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HomeMy WebLinkAbout11-16-05 REV-1500 EX + (6-00) W., . ". I W I- ",,5C/) uO::"" wQ.u xoo uO::..J Q.al Q. ..: OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10 Spousal Povert~ Credit (date of death between '.1 11.Election to tax under Sec. 9113(A) (Attach Sch 0) . 12-31-91 and 1-1-95) L -,~'-",---,-,~,~"~-,~,-~~-,-.-,,,,~,--~,".,.,~,--...__.~-.'.-.~"~~,~~~-~--.~- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 ~-ID:;:~T:;~:E ~LA:~ ::S~ ~ND MIDDLE INITIAL) ~ I D~f;~~-~E~~-~M~bD-YEAR) DA~E50:;~~H1(;~-;-YEAR) :!:: I (tFAPf'LICABLE) SURVIVING- SPOUSE-;S NAME (LAST, FIRST AND MIDDLE INITIAL) ! II xJ 1. 114. I xj 6. I 19 Limited Estate [J [J [J 2. Supplemental Return Original Return Decedent Died Testate (Attach copy of Will) Litigation Proceeds Received FILE NUMBER II 05 0253 NUMBER COUNTY CODE YEAR SOCIAL SECURITY NUMBER 176-14-2578 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 208-24-9739 o 3. Remainder Return (dale of death prior to 12-13-82) LJ 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes THIS SECTION MUST BE COMPLETED. ALL CORRE$PONDENCE ANp CONFIQEllITIAL TAX INFQRMATIONSHOULO BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Michael L. Bangs FIRM NAME (If applicable) I- Z W C z o Q. C/) W 0:: 0:: o U TELEPHONE NUMBER 717 -730-7310 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o i= <( ...J ~ l- ii: <( o w a:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) II Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) lJ Separate Billing Requested 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) 429 South 18th Street Camp Hill, PA 17011 r-:J c---"] , , -TJ ) :,~'-~ ~'m" ...., ..-=+-- - (1 ) None OFF1CIAl:,-QSE ONL.~ 1 (2) 77,497.82 (',\ (3) None -" ) (4) None "..-=, - i-T .. (5) 27,939.38 c..) i"\ --~--- u...., (6) None ~ (7) 131,959.80 (8) 237,397.00 (9) 18,927.08 - ---_.._-~. (10) 2,314.06 SEE INSTRUCTiONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 (11 ) 21,241.14 (12) 216,155.86 -_._--~---- (13) 0.00 (14) 216,155.86 x .00 (15) 0.00 --_.."----_.---- x .045 (16) 9,727.01 -~--~-~- x .12 (17) 0.00 x .15 (18) 0.00 (19) 9,727.01 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) z o i= ~ ~ a.. ::i: o o x ~ 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 20.0 216,155.86 0.00 0.00 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00; Decedent's Complete Address: STREET ADDRESS 820 Lisburn Road, Apt. 811 CITY Camp Hill STATE P A ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 9,727.01 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) 4. If Line 2 is greater than line 1 + line 3, enter the difference. This is thEOVERPA YMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is theTAX DUE A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (3) (4) (5) (5A) (5B) 9,727.01 9,727.01 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 No a. retain the use or income of the property transferred;............................................................................. I] [!:I b. retain the right to designate who shall use the property transferred or its income;...........................m.. l--:J [x] c. retain a reversionary interest; or..............................-............................................................................. [] ~ d. receive the promise for life of either payments, benefits or care?........................................................... [] [x J 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................... ........ .................................................................................... I] Ii] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... [J [~J 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which __ contains a beneficiary designation?................................................................................................................ i~J I" J 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 perjury, 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 col11j>l,,~Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE F FILING RETURN ADDRESS --.-- DATE-- Stua penc ~ 337 Evergreen Street New Cumberland, PA 17070 .J! I;uk 1-tX1 JI VJ}/ J- I-L/--~ DATE si NATURE-6TpERSONRES8 SIBLE FOR FILING RETURN ~'fu4zm"" Michael L. Bangs ADDRESS ADDRESS 429 South 18th Street Camp Hill, PA 17011 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. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return 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. ~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 is 4.5%, except as noted in 72 P.S. ~9116 1.2) [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 defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ) , Rev-1503 EX+ (6-9B) . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Spencer, Selva A. FILE NUMBER 21-05-0253 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 Series E Savings Bonds - 31 Series E Savings Bonds 13.099.82 2 Series EE Savings Bonds - 24 Series EE Savings 14.898.00 Bonds 3 Series HH Savings Bonds - 99 Series HH Savings 49.500.00 Bonds TOTAL (Also enter on Line 2, Recapitulation) 77 .497 .82 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleS (Rev. 6-98) , ' ;t:> en "0 C1> ::J () C1> -, :s:: z rr o ::J 0.. iii' (f) ~ ~. 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Dl W W W W W W W W W W W W W W W ...... ...... ...... ...... ...... ...... ...... ...... o- N -- -- -- N -- -- N -- -- N -- -- -- N -- -- -- N -- -- -- N N N N N N N N N N N N N N N N N DlS:: ll) Cl Cl 0 Cl 0 0 0 Cl 0 0 Cl 0 0 0 0 0 0 0 0 0 0 0 0 -Dl N N N N N N N N N N N N N N N N N N N N N N N CD_ CD .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. .j:>.. w w w w w w w w C ... ;:;: '< Z 0 - CD 01 OJ a. ~ )>< UCO <' ~ CD 0 ~~ ~ ::c ......CO 0"0 -< 0 ;::1. '! "U~ .:J .-+ o ll) oct .-+ o .j:>. - o -'" ww -- I'VI'V 00 00 01 , . Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Spencer, Selva A. FILE NUMBER 21-05-0253 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 DESCRIPTION 1 Refund - Final Refund of Security Deposit VALUE AT DATE OF DEATH 485.00 2 Refund - Refund from Verizon 30.48 3 Refund - Refund from Comcast Cable Communications 29.23 4 Interstate Realty Management Co. - Refund of Security Deposit for apartment 151.00 5 PNC Bank, N.A. - Checking Account #62894284944 10.237.31 6 PNC Bank, N.A. - Savings Account 6928663079 8.957.10 7 Refund - Refund of unearned insurance premium from Highmark Blue Shield 747.29 8 State Street Retiree Services - April 2005 Pension Benefit 301.97 9 Automobile - 2000 Dodge Caravan 7.000.00 TOTAL (Also enter on Line 5, Recapitulation) 27.939.38 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) RPR~27-2005 22:14 PNCBRNK 412 768 3458 P.01/01 o PNCBAN< April 28, 2005 Michael L. Bangs 429 South ISm Street Camp Hill, PA 17011 RE: Estate of Selva A. Spencer, deceased SSN: 176-14-2578 DOD: 3/612005 Dear Mr. Bangs~ In response to your request for Date of Death balances for the customer noted above, our records show the fol1owing: Checking A~count Account #6289284944 Established 01/05/1981 SELVA A SPENCER DOD balance: $10,237.31 + $.60 accrued interest Interest paid 1/1/2005 - 3/6/2005 - $3.38 Savings Aeeount Account #6928663079 Established 04/30/1970 SELVA A SPENCER ODD balance: $8,957.10 + $3.11 accrued interest Interest Paid 1/112005 - 3/6/2005 - $17.93 The decedent maintained Investment Account (INV #79266862). For further information, you may call the Brokerage Department at 1-800-762-6111. Please DOte that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please callI ~888-PNC-BANK (1-888-762-2265) or stop by your loeaJ PNC Bank branch office. Sincerely, ~uJjJJJJ- Rachelle Wells I-800-762~1775 P7-PFSC-04-F 500 first Ave. Pittsburgh P A 15219 Member FDIC TOTAL P.01 . . STUART A. SPENCER 337 EVERGREEN STREET NEW CUMBERLAND, PA 17070 May 2, 2005 Matthew 1. Spencer 213 N. Arch Street Apt. A Mechanicsburg, PA 17055 RE: Bill of Sale I, Stuart A. Spencer, Executor for the Estate of Selva A. Spencer have sold a vehicle owned by the late Selva A. Spencer to his grandson Matthew 1. Spencer for the sum of $7000.00. The vehicle being a 2000 Dodge Grand Caravan with a Vin: 1B4GP54IAYB711788. Payment in full has been received in the form of a personal check with a number of 112 and written on a Member's 1st Federal Credit Union account. ~~_.~ S"-~_~~~ C-- Y-os- Matthew 1. Spencer Date Stuart A. Spencer Date , . Rev-1510 EX+ (6-98) *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Spencer, Selva A. FILE NUMBER 21-05-0253 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. ITEM ut:~L;I<IPTIUN uF PRuPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 Allstate Life Insurance Company - Glenbrook 131.959.80 131.959.80 Life Annuity Contract GA0594215 TOTAL (Also enter on Line 7, Recapitulation) 131.959.80 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleG (Rev. 6-98) < . A.f'R-28-2005 07: 48 ~."'I-"L"V'" #' PNC INVESTMENTS 717 730 2241 ,-v. J I.. j P.002 \1 I -.......) "-' ~ Allstate. 'Ibm m liood hands. Life tmtl .AJmtA6' 0lIbtts P.O. Box 94212 Palatine,1L 60094-4212 Aprl14! 2005 GfDa Albright PNC rn"est'.u)eDts Vla Fa: (717) 730-2241 Re: Administrator for: eo.tract No~ Cla.immt(s): SclVi!. Spencer Allstate Life Insurance Company GA0594ZlS Stephc:n Spe:ocer. Stuart A. Spencer. Matthew Spc:ncer, and ElizabethAbe.l wi VuginiA G. ROSttette.r, payableto Se.h,a A S~s 0>- TIUStees under Mr Last Will and TestamerU dated May 19, 2004. De-m- Ms. Albright: We have been re<rJC'Sted to complete Intcmal Revenue Service (IRS) FOIm 112 with regard to the refetenoec:i oont:ract. The p\UpOSl; ofFonn 712 is to provide an estate or donor with the V31u.e of a life i:Dsunnce contract or with its proceeds as of certain date (usually the owner's date of dee.tb. or date oftraDsfer of the c:ontract). The (:Ont:l:'a.et referenced W3S an am:nUty contract, which is not reportable on IRS foPn 712- The following information is provided regarding the ~ue of'the amluUy and. othet data as of the date specified: Date ofDeatb.: 3/612005 .Axln\1ity Value. as of Date ofDcath.: S 131,959.80 Cost Basis: $ 100,000.00 Named Beneficiaries: Stepb.el1 Spencer, Stuan A. Spenca, Matthew SpCDCet', and Elizabeth Abel and Virginia G. Hosttetter, payable to Selva A. Sp~'s Co- Trugtees under her Last Will and TestameIltdated May 19, 2004. If you have any que.sti.ons, or need futtber assistance, please contact the Customer Care Unit at 1-877-499- 6418. Sincerely, ~- ~ AddI'w: 544 Lalcev:iew Parkway, VemonHills, n., 60061 Toll Free Fax: 1-866-635-4523 TOTAL P.002 REV.1151 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Spencer, Selva A. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. Stuart A. Spencer Social Security Number(s) I EIN Number of Personal Representative(s): Street Address 337 Evergreen Street City New Cumberland State Year(s) Commission paid PA Zip 17070 Attorney's Fees See continuation schedule(s) attached 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 2. Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs TOTAL (Also enter on line 9, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. FILE NUMBER 21-05-0253 AMOUNT 8,421.35 5,000.00 5,000.00 330.00 175.73 18,927.08 Form PA-1500 ScheduleH (Rev. 6-98) . . Rev-1502 EX+ (6-98) . SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Spencer, Selva A. FILE NUMBER 21-05-0253 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Dusckas Martin Funeral Home, Inc. 8.421.35 Subtotal 8.421.35 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleH-A (Rev. 6-98) Rev-1502 EX+ (6-9B} '. SCHEDULE H-81 PERSONAL REPRESENTATIVE'S COMMISSIONS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Spencer, Selva A. FILE NUMBER 21-05-0253 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Executor's Commission 5.000.00 Subtotal 5.000.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B1 (Rev. 6-98) , . Rev-1502 EX+ (6-98) *' SCHEDULE H-B2 ATTORNEY'S FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Spencer, Selva A. FILE NUMBER 21-05-0253 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Michael L. Bangs - Attorney Fee 5.000.00 Subtotal 5.000.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B2 (Rev. 6-98) . . Rev-1502 EX+ (6-98) *' SCHEDULE H-B4 PROBATE FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Spencer, Selva A. FILE NUMBER 21-05-0253 ITEM NUMBER DESCRIPTION AMOUNT 1 Probate - Register of Wills 330.00 Subtotal 330.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B4 (Rev. 6-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Spencer, Selva A. FILE NUMBER 21-05-0253 ITEM NUMBER DESCRIPTION AMOUNT 1 Advertise - Cumberland Law Journal 75.00 2 Advertise - The Sentinel 100.73 Subtotal 175.73 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) . . Rev-1512 EX+ (6-98) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Spencer, Selva A. FILE NUMBER 21-05-0253 ESTATE OF Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 AAA Financial Services - Credit Card Balance VALUE AT DATE OF DEATH 190.00 2 Bonnie Miller, Treasurer - 2005 Personal Tax 9.80 3 Internal Revenue Service - 2004 Income Tax Due 1.071.00 4 International Paper Pension Services - Refund of April pension payment 301.97 5 PA Department of Revenue - 2004 Income Tax Due 12.00 6 Pinnacle Health Hospitals 547.75 7 PP&L Electric Utilities 31.11 8 Verizon - Phone Service 3/10/05 to 4/9/05 36.69 9 Verizon - Final Bill 6.21 10 We is Markets, Inc. - Prescription account balance 92.12 11 Weis Markets - Prescription Cost 15.41 TOTAL (Also enter on Line 10, Recapitulation) 2,314.06 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) ESTATE OF NUMBER I. *' SCHEDULE .J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 1 Spencer, Selva A. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Elizabeth Rebekah Abel 22 East Street #7 Mount Holly Springs, PA 17065 FILE NUMBER 21-05-0253 RELATIONSHIP TO DECEDENT Do Not List Trusteelsl SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) Great-granddaug Twelve and hter one-half Percent 2 Virginia Grace Hostetter 22 East Street #6 Mount Holly Springs, PA 17065 Matthew I. Spencer 213 North Arch Street Apt. A M..,.h.:llni,.chllrn P4 17n~~ Stephen A. Spencer 270 Stone Gate Court Naples, FL 34119 Stuart A. Spencer 337 Evergreen Street New Cumberland, PA 17070 Great-granddaug Twelve and hter one-half Percent 3 Grandson Twenty-five Percent 4 Grandson Twenty-five percent 5 Grandson Twenty-five Percent Total 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 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleJ (Rev. 6-98) ,. . ~ ~ ~ ~ l'{j \ ~ .. ~ ~ 6)fG !/ (?/~ !:tI r?J;~ I, SELVA A. SPENCER, of 820 Lisburn Road, Apartment 811, Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, be paid from my residuary estate. All death taxes and assessments imposed by any governmental body as a result of my death, on property forming my gross estate, whether or not it passes under this Will or otherwise, shall be paid on a pro-rata basis from the assets that make up my gross estate. ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, equipment and ornament, together with all insurance thereon and relating thereto, in accordance with the following: A. Twenty-five (25%) Percent to my grandson STEPHEN A. SPENCER provided he survives my death by thirty (30) days or in the event that he predeceases me or fails to survive my death by thirty (30) days, to his issue per stirpes; B. Twenty-five (25%) Percent to my grandson STUART A. SPENCER provided he survives my death by thirty (30) days or in the event that he .. . ~ ~ ~ ~ ~ \ ~ -l ~ ~ ~ '~ predeceases me or fails to survive my death by thirty (30) days, to his issue per stirpes; C. Twenty-five (25%) Percent to my great-grandchildren ELIZABETH ABEL and VIRGINIA G. HOSTETTER in equal shares or to the survivor of them, provided they sUJVive my death by thirty (30) days; and D. Twenty-five (25%) Percent to my grandson MATTHEW I. SPENCER provided he survives my death by thirty (30) days or in the event that he predeceases me or fails to survive my death by thirty (30) days, then his share shall go one-third to Stephen A. Spencer or his survivors as set forth in subparagraph A above; one-third to Stuart A. Spencer or his survivors as set forth in subparagraph B above; and one-third to be shared equally between Elizabeth Abel and Virginia G. Hostetter. ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate in accordance with the following: A. Twenty-five (25%) Percent to my grandson STEPHEN A. SPENCER provided he survives my death by thirty (30) days or in the event that he predeceases me or fails to survive my death by thirty (30) days, to his issue per stirpes; B. Twenty-five (25%) Percent to my grandson STUART A. SPENCER provided he survives my death by thirty (30) days or in the event that he predeceases me or fails to survive my death by thirty (30) days, to his issue per stirpes; 2 . . C. Twenty-five (25%) Percent to my great-grandchildren ELIZABETH ABEL and VIRGINIA G. HOSTETTER in equal shares or to the survivor of them, provided they survive my death by thirty (30) days; and D. Twenty-five (25%) Percent to my grandson MATTHEW 1. SPENCER provided he survives I1?Y death by thirty (30) days or in the event that he predeceases me or fails to survive my death by thirty (30) days, then his share shall go one-third to Stephen A. Spencer or his survivors as set forth in subparagraph A above; one-third to Stuart A. Spencer or his survivors as set forth in subparagraph B above; and one-third to be shared equally between Elizabeth Abel and Virginia G. Hostetter. ITEM IV. Should any of my issue entitled to a share of my estate not have attained the age of twenty-five (25) years at the time for distribution to him or her, I devise and bequeath the share of such issue to my hereinafter named trustee, IN SEP ARA TE TRUSTS, to hold, manage, invest, and re-invest, the shares so received, and the accumulation of income thereon, and to use and apply from time to time such portion of income and principal thereof as my trustee thinks proper for the comfortable support, maintenance, health, welfare, and education of the issue or to make payment for such purposes, without further responsibility, directly to such issue, or directly to any person taking care of such issue. Any principal or income not so applied shall be distributed to such issue when he or she attains the age of twenty-five (25) years, or ifhe or she dies prior thereto, to his or her personal representative. 3 '~ ~ "'" ~ ~ ~ ~ . . ITEM V. I appoint my grandsons STUART A. SPENCER and STEPHEN A. SPENCER Co-Trustees of the trust or trusts created by this my last will. In addition to the other powers and authorities granted to my trustee by Pennsylvania Law and by the preceding paragraph of this my last will, I hereby give my trustee the following special powers and authorities: A. To retain any or all of the assets of my estate, real or personal (including any stock or securities of any corporate fiduciaries), without any regard to any principle of diversification, risk, or productivity; B. To invest and re-invest in all forms of property without restriction to investments authorized for Pennsylvania Fiduciaries, as my trustee deems proper, without regard to any principle of diversification, risk or productivity; C. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my trustee deems proper and in the best interest of the beneficiary or beneficiaries of said trusts; D. To allocate receipts and expenses to principal or income or partly to each as my trustee from time to time deems proper in its sole discretion; E. To compromise any claim or controversy; F. To exercise any option, right, or privilege granted in insurance policies or in any other investments; 4 ~ ~ ~ ~ ~ lr) ~ t \ ~ '\ . .. G. My trustee may accumulate the income from this trust during the term thereof but may, from time to time, distribute from current income or from accumulated income or from principal such amounts as my trustee, in its sole discretion, deems advisable for the education, welfare, and comfort of the trust beneficiary. ITEM VI. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM VII. I appoint my grandson STUART A. SPENCER executor of this my last will. Should my grandson Stuart A. Spencer predecease me or otherwise fail to qualify or cease to serve as executor of this my last will, I appoint my grandson STEPHEN A. SPENCER executor of this my last will. ITEM VIII. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; 5 '. M to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM IX. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this /f' day of ?n u:; . ,2004. ~~ II", ?-t<1 SELVA A. SPENCER 6 ..... ..., The preceding instrument, consisting of this and SIX other typewritten pages, each identified by the signature of the testator was on the date thereof signed, published, and declared by SELVA A. SPENCER, the testator therein named, as and for his last will, in the presence of us, who at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. 7 . "..... ... COMMONWEAL TH OF PENNSYLVANIA ) ( SS: ) COUNTY OF CUMBERLAND The undersigned, being the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes tllerein expressed. k ,4f. . ,~GL-~ SELVA A. SPENCER 0 NOTARW. SEAl S. CtESBRO. Nobly Nic lower AIen lWp.. Cumbel1Ind Coooty My Cornnaaton ExpIreI May 10. 2007 COMMONWEAL TH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) WE,-1!1,(Ll L~;.rv~ and S7~~Lr A S/E..-7C~ ,the witnesses whose names are signed to ~ attached or foregomg mstrument, bemg duly qualified accordmg to law, do depose and say that we were present and saw the testator sign and execute the instrument as his last will; that he signed it willingly and that he 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 that time 18 or more years of ~ of sound mind, and under no constraint or undue influence. Wl ') nd acknowledged day of ,2004. NOtIlRW.. SEAl wec>'Y S. CtE88RO':1 NJIc U- Men Twp., CUIrAl. Cw'lty lIrIIt ~ ExptM MIy 10, 'JJ.'1J7 8 NF\PD cv- .~ ~ '~..... BANGS LAW OFFICE 429 SOUTH 18TH STREET CAMP HILL, P A 17011 E-mail: mikebangs@verizon.net PHONE: 717.730-7310 FAJ{: 717-730-7374 MICHAEL L. BANGS, Attorney-at-Law WENDY S. CHESBRO, Paralegal WILLIAM E. MILLER, JR. Of Counsel November 14, 2005 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 RE: Estate of Selva Spencer File No. 21-05-0253 Dear Mrs. Strasbaugh: Enclosed for filing as a part of the above-referenced estate you will find the following: 1. The original and one copy of the Pennsylvania inheritance tax return; 2. A check in the amount of $9,727.01 to pay the tax shown to be due; 3. An original Inventory; and 4. A check in the amount of$30.00 to pay the filing fee for these documents. Kindly file there return accordingly and send me a receipt in the enclosed, stamped, pre-addressed envelope. If you have any questions or require anything further, please contact me directly. \ Very truly yours, v~~~ .) .., I.,.; i wsc Enclosures cc: Mr. Stuart A. Spencer c.~....') U' Register of Wills, Cumberland County, Pennsylvania INVENTORY Estate of Selva A. Spencer No. 21-05-0253 , Deceased Date of Death 03/06/2005 -.-.---.-----.- Social Security No. 176-14-2578 also known as Stuart A. Spencer Th-ePersonal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. l!We verify that the statements made in this Inventory are true and correct. I!We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. 1.0. No.: Michael L. Bangs 41263 Signatur . Attorney: Signature: Signature: Firm: Address: 429 South 18th Street ~amp Hill, PA 17011 Telephone: 717-730-7310 Address: 337 Evergreen Street New Cumberland, PA 17070 Telephone: 717 -774-1717 Dated: lI-/~-o) Personal Property Cas h................................................... ..... ....................................... Personal Prope rty.................... ..................................................... Stocks/Listed................... ........................................... ................... Stoc ks/Closely Held ......................... .......................... ................ ... Bon ds............ ....................................... .......................................... Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... All Othe r Property.............................................. ........................... i~. ) .. , 20,939.38 7,000.00 .1 77 ,497,.82 j , ~- -I (~) (j' Total Personal Property......................................... 105,437.20 Total Real Property................................................ 105,437.201 Total Personal and Real Property......................... Total Out-of-State Real Property.......................... Register of Wills, Cumberland County, Pennsylvania INVENTORY , Deceased No. 21-05-0253 Date of Death 03/06/2005 Social Security No. 176-14-2578 Estate of Selva A. Spencer also known as Cash Interstate Realty Management Co. - Refund of Security Deposit for apartment 151.00 PNC Bank, N.A. - Checking Account #62894284944 10,237.31 PNC Bank, N.A. - Savings Account 6928663079 8.957.10 Refund - Final Refund of Security Deposit 485.00 Refund - Refund from Verizon 30.48 Refund - Refund from Comcast Cable Communications 29.23 Refund - Refund of unearned insurance premium from Highmark Blue Shield 747.29 State Street Retiree Services - April 2005 Pension Benefit 301.97 Total Cash 20,939.38 Personal Property Automobile - 2000 Dodge Caravan 7,000.00 Total Personal Property 7,000.00 Bond Series E Savings Bonds - 31 Series E Savings Bonds 13.099.82 Series EE Savings Bonds - 24 Series EE Savings Bonds 14.898.00 Series HH Savings Bonds - 99 Series HH Savings Bonds 49.500.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate 105.437.20 '. Estate of also known as Register of Wills, Cumberland County, Pennsylvania INVENTORY :;elva A. Spencer No. Date of Death Social Security No. , Deceased Total Bond 2 21-05-0253 03/06/2005 176-14-2578 77 .497 .82 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BANGS MICHAEL L 429 S 18TH STREET CAMP HILL, PA 17011 -------- fold ESTATE INFORMATION: SSN: 176-14-2578 FILE NUMBER: 2105-0253 DECEDENT NAME: SPENCER SELVA A DATE OF PAYMENT: 11/16/2005 POSTMARK DATE: 11/14/2005 COUNTY: CUMBERLAND DATE OF DEATH: 03/06/2005 NO. CD 006004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $9,727.01 I I I I I I I I TOTAL AMOUNT PAID: $9,727.01 REMARKS: CHECK#106 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS - : or c: -. I~) J '. 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