HomeMy WebLinkAbout10-24-05
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 171 8-0601
DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INmAL) use a blank block to sep...alll words
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OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Lan t z y
C h a r
e 5
A
SOCIAL SECURITY NUMBER
DATE OF DEATH
o 2 /1 2 /2 0 0
5
TELEPHONE NUMBER
717 766-3172
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)
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)
15. Amount of line 14 taxable 2 3 0 0
at the spousal tax rate , ,
See instructions on reverse side for applicable percentage
16. Amount of line 14 taxable
at 6% rate
17. Amount of line 14 taxable
at 15% rate
7
5 ,0
2 0 9 -1 2 -6 6 7 0
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~l
I
FIlE NUIlBER
2 1
o
5 0 1
7 8
COUNTY COllE
YEAR
NUIIIlER
DATE OF BIRTH
o 1 /2
1 /1 9 0 2
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
IXI 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of deaIh prior to 12-13-82)
o 4. Limited Estate 0 4a. Future Interest Compromise (dale of deaIh aIIer 12-12-82) t81 5. Federal Estate Tax Return Required
~ 6. DecedentDied Testate (AIlach copy of Will) 0 7. Decedent Maintained a Living Trust (AIlach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (dateofdealh belween 12-31-91 and 1-1-95) 0 11. Election to tax under See. 9113(A) (AIlach Soh 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
John M. Eakin Market Square Building
FIRM NAME (If Applicable)
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(5)
(6)
(7)
(9)
(10)
Mechanicsburg, PA 17055
OFFICIAL USE ONLY
,8 3 0 ,0 0 0 .0 0
,1 4 4 ,4 0 0 .0 1
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12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 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)
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18. Tax Due
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(18)
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19.
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Under penalties of perjury, I declare that I have examined this retum, including accompanying scheduies and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other
than the ~rsonal representative is based on all information of which preparer has any knowledge.
SIGNA I RE OF PERSON RESP~N LE FOR FILI~G RETURN ADDRESS DATE
,/ ~2 /
, / 5/, ~ {-1/ CJd-;;J ( ';:;0&6
SI ATURtOF PREPARfR OTHER THAN REPRESENTATIVE ADDRESS DATE
) j i j/ f '--- j, 11 t' ' J;/ / ~; I
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Decedent's Complete Address:
STREET ADDRESS 261 M d b k D .
5 ea ow roo nve
CITY I STATE I ZIP
Mechanicsburg Pa 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 18)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
29,250.00
28.000.00
1.400.00
Total Credits (A + B + C) (2)
29,400.00
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
5.
Total Interest/Penally ( D + E ) (3)
If line 2 is greater than line 1 +Iine 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 19 to request a refund (4)
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
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
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 on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? 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? ..... D
4.
150.00
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
72 P.S. ~9116 (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995.
72 P .S. ~9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use of the surviving
spouse from 3% to 0% for dates of death on or after January 1, 1995. The statute does not exemDt a transfer to a surviving spouse
from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse
is the only beneficiary.
FOR DATES OF DEATH ON OR AFTER JANUARY 1,1995 - Please answer the following question by placing an "x" in the
appropriate space.
Did the decedent create a trust or similar arrangement which is soley for the surviving spouse's benefit for his or her entire
lifetime? Yes D No D
If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second
spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on
Schedule J, Part II, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule 0 in order to
make the election available under Section 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the
first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate,
and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must
attach Schedule 0 to a timely-filed tax return, along with Schedule(s) K and/or M in order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficiary(ies).
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
TD T
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Lan~y Charles. A. 21 05 0178
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
survivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Three Tracts Mountain Land - Middle Paxton Township, Dauphin County
Settlement Sheet Attached
VALUE AT DATE
OF DEATH
130,000.00
2
78 Acres Mountain Land - Middle Paxton Township, Dauphin County
Appraisal Attached
700,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
830000.00
A. Settlement Statement
B. T of Loan
1. 0 FHA 2. 0 FmHA 3. 0 Cony. Unl"s. e. File NuIT'b4M'
4. 0 VA 5. 0 Conv. Ins.
U.S. Departmant of Housing
and Urban Development
~
OMB Approval No. 2502'()265
7. lOIn Nuni)er
8. MoItgage Insurance Case Nunil81
C. Nota: This form Is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are
shown. Itemsmarlced "(p.o.c.)" were paid outskle closing; they ara shown here for Informational purposes and not
Included In the totals.
D. ...... end AdI:nII of Bcln'ower E. ~ 8nd Address r:I Sener F. Heme end Address of lender
Nathan L. Fite
Angela E. Fite
.
Estate of Charles A. Lantzy
Commerce Bank
H. St\t!ement Agent
Scott W. Morrison Esoulre
Pteee of Setttement
6 West Main Street
New Bloomfield PA 17068
o._~
Middle Paxton Township, Dauphin County, Pennsylvania
Lot: Blod<:
J. Summary of Bonower'. TrlnneUon
100 Groll Amount Duo From Borrower
I;' Settlement Date
08/3112005
OItblnemenl Dele
K. Summ.ry of s.ne,'. Transaction
400 Groo. Amount Due To sener
;01. Conlrlcllll.. orice 130.000.00 401. Conlrlcll8le. orice 130000.00
102. P_ orooertv 402. P""""ellltOOllrtv
103. ~t """""'" to bonower nine 14001 2 558.50 403.
104. 404.
105. 405.
AdJustments lor Item. Plld bv .ener In Idvance Adlu.tmento lor Itom. alld bv .ener In Idvlnee
100. CftWlown_ to 400. Cltvllnwn 18x.. 10
107. CllunIv_ 06I3112oo5to 12/3112005 5.44 401. Counlv_. 06131120051012/31/2005 5.44
100. AooeoImenCI 10 408. Asoeoomenlo to
1011.' School 06l3112OO5to 0613012006 22.43 4011. School 0613 1/2005 to 06130/2006 22.43
110. to 410. 10
111. to 411. tb
112. I<> 412. to
113. to 413. 10
114. I<> 414. to
115. to 418. 10
; 120. GI'OOO Amount Duo From Borrower 132,586.37 420. Groo. Amount Due To Seller 130,027.87
Commerce Bank
.-
10
to
to
to
to
to
10
III
10
III
. 303. Caeh
!XI From
o To Borrower
13000.00
1 300.00
..lle,
......
