HomeMy WebLinkAbout01-13-06
REV-1500 EX + (6-00)
*'
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 3 7 6
COuNTYCOOE -vEAA- - - NUMBER- -
DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
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DRANE J. LOU
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
2 1 2 - 4 6 - 5 1 8 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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04/14/2005 08/14/1929
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
D 3. Remainder Retum (date of death prior to 12-13-82)
D 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
[R] 1. Original Return
D 4. Limited Estate
[R] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy oITrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
THIS SECTION. MUST BE. COMPLETED. ALL CORRESPONDENCEAND.CONFIDENTIALTAXINFORMATI ON SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
David H. Radcliff Es . 20 Erford Road
FIRM NAME (If Applicable)
Radcliff Law Office P.C. Suite 200
TELEPHONE NUMBER
717236-9318 Lemo ne PA 17043
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
123,6096;1
i
150,175.611
OFFICIAL USE ONLY ~
c-::>
(
;("--
3. Closely Held Corporation, Partnership or Sole-Proprietorship
C)
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11 . Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
--
'.j
I -c .'
435, 195.84 ~__~__~
708,981.05
31,389.84
868.68
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19. Tax Due
0.00 X _(15)
0.00 X _(16)
244,130.03 X .12 (17)
204,986.27 X .15 (18)
(19)
32,258.52
676,722.53
227,606.23
449,116.30
0.00
0.00
29,295.60
30,747.94
60,043.54
I<A
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
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
. Decedent's Complete Address:
STREET ADDRESS
1297 Kelton Road
CITY I STATE I ZIP
Camp Hill PA 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)
55.000.00
2.894.65
Total Credits (A + B + C)
(2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
60,043.54
57,894.65
0.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; ........................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ........................................ D
c. retain a reversionary interest; or ...................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ............................................................. D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............. ..... ....... ......... ....... ....... ................... ............... ..... ....... D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
t . b f" d' t'? f)(l
con alns a ene IClary eSlgna Ion. ....................................................................................................... ~
0.00
2,148.89
2,148.89
No
[Z]
[Z]
[Z]
[Z]
[Z]
[Z]
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 complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
D
ADORE
PA 17324
DATE
I II J!...col(;
PA 17043
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 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. ~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-1502 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DRANE J. LOU 21 05 0376
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.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
Residence at 1297 Kelton Road, Camp Hill, PA 17011
(See Deed and Statement of Value attached)
VALUE AT DATE
OF DEATH
123,609.60
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
123609.60
,_;~'~ ~ : ::: T f". Z i C i~ L r ;'(
THIS DEED:;.; (;;\u;~F .';.r:- I'. C ,-."
(' ! . " : .(.~ < .c~ L. :~'. ~!_\, ~~ '!"'" ~~' ~". J
;,,rrlde, the '---;j' -L IYJ
m" --- ~ day of III; 2DGJiI1Jtlr1 yczr ttij~ t~u59d five (2005)
Between:
JAMES D. DAY, Executor of the Estate of J. LOU DR.A.NE, Party of the
First Part (GRAl"JTOR)
AND
JAMES D. DAY, of Gardners, Cumberland County, Pennsylvania, Party
of the Second Part (GRANTEE).
\VHEREAS, J. Lou Drane, became in her lifetime seized as of fee of and in a
certain tract or parcel ofland situate in the TOViDShip of Lo\ver Allen, Cumberland
County, Pennsylvania, knO\V11 as 1297 Kelton Road, and more particularly described
hereinafter; and being so thereof seized, departed this life on April 14, 2005, having first
made her last \"ill and testament in writing, dated December 9, 2004, duly probated and
registered in the Office of the Register of Wills of Cumberland County on April 22, 2005,
to No. 2105-0.376, wherein and whereby she appointed as Executor thereof, James D.
Day. to .whom letters testClmentary were duly issued by said Register of \VilIs on April 22,
2005, and wherein and whereby said premises hereinafter described was specifically
devised to James D. Day, al1 as in and by said will and the records of said Register of
Wills, recourse thereunto being had appears:
Witnesseth, Th:lt in consideration of One ($ 1.00) DOLLAR, in hand paid, the
receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey
to the said grantee, his heirs and assigns.
ALL THAT CERT AI;'\" tract or parcel of ground situate in Lovier Allen T oViDship,
Cumberland County, State of Pennsylvania, more particularly bounded and described
according to survey of D. P. Raffensperger, Registered Surveyor, dated February 15,
1956, as follo\vs:
BEGINNING at a point on the Southern side of Kelton Road, three hundred twenty-five
and thirty-seven one-hundredths (325.37) feet East of the Southeast comer of the
intersection of Kelton Road and Manchester Road, also at the dividing line between Lots
Nos. 15 and 16, Block "0", on hereinafter mentioned Plan of Lots; thence Eastwardly
along the Southern side of Kelton Road fifty-five (55) feet to a point at the dividing line
between bet\veen Lots Nos. 14 and 15, Block "0" on said Plan; thence Southeastwardly
along the same, one hundred five and twenty-eight one-hundredths (105.28) feet to a
point at the dividing line betv;een Lots Nos. 15 and 24, Block "0" on said Plan; thence
Westwardly along same and along the dividing line between Lots 0;05. 15 and 23, a point
at the dividing line between Lots 0;05.15 and 16, Block "0" on said Plan; thence
Northwardly along same at right angles to Kelton Road, one hundred five (105) feet to a
point, the Place of BEGINNING.
BEING Lot No. 15, Block "0", on Plan of Lots known as Highland Park, BlocksM, N,
0, P, Q, R, S, and T, said Plan being recorded in Plan Book 4, Page 98, Cumberland
County records.
HAVING thereon erected a one-story brick and frame dw'elling house, kno\'rTI and
numbered as 1297 Kelton Road, Camp Hill, Pennsylvania.
BEING the same premises which R. Russell Drane and J. Lou Drane, husband and wife,
by their deed dated June 8, 1999 and recorded in the Office of the Recorder of De~ds in
and for Cumberland County in Deed Book 201, Page 820, granted and conveyed unto J.
Lou Drane. hmes D. Day, Executor of the Estate of J. Lou Drane, is the Grantor herein.
V~DER AND SUBJECT nevertheless to restrictions, conditions and easements of prior
record pertaining to said premises.
TOGETHER \vith all and singular, the tenements, hereditaments and apputenances to
the same belonging or in anywise appertaining. and the reversion and reversions,
remainder and remainders, rents, issues, and profits thereof; AND ALSO all the estate,
right, title, interest, property, cbim and demand whatsoever, both in law and equity, of
the said P3rties of the First Part, of, in, to or out of the said premises, and every part and
parcel thereof
TO HAVE Al\D TO HOLD the said premises, \vith all and singular the appurtenances
unto the said Party of the Second Part, his executors and assigns to and for the only
proper use and behoof of the said Party of the Second Part, his executors and assigns
forever.
k'lD the said grantor will Specially TVarrant and Forever Defend the property hereby
conveyed.
In }vitnesswhereoj, said grantor has hereunto set his hand and seal, the day and year first
above \\Titten.
Sealed and celivered in the prese~ce of
f g
~~~ . la-fil
Estate of J. Lou Drane
. ~t.%~
Certificate of Residence
I hereby certify, that the precise address of the grantee herein is as follows:
4231 Carlisle Road
Gardners, P A 1732
12"-'<
Attorney for Grantee
~
COj\lMON\VEALTH OF PEl'.,TNSYLVANIA
COUNTY OF CUMBERLAND
On this 3/ sf day of /11,,17' ,2005, before me, a Notary Public,
the undersigned officer, personally appeared JAMES D, DAY, Executor of the Estate of
J. Lou Drane, kno\vn to me (or satisfactorily proven) to be the person \vhose name is
subscribed to the within instrument, and acknovv'ledged that he executed the same for the
purposes therein contained.
In \Vitness Whereof, I hereunto set my hand and official seal.
NOtARIAL SEAL
DAVID H RADCLIFF
Notary Public
LEMOYNE BQ4\OUGH. CUMBERLAND COUNTY
My Commwlon Expires Jun 29,2008
REV-183 EX (3-04)
*
REALTY TRANSFER TAX
STATEMENT OF VALUE
RECORDER'S USE ONLY
State Tax Paid
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280603 See Reverse for Instructions
HARRISBURG. PA 17128-0603 I
Complete each section and file in duplicate with Racorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) when the
deed is without consideration, or by gift, or (3) a tax exemption is claimed. A Statement of Value is not required if the transfer is wholly exempt from
tax based on: (1) family relationship or (2) public utility easement. If more space is needed, attach additional sheet(s).
A. CORRESPONDENT - All inquiries may be directed to the following person:
Name Telephone Number:
Book Number
-'
Page Number
Date Recorded
David H. Radcliff Eso.
Street Address
20 Erford Road. Ste 200
B. TRANSFER DATA
717 )
Zip Code
PA 17043
5/31/2005
17324
City
Lemo ne
Date of Acceptance of Document
Grantee(s)/Lessee(s)
James D. Dav
Street Address
4231 Carlisle Road
City
Gardners
Zip Code
17324
Gran ~or(s)/Lessor(s)
James D. Da . Exec Estate of J. Lou Dran
Street Address
4231 Carlisle Road
City
Gardners
C. PROPERTY LOCATION
Z:p Cede
Street A:f<::ress
1297 Kelton Road
Cc:unty
Cumberland
D. VALUATION DATA
School Dis~r;ct
City. TO'Nnship, Eorcugh
Lower Allen Townshio
Tax Parcel Number
West Srore School District
13-23-0545-195
1 Act~al Cash Ce,~s:deration
2. Other Cons deration
3. Total ConS;deration
4. Cou,1ty AS$essed Value
100 +
5. Cemmen Levei RatiO Fact:,
=
1.00
6 Fair Market Value
111.360.00 X
1 11 =
123.609.60
E. EXEMPTION DATA
1 a. Ainount of Exemption Claimed
1 b. Percentage of Interest Conveyed
100001 100%
2. Check Appropriate Box Below for Exemption Claimed
o I,Viil or intestate succession J LOU DRANE
o Transfer to Industrial Development Agency.
o Transfer to a trust. (Attach complete copy of trust agreement identifying all beneficiaries.)
o Transfer between principal and agent. (Attach complete copy of agency/straw party agreement.)
o
(Name of Decedent)
21-05-0376
(Estate File Number)
Transfers to the Commonwealth, the United States and Instrumentalities by gift, dedication, condemnation or in lieu
of condemnation. (If condemnation or in lieu of condemnation, attach copy of resolution.)
o Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number
o
o
o
Statutory corporate consolidation, merger or division. (Attach copy of articles.)
CorrecLve or confirmatory deed. (Attach complete copy of the prior deed being corrected or confirmed.)
, Page Number
Other (Please explain exemption claimed, if other than listed above.)
Under penalties or law, I declare that I have examined this Statement, including accompanying information, and to the best
of my knowledge and belief, it is true, correct and complete.
Signature of Correspondent 0~?9.~e Party ",/_' ,,~e. _, 7~. ,// Date /'_
C. / I ~ '~-'<-~--' . ~C.-<.::'/ " / / //.. /J-.
':".----J' I " (" v L.:..::/ /r//
FAILURE TO COMPLETE THIS FORM PROPERLY OR ATTACH AP"PLlCABLE DOCUMENTATfoNMA Y RESULT IN
THE RECORDER'S REFUSAL TO RECORD THE DEED. /
REV-1508 EX + (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DRANE. J. LOU
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0376
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
DESCRIPTION
PNC Bank - Savings Acct #5003551492
VALUE AT DATE
OF DEATH
51,635.35
M & T Bank - Checking Acct # 29117100
23,078.64
M & T Bank - Checking Acct #98292927
58,754.04
1995 Cadillac DeVille
5,700.00
Refund - Hospice of Central PA
6,000.00
Refund - Patriot News
27.86
Refund - AAA
13.32
Refund - Motorist Mutual Insurance
270.30
Refund - Verizon
16.60
Refund - NY Life LTC premium
31.39
Barclay's Bank - Traveler's Checks
260.00
NY Life Insurance Company - Commissions paid
1,979.36
Personal Property (See attached listing)
2,408.75
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
150175.61
ESTATE OF J. LOU DRANE
S.S.N. #212-46-5185
PERSONAL PROPERTY ATTACHMENT TO SCHEDULE E
Dining table
Loveseat & Sofa
End Table
Lamps
Chair with ottoman
TV, Stereo, Tape
Wood entertainment wall unit
Room divider/screen
Woven basket
Various Kitchen cooking items
Refrigerator
Desk and chair
Lawn mower
Wicker shelves
Metal Bell
Miscellaneous household items
Two twin beds, wicker dresser, lamp, stands
Master bedroom furniture set
Washer
Dryer
Exercise bike
Garden tools
Shovel
Sewing machine
Blue willow tea cup
Bowls
Chinese ceramics
Miscellaneous household
6 ft ladder
Dish
Miscellaneous linens
Box lots
Miscellaneous household items
Miscellaneous kitchen items
Miscellaneous dishes
Tea cart
Rug
Pictures
Miscellaneous mixed lots
Miscellaneous household
$ 125.00
550.00
15.00
30.00
30.00
40.00
75.00
75.00
10.00
35.00
100.00
50.00
150.00
30.00
35.00
13.00
200.00
325.00
125.00
125.00
5.00
12.00
10.00
25.00
20.00
26.00
16.00
16.25
15.00
12.00
17.00
13.00
7.50
14.50
17.50
4.00
6.00
12.00
9.50
12.50
$2,408.75
REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DRANE. J. LOU
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
FILE NUMBER
21 05
0376
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 DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATIACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST VALUE
(IF APPLICABLE)
1. NY Life Trust Company, Custodian for the IRA of 20,963.84 100. 20,963.84
J. Lou Drane (3322.320 sh Mainstay Hi Yld Corp Bd B
@ $6.31) Acct #55583851
2. New York Life Insurance and Annuity Corporation #N3025709 149,427.39 100. 149,427.39
3. New York Life Insurance and Annuity Corporation 175,306.64 100. 175,306.64
#NP309291
4. New York Life Insurance and Annuity Corporation 10,569.79 100. 10,569.79
#AN711689
5. New York Life Insurance and Annuity Corporation #58110048 78,928.18 100. 78,928.18
TOTAL (Also enter on line 7 Recapitulation) $ 435 195.84
(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
FILE NUMBER
ESTATE OF
DRANE. J. LOU
Debts of decedent must be reported on Schedule I.
21
05
0376
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers-Harner Funeral Home 5,910.00
Funeral Meal 366.95
B. ADMINISTRATIVE COSTS:
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 Radcliff Law Office, P.C. 24,066.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 356.00
5. Accountant's Fees
6. Tax Return Prepare~s Fees
7. Filing fees - inheritance return and inventory 30.00
8. Legal advertising - Cumberland Law Journal 75.00
9. Legal advertising - The Sentinel 107 99
10. S.W. Battett Real Estate & Appraisal Service 275.00
11. Lisburn Junction Auctions (appraisal) 100.00
12. Check printing charge - estate account 15.75
13. Jim Day - reimburse car repair 45.00
14. DeHart Auction - commission on personal property sold 42.15
TOTAL (Also enter on line 9, Recapitulation) $ 31 389.84
(If more space is needed, insert additional sheets of the same size)
. REV-151~ EX + (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DRANE. J. LOU
FILE NUMBER
21
05
0376
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Crumay Parnes Associates
46.82
2. Susquehanna Internal Medicine
3. Andrews & Patel
4. CVS Pharmacy
5. Lower Allen Township
6. PP&L
7. Verizon
8. UGI Utilities
9. PA-Am Water
10. Charles Knipe
27.69
50.26
47.17
87.29
42.71
67.43
325.21
54.10
120.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
868.68
"""""""<'-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
DRANE ./. LOLl 21 Of) 0~76
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. James D. Day Collateral 123,609.60
4231 Carlisle Road
Gardners, PA 17324
2. Jean Browneller Sibling 81,376.68
310 North 8th Street
Oskaloosa, IA 52577
3. Betty Brooks Sibling 81,376.68
904-14th Street
West DesMoines, IA 50265
4. John Nicholson Sibling 81,376.67
2433 Pilgrim Path
Oskaloosa, IA 52577
5. William D. Flaharty Collateral 81,376.67
1392 King Street
York, PA 17404
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Market Square Presbyterian Church 105,183.98
20 South Second Street
Harrisburg, PA 17101
2. The Greater Harrisburg Foundation, NKA The Foundation for Enhancing Communities 52,299.59
200 North Third Street, 8th Floor
3. The Salvation Army, Legal Department 35,061.33
440 West Nyack Road
West Nyack, NY 10994
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 227 606.23
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
DRANE, J. LOU
Decedent's Name
Page 1
21 05 0376
File Number
Schedule J - Beneficiaries - 2B
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
4. Hospice of Central PA
POBox 266
Enola, PA 17025
35,061.33
SUBTOTAL SCHEDULE J.2B
35,061.33
....--...
LAST WILL AND TESTAMENT
I, J. LOU DRANE, of Camp Hill, Cumberland County, PeIllisylvania, do hereby declare
this to be my Last Will and Testament and hereby revoke all prior Wills and Codicils made by
me.
FIRST: I direct that all of my debts not barred by the statute of limitations,
expenses of my last illness, funeral expenses, costs of administration, and claims allowed in the
administration of my estate shall be paid by my Executor hereinafter named, from my estate as
soon after my decease as shall be found convenient.
SECO~D: I give and devise the real estate known as 1297 Kelton Road, Camp Hill,
Pennsylvania of the identifiable proceeds of that real estate sale to James D. Day.
THIRD: I give, devise and bequeath the rest, residue and remainder of my estate of
\vhatsoever nature and wheresoever situate as follows:
A. Twenty-five (25%) percent to my sister JEAN BROWNELLER provided that she
surVIve me. If she does not survive me, then her share shall be distributed equally among the
other beneficiaries under this paragraph of my Will
B. Twenty-five (25%) percent to my sister BETTY BROOKS provided that she
survive me and if she does not survive, then I make the same gift to her issue, per stirpes.
C. Twenty-five (25%) percent to my brother JOHN NICHOLSON provided that he
survive me and if he does not survive, then I make the same gift to his issue, per stirpes.
D. Twenty-five (25%) percent to my friend WILLIAM D. FLAHARTY provided
that he survive me. Ifhe does not survive me, then his share shall be distributed equally among
the other beneticiaries under this paragraph of my Will.
-4 1:L) -:-
FOURTH: I hereby nominate, constitute, and appoint JAMES D. DAY as Executor of
this my Last Will and Testament without necessity for posting security regardless of state of
residence, provided that he agrees to serve without compensation. In the event that JAMES D.
DA Y should be unable or umvilling to act as my Executor without compensation, I then
nominate, constitute and appoint JOACHIM GRIMM without necessity for posting s~curity
regardless of state of residence, as Executor of this, my Last Will and Testament and specifically
state my intention that he receive compensation at the rate of ten (10%) percent of my estate for
serving as Executor.
FIFTH: My Executor shall have, in addition to the powers and authority conferred
upon him by law, the following additional powers and authority:
1. To sell at public or private sale, exchange, transfer, partition, give options upon,
lease. mortgage, pledge or otherwise dispose of any property, real or personal, at any t~me
constituting a portion of my estate, and upon such terms and conditions as the Executot shall
deem wise.
2. To invest any money at any time in such bonds, stocks, notes, real estate,
mortgages, life insurance, annuities or other securities, or such property, real or personal, as the
Executor shall deem wise, without being limited by any statutes or rule of law regarding
investments by the Executor.
3. To retain, without incurring any liability, as investments, any property o\vned by
me at the time of my death, as long as my Executor may deem it \-vise, and even though such
property is not the kind of property an Executor would purchase as an investment; and even
though to retain such property might violate sound diversification principles.
4. To cause any security or other property which may constitute a portion of my
estate to be issued, held or registered in the Executor's own name, or in the name of a nominee,
or in such form that title will pass by delivery.
5. To consent to the reorganization, consolidation, readjustment of the finan~ial
structure, or sale of the assets of any Corporation or other organization, the securities of which
~
.J J-~i.),
2
consolidation, readjustment or sale; to exercise any conversion privilege or subscription right
given to my Executor as owner of any securities constituting a portion of my estate resulting
from any reorganization, consolidation, readjustment, sale, conversion or subscription.
6. To pay all costs, taxes, charges and expenses in connection with the
administration of my estate, including such compensations to Executor which shall be in
accordance with established fees throughout the period of administration of my estate.
7. To determine what is "income" and what is "principal" hereunder, and my
Executor's decision thereon shall be final; and to purchase securities at a premium or discount,
and to apply or charge said premium or discount against income or principal as the Executor may
determine.
8. The Executor may make payments to or on behalf of any person who is the
beneficiary hereunder but in no event, however, shall payments be made to any creditor or other
such person because of anticipation of payment by the beneficiary, and any such claim made by
way of anticipation by the beneficiary shall be of no validity or legal effect.
9. To borrow money from any person, firm or corporation, including any
corporation acting as an Executor hereunder, for the purpose of protecting and preserving or
improving my estate hereunder; to execute promissory notes or other obligations for amounts so
bOlTo\;;ed.
10. To employ legal counsel, accountants, brokers, investment advisors, custodians,
managers and other agents and employees and to pay reasonable compensation out of my estate
or any funds held hereunder to \vhich said compensation is attributable.
11. To carryon any business o\vned or controlled by me at my death for whatever
period of time my Executor shall think proper, and my Executor shall have the power to cf.o any
and all things my Executor deems necessary or appropriate, including the power to close <out,
liquidate or sell the business at such time and upon such terms as my Executor shall deem best.
J.J / cPy-
3
.
12. To do all other acts in my Executor's judgment necessary or desirable! for the
proper and advantageous management, investment and distribution of my estate.
SIXTH: All federal and state death taxes, excluding generation skippin~ tax,
payable on the property forming my gross estate for those purposes, whether or not itl passes
I
under this Will, shall be paid out of my probate estate just as if they were my debts, ahd none of
those taxes shall be charged against any beneficiary.
IN WITNESS WHEREOF, I, J. LOU DRANE, the Testator to this, my Last Will and
Testament, typewritten on four sheets of paper which I have identified at the bottom o~ each page
by my initials, hereunto set my hand and seal the ~ day of ~ 2004.
Co."
ofL J <~:Th a~~
J. L U DRANE .
The preceding instrument consisting of this and three other typewritten pages, each ide*tified by
the signature of the Testator, J. LOU DRANE, this day and date thereof signed, publis!ed and
declared by J. LOU DRANE, the Testator therein named, as and for her Last Will, in the
presence of us who, at her request, in her presence, and in the presence of each other have
subscribed our names as witnesses.
\'&rn-u--t~' [ 1J;i-~
l;)T; a~)/~~~
p:'
//
.,
4
COMMONWEALTH OF PENNSYLVANIA
Qloe.~
~ "es."1' -
COUNTY OF CUMBERLAND
ss
I, J. LOU DR-'\NE, Testator whose name is signed to the attached or foregoing ins~rument,
having been duly qualified according to law, do hereby acknowledge that I signed and executbd the
instrument as my Last Will; that I signed it willingly; and that I signed it as my free and volurltary act for
the purposes therein expressed.
~.1 ~D~o-
J. LOU DRANC=
1
Sworn or affirmed to and acknowledged before me by J. LOU DR-'\NE, Testator, the
day of ,f)(l.-f'/.
,2004.
/)
S'<C0-&A /
Notary Public
- /)
~'kc.~j
\.
;//
~)
(SEAL)
. NOT ARL~L Sc,~L .
, d 'ft NO'a",! Public
R ...",rta l Ra C;\, , ,. ., nd
ou_' . h Coun'y oj CJITK;ef,a .
\NMmleysbufg Boraug "'J 2.0 2005
.oJ' . E '''If'''' an. '
My Commission XI"' -~__
COMMONWEAL TH OF PE]\;'NSYL VANIA
: 5S
COUNTY OF CUTVlBERLAND
We &7ll/A! I ~ r=;HA-~(Y)AtJ and 'DAj I}) "I( v&c/.!~ . the
witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw Testator sign and execute the instrument as her
Last Will; that she signed willingly and that she executed it as her 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 eighteen or more years of age, of sound
mind and under no constraint or undue influence.
~yYnA1/ t. tk~
~L%C'C?/:f;~~.
'-- 0
/;
-~Sworn or affi.mneK:' t' and subscribed to before me by /~ /-1(1) if f- ~1/.1'K!.J:/7;AA1/
'\ A \ II ".~- U/' U . J
.I /tt-l'i I) r 41) LL i j- t- witnesses, t~~!'y..../~ dayof:.: . c~nL.{u...J
. ..- u/
. I) /
(SEAL) , tt.J!LL/'2~ /\
Notary Public
and
,2000.
5
NOTARIAL SEAL
Roberta L. Radcliff, Notary Public I
Wormleysburg Borough, County of Cumberland _'
My Commission Expi:2S Jan. 20, 2005 _