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HomeMy WebLinkAbout10-31-05 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CRIST HENRY S 2311 NORTH FRONT ST APT 918 HARRISBURG, PA 17110 u______ fold ESTATE INFORMATION: SSN: 084-22-4170 FILE NUMBER: 2105-0740 DECEDENT NAME: CRIST RAY H DATE OF PAYMENT: 10/31/2005 POSTMARK DATE: 1 0/31/2005 COUNTY: CUMBERLAND DATE OF DEATH: 07/23/2005 NO. CD 005945 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,486.21 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: H CRIST CHECK#1003 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $1,486.21 GLENDA FARNER STRASBAUGH REGISTER OF WILLS REV-1500 EX (6<lO) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT N"'~N~~'~'_-"'~"'~'~'=~~__^'~WA~~~~',,*~___~W~~ FILE NUMBER 21 05 0740 COUNTY CODE YEAR NUMBER I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) CRIST, RAY H. SOCIAL SECURITY NUMBER 084-22-4170 DATE OF BIRTH (MM-DD-YEAR) 03/08/1900 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ lI:::!:Ul uQ:lI:: w&g J:Q:..J ull..lll ~ D 2. Supplemental Return D 4a. Future Interest Compromise (dale of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copyofTrust) D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) D 3. Remainder Retum (dale of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Soh 0) 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 Governmental Bequests/See 9113 Trusts for which an election to lax has not been made (Schedule J) DATE OF DEATH (MM-DD-YEAR) 07/23/2005 [!] 1. Original Return D 4. Limited Estate [!] 6. Decedent Died Testate (Attach copyofWUI) D 9. Litigation Proceeds Received NAME Thomas E. Flower, Esquire FIRM NAME (If Applicable) Saidis, Shuff, Flower & Lindsay TELEPHONE NUMBER (717) 737-3405 z o ~ ..J ~ ~ U w 0:: 14. Net Value Subject to Tax (Line 12 minus Line 13) COMPLETE MAILING ADDRESS 2109 Market Street Camp Hill, PA 17011 (1) (2) (3) (4) (5) 134,440.60 t-..;) (~'::'J C..::..) c.....'I C) ,) --; (..) ::0 , '1 ~3 ::1_') ~,.. , r 'I ,',", .',::1 C:J CO) C) "'71 ~+j - (~ :"-.I'TI 85,476.99 (j .-~l ~ (6) 4,146.30 ~ o (7) 31,000.00 (9) (10) (8) 21,263.12 1,943.76 (11) (12) (13) .... 255,063.89 23,206.88 231,857.01 0.00 (14) 231,857.01 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o 1;( ~ ::;) D.. :IE o u ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 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 x .0 (15) ..?~.1.113!5Z.0_L x .0 !~_ (16) 10,433.57 '__ x .12 (17) x .15 (18) (19) 10,433.57 Decedent's Complete Address: STREET ADDRESS 619 Devonshire Drive CITY Carlisle I STATEpA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 10,433.57 8,500.00 447.36 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C ) (2) 8,947.36 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) (5B) 1,486.21 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT 1,486.21 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or..............................................................................................""""'''''''''''''''''''' 0 [K] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [K] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ~ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pe~ury. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P SON RESPO~I~LU9R FILING RETURN ~~ ADDRESS Dr. Henry S. Crist, 2311 N. Front Street, Apt 918, Harrisburg, PA 17110 slq OF PREPARER OTHER TH EP. ENTATIVE DATE /o/z.