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Home My WebLink About12-08-05 REV .1500 EX'" \S,") *' REV-1500 OFFICiAL USE ONLY I . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN FILE NUMBER DEPARTMENT OF REVENUE RESIDENT DECEDENT 21 2005 0856 DEPT. 280601 HARRISBURG. PA 17128-0601 COUNTY CODE YEAR NUMBER DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER CAMERON!, MARIE E. 167-24-8832 .... z DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE w 0 w 09110/2005 07/05/1931 U REGISTER OF WILLS w 0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ 1 _ Original Retum 0 2. Supplemental Return o 3. Remainder Retum (date of death prior to 12-13-82) w .... 0 4. Limited Estate 0 4a. Future Interest Compromise (date of death after 05. ,,:$tJl Federal Estate Tax Return Required u"'" 12-12-82) w:58 . . :x:"'... UlLm lL c( 7. Decedent Mamtamed a Llvmg Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 1 2 8. Total Number of Safe DepOSit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) '\ 0 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received ,C) i --c-1 ::::1 C) . ,-n 3901 Market Street Camp Hill, PA 17011-4227 (1 ) 140,000.00 (2) None (3) None (4) None (5) 295,879.83 (6) None (7) 15,305.29 (8) (9) 48,225.95 (10) 1,149.29 (11 ) 13. Charitable and Govemmental Bequests/Sec 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) ??: ...;.;"'- C::l .. .... z w o z o lL AME Lisa Marie Coyne IRM NAME (If applicable) Coyne & Coyne, P.C. SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES W .0:- 451,185.12 (12) 49,375.24 401,809.88 717/737-0464 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o ;:: ~ ::> .... ii: c( U W '" 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) B. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (13) (14) 401,809.88 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1 .2) z .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x ;:: c( .... ::> (17) lL 17. Amount of Line 14 taxable at sibling rate 401,809.88 x .12 ::!i 0 U ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 48,217.19 48,217.19 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 571 Poplar Church Road CITY Camp Hill [STATE PA I 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 ) 48,217.19 2,410.86 Total Credits (A + B + C) (2) 2,410.86 3. Interest/Penalty if applicable D. Interest E. Penalty B. Enter the total of Line 5 + SA. This is theBALANCE DUE. (3) 0.00 (4) (5) 45,806.33 (SA) (5B) 45,806.33 Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. 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. 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;............................................................................. ~ ~ ~: ~::::~ :h;e~~~;i~~:~s:~~e~=s~~~. ~~~~'. .~.~~. ~~~. :.~~:.~~~ .t~~.~.~~~~~~.~..~~ .i.~ .~~~:.~~.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'~~::::::::::: .'.'..... lj ~ 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 ~ 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 perjury. I declare that I have examined this retum. including accompanying schedules and statements. and to the best of my knowledge and belief. it is true. correct and complete. Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Clarence Gerg DATE P.O Box 112 Dagus Mines, PA 15831 oS DATE ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Lisa Marie Coyne ADDRESS DATE 3901 Market Street Camp Hill, PA 17011-4227 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. g9116 (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. g9116 (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. g9116 (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. g9116 1.2) [72 P.S. g9116 (a) (1)]. The tax rate imposed on the net value of transfers to orfor 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. """ .