HomeMy WebLinkAbout08-05-05
)an M. Wiley
David ). Lenox
Timothy). Colgan
Christopher ). Marzzacco
David E. Hershey
Bradley A. Winnick
Thomas M. Clark
Ari D. Weitzman
August 3, 2005
THE 'WILEY GROUP
Attorneys at La"W'
Wiley, Lenox, Colgan & Marzzacco, P.c.
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
In Re: Estate of Jean E. Dennis, deceased
File Number 21-05-00206
Dear Register:
Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status
report with regard to the above captioned estate. AlsO' enclosed is a check in the amount of
$30.00 representing the filing fee.
Please return the recording receipt to my attention in the enclosed envelope.
Thank you for your cooperation.
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130 W. Church Street, Suite 100 . Oillsburg, PA 17019 · Phone: (717) 432-9666 · (800) 682-4250 · Fax: (717) 432-0426
Offices in Harrisburg · York · Carbondale
www.wileygrouplaw.com
Register of Wills of
Cumberland
County, Pennsylvania
INVENTORY
Estate of
Jean E. Dennis
No.
21-05-00206
also known as
. Deceased
Date of Death 03/01/2005
Social Security No. 172-01-1864
Michael R. Dennis Marsha J. Hertweck
--- -------- ------
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of
the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except
that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory
are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S.
Section 4904 relating to unsworn falsification to authorities.
I.D. No.:
Jal1,M~~.il~~___._ .
06298
Personal Representative , " /j
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Signature: / 4/~,,_,..
. ~I R. ennis /l
Slgnatu' ~~~
Mars a J. Hertweck
Signature:
Attorney:
Firm:
Wiley, Lenox, Colgan, & Marzzacco,
..P.&...._ u___
Address: 130 W. Church St
[)il!~p.urg, PA 17019
Telephone: 717-432-9666
Address: 6640 N. Donna Beatrix Circle
Tucson,AZ. 85718
Telephone: 520-299-0107
Dated:
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Personal Propertv
Cash...............................................................................................
Miscellaneous Property.......................... ..... ..... ............................
Stocks/Listed.................................................................................
Stocks/Closely Held......................................................................
Bonds.............................................................................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
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394,636.9'fi
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Total Personal Property.........................................
394,636.97
Total Real Property................................................
Total Personal and Real Property.........................
Total Out-of-State Real Property..........................
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REV.1500 EX + (5.00)
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OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
II 05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Dennis, Jean E.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD.YEAR)
03-01-2005
11-12-1918
172-01-1864
00206
NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WiTH THE
REGISTER OF WILLS
SOCIAL SECURI1Y NUMBER
4a. Future Interest Compromise (date 01 death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 SpOusal Povertv Credit (dale of death between
. 12-31-91 and 1-1-~5)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5, Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
~ 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach
copy 01 Will)
o 9. Litigation Proceeds Received
o
o
o
o
2. Supplemental Return
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
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NAME
Jan M. Wiley
FIRM NAME (If applicable)
Wiley, Lenox, Colgan, & Marzzacco, P.C.
TELEPHONE NUMBER
717-432-9666
COMPLETE MAILING ADDRESS
130 W. Church St
Dillsburg, PA 17019
(1) None
(2) None
(3) None
(4) None
(5) 394,636.97
(6) None
(7) None
(9) 30,274.36
(10) 5,250.17
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)
:--.1
--pFFIClAt US~.G)NL Y
! :'" )',:,3
(8)
(11 )
(12)
(13)
(14)
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2}
0
i= 16. Amount of Line 14 taxable at lineal rate 359,112.44 x .045 (16)
~
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0. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
:!i
0
0 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18)
>< x
0:(
.... 19. Tax Due
(19)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3, Closely Held Corporation, Partnership or Sole-Proprietorship
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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) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
seE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
1
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394,636.97
35,524.53
359,112.44
0.00
359,112.44
0.00
16,160.06
0.00
0.00
16,160.06
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX {Rev. 6-00;
Decedent's Complete Address:
STREET ADDRESS
100 Mt. Allen Drive
CITY Mechanicsburg
I STATE PA
IZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditsfPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
16,160.06
16,672.50
808.00
Total Credits (A + 8 + C)
(2)
17,480.50
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 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)
A. Enter the interest on the tax due. (SA)
8. Enter the total of Line 5 + SA. Thi:s is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,320.44
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;.................................................................................. D [!]
b. retain the right to designate who shall use the property transferred or its income;.................................... D [!]
c. retain a reversionary interest; or.................................................................................................................. D [!]
d. receive the promise for life of either payments, benefits or care?.............................................................. D [!]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 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?......... D [!]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................................... ... .......................................... ... 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 pe~ury, 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 infonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
MichaejR' ~b
S(~~~~NSIBLE FOR FILING RETURN
a J. Hertwe
DATE
6640 N. Donna Beatrix Circle
Tucson, AZ 85718
~t)~
ATE
ADDRESS
840 Grantham Road
Grantham, PA 17027
ADDRESS
~A
130 W. Church St
Dillsburg, PA 17019
For d tes 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
Iving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net v
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a survivir
of assets and filing a tax return are still applicable even if the surviving spouse is
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.
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P .S. 99
The tax rate imposed on the net value of transfers to or for the use of the decede
99116 1.2) [72 P.S. 99116 (a) (1)].
() APD
urviving spouse is 0%
Jirements for disclosure
-J
Au.S{
Jr for the use of a
IS noted in 72 P.S.
The tax rate imposed on the net value of transfers to or for the use of the de cede
defined under Section 9102, as an individual who has at least one parent in com
.3)]. A sibling is
- ______...., nll....Ulvl uy UIUUJ or adoption.
funs! lIill Nnn {[psmm.put
OF
JEAN E. DENNIS
BE IT REMEMBERED, that I, JEAN E. DENNIS, of 205
Mountain Road, York County, pennsyivania, being of sound
mind, memory and understanding, do make, publish and
declare this as and for my Last will and Testament,
hereby revoking and making null and void any and all
wills and Testaments and writings in the nature thereof
by me at any time heretofore made.
ITEM 1: I direct that all my just debts and funeral
expenses be paid as soon after my demise as may be
convenient.
ITEM 2:
I give my horne, situate at 205 Mountain
Road, Dillsburg, Pennsylvania, or any other home which
may be" my principle place of abode at my death, together
with all household goods and furnishings therein, and all
policies of insurance on said real and personal property,
to my husband, RICHARD C. DENNIS, without liability for
waste, for his life so long as he desires to use such
premises as a horne, and pay all cost of maintenance
thereof, including taxes, assessments, insurance and
ordinary repairs, said property to be insured in a
reasonable amount, insuring the interest of remaindermen
as well as himself.
ITEM 3: All the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate,
whether it be real, personal or mixed, including property
J
a -<1/1/7 t> dr /n..?~.v
~ E. DENNIS
(SEAL)
over which I have a power of appointment, I give, devise
and bequeath unto my husband, RICHARD C. DENNIS,
absolutely, provided he survives me for a period of
thirty (30) days.
ITEM 4: Should my husband, RICHARD C. DENNIS, fail
to survive me for a period of thirty (30) days, or should
we die simultaneously, I then give, devise and bequeath
my entire residuary estate unto my two step-children,
MICHAEL R. DENNIS and MARSHA J. HERTWECK, in equal
shares, per stirpes.
ITEM 5:
I appoint MELLON BANK, N.A., as guardian
over any property which passes either under this will or
otherwise to a minor and with respect to which I am
authorized to appoint a guardian and have not otherwise
specifically done so, provided that this appointment of
a guardian shall not supersede the right of any fiduciary
in its discretion to distribute a share where possible to
the minor or to another for the minor's benefit.
Such
guardian shall have the power to use principal as well as
income from time to time for the minor's support and
education, (including college education, both graduate
and undergraduate), without regard to his or her parent's
ability to provide for such support and education, or to
make payment for these purposes, without further
responsibility to the minor's parent or to any person
taking care of the minor.
ITEM 6: I direct my hereinafter named Executor to
t:--0
L/YI t::.~ (SEAL)
~ E. DENNIS
pay all inheritance, estate, succession and legacy taxes
of whatsoever nature and kind, to which my estate or the
transfer of any property passing hereunder or otherwise
passing by reason of my demise, may be subject and to
charge such taxes against my residuary estate, it being
my intention that none of the aforesaid taxes, either
federal or state, on any property required to be included
in my gross estate, under the provisions of any state or
federal law now in force or hereafter enacted, shall be
prorated among the persons interested in my estate to
whom such property is or may be transferred or to whom
any benefit accrues.
ITEM 7: I appoint my husband, RICHARD C. DENNIS, as
Executor of this my Last will and Testament. Should my
husband predecease me, fail to qualify, cease to act or
renounce probate, I then appoint my two step-children,
MICHAEL R. DENNIS and MARSHA J. HERTWECK, as alternate
Co-Executors of this my Last will and Testament.
ITEM 8:
I direct that my Executor, Guardian or
their successors shall not be required to give bond for
the faithful performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this IS~ day of ~
, 1993.
~ t'. ,ft&--rl/J-u';,.A, SEAL)
.~E. DENNIS
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF YORK
We, JEAN E. DENNIS, JAN M. WILEY, ESQUIRE and
PATRICIA A. OGG, 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 ~hat the Testatrix.
signed and executed the instrument as her Last will and
Testament and that she had signed willingly (or willingly
directed another to sign for her), 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 this Last
will and Testament as witness 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 to and subscribed
before me this I~ day of
~Q , 1993.
s.AOLu/r; hjrx ~ -I :/-M.
NOTARY. PUBLIC
MY COMMISSION EXPIRES:
. . Notarial Seal
~Da'M1 Gladfelter, Notary poorlC
. CalTllnTwp., YorkCounly
My Commission Expires May 17, 1997 .
Member, Pemsytvania AssoCiation of No1al1eS
Rev.1508 EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dennis, Jean E.
FILE NUMBER
21-05-00206
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Citizens Bank Checking Account Number 6100745694:
VALUE AT DATE
OF DEATH
7.209.05
2 Interest to date of death earned on Masland & Barrick accounts:
3.566.92
3 Masland & Barrick Investment Account:
358.199.00
4 Masland & Barrick Money Market Account:
25.662.00
TOTAL (Also enter on Line 5, Recapitulation)
394.636.97
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
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MAsLAND
&
BARRICK
-ADVISORY. INC.-
INDEPENDENT FINANCIAL ADVISORS
~~
JanM. Wiley, Esq.
130 W. Church St.
Dillsburg, P A 17019
------ --...
- ----.-----------------
March 16, 2005
-- -.- .--
- --_.--- ----_._-----~--------_...
RE: Estate of Jean Dennis
Jean Dennis had one account with our company. I am enclosing a copy of the values as
of 4:00 p.m. on March 1, 2005. The investments totaled $358,199 with an additional
$25,662 in money market.
~ ~
.._ ____________.__.u._._.__~
-.. . - -..
------._--------~ -~ -----------
The projected cash flow (dividends and interest) accrued to date of death was $691.92.
Accrued interest on her two certificates of deposit woul~ be $2,875. making a total of
$3,566.92.
-. ---
...-.---..----"----- ----
=~.::i~E:~~~_===;_::;_==~::=_::.~~ This brokerage account was registered in the single name of Jean E. Dennis and was
==:.=-~::_~=~~~~~=:':::~j opened on July 25, 1997. Marsha Hertweck has had power of attorney for several years.
.=~~-:-::.---=-::.::.:c:::::::===c:~~ Please contact me if you have any further questions.
_.======::c....--=-:-=---= Sincerely
_._._-------~---_._---. ,
.~~:_~-'~~~~~~--~;::_~~ ~~~
-'-=:---~--'~-'~"-=:=~:,,:=- Isabel C. Masland, CFP@, CDF A
---. - -.
~.~::__:.~_:;:.:::~:::::=~~_==; Enclosures
~---:c-:=_:::-_:::=_==~:_=::_:::-_=~ Wiley, Ian 16 Mar 2005
- -- ----~--_._--_._-._.~-------
._------.---- --,-..
3461 Market St., Suite 102, Camp Hill, PA 17011 / TeL 717-761-6606 Fax 717-761-7524 / www.maslandandbarrick.com
Securities offered through Walnut Street Securities, Inc. ;' Member NASD, SIPC
Masland & Barrick Advisory, Inc~ and Walnut Street Securities are unaff1liated entities~
~~
~-~---_._-- - --. .._-------~
Ac~~_~~~ ~_'!!!l_I!!~_~.x '.
P5WLIMAS DENNIS JEA - 5W8162153
03/02/2005 8:32:38
Balance Information as of 03/01/2005
Long Market Value:
Short Market Value:
Tech Short:
Net Balance:
Cash Avail:
357,842.04
0.00
0.00
-357.44
357.44
Total FC:
Total Equity:
MMF Current:
PCF Amount:
0.00
358,199.48
25,662.44
691.92
No Orders
Holdings as of 03/01/2005
Symbol qj~q> '. QU_~I!-t!ty_ . ,. .p.~iC!l'Jg!!~lli!lii':'Y!ilu.~~~~sitiii~!g!!IT1@ti;;i':$-!lsy.RtJEtgp~1ili~rti(jiJ;Hll&'U~C'cQtiilf?j;yJli~i;tiJUii.cLi;,:;,~:~z:;2~:.;:::_;~c..:;
MMF.oo 25662.44 1 25,662.44 USD Money Fund Cash
AMIFX 00142... 6592.13 6.56 43,244.39 USD Mutual Fund USD Cash
EVPRX 27791... 8563.42 9.41 80,581.75 USD Mutual Fund USD Cash
33762... 34000.00 9S.943 33,640.62 USD Money Fund USD Cash
49777... 100000.... 95.434 95,434.00 USD Money Fund USD Cash
70883... 20.00 ~9.45 1,989.00 USD Other USD Cash
70910... 500.00 41.15 20,575.00 USD Stock USD Cash
79547... 2000.00 1,2.95 25,900.00 USD Stock USD Cash
88521... 500.00 28.79 14,395.00 USD Stock USD Cash
92091... 4599.16 9.15 42,082.28 USD Mutual Fund USD Cash
I
2
3
4
5
6
7 PEl
8 SBF
9.TMA
10 XPRTX
5
. . !;'e.~,(ritY..Q~~ripJl~Il.~:'l~:,\.:;;;f.'.,..,'.:'::J~!~_ij,.r!&~;Ql!t~f;Mygt.iiiQ,teluj!inp~J!;~f!!~~~t;j;{fg~"iLij~illiff!t~~~-!l:O'lll~.m~!if~1~J~Yt~J&!.~;;1;!1:~;;;::t
CORTLAND GENERAL MNY MKT Not Available N/A
FUND
AIM INCOME FUND CLASS A
EATON VANCE PRIME RATE
RESERVES fUND
FIRSTBANK P R CTF DEP ACT/365 12/18/2023
6.000% 12/18/23 B/E DTD 12/18/03
CLB CLB 06/18/05 @IOO.OOO
KISLAK NATL BK MIAMI LAKES 12/13/2022
FLA CTF DEP ACT/365 FDIC INSD
5.500% 12/13/22 BIE DTD 12/13/02
CLB CLB 12/13/05 @IOO.OOO
PENNSYLVANIA INSD MUNS
INCOME TR UNIT 42ND SER
MONTHLY
PENNSYLVANIA REAL ESTATE
INVT TR
8 SALOMON BROS FD INC
9 THORNBURG MTGE INC COM
10 V AN KAMPEN SENIOR LOAN
FUND CLASS IB
Standard
Standard
100%
100%
43,244.39
80,581.75
2
3
4
Standard
NIA
Standard
N/A
6
Standard
N/A
7
Standard
30%
6,172.50
Standard
Standard
Standard
30%
30%
100%
7,770.00
4,318.50
42,082.28
Last Week's History as of 03/01/2005
nat~ ' -'.i" :l'r~t Nn()untA~tivitYIf::i~;i\~':;;~~;\J.,;;i;ti;'E{'~;i)i~~iiEgli~~ . :QJJ~ri!iiy.;iJ[~~~~&gE~i~w~~t{~~!f:;;rjf~!i~K~1i1t~~cI;t\}dti;&:.;,:j1;;;;;'":(
1 03/01/2005 -136.10 CASH DIVIDEND RECEIVED 0.00 0.000000 US9209141087 USD -136.10
2 03/01/2005 -221.34 CASH DIVIDEND RECEIVED 0.00 0.000000 US2779131091 USD -221.34
3 03/01/2005 -3000.00 MONEY FUND REDEMPTION 0.00 0.000000 USD -3000.00
4 03/01/2005 3000.00 ELECTRONIC TRANSACTION 0.00 0.000000 USD 3000.00
5 02/28/2005 7.80 MONEY FUND PURCHASE 0.00 0.000000 USD 7.80
6 02/25/2005 -7.80 NON-TAXABLE DISTRIBUTION Roo. 0.00 0.000000 USD -7.80
This report is a service from your [nvestmenl Professional, not a substitute for your account statements and confirmations. This report is prepared as of trade date rather than settlement date and may be prepared on a different date
than your statement. This report uses infonnation from sources that Pershing believes to be reliable, but Pershing cannot guarantee the accuracy orlhis information or the reliability of these sources. If you find discrepancies in this
~~r:!t_pJ~e cont!l~.!.y~uf .~~'!~tmcn.!.f~~=!.s.i<<1~.__. ___ _________
to 2000 NelExchange Pro. All Rights Reserved.
Page 1
+: CITIZENS BANK
525 William Penn Place
Suite 153-2510
Pittsburgh, PA 15219
March 31, 2005
THE WILEY GROUP
130 W CHURCH STREET
SUITE 100
DILLSBURG, P A 17019
Estate of JEAN E DENNIS
Date of Death: Mar 01,2005
SSN: 172-01-1864
Dear SirlMadam:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of hislher 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.
~D1 ~\~
Pamela M Lewis
Operations Services
.~ CITIZENS BANK
Account Number 6100745694
Account Title JEAN E DENNIS
Date Opened 6/6/1966
Account Type Checking
Principal Balance as ofDOD $7209.05
Interest from Last Posting to DOD $.00
Account Balance as of DOD $7209.05
YTD Interest to DOD $.00
Rev-1502 EX+ (6-98)
*
SCHEDULE H-A
FUNERAL EXPENSES
continued
CO!/MONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Dennis, Jean E.
FILE NUMBER
21-05-00206
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cocklin Funeral Home:
10.136.18
2
Funeral Luncheon:
85.89
3
Funeral Travel expenses for step-son and granddaughters:
1.200.00
Subtotal
11,422.07
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
REV-1151 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Dennis, Jean E.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-00206
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 11,422.07
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Wiley, Lenox, Colgan, & Marzzacco, P.C. 16,800.00
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 460.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,592.29
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 30,274.36
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rey-1502 EX+ (6-98)
.
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Dennis, Jean E.
FILE NUMBER
21-05-00206
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland Law Journal (advertise estate):
75.00
2
Masland - Commission:
30.00
3
Masland - Expenses for commissions, services charges, transfer fees and
interest/state tax:
1.273.61
4
Stamps:
22.20
5
The Sentinel (advertise estate):
191.48
Subtotal
1.592.29
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Dennis, Jean E.
FILE NUMBER
21-05-00206
ESTATE OF
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Alert Pharmacy:
VALUE AT DATE
OF DEATH
110.28
2 Burick & Azizkhan physicians:
3 Holy Spirit Hospital:
4 Internists of Central PA:
5 Messiah Village (nursing home):
6 Mobile X-Ray Imaging, Inc.:
7 Neurology Center:
8 Physicians of Rehab:
9 Quantum Imaging:
10 Smith Radiology:
71.57
177 .60
21.06
4.671.20
17.83
7.52
162.74
6.39
3.98
TOTAL (Also enter on Line 10, Recapitulation)
5,250.17
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
I
REV 1513 EX+ (9 00)
*'
.
SCHEDULE .J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dennis, Jean E. 21-05-00206
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not LIst Trusleelsl
I. TAXABLE DISTRIBUTIONS [include outright Sfrousal
aistributions, and ransfers
under Sec. 9116(a)(1.2)]
Michael R. Dennis Son one-half
PA
Marsha J. Hertweck Daughter one-half
PA
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropriate, on 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 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)