10
I<>
I<>
I<>
I<>
to
to
to
to
130,000 .00 820. Totsl ReducUon Amount Duo Seller
800. ClOh No S_ment ToIFrom Seller
132 586.37 001. Grooo omount due III oeIIer ne 420
130 000.00
14,300.00
130027.87
14300.00)
115,727.87
2,586.37 803. CI.h
!XI To
o From Sene,
SUBSTITUTE FORM 1099 SELLER STATEMENT
The InIonnIIIon contained In Block. E. G. H. and land on Hne 401 (or. Dne 403 end 404) '"lmportanl tox Informallon and 10 being fumllhed I<> the Intemo! Revenue
SeMoe. H you ""' _Ired I<> file n retum. a negligence penolty or other HncIIon wlR be Impoled on you H It1lIItam 10 required to be reported and the IRS _Ineo
thet" has not been reported. ~ thl. """ellate I. your principal ....ldence. file FOITTl 2119. Sale or Exchange af Pnncfpa! Re.ldence. lor ony gain. with your Income lax
return; lor _lranoactlon.. complele Ih. .pplloohle po'" of Form 4797. Form 8232 IndlO' Schedule D. Form 1040). You a... required to provide"", Selllement Agent
(nllned above) """ your oonac:1l8xpayer IdenMcalion number. H you do not provldu the Snfflement Agent with your correct Iaxpayer Idanlfficallon number. you may be
oubjeclto cIvR or _Inal penaltleo Impoled by law. Under ponalll.. of pa~ury. I cerllf;' lhallhe number.hown on thl. .latement i. my correct Iaxpayer Identirlcatlon number.
(Se!!er'. Slgnatura)
L Sottloment Charg".
700. TObII Sel_rokor'e Commission booed on Drlee S 130000.00 II %- Plld From PeId From
DMeIon 01 Commlsolon (IInl 700) IS follows: BOfTtIW8l'8 8e1181'.
701. S to Funds At Fundi At
~I ~I
702. S to
703. Commission peld It S.ttlement
704.
100. Items Pavable In Connection With Loan
801. Loen OrkIInltlon Fee 117 000.00 %
802. Loen DiIcounl 117 000.00 %
803. Arxlf1IIseI Fee to
804. CledR Report to
808. LInder'. InlOlCtion Fee
808. - II1IUI8IlC8 ADollcetlon Fee to
807. Ae8umDtIon Fee
808.
809.
8'0.
811.
812.
813.
800. Item. RlCIUlrod By Lendor To Be Peld In Advenc. Exclude lelll d8v In celal-11ne 901
90'. ,"-Irom 10 iIIIS IdlY
902. Mor1aeaelneurence Premium lor monthl to
903. Hezerd lneurence Pl1lf11lum lor _re to
904. _re to
905.
IWd WI1h Lendor
1
1
1
1
1
1
1
Ad Imlnl
month
month
month
month
month
month
t100.Tl1IeC"-
1101. SettIem8nt or doIIno fee to
1102. AboIreclorlltleMM:h to
1103. TItle_lion to Scott W. Morrison ESQuire 600.00
1104. TItle InlUf8nce binder to
1108. Document preperelion 10
1100. __ to
1107. A_._ to John Eakin ESQuire (POCl
Oncludel ebove IlemI numbsre: I
1100. TItIe'1neur8nce to Elizabeth P. Qulalev 620.00
llncludee ebove Item. numbsre: I
1108. L.ender'....-- S
1110. Owner'......,... S
1111.
1112.
1113.
:RI_ S
38.50
1 300.00
S
S
1 300.00
1300. ~I So11Iem.nl Chera..
1301. Surwy to
1302. PilI InI08Ction to
1303.
1304. .
1308.
1300.
1307.
1300.
1400. To181 Set1I.......1 Che'18l C.riler on n_103, SIC1/on J end 502, SectIon KI 2 558.50 1 300.00
IIomlwer
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IFile No. BLUEMTNPARKWvI Paue #21
SUMMARY OF SALIENT FEATURES
Subject Address BLUE MOUNTAIN PARKWAY
Legal Description DEED BOOK V059, PAGE 240
City HARRISBURG
County DAUPHIN
State PA
Zip Code 17112
Census Tract 24798
Map Relerence 43-001-017
Sale Pliee S N/A
Date of Sale N/A
Borrower I Client N/A
Lender ATIORNEY JOHN EAKIN
Size (Square Feet)
Price per Square Foot $
Location BTR AVERAGE
Age
Condition
Total Rooms
Bedrooms
Baths
Appraiser ROBERT K. BANZHOFF
Date of Appraised Value 4-22-05
Final Estimate of Value S 700,000
Form SSD - 'TOTAL for Windows' appraisal software by a la mode, inc. -1-800-ALAMDDE
1
LAND APPRAISAL REPORT
IF;le No. BLUEM iNPARKWYI Paoe #31
Census Tract 24798
File No. BLUEMTNPARKV
Map Reference 43-00 1-0 17
wer N/A
rty Address BLUE MOUNTAIN PARKVVAY
City HARRISBURG
Legal Description DEED BOOK V059, PAGE 240
Sale Price $ N/A Date of Sale N/A Loan Term~ yrs. Property Rights Appraised !8:1 Fee D Leasehold D De Minimis PUD
Actual Real Estate Taxes $ 1,500EST (yr) Loan charges to be paid by seller $ ~Other sales concessions NONE
Lender/Client ATTORNEY JOHN EAKIN Address MARKET SQUARE BUILDING, MECHANICSBURG PA 17055
Occupanl N/A Appraiser ROBERT K. BANZHOFF Inslructions to Appraiser ESTIMATE MARKET VALUE
County DAUPHIN
State P A
Zip Code 17112
Location
Bui<< Up
Growth Rate
Property Values
Demand/Supply
Marketing Time
Present Land Use
Good Avg. Fair Poor
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
D!8:IDD
Urban Rural
DOver 75% D Under 25%
D Fully Dev. D Rapid D Slow
i:8J Increasing D Declining
o Shortage D Oversupply
i:8J Under 3 Mos. D 4-6 Mos. DOver 6 Mos.
~% 1 Family --.11% 2-4 Family --.11% Apts. --.11% Condo --.11% Commercial
0% Industrial 50% Vacant %
Change in Present Land Use D Not Likely - D Likely (*)
(*) From VACANT To
!8:1 Owner D Tenant
$ 140 to $ 600
~ yrs. to 100+ yrs.