~~~c.~~......."."......'","',,,.,",'"'...,,.."".,,"'~~."" '" . SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER 21 - 2005 - 0856 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. CAMERONI, MARIE E. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 140,000.00 571 Poplar Church Road, Camp Hill, PA-- Per Settlement Sheet TOTAL (Also enter on Line 1, Recapitulation) 140,000.00 B. TYPE OF LOAN: \ 1.DFHA 2.DFmHA 3.IRICONV. UNINS. 4.oVA 5. DCONV. INS. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 6. FILE NUMBER; j 7. LOAN NUMBER: ~ETTLEMENT STATEMENT A105-701 8.. MORTGAGE INS CASE NUMBER: JOTE: This form is furnished to give you a statement of Betua! settlement costs. Amounts paid to and by the settlement agent are shown. Items marked ,/POCr were paid outside the closing; they are shown here for informational purposes and are not included in the lotals. JAME AND AODRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: R TJ4--TG OF HAEL J. CHERVANICK MARIE A. CAMERON I LEESPORT BANK POPLAR CHURCH ROAD IP HILL. PA 17011 'ROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE: POPLAR CHURCH ROAD A-1 Abstract Associates, Inc. IP HILL. PA 17011 November 21.2005 IBERLAND County, Pennsylvania PLACE OF SETTLEMENT COYNE AND COYNE J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: Contract Sales Price 140,000.00 40'1. Contract Sales Price 140,000.00 Personal ProDertv 402. Personal prooertv Settlement Charges to Borrower (Line 1400) 5,636.97 403. 404. 405. Adiustments For Items Paid Bv Seller in advance Adiustments For (Iems Paid Bv Seller in advance CitvlTown Taxes 11/22/05 to 01/01/06 52.68. 406. CilvlTown Taxes 11/22/05 to 01/01/06 52.68. County Taxes to 407. CountVTaxes to School Tax 11/22/05 to 07/01/06 669.78 408. School Tax 11/22/05 to 07/01/06 669.78 409. SEWER AND TRASH 11/21-12/31 49.84 410. SEWER AND TRASH 11/21-12/31 49.84 411. 412. GROSS AMOUNT DUE FROM BORROWER 146,409.27 420. GROSS AMOUNT DUE TO SELLER 140,772.30 AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: Deoosit or earnest money 1,000.00 501. Excess Deoosit See Instructions Principal Amount 01 New Loan(s) 112,000.00 502. Settlement Charges to Seller Line 1400) 1,592.20 ExistinClloan s taken sub.eet to 503. Existing loan(s taken sub'ect to 504. Payoff of first Mortgage 505. Payoff of second Mortgage :Jrincipal Amt of New Loan s 21,000.00 506. DeDosit retained bv seller' 1,000.00 507. 508. 509. Adjustments For ItemsUnDaid Bv Seller Adjustments For Items Unpaid Bv Seller ~itvlTown Taxes 10 510. Citvrrown Taxes \0 ::ountv Taxes to 511. County Taxes 10 3chool Tax to 512. School Tax to 513. 514. 515. 516. 517. 518. 519. rDTAL PAID BY/FOR BORROWER 134,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 2,592.20 ;ASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 3ross Amount Due Ftom Borrower (Line 1201 146,409.27 601. Gross Amount Due To Seller (Line 420 140,772.30 _ess Amount Paid By/For Borrower (Une 220) ( 134,000.00) 602. Less Reductions Due Seller (Line 520) I( 2,592.20 ~ASH ( X FROM) ( TO )'B9RROWER 12,409.27 603. CASH ( X TO) ( FROM) SELLER 138,180.10 OMS NO. 2502-0265 1=r undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. MICHAEL BU6 Borrower L. SETTLEMENT CHARGES )T AL COMMISSION Based on Price $ I1il % PAID FROM PAID FROM )ivision of Commission line 700 as Follows: BORROWER'S SELLER'S , to FUNDS AT FUNDS AT to SETTLEMENT SETTLEMENT ommission Paid at Settlement ransaction Fee to EMS PAYABLE IN CONNECTION WITH LOAN )an Oriaination Fee % to )an Discount 1.6250 % to LEESPORT BANK 1,820.00 ppraisal Fee to WOOF APPRAISAL GROUP 300.00 red it Report to CBCINNOVAS 14.95 ender's Inspection Fee to lortaaae Ins. AoiJ. Fee to ssumption Fee to OC PREPARATION to LEESPORT BANK 2.50.00 AX SERVICE FEE to LEESPORT BANK 82.00 NDERWRITING FEE to LEES PORT BANK 150.00 LOOD CERT to FIRST AMERICAN FLOOD SERVICES 16.00 'EMS REQUIRED BY LENDER TO BE PAID IN ADVANCE terest From' 11/21/0.5 to 12/01/0.5 @ $ 18.027430/day ( 10 days %) 180.27 lortaaae Insurance Premium for months to azard Insurance Premium far 1.0 vears to MILLER AND MILLER POC $290.00 RESERVES DEPOSITED WITH LENDER Hazard Insurance months $ ner month Mortaaae Insurance months $ ner month CitvrTown Taxes months $ eer month CounTv'Taxes . months $ ner month School Tax months @ $ per month months I1il $ eer month months @ $ per month ;;;;;;;:;;;;-ate Ad'ustment months @ $ on,,, menth TITLE CHARGES Settlement or Clesino Fee-2ND to A-1 Abstract Associates, Inc. 50.00 Abstract or Title Search to A-1 Abstract Associates, Inc. 100.00 Title Examination to Title Insurance Binder to COYNE AND COYNE 496.25 Document Prenaration te Netarv Fees to A-1 Abstract Associates, Inc. 10.00 Attorney's Fees te (inclUdes above item numbers: ) Title Insurance to A-1 Abstract Associates Inc. PeliCV# 462.50 {includes above item numbers: Lender's Coverage $ 112,000.00 Owner's Coverage $ 140,000.00 Endorsements 100,300,8.1 to A-1 Abstract Associates, Inc. 150.00 Closing Protection Letter to First American Title Insurance Company 35.00 Overnight (Payoffs/Package) to A-1 Abstract Associates, Inc: 15.00 Tax Rece"ipts te A-1 Abstract Associates, Inc. 2.00 COPIES to A-1 Abstract Associates, Inc. 10.00 GOVERNMENT RECORDING AND TRANSFER CHARGES Recording Fees: Deed $ 38.50; Mertgage $ 66.50; Releases $ 105.00 CifVlCeuntvTaxlStam 5: Deed 1,400.00' Mortnane 1,400.00 State Tax/Starnes: Revenue Starnes 1,400.00; MOrtoane' 1,400.00 ADDITIONAL SETTLEMENT CHARGES Survev to Pest Insnection to PENN PEST CONTROL 180.20 /' TOTAL SETTLEMENT CHARGES (Enler on Lines 103, SecUon J and 502, Section K\ ./ "" 5,636.97 1,.592.20 "'9 pa9' , of Ihi, ,Ial,mool, Ih, .'001"'" acl<nowl.d" '''~pl of, oompl'l.d copy of p'" 2 of Ih;' two pa,. ,I,I,moot. L#.. A-1 Abstract Associates, Inc.L....--- Settlement Agent (A105-7011 A105-701-S CHERVANIC /15) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CAMERONI, MARIE E. I FILE NUMBER 21 - 2005 - 0856 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Wachovia Bank-- Certificate of Deposit No. 247412051083695 52,244.56 2 Wachovia Bank-- Certificate of Deposit No. 24741051083709 52,244.56 3 Various U.S. Savings Bonds Per Attached Inventory 82,456.20 4 PNC Bank--Certificate of Deposit No. 21001022535 14,077.69 (Richard P. Cameroni Predeceased Marie E. Cameroni) 5 PNC Bank--Certificate of Deposit No. 21001022536 14,077.69 (Richard P. Cameroni Predeceased Marie E. Cameroni) 6 PNC Bank--Certificate of Deposit No. 21001022537 14,077.69 (Richard P. Cameroni Predeceased Marie E. Cameroni) 7 PNC Bank--Certificate of Deposit No. 31100087982 13,194.21 (Richard P. Cameroni Predeceased Marie E. Cameroni) 8 PNC Bank--Certificate of Deposit No. 31900172954 5,601.37 (Richard P. Cameroni Predeceased Marie E. Cameroni) 9 PNC BanknCertificate of Deposit No. 31800172290 5,594.68 (Richard P. Cameroni Predeceased Marie E. Cameroni) 10 PNC Bank--Certificate of Deposit No. 31900172955 5,594.68 (Richard P. Cameroni Predeceased Marie E. Cameroni) 11 PNC Bank--Certificate of Deposit NO. 5140199456 5,122.25 (Richard P. Cameroni Predeceased Marie E. Cameroni) 12 PNC Bank--Savings Account No. 5002036499 24,897.25 (Richard P. Cameroni Predeceased Marie E. Cameroni) 13 2003 Buick