` �,�I � ',: �:> DA7E'FIL�D STAMVv . "�7 ,.. _..,.i �'.�i � (tiJ �' -�`1 : C1�1 Side 1 I I�II�I IIIII IIIII IIIII IIIII IIIII II�II IIIII IIIII IIIII IIII IIII I..� 1505618403 1505618403 � � � J1505618411 REV-1500 EX DecedenYs Social Security Number oecedent'sName: Hykes� Laura Romaine _J rxEca�irur..A�ror� 1. Real Estate(Schedule A)--•-••••--------�--------------•-------------......__._................................ 1. 2. Stocks and Bonds(Schedute B)............................................................................. 2- 3. Closely Held Corporalion,Partnership or Sole-Proprietorship(Schedule C)......... 3_ 4. Mortgages and Notes Receivable(Schedule O).................................................... 4. 5. Cash,Bank Deposits and Misce!laneous Personal Properry(Schedule E).......... 5. 13,3,4 2 4 . 15 6. JoinUy Owned Properiy(Schedule F) ❑ Separafe Billing Requested............ 8. 7. lnter-Vivos Transfers�4 Miscellaneous(Yon-!'robate Property . (5chedule G) ❑ Separate Biiling Requested...._....... 7. 7 5,9 3 5• 4 D 8. Total Gross Assets(hotal Lines T through 7}-•••••.................•----------------................ 8. 18 9,3 5 9 - 5 5 9. Funeral Expenses and Adminisirative Costs(Sched�le H).................................... 9. 14,4 7 8 • �5 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 3,2 8 3 • 9 5 11. Total Deductions(total Lines 9 and i0)-----------------••-••-...-•----._.............................. 11. 17,7 6 2 -2 0 42. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 17 7,,5 9 7 • 3 5 13. Charitable and Gavemmerrtal 8equestslSec 9113 7rusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Va[ue 5ubject to Tax(Line 12 minus Line 13)............................................... 14. 171,5 9 7 • 3 5 TAX CALCULATION-SEE[NSTRUC7'IONS FOR APPLICABLE RATES 35. Amount of Line'14 taxable at the spousal tax rate,or transfers under Sec.99 i 6 (ax1.2}X_00 15. 0 • 0 0 16. Amaunt of Line 1d taxable at lineaf rate X .045 171,5 9 7 • 3 5 16. 7,7 21 . 8 8 17. Amount of Line 94 taxable at sib[ing rate X.12 0- �� 1�• � •�� 98. Amounf of Line 14 taxable at collateral rate X.15 �- �0 '�8- d • �� 19. TAX DUE................................................................................................................ 19. 7,7 21 •8 8 20. FILL IN 7HE OVAL EF YOU ARE REQUESTING A REFUND OF AN OYERPAYMEN7 � Under penaldes of perjury.I dedare I have examined this retum,Sncludfng acoompa�rying schedules and statements,and to the best of my kno�uledge and belief, it ffi true,correct and complete.Dedaration of preparer other tlian the person responsble for filing the retum is based on a11 informa6on of whlch preparer has any krtowledge. S1G RE O ER�ON RE� LE FOR Flll(G�RE'T��e K�n�eth D Hykes �A� / ...�� f� �� AdDRESS 54 Chestnut ' o Gardners,PA 17324 SIGIdANRE OF ER RESENTATNE James D. Hughes Esq. DATE 'D '� ADDRESS 354 AI xan r Sp ' g Road,Suite 1,Carlisle, PA � l Nlfl[(�I Illll I�IiI il(11 Illll 11111 l�il IIIII IIII Ilfl S'de 2 � b5D5618411 15�561841b PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Hykes, Laura Romaine 21-15-0319 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#2 �� '� � Name Laura J Byers Address1 193 Carlisle Road Address2 City, State,Zip Newville PA 17241 Date �2 —Zz -/S REV-1500 EX Page 3 File Number 21-15-0319 Decedent's Complete Address: DECEDENT'S NAME Hykes, Laura Romaine __._,_ STREET ADDRESS Green Ridge Village ______ 210 Big Spring Road ___. __ CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 7,721.88 2. Credits/Payments A. Prior Payments 7,000.00 B. Discount 368.42 Total Credits(A +B) (2) 7,368.42 3. Interest �3� 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 353.46 Make Check Pa able to: REGISTER OF WILLS, AGENT. ,�,y., �� i��' �y3 ,, 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:............................................................................... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... x 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 ❑ ❑ receivingadequate consideration?.................................................................................................................... 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ �x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑ contains a beneficiary designation?.................................................................................................................. X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. tY'� ,4�, Ht�- ��-{• d ':a3i� �;;�,'. �' . . � �d�; ... 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 January 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 decedenYs 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. .:�w nrn...ii.n.��. M Rev-7508 EX+(08-12) SCHEDULE E � pennsylvania CASH, BANK DEPOSITS, 8� MISC. _�- DEPARTMENT OF REVENUE p E RS O NAL P RO P E RTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hykes, Laura Romaine 21-15-0319 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 1 Cash On Hand-cash found in decedenYs purse 1.85 2 Green Ridge Village-savings account at nursing home 220.03 3 Santander Bank Checking Account#2891032527-date of death balance 98,680.46 4 United States Treasury-social security deposit(reclaimed as shown on Schedule I) 2,296.39 5 Members 1st Checking Account#7287-00-date of death balance 1,177.44 Accrued interest on Item 5 through date of death 0.08 6 Members 1st Investment Savings Account#7287-05-date of death value 6.025.22 Accrued interest on Item 6 through date of death 0.41 7 Members 1st Life Savings Account#7287-04-date of death value 4,000.00 Accrued interest on Item 7 through date of death �•27 8 United States Treasury-2014 federal income tax refund 1,022.00 TOTAL(Also enter on Line 5, Recapitulation) 113,424.15 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12) � . . � . � . � .. � � L ROMAINE HYKES Account!i 289f 032527 KENNETH D HYKES ATTY IFF Balances 6� innin. �a1�n€�.... : ��rrent$afance ;i . .. : $'E.Ot�,9�2��. .: :.. .... �;it�€�,9�1.:��... Deposits/Credits � +$2,298J5 Average Daily Balance $101,883 40 VVith�i�+Na�b� .. .:: $40,�97:5�... ; ; : Interest t�a�d.��s�n4d'* ": . : ��6 ;Annu�1�?ercaniag�'Yie�r�C�rn��( ' (3;G13�'�0 Earned this Periad $2-34 Paid Last Year � �� $�6?0 � #'3t�1�'�ar,�"ca E�ac� __.::: ': b8;0E.. = ;:: _...�__ _.W:=��._._ .;: . ._. _________ , ... *The interest earned and the interest paid may drffer depending on when interest is credited !O yOUf�CCOU.^:i. Checks Posted Check# Date Paid Amount Reference Check# Date Paid Amount Reference 2�1� (}�/24: $1�a24c��5;. . . ... :: 497��€�4�1. 2�18 63lQ� �6;:49 :;:�975658545.;; 2517 03/09 550.10 0975525565 3 Check(s)Posted=510,297.54 Account Activity Date Description Additions Subtractions Balance 02-19 Beginning Balance $108,921.41 t��::�t��c�aoo�na�zs��...:... . :... . ...::..... ;... .. ��;i�aa�ss: . '��s,�ao��: ** 03-02 XXUS TREASURY 312 XXCIV SERV030115 F 2130123 W CSF $2,Z96.39 $100,976 85 :; , `$tt�Ci,970,36: �13..9'CN��K�#E10�QOt1tk2�� : S��9;: 03-09 CHEIX 000000002517 J $50 10 $100,9�0 76 031?;�tJ"CEItES;TCCtE�7iT"�Ri)M{��!}61��1;��`f��3/,:15f2�t5 ; . ;: ;: $��"a. ;; . €' $40��2.62: —_`_ 03-18 Ending Balance $100,922 6? **Date of c�eath value = $9�, 680 .