HomeMy WebLinkAbout11-28-05
RF.V.l5(\<l EX: (f':-On
REV-1500
FILE NUMBER
;;AL-l1 5
COUNTY CODE YEAR
QS-LK_
NUMBER
SOCIAL SECURITY NUMBER
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7::<5<0
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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o 3. Remainder Return (dale 01 dealo pilor Ie 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11 Election to tax under Sec. 9113(A) (Atlach Sch 0)
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NAME t'rl \ L . H Q 105 e COMPLETE MAILING ADDRESS
10$.$ '":J lor Fr" Il'.lflc.."k ~T,
FIRM NAME (1IAppIiCilble) <...) 0 u' vOl '-'
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TELEPHONE NUMBER"--,
,I, '" 195- 7),30
1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
:<10000.
I ::l;} .3 53"
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
i-i Q I S G V i 0 lei YY)
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
05-J.9~~oo 05~ 13~1'1)'5
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Allach cooy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of dealh after 12-12-82)
o 7. Decedent Maintained a living Trust (Allach CODY 01 TrU51)
- 0 10. Spousal Poverty Credit (dale 01 dealh between 12-31-91 and 1.1-951
(1)
(2)
(3)
(4)
(5)
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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)
o Separate Billing Requested
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(7)
1~~14(',
(8)
5C~ 15l.\.
E~ ~5 5~
(6)
8 Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
14.;l.13.
Ig.s~t
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 tax has not been
made (Schedule J)
14 Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
18 Amount of line 14 taxable at collateral rate
x .0_ (15)
x .0 45 (16)
x .12 (17)
... ...". "........ .~...._." x .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
lf74Sg9.
17 Amount of Line 14 taxable at sibling rate
19. Tax Due
(11) :<~ Ilo5.
(12) LJ8Y5C69.
(13) 10000.
(14) y,Y5<69.
~1357.
;tJ3.5 7.
20.D~iJ=j,.~.~~~
.....;... ......;;..3,;<~):'~.st;~'~~.~gf-~'t!i~g,'ffi~(~~~g~'.~glf9!i.'.~~~!~~:a~i1i!~I~~ltrgj)~J;~~~~~ji::)j~~~,fjE~~lilf;itA.I.I;I..:~.~l'..\.','i+""
Decedent's Complete Address:
STREET ADDRESS t
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$T reo"t
CITY
C-QM
Hitl
STATE (J fJ
ZIP J 7 0 J
Tax Payments and Credits:
1 Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C Discount
~1351,
Total Credits ( A + B + C ) (2)
-o~
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresllPenalty ( 0 + E )
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A Enter the interest on the tax due.
B Enter the total of Line 5 + 5A This is the BALANCE DUE.
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;.......................................................................................... 0 ~
b. retain the right to designate who shall use the property transferred or its income;.. ........................................ 0 Jg}
c. retain a reversionary interest; or......... ................................................. .......................... ........... 0 EI
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~
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 gj
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 pen allies of perJury. I declare thai 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 inform3\ion of which preparer has any knowledge.
~ DATE II/Z8/rs S
....mm......~~?~.m........ mm.....m.....
/~e #9/;AI~-r $-1.
mm.....m._CL'J_~/e..&/l,eA.../7'O.II.
DATE
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ST.
N(:.1AJ
t-1.I1'-11o (~I QH) I A
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 PS S9116 (a) (11) (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. S9116 (a) (1.1) (ii)J.
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 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. s9116(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. 39116(1.2) [72 P.S. s9116(a)(1)l.
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. 39116(a)(1.3)J. 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
~I 0 1 S G'J I
Violet
YtI.
FILE NUMBER
;( ) ~ 0.5 - OS I ~
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
DESCRIPTION
VALUE AT DATE
OF DEATH
H OlJ ~(5
J93'2>
L 0 ut(r,.J
Wc.l1\vt
o.r
STrelY T)
c.. Ot,p Hill
fill
/lo/J
~JO)OOO.
TOTAL (Also enter on line 1. Recapitulation) $ ;( 10 000_
(If more space is needed. insert additional sheets of the. same size)
REV-1503'EX+ (6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
)~ c.15 01 I
VioleT
tv\
FILE NUMBER
;< J - 0.5 .- oS I c&
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
PN~ :rJlv~SiM.er.jt..s fkc-OviJ't Nvi\jkC7~ 43~/S&S 1
'P 0 boY-. 3 ;(,/\.,O I LOlAjJvi lie kY L./O;lJ;2,
VALUE AT DATE
OF DEATH
I ""). ~J 353.
TOTAL (Also enter on line 2, Recapitulation) $ I ~ ~ I 353.