Employment Stability
Convenience to Employment
Convenience to Shopping
Convenience to Schools
Adequacy of Public Transportation
Recreational Facilities
Adequacy of Utilities
Property Compatibility
Protection from Detrimental Conditions
Police and Fire Protection
General Appearance of Properties
Appeal 10 Market
Predominant Occupancy
Single Family Price Range
Single Family Age
[8J Taking Place (*)
SINGLE FAMILY
~% Vacant
Predominant Value $ 300
Predominant Age 10 yrs.
Comments including those factors, favorable or unfavorable, affecting marketability (e.g. public parks, schools, view, noise): This suburban nei hOOr hood has relativel
eas access to em 10 ment and services and is com titive with other nei hborhoods in the eneral area. Most have similar amenities. No
unfavorable factors were observed which would adversel effect marketabilit .
Dimensions SEE LEGAL 78.40 Sq. Ft. or Acres Corner Lot
Zoning classilication R-1 SINGLE FAMtL Y RESIDENTIAL Present Improvements !8:1 do D do not contorm to zoning regulations
Highest and best use D Present use !8:1 Other s ecil RESIDENTIAL DEVELOPMENT
Public Other (Describe) OFF SITE IMPROVEMENTS Tapa SLOPE
i:8J Street Access !8:1 Public D Private Size TYPICAL FOR AREA
o NONE Surface ASPHALT Shape IRREGULAR
o NONE Maintenance!8:1 Public D Private View AVERAGE
o NONE D Storm Sewer D Curb/Gutter Drainage APPEARS ADEQUITE
o Underground Elect. & Tel. Sidewalk Street L hts II the properly located In! HUDldentlfled Speclel Flood HUlI'd Area? !8:1 NoDv"
Com...nts (fa'lOlllble 01 unfavorable Incklllng any apparent adverse easements, encroach...nts, 01 other adverse conditions): There are no a arent adverse easement
encroachments or other adverse conditions on this site. ADJOINIG PROPERTY OWNER HAS BENN GOING THROUGH THIS LAND TO
ACCESS HIS OWN.
E1ec.
Gas
Water
San. Sewer
The undersloned has recned three recent sales of properties mosl similar and proximale 10 subjecl and has considered the.. In the market analysis. The description Includes a dollar
ad;.strnenl reflecting markel reaction 10 those noms of signillcanl variation between the sublecl and comparable properties. " a slgnillcanl nem in the comparable property is superiOl
10 01 mOle lavorable than the subjecl property, a minus (-) adjustment is made thus reducing the Indlcaled value of subjecl; " a slgnillcant nem In the comparable Is InferiOl 10 01 less
favorable than the subject property, a plus (+) adjustment is made thus increasing the indicated value of the subject.
ITEM SUBJECT PROPERTY COMPARABLE NO.1 COMPARABLE NO.2
Address BLUE MOUNTAIN PARKVVAY GRANDVIEW ROAD BISHOP ROAD
HARRISBURG HUMMELSTOWN MECHANICS BURG
Proxim' 0 Sub' ct 7.95 miles 18,56 miles
Sales Price
Price
Data Source
Date of Sale and
Time Adjustment
Location
S' HlW
WATE EWER
N/A
BTR AVERAGE
78.40 ACRES
ON SITE
+131 200
-195 DOO
-260 DOO
-12800
-455 000
NONE
NONE KNOWN
NONE KNOWN
NONE KNOWN
'. ~
; ~
....l ,J....~1ll:.L. ULW~...
63 800
727 800
716200
Final Reconciliation: See attached addenda.
4-22-05 20~ to be $ 700 000
o Did D Did Not Physically Inspect Property
Central Penn Appraisals, Inc, (717) 737-4600
Form LND - 'TOTAL for Windows' appraisal software by a la mode, Inc. -1-800-ALAMODE
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LAND APPRAISAL REPORT
MARKET DATA ANALYSIS
Wile No. BLUI:M I NPARKWYI Paaen
File No. BLUEMTNPARKV
ITEM I SUBJECT PROPERTY COMPARABLE NO.4 COMPARABLE NO.5 COMPARABLE NO. 6
Address BLUE MOUNTAIN PARKWAY VALLEY ROAD
HARRISBURG MARYSVILLE
Proximitv to Subioct ~
Sales Price S N/A 11$ 345 000 i!':~H~ , ;,::lJ~ij~!1;'.1.~1 !t
,
Plice S ;'1 'I S 4926 :~I<:,.. "",, ,:'\~J_~"!~~I;;~'t~1 ~
Data Source INSPECTION ASMT RECORDS/MLS/AGENT
Date of sale and DESCRIPTION DESCRIPTION 1+ I-lS Adiust DESCRIPTION 1+I-lSAdiust DESCRIPTION I + I-lSAdiust
Time Ad'Jstment N/A 9-19-03/15 : + 27 300 :
Location BTR AVERAGE AVERAGE : +66 300 : :
SiteNiew 76.40 ACRES 70 ACRES : +67 200 : :
WATER/SEWER ON SITE ON SITE : : :
: : :
: :
: :
Sales or Financing NONE. NONE KNOWN
Concessions
Net Ad'. IT olall " + il- :$ 160 600 il + il- : $ I 1+ 11- : S
Indicated Value ';JJW"~'.J : . .:'~:r'n";:i"'''' '. "lm . " 'I ". ',.'. "::1$
'V(I~, ':",~' -,{ ,b., .:J l" ~H l" " ,,'t l ,........... ."."
of Sub'ecl .t. e1,fS2.Ukl S 525 600 :',::~,~~~,~'N" ~~X_:!t_,;\;'1 $ ')(1: 'N~ll~:t',,:[,
Comments:
Central Penn Appraisals, Inc. (717) 737-4600
Form LNO.(AC) - 'TOTAL for Windows' appraisal software by a la mode, inc. -l-600-ALAMOOE
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li'iieNolflUEMTNPARKWYfPaae#91
Location Map
DAUPHIN
State PA
Zi Code 17112
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT D EDENT
ESTATE OF
Lantzy Charles. A.
All property jointly-owned with right of survivorship must be disclosed on SChedule F.
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21 05
0178
ITEM
NUMBER
1.
DESCRIPTION
548 Prudential Finanical Common Stock @ 57.63
VALUE A T DATE
OF DEATH
31,581.24
2.
