HomeMy WebLinkAbout06-17-05
217 REV -1500 OFFICIAL USE ONLY
REV-1500 EX (6~OO) COMMONWEALTH OF
I
, PENNSYLVANIA
, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN
DEPT. 280601 FILE NUMBER 21-05-0225
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT -
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~ Jumper, Carrie E. 182-22-8823
z DATE OF DEATH (MM-DD-YEAR) rATE OF BIRTH (MM-DD-YEAR)
w THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
0
W 2/25/2005 9/14/1926 REGISTER OF WILLS
(.)
w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
0
w [Rh Original Retum o 2. Supplemental Return o 3. Remainder Return (date of death prior to 12-13-82)
...
>::$'" 04. 04a. Future Interest Compromise (date of death after 12-12-82) o 5. Federal Estate Tax Return Required
u~~ Limiled Estate
woo [R] 6. o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
:J:o:.J 0
o a.. III Decedent Died Testate (Attach copy of Will) B. Total Number of Safe Deposit Boxes
a..
<l: 09. 010. Spousal Povel1y Credft (dale of death between 12-31-91 and 1-1-95) 011. Election 10 lax under Sec. 9113(A) (Attach Sch 0)
Litigation Proceeds Received
~ nus SECTION MUSTBE COMPLETED, ALL CbRRESP.(),NDENC!:Af',(DCONFIDENTIALIAXINFORMATION SHOULD BE DIRECTED TO:
z NAME
w COMPLETE MAILING ADDRESS
0 5 South Hanover Street
z Stephen D. Tilev
0
ll.. FIRM NAME (If Applicable) Carlisle, PA 17013
rn
w
a:: Frey & Tiley
a:: TELEPHONE NUMBER
0
(.)
717-243-5838 f~~"_'
.........
") OFFICIAi:'"eJSE ONt y 11
.-"")
1. Real Estate (Schedule A) (1 ) 142,000 ! C,') C'.J
(-') 'TJ
2. Slacks and Bonds (Schedule B) (2) NONE : I i '.:)
: \--:'1
(3) NONE ., ~,., " CJ
3. Closely Held Corporation, Partnership or Sole-Proprietorship ~ , :~-)
.~ - -F!
4. Mortgages & Notes Receivable (Schedule D) (4) NONE , ..
.. - c:::>
5. Cash. Bank Deposits & Miscellaneous Per~onal Property ",C'; ;-11
(Schedule E) (5) 16,704 n .,",\
~-.:)
6. Jointly Owned Property (Schedule F) (6) NONE en
z Dseparate Billing Requested
0
i=
< 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property
...J
::l (Schedule G or L) (7) NONE
l-
ii:
< B. TOTAL GROSS ASSETS (total Lines 1-7) (B) 158,704
(.)
w
a:: 9. Funeral Expenses & Administrative Costs (Schedule H) 7,884
(9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) :10) 52,379
11. TOTAL DEDUCTIONS (total Lines 9 & 10) (11) 60,263
12. NET VALUE OF ESTATE (Line B minus Line 11) (12) 98,441
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not
been made (Schedule J) (13) 0
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 98,441
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
Z rate ,or transfers under Sec.9116 (a)(1.2) x .0 (15) 0
-
0
i= 16. Amount of Line 14 taxable at lineal rate 98,441 .O~ 4,430
< x (16)
~
::l
D..
::E 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0
0
(.)
><
< 1B. Amount of Line 14 taxable at collateral rate x .15 (1B) 0
I-
19. Tax Due (19) 4,430
20.0 '--'--'~---'~"-"-~T:~--'-~ . E~tfia~lf~jftjND~iW~'~{.':f.~x~~Elt~
;~jfEe'RraERE~8Y..Oi)jAROEfRE:
.- .
>q:>BE.S.URETOANSWEfho\LLQIJE;~mqN~ON.R!=VERSE S.lPI;AND RECHECK MATH < <
STATE ZIP
PA 17013
(1) 4,430
3,895
195
Total Credits ( A + B + C ) (2) 4,090
217
1 DeceCfent's Com Jete Address:
, STREET ADDRESS
1846 Ras Drive
Jumper, Carrie E.
CITY
Carlisle
Tax Payments and Credits:
Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. I nterest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check hox on Page 1 I. ine 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. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
182-22-8823
o
o
340
340
1.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
~~ IOjfW1 On-J~ )( i JiJJ~ ~4~ u'--_
ADDRE /' '
330 Juniper St., Carlisle, PA 17013 II 1295 Twin Lakes Rd., Lewisberry, PA 17339 II 80 Hickory town Rd., Carlisle, PA 17013
SIGNATU OF P EPARER OTHER THAN REPRESENTATIVE DATE
,,0 .7 ~47
Did decedent make a transfer and:
a. retain the use or income of the property transferred;
b. retain the right to designate who shall use the property transferred or its income;
c. retain a reversionary interest; or .
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
Yes
o
o
o
o
o
o
2.
3.
4.
Did decedent own an Individual Retirement Account, annuity or other non-probate property which
contains a beneficiary designation?
o
)(
DATE
X ,-.., . .,/) /,i n
I ,.~4u r l ~~_ AUQ. ...z;z
Au . /5
ADD
Stephen D. Tiley, 5 South Hanover Street, Carlisle, PA 17013
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 sUNiving spouse is 3%
[72 P.S. Section 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 sUNiving spouse is 0% [72 P.S. Section 9116 (a)(l.l )(ii)l.
The statute does not exempt a transfer to a sUNiving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicabie 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.S. Section 9116(a){I.2)].
No
o
o
o
o
o
o
,2005
2005
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. Section 9116(a){l.3}] .A sibling is defined, under Section 9102, as an
indiVidual who has at least one parent in common with the decedent. whether by blood or adoption.
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. Section 9116(1.2) [72 P.S. Section 9116(a)(1)J.
. 217
. REV-150iZ EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Jum er Carrie E. 21-05-0225
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 knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
142,000
1846 Rasp Drive
Carlisle, PA 17013
Single family residence purchased by decedant and husband by deed dated
May 14, 1982 and recorded May 14, 1982 in Book "T," Volume 29, Page 852.
TOTAL (Also enter on line 1, Recaoitulationl
(If more space is needed, insert additional sheets of the same size)
$
142,000
l(l'm ~ll1U" IJlt:l!:l1 reI HanOl)OOIl. 4JU:J.;t
A. Settlement Statement
U.S. Deparlment of Housing and Urban Developmenl
S. Tvpe or Loan OMS Approval No. 2502-0265 (expires 9/30/2006)
1. DFHA . 2. OF~HA 3. DConv. Unins. '6. File Number I 7. Loan Number I B. Morlgage Insurance Case Number
4. OVA 5. DCony. Ins. ST200S-47 JDF
C. Note: Ile~s or:'k~~~(~~~.~~)~~~~: :~i~ ~~I~J.~~~' c~0:i;;~;8 thS~I~~:':~~~5 ~se:;f~~~I~r~~'i'i~~ ~p:~~ea~'~~~~~l ~~:d};~~~v~lals. I TilleExpress Seltlemenl System
~:~i~Gc~~i~~::~ ~fn~~~~~~~~~:,:~~e F~~~~;~~~~:I~~,~~I~~.S~~IC~~ ~~~I~n.~~~~~~ds~~~~I~rro.16~nBI"es upon Printed 061061200S a116:32 RLM
D. NAME OF BORROWER: Russell L. Morrison and Doris A. Morrison
ADDRESS:
E. NAME OF SELLER: Estate of Carrie E. Jumper
ADDRESS:
F. NAME OF LENDER: Cash
ADDRESS:
G. PROPERTY ADDRESS: lB46 Rasp Drive, Carlisle, PA 17013
North Middleton
H. SETTLEMENT AGENT: Saidis, Shuff, Flower & Lindsay, Telephone: 717-243-6222 Fax: 717-243-6486
PLACE OF SETTLEMENT: 26 West Hich Street Carlisle PA 17013
I. SETTLEMENT DATE: 06/07/200S
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. .GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Conlracl sales price 142 000.00 401. Conlracl sales price 142000.00
102. Personal Property 402. Personal Property
103. Selllemenl charoes to borrower (line 14001 2 S31.2S 403.
104. 404.
105. 405.
Adiuslmenls for ilems p_aid by seller in advance Adiustmenls for items paid by seller in advance
107. CounlY taxes 06/07/0Slo 12/31/0S 24S.92 407. County laxes 06/07/0Slo 12/31/0S 24S.92
lOB. School Taxes 06/07/0S to 06/30/0S 10S.4S 408. School Taxes 06/07/0Slo 06/30/OS 10S.45
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 144 882.62 420. GROSS AMOUNT DUE TO SELLER 142 351.37
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER SOO. REDUCTIONS IN AMOUNT DUE TO SELLER
201. DeDOsit or earnesl money 14 200.00 501. Excess Deposit fsee instructions) 14 200.00
202. PrinciDal amount of new loans 502. Selllemenl charces to seller (iine 1400) 1 482.S8
203. ExisUno loanls) laken subieclto 503. Exislino IDanls) laken subiectlo
204. 504. Pavoff of Firsl MorlDaoe Loan
205. 505.
206. 506.
207. 507.
20B. SOB.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid bv seller
213. 5t3.
214. 514.
215. 515.
216. 516.
217. 517.
21B. 518.
219. 519.
220. TOTAL PAtD BY/FOR BORROWER 14 200.00 S20. TOTAL REDUCTION AMOUNT DUE SELLER 1S 682.58
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower IIine 1201 144882.62 601. Gross amounl due 10 seller (iine 420) 142.3S1.37
302. Less amounts Daid by/for borrower (iine 2201 14.200.00 602. Less reduction amount due selleUline 520) 1S,682.S8
303. CASH FROM BORROWER 130 682.62 603. CASH TO SELLER 12666B.79
SUBSTITUTE FORM 1099 SELLER STATEMENT: The infOlmalion conlained herein is imporlanlliillC informalion and is being furnished 10 the Inlernsl Revenue Service If you are required 10 rile a relum.
a negligence penally or oltler sanclian will be impOSed on you illhis item is required to be reported and Ihe IRS determines Ihal il has nol been reported. The ConIlact Sa~s Price described an
line &101 above conslilules the GlOSS Proceeds of lhis lrensaclion.
SELLER INSTRUCTIONS: II lhis real eslale was your princlp.hesidence, me Form 2119, Sale 01 Exchange 01 Principal Residence, 101 any gain. wllh youllncame tall retUln: far olhellransacUons.
cDmplele Ihe applicable paris of Form 4797. Farm 6252 andlol Schedule 0 (Fonn 1040).
You are required by law 10 provide the selUemenl agenl (Fed. Tax 10 No: ).wlth YOU' COfrecllaxpayer Jdenlil'icalion number. If yau do not plovide your C~rtect laxpayt!f idenlirlcalion
numbel, you may be subject 10 ci.,,~ or climinal penallies unposed by law. Under pcnallles of pefJury, I certify Ihallhe mxnber shown on Ihis slall!menl is my cOlrect taxpayer l::IenlirtCalion number.
TIN:
SELLER(S) SIGNATURE!S):
SELLER(S) NEW MAILING ADDRESS:
I-'reVIOU5 eOllIOf1S are obso'el~
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Number: ST2005-47
S I S
fo,m BUD-, (JIBS) ref Handbook "305.2
PAGE 2
TilleExoress ell emenl svslem Prinled 06/0612005 a116:32 RLM
L. SETTLEMENT C:~ARGES PAID FROM PAID FROM
700. TOTAL'SALES/BROKER'S COMMISSION based on orice $142 000.00 (cj) 0.000 = BORROWER'S SELLER'S
Division of commission lline 700\ as follows: FUNDS AT FUNDS AT
701. $ 10 SETTLEMENT SETTLEMENT
702. $ to
703. Commission naid at Settlemenl
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN
B01. Loan Orio/nalion Fee %
802. Loan Discounl %
803. Annra/sal Fee
804. Credil Renart
805. Lender's Insoeclion Fee
806. Morloaoe Aoolication Fee
807. Assumolion Fee
808.
809.
810.
811. .
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Inleresl From to (a)$ /dav
902. Mortoaoe Insurance Premium (or 10
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. (a) $ Imo
1002. Morloaoe Insurance mo.liil$ Imo
1003. Cilv Prooertv Tax mo. fa) $ Imo
1004. Counlv Prooertv Tax mo. (a) $ 35.96 Imo
1005. School Taxes mo. (a) $ 133.65/mo
1009. Annreoate Analvsis Adiuslment
1100. TITLE CHARGES
1101. Selllemenl or closino fee
1102. Abstract or Iille search
1103. Tille examinalion
1104. Tille insurance binder
1105. Document Preoaralion
1106. Notarv Fees to Said Is Shuff Flower & Lindsav 4.00
1107. Allarnev's fees 10 Frev & Tilev pac SELLER
(includes above ilems No: I
1108. Tille Insurance to ACCP Inc. 1 068.75
!includes above ilems No: I
1109. Lender's Policv
1110. Owner's Policv 142 000.00 - 1 068.75
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordino Fees Deed $38.50 . Mortoaoe $ . Release $ 38.50
-210.2. CilvlCountv tax/stamas Deed $1 420.00 . Mortoaoe $ 1 420.00
1203. State Tax/slamos Deed $1 420.00 . Mortoaoe $ 1 420.00
120.1.
l_fl.o.5.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Final Waler/Sewer 10 North Middleton Authoritv 62.58
1302. Pesllnsoeclion
1303.
...flJ:1
1300.
139G.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES lenler on lines 103 Section J and 502 Section 1(\ 2531.25 1 482.58
HUO CERTIFICATION OF BUYER AND SELLER
I ha~e carefuOy reviewed Ihe HUD-1 Selllemenl Slalemenl and 10 Ihe besl of my knowMtdg8 and belief. II Is a lIue and aecurale slalemenl of aU receipts and disbursements made on my accounl or by me
illlhls lransachon I further certify thai I have receIved a copy of Ihe HUQ.1 SeUlemenl Slalemenl.
~~//;?/~------ U,""A~~ <b..~~
~~~dJ. 'J~/
W^mUNG: IllS ^CIUME TO KNOWINGLY MAKE FALSE STATEMENTS TO TIlE
UtJIII.:LJ STATES ON THIS OR ANY SIMILAR FORM. PENAL TIES UPON CONVICTION
CA,.. INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SeE TITLE 18:
U.S CODE SECTION 1001 ANQ SECTION 1010
~~
The HUO.l Selllement 51alernenl which I have prepared is B true and accurate accounl ollhis ItanS.Clion
I have.ee sed or will cause the funds to be disbursed in accordance wilh !hIS slelement.
/'
e/
217
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jumper, Carrie E.
ITEM
NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All prooertv iointlv-owned with riaht of survivorshio must be disclosed on Schedule F.
FILE NUMBER
21-05-0225
DESCRIPTION
M&T Bank personal checking account number 714224.
Non-interest bearing.
See attached 0.0.0. Balance letter.
VALUE AT DATE
OF DEATH
5,329
2
April 20, 2005. Refund from GE Life and Annunity Assurance Co.
(Medical insurance.)
468
3
Sale of personal household effects at auction May 7,2005
See attached "Final Settlement" from auctioneer.
10,670
4
5
July 8, 2005. Refund, Reamstown Mutual Insurance Co.
Refund of homeowners insurance upon sale of 1846 Rasp Drive
237
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
16,704
~ M&TBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
March 30, 2005
Frey & Tiley
Attorneys At Law
5 South Hanover Street
Carlisle, Pennsylvania 17013-3385
Re: Estate of Carrie E Jumper
Social Security: 182-22-8823
Date of Death: Februarv 25. 2005
Dear Sir or Madam:
Per your inquiry dated March 22, 2005, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
I.
Type of Account
Checking Account
Account Number
714224
Ownership (Names oj)
Carrie E Jumper, Joint Owners *
Paul R Jumper, Joint Owners *(his #199-07-5019)
Connie P Calaman, POA
Opening Date
9/4/67
Balance on Date of Death
$5,329.16
Accl1led Interest
$ 0.00
Total
---..- ~- -...------~___...__ .M..____...__ ~_.._.__._ _______.._.._ _.______._______. .._.._...___..__________...___.._...____..
$5,329.16
Please be advised, there was no safe deposit box found for the above decedent.
* For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call
the High Street Carlisle Office # 717-240-4536.
Sincerely,
~?-;7?~7C-;?::?~
Nancy Clagett .
Records Management
-'.
~('1:-/i ;'
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g/I./~od-
\ U \ U l .....-J a ! t- ....- I U I W o' {, . I -5
r In IiL
SETTLEMENT
SELLER NAME r- s + r:t+e of P {J U I t C, (j (,/ ~
ADDRESS _I g 4- (0 K Q SD .Dr /"v e
Lorll'sle) I PA
.OCATION OF SALE S a m f a s a b n \Ie...
~UCTIONEER --.K 'e J " (j M. W ; ej< a ( c1
Ju. fYlDe.r
I
DATE OF SALE 1\;1 a y 7; ~ DO!:.
PHONE
ZIP
PHONE 7' 'J - d. Lf ( - 53 if I
?~~~~!~:{~~:~~~1jfr.::6!i~:~~t~jbA}f~;".~.' ..', .
],,: ~~6~I:ER~Sl;EX~fJ$l.Se:S.iD
j PROFESSIONAL FEES $ /1_ 0 "'l. J.., 7
AUCTIONEER l.t) 0{ 0<.
CLERK 1.5% $
tS?~~~t.~I~1[;i~~~~~g~ti~~~~~~~~~~1ft~;~r.:j~~2-:':;;);..
~~~~~'~J;I~r.~~~~
"'
.~:~
CASH
$ J. Lf'f~5[){,f
$ ~ ;JdL/ dS~
CHECKS
$ ;f
OTHER RECEIPTS
OTHER EXPENSES
Ad\levtls 'l~
'POl1--o john
,
; $ 1
I Sa {e (j f Ren LEsb.ie- J
r *ILfd.()OO x (io $ II LfJo.oo !i
'I ,
$
'::~
79. dO )
"."--:f
. -~"'
....1
$
$
$
$
TOTAL RECEIPTS
, ,$
pC!:\ ~~W-.4)1t 3 '17 ~. d 5
U.j~S';(i; .,,' '. '", ',.:~ ' .
Gi&l~iiEXPENSES. . $'~"': . .
LESS TOTAL EXPENSES
w' . ,_ .~:" . .
~?~:~;1~~)::~~~~~~X:::~~~ti:1::~~~;:.:.'_
";~;;:"':"~t;:;:;i:;:.2;~~:tf;~~i;;$j~~~"1--~~\;.,;;;;::.~,';._ ~;.;;7F~~~:;;~~,'F~J:';:::;;~','.. . .
I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds
from the auction of my goods and property sold on the above date. I accept all responsibility for providing
merchantable title to all goods, and property sold, and for delivery of title to the purchaser.
~/L-~~ iJ_L_/
Auctioneer or Cashier's Signature
('-7-0j- Date
c~ f? C~./
(Seller's Signature)
Date
5- 7- 0.3
(Seller's Signature)
Date
217
REV-1511 EX'+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jumper, Carrie E.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-0225
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman-Roth Funeral Home, Inc. (Net due after pre-planning account.) 496
2. Carlisle Memorial Gardens - Engraving 330
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid: 0
2. Attorney Fees 6,500
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Add ress
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 302
5. Accountant's Fees 0
6. Tax Return Preparer's Fees 0
7. Advertising Letters - Cumberland Law Journal 75
8. Advertising Letters - The Sentinel 166
9. Filing Fee - Inheritance Tax Return 15
TOTAL (Also enter on line 9 Recaoitulation \ $ 7884
(If more space is needed, insert additional sheets of the same size)
REV-15.12 EX+ (12-03) 217
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Junper, Carrie E.
FilE NUMBER
21-05-0225
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
VALUE AT DATE
OF DEATH
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
DESCRIPTION
Check cleared after death, M&T Bank account no. 714224
(Premium payment to G.E. Life & Annunity Assurance Company
for medical insurance.)
439
2.
Estate Check no. 93. - North Middleton Authority (water and sewer)
80
3.
Estate Check no. 94. - PP&L
76
Estate Check no. 95. - York Waste Disposal, Inc.
39
Estate Check no. 96. - Shipley Energy
35
Estate Check no. 101. - PP&L
37
Estate Check no. 106. - Lee Calaman (Installation of night light.)
28
Estate Check no. 108. - North Middleton Authority (water and sewer)
84
Estate Check no. 109. - Kevin M. Wickard, Auctioneer
3,476
Estate Check no. 112. - PP&L
39
Estate Check no. 113. - Department of Public Welfare
46,859
Estate Check no, 117. - Vicki Jo Shearer (Reimburse for PP&L)
55
Sale of Real Estate - Realty Transfer Tax
1 ,420
Sale of Real Estate - North Middleton Authority (final water and sewer bill)
63
Sale of Real Estate - County and Township Tax Pro-ration
-246
Sale of Real Estate - School Tax Pro-ration
-105
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
52,379
, .
2'17 '
I'lEV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Jumoer Carrie E, - -0 25
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Sherry Logan Johnston, 330 Juniper Street, Carlisle, PA 17013 Daughter One Third
2 Vicki Jo Shearer, 1295 Twin Lakes Rd., Lewisberry, PA 17339 Daughter One Third
3 Connie P. Calaman, 80 Hickory town Road, Carlisle, PA 17013 Daughter One Third
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 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
21 05 2
(If more space is needed, insert additional sheets of the same size)
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LAST WILL AND TESTAMENT OF
CARRIE E. JUMPER
I, CARRIE E. JUMPER, of South Middleton Township, (34 Valley Street,
Carlisle), Cumberland 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 and making void any
and all Wills by me at any time heretofore made.
1. I direct my hereinafter named Executor to pay all of my just debts
and funeral expenses as soon after my death as may be found convenient to
do so. I direct that my body shall be interred on my burial lot in Westminste
Cemetery and that my fu~eral services shall be conducted by the G. Book
Roth Funeral Home, Carlisle, Pennsylvania.
2. All the rest, residue and remainder of my estate, real, personal and
mixed, and wheresoever the same may be situate, I give, devise and
bequeath to my husband, Paul R. Jumper, his heirs and assigns, to the
exclusion of my children, born and unborn, provided my said husband, Paul
R. Jumper, shall survive me by a period of Ninety (90) days.
3. Should my said husband, Paul R. Jumper, pre-decease me or fail to
survive me by the aforesaid period of Ninety (90) days, then in such event
all the rest, residue and remainder of my estate, real, personal and mixed,
and wheresoever the same may be situate, I give, devise and bequeath in
equal shares to my Three (3) step-children, their heirs and assigns, they
being Connie P. Calaman, of R. D. # 1, Carlisle, Pennsylvania; Sherry
Ellen Logan, of 32 Valley Street, Carlisle, Pennsylvania; and Vicki Jo
Shearer, of R. D. # I, Carlisle, Pennsylvania.
4. I hereby nominate, constitute and appoint my said husband, Paul R.
Jumper, as Executor of this my last Will and Testament, but should he pre-
decease me or fail to qualify, then in such event I nominate, constitute and
appoint my said Three (3) step-children, Connie P. Calaman, Sherry Ellen
Logan, and Vicki Jo Shearer, or any of them, as Co-Executrices of this my
last Will and Testament and I further direct that no person serving as