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98')
SCHEDULE E
CASH, BANK DEPOSITS, & MISe.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF I
It Q Is ey
VIolet t11
FILE NUMBER
;< J ~ D5 ... OS I </
Include the'p~oceeds 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
In
DESCRIPTION
me-a T Bq~K. '- CkG-(/ki~- Ac<,t* IO{,()~~Cil
VALUE AT DATE
OF DEATH
313<6.
~.
1993 c..'v.GVrtd61 Lbr6;C,
V:tAl it /G-JLT,53T [NY Jl.Jq;UO
}";), 0 O.
3.
H OlAc5C1 holt,! :Iie II1J I FlArAJitvre - Se0 AtTt:vl.c-J.
/.53).
Ii. Retl4JJ ~t f\1 td i u-I E~pewJW o VC1l "y Jc1c.,..d-J ) ~~.
5. R (jfL+..J 0+ Pre Pc.iJ Tn, - CevtrJ ffrlltj I1IlIl J ) J.
~. P tV t. Bo~k-. C'.J~6'uk,)JJ Au;t#- 5IYOO~('OO.:2 YoISl.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
.s~~55.
REV-151O'EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
{-I a l s e '[
M
FILE NUMBER
~1'" 05- 05/<6
VIolet
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISe. NON-PROBATE PROPERTY
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 INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DE CD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COpy Of THE OEED fOR REAL ESTATE. VALUE OF ASSET INTEREST (If APPLICABLE) VALUE
1. :rR1t~ fulToN 16(f~1\ IS g81. "
100'0 ,<&9/di,
ro4t o~III~/~5~
().J 1 '''/Er41~1Jt' P/~w q35J.~. 1001.; 435.<9.
~, 4 0\ ~ /( - Ou Po~t Sf-vi WJS
if'vJteG' ~ Y'11Gff/lI LYAl01,
TOTAL (Also enter on line 7 Recapitulation) $ I ~ ~ 14 (0,
(If more space is needed, insert additional sheets of the same size)
REV-1511 'EX+ (12-99) \~
. $*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
fY'}
ITEM
NUMBER
H 0 I s 0~ i
FILE NUMBER
;< ) - OE - OS J <6
VIoleT
Debts of decedent must be reported on Schedule I
DESCRIPTION
AMOUNT
A.
FUNERAL EXPENSES:
fY\yer~ - Hc.fJJBY
I c,O 3 fl1c..rJ,c;t
/74 o.
FUI16Y't:/ H0Jt16
ST.; CC,"f Ii j II
:rilL,
p~
B. ADMINISTRATIVE COSTS:
~,
q,
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _Zip
Year(s) Commission Paid:
2.
Attorney Fees Ro b<2; r; t'tI y (::;r.5 / L. P.. f:,'f.. B i c..J{) ay
951,
3.
Family Exemption: (If decedent's address is nol the same as claimant's. attach explanation)
Claimant rV\ a r k f H 0.1.$ (;;y
Street Address ~ q 3 <t, W 01", (.It ST.
City CQ"", H d I State ~ZiP 170 II
Relationship of Claimant to Decedent .s 0 IJ
Probate Fees ~u>-rb~lvIl4 COl.l4'l Ae8iJt(;jY of wi JJJ
51<6.
.3 500.
4.
5. Accountant's Fees
6.
Tax Return Preparer's Fees.... A ""0 1. T 4 ~ S Crill c.c 'Inc..-.
105.
t d.. I <0.
fOg,
IS.
7.
RO\\i09 GreE:V c..eMetery ~,," CC,ro.,f Hitl f'A.
E stc.te Noti Ce Lettc:;rs Test 4hto.i1tjry ~ /he SentiJJe 1
CUl'1b6YltJld GovlfiV Lo1.J Vovf}H.l" fs'tt:1o NotiU:
TOTAL (Also enter on line 9, Recapitulation) $ I L.l ;]. 1 3.
(If more space IS needed, Insert additional sheets of the same size)
RE\f.1512 EX7 (6-98) ,
ESTATE OF
ITEM
NUMBER
::<,
SCHEDULE I
DEBTS OF DECEDENT
MORTGAGE LIABILITIES, &' LIENS
violet Yl1
FilE NUMBER
~)-'OS--OSlg
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
H cIs 6y
Include unreimbursed medical expenses.
DESCRIPTION
rn~cJi(t.1 f 1-fCJ../..H:J - f.J ONe J1l6te~J SC:;Mior Cvru
f'r\ <:::d (,.0 Prc:s UJftIOJ<J SC--rvl CG
Pi nnc.uJ& HGt.}r~ HoJl'i't-e.l
GC:;M9 (1 Skc.h j}.}Jc,.v I ""fJ
Q U Gllltt..~ I/'1 '[} j JvJ
VALUE AT DATE
OF DEATH
'10)..