~ of AD ES Said is, Shuff, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17011 DATE ___ -O~ 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 surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt 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 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. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(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. 99116(a)(1.3)]. 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. ~reVlr.t.lJS ecmons are aOSQlete A. Setflement Staten torm HUU-.l (..:S/t'lb) rer HanaOOOK q":sUO.L t J. Department of Housing and Urban Development B...Type of Loan OMB Approval No. 2502-0265 (expires 9/30/2006\ 1. DFHA 2. DFmHA 3. DCony. Unins. I 6. File Number I 7. Loan Number I 8. Mortgage Insurance Case Number 4. OVA 5. DCony. Ins. MT2005.238JDF C. Note: I nls arm IS urnlsneo 10 give you aSia emen 0 aClual. selllemenl costs. Amounls palo 10 ana oy me selllemen agen are snown. I TitleExpress Settlement System Items marked Il(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the lolals. WARNING: II is a crime to knowingly make false statements to Ihe United States on this or any other similar form. Penallles upon conviction can include a fine and Imorisonment. For details see: Tille 18 U. S. Code Section 1001 and Section 1010. Printed 09/13/2005 at 14:29 RLM D. NAME OF BORROWER: Robert L. Crist and Despina L. Crist ADDRESS: E. NAME OF SELLER: Estate of Ray H. Crist ADDRESS: F. NAME OF LENDER: M & T Mortgage Corporation ADDRESS: One Fountain Plaza. Post closinQ 6th Floor. Buffalo NY 14203 G. PROPERTY ADDRESS: 619 Devonshire Drive, Carlisle, PA 17013 Borouoh of Carlisle H, SETILEMENT AGENT: Said is, Shuff, Flower & Lindsay, Telephone: 717-243-6222 Fax: 717-243-6486 PLACE OF SETILEMENT: 26 West Hioh Street, Carlisle. PA 17013 I. SETILEMENT DATE: 09/14/2005 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 10~GROSSAMOUNTDUEFROMBORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales orice 136 000.00 401. Contract sales Drice 136 000.00 102. Personal Prooerty 402. Personal Property 103. Settlement charnes to borrower (/ine 1400\ 4 300.96 403. 104. 404. 105. 405. Adiustments for items Daid by seller in advance Adiustments for items paid by seller in advance 107. County taxes 09/14/05 to 12/31/05 212.31 407. County taxes 09/14/05 to 12/31/05 212.31 108. School Taxes 09/14/05 to 06/30/06 1.356.77 408. School Taxes 09/14/05 to 06/30/06 1 356.77 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 141870.04 420. GROSS AMOUNT DUE TO SELLER 137.569.08 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. DeDosi! or earnest money 501. Excess Deposit (see instructions) 202. Principal amount of new loans 96 000.00 502. Settlement charaes to seller !line 1400) 3128.48 203. Existina loan(s) taken subiect to 503. Existina loan(s) taken subiect to 204. 504. Payoff o( First Mortaaae Loan 205. 505. 206. Credit for Inherit Share of 45.333.00 506. Credit for Inherit Share of 45 333.00 207. Est of Ray H. Crist:to 507. Est of Ray H. Crist to 208. Beneficiary Robert L. Crist 508. Beneficiary Robert L. Crist 209. 509. Adiustments for items unoaid bv seller Adiustments for items unpaid bv seller 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 141.333.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 48 461.48 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120\ 141.870.04 601. Gross amount due to seller (line 420\ 137569.08 302. Less amounts oaid by/for borrower (line 220\ 141.333.00 602. Less reduction amount due seller (line 520\ 48.461.48 303. CASH FROM BORROWER 537.04 603. CASH TO SELLER 89.107.60 SUBSTiTUTE FORM 1099 SELLER STATEMENT: The infonmation contained herein Is important tax information and is being fumished to the Internal Revenue Service. If you are required to file a retum, a negligence penally or olher sanclion will be imposed on you If this item is required 10 be reported and the IRS determines that It has not been reported. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of Ihls transaction. SELLER INSTRUCTiONS: If this real estate was your principal residence. file Form 2119. Sale or Exchange of Principal Residence. for any gain. with your Income tax return; for other transactions. complete the applicable parts of Form 4797. Form 6252 and/or Scheduie 0 (Form 1040). You are required by law to proVide Ihe selllement agent (Fed. Tax 10 No: . )wilh yourcorrecltaxpayer idenlillcation number. If you. do not provide your c~rrect taxpayer idenlificatlon number, you may be subject 10 civil or criminal penalties Imposed by law. Under penailies of perJury. t certify that the number shown on thiS slatement IS my correct taxpayer Identification number. TIN: SELLER(S) SIGNATURE(S): SELLER(S) NEW MAiliNG ADDRESS: PrevIOus editions are oDsOrete U.S. DEPARPAENT OF HOUSI~''"' "ND URBAN DEVELOPMENT SETTLEMENT ST A TEl T Filr "Imber: MT2005-238 r S I form HUU~l (:.::smb) rer HanaOOOK 4:::SUo.L - . /, Jress ell ement System Printed 09/13/2005 at 14:29 RLM . L. SETTLEMENT CHARGES PAID FROM PAID FROM - 700. TOTAL SALES/BROKER'S COMMISSION based on price $136.000.00 @ 0.000 = BORROWER'S SELLER'S Division of commission (/ine 7001 as follows: FUNDS AT FUNDS AT 701. $ to SETTLEMENT SETTLEMENT 702. $ to 703. Commission oaid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Oriaination Fee % 802. Loan Discount % 803. Aooraisal Fee to M & T Mortgaae Corooration (P.O.C.1 300.00 Buyer LA 20.00 804. Credit Reoort 805. Lender's Insoection Fee 806. Mortaaae Aoolication Fee to M & T Mortgaae CorDoration (P.O.C.1 100.00 Buyer LA 807. Assumotion Fee 808. Processina Fee to M & T Mortaaae Corooration LA 195.00 809. Tax Service Fee to M & T Mortaaae Corooration LA 76.00 810. Flood Cert Fee to M & T Mort!la!le Corporation LA 8.00 811. Doc Preo Fee to M & T Mortaaae Corooration LA 400.00 900. ITEMS REQUIRED BY LENDEA TO BE PAID IN ADVANCE 901. Interest From 09/14/2005 to 10/01/2005 @$ 15.7808/dav 17 Days LA 268.27 902. Mortaaae Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. AESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo. @ $ 31.17/mo LA 93.51 1002. Mortaaae Insurance mo. @$ Imo 1003. City Prooertv Tax mo. @$ Imo 1004. County Property Tax 8 mo. @ $ 59.25 Imo LA 474.00 1005. School Taxes 4 mo. @ $ 145.21 Imo LA 580.84 1009. Aqqreqate Analvsis Adjustment to M & T Mortaaae Corporation LA -441.54 1100. TITLE CHARGES 1101. Settlement or c10sina fee 1102. Abstract or tille search 1103. Title examination 1104. Tille insurance binder 1105. Document Preparation 1106. Notary Fees to Saidis Shuff. Flower & Lindsay 14.00 1107. Attornev's fees (includes above items No: ) 1108. Tille Insurance to ACCP Inc. 934.88 (includes above items No: ) 1109. Lender's Policv 96 000.00 - 1110. Owner's Policy 136000.00 . 934.88 1111. END 100 300 8.1 to ACCP. Inc. 150.00 1112. Insured Closina Letter to ACCP, Inc. 35.00 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordinq Fees Deed $ 38.50. . Mortaaae $ 64.50 . Release $ 103.00 1202. CitvlCountv tax/stamps Deed $1 360.00 . Mortaaqe $ 1,360.00 1203. State Tax/stamps Deed $1 360.00 . Mortqaqe $ 1 360.00 1204. 2005-06 School Taxes to Darlene Mover. tax collector 1,742.52 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Su rvev 1302. Pest Insoection 1303. Wire Fee to ACCP. Inc. 10.00 1304. Airborne Packaae to Saidis Shuff. Flower & Lindsay 20.00 1305. Final Water & Sewer to Borouah of Carlisle 25.96 1306. 1307. 1308. 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K\ 4.300.96 3.128.48 PAGE 2 HUD CERTIFICATION OF BUYER AND SELLER on my account or by me 7 / WA NING: IT IS A CRIME TO KNOWINGLY MAKE FAL STAT MENTS TO THE U ED STATES ON THIS OR ANY SIMILAR FORM. PE AL TI UPON CONVICTION AN INCLUDE A FINE AND IMPRISONMENT. FOR DET L EE TITLE 1 B: U.S. CODE SECTION 1001 AND SECTION 1010. The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. aye caused or will caUse the funds to be disbursed in accordance with this statement. q - I t/ - 0.5"-- REV-1502 EX+ (6-9* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF CRIST, RAY H. FILE NUMBER 21-05-0740 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 Dwelling house and lot, 916 Devonshire Dr., Carlisle, PA, net proceeds per HUD-1 attached VALUE AT DATE OF DEATH 134,440.60 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 134,440.60 REV-1508 EX+ (6-98) .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CRIST, RAY H. FILE NUMBER 21-05-0740 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. ITEM NUMBER DESCRIPTION 1 M&T Investments, securities account per attached itemized valuation VALUE AT DATE OF DEATH 2. Household furniture and furnishings, estimated value 80,476.99 5,000.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 85,476.99 Date of Death: 07/23/2005 Valuation Date: 07/23/2005 Processing Date: 08/30/2005 Shares or Par Security Description 1) 2) 2787 Cash (CASH) 1535.472 MTB GROUP FDS (55376T817) INTRM BD I I Mutual Fund (as quoted by NASDAQ) 07/22/2005 3) 1418.84 MTB GROUP FDS (55376T221) SHR DUR GV I I Mutual Fund (as quoted by NASDAQ) 07/22/2005 4) 1015.746 MTB GROUP FDS (55376T189) STRM CORP BD I I Mutual Fund (as quoted by NASDAQ) 07/22/2005 5) 354.359 HARBOR FD (411511504) CAP APPR INSTL Mutual Fund (as quoted by NASDAQ) 07/22/2005 6) 2547.173 MTB GROUP FDS (55376T692) LCP STK I I Mutual Fund (as quoted by NASDAQ) 07/22/2005 7) 437.943 MTB GROUP FDS (55376Tl14) SMCP ST INST I Mutual Fund (as quoted by NASDAQ) 07/22/2005 8) 1213.51 Cash (CASH) Total Value Total Accrual Total $80,476.99 Estate Valuation High/Ask Page 1 Estate of: Ray H. Crist Account: 411610603 Report Type: Date of Death Number of Securities: 8 File 10: crist Low/Bid Mean and/or Div and Int Security Adjustments Accruals Value 9.95000 Mkt 9.57000 Mkt 9.79000 Mkt 30.29000 Mkt 8.92000 Mkt 9.64000 Mkt 9.950000 9.570000 9.790000 30.290000 8.920000 9.640000 2,787.00 15,277 .95 13,578.30 9,944.15 10,733.53 22,720.78 4,221. 77 1,213.51 $80,476.99 $0.00 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.3) REV-1509 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF CRIST, RAY H. FILE NUMBER 21-05-0740 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.. Henry S. Crist 2311 N. Front Street Apt. 918 Harrisburg, PA 17110 son B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 12/26/85 M&T Bank, checking account no. 651664 8,292.60 50 4,146.30 "" TOTAL (Also enter on line 6, Recapitulation) $ 4,146.30 (If more space is needed, insert additional sheets of the same size) .M&fBank .: .:. .: .. .:. .:. 651664 M&T FIRST WITH INTEREST JUL.23-AUG.23,2005 1 OF 2 00 6 04345M M 021 RAY H CRIST HENRY S CRIST 2311 N FRONT ST APT 918 HARRISBURG PA 17110 INTEREST PAID YEAR TO DATE 6.14 STONEHEDGE : : BEGINNING : : :>DEP.OSI'l'S:&> >::: : : :::::::OTHER:::..::::: ::.:.'CURRENT:: .:.:::.:......=~~ :.BALANCI!: : :OTHl!:lf:ADOI'l'IONS> < . Stm1'RACTIONS: :IN'1'ltREsTl?O NO I AMOUNT NO AMOUNT NO I AMOUNT 8 , 2 92 6 0 41 4 , 6 72 2 8 6 6 , 95 8 42 3 I 1 , 1 97 6 1 0 43 4 , 8 0 9 2 8 ACCOUNT SUMMARY : POSTING ::..:: I)EPOSITS~:.INT:e:REST: c;HECKSilOOTHER:.. : DATI!:: >< &::'.OTHER:..AImlTIONS: SUBTRACT10NS :: .:< 07-23-05 BEGINNING BALANCE $8,292.60 07-25-05 CHECK NUMBER 1349 5,000.00 3,292.60 08-01-05 UNION CARBIDE CO PAYROLL 2,500.40 08-01-05 UCC EMPLOYEES PE PAYROLL 975.27 08-01-05 TIAA-CREF DISTR. ANNUITY 168.61 6,936.88 08-02-05 CHECK NUMBER 1350 300.00 6,636.88 08-03-05 US TREASURY 303 SOC SEC 1,028.00 7,664.88 08-04-05 CHECK NUMBER 1323 400.00 08-04-05 CHECK NUMBER 1322 1,121. 73 6,143.15 08-05-05 CHECK NUMBER 1324 97.75 6,045.40 08-08-05 CHECK NUMBER 1325 38.94 6,006.46 08-12-05 TIAA-CREF DISTR. RECLAIM 168.61 5,837.85 08-22-05 REVERSE DIRECT DEPOSIT 1,028.00 4,809.85 08-23-05 INTEREST PAYMENT 0.43 08-23-05 FEE FOR CHECK RETURN OPTION 1.00 4,809.28 ENDING BALANCE $4,809.28 ACCOUNT ACTIVITY . ..........- .-.. ..-....... .-.............-.,..... . : CHECl<S:li'Mb SUMMARY: ...1 .. . 1322 08-04-05 1325 08-08-05 1,121.73 38.94 1323 08-04-05 1349* 07-25-05 400.00 5,000.00 1324 08-05-05 1350 08-02-05 97.75 300.00 ANNUAL PERCENTAGE YIELD EARNED 0.09 % "M&rBank .: .:. .: .:: . .::.. ::. .:: ..: ... ........ . .. 651664 M&T FIRST WITH INTEREST JUN.24-JUL.22,2005 1 OF 2 00 12 04345M M 021 RAY H CRIST HENRY S CRIST 2311 N FRONT ST APT 918 HARRISBURG PA 17110 INTEREST PAID YEAR TO DATE 5.71 STONEHEDGE : BEGINNING:: ..O'r:E~POkW'IST.I&I"It.tS....:... :::::. : .::::.. :.oTHER:: :.:::: : : : :>CURR.ENT .:.ENDING:: : BALANCE ::::: .::.. : suBTRACTIONS :.INTERES'r.:.PO BAtJu;lCE: NO I AMOUNT NO AMOUNT NO I AMOUNT 7 , 7 54 4 9 4 I 7 , 17 1 8 8 1 2 6 , 6 3 3 53 1 I 1 0 0 0 76 8 , 2 9 2 6 0 ACCOUNT SUMMARY POSTlNG ...... ::. DEPOSITS~..INTEREST. ...:.:~ECKS>".OTHER : ::.::: . ....DATE> &iOTHER:MiDITIONS: :.:.. :SUB1'R1I.CTI6~s 06-24-05 BEGINNING BALANCE $7,754.49 06-28-05 CHECK NUMBER 1348 2,000.00 06-28-05 CHECK NUMBER 1309 36.64 5,717.85 06-30-05 DEPOSIT 5,000.00 10,717.85 07-01-05 US TREASURY 303 SOC SEC 1,028.00 07-01-05 UCC EMPLOYEES PE PAYROLL 975.27 07-01-05 TIAA-CREF DISTR. ANNUITY 168.61 12,889.73 07-06-05 CHECK NUMBER 1310 345.00 12,544.73 07-07-05 CHECK NUMBER 1347 2,796.37 9,748.36 07-11-05 CHECK NUMBER 1312 140.00 07-11-05 CHECK NUMBER 1315 103.36 07-11-05 CHECK NUMBER 1313 68.84 9,436.16 07-12-05 CHECK NUMBER 1314 32.45 9,403.71 07-14-05 CHECK NUMBER 1311 500.00 8,903.71 07-19-05 CHECK NUMBER 1320 43.36 8,860.35 07-21-05 CHECK NUMBER 1316 63.00 8,797.35 07-22-05 INTEREST PAYMENT 0.76 07-22-05 CHECK NUMBER 1321 504.51 07-22-05 FEE FOR CHECK RETURN OPTION 1. 00 8,292.60 ENDING BALANCE $8,292.60 ACCOUNT ACTIVITY ....................-................,......,-.......... ." ...,....... .-. ---... ,. . . . > :..CHECKSPi\ID~Y:: I 1309 1312 1315 1321 06-28-05 07-11-05 07-11-05 07-22-05 36.64 140.00 103.36 504.51 1310 1313 1316 1347* 07-06-05 07-11-05 07-21-05 07-07-05 345.00 68.84 63.00 2,796.37 1311 1314 1320* 1348 07-14-05 07-12-05 07-19-05 06-28-05 500.00 32.45 43.36 2,000.00 ANNUAL PERCENTAGE YIELD EARNED 0.10 % REV-1510 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Ray H. Crist FILE NUMBER 21-05-0740 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV.1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUOE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO OECEOENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. cash gift to Robert Crist on or about January 15, 2005 5,000.00 100 3,000.00 2,000.00 2. cash gift to DeLanson Crist, on or about January 15, 2005 17,500.00 100 3,000.00 14,500.00 3. cash gift to Henry Crist on or about January 15, 2005 17,500.00 100 3,000.00 14,500.00 .... ... TOTAL (Also enter on line 7 Recapitulation) $ 31,000.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99>* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RAY H. CRIST FILE NUMBER 21-05-0740 ITEM NUMBER A. B. 1. 10. 11. 12. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: MALPEZZI FUNERAL HOME, Professional Services Casket ($2,400) and Grave Liner ($640) Guest Register and Folders Grave Opening ($700) and Cemetery Equipment ($110) Obituaries ($675.50), Flowers ($318), Mass Offering ($125) & Clergy Honorarium ($300) Death Certificates Memorial Buffet - Allenberry Inn ADMINISTRATIVE COSTS: 3,040.00 165.00 810.00 1,418.50 150.00 21.73 2. 3. 4. 5. 6. 7. 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 6,675.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Robert L. Crist Street Address 619 Devonshire Drive City Carlisle State PA .Zip 17013 Relationship of Claimant to Decedent 4. Probate Fees 361.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. The Sentinel ($173.33) & Cumbo Law Joumal ($75), Publish Estate Notices Express mail charges to over-night New York Times obituary Trash removal 248.33 13.65 100.00 99.91 15.00 9. UGI (44.35) and Sprint (45.56), decedent's pro-rated portion of final phone and utility bills Inheritance tax return filing fee TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 21,263.12 REV-1512 EX+ (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RAY H. CRIST FILE NUMBER 21-05-0740 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PA Academy of Science, publishing cost decedent's final paper 240.00 2. Sprint, phone bill 45.90 3. UGI, utility bill 44.35 4. Comcast. tv cable 47.82 5. Homeowners Insurance 345.00 6. Borough of Carlisle, water bill 38.94 7. PPL, electric bill 97.75 8. Robert L. Crist, reimburse for cost of medications & postage to mail decedent's books to chem. depts. 400.00 9. Thomwald Home, unreimbursed nursing care during final illness 684.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,943.76 REV-1513 EX+ (9-00) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF CRIST, RAY H FILE NUMBER 21-05-0740 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 Robert L. Crist, 619 Devonshire Dr., Carlisle, PA 17013 son 0.33 2 DeLanson R. Crist, 3611 Raymond St., Chevy Chase, MD 20815 son 0.33 3 Henry S. Crist, 2311 N. Front St., Apt. 918, Harrisburg, PA 17011 son 0.33 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 $ 0.00 (If more space is needed, insert additional sheets of the same size)