1589.162 Execlon Corp. Common Stock @ 45.30
71,989.04
3.
545.375 PP&L Common Stock @ 54.64
29,799.25
4.
137.118 AXA Common Stock @ 24.85
3,407.38
5.
530 Wilshire Oil Common Stock @ 8.77
4,648.10
6.
700 Cincinati Bell Common Stock @ 4.25
2,975.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
144.400.01
~,~~."., .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Lantzy. Charles. A.
FilE NUMBER
21 05
0178
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
NUMBER
1.
DESCRIPTION
PNC Bank Account # 50-7008-1793, See Attached
VALUE AT DATE
OF DEATH
121,721.10
2.
Country Meadows, Nursing Home Refund
4,225.17
3.
Bankers Fidelity Life Insurance, Premium Refund
734.49
4.
Comcast Television Refund
13.79
5
2499.717 Shares PA Tax Free Income Class A @ 10.68, See Attached
26,696.98
6
Indianapolis Life Annuity Policy #DAR0066992, See Attached
304,329.70
7
Smith Barney Brokerage Account # 729-05064-15-410, See Attached
351,474.16
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
809.195.39
PrcnUUlll Phul Account Statclllcnt
l'Ne Balik
~~_.---
o PNCBAT
j.
j
I
I N
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, p
For the P~~1/2212005t;lJ2I.17/2005
,",""'."
........ ".
C A LANTZY" ,.---------q
ANNA LANTZY
C/O JOANNE DONALDSON
5261 MEADOWBROOK DR
MECHANICSBURG PA 17050-6833
Primary account number: 50-7008-1793
Page 1 of 2
Number of enclosures: 3
S For 24-hour banking, customer service and
transaction or interesl rale information,
"U' sign-on lo Accounllink ~ by Web on
pncbank.com or call1-888-PNC-BANK
Para selvicio en espanol, 1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANt
I2!SJ Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
a Visit us at pncbank.com
II TOO terminal: 1-800-531-1648
For hC:l:ring imp3ircd dicnt~1 ani)'
For more information on exciting offers and promotions for our free Online Bill Payment service, stop by any PNC Bank office, visit
pncbank.com, or call1-BOO-PNC-BANK for further details.
PrenliulU Plan
Interest Checking Account SUlnmary
Account number: 50-7008-1793
C A L::lI1tzy
Anna Lantzy
Please see the Activity Detail section for
additional information.
Balance Summary
Beginning
balance
122,798.35
Deposits and
olher additIons
2,613.66
Checks and olher
deducllons
3,673.25
Ending
balance
121,738.76
Average monthly
balance
123,lG6.30
Charges
and fees
.00
Transaction Summary
I
I Checks paid/ Check Card pas
withdrawals ' signed transacllons
Check Card/Bankcard
pas PIN transacllons
3 0
o
Tolal ATM PNC Bank
transacllons A TM Iransacllons
other Bank
ATM transacllons
o ()
o
As of 02/17, a tolal of $32.72 In interes!
earned this year.
Interest Summary
27
123,W6.30
Interest Earned
this period
17.66
Annual Percentage
Yield Earned (APYE)
0,19%
Number of days
In Inlerest period
Average collected
balance for APYE
Activity Detail
Deposits and Otber Additions
Dale Amounl Descrlpllon
, 02/03 2,596.00 Direct Deposit - Soe See
US Treasmr 303 XXXXXG670A
02/17 17.66 Interest Parment
There were 2 Deposits and Other Additj,
totaling $2.813.88.
FORM9'
"
...."nnalion, sign-on to Account Link iP)
an .com or call1-888-PNC-BANK
.~: 5/1-7ClCl8-17!1:l-l'ontinllcd
if Substitute Checlts
Date
Amount paid
1.J.l.OO 01/21
'12.2.1 0 II:.!!)
;:.t.~, .
For the period 01/22/200& to 02117/20011
C A LANTZY
Primary account number: 50-7008-1793
Page 2 of 2
Reference
number
Check
number
139.\7
Amount
3,487.01
Date
~ paId
02/11
Referenc
number
112~~177~12
1,))\) 11f) 1\)2\)
02638339
There were 3 checks listed totaling
$3.673.25.
Bal ance
122,79i:l.35
l22,65-1.35
Date
01/25
02/03
Balance
122,612.11
L!5,208.11
Dale
02111
02/ 17
/t~annjce--' ""'.
~! 21 ,721. IQ
121,73'8.76
ONTHLY nILLS GETTING OUT OF CONTROL?
,\".,
,to consolil.late your l.lebts iulo one lower monthly payment with a debt cOlISolidationloan at PNC. If you own:
,lakc allvunlage o[ a home Cfiuit y loau or linc or cree.Htto par 0[[ rour outstanding crcdit cards, auto loam, or ot
.~ls at a lower rate thai I you're probably paring now. Ami with a homc equity loan, the intcrcst you par may be t
. Asult your lax allvisor about lhe deduclibililr or interest) - saving you even more moncy in the long run. If you'..,
.,." -
'Cl', )'Oll Gill slill consolidate yom debt wilh a l'ersonalloan or line of crce.lit. Call us today and ask for details at
K~r visit us on the weh al pncbank.com Don t llelay - take control o[ your finances today.
eright. Get your refund fast when you e-file. Save 15% on Intuit s TurboTax@for the WebSM service. Visit
'i/TTW for more information.
~:",..~, .
~S"
Is link to access our Tax Center to learn more about taxes, taxwise investing and how you can maximize your
Account Activity 1
YOUR PORTFOLIO REVIEW
BLACKRoCK
Jan uary 01, 2005 - March 31, 2005
Pennsylvania Tax Free Income-Class A
PNPAX
Fund Number 015
Fund Symbol
1 Please see lhe Legal Noles section at the
end of this document for an explanation of the
account activdy presented by this Statement.
BRF100R
BlackRock
Estimated Cost Basis a5 of
03/31/2005
Average Cost
Per Share
Total Cost Basis
N/A
N/A
Activity in This Fund
Trade
Date T ransaclion
01AJ1AJ5
01fJ1AJ5
02128AJ5
03fJ1AJ5
Beginning Balance
Dividend - Reinvest
Dividend - Reinvest
Dividend - Reinvest
Your Personal Rate of Return
Current Year- One- Since Inception
Quarter to-Date Year Inception Date
-0.18% -0.18% N/A -0.18% 01AJ112005
Dollars This Shares This Total
T ransaclion Share Price T ransaclion Shares Held
2,490.360
$99.84 $10.67 9.357 2,499.711
$100.24 $10.61 9.448 2,509.165
$100.70 $10.53 9.563 2,518.728
Page 4 of 6
0021053566
Lor 01
Daily Confirmation
BLACKRoCK
e
SII.OO5173-BLK-BlKlrA02
CHARLES A LANTZY
JOANNE 0 DONALDSON POA
5261 MEADOWBROOK DR
MECHANICSBURG PA 17050-6833
<:>.;:':-:';::;>i::::"::>';:>:<:>',--: -:;: :'.>:..:::::>':<:>:::>;:::>>>)!)}/<:<:':':'- :>:' ',' - -: ":-:'::':" :,,:: ::<:<'-'-", :>':: ;:-: -:: :":':-" ,:.:':: :::' ":';-:::>::: ;::)/.::::;:' . <:::,:' ::- - .'::' :',,' ::': "::::-::::.::::':::>~::::::,::: .::::,:{>:<:)::>< :.,:.::
< <Oidyou knowthatJ3lackRock Funds now offers electronicdeliveryofquar~erlY statemehts,al1hualsndi .. ,
semi-annuaL reports, and prospectuses? To learn more, visit us on the web at www.blackrock.colll/funds.
or call us at 800-441-7762.
e
Personal Account Activity
PENNSYLVANIA TAX FREE INCOME-CLASS A
Trade
Date Transaction
02/28/05 Beginning Balance
02/28/05 Dividend - Reinvest
Distribution Options:
Income Dividends: REINVEST
Capital Gains: REINVEST
Fund No: 0015 Account No: 0021053566
Transaction Share Number of Shares Total Number
$ Amount Price This Transaction of Shares
2,499.717
2,509.165
9.448
$200.08
$0.00
$200.08
==
~
-
-
-
==
==
~
-
~
-
==
~
==
=
-
-
E
~
~
$100.24 $10.61
Income Dividends:
L.T. Cap Gains Distributions:
Total Dividends & Other Distributions:
aLK:B.LKl.UOLSI-L I.
15172 15172 0768.}2
0021~53?~_~~
Investment
Page 1 of 1
To Invest By Mail: For purchases into this account, return this stub and your check made payable to BlackRock Funds in the enclosed
envelope.
Mall To: BlackRock Funds, P.O. Box 9B19, Providence, RI 02940
CHARLES A LANTZY
JOANNE 0 DONALDSON POA
5261 MEADOWBROOK DR
MECHANICSBURG PA 17050-6833
Fund: PENNSYLVANIA TAX FREE INCOME-CLASS A
Fund No: 0015
Account No: 0021053566
Investment Amount: $
1$50 Minlmuml
'....,,,A
>..."
o Please che~k box and indicate address change on reverse side, or call us at IBOO) 441-7762.
50~O 015 00210535bb OOODDDDDOD DDDODOOOOO 5
.......
INDIANAPOLIS LIFE
t" AWER lISt-IIm",w,
May 31,2005
Administrative Office:
P.O. Box 7873
San Francisco. CA 94120-7873
Telephone: 877-549-7663
Fax: 800-211-5642
John M. Eakin
Attorney at Law
Market Square Building
Mechanicsburg, P A 17055
Contract No.:
Deceased:
Date of Death:
DAR006G992
Charles A. Lantzy
February 12, 2005
Dear Mr. Eakin,
As requested, below please find the values of the above referenced annuity contract as of the date
of death for estate tax purposes.
Contract No.
DAR0066992
Annuity Value
$318,669.84
Surrender Value
$304,329.70
Tax Cost Basis
$271,811.28
Death Benefit
$304,329.70
For your reference, the claim for this annuity has been approved. The settlement check will be
mailed today to the Personal Representatives of the Estate at the address provided on the claim
form.
Should you require any additional information, please contact our Claims Department toll free at
(800) 274-3179, extension 4017.
Sincerely,
'r' / . /'
,,---C ,.:x... &.C eX C) l tj\ v lz.cl (' (
Desiree Loughmiller
Claims Department
cc: Robert Griffin 0000029435
~
SMITHBARNEY~
cltlgroupJ
March 30, 2005
Joanne Donaldson
5261 Meadowbrook Drive
Mechanicsburg, PA 17050
RE: Charles A. Lantzy - Account # 724-05064-15-410
Dear Joanne:
This letter is to inform you that the date of death value on the above referenced
account on February 12, 2005 was $351.474.16.
Also, per our conversation yesterday, you will need the following documents for
the account:
1. Death Certificate
2. Court Appointment
In order to deposit the stock certificates you have in Mr. Lantzy's name you will
need the following:
1. Original Court Appointment
2. Stock Power or Endorsed Certificates
3. Notarized Affidavit of Domicile
During our conversation, you mentioned that once you had the information you
needed you would set up an appointment with the Financial Consultant, Doug
Smith. At the time of your appointment, we can obtain the required information
for the Affidavit of Domicile and have it notarized in our office for your
convenience.
I have notified Doug that you will be setting up an appointment. If I can be of
further assistance, please do not hesitate to call me.
Sincerely,
~l-L IJ t ~UL it"'Y J
Loni Rothenberger
Control Administrator
l)-ji: d,!i<~.)Rtl\t..ll()t.-J t.('~cli~ HA5 Glt:.~
C.H All'iW FRC;f..\ ;.n~,(:~ES WE IJEUL\'"
TO BE RELIABLE, Bu I D;) NOT GUARAI">ll tt
IT5 ACCURACY OK. (OMPLEl E:Nr.5S.