100.
3~LJ.
5i.l~
J 3.
HOlAJ6 uti )ititS - Elc:,e,lriC-} Gc.sl w'tc-r [i".
141.
3" A frrc.isG-J F(;:0'"' p"(:;(..J G.d4v- L, G. eo~~or
300.
11.
.5.
Co,
/,
Afprc.isc-I - PC:TJUJI"I Pi'Oltily'" C ]at.-Jrr c.lcJo}fc.c.J Atf $ oc...
3.50.
R c:;d f.>T4tO I&.'f.(;j - Jc~ct L. }t.,jJ/er - T"1- t.J;JICkf(Jr
J4J5w
Re. iMhvrJ(,J ;0 Pinll c.d Ct I-l ee.JT~ PC:;JJJi()A.J fl"
ovcrp~Yt>t(j..;f at f&1)J/"UJ - Il\dllaG-J ju C,;~Ge,kiJllj
A u...o"",t 8(,./ c.vc{j.
;20;<0.
fNt. IYlv65tM6wt F6&
100..
'61
.s {Cot 6 r" r M J: Y16 yrliv CO
Ho~eoI.JAI(;'rJ Pol/GY 11 3S...11g-I,Og(,.g
59~.
TOTAL (Also enter on line 10, Recapitulation) $ 7 '15 ~
(If more space is needed, insert additional sheets of the same size) ,
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITIl-NCE TIl-X RETURN
RESIDENT DECEDENT
ESTATE OF
I-IQ 15&1
Vi 0 (e t
fYJ
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TI'.XABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
h)lliSJ ttr., HaI6C''''
31 <t ~ j fr<;-de-r ;c,k bT.) ""ev~~NjvJb~J 'P J}
o C,bS ~ 7(7"
-;).
Mqrl~
/93<6
E, HCtl~(ty
wc.ll'\vt .st J C-c.nf Hill
pYf
SOAJ
FILE NUMBER
cJ 1 - 05 - 051 ~
AMOUNT OR SHARE
OF ESTATE
E 0 ~l)
50fo
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 B. AS APPROPRIATE. ON REV-1500 COVER SHEET
lJ NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TrjpJity Eva,,~(;;IIGC41 LlJt~0r(;1ll c..~lirv~
CON' WilL fA IlolJ
IO} 000;
(If more space is needed. insert additional sheets of the same size)
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS - APPRAISERS - RELOCATORS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET - CAMP HILL, PA 17011-3842
(717) 737-0734 - E-mail: k3wc@arrl.net
September 20, 2005
Estate of Violet Halsey
1938 Walnut Street
Camp Hill, PA 17011
INVOICE
Fair Market Value appraisal and documentation of personal property.
$ 350.00
IFile No. 05-1461
Rle No. 05-146
INVOICE
FILE #
DATE
TAXID#
05-146
September 14, 2005
EIN 23-3029080
. G. Connor Real Estate
ppraisers, Ltd.
159 Market Street
Camp Hill;-PA17011---
17f737-DS74 FAX: 717f737-3906
TO:
Mark Halsey, EXR
1938 Walnut Street
___C?~!l1:p_;HJ~l,_~A IZQl1
FOR PROFESSIONAL APPRAiSAL SERVICES RENDERED
Phone: 737-4643
ESCRIPTION
AMOUNT
PPRAISAL of Property Located at:
1938 Walnut Street
Borough of Camp Hill, Cumberland County,
Camp Hill, PA 17011
$ 300.00
RE: ESTATE OF VIOLET M. HALSEY
PAID 9-14-05 Check #1013
- ( 300.00)
1J[./I.:N1C ryoV poC]( ryOVC]( (]3VSI'JIfESS!
SUBTOTAL
RATE 2 % ADJUSTMENT
SUBTOTAL
RATE 2 % ADJUSTMENT
SUBTOTAL
RATE 2 % ADJUSTMENT
SUBTOTAL
$0
TOTAL
$0
NOTICE: A 2% service charge per month will be applied to all accounts more than 30 days past due,
and reasonable attome fees if collection fees. are un aid.
State Farm Fire and Casualty ()ompany
One State Farm Dr.
Concordville, PA 19339-0001
RENEWAL CERTIFICATE
POLICY NUMBER 38-48-6086-8
Homeowners Policy
SEP 22 2005 to SEP 22 2006
HAlf '''U'l
IS> .
