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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV-1500 EX + (1-97)
OFFICIAL USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT
CHECK
APPRO-
PRIATE
BlOCKS
CORRES-
PONDENT
RECAPlT -
ULATIOM
TAX
COMPII1'A-
TlON
FILE NUMBER
t:J1 0/
COUNTYCQOE YEAR
oJ .;:bD
NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INmAL)
Luckenbill Ella Ma:
SOCIAL SECURllY NUMBER
177-24-4699 03 28 99
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (L.AST, SOCIAL SECURITY NUMBER
f:IRST, AND MIDDLE INITIAL)
DATE OF BIRTH
07 16 1904
11115 RETURN MUST BE FILED IN DUPUCATE
WI11I 11IE REGISTER OF WILLS
3. Remainder Return
(dateoi death prior to 12-13-&2)
5. Federal Estate Tax Rtm. Required
o 8. Total No. ot Sate DeposIt Boxes
11. ElectiontotaxunderSec.8113(A)
AttAchSch
...............i.~_'tiiili1Jmmitj'Mt
1. Orlginal RetUrn
4. Umited Estate
6. Decedent Died Te.tate
(Attach capy of Will)
9. . ation Proceeds Received
2. Supplemental RetUrn
4a. Fu1urelnterest Compromise
(date of death after 12-12-82)
7. Oecedent Maintained a living Trust
(Attach copy of Trust\
10. Spousal Po....rty Credit(d.lte of death betw..n
'2-3'-91 and 1-'-95
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COMPLETE MAILING ADDRESS
501 Washington Street
P. O. Box 942
Readi.ng, PA 19603-0942
NAME
John S. H:i!:lschlan,
FIRM NAME (II Applicable)
Bar 1 Senft & O:>hen, I.J..C
TELEPHONE NUMBER
(610) 376-6651
1. Real Estate (Schedule A)
2. Slocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership
or SoIe-ProprletorshIp
4. MortgagGS & Notes Receiv_ (Schedule D)
5. Cash, Bank DeposIIs & Miscellaneous Personal
Property (Schedule E)
6. Jointly 0WI1ed Proper1y (Schedule F)
7. Inter-VIVOa T....-s & MIeoeIlaneous
Non-Pro_ Property (Schedule G or L)
(1)
(2)
N::lne
N::lne
OFFICIAL USE ONLY
(3)
(4)
Nooe
N::lne ..
.,:- ,
(5)
(6)
N:::IIie
7,453.14
(7)
Nooe
8. T___{IolaIUnes1-7)
9. Funeral Expenses & AdmlnIo1ra1lve Costs (SCh..". H) (9)
10. Dobis ot Decedent, Mortg. UabilItIes, & LIens (Sch. Q (10)
(8)
2,485.00
598.20
7,453.14
11. T_ DacIuc:lIon8 (1otal Unes9 & 10)
12. Net v_ of EalaW (Une 8 moos Une 11)
13. Charitable and _ Bequests/Sec 8113 Trusts
for which on _n to tax has not been made (Schedule J)
(11)
(12)
3,083.20
4,369.94
N::lne
(13)
14. Net V_ to Tu Una 12 mnue Una 13
15. Amount 01 'ne 14
taxable lithe epouSll
~~ x~
See Instructions on p_ 2 for applicable percentage
18. Amount ollne 14
taxable at 6% rate 4 ,369.94 X .06
17. Amount of line 14
taxable at 15% rete 0.00 x .15
18. Tax Due
18.
4 369.94
14
(15)
(16)
262.20 .
0.00
262.20
ADDRESS
501 on Street P .0. Box 942
Reading, PA 19603-0942
Estate of: Ella May lllckenbill
SU+11\RY OF ALlDCATlcm 'lO BmEFICIARIES
Class A
Jeanne L. ~
!):)ris H. Luckenbill
4,369.94
0.00
4,369.94
Estate of: Ella May lllckenbill
'!'he folla.ring person(s) are signing the return as representative(s) of the estate:
Jeanne L. Ibrers
558 W. Perm Street Carlisle, PA 17013
PA REV-1500 EX (1-97) Page 2
Co let Add
Decedent's mDI' e ress:
STREET ADDRESS
One . rf Way
CllY I STATE I ZIP
Carlisle PA 17013
Tax Payments end Credits:
1. Tax Due (Page 1 Une 18)
2. CreelIlB/Paymen1s
A. Spousal Poveny Creel"
B. Prior Payments
C. Discount
(1)
262.20
0.00
Totsl Credits (A + B + C) (2)
0.00
3. Interest/Penalty K applk:able
D. Interest
E. Pen8l\y
24.46
II.
T_ Interest/Pen8l\y (0 + E) (3)
II Une21s ~than Una 1 + 1093, enter tile dIfIenlnee. This 10 the OVERPAYMENT.
~ box on "-11..1M 18 to NqIl8St a NIund (4)
II 109 1 + 109 3 10 ~ than lne 2, _ tile dIfIenlnee. This 10 tile TAX IlUE. (II)
A. Enter tile I_on the lax due. (SA)
B. Enter the total of Une II + SA. ThIs 10 the BALANCE IlUE. (58)
Make Check Payable to: REGISTER OFWII~S,-AGElff-----
., " . .....>>>>. ,. "." "..
24.46
4.
286.66
24.46
311.12
PLEASE ANSWER THE FOlLOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. DId decedent make a 11'_ and: Ves
a ratalntheuseorlncomeoftlleproperly1rat"""'...d,........................................
b. _ tile rtgh!1O designalIl who ahaII use tile properly ,,,""""ed or "Income;. . . . . . . . . . . . . . . . . .
c. rataIn a~narylntllr8sl;or.......................... ..............................
d. .-lheproniaelorlleol_p..-. ben8lllBorcara?.......................... ;'...
2. II _ 00CUtted on or beIole D.c..... 12, 1882, cId ~14 _ _ yeIIB
pI1IClldIng daaIh 1I1UlaIw properly _.-..ng -..,... ooueldel_1I daaIh occurred
_ 0.c.ftIber12, 1882, did decedent1l1Ulalw property _ one year of _ without
~ngadequal9CONOderation?........................................................ (]
3. Old decedent own an 'n !rUst lor" or payoble upon delllh bank account or secur1ty
at his or her _7 .. . . . . . . .. .. . .. . ... ... ... . . . . . .. . .. . ... . .... ......... .. .. .. . . .. . .. . .
4. Old decedent own an lndIvtduel,......nent account, annuity. or _ non-probala propeny? . . . . . . . . . . .
_~..fm~'" ~ %'
...<<<<.--:-$:.;,.~~.::;.1#1&m.:t~
','\MIDmt~-m~~
No
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B i
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
72 P.s. 18118 (e) (1.1) (l) plll-.Ilor lhe I8duclIon oflhelax... iqloaed onlhe ""'''-01_10 orlorlhe use oIlha lIU1'IIMng epouae IIllm 8% 10
3% lor _01_ on or _.lJfy 1.1_ and _January 1. 1_.
72 P.s. "118 (e) (1.1) (I) plll-.Ilorlhe I8duclIon of tile ndII iqloaed on lha net "-01_10 orlorlha use oIlhe Illft/Mng epouaellllm 3% 10 0%
lor _ 01_ on or _ Jan.Iary 1. 1_. The _..... not _ a _to a euMwIng epouae lrom", and 1he......., l1IqUII_,_1or
-.. 01_ and ling a tax nllUm ..lllII ~ ""'"" If lhe auMvtng apouae 10 lha only benellcIary.
FOR DATES OF DEATH ON OR AFTER.JANUARY 1, 1_ - _.-tIle -Ill question bV placing an "l(' In lhe epproprtaIa apace.
Old "'" Jl C ,lIent _ a1rual or aImllar arrangement which .. aoIaIy for "'" aurvIvIng apou.... benaIIt for hi. or her _re _me?
V.. 0 No:f9c
" you ...... _ed yes 10 lha above question, lhe tax on lhe 1rulII or _ aITlIftg8II18nllo pOaIponed unll "'" _ 01 lhe aeoond opouae, at which _It will
be luIIy _ at lhe rate(.) ~ to lhe __ beneIIcIary(Ies). Enter lhe vMM 01 lhe 1rUaI on ~le J, Part II, In OrderlO remove It IIllm lhe
caIcu_n of lhe lax due In this....... Vou may wish to IIle Schedule 0 In order to make lhe _n av_ under SectIon 8113. lithe _n 10 made.
the _ or _ lIITongement le _din tile _ 01 tile lIraI_ apouae, lhe portlon 01 lhe 1rulII or _ atrllngernent which ben8IIIB lhe au.lllvlng
opouae Ie _ at lhe zero lax ndII, and lhe __ 10 _ at lhe rate(.) appIloabI9tolha _nder beneIIcIary(Ies). "you chooee 10 make \he _no
you "... _ SchedUle 0 to a timely-flied laK _. eIong with SchedU\e(e) K and/or M In order to show lhe apportIonmenI 01 lhe !rUst or lIim/lar
arrangement between \he ourvtvlng spouse .nd \he remainder benellclary(lea).
7 PA15002 NTF 10870
Copyright Forms Software Only, 1991 Nelco, Inc.
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LAST WILL AND TESTAMENT
OF
ELLA S. LUCKENBILL
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" Pennsylvania, do make, publish and declare this to be my last Will, hereby
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I, ELLA S. LUCKENBILL, of the Borough of Fleetwood, Berks County,
revoking and making null and void any wills and codicils or writings in the
nature thereof by me at any time heretofore made.
1.
1 authorize and direct that my debts and funeral expenses be
paid as soon as practicable after my death by my hereinafter named Executors.
2.
I give all my property, real, personal and mixed, which I may
own or have the right to dispose of at the time of my death, in as nearly
equal shares as possible to my son, John W. Luckenbill, Jr. and my daughter,
Jeanne L. Bowers.
If my said son, John W. Luckenbill, Jr. shall fail to
survive me, I give my son's share to my daughter-in-law, Doris H. Luckenbill.
If my said daughter, Jeanne L. Bowers shall fail to survive me, I give my
daughter's share to the issue of Jeanne L. Bowers, per stirpes.
3.
All estate, inheritance and
other death taxes, together with
may be i~~ed by reason of my
I any interest and penalties thereon, which
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death shall be paid by my Executors and charged against the principal of my
testamentary estate as if such taxes were my debts.
4. The fiduciaries acting hereunder shall, in addition to the
powers conferred by law, have the following powers applicable to all property
until the actual distribution or other disposition thereof:
(a) To accept in kind from my estate and retain without
regard to the principal of diversification any property, real or personal,
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including stock of any corporate fiduciary hereunder, as long as they, in
their discretion, may deem it advisable to do so.
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I or personal, that they may deem prudent, including common and preferred stock
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(b)
To invest, reinvest and keep the principal hereof,
including all accumulation of income, invested in any kind of property, real
and units or shares of diversified or common trust funds managed or operated
by any corporate fiduciary hereunder, without at any time being limited to
such classes of investments as may from time to time be designated as legal
investments for fiduciaries.
(c) To hold investments in bearer form or to register them in
their name or in the name of a nominee.
(d) To purchase investments at a premium or at a discount.
(e) To determine whether any receipt or disbursement shall be
allocated to principal or income, or partly to each.
(f) To join in any corporate action, reorganization or voting
trust plan, to deposit securities under agreements and pay assessments, or
subscribe for stocks and bonds,
to give proxies, to grant, obtain or exercise
all rights of secu~ies holders.
options, and generally exercise
(g) To sell or lease for any period of time any property,
real or personal, for such prices, on such terms, and at public or private
sales, as they may deem proper, and to grant options for the purchase or
lease of any such property.
(h) To borrow money, mortgage real estate, pledge personal
property as collateral for loans, and compromise claims.
(i) To make distributions hereunder either in cash or in
kind.
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:i federal and other tax laws, including, without limiting the foregoing, the
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(j)
Retain and pay agents, employees, accountants, and
advice and other professional services; no fiduciary acting hereunder,
however, shall be obligated to follow any such advice.
(k)
To exercise any election or privilege given by the
payment of any portion of income or gift tax due under any income or gift tax
returns, the election of the alternate valuation for federal estate tax
purposes and the election to claim deductions for death tax or for income tax
purposes; and to make or not make equitable adjustment for the exercise or
nonexercise of any such election or privilege.
5. I direct that nO fiduciary acting hereunder shall be required
, to enter bond in any jurisdiction.
"
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II.JEANNE L. BOWERS as Co-Executors hereunder.
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\1 (]Y-h day of Yl.~ ' 1984.
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6.
I appoint my son, JOHN W. LUCKENBILL, JR. and my daughter,
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
J::,) ~/fu ~~//c~dtl
E la S. Luckenbill
(SEAL)
Signed, sealed, published and declared by the said ELLA S.
LUCKENBILL, to be her will in the presence of us, who at her request and in
her presence and in the presence of each other, have hereunto subscribed our
names as witnesses.
/.4 ~Cb4 >>1 ~
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I COMMONWEALTH OF PENNSYLVANIA
COUNTY OF BERKS
ss.
We, ELLA S. LUCKENBILL, THOMAS M. GOLDEN and
~y/
I~
Ii signed to the
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, the Testatrix and witnesses, respectively, whose names are
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 signed willingly and that she
executed it as her free and voluntary act for the purposes therein expressed,
and that each of the witnesses, in the presence and hearing of the Testatrix,
signed the Will as witnesses and that to the best of their knowledge, the
Testatrix was at that time eighteen (18) years of age or older, of sound mind
and under no constraint or undue influence.
/:sJ I'.IPn..J. :l.Lt:lJ>>Ar./k/t! (SEAL)
11a S. Luckenbill
Ii. ~ao yn.~~J (SEAL)
I omss M. Golden
,I
Ii hi tRJ,~ A ()~
I Subscribed, sworn to and acknowledged before me by ELL\( S.
i LUCKENBILL, the Testatrix, and subscribed and swo~; before me by THOMAS M.
I ~Aa~
, witnesses, this 'l{+day of n~
( SEAL)
GOLDEN and
1984.
;:)J; I/l}....' lbj~;;H ~.!
,,,""'Alt, r'UttUC (;
__. Il<<Ics Couott. PI.
... c."..".... bpi'.. ~. 18. 191
4
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CODICIL TO IAST WILL AND TESTAMENT
QE
ELIA S. LUCKENBILL
I, ELIA S. LUCKENBILL, of Carlisle, Cumberland County,
Pennsylvania, having made my Last will and Testament dated
November 9, 1984, do hereby make, publish and declare this to be
a Codicil to my said Last Will and Testament.
1. paragraph 6 of my said Last will is hereby deleted
and the following substituted therefor:
"6. I appoint my daughter, JEANNE L. BOWERS, to
be the Executrix of this my Last will and Testament. In the
event my said daughter, JEANNE L. BOWERS, is unable or unwilling
to complete her duties as my Executrix, then I appoint my
granddaughter, JERI ANN FITZSIMONS, as Executrix in her place and
stead."
2. I hereby ratify and confirm my said Last will and
Testament except insofar as any part thereof is revoked or
modified by this Codicil.
IN WITNESS WHEREOF, I have to this a Codicil to my Last
will and Testament dated November 9, 1984, subscriJJed my name and
.et lilY seal this 31:0 day of AloVE,./)1e~
, 1993.
tJiA- A ~ (SEAL)
Ella S. Luckenbill
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-
named ELLA S. LUCKENBILL as and for a Codicil to her Last will
-1-
-._....,...,.,
,
and Testament in the presence of us, who, at her request, and in
her presence, and in the presence of each other, have hereunto
subscribed our names as witnesses thereto.
&zy ft (k~^<<~
l itness
~~/Y''-- ~-ld~
witness
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COMMONWEALTH OF PENNSYLVANIA:
~ltMSe:.~lJ : ss.
COUNTY OF ..fIRRKS ~ :
I, ELLA S. LUCKENBILL, Testatrix, whose name is signed
to the attached or foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Codicil to Last Will; that I
signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
I'~ .Ai /.U'l~.ku.
Ella S. Luckenbill, '1'estatrix
SWOrn or affiraed to and acknowledged before me, by
ELLA S. LUCKENBILL, the Testatrix, this..lt2(l day of Al~~. ,
1993.
~~o~~~~J-.
Ncaial Seal
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......:,;;;w- .-..".",.",
COMMONWEALTH OF PENNSYLVANIA:
CJ{A1-P.>~NP : ss.
COWTYOFB~~ :
We I3E:rT'i J. {!1l,lP~I/F4
,
~/")~;1 ..Jp/r}/ fiC'I'LWAfl~
and ,.~. ,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified. according to law, ~o depose and
say that we were present and saw Testatrix, ELLA S. LUCKENBILL,
sign and execute the instrument as her Codicil to Last Will; that
she signed willingly and that she executed it as her free and
voluntary act for the purposes therein expressed; that each of us
in the hearing and sight of the Testatrix signed the Codicil to
Last Will as witnesses; and that to the best of our knowledge the
Testatrix was at that t1ae 18 or JIOre years of age, of sound aind
and under no constraint or undue influence.
&r .ft a,,,wu(
ness
';r~p,.a~~~~~
witness
SWorn or affiraed to and subscribed to before .i1e by
1&JE:.TT'f J. t!./lJ..Pt.(Jt=I-L
witnesses, this 2>Il.O day of
and HtlM ~6A/I/
;valfE-M.,./!1fS.t<
"fSe:>"J.-w~e
,
, 1993.
__Seal
GeorgeL-.Jr-5
CarISIo Boro. CI.mortand
MyC","""'iool'~.u-.e7.1
1~;.;Aii:' ',urmlilf
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REV-1509 EX + (1-97)
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ella May Illckenbill
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
If an asset was made Joint _In one year of the decedent's dale of _. It must be reported on Schedule G.
SURVIVING JOINT TENANTiSlNAME ADDRESS RELATIONSHIP TO DECEDENT
A Jeanne L. l3cMers sse w, Penn Street Laughter
Carlisle, PA 17013
JOiNTlY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR MADE Include name 01 financlallns1i1utlon and bank DATE OF DEATH DECO'S VAlUE OF
.lOINT llCCOUnt number or -.. idenllIyIng number.
NO. TENANT JOINT AlIach _lor jointly-held ....._. VAlUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A Mar. 1997 First tmi.a1 Club 50 0Iecki.n3 14.906.28 50.00% 7,453.14
Account #1000513730811
lOTAL IAIeo enter on lne 8. n' $ 7.453.14
7 CPM1 NTF1010t
(IIrnorellPlCelll.-. ___nil _oflhe_lllze)
CopyrlgM forma So1twu. Only, '"7 N.lco. lnc.
REV-1511EX + (1-97)
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ella May Luckenbill
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Dtobls of decedent must be
ITEM
NO.
A. FUNERAL EXPENSES:
on SeIllclute I.
DESCRIPTION
AMOUNT
See Schedule attached
'Ibtal fran continuation page (s)
1,725.00
B. ADMINISTRATIVE COSTS:
1. Personlll Rep_'. CormisslOns
N......ol Personal ~.)
SOcIal Securlty Numbor(.)lEIN No. 01 Persons/ ~.)
Street Address
City -
0.00
ZIp
Y88I{s) CormisslOn Psid:
2.
3.
A1lDmey "- Name: John S. Hi.bsclJtan, Esq.
FsmIIy ~: (II deolIdenI'8l1ddr-.lI not"''''' so -.., -. 8lqlIanIIdon)
ClaImant
Street Address
City - ZIp
Relallonshlp 01 ClaImant 10 DecedenI
500.00
0.00
4. Probate "- 0.00
5. 1\CCOUntanl'. "- Name : John P. Hassler. P.C. 195.00
6. Toxl\e1Urn Prep.."'. Fees 0.00
7 Register of Wills - filinJ Inheritance Tax Retum 15.00
8 Register of Wills - future adninistration expenses 50.00
TOTAL/Also enter on line 9, R
(II mont splIC8l1_, Insert addltlonel._ 01... ......._)
nl $
.2.485-00.
7 CPA11 NTF 10111
CopyriGht Form. Software Only, 1997 Nelco, Inc.
Estate of: Ella May Luckenbill
SOlEDJLE H, PARI' A -- Funeral Expenses
Item
No. Description
~ St. Paul's Illtheran Church - contri.hltion
2 Hoffrran-Roth Funerallbre - additional expenses rot =vered in
pre-planned arrangem:mts
3 J:bris Luckenbill - rei.nb.trserrent for tanbstone err:Jraving
4 Pastor SiImons - honorarium
5 Funeral luncheon and t:ruck rental for lift chair
'lUI7'IL. (Carry fmward to main schedule) . . . .
Page 2
Airount
200.00
260.00
65.00
~oo.oo
1,~00.00
1,725.00
.
REV-1512 EX + (1-97)
COMMONWEALTH OF PeNNSYLVANIA
INHERITANCE TAX RET\JRN
RESIDENT DECEDENT
ESTATE OF
Ella May lllckenbill
Include vnreimbursed medical """"noes.
ITEM
NO.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABILlTIES & LIENS
FILE NUMBER
DESCRIPTION AMOUNT
1 PharMerica - rredicatioos
413.20
2 JaIm P. Hassler, P. C. - preparation of 1998 tax returns
185.00
7 CPA12 NTF 10912
Copyright Forms Software Onlv. 1997 Nelco,lnc.
TOTAL tAlon enIiOf on 1118 1Q
(If more apace 19 needed, Insert addlllonaJ sheets of the same size)
$
598.20
REV-1513 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Ella Mav lllckenbill
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (Include oulright spousol dislrfbullons)
RELATIONSHIP TO DECEDENT
Do Not Ust Trua""'(a)
1 Jeanne L. Bowers
558 W. Penn Street
Carlisle, PA 17013
r:aughter
AMOUNT OR
SHARE OF ESTATE
4,369.94
II All &UT<I """ I , TI-IROUGH 17 A" APPROPRIATE ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
Po. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
None
B. CHARITABlE AND GOVERNMENTAl DISTRIBUTIONS
None
TOTAL OF PART II -- ENTER TOTAl NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV 1500 COVER SHEET $
7 CPA13 NTF 10113
(tt more space Is needed, Insert addl1lonal ._ ol1he same .Iza)
Copyright Forms Software Only, 1997 Nelco, Ino.
0.00
501 Washington Street P.O. Box 942 Reading, PA 19603-0942 Tel (610) 376-6651 Fax (610) 376-5243
Attorneys at Law
www.barley.com
Reading Lancaster York
Harrisburg Hanover Chambersburg
JOHN S. HmSCHMAN
Extension Number: 260
E-mail: jhibschman@barley.com
February 20, 2001
Register of Wills of Cumberland County
One Court House Square
Carlisle, P A 17013
Re: Estate of Ella May Luckenbill, Deceased
Gentlemen:
Enclosed for filing is an original and one copy of the Pennsylvania Inheritance Tax
Return in the above-captioned estate, along with two checks: One payable to "Register of Wills,
Agent" for $311.12 to pay tax and interest through February 28th, and another check for $15
payable to the "Register of Wills" as a filing fee. Also enclosed is the Estate Information Sheet
and an original death certificate for your records.
Please mail us a receipt in the enclosed envelope.
Very truly yours,
BARLEY, SNYDER, SENFT & GOHEN, LLC
~S~~
John S. Hibschman
JSH:mes/962298_1.doc
Encls.
H10S.80'5 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~\\.~~~~
Local Registrar
Fee for this certificate, $2.00
5633914
MAR. 30 1999
Date
0/-0 1- ..:).::.2 0
Hl0S. i43Aev. 2f87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
~T
~\
. ..Cumberland
DECEDENT'S USUAL OCCUPJmON
(~-=:~~::~:'r
".. Nurse 11b. Hos i tal
DECEDENT'S MAILING A~ESS {Street. Cityrro.,..,.,. Slate. ZIpCodel DECEDENT'S
ACTUAL
RESIDENCE
ese. InStrucllOns
Or'l other Sldel
,p..
STATE FILE NtJM8EA
SOCIAL SECURITY NUMBER
~T
IK
NAME OF DeCEOENT IF"SI. Middle, La-I
1. Ella May Luckenbill
AOE (Last BirthdIy) UNDER 1 YE.AA UNDER 1 OM
MonIhs Days HourI MInut8Ia
BlRTHPlACE (City and
StlIIe Of For8lgtl Counlry)
1999
.. 94
COUNTY OF OEArH
v...
~.D
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
- 0 Noll
RACE. A"*'Can lndien. BaKtr.. MItt.. Me.
- .
,..White
SUfMVIHG SPOUSE
(tr....... gtYe matdlIn namel
12.
1 Longsdorf Way
l~r1is1e, Pa 17013
17b. Coun
Pa ""'
-.-.
lMIina
cumberland township? 17d.0 :t.=--=ot
MOTHER'S NAME (Firs:. MlCkIIe, M8Iden ~"ameJ
...
s. Middleton
....
17a, State
FATHER'S NAME (~IfSI, MidcIe. Lastl
...James S. Spangler
'NFOAMANT'S NAME (T_Prinll
... Jeanne L. Bowers
METHOD OF OtSPOSlTlOH
-:8: c.....- 0
00..._
...,-...
1999
012748 L
2.. ,: '1<;' It...... ... 2..
27. ~ t: E,..... fhe di..aMS, injuries or compficalion$ which CIIused ,,,. death. 00 nolem., the mode of dying, IUCfl as cardiac or resprafOry arrest, shOclc or"'art faiNre.
Lilt onfy ~ cause on HCh IiM.
"0. KII! 03'11 S" u. '- ....
M3 CASE REFERRED 10 MEOlCAL EXAMINeRICORONER?
....0
t b.
..
d.
0" e....,....-.""
CUE 10 fOR AS It. CONSEOUENCE Of}
C . I-..... ~.... f-.. . L.....
DUE 10 (OR "'8 A CONSEOUENCE Of):
21.
t Appro..imale
tinl""'~
: 0ftMI and dItaIh
I
:
PART n: Other signibnC concMiona c:oncfit)ultng 10 deattl, CuI
not""" inb undertvIng ~ Qiven In PMT 1.
DUE TO lOR.,,' CON5[OUENCE OFt.
WERE AU10PSY FJNOINGS MANNER OF DEATH
"""'lAkE PmeA 10
COMPLET1ON OF CAUSE -- r:;:,j.--- HomiCide 0
OF OERH?
........ 0 P.ming Ifw4tstlgaliOn 0
_0 No 0 ....... 0 Coutd noc be determined 0
Olt.TE OF INJURY
(MQnIh. Cay, __I
TIME OF INJURV
INJURY XI WORK? DESCFUBE HOW INJURY OCCURRED.
.... 0 NoD
"0.
ClRTtFJEA (<;hack My one!
-CEJnlfYING PHYSICIAN (PhySlC>an Cet'ltty.ng cause of Cleeth..ner anolner CJtl'o'SIClMl haS oronovt"'Cecl deal'"' ana comPleted "em 231
To Che beMot my kno.rfadve, Malh occu~ due to ttle cauu(slend manMr a. stated.
21.
. ....
PLACE OF INJURY. At hOrM. fa"", street, 'actort, otfIc:e
buikino. etc. ISpeol".
....
.PRONOUNCING ANO CERTIFYING l'HYSICfAN (Physc.an bOlh ;>f0f'l0ut'lC1l'I9 oealt1 and cMIfy.ng 10 cause of aealtol
To the beet of my knowlectve, aath occurred at the Ume, dllte, and piece, and due 10 the cau..e.) and manner a. .lated.. .
o
...
).'J
.MEDlCAL EXAMINER/CORONER
On .....IM.I. or ..amlnatlon andlor Investigation, in my opinion. death occurred 11lhe lime, data, and plica, and due to the cause(l) and
manner a.stlted.. . . . . . , . . . . . . . . . . . , .. .. . . . . , . . . . . . . . . , , . , .
31a.
REG1STRlt.R'S SIGNATURE AN
o
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~\ id...\.IO I
It -';LJ3--3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
7~.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
REY-1U7 EX AFP 112-DDl
JOHN S HIBSCHMAN
501 WASHINGTON ST
PO BOX 942
READING PA l'lo3
.,
-. r
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-14-2001
LUCKENBILL
03-28-1999
21 01-0220
CUMBERLAND
101
elLA
M
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=i6oj-ix-AFP-fi'2-:ooY-----...-INiriRiYANcETAX-STATEMi:-rif-irF'-ACCouiff--.-i.----------------- ----
ESTATE OF LUCKENBILL elLA M FILE NO. 21 01-0220 ACN 101 DATE 05-14-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-02-2001
PR I NCI PAL TAX DUE: .___.......__........___.._.........__........___._.._............_...._............_..........._.............._..........._.
262.20
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-26-2001 AA478072 24.86- 311.12
04-30-2001 REFUND .00 24.06-
TOTAL TAX CREDIT 262.20
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IE IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ""CREDIT"" (CR),
vnll MAV Ill': nlll: A IlFFIINn.. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
\'/6-;:;2/..3 -3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-09-2001
lUCKENBILl
03-28-1999
21 01-0220
CUMBERLAND
101
JOHN S HIBSCHMAN
501 WASHINGTON ST
PO BOX 942
READING
,-
I.i
PA 19603
<5t, ~
./ ~
REY-1547 EX AFP 112-DDl
EllA
M
Allount Rellitted
) CHANGED
Cl)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
7,453.14
.00
(8)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is'4i-EX-AFP--ci'2:ocjr-Nc;ricE--oF-YNHEiiiTANCE-YAirAPPRAYSEMENT~--AiroWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF lUCKENBILl EllA M FILE NO. 21 01-0220 ACN 101 DATE 04-09-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (5)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. AllOUnt of Line 14 at Sibling rate (17)
18. AlIOunt of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS.
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 = .00
4,369..94 X 06 = 262.20
.00 X 00 = .00
.00 X 15 = .00
Cl9)= 262.20
(9)
ClO)
2,485.00
598.20
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
7,453.14
Cll)
(12)
(13)
(14)
3.083 ?O
4,369.94
.00
4,369.94
.
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-26-2001 AA478072 24.86- 311.12
TOTAL TAX CREDIT 286.26
BALANCE OF TAX DUE 24.06CR
INTEREST AND PEN. .00
TOTAL DUE 24.06CR
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO pAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)