HomeMy WebLinkAbout06-22-05
,
REV.1500 EX (6-00)
OFFICIAl USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
05
048
COUNTY CODE
YEAR
NUMBER
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DECEDENTS ~ME (LAST, FIRST, AND MIDDLE INITIAL)
Alspaugh Mary
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
12/23/2004 5/19/1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
H
SOCIAL SECURITY NUMBER
198-05-8701
THlSRETURN MUST BE FILED IN DUPLICATe WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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Limited Estate
Original Return
D 2. Supplemental Return D 3. Remainder Return (date of death priorlo 12-13-82)
D 4a, Future Interest Compromise (dala of death after 12-12-62) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copy of Trustj L 8. Total Number of Safe Deposit Boxes
o 10. Spousal Poverty Credit (date of death between 12-31.91 and 1-1-95) D 11. Election to tax under Sec. 9113(A)(AttachSchO)
Decedent Died Testate (Attach copy of 'Mil)
Litigation Proceeds Received
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
James D. Hughes, Esquire 95 Alexander Spring Road, Suite 3
FIRM NAME (If Applicable)
SALZMANN HUGHES PC
TELEPHONE NUMBER
717-249-6333
Carlisle, PA 17013
2. Stocks and Bonds (Schedl!le B)
(2)
126,500
130,133
OFFICIAL USE oNLY
1. Real Estate (Schedule A)
(1)
3 Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Depm,its & Miscellaneous Personal Property
(Sd'leduIeE) (6)
Z 6 Jointly Owned Property (Schedule F) (6)
0 D Separate Billing Requested
i=
~ 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
::> (Schedule G or l)
l-
ii: 8. Total Gross Assets (total Lines 1-7)
<(
0
W 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
It:
10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) '(10)
11. Total Deductions (total Lines 9 & 10)
12 Net Value of Estate (Line 8 minus Line 11)
o
o
299,601
o
18,488
574,722
(8)
32,896
598
(11)
(12)
(13)
(14)
33,494
541,229
1,000
13 Charitable and Governmental BequestsfSec 9113 Trusts for'M"lich an election to tax has not been
made (Schedule J)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax 0
z rate, or transfers under Sec. 9116 (a)(1.2) x .0
0
;:: 16. Amount of Line 141axable at lineal rate 347,827 x .0
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=> 0
... 17. Amount of Line 14 taxable at sibling rate x .12
:IE
0 192,402
0 18 Amount of Line 14 taxable at collateral rate x .15
)(
'" Tax Due
I- 19.
540,229
~(15)
45 (16)
o
(17)
15,652
o
20.
D
CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPA YMENT
(19)
28,860
44,513
(18)
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W46451.000
Dece ents omp,e e ress:
Sl'REET ADDRESS
230 Henderson Avenue
CtUDber1and County
CI1Y ! STATE I ZlP
Carlisle PA 17013-
No
og
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~
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. KJ D
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 of perjury, , declare that I have examined this return. induding accompanying SChedules and statements. and to the best of my knowledge and belief. it is true, correct and complete.
Declarati of preparer other than the pe~onar representative is based on all information of which preparer has any knowledpe.
SIG U OF PER ES ONSIBL OR Fill R RN
d
'C
I t Add
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
o
35,000
1,750
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. penatty
o
o
TotallnteresVPenalty (0 + E) (3)
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
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
A Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A.
(5B)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
D
D
D
D
without receiving adequate consideration? . . . . . . ; . . . . . . . . . . . . . . . . . . . .. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . .
o. retain the right to designate who shall use the property transferred or its income; .
c.retainareversionaryinterest;or . " .. ..... .. ... .. . . .. .. .
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
p{
RE
Boiling Springs, PA
Carlisle, PA 17013
44,513
36,750
o
o
7,763
o
7,763
DATE
-::2:2 -6.Y
For dates 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 sul"viving spouse is 3%
(72P.S. 9916 {a) (1.1> (i)].
For ates 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 sUMving spouse is 0% [72 P,S. f3 9116 (a) (1.1) (fill
e 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 apphcable 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 ofa natural parent, an adoptive patenl,
or a stepparent of the child is 0% f72 P.S. 89116(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.S. f3 9116{1.2) [72 P.s. 89116(a)(1)J.
The tax rate imposed on the net value of transfers to or for the use ofine decedent's sib~ngs is 12% (72 P.S. S 9116(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.
3W46461,OOO
REV-1502 EX+ (5-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Mary H. Alspauqh
21 05 04B
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 kna.oAedge of the rele\fallt facts.
Real property which is jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
230 Henderson Avenue
Carlisle Borough, Cumberland
County
126,500
b-~.-05
<Q J - 05- 00 t.f 8"
iY A P D oQU-.SL
Q;<'
3W46951,OOO
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
126,500
REV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Mary H. Alspauqh
21 05 048
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NLfJlBER
1.604 Shares
Carlisle Companies Inc.
DESCRIPTlON
VALUE AT DATE
OF DEATH
39,188
2 14,232.494 Units
Waddell & Reed Services
Company, investment account
#35206206/624
90,946
3W46961.000
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
130,133
REV-l508 EX + (6-98)
COMMONIIVEAL TH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Mary H. Alspaugh
FilE NUMBER
21 05 048
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VAlUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cash 1,340
2 Citizens Bank, checking
account #6200261788 104,472
3 Citizens Bank, checking
account #6100734935 18,333
4 Miscellaneous personal
property 3,515
5 Waypoint Bank, checking
account 25,627
6 Waypoint Bank, certificate of
deposit #1756220574 26,372
7 Waypoint Bank, certificate of
deposit #1756229011 80,774
8 Waypoint Bank, certificate of
deposit #9600014991 39,167
3W46AD 1.000
TOTAL (Also enter on line 5 Recaoitulation) $
(If more space is needed, insert additional sheets of the same size)
299,601
REV-1510EX+ (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
JNHERITANCETAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary H. Alspaugh
FILE NUMBER
0521 048
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
OESCRIPTION OF PROPERTY
ITEM Ir-oJDETH: NOME OF Tl-E TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT N.() DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBE' Tl-E DATE OF TRi'MFER ATT,6CHAOOPf OF Tl-E OEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPUCABLE) VALUE
1. Transamerica Life & Annuity,
payable to Donald Rynard,
friend 18,488 100.000 0 18,488
TOTAL (Also enter on line 7, Recapitulation) $ 18,488
(If more space is needed. insert additional sheets of the same size)
3W46AF1.000
REV-1511 EX-+ {12-9S)
COMMONWEALTH OF PENN$YL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary H. Al.spauqh
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 05 048
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTlON AMOUNT
A FUNERAL EXPENSES:
1. Hoffman-Roth Funeral Home Inc. 6,209
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s} f EIN Number of Personal Representative{s) - -
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 20,550
3. Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 514
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1 Cumberland Law Journal 75
2 Register of Wills 30
3 Roy Gotshall Auctioneer 1,536
Total from continuation pages 3,982
TOTAL (Also enter on line 9, Recapitulation) $ 32,896
3W46AG 1000
(If more space is needed, insert additional sheets of the same size)
Schedule H part 2 (Page 2)
Estate of: Mary H. Alspaugh
Item
No.
Descripti.on
Amount
4
Roy Gotshall Auctioneer,
appraisal fee
55
5
Settlement charges
3,827
6
The Sentinel - Legal
100
Total (Carry forward to mai.n schedule)
3,982
REV-1512EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INI-ERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary H. Alspauqh
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
05 21 048
Include unrelmbursed medical expenses.
ITEM
NUMBER
1. Borough of Carlisle
2 Comcast Cable
3 Kough's Oil Service
4 PP&L
5 Sprint Telephone
6 West Shore EMS
DESCRIPTION
VALUE AT DATE
OF DEATH
32
90
238
57
77
103
3W46AH 1.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
598
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONll\lEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Marv H. Alspauqh
NUMBER
I
1
2
3
NAME AND ADDRESS OF PERSON(S) ReCEIVING PROPERTY
T MABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Robert L. Alspaugh
110 Alters Road
Carl~sle, PA 17013
Donald R. Rynard
262 Red Tank Road
Bo~l~ng Spr~ngs, PA 17007
Patricia M. Trimmer
471 Hunting Park Lane
York, PA 17402
FILE NUMBER
21 05 048
RELAnONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Step-son
Friend
Step-daughter
1/3
1/3 & annuity
1/3
ENTER OOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBLlTIONS UNDERSECnON 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
3W46A11.000
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Mt. Z~on Un~ted Method~st
Church
420 Park Drive
Carl~sle, PA 17013
TOTAL OF PART". ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the same sjze)
1,000
$
1,000
Jrast Win ani) rlrestament
OF
MARY H. ALSPAUGH
I, MARY H. ALSPAUGH, of230 Henderson Street, Carlisle, Cumberland County, Pennsylvania,
declare this instrument to be my Last Will and Testament, in manner and foml following:
I. \ hereby expressly revoke all Wills and Codicils heretofore made by me.
2. \ hereby direct my Executor to pay all my just debts, funeral and administrative expenses out of
my estate, as soon as practicable after my death.
3. I direct that all taxes which may be assessed in consequence of my death of whatever nature and
by whatever jurisdiction imposed shall be paid out of my estate a; a p31tJftlle administration of my estate.
I ;: ":;':' ~1 ~~
Mt. ZiOil Lllited ~dcth0djst Church, 589 Park Drive. Carlisk, Penllsylvania.
5. I direct that my Executor liquidate all of my remaining property, \Vhich shall be distributed as
hereafter provided.
6. I give, devise and bequeath the remainder ur my estate as follows:
A. One-third thereof to my friend. Donald R. Rynard, if he survives my death.
B. One-third thereof to my stepson, Robert Lee Alspaugh. or to his issue in the event he fails
to survive my death.
c. The remaining one-third to my stepdaughter, Patricia M;1rie Trimm~L or to her issue in
the event that she t"ils to survive my death.
7. I direct that in the distribution of my estate, the share of my stepson, Robelt Lee Alspaugh. shall
be charged with an advancement of Six Thousand Five Hundred Dollars ($6,500.00). Said advancement
represents the remainder interest in the Perry County Hunting Cabin, formerly owned by me and my late husband,
which was conveyed to Robert Lee Alspaugh.
8. ! nominate and appoint my friend, Donald R. Rynard, as my Executor of this my Last Will and
Testament; and should he for any reason fail to qualifY or cease to serve in that capacity, ! nominate and appoint,
as substitute Executor, my stepson, Robert Lee Alspaugh. I further provide that my personal representative shall
not be required to f,le any bond or other security in any jurisdiction to secure the faithful performance of his
duties nor be required to obtain any order or approval of any Court for the exercise of any power or discretion set
forth in this Wi!!.
9. All income or principal held for the use and benefit of the beneficiaries of this Estate shall not be
in any way or manner subject to anticipation, assignment, pledge, sale or transfer, nor shall any such interest,
while in the possession of my Executor, be liable for or subject to the debts, conlracts, obligations, liabi!ities or
C., i"~ < i', t
,- :.;; ~,(. .~!;y, '
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10, If any beneficiary of the Estate shall, in the sole opinion of my Executor, be or become mentally
or physically incapacitated, by reason of illness, accident, minority or other circumstance, my Executor may apply
either income or principal for the support and welfare of such beneliciary directly or to the person who has the
care ami control of such belleficiary, without the intervention of any Guardian and without obligati0n to supervise
application of said amounts in any way.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this }'!L day of December, J 999,
./ .'
MARY H. ALSPAUGH
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
~".!! /)').,.1 .,'
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COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, Mary H. Alspaugh, Roger M. Morgenthal, and Steven J. Fishman, the testatrix and the
witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn,
do hereby declare to the undersigned authority that the testatrix signed and executed the instrument of her Last
Will, and that she signed willingly and that she executed 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 the time eighteen (18) years of age or older, of sound
mind and under no constraint or undue influence.
, ;..,-'
Sworn III uncI subscribed before mc
this ' day of
1999.
NOTARIAL SEAL
KATHY L. IIUIIlIEiiT, NOTARY PU8L1C
CITY OF CARLISLE, CUM8ERlAND CO., PA
IIY CO~~!SSICN EXFIRES ,'''''n 11,2003
A Settlement Statement
U.S, Department c~ Housing and Urban Development
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D. NAME or HORROWER Stephanie M. Zacngle
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E. NAME 01' SFLLFR
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ti PROPERTY I\DDRESS 230 Henderson Avenue, Carlisle, PA 170]]
_ _____ C!1Ll.ig\e Boroul!h
II SFTTI!:l\lI'NT NiFNl PA Real Estate Settlement Sc:rviccs, LLC
~l L OUEllJdJ:~1JJ:' I 25 Alcx.am.!.er Smilli!._.RQ&Q Sic. Carlisle. l' ^ 17013
L SlTILE."'IENIPATE: ,05/26/2005
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-ID.- . ..-
~QIAl....BEUU~,AMOUNT DUE '='<::, I <::0 ;l_L~n_".J_'
"~T SETTLEMENT TOOR fR~M SEl\..E!~__. -,
,,,,,-;"'[ \ {li""-4Wl __ _ ~1,1h~~22
6QL-J..e.liS-IllliUCtinn"r1\OlJnln'oe5~20 .3.8272
,,,,., 123Lo.,,40.21
129 021. O~
12 650.00
..J.o'...CllSH.fRQM1lORBillI'ER
1:1,,6 371.06
SU8STltUtf fORM 1M\! SEI l~R. SlI\lF"M'I-H: ll1" 'Inl~rmal;on tQ<llained he'",n i" 'm~or\a"i 18> informal,on and I,s being fU'n1~h"d 10 lhe Inl",nal Rev~nu~ S"""ce, If youa'e 't>QtJ"e~ 10 f,l" a '~Iu,n
"~eiilio~nce ~e"alty 0' Otll~' sanCllon will h" imposed ('~ you,f Ihi~ ilen1 '" reqUIred 10 be 'eppned and ll1e IRS dele,m,nes (hal ot has not heen rep"~e<l Th~ CM\ta~\ S<<l"S P"~"<!"SC<1t>..<! <>"
(Ine~01 aboveconstlloJleStl\"G,0%~P<ocudsGl\I1\S\'<lI'Sacl1Of1
Yo'o are r "i'"d by laW 10 proVIde 1M selllems<1\ aget>\ (Fed la, to Nt}', __ ",_ __Jwi\tl you, ,correcllaxpayer idenlification Mmbe' If you do no! provide your correclla.~aye[ i::"en~i:,icat'on
nu;"ber, ~ may be ~ubJecllo ~,"il Of CrirJllnal penalt'es i'nposed l>y law, [Jii(fer penalj'E!S Of De'lury, t ceMy Ihat Ihe nUm~er 5nOIVn On thrs slatement IS my correct taxpay<'lr 'denhf,cat 00 f\U b
illll __.__'~_ _SEllERISISIGNATUREISl ,~~~~-
S~~\ 'i'.R.\S) NF.IN 'M"il\N(', IIDDRES5
S1':LU::tl.(S\ PHONE: NUMBERS
_,,___.._~_,,_(HI_,____,_
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-.--1.--..SETTLEMEtiI CHAH_G.E..S-~..._..~_..
......lQQ.......lQ..IAL_SAJ.ESL6BQISER:S..NMM1SSION baser} nn DIj~l!26 5~OO
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701 ~ _..........J.Q..
....1i1..Li~_.__ _Ill....
Title~1.l.lt....~~r~~QQ.5....aUJ'fl!LK....sC
PAID FROM PAID FROM
__...~ BORROWER'S SELLER'S
FUNDS AT FUNDSAT
_.~__ SETTLEMENT SETTLEMENT
....10J r.nrnrnission..paJd..aISfHII@.rn...nl
~lI~AYA6LE..JN.CQtlN......ECI..lQl-WJTH ! OAN
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%
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1104 r:r"'clll fu:I!llIL-
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RlJ7 AssLlmntinnF..",
-""---
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~-----
au
....9Q!LJIEMS REQUIRED BY LENDER TO Btl~CE
Jill1 1"I"'f",sl From
In
@s
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:~
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~..QE.eQSlIfQ...Y!I.lIt1 LFNOFR FOR
~.'T~
lOmM()(j():lnA~_
.~ [fi:.._
l1QQJlJLE CHARGFS
..101..........ftl~~_.
~i ~~
:~;
102 Abslrar.t.QL1ill~_X2!ch
JQ;L]..i..lli:....u
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In''inOCLJm''''1lP~_
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107 Altoml'!v'sfpp'i
--------1iru:1~~~n.
lOR TltI",lnsl"..nr....
Itnr.lL,rlesallnveilemsNn
llm......l~1IeIaWl..~____~.
~~.:i~
126,500.00
1.11 Arl"'''''v(;...rjjf;r."t''~~a1zmann Huahes, P.C.
850.00
1J-'-----__.~
III
2lll1.....QQ\jE.B1iMENI_RFr:ORnlNG AND TRANSF!=R CHARGFS
m~f~~~50 MnrtClanP.$ RI'!Ip.F1sp.$
'0;> r:llvIColJnlv.Jaxlstamns
}OCl !'>lat!!Taxlstamns
1(J4
n...p.d$;l,265.00 MnrtnMA!t
nep.d~~ortoaClp.$
_38.5.<2...___ ______~_
1 ?65. 00 ___~
._.------1--L265.Q_ll
~-
illD......8.QQITIONAJ SFTTl FMFNT CHARGES
~l........EinQl..Swf tn Carlisle BorouQh
~ai~_~. Gottshall
lQQJQLAL SETTl FMFNT CHARGE'S
("nl...ronlin..sl01S....,ti"nJ"nrl!in?~l
t~--------
------2.~~
2 530.00
-- 2.153.5Q, '"-~~!l27.3:
HUD CERTIFICATION OF BUYER AND SELLER
I ha.a caruful<y r~",~...ed Il1e liUU'l 5euremenl Statemenl and 10 the beSI of my knowledge and bul,el, ,I ,s a true and accurata .1..1"lIle"l of all f=celpt. aM Oi.bursemenl5 made {)(l "'y accounl or by ,,",
Ln Ill" fta".aclLOl1 I futthal 'un,l~ Irlat I ha_a rece<vall a wp~ af Irla HUD-l SeWemant Statamant
,
" 1
~c
~\U\~
Ph.anie M.j"~ .Is
cE>tatf'LlfMaryH,Alspi1ugh
C" / ~'/
/ /11'1(" /(
Iro ~Rynard,E.aCu{)f
Xl\.
i~~)~
, /'
~''--:7f(?~,<t.:.-
.[
, ,
RNING IT IS A CRIM!: to KNOWINGLY MAKE FALSE STATEMEN rs TO THE
1 EO STATES ON nilS OR ANY SIMilAR fOHM. PENAL T'ES UPUN CONVICTION
~ INClUDE A FINE AND IMPrJ.ISONMI'.Nf. FOR DETAilS SEE TITLE 18
CODE SECTION 1001 AN(J ;;EcnON 1010
TheH 0 1 SeltlamenISlaamemwh,ohtha,epr"paredlsal"'eandaocuralaaccounlofUu.lrdll.ac!~n
i ha.e ~u~e~ or '''II cau lie tun 1<> be U'.b~'1d In dccorOd'lCe w \ll UtI> .1~\..m~1l1
" . 1~~~/cf>
PlWay~qirtt
1/10/2005
SALZMANN HUGHES & FISHMAN PC
95 ALEXANDER SPRING STE 3 RD
CARLISLE PA 17013
The information which you requested on the account(s) of MARY H ALSPAUGH
(Social Security Number 198-05-870 I) is/are as follows:
Account Number 1756220574 1756229011 4100003327 9600014991
Class of Account CERTIFICATE CERTIFICATE CHECKING CERTIFICATE
Date Opened 020592 073092 081700 072103
Principal Balance 26351.89 80571.86 25607.45 39117.04
Accrued Interest 19.69 202.51 19.32 50.21
Balance at Date of 26371.58 80774.37 25626.77 39167.25
Death
Account Ownership SOLE SOLE SOLE SOLE
Name of Joint
Owner, if any
Date Ownership 020592
Was Established
073092
081700
072103
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of joim
Owner, if any
Date Ownership
Was Established
Additional
Information
Requested
~il
'. 'tC d!l4--
E ATTS
SENIOR SERVICES REP.
P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711
.. --- --- -- .-- .....,--.. A__. ""7I""1'/nlr:::" ",en,.,.. .........A".'~I.nnin..h:::anlt-,.nm
.: CITIZENS BANK
525 William Penn Place
Suite 153-2510
Pittsbumh, PA 15219
January 14, 2005
SALZMANN, HUGHES & FISHMAN, PC
JAMES D. HUGHES
95 ALEXANDER SPRING RD
SUITE 3
CARLISLE, PA 17013
Estate of MARY H ALSPAUGH
Date of Death: Dec 23, 2004
SSN: 198-05-870l
Dear SirlMadam:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as ofhislher date of death.
For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 1-888-999-6884.
Sincerely,
(11f;;c&'
Ann Rhodes
Operations Services
+~ CITIZENS BANK
Account Number 6100734935
Account Title MARY H ALSPAUGH
Date Opened 3/5/86
Account Type Checking
Principal Balance as ofDOD $18333.26
Interest from Last Posting to DOD $.00
Account Balance as ofDOD $18333.26
YTD Interest to DOD $167.15
+~ CITIZENS BANK
Account Number 6200261788
Account Title MARY H ALSPAUGH
Date Opened 8/26/02
Account Type Checking
Principal Balance as of 000 $104472.30
Interest from Last Posting to 000 $.00
Account Balance as of 000 $104472.30
YTD Interest to 000 $1919.47
f!WADDEIl
.. N~ REED
~ Sm'mC,m","y
lvy funds
Waddell & Reed Adrisors funds
Waddell &. Reed [nvestEd Ponfoiios
6300 lamar Avenue ... Post Office Box 29217 .. Shawnee :Vlission, KS 66201-92] 7
James D Hughes
Salzmann Hughes & Fishman PC
95 Alexander Spring Rd STE 3
Carlisle, P A 17013
Date: 01/03/2005
Decedent Name: Mary H Alspaugh
This is a written response to your request for date of death valuation for the above persoll
We show the following account(s) in the name of the deceased (The following shares and
net asset prices are provided as of the date of death:I2/2312004
Account/Fund
35206206/624
Number Shares
14,232.494
Price
$6.39
Value
$90,945.64
Rel!istration
Mary H Alspaugh
Beneficiary: Estate of Mary H Alspaugh
In order to transfer* (change registration) or redeem these funds, please provide:
. Letter of instruction signed by the executor of the estate of Mary H Alspaugh
. Copy ofletters of testamentary naming said executor
. Certified copy of the death certificate
Thank you for the opportunity to be of services. Additional questions may be directed to
our Client Services Representatives at 800-366-5465.
'/ ~ir
, : ;il'!.. .-. ,y-
, L L-Lc: . ./!'
Client Services Division
Waddell & Reed Services Company
* New registration instructions
must itzc/ude the social security
number and date of birth for new
accollnt o}veners
Waddell &, Rcrd Scrvias Company serves as the Shareholder Servicing Agent and (he ACcOlmting Services Agent for
the Ivy Funds, the \.\/addelJ & Rwl Advisors Funds, and the \\/addelI & Reed InvestEd Portfolios.
!.TM1'i~~~~A
Transamerica Life Insurance and
Annuity Company
Home Office:
Charlotte, Nom Carolina
Administrative Office:
4333 Edgewood Road NE
PO Box 3183
Cedar Rapids, Iowa 52406-3183
March 15, 2005
Donald R Rynard
C/O Salzmann, Hughes & Fishman PC
Attn James Hughes
95 Alexander Spring Rd Suite 3
Carlisle PA 17013
RE: Annuity Number 26149935
Dear Donald R Rynard:
We have received notification, Mary H Alspaugh, annuitant of the above
listed non-qualified tax deferred annuity is deceased. Our office
wishes to extend sincere condolences for your loss.
Our records indicate the following annuity information:
Annuitant:
Owner:
Primary Beneficiary(ies)
Annuity Policy Date:
Full Value as of 03/15/2005:
Taxable Portion:
Full Value as of 12/23/2004:
Mary H Alspaugh
Mary H Alspaugh
Donald R Rynard
April 03, 2001
$18,595.02
$2,971.99
$18,471.95
The attached document reflects the options available to the primary
beneficiary(ies) listed above.
The full value as of the date of death is for tax purposes only and is
not a guaranteed death benefit amount.
The attached document contains general tax information based on
Transamerica Life Insurance and Annuity Company's interpretation and
should not be relied upon for your personal tax planning. If you have
questions concerning the direct tax consequences when selecting an
option, you may wish to consult a tax advisor.
Member of tbe eEGON. Group
.
Any additional questions regarding this annuity can be directed to the
Annuity Service Center at 1-800-553-5957. A Transamerica Life
Insurance and Annuity Company representative will gladly assist you
with any questions you may have regarding this annuity and help you
meet your financial goals.
Sincerely,
~!~
Kerry J. Strait
Transamerica Life Insurance and Annuity Company
Claims
Enclosure(s)
Annuity Claimants Statement
Postage Paid Return Envelope
Death Option Packet
COMMONWEALTH Of PENNSYLVANIA
COUNTY Of CUMBERLAND
I
j
55:
funald R. Rynard
being duly
sworn according to law, deposes and says that he is the Executor
_._...._._.....___._ of the Estate of MarY H. Alsoauqh
Carlisle Borough
tbn ~tb I?- (jr0'~
Executor - Administr r
262 Red Tank Road, Boiling Springs
J
o PENNSYLVA
taria/ Seal
Jacqueline L Orawbaugh, Notary Publ;
SOUth MJdd.let~n Twp., Cumberland Coun
My CommISsion Expires Aug. 14, 20~
Member, Pennsylvenle Asooc:Iallon of Notariea
23
Death _______._..
Doy
PA
17007
Address
Date of
December 2004
Month
Yeer
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may b. attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
. "
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Inventory of the real and personal estate of
:'1ary H. Alspaugh
deceased
1. 230 Henderson Avenue, Carlisle, Cun1terland County, PA
2. Carlisle Canpanies Inc., 604 shares
3. Waddell & Reed Services Company, 14,232.494 units
4. Cash on hand
5. Citizens Bank
6. Ci tizens Bank
7 . l-liscellanous personal property
8. Waypoint Bank
9 . Waypoint Bank
10. Waypoint Bank
11. Waypoint Bank
$126500 00
39188 00
90946 00
1340 00
104472 00
18333 00
3515 00
25627 00
26372.00
80774.00
39167.00
COMMON\'l/EALTH DF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV~1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HUGHES JAMES 0
95 ALEXANDER SPRING RD
SUITE 3
CARLISLE, PA 17013
~_H_.__ told
EST A TE INFORMATION: SSN, 198-05-8701
FILE NUMBER: 2105-0048
DECEDENT NAME: ALSPAUGH MARY H
DATE OF PAYMENT: 06/22/2005
POSTMARK DATE: 06/22/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/23/2004
NO. CD 005478
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $7,763.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$7,763.00
REMARKS: SALZMANN HUGHES & FISHMAN
CHECK# 3276
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS