HomeMy WebLinkAbout10-13-05
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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Kuhn Inez K. a/kJa Kuhn A nes Inez
DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year)
01/05/2005 01/06/1913
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
2 -05 0 0 2 4
CQ'u'N'h"'C"O'5'E" ----YEAr- - - NUMBER--
SOCIAL SECURITY NUMBER
2 0 8 - 2 8 - 6 4 4 8
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dale of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
Q.. 8. Total N umber of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE
NAME COMPLETE MAILING ADDRESS
Joel R. Zullin er Es uire 14 North Main Street, Suite 200
FIRM NAME (If Applicable)
Zullin er Davis P.C.
TELEPHONE NUMBER
717 264-6029 Chambersbur PA 17201
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29,948.60
325.31
(11)
(12)
(13)
(14)
[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Corn promise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1-95)
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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)
D 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)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governrnental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 X _ (15)
151 ,285.19 X .045 (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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160,292.80 r ,")
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OFFIC~ USE ONLY
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21 ,266.30
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181,559.10
30,273.91
151,285.19
0.00
151,285.19
Decedent's' Com lete Address:
STREE, ADDRESS
307 Walnut Street
CITY
Shippensburg
STATE
PA
ZIP
172$7
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
6,807.83
Total Credits (A + B + C)
(2)
0.00
3. Interest/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 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. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF WILLS, AGENT
0.00
0.00
6,807.83
6,807.83
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; ........................................................................... 0 I&J
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 I&l
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.......... ................................. ..... ......... .......................... ....... .... 0 !Xl
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 00
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
/
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net vail
[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 t ~ A P D
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for (
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 youn
or a stepparent of the child is 0% [72 P.S. ~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 il !) [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. ~9116(a)(1.3)]. A sibling is aennea, ulluer Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
i. ~9116 (a) (1.1) (ii)].
l s~1I applicable even if
~. AlA<'5l
ent: an adoptive parent,
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REV-1508 EX + (6,-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Kuhn. Inez K. a/k/a Kuhn
FILE NUMBER
Agnes Inez 21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F,
0024
ITEM
NUMBER
1.
DESCRIPTION
Gross proceeds from sale of personal property by
Dan Hershey Auctioneering Services
VALUE AT DATE
OF DEATH
3,609.50
2.
Checking Account #97352098, M& T Bank, including
interest accrued to date of death
10,823.96
3.
Refund, homeowner's insurance, Nationwide Insurance
48.00
4.
Refund, Combined Insurance Company
17.55
5.
Refund, Menno-Haven, Inc., nursing home care
836.54
6.
Refund, nursing home insurance payment
5,760.75
7.
Refund, homeowner's insurance
170.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
21 266.30
REV-1511 EX + (1,2-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kuhn Inez K.. a/k1a Kuhn. Agnes Inez
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
05
0024
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home, funeral services 7,755.50
2. Food and preparation for meal after funeral services 221.81
3. Spring Hill Cemetery, grave opening 425.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Joel R. Zullinger 1,500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) 0.00
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees JCP fee 10.00; letters 260.00; short certificates 16.00; automation fee 5.00; 334.00
will 15.00; filing return and inventory 28.00
5. Accountanfs Fees 0.00
6. Tax Return Prepare(s Fees 0.00
7. Charge for estate checks 8.62
8. Cumberland Law Journal, advertise letters 75.00
9. Borough of Shippensburg, water, sewer and refuse 125.11
10. Edward Straley & Associates, prepare final personal income tax returns 225.00
11. Lisa L. Helm, Tax Collector, county & borough real estate taxes 631.75
12. News-Chronicle, advertise letters 92.75
13. Appraisal of decedent's real estate 200.00
14. Daniel Kuhn, work in preparation for public sale and postage reimbursement 1,339.97
15. Nanci Atkeson, work in preparation for public sale and reimbursement for postage 1,035.54
16. Marie Duggan, work in preparation for public sale 350.00
17. Julie Kuhn, work in preparation for public sale 900.00
18. Kristine Butz, work in preparation for public sale 290.00
TOTAL (Also enter on line 9, Recapitulation) $ 29 948.60
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Kuhn, Inez K., a/k/a Kuhn, Agnes Inez
Decedent's Name
Page 1
21 05 0024
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
AMOUNT
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
DESCRIPTION
Laurie Kuhn, work in preparation for public sale
Adam Kuhn, work in preparation for public sale
Jim Karper, moving items to location for public sale
Tim Butz, use of truck for removal of items from decedent's residence
PPL Gas Utilities, gas service
Penelec, electric service
Borough of Shippensburg, water, sewer, and refuse
PPL Gas Utilities, gas service
Penelec, electric service
PPL Gas Utilities, gas service
Penelec, electric service
Dan Hershey Auctioneering Service, commission and expenses of public sale
Realtors' commission on sale of decedent's real estate
1 % realty transfer tax on sale of decedent's real estate
AON Home Warranty, sale of decedent's real estate
Overnight mailing fee for delivery of deed for sale of decedent's real estate
450.00
120.00
80.00
200.00
278.22
25.68
125.11
223.33
19.73
183.77
36.14
1,076.50
9,594.00
1,599.00
409.00
18.07
SUBTOTAL SCHEDULE H.B7
14,438.55
REV-1512 EX + (6-98)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kuhn. Inez K.. a/k/a Kuhn. Agnes Inez
FILE NUMBER
21
05
0024
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Penelec, utilities due at death
VALUE AT DATE
OF DEATH
34.08
2. Borough of Shippensburg, water, sewer and refuse due at death
122.53
3. PPL Gas Utilities Corp., gas service due at death
160.43
4. Sprint, telephone service due at death
8.27
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
325.31
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Kuhn Inez K a/k1a Kuhn Aanes nez
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec, 9116 (a) (1,2)]
FILE NUMBER
21 05
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
0024
AMOUNT OR SHARE
OF ESTATE
1.
Daniel H, Kuhn
9284 Possum Hollow Road
Shippensburg, PA 17257
Nanci L. Atkeson
104 Two Does Lane
Clayton, N,C, 27520
Marie K, Duggan
514 Crest Drive
Jefferson City, MO 65109
Lineal
one-third of residue
2.
Lineal
one-third of residue
3.
Lineal
one-third of residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 GOVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. 0.00
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
0.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
$
0,00
Page 1 of 3
A. Settlement Statement
U.S. Department of Housing
and Urban Development
OMB Approval No. 2502-0265
B. Type of Loan
1. \ I FHA2. [ J FmHA3. [ X J Conv.Unins.
4. ( } VA 5. I I Conv.lns.
II 0 ! 6. File Number: \017. Loan Numbar; I 0 18. Mortgage Insurence Case Number:
I 400500930-CB ... 0054092994 I. i
THIS NOTE IS FURNISHED TO GIVE YOU A STATEMENT OF ACTUAL SETILEMENT COSTS. AMOUNTS PAID TO AND
BY THE SETILEMENT AGENT ARE SHOWN. ITEMS MARKED "(P.O.C.)" WERE PAID OUTSIDE THE CLOSING: THEY
ARE SHOWN HERE FOR INFORMATIONAL PURPOSES AND NOT INCLUDED IN THE TOTALS.
D. Name and Address of Borrower I I E. Name and Address of Seller l""'l F. Name and Address of Lender
DEBORAH FRANCIS 0 MARIE K. DUGAN, CO-EXECUTRIX, 0 I FIRST HORIZON HOME LOAN CORPORATION
I . NANCI L. A TKESON, CO-EXECUTRIX . .. 681 ANDERSON DRIVE.. SUITE 420,
AND DANIEL HARRY KUHN, PITISBURGH" PA 15220
CO-EXECUTOR OF ESTATE OF
AGNES
INEZ KUHN AlKJA INEZ K. KUHN
C. NOTE:
200 11TH ST.
JACKSONVILLE, AL 36265
, PA
G. PROPERTY LOCATION
307 WALNUT STREET,
SHIPPENSBURG. PA
COUNTY: CUMBERLAND
PARCEL 10: 32.34-2413-113
TOWNSHIP: SHIPPENSBURG BOROUGH
H. Settlement Agent
SECURED LAND TRANSFERS - MECHANICSBURG
I. -.\ Place of Settlement I.G..II. Settlement
o 1068 HARRISBURG PIKE Date /
. . _ CARLISLE, PA .. ...... Disbursement Date
J. SUMMARY OF BORROWER'S TRANSACTIONS K, SUMMARY OF SELLER'S TRANSACTIONS
100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller
101. Purchase Price $159,900.00 401. Purchase Price $159,900.00
102. Personal Property 402. Personal Property
103. Settlement Charges to Borrower $4,446.30 403.
104. 404.
105. 405.
Adjustments For Items Paid By Seller In Advance Adjustments For Items Paid By Seller In Advance
106. Cityrrown Taxes 406. Cityrrown Taxes
107. County Taxes 644.65/yr 6/17/2005 10 111/2006 $347.39 407. County Taxes 64465/yr 6/17/2005101/1/2006 $347.39
108. Assessments 408. Assessments
109. School Taxes l,16765/yr 6/17/200510 $45.41 409. School Taxes 1,167.651yr 6/1712005 to $45.41
71112005 7/112005
110. 410.
111. 411.
112. 412.
6/17/2005 11 :00:00
AM/6/17/2005
120. Gross Amount Due From Borrower I $164,739.10 420. Gross Amount Due To Seller I $160,292.80
200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller
201. Earnest Money $1,500.00 501. Excess deposit
202 Principal from First Horizon Home Loan $127,920.00 502. Settlement Charges To Seller (line 1400) $11,783.18
Corporation 503. Existing Loan(s) taken Subject To
203. Existing loan(s) taken subject to 504. Payoff of First Mortgage Loan
204. 505. Payoff of Second Mortgage Loan
205. 506.
206. 507.
207. 508.
208. 509.
209 Adjustments For Items Unpaid By Seller
Adjultm~.,,- For Items Unpaid By Seller 510. CilylTown Texes
210. Cityrrown Taxes 511. County Taxes
211 . County Taxes 512. Assessments
212. Assessments 513.
213. 514.
214. 515.
215. 516.
216. 517.
217. 518.
218. 519.
219.
220. Total Paid By/For Borrower
300. Cash At Settlement FromlTo Borrower
301. Gross Amoun! Due From Borrower (line 120) I
302. Less Amounts Paid By/For Borrower (line 220) I
$129,420.00
520. Total Reduction Amollnt Due Seller
I
$11,783.18
600. Cash At Settlement To/From Seller
$164,739.10 601. Gross Amounl Due To Seller (line 420) I
$129,420.00 602. Less Deductions In AmI. Due To Seller (line 'T
520) I
$160,292.80
$11.783.18
303. Cash [X J From I ] To Borrower
$35.319.10
603. Cash [X] To [ ] From Seller
$148,509.62
I
Page 2 of3
400500930 - CB Page 2
L. Settlement Statement
700. Total Sale. Commission 159900.00 @ 6 % = 9594.00
Divlsian af Cammissian (line 700) As Fallaws: Paid From Paid Fram Seller's
701. $4797.00 to. Remax Really Agency, Inc. Barrawer's Funds At Funds At Settlement
Settlement
702. $4797.00 to. ERA-NRT, Inc.
703. Cammlssian paid at settlement $9,59400
707. Transectian Fee to. ERA-NRT, Inc. $125.00
800. Item. Payable In Co.nnectlon With Loan
801. Loan Originatian Fee
802. loan Discaunt
803. Appraisal Fee to. First Harlzan Hame laan Carparatian (POC 275.00 by Buyer)
804. Credit Repart
805. lender's Inspectian Fee
808. Underwriting Fee to. First Horizon Hame laan Corparatian $250.00
810. Tax Service to. TMS $90.00
811. Flaad Cert. Fee to. FED Flaad $24.00
812. Cammitment Fee to. First Harizan Hame Laan Carparatian $150.00
813. Pracessing Fee to. Turnstane Martgage Campany $137.00
814. Martgage Broker Fee to. Turnstone Martgage Campany $200.00
815. Wire Fee to. First Harlzan Hame Laan Carporatian $45.00
816. MERS Fee to. Mers $3.95
819. Yield Spread Premium to. Turnstane Martgage Campany (POC $2,078.70 by First Harizan Hame
Laan Carparallan)
900. Items Required By Lender To. Be Paid In Advance
901. Interest fram 611712005 10. 71112005 @19.5430Iday $273.60
902. Martgage Insurance Premium far
903. Hazard Insurance Premium far
1000. Reserve. Depo..lted With Lender
1001. Hazard Insurance
1002. Mortgage Insurance
1003. City Property Taxes
1004. Caunty Praperty Taxes
1100. Title Charges
1101. Setllement ar Clasing Fee
1102. Abstract ar Tille Search
1103. Tille Examination
1106. Natary Fees to. Cash $12.00 $10.00
1107. Attarney's Fees
1108. Tille insurance to. Secured Land Transfers - Mechanicsburg $1,158.75
1109. Lender's Caverage $127920.00 ($)
1110. Owner's coverage $159900.00 ($1158.75)
1111. Endarsement10013001900 to. Secured Land Transfers - Mechanlcsburg $150.00
1113. Insured Clasing Protectian Letter to. First American Tille Insurance Campany $35.00
1114. Overnight Delivery & Processing Fee to. Secured Land Transfers - Mechanicsburg $20.00
1116. Wire Fee to. Secured Land Transfers - Mechanicsburg $20.00
1120. Dac Print to. Secured land Transfers - Mechanicsburg $50.00
1200. Gavernment Recardlng And Transfer Charge.
1201. Recording Fees: Deed $ 38.50; Martgage $ 64.50 $103.00
1202. CilylCaunty TaxlStamps 1599.00 $1,599.00
1203. State Deed Tax $ 1599.00 $1,599.00
1205.
1300. Addltlo.nal Settlement Charge.
1302. Pestlnspectian to. Saulh Central PA Harne Inspection Ca., Inc. (POC 0.00)
1303. Harne Warranty to. AON Hame Warranty $409.00
1304. Final Sewer to. Shippensburg Baraugh Office $153.11
1305. Hame Inspectian to. Sauth Central PA Harne Inspectian Ca., Inc. (POC 0.00)
1306. Overnight Fee to. Jael R. Zullinger, Esq. $18.07
1400. Total Setllement Charges (Enter On Line. 103, Secllo.n J And 502, Secllo.n K) $4,446.30 $11,783.18
I have carefully reviewed the HUD-l Settlement Statement and to. the best af my knawledge and belief it is true and accurate statement af all receipts
and disbursements made an~y acc nt or by me In thiS transactlan. I further certify that I have received a capy af the HUD-l Settlement Statement.
BU~) d I ;} < SELLERS
~....____ Estate C)J4\jlnes Inez Kuhn alkla Inez K Kuhn
Debarah FranCIS g ~
By: Man. . DuganYo-Executrix
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By: Nanci L. Atkesan. Co.-Executrix
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By: Daniel Harry Kuhn. Co.-Executor
The HUD-l Selltement Statement which I have prepared is a true and accurate accaunt af this transactian. I have caused ar will cause the funds to. be
disbursed in accardance with this statement.
Settlement Agent ;"
Date
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FINAL
SETTLEME~
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SElLER NAME
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DATE OF SALE J/' /;/ t. -'
PHONE 5Jo-S(/3?
/';7 .23' 7
ADDRESS
S?"'.
ZIP
J 6 tJ ~ ell? CASH $
CLERK $ CHECKS $
CASHIER $ OTHER RECEIPTS
OTHER EXPENSES $
Jl J- Vi:. $ / J i~. t:' C\ $
v_ 31 / # .f c)
/} V 1/% /ff $ $
'/Rtf c t:J/rJ fl (t& J.. $ 35', c () $
I
LiJ e c ~ $ I f'~)vt'o $
$ $
$ $
$ $
$ $
$ TOTAL RECEIPTS $ .J6tJ r. 5 t3
$ LESS TOTAL EXPENSES $ 1t17~ ..sty
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
mercha able title to all goods, and property sold, and for delivery of title to the purchaser.
1: A%eer or Cashier's Signature
,5) ~ rs- Date
~~~
(Seller's Signature)
Date 5/IY/oS-
Date
(Seller's Signature)
SELLER'S COPY
m1M&rBank
499 Mitchell Street, Millsboro, DE 19966
February 22, 2005
Law Offices
Zullinger- Davis
14 North Main Street
Suite 200
Chambersburg, PA 17201
RE: Estate of Inez K. Kuhn
Date of Death: January 5, 2005
Social Security Number: 208-28-6448
Dear Mr. Zullinger:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
1. Account Type.. . . ..... .. . .. .. . . .. .. . .. .. Checking Account
Account Number...................... 97352098
Ownership (Names of).............. Inez K. Kuhn
Opening Date...........................01/28/80 (account closed 01/11/05)
Balance on Date ojDeath.........$1O,823.58
Accrued Interest
$
0.38
Total.............. ....................... ..$10,823.96
The above named decedent did not have a safe deposit box with this bank.
For any additional information on this account please contact our Walnut Bottom
branch at 717-532-2414.
Sincerely,
QUJLlCNJ L1alk~fli(jl(
Charlene Warrington, RecordR'Management
1-888-502-4349
,
INVENTORY
Estate of Kuhn, Inez K., a/k1a Kuhn, Agnes Inez No.21 05 0024
also known as Date of Death 1/5/2005
, Deceased Social Security No. 208286448
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 in the Commonwealth of Pennsylvania of said Decedent, that the valuati n
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent own d no
real estate outside 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 made are subjE ctto the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of W-T~~
Attorney: Joel R. Zullinger, Esquire
I.D. No.: 17516
Address: 14 North Main Street, Suite 200 Dated /~' /3~)S~
Chambersburg PA 17201
,. ~._-]
Telephone: (717)264-6029 ) "
I ;",
"
Description Value
Stocks & Bonds
'.
---,
Closely-Held Corporation, Partnership or Sole-Proprietorship I '" ..
,.
.--
-.J
Mortgages & Notes Receivable I
Cash, Bank Deposits, & Misc. Personal Property
Gross proceeds from sale of personal property by ~,609.50
Dan Hershey Auctioneering Services
Checking Account #97352098, M& T Bank, including 1 D,823.96
interest accrued to date of death I
:
I
I
Total
18 1,559.10
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal represent; tlve,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
]1
I
Continuation of Inventory
Kuhn,"~z K., a/k1a Kuhn, Agnes Inez
21
05
00~4
Paqe 1
Description of Inventory
Description
Refund, homeowner's insurance, Nationwide Insurance
Value
4€.00
Refund, Combined Insurance Company
17.55
Refund, Menno-Haven, Inc., nursing home care
83€ .54
Refund, nursing home insurance payment
5,76C .75
Refund, homeowner's insurance
17C. 00
Real Estate
Gross proceeds from sale of real estate situate at 307
Walnut St., Shippensburg, PA, to Deborah Francis,
copy of H U D attached
Received on proration of real estate taxes for above
sale of real estate
159,900.00
392.80
Subtotal $
167,12564
181,559.10
Grand Total $