@@
STATE FARM INSURANCE COMPANIES
P-13- 2985-F381 F H
DATE DUE
SEP 22 2005
PLEASE PAY TH
HALSEY, ValLET THE ESTATE OF
EXECUTORS: M'LISS HALSEY
& MARK HALSEY
1938 WALNUT ST
CAMP HILL PA 17011-3853
1,1111111.111,11,111111.111111.1..1111.1...11...11 .1..1.111111
Coverages and limits
Section I
A Dwelling
Dwelling Extension
B Personal Property
C Loss of Use
Up To
$282,300
29,200
155,265
Actual Loss
Sustained
Deductibles - Section I
All Losses
1,000
Location: Same as Mailing Address
Loss Settlement Provisions (See Policy)
A 1 Replacement Cost - Similar Construction
82 Depreciated Loss Settlement - Coverage 8
Section II
L Personal Liability
Damage to Property of Others
M Medical Payments to Others
(Each Person)
$300,000
500
5,000
Forms, Options, and Endorsements
Homeowners Policy
Ordinance/Law 10%/ $28,230
Increase Dwlg up to $56,460
Amendatory Endorsement
Special Limits Endorsement
Policy Endorsement
Fungus (Including Mold) Excl
Motor Vehicle Endorsement
FP-7955
OPT OL
OPT 10
FE-7269
FE-5258
FE-5320
FE-5398
* FE-5452
Annual Premium
Amount Due
$598.00
$598.00
* Effective: SEP 22 2005
Premium Reductions
Your premium has already been reduced
by the following:
Claim Free Discount
110.00
Inflation Coverage Index: 196.0
NOTICE: Information concerning changes in your policy language is included. Please call your agent if
you have any questions.
7G J ... 72.77
.J 17 C )'fl e
;;j,9.J t (I) i1-1 M
$""8/. -fl
{1J-X,
/~oz 5ell^1I c Ie Rei
c t'J ~ J' J-J J j f P f) I 70 } J
Tk,&~/kt;~aS~p-<. 2ktp~(Kq< kjtutK~en.
Agent ~OB BAitER JR
Telephone (717) 761-1263 or (717) 761-1375 Prepared AUG 02 2005
tf--z 50 3434 1442
See reverse side for important information.
Please keep this part for your record.
ACCOUNt NO.
JUN.28-JUL.27,2005
1 OF 1
(!;11Vl&l" liank.
00
o 06123H NH 017
17776
WALTER L HALSEY
OR VIOLET M HALSEY
1938 WALNUT ST
CAMP HILL PA 17011-3853
WEST SHORE PLAZA
3,137.54
ACTIVITY
. DEPOSITS:, INTEREST CHECKS & OTHER
.. & OTHER ADDITIONS .. . SUBTRACTIONS
06-28-05 BEGINNING BALANCE
06-29-05 CLOSEOUT
3,137.54
$3,137.54
0.00
ENDING BALANCE
$0.00
LOOSA (1/03)
Fulton Bank
LISTENING.
VIOLET M HALSEY
1938 WALNUT ST
CAMP HILL PA 17011-3853
INDIVIDUAL RETIREMENT ACCOUNT
STATEMENT PERIOD
FROM THROUGH
1-01-05 6-30-05
PAGE
1 OF
2
RETIREMENT ID NUMBER
0211127256
SOCIAL SECURITY NO 211-12-7256
EARLY DISBURSEMENT 11-13-84 REQUIRED DISBURSEMENT 11-13-95
DATE TRANSACTION/DESCRIPTION DEPOSIT/CREDIT WITHDRAWAL/DEBIT BALANCE
ACCOUNT 000002201902323 TYPE- VAR C OF DEP RATE 6.750 MATURITY 04-12-07
13,750.38
14,218.38
MATURITY 05-04-07
13,371.36
13,811.39
MATURITY 08-01-05
1,181.17
1,218.05
MATURITY 04-14-12
6,000.14
6,187.46
RATE 3.830 MATURITY 07-26-14
PRIOR BALANCE
06-30-05 INTEREST 468.00
ACCOUNT 000002201902399 TYPE- VAR C OF DEP RATE 6.530
PRIOR BALANCE
06-30-05 INTEREST 440.03
ACCOUNT 000002251905652 TYPE- VAR C OF DEP RATE 6.200
PRIOR BALANCE
06-30-05 INTEREST 36.88
ACCOUNT 000002251907205 TYPE- VAR C OF DEP RATE 6.200
PRIOR BALANCE
06-30-05 INTEREST 187.32
ACCOUNT 000003901958459 TYPE- VAR C OF DEP
PRIOR BALANCE
01-07-05 PAYOUT DISTRIBUTION
02-07-05 PAYOUT DISTRIBUTION
03-07-05 PAYOUT DISTRIBUTION
04-07-05 PAYOUT DISTRIBUTION
05-07-05 PAYOUT DISTRIBUTION
06-07-05 PAYOUT DISTRIBUTION
06-30-05 INTEREST
400.00
400.00
400.00
400.00
400.00
400.00
45,014.09
44,614.09
44,214.09
43,814.09
43,414.09
43,014.09
42,614.09
43,452.10
PRIOR CASH BAL
PLUS CREDITS
PLUS INTEREST
LESS DEBITS
79,317.14
.00
1,970.24
2,400.00
838.01
DISBURSEMENTS 2,400.00
FED TAX WITHHELD .00
8T TAX WITHHELD .00
CONTRIBUTIONS SINCE 01-01-05
Member ED.I.e.
fultonbank.com
.LV':> 1 VVL.L.
.LV':> I':>
Fulton Bank
LISTENING.
STATEMENT PERIOD
FROM THROUGH
1-01-05 6-30-05
PAGE
2 OF
2
VIOLET M HALSEY
1938 WALNUT ST
CAMP HILL PA 17011-3853
RETIREMENT ID NUMBER
0211127256
INDIVIDUAL RETIREMENT ACCOUNT
SOCIAL SECURITY NO 211-12-7256
EARLY DISBURSEMENT 11-13-84 REQUIRED DISBURSEMENT 11-13-95
NEW CASH BAL 78,887.38 FOR 2004
FOR 2005
TOTAL PLAN VALUE 78,887.38 ROLLOVERS
BENEFICIARY DESIGNATION AS OF 02-20-96
M'LISS THOMAS
BANK FIN NUMBER 23-1928421
.00
.00
.00
Member ED.I.e.
fultonbank.com
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CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET. CAMP HILL, PA 17011
717-737-0734
Halsey appraisal
Page 8 of 8
GARAGE
Shelving
Snow blower
Lawn mower
Metal cabinet
Shop vac
Craftsman toolbox
1993 Chevrolet Corsica LT 4-door, V-6, Burgundy, 60,000 miles,
automatic, power steering, power ABS brakes, good condition
Misc. contents of garage
10.00
75.00
20.00
1.00
5.00
40.00
1,200.00
25.00
APPRAISAL TOTAL $ 8,731.00
This Fair Market Value appraisal is true and correct to the best of my ability as an
auctioneer and appraiser with 35 years experience.
Member: Certified Appraisers Guild of America
CLAUDE C. WOLFE & ASSOCIATES
;,"""-.'., . ,r)
\,J y.. - v~ 'tI0 ~ "'^"-
W. K. Dusty Chapman, CAGA
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET · CAMP HILL, PA 17011
717-737-0734
September 12, 2005
Appraisal for the Estate of Violet Halsey
1938 Walnut Street, Camp Hill, PA 17011
LIVING ROOM
Pair of end tables
Sofa
Green recliner
Pair of brass table lamps
Brass floor lamp
5.00
5.00
25.00
5.00
8.00
Magazine rack
Cuckoo clock
Oak server
RCA XL 1 00 console TV
Glass dome clock - W. Germany
2.00
30.00
65.00
20.00
10.00
Stereo system - old Sony & Technics
tvfisc. CD's - approximately 65
tvfisc. cassettes
Stereo entertainment center
Oak rocking chair
40.00
130.00
10.00
2.00
25.00
Telephone
Brown recliner
Hassock
Coffee table
Oval rugs
2.00
15.00
LOO
25.00
2.00
Brass floor lamp - green shade
3 Framed floral motif prints
4 Framed Dutch style prints
1931 Sampler
Misc. pictures
12.00
10.00
10.00
35.00
10.00
Bell collection - 14 pieces
Misc. contents of living room
15.00
25.00
ClAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET. CAMP HILL, PA 17011
717-737-0734
Halsey appraisal
Page 2 of 8
DINING ROOM
Small lighted curio cabinet
Large lighted curio cabinet
Misc. Swarovski crystal pieces - approximately 228
Doll house furniture - 15 pieces
Misc. animal figurines - 11 pieces
9 Santa's from foreign lands
China tea set
7 Dolls
Baby shoes
Misc. contents of curio cabinets
C. Coldren - Scherenschnitte of a tree - "1983"
Giraffe painting
Holmes & Edwards svc/8 silver plated flatware
Misc. stainless steel flatware
Dining room suite
Misc. chairs
Kitchen stool
Dinnerware - svc/6
Misc. contents of china closet
Misc. pictures
Radio Shack TV - old
TV stand
27 Quarters - new state style
Kenmore upright vacuum cleaner
27 Piece B&G bell collection
29 Piece misc. bell collection
Misc. contents of dining room
60.00
75.00
3,500.00
45.00
20.00
10.00
15.00
10.00
25.00
75.00
10.00
15.00
40.00
20.00
150.00
5.00
1.00
8.00
25.00
5.00
5.00
3.00
7.00
10.00
50.00
30.00
50.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET · CAMP Hill, PA 17011
717-737-0734
Halsey appraisal
Page 3 of 8
KITCHEN
Misc. everyday dishes 10.00
Cookware 10.00
Utensils 5.00
Flatware 5.00
Coffee pot 2.00
Toaster 2.00
NC music box 20.00
Telephone 2.00
Sharp Carousel microwave 10.00
Trash can 1.00
Kenmore refrigerator - old 30.00
Electric mixer 3.00
Crock pot 2.00
Canister set 1.00
Cutlery 4.00
Cuisinart Quick-PREP 3.00
Clock 1.00
Misc. reproduction tins 5.00
Misc. Willowware dishes 10.00
Maytag washer/dryer combo 60.00
2 Chairs 1.00
Misc. contents of kitchen 15.00
DEN
3 Painted Oak apothecary cabinets 100.00
10-Drawer cabinet 30'.00
Regency scanner 5.00
4_ drawer file cabinet - old 2.00
Typewriter - old 1.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET. CAMP HILL, PA 17011
717-737-0734
Halsey appraisal
Page 4 of 8
DEN - continued
2-Drawer painted cabinet 75.00
Telephone 6.00
Clock 1.00
Trash can 1.00
School desk 40.00
Upholstered chair 1.00
4-Drawer chest 5.00
Kenmore chest freezer 20.00
Table 5.00
3 Assorted chairs 1.00
Lord's Prayer cross-stitch 10.00
Misc. contents of den 25.00
BATH
Trash can 1.00
Telephone 1.00
SEWING ROOM
Floor lamp 1.00
Hospital bed 1.00
Quilt 20.00
Ironing board 1.00
6-Drawer chest 30.00
Emerson cassette/radio 7.00
Misc. sewing notions 10.00
Electric iron 1.00
Kenmore sewing machine 15.00
Card table 1.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET. CAMP Hill, PA 17011
717-737-0734
Halsey appraisal
Page 5 of 8
SEWING ROOM - continued
Desk chair
Mission style 6-drawer cabinet
Misc. contents of sewing room
FIRST FLOOR BEDROOM
4-Piece Pine bedroom suite
Pair oftable lamps
Misc. gold jewelry & small diamond ring
Trash can
Microwave cart
Bookcase
Telephone
Alarm clock
Quilt
Dressing table stool
Scales
Oak type stand
Recliner - worn
Hamper - worn
Luggage
Sentry 1230 safe
Pictures
Misc. contents of bedroom
SECOND FLOOR LANDING
Thomas Lee - Horse painting
Rug
Misc. contents oflanding
10.00
100.00
20.00
250.00
5.00
95.00
1.00
1.00
7.00
1.00
1.00
20.00
1.00
1.00
1.00
1.00
1.00
1.00
20.00
7.00
20.00
40.00
3..00
2.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET. CAMP HilL, PA 17011
717 -737 -0734
Halsey appraisal
Page 6 of 8
PORCH
Misc. furniture
SECOND FLOOR MASTER BEDROOM
Double bed
4 Quilts
Mirror
Small chair
Child's quilt
Quilted wall hanging
3 Quilts
Eureka upright vacuum cleaner - old
Empire chest
Aluminum ladder
Bookcase
Chest of drawers
Misc. foreign money
9 Silver dollars
Cedar chest
Valet - chair
Misc. contents of bedroom
SECOND FLOOR SPARE BEDROOM
Maple chair
Vanity
Rocking chair
Library table - painted blue
3 -Drawer chest
Wardrobe
8 Quilts
Misc. contents of bedroom
8.00
10.00
80.00
1.00
2.00
5.00
5.00
60.00
3.00
250.00
3.00
1.00
15.00
10.00
63.00
30.00
1.00
15.00
1.00
25.00
2.00
20.00
10.00
2.00
160.00
20.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET . CAMP HilL, PA 17011
717 -737 -0734
Halsey appraisal
Page 7 of 8
SECOND FLOOR SITTING ROOM
Oak 5-drawer file cabinet
2-Drawer file cabinet
IS-Drawer cabinet
5-Drawer chest
Misc. contents of sitting room
MARK'S ROOM
Chair - old
Desk - old
Single bed - old (1930's)
ATTIC
Metal cabinet
Blanket chest - painted "MC 1886"
Luggage
Misc. contents of attic
BASEMENT
1 O-Drawer cabinet
Metal cabinet
Washer - old
Dryer - old
Charcoal grill
Old cabinet
Cabinets
18-Drawer cabinet
Misc. contents of basement
65.00
5.00
15.00
10.00
10.00
1.00
1.00
30.00
1.00
150.00
1.00
25.00
50.00
1.00
5.00
5.00
2.00
50.00
25.00
10.00
50.00
RETAIN THIS PORTION FOR YOUR RECORDS
REMITTANCE ADDRESS I BILL TO
THE SENTINEL - LEGAL M'LISS HALSEY
P.O. BOX 130, CARLISLE, PA 17013
AD NUMBER I CLASS SALESPERSON BILLING DATE LINES
293743 10 PUBLIC NOTICES wolfc 09/28/05 28 * 2
AD DESCRIPTION START DATE STOP DATE
ESTATE NOTICE LETTERS TESTAMENTARY 09/13/05 09/27/05
PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT
3 THE SENTINEL - LEGAL 3 LGL 101.64
TOTAL AD CHARGE 101.64
3 PROOF OF PUBLICATION 01PRF 6.35
PREVIOUSLY PAID -107.99
DAYS RUN
PURCHASE ORDER PAY THIS AMOUNT .00 .00*
Est.V. Halse
y
* AFTER 10/28/05
MESSAGE:
Thank you for advertising with The Sentinel.
Deadlines for in-column legal advertisements: Monday is Friday at
11 a.m.j Tuesday is Friday at 4 p.m.j Wednesday is Monday at 12 Noon;
Thursday is Tuesday at 12 Noonj Friday is Wednesday at 12 Noon; Sunday
is Thursday at 12 Noon.
If you have any questions regarding your Legal bill please call
Tammy Shoemaker 243-2611, ext 203.
Fax your legals to 243-3754, attention Tammy Shoemaker
You can also EMAIL yourlegaltoClassifiedads:classified@cumberlink.com
Please send a cover letter including your name and address as an attachment
DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT
THE SENTINEL - LEGAL
P.O. BOX 130 CARLISLE PA 17013
AD NUMBER CLASSO
293743 PUBLIC NOTICES
Est.V. Halsey
START DATE
STOP DATE
AD DESCRIPTION
ESTATE NOTICE
LETTERS TESTAMENTARY
09/13/05
BILLING DATE
09/28/05
09/27/05
TELEPHONE NUMBER
717-795-7230
GROSS AMOUNT OF
.00
DUE AFTER 10/28/05
TOTAL AMOUNT DUE
.00
ENTER AMOUNT ENCLOSED
M'LISS HALSEY
318 S. FREDERICK ST.
MECHANI CS BURG , PA
111.11 1'1111111111.1..1.111.1.11
17055
20200000002937430000000000000000000000000000007
o PNC1NVESTMENTS
. Member NASD and slPe
Asset Transfer Confirmation
M'LISSA M HALSEY mOMAS AND
MARK E HALSEY CD-EXECUTORS
ESTA1E OF VIOLET M HALSEY
1938 WALNUT ST
CAMP IfiLL P A 17011
Financial Consultant: J202
SCOTT CARTER
CENTRAL REGION
PNC INVESTMENTS
9 W CHOCOLATE AVENUE
HERSHEY, PA 17033
Hilliard Lyons is pleased to confirm the following transaction.
Thank you for the trust and confidence you have placed in us.
Share
Ouantitv
Dollar
Amount
$122,353.14
Securitv Descrintion
Pavee or ReceivinlJ' Account Information
Bank PNC Bank [SCP]
Bank ABA: 031312738
Account Name: VIOLET HALSEY ESTATE
Account#: 5003871314
ACCOUNT NUMBER: 27894605
ACCOUNT TYPE: 1
TRANSACTION DATE: 09/14/2005
TRANSACTION TYPE: ACH Credit
Hilliard Lyons processed the above transaction based on instructions received from you.
Please contact the following to address any questions or concerns regarding the above transaction.
PNC Investments Client Service Department:
TollFree 800-762-6111
Processing Date: 09/14/2005
Page 1 of 1
J.J.B. Hilliard, W.L. Lyons, Inc. Investments Since 1854
Member New York, American, and Midwest Stock Exchanges; CBOE; NASD; and SIPC
A to Z Tax Service
321 Second Street, New Cumberland, PA 17070 774-4068
249-8166 ,
Name Estc.t& Of Vi ok t 1\1. NcifGY
Phone Pickup Date
Ote
Copy
FORM
FED
ST
FIST
LOC
CLI
Total
(J A ;;
I Fe r {.AJ (;
J) ^ () ~ \ I ......: 1 r f)(
f 11 7\ t:... v , V v-v<
SPECIAL INSTRUCTIONS:
,-... A (\ I
PREPARED By:l 1;K 1/ .u -'..... A"'A
COST:
Tax Consultant
/ 05~. ()O
MYERS-HARNER FUNERAL HOME, INC.