CenturynBlue Book Value 5,625.00 14 Misc. Household Furnishings-- Per Attached Inventory 1,072.00 TOTAL (Also enter on Line 5, Recapitulation) 295,879.83 ! ! ~ ~OVIA Referencell): 1369770 Wachovia Bank N.A. Balance Confirmation Services POBox 40028 Roanoke, VA 24022-7313 September 29, 2005 Iocr ~ v - :?nu'Q.;; ~_ .V COYNE & COYNE ATTORNEYS AT LAW 3901 MARKET STREET CAMP HILL, PA 17011 SUBJECT: Verification! Confirmation of Account and Balance Information provided for: Customer: MARIE E CAMERONI (SSN# 167-24-8832) Date of Death: September 10, 2005 Deposit Account Information Account Type Account Number Date of Death Balance Average Balance* Date Opened Maturity Interest Accrued YTD Date Date Rate Interest Interest Paid Closed :::ERTIFICATE OF DEPOSIT 247412051083695 LEGAL TITLE: MARIE A CAMERONI RlCHARD P CAMERONI $52,244.56 3/10/2002 $8.74 $632.20 9/26/2005 CERTIFICATE OF DEPOSIT 247412051083709 LEGAL TITLE: MARIE A CAMERONI RICHARD P CAMERONI $52,244.56 3/10/2002 $8.74 $632.20 9/26/2005 * Due to system limitations, we can only provide a twelve month average balance on depository accounts. No Safe Deposit Box found for customer. · Date of death balance does not include accrued interest. · If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that Were r>ma~~ri~g~ ~ Servicenter Associate Phone: (540)563-7323 abs; at 0000 000614 CD ~ (5 z (() (() (() (() (() (() (() (() (() (() (() (() (() L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) L{) ~ .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- .,...- I I I I I I I I I I I I I I I I I ..!. ..!. I I I I I I ....!.. I I I I I I I I '- C C >- >- '- '- '- '- '- .0 .0 C C U U > > - a. a. 0) 0) c c >- >- >- '- '- '- J ro :J :J :J CO CO a. a. a. CO CO CD CD CO CO CD CD 0 0 u u u CD CD :J :J :J :J :J :J CO CO CO a. a. 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'<:t L() L() CI) 0> N N N CO CO r-- r-- r-- CO CO CO CO -l '<:t CO CO CO L() L() 0 0 0 L() L() L() L() ~ '<:t '<:t '<:t '<:t L() L() to to to to to to to 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N N N N N N N N N N N N N -l -l -l -l -l -l -l -l -l -l -l -l -l f- 0> 0 ...- N C'? '<:t L() to r-- CO 0> 0 ...- N C'? CO 0> 0> 0> 0> 0> 0> 0> 0> 0> 0> 0 0 0 0 N N N N N N N N N N N C'? C'? C'? C'? ;T-30-2005 20:35 Pt~CBANI< / / I 0PNCBAN< October 3 ], 2005 Lisa Marie Coyne 3901 Market Street CampHill,PA 11011~4227 RE: Estate of Marie A. Cameroni, deceased SSN: 167-24-8832 000: 9/1 012005 Dear Ms. Coyne: 412 768 3458 In response to your request for Date of Death balances for the customer noted above, our records show the followi~g: Certificates of J>eposit Account #21001022535 RICHARD P CAMERON! MARIE A CAMERONI DOn balance: $ t 4,077.01 + $.68 accrued interest Account #21 001 022536 RICHARD P CAMERONI MARJE A CAMERONJ 000 balance: $14,077.01 + $.68 accrued interest Account #21001022537 RICHARD P CAMERONI MARIE A CAMERONJ OOD balance: $14,077.01 + $.68 accroed interest Account #3] 100087982 RICHARD P CAMERONI MARIE A CAMERONr OOD balance: $ J 3, 172.76 + $21.45 accrued interest Account#319001729S4 RICHARD P CAMERON I MARIE A CAMERONI DOD balance: $5,586.87 + $14.50 accroed interest Page 1 of3 Established 03/10/1995 Established 03/10/1995 Established 03/1 0/1995 Established 05/13/1997 Established ] 2/28/1999 P.0l 21-2005 20:36 Pt'lCBRHK 412 768 3458 P.02 Account #31800172290 Established 12/28/1999 RICHARD P CAMERON! MARIE A CAMERONI DOD balance; $5,574.37 + $20.31 accrued interest AcC6Urtt#31900l72955 Established 12/28/1999 RICHARD P CAMERONI MARIE A CAMERONI DOD balance: $5,574.37 + $20.31 accrued interest Checking Account Account#5140l99456 Established 03/28/2000 RICHARD P CAMERON! MARJE A CAMERONI DOD balance: $5,121.65 + $.60 accrued interest Savings Account Account #5002036499 Estabtished 06/08/2000 RICHARD P CAMERON! MARIE A CAMERONI DOD balance: $24,892.90 + $4.35 accrued interest IRA Account Account #65001008361 Established 04/1111994 MARJE A CAMERONI DOD balance: $15,259.81 + $45.48 accrued interest Fol" IRA or Beneficiary information, please call1-888-PNC-IRAS. Safe Deposit Box #243 Established 04/1111985 RICHARD P CAMERON! MARIE CAMERON! Located: EAST PENNSBORO BRANCH 29 HUNTER LANE CAMP HILL PA 17011 717-763-8265 Page 2 of3 / I '~ ;1 - ..:51a- C::\:XIJ Please note that this office only provides date of death balances for deposit accounts (lRAs, CDs, Chec1cing and Savings accounts). We do not process allY financial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, @QLJ,fldet ld-tlt> Rachelle Wells 1-800-762-1775 P7 -PFSC-04-F 500 first Ave. Pittsb\lrgh P A 152 J 9 Page 3 of3 MembaFDTC TOTAL P.03 I . ey Blue Book - Trade-In Pricing Report - Buick, Century Page 1 of2 advertisement ... .--........--..--..---... C Quick Dealer Price Quote 0 Search Used Car Listings 0 Lis ___~IIM~~ USED CA"$ "\ BLUE BQOK~nADE-IW VALUE Pennsylvania. October 7,2005 2003 Buick Century Sedan 4D RMEWS'& "liNGS AtiVta _ :RNANaNG Search ListinQs for This Car List Your Car For Sale Online Quick New Car Price Quote Free CARFAX. Record Check Auto Loans from 5.09% APR Insurance Quote Payment Calculator Engine: V6 3.1 Liter Trans: Automatic Drive: FWD Mileage: 30,000 Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FM Stereo Cassette Dual Front Air Bags Consumer Rated Condition: Fair "Fair" condition means that the vehicle has some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. This vehicle has a clean title history, the paint, body and/or interior need work performed by a professional. The tires may need to be replaced. There may be some repairable rust damage. Trade-In Value List Your Car For Sale Online $5,625 Trade-in Value is what consumers can expect to receive from a dealer for a trade-in. vehicle assuming an accurate appraisal of condition. This value will likely be less than the Private Party Value because the reselling dealer incurs the cost of safety inspections[ reconditioning and other costs of doing business. NE'Xl SlEP: .t;J Get New Car Pricing RUlE SOnK List 1&Ui tOt For one 10'" appear on I cars.com, F popular we I lWt -ad\ ---~ http://www.kbb.comlkb/ki.d11/kw.kc.ur?kbb.P A;561389;P A041&17011;+t&278;Buick;20... 10/7/2005 CLAUDE C. WOLFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 lJNCOLN STREET. CAMP HILL, PA 17011 717-737-0734 Appraisal for the Estate of Marie A. Cameroni 571 Poplar Church Road, Camp Hill, PA 17011 LIVING ROOM 3 Stack tables Green colored recliner Brass floor lamp Pedestal candle stand 4-Piece Danish Modern set(coffee, pair matching end & mid size tables Magazine rack Zenith console TV Vase with flowers 2 Clocks RCA - Zenith stereo system - old 33 1/3 rpm record albums Record cabinet Pair oftable lamps Sofa & matching recliner 2 Throw rugs Barometer Desk & chair Desk lamp Telephone Answering machine Electric pencil sharpener Misc. picture~_ Misc. knick-knacks DINING AREA Table & 4 chairs Misc. crystal ,{}j~ J- V/ ,/ ~ 8 'h ::::~{?5-' October 7,2005 3.00 25.00 8.00 2.00 40.00 2.00 30.00 2.00 2.00 5.00 5.00 10.00 5.00 50.00 1.00 2.00 20.00 2.00 1.00 2.00 2.00 5.00 5.00 25.00 5.00 CLAUDE C. WOLFE & ASSOCIATES AUCTIONEERS. & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET · CAMP HILL, PA 17011 717-737-0734 Cameroni appraisal Page 2 of 5 KITCHEN Toaster Table & 5 chairs GE refrigerator - green ~ old Clock Trash can Yellow cart Sharp microwave Radio Coffee pot Cookbooks Misc. glasses Misc. everyday dishes Hall's bowl Cookware Misc. contents of kitchen HALL Hoover tank vacuum cleaner with power head Crucifix REAR BEDROOM Paper shredder 3-Piece bedroom suite Upholstered chair Pair of milk glass hobnail lamps Alarm clock Night stand Bed linens Trash can Misc. contents of bedroom 1.00 5.00 25.00 1.00 1.00 1.00 10.00 1.00 1.00 2.00 2.00 10.00 10.00 10.00 5.00 7.00 2.00 5.00 100.00 1.00 3.00 1.00 5.00 2.00 1.00 10.00 CLAUDE C. WOLFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET. CAMP HILL, PA 17011 717-737-0734 Cameroni appraisal Page 3 of 5 MASTER BEDROOM Double bed, end table & dresser (matches desk) :Milk glass hobnail table lamp Crystal lamp Bed linens Zenith console TV Trash can Night stand 2 Alarm clocks Telephone Chest of drawers Mlsc. contents of bedroom BASEMENT - SMALL ROOM Metal table Metal cabinet Mlsc. office supplies Mlsc. typewriters & adding machines Mlxer Electric can opener Mlsc. radios/cassettes/speakers Hardware LAUNDRY Wringer/washer_ GE Profile washer GE dryer - old Metal cabinet 3 -Drawer chest 75.00 1.00 2.00 5.00 30.00 1.00 17.00 1.00 1.00 40.00 10.00 2.00 10.00 5.00 1.00 1.00 1.00 5.00 2.00 5.00 75.00- 10.00 1.. 00 5.00 CLAUDE C. WOLFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET . CAMP HILL, PA 17011 717-737-0734 Cameroni appraisal Page 4 of 5 LAUNDRY - continued Linens Trash can Misc. contents of laundry BASEMENT OFFICE Metal desk & chair (2) 4-Drawer file cabinets Typewriter & stand Misc. stereo equipment - old Exercise bike Albums Walker Electric stove - old 16 Stackable orange colored chairs 6 Misc. tables Portable radio Dehumidifier Misc. cassette tapes Misc. office supplies Clock Telephone Electric burner Misc. contents of basement office BREEZEWAY 5 Stackable orange colored chairs 4 tables Pole light Clock Table lamp 2.00' 1.00 10.00 5.00 20.00 1.00 5.00 1.00 5.00 1.00 2.00 5.00 5.00 1.00 40.00 5.00 5.00 1.00 1.00 1.00 25.00 2.00 4.00 1.00 1.00 1.00 CLAUDE C. WOLFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET. CAMP HILL, PA 17011 717-737-0734 Cameroni appraisal Page 5 of 5 BREEZEWAY - continued Chair Misc. contents of breezeway 1.00 5.00 GARAGE Metal shelving Hedge trimmer Aluminum step ladder Misc. garden tools Toolbox 2.00 5.00 5.00 5.00 5.00 Misc. hand tools Stools Creeper Hydraulic floor jack Pedestal fan 25.00 1.00 5.00 10.00 1.00 Log chain Router Heathkit VOM Misc. power tools Misc. glassware 2.00 5.00 3.00 15.00 5.00 4 Vacuum cleaners - old Dolly Folding tables Misc. contents of garage 1.00 3.00 5.00 25.00 APPRAISAL TOTAL $ 1,072.00 This Fair Market Value appraisal is true and correa f6Pthebesf of my abilitY~ as an auctioneer and appraiser with 35 years experience. Member: Certified Appraisers Guild of America \ .) \ j ()... ~/\ , f. , I \/," '\(. v~ r .,~~ W. K. Dusty Chapman, CAGA SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CAMERONI, MARIE E. FILE NUMBER 21 - 2005 - 0856 IS sc e u emus e comple e an Ie I e answer 0 any 0 Ques Ions roug on page IS yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF NUMBER Indude the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECO'S EXCLUSION TAXABLE VALUE Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE) 1 PNC Bank--IRA Account No. 65001008361 15,305.29 100% 15,305.29 I I TOTAL (Also enter on line 7, Recapitulation) 15,305.29 Th' h d I tb I t d d fI d'f th t f f 1 th h4 2" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H RJNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CAMERONI, MARIE E. I FILE NUMBER 21 - 2005 - 0856 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: Lynch - Radkowski Funeral Home, Inc. 2 Headstone Engraving 3 Reception and Honorarium 4 Flowers B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. DESCRIPTION AMOUNT Social Security Number(s) I EIN Number of Personal Representative(s): 2. Street Address City Year(s) Commission paid Attorney's Fees COYNE & COYNE, P.e. State _ Zip 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees Cumberland County Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Postage 2 W ormelysburg Borough-- Sewer & Trash Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 10,296.00 145.00 300.00 300.00 19,000.00 374.00 74.00 112.00 17,624.95 48,225.95 . . Schedule H Funeral Expenses & AdninisbatiYe Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 2005 - 0856 ESTATE OF CAMERONI, MARIE E. 3 Mileage for Executor @ $.48/mile 2,400.00 4 Toll Calls for Executor 100.00 5 Legal Advertising--Cumberland Law Journal 75.00 6 Legal Advertising--Patriot News 100.95 7 Woof Appraisal Group 300.00 8 Closing Costs for Sale of Real Estate 1,592.20 9 Federal Income Tax Due 7,000.00 10 Income Tax Preparation Costs 500.00 11 Filing Fee--Inheritance Tax Return 15.00 12 Claude Wolfe & Associates-- Inventory Costs 225.00 13 Reserves 5,000.00 14 State Farm Insurance 316.80 Page 2 of Schedule H . . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CAMERONI, MARIE E. I FILE NUMBER 21 - 2005 - 0856 Include unreimbursed medical expenses. ITEM NUMBER 1 Verizon DESCRIPTION AMOUNT 65.00 2 Comcast 3 PP&L 4 UGI 5 AT&T 6 Checks Uncleared at time of death 7 PAWC 8 Quantum Imaging 90.52 250.00 150.00 15.00 478.00 62.77 38.00 TOTAL (Also enter on Line 10, Recapitulation) 1,149.29 . REV-151J EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CAMERONI, MARIE E. I FILE NUMBER 21 - 2005 - 0856 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE nnNnt I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Clarence Gerg Brother 1/3 of Residual Estate P.O. Box 112 Dagus Mines, P A 15831 2 Jerome Gerg Brother 1/3 of Residual Estate 345 Toby Rd, R.D.1 Kersey, PA 15846 3 Kathleen Sorge Sister 1/3 of Residual Estate 268 Euclid A venue Ridgway, PA 15853 Enle, do""' ,moools to< d;,lrib"I;"", ,h~ ,lKwe on IIn", 15 ~rn"gh 18, '" 'ppropri,te, on Re, 1500 oo'e, 'hJ 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 I TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEr . ~ ~ . REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF' GRANT OF LETTERS \ ". .~. i., I., ,,' . . ". ()\. '.- ~ '..~~.".~,' ,..... ' ~,\ j .' ~7r;' .,. '.'~ 'i""'~ '., (.' .,\ '~'I.\'7)" . I"{, .'1 ~" ,'J f~ ) -Ii' ,,,~ ~1O',I';'.' . t \{!,~. .'~';: (I~. t (~"'\, . '). ,.' , ,; l. t* '.It ""', " ". .!. ~ . ,. "il, '.r"'f!1 " " t ,:. \?~~ '~ ' . 6. ,. .r. () ,',. ",.. '".- ..... ,.~...,. 'O<."'."'1'1~1~H~'..' tt""'~ ''l;-~ .. I)I,~ ill ".,. ,.... No. 2005-00856 PA No. 21-05-0856 Estate of: MARIE A CAMERONI (First, Middle, Last) Late Of: WORMLEYSBURG BOROUGH 'CUMBERLAND COUNTY Deceased Social Security No: 167-24-8832 WHEREAS, on the 23rd day of September 2005 an instrument dated August 6th 2003 was admitted to probate as the last will of MARIE A CAMERONI (First, Middle, Last) la te of WORMLEYSBURG BOROUGh CUMBERLAND County, who died on the lOth day of September 2005 an WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH Register of wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: CLARENCE L GERG who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 23rd day of September 2005. ,-~'::4n'nQ'~uol.> RegIster of Wills ~~~ ~ ~~~ t Deputy * * Nn'T'R* * ALL NAMES ABOVE APPEAR (FIRSTr MIDDLE, LAST) "-""_.......-....~_......._..'" . . ----r-- --- --.--- ------ ~--- -- - ~- - - ----- - --- - .-- -. -------,~-------- - --.-.-.-q-----..--.-.-..... ---..-- - ..-.-----...-.-,. --. ;-----_._.