�6 page 2 of 5 �RQ�n3�S» St 0 MEMBERS lst FEDERALCREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 7287-00 Date Account Established 06/16/1964 Principal Balance at Date of Death $1,177.44 Accrued Interest to Date of Death $0.08 Total Principal and Accrued Interest $1,177.52 Name of Joint Owner None LIFE SAVINGS ACCOUNT: Account Number/Suffix 7287-04" Date Account Established 06/16/1964 Principal Balance at Date of Death $4,000.00 Accrued Interest to Date of Death $0.27 Total Principal and Accrued Interest $4,000.27 Name of Joint Owner None '`Rollover from 7287-00 on 02/01/2001. INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 7287-05 Date Account Established 11/04/1993 Principal Balance at Date of Death $6,025.22 Accrued Interest to Date of Death $0.41 Total Principal and Accrued Interest $6,025.63 Name of Joint Owner None IRA SAVINGS/CERTIFICATE: Account Number/Suffix 7287-10" *This information will be supplied by an IRA Specialist under a separate mailing. Any questions can be directed to an IRA Specialist at 717-697-1161, extension 5715 or 5707. MEMBERS 1ST FEDERAL REDIT UNION l./ Tessa L Klugh Lending Insurance Support Specialist April 2, 2015 Estate of: LAURA ROMAINE HYKES Date of Death: 02/2612015 Social Security Number: 182-38-7487 5000 Louise Diive • P.O. Boa 40 • 1��Iechanicsbutg, Peuns�-lirania 17055 • (�,00) 283-2328 • ��n��memberslstor� Rev-7 57 0 EX+(08-09) SCHEDULE G , pennsylvania lNTER-VIVOS TRANSFERS AND � DEPARTMENTOFREVENUE MISC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hykes, Laura Romaine 21-15-0319 This schedule must be completed and filed if the answer to any of queslions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER T E DATE OF TRANSFERSATTACFi A CO Y OF TI�HE DEED FOR RFE.a�,�ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Fidelity Investments IRA Account#00064974868- 4,869.56 4,869.56 named beneficiaries are decedenYs four children- date of death value 2 Members 1st IRA Savings Account#7287-10-named 2.848.61 2,848.61 beneficiary was decedenYs deceased husband with no contingent beneficiaries designated; payable to the estate-date of death value 3 Reliance Standard Annuity Contract#K700001426- 68,217.23 68,277.23 named beneficiaries are decedent's four children- date of death value TOTAL(Also enter on Line 7,Recapitulation) 75,935.40 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) .w� ni�n-�n�n•r�� e Transaction Confirmation Date :05/08/2015 /�ide/i � / /V VESTMENT� 0�00�9 BBKMRWBBBBGDL SD1 CON FI RMATION FMTC CUSTODIAN IRA Account#00064974868 FBO L ROMAINE HYKES AMERICAN PORTFOLIOS FINANCIAL SERVICES I 54 CHESTNUT RIDGE RD PO BOX 1243 GARDNERS, PA 17324-9064 LEBANON, PA 1 7042-1 243 Rep. Name: BUTTACAVOLI Dealer#:4515 Rep.#:C60 Branch#:656 ; ,; ' -:."�'1�A1'st�fl�'�"IC��I;A�"C`��f ITY :. FIDELITY ADV HEbLTH CARE-CL A Fund#0177 Account#00064974868 CUSIP#315918847 Transaction Front-End Trade Dollar Share Share Description Sales Charge Date Amount Price Amount Transfer Debit To 05/08/15 $(1,217.42) $43.24 (28.155) g Adv-Hc-A 01483329973 $ TransferDebitTo 05/08/15 (1,217.38j 43.24 (28.154) g Adv-Hc-A 01483329957 � Transfer Debit To 05/08/15 (1,217.38) 43.24 (28.154) g Adv-Hc-A 01483329932 o Transfer Debit To 05/08l15 (1,217.38) 43.24 (28.154) m Adv-Hc-A 01483329924 � U F- � This account summary is for informational purposes only,please review your account statement for more details. � `: , ; fi►.�`,.��.'r��T�'1:��11U1A�1f. ' - , . ' Sha�e`�al�ne�s(�s t�t'{��t��l�(�15) :', _.. : . .. . Fund Name Fund# Shares Held NAV Market Value '' FIDELITY ADV HEALTH CARE-CL A 0177 0.000 $43.24 $0.00 Toial Value $0.00 Web Address:advisor.fidelit .com Fidelity Distributors Corporation enera is n ution Agent Regular Mail:Fidelity investments lnstitutional Operations Company,Inc.,PO Box 7700 2 Cincinnati,OH 45277-0083 Overnight Delivery:Fidelity Invesiments Institutional Operations Company,Inc.,100 Crosby Parkway Mailzone KC1 G,Covington,KY 41 0 1 5-43 25 PAGE 1 of 2 OP=FCCM M#20150508 DFC BBKMRWBBBBGDL BBBBB �a� � •i i i� � r�-�� •, .�i�i.�,a �� -r� r�; i� ii �..r.i•i a. �•�t��n:a�,-az:.•i:va+,e�:i��a+,�.n �:ea.•_t-x� ��'�•�V+ie.�."�"-�:t_-ia::h��t:��.7�a>��:t�.-�'��n e�:l��V�11:�_a'[.1JSrv'�;9A st No, 0001023556 MEMBERS 1St _ Issued By:hloneygram Payment Systems,Inc. __ P.O.Box 9476,Minneapolis MN 55480 m FEDERAL CREDIT UNION - - Drawee: BOKF,NA P.O.BoX 40 EUFAULA,OK q Mechanicsburg,Pennsylvania 17055 49�55 � _—_= io3� 05/20/15 *** TWO HUNDRED TWELVE DOLLAR.S AND 50 CENTS *** _ $212 . 50 PAY EXACTLY��2 � 2 Dollars ,rj Q Cents two ene two aon�r� r�re zero eems OFFICIAL CHECK Dra��^,;er. MEMBERS 1ST FEDERAL CREDIT UNION � TOTNE ESTATE OF L ROMAINE HYKES ll ORDER OF lV�;'0 SIGNATURES REQUIRED FOR CHECK OVER$2,500.00 C/O KENNETH D HYKES � 54 CHESTNUT RIDGE RD GARDNERS PA 17 3 2 4-9 0 6 3 CONTR ER � ��■000 LO 2 3 5 5 6�i' �: LO 3 L00 5 5 L�:O L 600 L L 30 4 78 2i�■ ---- - - - -- _ _ __ ._ _-,-:--------- - -------- - - -- -- . . _._ . __________ _ ______ ,. . . -. . ,. . . . . .• st No. 0001023558 MEMBERS 1St _= Issued E3y:Moneygram Payment Systems,Inc. - P.O.Box 9476,Minneapolis MN 55480 •FEDERALCREDIT UNION Drawee: BOKF,NA P.O.BOx 40 EUFAULA,OK ' Mechanicsburg,Pennsylvania 17055 49=55 � __ 06/16f2015 14:16 17172490296 LANDIS & CO FIN�NCIA PAGE �2/02 �'roy H. La�dis, CFP .L,�ANDTS � CQ. �NANCTA� SE,�tVIC�CS, LLC 74 Weat Pomfret St�reeti Carlisle, �A, 1741.3 (7�� za�s-��z2 �a� (717) 2►�9-OZ96 June 1.0, 2015 S.A,LZMA,NN& HUGk�ES AT'�'N; Jul i E M�tz �.�: Estat�� of L.. Rot�na.zn.e Hykes I7ear. Ju1ie: My cl.x�nt above k�.ad o�� account wiL•h. Rel�ance Stan.dat��i Life �.t��urance Campany (No. K700001426) and xlxc d�,t� of death va:l.u�e was $68,217.23. Rom.ain.e also had an account with Fi.del.ity �n.vestaments (ZVo. OOQ64974$C�8) in wl�ict� we ar� u.nable 1:0 obtai�vez�ba.l infvnnatiox� as Z a.in n.�t 1.isted as tJ�e broke.r on this account, Upon completi.n.g tk�� necessary paperwoxk for th.� beneficia�i.�s, I was ab�e to s��that each of�l�e foux bet�e�ci.az�i.�s received approxirrat��y $�,217.3$ for a total 0�$4,869.52. This may or inay n.ot have b��n the date o� death v�.lue. R��n�ine had an. accaunt iuith Fidelit� �.nd Gu�.r.anty I��'� Inauranca Compntty (Plo. Z.,9017193) but it was cl.o�ed xn Jun�, �013. S�.n.cexc�Y, � l T�'�y H. Landis TI-:Ci�/�11 Re�istered Kepresentative o�'and Securities ot�ered 1�rou�h Voyfl�'inancial Ad.visors,Inc.,M�mber SIPC, Landis&Co.Financiaf Services,i,i..0 is not a sabsidiary of nor controlled by Voya Fina.neial Advisprs. REV-1577 EX+(08-13) SCHEDULE H . pennsylvania � DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Hykes, Laura Romaine 21-15-0319 DecedenYs debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q, FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Kenneth D. Hykes Laura J Byers Street Address 54 Chestnut Ridge Road city Gardners state PA zio 17324 Year(s)Commission Paid 2015- Ken only 4,377.20 2. Attorney's Fees Salzmann Hughes, P.C. 9,504.39 3, Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zio Relationshi�of Claimant to Decedent 4. Probate Fees 320.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 276.16 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 14,478.25 Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13) .��. ��.,, ,,..,.- � SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Hykes, Laura Romaine 21-15-0319 _ ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Cumberland Law Journal-legal advertising fee 75.00 2 The Sentinel-Legal -legal advertising 201.16 H-67 276.16 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(72-12) SCHEDULE 1 -, pennsylvania DEBTS OF DECEDENT, .____ � DEPARTMENTOFREVENUE MORTGAGE LIABILITIES AND LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hykes, Laura Romaine 21-15-0319 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 Checks Written Prior to Death -which cleared after death 56.59 2 Darryl Guistwite, DO-medical services rendered prior to death 199.86 3 Darryl Guistwite, DO-medical services rendered prior to death 199.09 4 Green Ridge Village-nursing home services rendered prior to death 229.57 5 Holy Spirit Hospital -services rendered prior to death 35.33 6 Holy Spirit Hospital -services rendered prior to death 4.65 7 Holy Spirit Hospital -services rendered prior to death 7•$7 8 Millenium Pharmacy-services rendered prior to death 197.08 9 Millenium Pharmacy-services rendered prior to death 57.52 10 United States Treasury-reclaimation of February social security deposit 2,296.39 TOTAL(Also enter on Line 1Q, Recapitulation) 3,283.95 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-12) REV-1573 EX+(07-70) . pennsylvania SCHEDULE J - DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER H kes, Laura Romaine 21-15-0319 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee s I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 1 Christopher J Byers Grandson $2,000.00 390 Mohawk Road Newville, PA 17241 2 Laura J Byers Daughter 25%of residue 193 Carlisle Road Newville, PA 17241 3 Michael L Byers Grandson $2,000.00 46 Sir William Drive Newville, PA 17241 4 Janet N Dick Daughter 25%of residue 942 Virginia Avenue Lancaster, PA 17603 5 Sanjay Rajiv Kevin Dick Grandson $2,000.00 942 Virginia Avenue Lancaster,PA 17603 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) SCHEDULE J BENEFICIARIES (Part I,Taxable Distributions) ESTATE OF: Laura Romaine Hykes 02/26/2015 182-38-7487 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Sunil Ravi Dick Grandson $2,000.00 942 Virginia Avenue Lancaster, PA 17603 7 Joshua D Hykes Grandson $2,000.00 54 Chestnut Ridge Road Gardners, PA 17324 8 Kenneth D Hykes Son 25%of residue 54 Chestnut Ridge Gardners, PA 17324 9 Tylor Hykes Grandson $2,000.00 238 Revere Street Harrisburg, PA 17109 10 Nicole E Lester Granddaughter $2,000.00 2776 Eton Street Myrtle Beach, SC 29579 11 Joseph C McLaughlin Grandson $2,000.00 PO Box 300 York Springs, PA 17372 12 Joyce A. M. McLaughlin Daughter 25%of residue PO Box 300 York Springs, PA 17372 13 Laura M Minor Granddaughter $2,000.00 4 Cardamon Drive Mechanicsburg, PA 17050 1 ,.�.z:�^1�IP"Ii....l�..�..h�r.. R LAST WILL AND TESTAMENT I, L. ROMAINE HYKES, of Dickinson Township, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this will, shall be paid by the Executor or Executrix of my estate. TWO. I authorize and empower my Executor or Executrix, at his or her discretion, to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and empowered to engage in any business in which I may ne engaged at my death, for such period of time after my death as seems expedient to said Executor or Executrix. THREE. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my to be distributed in the following manner: � � �� a) I hereby give and devise to each of my grandchildren living at the time of my death a sum of Two Thousand Dollars ($2,000.00). For each said grandchild that has attained the age of twenty-one (21) years at the time of my death, their share shall be distributed as soon as convenient after my death as my Executor or Executrix deems appropriate. For each said grandchild that has not yet attained the age of twenty-one (21)years at the time of my death, their share shall be held in trust in accordance with Paragraph Four hereunder. b) I hereby give, devise and bequeath a11 of the rest, residue and remainder of my estate of whatever nature and wherever situate in equal shares to my children, Laura J. Byers, Janet N. Dick, Joyce A. M. McLaughlin and Kenneth D. Hykes, per stirpes, which provides that the child or children of any deceased child shall take the share their parent would have taken if living. FOUR. In the event that any of my grandchildren are under the age of twenty-one (21) years at the date of my death, then their share pursuant to Paragraph Three (a) hereof shall be held in trust by the hereinafter mentioned trustee according to the following terms and conditions: This trust shall be divided into equal shares with said shares being maintained separately throughout the duration of this trust. The trustee, as well as my Executor or Executrix, as the case may be, is hereby authorized to retain, unconverted, any property, real or personal, that I may own at my death and shall be under no duty to convert it into legal investments. The trustee shall have the power and authority to sell, transfer, convey, invest and reinvest and to pay over the net income of the trust property, to or for the use of my grandchildren, or to accumulate it in the sole discretion of the trustee. The trustee is also authorized and empowered to pay over to, or for the use and benefit of my grandchildren such portion of or all of their respective share of the principal of the trust estate as in the trustee's sole discretion seems proper for their continued support, maintenance, education, medical care or general welfare. NIy primary object is to ensure ��1r 2 the continued support, maintenance, education and medical care of my grandchildren until they reach the age of twenty-one (21) years. When each respective grandchild reaches the age of twenty-one (21) years, then whatever remains of income and principal of their respective share of the trust estate shall be distributed said grandchild, per stirpes, which provides that the child or children of any deceased grandchild shall take the share their parent would have taken if living. FIVE. I nominate and appoint Kenneth D. Hykes and Laura J. Byers as Co-Executors of this my Last Will and Testament. If my either of the above-named Co-Executors becomes deceased or is unable to serve for whatever reason, then in that event the remaining Co-Executor shall serve alone as Executor or Executrix of this my Last Will and Testament.. SIX. I nominate and appoint Kenneth D. Hykes to serve as trustee of the trust created in Paragraph Four hereof. It is my desire that Kenneth D. Hykes serve in such a capacity without compensation as a service to our family. SEVEN. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty(60) days. EIGHT. No Executor, Executrix or Trustee acting hereunder shall be required to post a bond or any other surety in this or any other jurisdiction. NINE. If any provision of this Last Will and Testament or any codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all of the remaining provisions thereof shall continue to be in full force and effect, so far as is possible and reasonable. ��• �1 3 IN WITNESS WHEREOF, I have hereunto set my hand and seal this 17th day of March, 1994. v SEAL 7��,yy- x��-.� ( ) L. ROMAINE HYKES Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ��LcyC- G�.> „�'/J �— j , � 4 ACKNOWLEDGMENT AND AFFIDAVIT WE, _L. RONIAINE HYKES, SHARON L. SCHWALM and CHERYL L. CLELAND, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound rrind and under no constraint or undue influence. � ��-�� L. ROMAINE HYKES �l HARON L. SCHWALM ,�� / �'/`�> > CHE L7.. CLELAND COMMONWEAL,TH OF PENNSYLVANIA . :SS: COUNTY OF CUIVIBERLAND . Subscribed, sworn to and acknowledged before me by L. 120MAINE HYKES, the testatrix herein, and subscribed and sworn to before me by SHARON L. SCHWALM and CHERYL L. �LE�,A'�'D, witnesses, this�day of March, 1994. 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