Citigroup Global Markets Inc. II North 3rd Street, 2nd Floor Harrisburg. PA 17101 Tel 717 780 1700 Fax 717 233 2090 Toll Free 800 2371700
~""~."., .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Lantzy Charles. A.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
05
0178
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers-Harner Funeral Home 10,908.00
2. Steller Kulp, Funeral Luncheon 186.83
3. Cresson Springs Family Restaurant, Funeral Luncheon 139.12
4. Carrolltown Cemetery Assn, Open Grave 325.00
5. Reverend John Sasway - Graveside Services 75.00
6. Myers Harner, Death Certificates 92.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) See Attachment Page(s}
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees John M. Eakin 49,100.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary 635.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7. Cumberland Law Journal, Estate Notice 75.00
8 The Sentinel, Estate Notice 126.14
9. Register of Wills, Filing Fee Tax Return 15.00
10. Central Penn Appraisals, Real Estate Appraisals (2) 450.00
11. Register of Wills, Filing Fee Account 980.00
12. Bonnie Kuntz-Smith, Real Estate School Tax 92.81
13. Lefever Title Research, Inc. , Copies of Deeds 120.00
14. Register of Wills, Filing Inventory 15.00
15 Recorder of Deeds, 1% Transfer Tax - Schedule A Item 1 1,300.00
16. Recorder of Deeds, 1 % Transfer Tax - Schdule A. Item 2 7,000.00
TOTAL (Also enter on line 9, Recapitulation) $ 120734.90
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Lantzy, Charles, A.
21
05
0178
PaQe 1
S.chedule H - Funeral Expenses & Administrative Costs - 81
ITEM
NUMBER DESCRIPTION AMOUNT
B. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Joanne Donaldson 24,550.00
Social Security Number(s) I EIN Number of Personal Representative(s) 166-26-2116
Street Address 5261 Meadowbrook Drive
City MechanicsburQ State P A Zip 17050
Year(s) Commission Paid:
Name of Personal Representative (s) J. Robert Stauffer 24,550.00
Social Security Number(s) I EIN Number of Personal Representative(s) 189-18-6995
Street Address Market Square Building
City MechanicsburQ State P A Zip 17055
Year(s) Commission Paid:
SUBTOTAL SCHEDULE H-B1 49,100.00
~"."."., '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
. RESIDENT DECEDENT
ESTATE OF
Lantzv. Charles. A.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
.
FILE NUMBER
21 05
0178
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
180.00
1.
Messiah Village, Nursing Care
2.
Greenawalt & Co., 2004 Income Tax Preparation
280.00
3.
PA Department of Revenue, 2005 PA 40ES
.100.00
4.
PA Department of Revenue, 2004 PA 40
79.00
TOTAl (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
639.00
~'m~."., .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
(STATE OF
I ::Int7v CharlF!~ A.
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
FILE NUMBER
?1 On
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
0178
AMOUNT OR SHARE
OF ESTATE
See Attachment Pagels)
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
See Attachment Pagels)
TOTAL OF PART n - 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)
400500.00
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Lantzy, Charles, A.
21
05
0178
PaQe 2
S~hedule J - Beneficiaries - 1
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)
1. Robert Dillon Stepson $50,000.00
4070 River Elan Drive
Gainesville, GA 30507
2. Richard Dillon Stepson $50,000.00
1426 Third Street
Cresson, PA 16630
3. Joanne Donaldson Stepdaughter $50,000.00
5261 Meadowbrook Drive
Mechanicsburg, PA 17050
4. Ruth Carpinello Sister $25,000.00
P.O. Box 314
Hastings, PA 16646-0314
5. Lela Lantzy Sister-in-Law $25,000.00
777 Woodward Heights Blvd. #115
Hazel Park, MI 48030
6. Helen Mellon c/o Susan Pluta Sister $25,000.00
7 Holly Drive
New Cumberland, PA 17070
7. Bernard Lantzy Brother $25,000.00
4450 S. Park Avenue Apt. 1611
Chevy Chase, MD 20815-3645
8. Allyn McCombie Cousin $60,000.00
Nicktown, PA 15762-0134
9. Lois Lantzy Niece $10,000.00
106 Lantzy Drive
Mechanicsburg, PA 17055
10. Beth Ann Reinhart Step-Granddaughter $10,000.00
11010 Abbey Lane
Fredricksburg, VA 22407
11. Denise Brice Step-Granddaughter $10,000.00
2826 Kleindale Road
Tucson, AZ. 85716
12. JoniBennett Step-Granddaughter $10,000.00
2383 Bronze Oak Lane
Braselton, GA 30517
13. Julie Holloway Step-Granddaughter $10,000.00
2830 Bordeaux Blvd.
Cumming, GA 30041
14. Mark Owens Step-Grandson $10,000.00
38990 Dobbins Creek Road
Lovettsville, VA 20180
- ~ .
"J. .- ..........r ... '''',vvv.......
815 Pueblo Court
Naperville, I L 60565
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Lantzy, Charles, A.
21
05
0178
Page 3
S~hedule J - Beneficiaries - 1
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)
16. Alan Dillon Step-Grandson $10,000.00
145 Bridgefield Road
Madison, AL 35758
17. Paul Dillon Step-Grandson $10,000.00
304 Park Avenue
Cresson, PA 16630
18. William Lantzy Nephew $1,000.00
116 Winston Drive
Mechanicsburg, PA 17055-3530
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Lantzy, Charles, A.
21
05
0178
PaQe 3
S~hedule J - Beneficiaries - 2B
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Our Lady of The Blessed Sacrament Church
4800 Union Deposit Road, Box 2153, Harrisburg, PA 17105-2153
10,000.00
2. Cathedral Parish of St. Patrick
4800 Union Deposit Road, Box 2153, Harrisburg, P A17105-2153
15,000.00
3. St. Bernard's Catholic Church
Reverend Thadeus Rettger
P.O. Box 497, 148 Beaver Street, Hastings, PA 16646
4. Prince of Peace of Northern Cambria
Reverend Larry Lacovic
811 Chestnut Avenue, Northern Cambria, PA 15714
5. St. Joseph Catholic Church
Diocese of Altoona_Johnstown, Larry Sutton
126 Logan Boulevard, Hollidaysburg, PA 16648
6 St. Michael's Catholic Church
Reverend Timothy Swope
321 St. Mary Street, Loretta, PA 15940-0144
7. Holy Spirit Hospital
503 N. 21st Street
Camp Hill, PA 17011
8. St. Labre Indian School Educational Association
James M. McDonald, CPA
P.O. Box 216, Ashland, Montana 59003
9. St. Benedict Church
Reverend Vincent Zidek
P.O. Box 447, Carrolltown, PA 15722
10. Oblate Missions
Reverend Richard Houlahan
323 Oblate Drive, P.O. Box 659432, San Antonio, TX 78265-9432
11. Claretian Missionaries
Barbara D. Mack
205 W. Monroe Street, Chicago, IL 60606
12. Association of Marian Helpers
Ellen M. Volkman
Eden Hill, Stockbridge, MA 01263
13. Covenant House
Planned Giving Office
346 W. 17th Street, New York, NY 10011-5002
14. American Heart Association
1517 Cedar Cliff Drive
Camp Hill, PA 17011
15. Easter Seals of South Central PA
Debbie Noel
2201 South Queen Street, York, PA 17402
16. Tri County Assn. for the Blind
1800 N. 2nd Street
Harrisburg, PA 17102
45,000.00
50,000.00
25,000.00
50,000.00
25,000.00
2,500.00
10,000.00
10,000.00
10,000.00
10,000.00
10,000.00
10,000.00
10,000.00
10,000.00
SUBTOTALSCHEDULEJ~B
302,500.00
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Lantzy, Charles, A.
21
05
0178
PaQe 4
Schedule J - Beneficiaries - 2B
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
17. American Cancer Society
Vick J. Harbin
Route 422 and Sipe Avenue, P.O. Box 897, Hershey, PA 17033-0897
18. Society for the Propagation of the Faith
Catholic Diocese of Harrisburg, Reverend Robert Sharman
P.O. Box 3657, Harrisburg, PA 17105
19. Villa Teresa Nursing Home
Sister Diane Mach
1051 Avila Road, Harrisburg, PA 17109
20. Seidle Memorial Hospital
120 S. Filbert Street
Mechanicsburg, PA 17055
21. Cambria County Historical Society
Fremont J. McKendrick
615 N. Center Street, Ebensburg, PA 15931
22. Francisscan FAthers
Reverend Nicholas Polichnowski
P.O. Box 40, Loretta, PA 15946
23. Order of Friar Servants of Mary
Reverend Anthony O'Connell
3121 West Jackson Boulevard, Chicago, IL 60612
24. Oratory of Rock Hill
Reverend Joseph Wahl
P.O. Box 11586, Rock Hill, SC 29731
25. Franciscan Friars of the Atonement
Friar Peter G. Gannon, SA
P.O. Box 300, Garrison, NY 10524-0300
26. Mt. Saint Mary's Seminary
16300 Old Emmitsburg Road
Emmitsburg, MD 21727
27. St. Joseph Church of Mechanicsburg
4800 Union Deposit Road, Box 2153, Harrisburg, PA 17105-2153
10,000.00
10,000.00
10,000.00
2,500.00
2,500.00
2,500.00
2,500.00
4,000.00
4,000.00
50,000.00
860,721.50
SUBTOTALSCHEDULEJ~B
958,721.50
~ .
..
lUclttt ~liJilI (lith lQ}~gtCUtt~nt
OF
CHARLES A. LANTZY
I, CHARLES A. LANTZY, of the Borough of Mechanics burg, County of
Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this my Last Will and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
l.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can be conveniently done.
2.
I direct that there shall be paid out of my residuary estate all estate, inheritance and like
taxes together with any interest or penalty thereon imposed by the Government of the United
States, or any state or territory thereof, or by any foreign government or political subdivision
thereof, in respect to all property required to be included in my gross estate for estate,
inheritance or like tax purposes by any of such governments, whether the property passes under
this will or otherwise.
3.
I give and bequeath the sum of FIFTY THOUSAND ($50,000.00) DOLLARS to each
of the following:
a.) My stepson, ROBERT DILLON.
b.) My stepson, RICHARD DILLON.
c.) My stepdaughter, JOANNE DONALDSON.
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4.
I give and bequeath the sum of TWENTY-FIVE THOUSAND ($25,000.00)
DOLLARS to each of the following:
a.) My sister, RUTH CARPINELLO.
b.) My sister-in-law, LELA LANTZY.
c.) My sister, HELEN MELLON.
d.) My brother, BERNARD LANTZY.
5.
I give and bequeath the sum of SIXTY THOUSAND ($60,000.00) DOLLARS to my
cousin, ALLYN McCOMBIE.
6.
I give and bequeath the sum ofTEN THOUSAND ($10,000.00) DOLLARS to my
niece, LOIS LANTZY.
7.
I give and bequeath the sum ofTEN THOUSAND ($10,000.00) DOLLARS to each of
the following:
a.) My step granddaughter, BETH ANN REINHART.
b.) My step granddaughter, DENISE BRICE.
c.) My step granddaughter, JONI BENNETT.
d.) My step granddaughter, JULIE HOLLOWAY.
e.) My step grandson, MARK OWENS.
f.) My step grandson, DANIEL OWENS.
g.) My step grandson, ALAN DILLON.
h.) My step grandson, PAULrDILLON.
8.
I give and bequeath the sum of ONE THOUSAND ($1,000.00) DOLLARS to my
nephew, WILLIAM LANTZY.
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9.
In the event any of the legatees named in Paragraphs 3 through 8, inclusive, predecease
me the gift shall lapse and become part of the residue.
10.
I give and bequeath the sum ofTEN THOUSAND ($10,000.00) DOLLARS as an
unrestricted gift to OUR LADY OF THE BLESSED SACRAMENT CHURCH of
Harrisburg, Pennsylvania.
11.
I give and bequeath the sum of FIFTEEN THOUSAND ($15,000.00) DOLLARS as
an unrestricted gift to ST. PATRICK CATHEDRAL of Harrisburg, Pennsylvania.
12.
I give and bequeath the sum of FORTY THOUSAND ($40,000.00) DOLLARS as an
unrestricted gift to ST. BERNARDS CATHOLIC CHURCH of Hastings, Pennsylvania.
13.
I give and bequeath the sum of FIFTY THOUSAND ($50,000.00) DOLLARS as an
unrestricted gift to ST. EDWARDS CATHOLIC CHURCH ofBarnsboro, Pennsylvania.
14.
I give and bequeath the sum of TWENTY-FIVE THOUSAND ($25,000.00)
DOLLARS as an unrestricted gift to ST. JOSEPH CATHOLIC CHURCH at Hart's
Sleeping Place, Carrolltown, Pennsylvania.
15.
I give and bequeath the sum of FIFTY THOUSAND ($50,000.00) DOLLARS as an
unrestricted gift to ST. MICHAEL'S CATHOLIC CHURCH of Loretta, Pennsylvania.
16.
I give and bequeath the sum of TWENTY-FIVE THOUSAND ($25,000.00)
DOLLARS as an unrestricted gift to HOLY SPIRIT HOSPITAL of Camp Hill,
Pennsylvania.
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17.
I give and bequeath the sum of TWO THOUSAND FIVE HUNDRED ($2,500.00)
DOLLARS as an unrestricted gift to ST. LABRE INDIAN SCHOOL.
18.
I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to the
CEMETERY ASSOCIATION ofSt. Bernard's Roman Catholic. Church, Hastings,
Pennsylvania, to be applied for the perpetual care of the Cemetery and for no other purpose; as
a condition precedent to this gift, the proper church officers shall certifY to my Executors that
said funds shall not be used for any purposes other than the perpetual care of said cemetery and
if such certification cannot be given, the gift shall lapse.
19.
I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to ST.
BENEDICT'S CEMETERY ASSOCIATION at Carrolltown, Pennsylvania, for the
perpetual care of St. Benedict's Cemetery at Carrolltown, and for no other purpose; as a
condition precedent to this gift, the proper church officers shall certifY to my Executors that
said funds shall not be used for any purposes other than the perpetual care of said cemetery and
if such certification cannot be given, the gift shall lapse.
20.
I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to ST.
BENEDICT'S CEMETERY ASSOCIATION at Carrolltown, Pennsylvania, for the
perpetual care ofSt. Joseph's Cemetery at Hart's Sleeping Place, and for no other purpose; as a
condition precedent to this gift, the proper church officers shall certifY to my Executors that
said funds shall not be used for any purposes other than the perpetual care of said cemetery and
if such certification cannot be given, the gift shall lapse.
21.
I give and bequeath the sum ofTEN THOUSAND ($10,000.00) DOLLARS as an
unrestricted gift to each of the following:
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. .
a.)
b.)
c.)
d.)
York.
e.)
Inc.
OBLATE FATHERS, of San Antonio, Texas.
CtARETIAN FATHERS, 221 West Madison Street, Chicago, Illinois.
ASSOCIATION OF MARIAN HELPERS, Stockbridge, Massachusetts.
COVENANT HOUSE, P.O. Box 731, Times Square Station, New York, New
AMERICAN HEART ASSOCIATION, South Central Pennsylvania Chapter,
f.)' EASTER SEALS OF SOUTH CENTRAL PENNSYLVANIA.
g.) TRI COUNTY ASSOCIATION FOR THE BLIND, Harrisburg, Pennsylvania.
h.) AMERICAN CANCER SOCIETY of Carlisle, Pennsylvania.
1.) SOCIETY FOR THE PROPOGATION OF THE FAITH
j:) VILLA TERESA NURSING HOME, Harrisburg, Pennsylvania.
22.
I give and bequeath the sum of TWO THOUSAND FIVE HUNDRED ($2,500.00)
DOLLARS as an unrestricted gift to each of the following:
a.) SEIDLE MEMORIAL HOSPITAL, Mechanicsburg, Pennsylvania.
b.) CAMBRIA COUNTY HISTORICAL SOCIETY, Ebensburg, Pennsylvania.
c.) FRANCISCAN FATHERS, Loretta, Pennsylvania.
d.) SERVITE FATHERS, 3121 West Jackson Boulevard, Chicago, Illinois.
23.
I give and bequeath the sum of FOUR THOUSAND ($4,000.00) DOLLARS as an
unrestricted gift to each of the following:
a.) ORATORIAN FATHERS, RockHill, South Carolina.
b.) ATONEMENT FRIARS, Garrison, New York.
24.
I give and bequeath the sum of FIFTY THOUSAND ($50,000.00) DOLLARS as an
unrestricted gift to MOUNT ST. MARY'S SEMINARY, Emmitsburg, Maryland.
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25.
I give and bequeath all my genealogy records to the CAMBRIA COUNTY
mSTORICAL SOCIETY, Ebensburg, Pennsylvania.
26.
All the rest, residue and remainder of my estate I give, devise and bequeath to ST.
JOSEPH CATHOLIC CHURCH, Mechanicsburg, Pennsylvania, to be used for the parish
center building fund.
27.
LASTL Y, I nominate, constitute and appoint my stepdaughter, JOANNE
DONALDSON, together with JOHN M. EAKIN and J. ROBERT STAUFFER, to be my
Co-Executors, of this, my Last Will and Testament, and in the event one or more should be
unable or unwilling to act as such, the others shall serve as Co-Executors. I further direct that
no bond or other security be required of my personal representative to guarantee faithful
performance of his or her duties.
IN WITNESS WHEREOF, I have hereunto set may hand and seal this 30 I L day of
July, 2001.
Charles A. Lantzy
Signed, sealed, published and declared by the above-named CHARLES A. LANTZY
as and for his Last Will and Testament, in the presence of us, who, at his request and in his
presence, and in the presence of each other, have hereunto subscribed our names as witnesses.
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COMMONWEALTH OF PENNSYLVANIA )
: SS
COUNTY OF CUMBERLAND )
I, CHARLES A. LANTZY, the testator, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge that
I signed and executed the same instrument as my Last Will and Testament; that I signed it
willingly, and that I signed it as my free and voluntary a t and d d, for the purposes therein
expressed.
Sworn and subscribed to
before me this Jd 7A day
of July, 2001.
/1~ C~.
Nqtarjal Seal
MiJrllyn f:. WiUisms, Notary Public
Meohanicat>vrQ Boro. Cl:lmbertand County
My Commisiion e~pires Noy. 6, 2001
Memtler, PennsylvilAia A$~ociatlon of NotarIes
COMMONWEALTHOFPENNSYLVANIA )
: SS
COUNTY OF CUMBERLAND )
We, the undersigned, Jo~^" 1'1. 8lj(/~d R"fJERT J. D'LL (J,./ , the witnesses
whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, depose and say that we were present and saw the testator, CHARLES A. LANTZY,
sign and execute the Instrument as hIS Last Will and Testament; that the said testator executed
it as his free and voluntary act for the purposes therein expressed; that each of us, in the
hearing and sight of the testator, signed the Will as witnesses; and that, to the best of our
knowledge, the testator was, at the time, eighteen 18) or more years of age, of sound mind,
and under no constraint, duress or undue influenc .
Sworn and submbed to
before me this '-If- day
of July, 2001.
L1~tary~
Notarial Seal .
Marilyn E. WiUlam~=~:r~nty
~~EXpires Noy. 6. 2001
My .
Member, PenntYlVlnla Association of Notanes
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