1903 MARKET STREET
ROBERT H. HARNER
SUPERVISOR
CAMP HILL, PENNSYLVANIA 1701 I
ZO-J
LOCALLY OWNED AND
OPERATED
TELEPHONE
717-737-9961
June 17, 2005
Mr. Mark Halsey
1938 Walnut Street
Camp Hill PA 17011
Services for Violet M. Halsey
June 3, 2005
Charges for Services Selected
Professional Services
Use of Facilities
Automotive Equipment
$ 3,990.00
$ 3,990.00
Charges for Merchandise Selected
Casket
Vault
$ 2,245.00
980.00
$ 3,225.00
Cash Advanced
Newspaper Notice/Local
Newspaper Notice/Out-of-Town
Certified Copies
Flowers
Hair Dresser
$ 128.00
97.00
90.00
165.00
45.00
Total due within thirty days, please:
$ 525.00
$ 7,740.00
PRENEED COUNSELOR SALES RECEIPT
/"~ .-"', r"
('~: E~'. r .of' !==
'f
r\,J ':~', ()CJ()S i
~ ~.- ~~, I
,-".'.. <!
DATE f), ~~ \--05
THE AMOUNT OF
f\ ..j
REGULAR PAYMENT~ l"- q J
CHECK~ ~~~~l)
bi)
b DOLLARS ( $ qq.s. w )
AS: DOWN PAYMENT 0
CASH 0
CREDIT CARD CHARGE 0
CARD TYPE 0
DATE
BY
FOR THE PURCHASE OF INTERMENT RIGHTS AND/OR MERCHANDISE AN
RECEIVED BY CEMETERY
GEN 8002 (6/02) @2002 SCI Management L.P.
ROLUNG GREEN C~r.~:::TERY COMP,A.NY
1--011 CARLlSLE RD
Cl\fVlP HILL, PA 17011
717-761-4055
~";l
-,"-OJ
t..l", nni ':tQ1?
i .z_~___.. _....... ~.-..
INDIVIDUAL CASH RECEIPT
DATE
Co- \\
\'{\ \ L \ "S. S
'd-005
\-\~\ <s€- 'i--
ACCOUNT NO.
$
ACCT/CONTR. NAME
ACCT/CONTR. NO. <6 0 ~ \ \ ~
(3:. APPROVAL # ~ \
$
~~\. 0 0
RECEIVED FROM
DESCRIPTION txswn
QA-Uvy\-Q~
,
c.c. TYPE
TRUST NO.
$
BY~ ~~w
GEN 8001 (5/04)
G/L ACCT.
$
r"iCHECK D CASH D CREDT CARD TOTAL (} C).. \ . (j 0
T" THANK YOU
APPRAISAL OF REAL PROPERTY
LOCATED AT:
1938 Walnut Street
Borough of Camp Hill, Cumberland County
Camp Hill, PA 17011
FOR:
THE ESTATE OF VIOLET M. HALSEY
c/o Mark Halsey, EXR
1938 Walnut Street, Camp Hill, PA 17011
Camp Hill, PA 17011
BY:
AS OF:
May 29, 2005*"
Karen Darney, PA State Certified General Real Estate Appraiser
L. G. Connor Real Estate Appraisers, Ltd.
2159 Market Street
Camp Hill, PA 17011
L.G. Connor Real Estate Appraisers
Form GA2 - "TOTAL for Windows" appraisal software by a la mode, inc. -1-BOO-ALAMODE
IFile No. 05-1461
SUMMARY OF SALIENT FEATURES
Subject Address 1938 Walnut Street
Legal Description Deed Book C19, Page 172
City Camp Hill
County Cumberland
State PA
Zip Code 17011
Census Tract 25420-0105.00
Map Reference ADC 3118-02
Sale Price
Date of Sale
$ NA
NA
Borrower / Client
Lender
NA
Mark Halsey, EXR
Size (Square Feel) 2,352
Price per Square Foot $
Location Average
Age 85 years
Condition Average
Total Rooms 10
Bedrooms 4
Baths 2
Appraiser
Date of Appraised Value
Karen Damey, PA Certified General Real Estate Appraiser
May 29, 2005** Retrospective Market Value as of the Date of Death
Final Estimate of Value
$ 210,000 (Market value range: $210,000 to $220,000
Form SSD - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-800-ALAMODE
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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
NO. CD 006031
HALSEY MARK E
1938 WALNUT STREET
CAMP HILL, PA 17011
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
~----~-- fold
101
$ 21, 357.00
ESTATE INFORMATION: SSN: 211-12-7256
FILE NUMBER: 2105-0518
DECEDENT NAME: HALSEY VIOLET M
DA TE OF PAYMENT: 11/28/2005
POSTMARK DATE: 11/28/2005
COUNTY: CUMBERLAND
DATE OF DEATH: OS/29/2005
TOTAL AMOUNT PAID:
$21,357.00
REMARKS:
CHECK#1026
SEAL
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS