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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMOIfNEAl TH Of PeMlSYLVHlIA
DEPARTMENT Of REVENUE
DEPT. 28Cl601
HARRISBURG, PI>. 17128-0801
DECEDENTS NAME (lAST. FIRST, AND MIDDlE INITIAl)
SCHNEIDER, HANNAH G.
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C-
OFFICIAL USE ONLY
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FILE NUMBER
21 01
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
1-6S-32-~O 1 ('f'
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DATE OF DEATH (MM-oo. YEAR)
DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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o 4a. Future Interest Compromise (date of death
after 12-12.a2)
o 7. Decedent Maintained a Living Trust (Attach
copy 01 Trust)
o 10. Spousal Poverty Credit (date of death between
12-31-91 and 1-1-
i.i~~flOijiMUi.t:jE:COMlroff.nU$~AAi$.~in~iD.:~~fi!(t:fjW"~M~f@fHlMootiiliit:~i$.ii5.Wl::i:i:~ltrnMlfm:Wrm~:i~
AME COMPLETE MAILING ADDRESS
DAVID FOSTER
04/26/2001
05/11/1908
3. Remainder Retum (date of death priortD 12-13.a2)
o 5. Federal Estate Tax Return Required
o
8. Total Number or Safe Deposit Boxes
o 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
831 MARKET STREET
LEMOYNE,PA 17043
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
Z 41,406.83 .045 (16)
0 16. Amount of Line 14 taxable at lineal rate x
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ll. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
:e
0
0
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
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19. Tax Due (19)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
1. Original Return
2. Supplemental Return
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5)
(6)
(7)
None
None.
None
o 4. Limited Estate
~
o
6. Decedent Died Testate (Attach copy
ofWilQ
9. Litigation Proceeds Received
IRM NAME (If applicable)
COSTOPOULOS, FOSTER AND FIELDS
lEPHONE NUMBER
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III
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
None
None
45,607.73
None
12. Net Value of Estate (Line 8 minus Line 11)
(8) 45,607.73
(9)
(10)
4,127.14
73.76
(11 )
(12)
4,200.90
41,406.83
(13)
(14)
41,406.83
1,863.31
1,863.31
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 fonn software only The Lackner Group, Inc.
20. 0
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Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
, . STREEf ADDRESS
4 PARTHERMORE CIRCLE
CITY
I STATE PA
I ZIP 17339
LEWSIBERRY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 line 20 to request a refund
5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(1)
1,863.31
(2)
0.00
(3) 0.00
(4)
(5) 1,863.31
(SA)
(5B) 1,863.31
Make Check Payable to: REGISTER OF WILLS, AGENT
_tUJ!mll~ii..._iU~VJ!t,mW~l{~1.WJrJf,1~~.~JW/.~'PJ!fl{urum~~-.mr&1WMJWAi!~w}~:~~~JM}};.!,m;~1J~
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;..................................................................................... R ~
b. retain the right to designate who shall use the property transferred or its income;......................................... ~
c. retain a reversionary interest; or..................................................................................................................... B ~
d. receive the promise for life of either payments, benefits or care?.......................................;......................... ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?............ ....... ............... ................. ...... ........................ ............ .......... ......... ......... 0 ~
3. Did decedent own an "in trust for" or payable upoh death bank account or security at his ot her death?............... 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?........................................................................................................................ 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN.
Under penalties 0/ peljury, I declare that I have examined this return, including accompanying schedules and statements. and txl the best 0/ my IcncMIedge and belief, it is tJue, correct
and complete.
Declaration of preparer other than the personal representative is based on all information 0/ which preparer has any knowledge.
SlGNAS:W:RE PERSON RESPONSIBLE FOR FILING RElURN ADDRESS
831~TSTREET g)
LEMOYNE, P A 17043
SIGNATURE OF PER ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
DATE
113 SOUTH MARKET STREET
ELlZABETHTOWN, P A 17022
R~~f_~~m-diJ'~W~tf'<<a.~tlfjm~f~i?t.;w.~_.~..~"i:~Jlrul ll:sr&Jl~~t:: :: ,ft.'!!:[[[[: [~i"lIl
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [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%
[72 P .5. ~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 twenty-one 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% [72 P .5. ~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%, except as noted in 72 P .5. S9116
1.2) [72 P.S. ~9116 (a) (1)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. S9116 (a) (1.3)J. 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.
...
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHNEIDER, HANNAH G.
I FILE NUMBER
21 - 01.1f()()
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
Daughter
B CHRIS SCHNEIDER
4 PARTIffiRMORE CIRCLE
LEWISBERRY,PA 17339
3 WEST ALPHA AVE.
EL YSBURG, P A 17824
Son
A PATRICIA A FOSTER
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE OA TE OF DEATH
FOR JOINT MADE Include name of financial institution and bank account number or DECO'S VAlUE OF
NUMBER TENANT JOINT similar identifying number. Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 A CERTIFICATE OF DEPOSIT 10,123.16 50% 5,061.58
#216351960 FIRST NATIONAL
TRUST BANK
2 B CERTIFICATE OF DEPOSIT 10,123.16 50% 5,061.58
#216357860 FIRST NATIONAL TRUST BANK
3 A CERTIFICATE OF DEPOSIT 10,028.77 50% 5,014.39
#21001019601 PNC BANK
4 A INTEREST CHECKING 11,842.46 50% 5,921.23
#51-4013-0096 PNC BANK
5 A PNC BROKERAGE ACCOUNT 49,097.89 50% 24,548.95
#81681718
TOTAL (Also enter on line 6, Recapitulation) 45,607.73
..-
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATlVE COSTS
COMMONWEAllli OF PENNS'flVANUI
II*iERITANCE TAX RETURN
RESIDENT OECEOENr
ESTATE OF SCHNEIDER, HANNAH G.
I FILE NUMBER
21 - 01 -of(J()
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
1 NEILL FUNERAL HOlVffi 2,440.10
2 GIANT FOOD- FUNERAL RECEPTION 477.04
3 MOLESEVICH MONUMENTS 595.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I E1N Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attomey's Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees FELTY & CO. L.L.P. 615.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1
TOTAL (Also enter on line 9, Recapitulation) 4,127.14
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COllllONWEAllH OF P~VANIA
INr\ERITANCE TAX RET1JRN
RESIDENT DECEDENT
ESTATE OF SCHNEIDER, HANNAH G.
I FilE NUMBER
21-01- OiO()
Include unreimbursed medical expenses.
ITEM
NUMBER
1 EMSAMBillANCEB~L
DESCRIPTION
AMOUNT
73.76
TOTAL (Also enter on line 10, Recapitulation)
73.76
...~
~
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHNEIDER, HANNAH G.
I FILE NUMBER
21 - 01 - Of'Cd
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 CHRIS SCHNEIDER Son 5,061.58
3 WEST ALPHA AVE
ELYSBURG,PA 17824
2 PATRICIA FOSTER Daughter 36,345.25
4 PARTHERMORE CIRCLE
LEWISBERRY,PA 17339
Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, 011 Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
TIm is to certit)! that the information here given is correctly copied liOln an original certificate of death duly filed with me as
Lppl R~gistrar. The original certificate will be forwarded to the State Vital Records GfEce tor permanent ~Iing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
?~"'~ /ilL4f. "
Local Registrar
Fee for this certificate, $2.00
p
7386277
a~
d &,,;z.co i
/
Date
HI05.;43A..... 2!&7
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
iYPEJPfUNl
IN
PERMANENT
Bt.ACK INK
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NAME Of ~CfOENT IFIl"!lI_ MIdaIe. LaslJ
1. !-! AA.:l,uA
AGE (Lasa 8.(!t'\Qa.,. UNDER t 'tEAR
MOIlItMI D.....
G.
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5.
aIRTtiPlACf ;c..., ;,nd
SUMorfaeognCa.nuYI
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COUNTY OF Oe..o'H
MARITAL STATUS. Watrwct
Navel Man-.d. WidowIId.
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RACE . AmerIcan indian. Stack, WhII.. INC.
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NAME AHO"OORE!;i~FAQlITY
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lICENSE NUMBER
l'1 III L
....
ME OF DEATH
DAlE SIGNED
(MInn. Day. "'1
2~ Zk
w-.s CAse REFERRED TO MEOtCAt. EXAWIHERlCOAONEA7
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.... 25.
27. PART I: EnI.r lhe dlM...S, If1jurle$ 01 compCalllON which caused 1M (Sealh Do not enretlhf mode 01
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DUE 10 (OR AS A CONSEOUENCE Of);
DUE ro,OR AS ACON&OUENCE Of)
WERE AUTOPSY FINDINGS
AlWlA8LE PfUOA 10
COMPLETJON OF CAUSE
OFOEMH1
MANNER OF OEATH
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OAre OF INJURY
(Morun, ~y. 'TUII
TJME OF INJURY
INJURY AT 'NOfU<1 DESCfUSE HOW INJURY OCCURRED
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DATE FILED '....0IIIh Day, Yeatl
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LAST WILL AND TESTAMENT
OF
HANNlH G. SCHNEIDER
I, HANNMG. SCHNEIDER, of Mt. Carmel, Northumberland
County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby make, publish and declare
this as and for my Last will and Testament hereby revoking all
other wills and codicils heretofore made by me.
FIRST - I direct that all my legal debts and funeral
expenses shall be paid from the assets of my estate as soon as
practicable after my decease.
SECOND - I hereby devise and bequeath all the rest and
residue of my estate, of every kind and nature and wheresoever
situate, to my children, PATRICIA A. FOSTER and CHRISTIAN P.
SCHNEIDER in equal shares, providing that they survive me by
thirty days. If any of said children fail to survive me by
thirty days, then the share of those children failing to so
survive shall go to their issue per stirpes.
FIFTH - I name and appoint DAVID J. FOSTER, ESQUIRE to
be the Executor of this my Last Will and Testament, and to so
serve without the necessity of having to post bond.
In the event DAVID J. FOSTER, ESQUIRE has
predeceased me or fails to survive me by thirty days, or for
some other reason cannot fulfill the duties as Executor, I
then name and appoint my daughter, PATRICIA A. FOSTER as
Executrix, of this my Last Will and Testament. The Executrix
named herein is appointed to serve without bond.
IN WITNESS WHEREOF, I have hereunto set my hand and
day of August, 1981.
seal this
<L&~J A JU,A~ ~~
HANNFI1 G. SCHNE!bER
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above
named Testator, HannanG. Schneider, as and for her Last Will
and Testament, in the presence of us, who at her request, in
her presence and in the presence of each other, all being
present at the same time, have hereunto set and subscribed our
names as witnesses.
tj&~~.J J2? .2#i~..('.<14-?eSiding at /0/ C9.
- ~ '
~/(/:t ~ ~ residing
"......, r... __ .
--~,.__._~
i
-_.1
FIRST NATIONAL TRUST BANK
Member FDIC
CHECK NO. 8 5 4 5 6 3 315
7/23/2001
Hannah G Schneider
Chris Schneider
4 Parthermore Circle
Lewisberry PA 17339
Certificate of Deposit Interest Check
Account #:
Certificate #:
Certificate Balance:
CD Term:
Rate:
216357860
6369
$10,000.00
182 days
4.9400%
Interest Paid:
Less Federal WithhOlding:
Net Check Amount:
$246.32
$0.00
$246.32
y~ \nt ~ '~~1~ 10 "\~
04
CD1403Pfnt
dDmmu~
MIrNlerFOlC
Hannah G Schneider
Chris Schneider
4 parthermore Circle
Lewisberry PA 17339
Date:
Certificate #:
Acct #:
Balance:
Current Rate:
MATURITY NOTICE
1/09/01
6369
216357860
10,000.00
5.2800%
Your certificate of deposit will mature and renew on January 22, 2001
as follows:
TERM: 182 days
INTEREST PAYMENT FREQUENCY: 182 days
Interest will be sent by check.
NEW MATURITY DATE:
7/23/01
You may redeem this certificate without penalty or change the terms up to
ten calendar days after January 22, 2001.
Certificates earn simple interest. If your interest payment shown above
is IIcompounded and credited to this certificate,lI interest will be credited
and compound at the interest payment frequency listed above.
~he new Interest Rate and Annual Percentage Yield (APY) that will apply to
xour renewed certificate have not yet been determined. You may call us on
or after January 221 2001 at 1-877-843-3477 to find out the rate on your
renewed certificate. The APY assumes interest will remain on deposit until
maturity and that a withdrawal will reduce earnings.
BALANCE COMPUTATION METHOD: We use the daily balance method to calculate
the interest on your account. This method applies a daily periodic rate
to the principal in the account each day. Interest begins to accrue on
the business day of your deposit.
TRANSACTION LIMITATIONS: You may not make deposits into this account until
the maturity date unless the account is an IRA additional deposit
certificate. Partial withdrawals are not permitted except for qualified
IRA accounts. If this is an IRA certificate 1 withdrawals are permitted
without IRS penalty any time after age 59 1/2. Minimum withdrawals must
be made after age 70 1/2.
EARLY WITHDRAWAL PENALTIES BY TERM:
32 days 1 but less than 1 year:-- 3 months interest
1 year and greater:------------- 6 months interest
'cIf you are unsure what investment term is right for you or wish to renew
/your CD for different terms, call or visit your local First National Trust
Bank office.
04
CD2161Pfnt
:f I
, I
FIRST NATIONAL TRUST BANK CHECK NO. 8 54 56 3 314
Member FDIC
7/23/2001
a ah G Schneider
atti Foster
4 Parthermore Cir
Lewisberry PA 17339
Certificate of Deposit Interest Check
4ccount #:
Certificate #:
Certificate Balance:
CD Term:
Rate:
216351960
6368.
$10,000.00
182 days
4.9400%
~ Lr\1a 10 ~I~
~ \~~,'~
\D~
Interest Paid:
Less Federal Withholding:
Net Check Amount:
$246.32
$0.00
$246.32
04
CD1403Pfnt
L3bmmm
~FDIC .... SUSQVlU-UNNA &uvC .
Hannah G Schneider
Patti Foster
4 Parthermore Cir
Lewisberry PA 17339
Date:
Certificate #:
Acct #:
Balance:
Current Rate:
MATURITY NOTICE
1/09/01
6368
216351960
10,000.00
5.2800%
Your certificate of deposit will mature and renew on January 22, 2001
as follows:
TERM: 1-82 days
INTEREST PAYMENT FREQUENCY: 182 days
Interest will be sent by check.
NEW MATURITY DATE:
7/23/01
You may redeem this certificate without penalty or change the terms up to
ten calendar days after January 22, 2001.
Certificates earn simple interest. If your interest payment shown above
is "compounded and credited to this certificate,lI interest will be credited
and compound at the interest payment frequency listed above.
The new Interest Rate and Annual Percentage Yield (APY) that. will apply to
your renewed certificate have not yet been determined. You may call us on
or after January 22, 2001 at 1-877-843-3477 to find out the rate on your
renewed certificate. The APY assumes interest will remain on deposit until
maturity and that a withdrawal will reduce earnings.
BALANCE COMPUTATION METHOD: We use the daily balance method to calculate
the interest on your account. This method applies a daily periodic rate
to the principal in the account each day. Interest begins to accrue on
the business day of your deposit.
TRANSACTION LIMITATIONS: You may not make deposits into this account until
the maturity date unless the account is an IRA additional deposit
certificate. Partial withdrawals are not permitted except for qualified
IRA accounts. If this is an IRA certificate, withdrawals are permitted
without IRS penalty any time after age 59 1/2. Minimum withdrawals must
be made after age 70 1/2.
EARLY WITHDRAWAL PENALTIES BY TERM:
32 days, but less than 1 year:-- 3 months interest
1 year and greater:------------- 6 months interest
If you are unsure what investment term is right for you or wish to renew
your CD for different terms, call or visit your local First National Trust
Bank office.
04
CD2161Pfnt
Total Banking Statement
PNC Bank
0. PNCBft
Primary account number. 51-4013-0096
Page 1 of 2
For the period 04127/2001 to OS/29/2001
Number of enclosures: 0
B
F
HANNAH G SCHNEIDER
PATRICIA A FOSTER
4 PARTHERMORE crR
LEWISBERRY PA 17339-9406
1:1' For 24-hour customer service or
current rates: Call 1-888-PNC-BANK
I2!SI Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
.e Visit us at www.pncbank.com
iii TOO terminal: 1-800-531-1648
For hearing impaired clients only
Relationship Overview
Bank Deposit Accounts
Description
Interest Checking
Certificate{ s) Of Deposit
Total Deposits
Account Number
Deposit Balance
51-4013-0096
Total ofl
11.842.46
10,028.77
21,871.23
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already low interest rate. 'Ve may even be able to offer alternative loan programs to satisfy your bill consolidation needs. StoF
by, call1-888-PNC-BANK or visit www.pncbank.com to apply today.
Premium Plan
Interest Checking Account Summary
Account number. 51-4013-0096 Account link ~ number. 0165329010
Hannah G Schneider
Patricia A Foster
Balance Summary
Beginning Deposits and Checks and other Ending
ba lance other additions deductions balance
11,800.10 42.36 .00 11,842.46
Average monthly Charges
balance and fees
11,828.62 .00
Intet'est Summary
Annual Percentage Number of days Average collected Interest Earned
Yield Earned (APYE) in interest period balance for APYE this period
0.60/. 33 11,828.62 6.40
Please see the Activity Detail section for
additional infonnation.
As of OS/29, a total of $31.03 in interest
eamed this year.
Activity Detail
Deposits and Other Additions
Date Aml)unt Description
05/04 35.96 Interest From Cel"tificate 21001019601
OS/29 6.40 Interest Payment
There were Z Deposits and Other Additic
totaling $42.36.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FOSTER DAVID J C/O
COSTOPOULOS FOSTER & FIELDS
831 MARKET STREET PO BOX 222
LEMOYNE, PA 17043
-------- fold
ESTATE INFORMATION: SSN: 165-32-9010
FILE NUMBER: 21-2001- 0800
DECEDENT NAME: SCHNEIDER HANNAH G
DATE OF PAYMENT: 08/28/2001
POSTMARK DATE: 08/27/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 04/26/2001
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: PA TTI A FOSTER
C/O DAVID FOSTER
CHECK# 597
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 000205
MARY C. LEWIS
REGISTER OF WILLS
AMOUNT
$1,863.31
$1,863.31
I?~- ;;
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DAVID J FOSTER
831 MARKET ST
PO BOX 222
LEMOYNE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-16-2001
SCHNEIDER
04-26-2001
21 01-0800
CUMBERLAND
101
'*
REV-1547 EX AFP 112-DDl
HANNAH
G
Allount Rellitted
PA 17043
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 ~
REV=is4-j-EX-AFP-fi'2-=oOY-NOYicE--OF-i-NHEifiTAifCi-YAi-ifPPRifisEifENi'-:--ALi-oWAifci-'(fli------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SCHNEIDER HANNAH G FILE NO. 21 01-0800 ACN 101 DATE 10-16-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Re.l 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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
45.607.73
.00
(8)
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/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
4,127.14
73.76
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this form with your
tax payment.
45,607.73
(11)
(2)
(13)
(4)
4.:?OO 90
41,406.83
.00
41,406.83
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
.00 X 00 = .00
41,406.83 X 045 = 1,863.31
.00 X 12 = .00
.00 X 15 = .00
(19)= 1,863.31
TAX CREDITS:
PAYI1ENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-27-2001 CDOO0205 .00 1,863.31
TOTAL TAX CREDIT 1,863.31
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYI1ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORI1 FOR INSTRUCTIONS.)
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