-~~.----_.--- JEctBt l1Ii11 aM W~6tctrlttttt Of MARIE A. CAMERONI I, Marie A. Cameroni, of Fox Township, Elk County, Pennsylvania, 15846, being of sound and disposing mind, memory and _ understanding, do make publish and declare the following as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills, Testaments or writings in the nature thereof by me at any time heretofore made. FIRST: - I direct that all my just debts and funeral expenses - be paid by my Executors hereinafter named, out of the first monies that shall come into his or her hands from any portion of my estate. SECOND: I give, devise and bequeath all the rest residue and remainder of my estate in equal shares to my brothers and sister hereinafter named as survive me, share and share alike to wit, Jerome Gerg, Clarence Gerg and Kathleen Gerg Sorge. LASTLY: _ I hereby nominate, constitute and appoint my brother, Clarence Gerg to be,the Executor of this, My Last Will and Testament. In the event Clarence Gerg is unwilling or unable to act, I appoint my brother, Jerome Gerg to be the Executor of this, My Last Will and Testament. I direct that my Executors shall not be required to give bond for the faithful performance of his or her duties ,in any jurisdiction. 1 .. In addition to all powers conferred by law, my Exe9utors shall have the power 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 or leases without the necessity of obtaining prior leave of court. IN WITNESS \VHEREOF, I have hereunto set my hand and seal to this my last Will ., and Testament, typewritten on these four (4) pages, this --La- day of/2l.~.A-.l1,12003. . ~ ~ r fl/l4!d tJ} flc?J'th?.47t~ (Seal) Marie A. Cameroni Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in the presence of us. Who have hereunto subscribed our names at her request as witnesses thereto, in the presence ofthe said Testatrix and of each other. 2 " . COMMONWEALTH OF PENNSYLVANIA 55 COUNTY OF ELK We, Marie A. Cameroni, the Testatrix and Norbert J. Pontzer and pavid S. Pontzer, witnesses, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, that she signed the same willingly, and that she executed the instrument as her free and vol~tary act for the purposes therein expressed, and that each of the witnesses, in the presence and l}earing of the Testatrix, signed said Will as witnesses and that, to the best of the knowledge of each of the witnesses, the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. T . '1PA-:;/ IJ(j . < estatrix: oI',;ft'~u /7. _ Z?-'7??L/M;?'7,,/.../' Witness: Subscribed, sworn to and acknowledged before me by Marie A. Cameroni, the Testatrix and subscribed and sworn to before me by-Norbert J. Pontzer and David S. Pontzer, witnesses, this to+\) daYOfA~lJ<Ot~, 2003 12m- .. . . 0. () . ... .. ChQ~ru~,-~ l,~ Notary Public I Notarial Seal I Shannon R. Heindl, Notary Pub He ! Ridgway Bora, Elk Countv I My CommissIon Expires Mar. 6~ 2004 ....... Msmber. PennS\lh/~ni~ ~,_r:-<:-,-,(..i,:,'+i...,!"":.<""\t r\l/'IT.=1rr8S 3 ,- ~~ L\ \ 0 ' oD 1> c\ 2> i 0 . e,rD t\PD \90.00 ~.~~ (U<61 ) ____ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2B0601 HARRISBURG, PA 1712B-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT COYNE LISA MARIE 3901 MARKET STREET CAMP HILL, PA 17011-4227 -------- fold ESTATE INFORMATION: SSN: , 67-24-8832 FILE NUMBER: 2105-0856 DECEDENT NAME: CAMERONI MARIE A DATE OF PAYMENT: 12/08/2005 POSTMARK DATE: 1 2/08/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/10/2005 NO. CD 006076 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $45,806.33 I I I I I I I I TOTAL AMOUNT PAID: $45,806.33 REMARKS: CHECK# 1015 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS