HomeMy WebLinkAbout03-02-06
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March 1, 2006
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Re: Estate of Ray E. Garman, deceased
File No. 2005-00296
Dear Ms. Strasbaugh:
Enclosed are the following documents for filing with your office for the above-
referenced Estate:
1. An original and two (2) copies of the Pennsylvania Inheritance Tax
Return.
2. An original and two (2) copies of the Inventory.
3. A copy of the United States Estate Tax Return (Form 706).
4. A check in the amount of Three Thousand Nine Hundred Sixty-seven
and 06/100 Dollars ($3,967.06) payable to the "Register of Wills,
Agent" representing the additional Pennsylvania Inheritance Tax due.
5. A check in the amount of Thirty Dollars ($30.00) representing the
filing fee for the Return and Inventory.
Please time-stamp the extra copies and return them to me in the enclosed self-
addressed, stamped envelope.
If you have any questions, please feel free to contact me.
Very truly yours,
Che . Baker, CP
Ce tiled Paralegal
Enclosures
cc:
Sandra L. Baum, Co-Executrix
Ann G. Gobin, Co-Executrix
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ESTATE
SECURITY
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Cheryl L. Baker, CP
Certified Paralegal
clb@jsdc.com
134 SIPE AVENUE
HUMMElSTOWN, PA 17036
MAILING ADDRESS
PO. BOX 650
HERSHEY, PA 17033
Tall FREE 1.800.942.3660
TEL. 717.533.3280
FAX 717.533.7771
www.jsdc.com
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RE~-1500 EX + Y'-QO)
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OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL)
Garman, Ray E.
A 0 TH (MM-DD- YEAR
FILE NUMBER
21
0296
NUMBER
05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
172-01-3643
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WillS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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TELEPHONE NUMBER
717-533-3280
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~ 1. Original Return D 2. Supplemental Return
D 4. Lirnited Estate D 4a. Future Interest Compromise (date of death after
12-12-82)
~ 6. Decedent Died Testate (Attach D 7. Decedent Maintained a Living Trust (Attach
copy of Will) copy of Trust) .
D 9. litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between D 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
12-31-91 and 1-1-95)
TfoIISSE,:CTlONNlUST.Be COM~~.ALL<:ORRESPONDENCEANDCONfIDENTIAL.TAX..INFOR~"I1()Ni$~J~.F:OIR.~J)1f():
NAME COMPLETE MAILING ADDRESS
Donna M. Mullin, Esq.
FIRM NAME (If applicable)
James, Smith, Dietterick & Connelly
D
3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
134 Sipe Avenue
Hummelstown, PA 17036
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)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash. Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) D Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
OFFICIAL USE ONLY
None
960,834.19
278,988.00
5,685.00
183,746.93
3,049.58
-0-
1.-1
( i
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11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(8) 1,432,303.70
21,499.50
12,705.66
(11)
(12)
(13)
(14)
34,205.16
1,398,098.54
0.00
1,398,098.54
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
20. D
0.00
62,914.43
0.00
0.00
62,914.43
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 X .00 (15)
or transfers under Sec. 9116(a)(1.2)
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0 1,398,098.54 .045 (16)
~ 16. Amount of Line 14 taxable at lineal rate x
~
:) (17)
D. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12
:IE
0
0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
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19. Tax Due (19)
?>?'f!.eSURE."rp'A~.sweR!'ILJ4'CillJESTI()NSi()N.)REVERSEsSJDEiJ1~J))1leeHE~j,(.tJI~lIt!1iC". .. ......'...'F?,... .....
Copyright 2002 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00:
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Decedent's Complete Address:
STREET ADDRESS
940 Walnut Bottom Road
CITY Carl isle
I STATE PA
IZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
62,914.43
56,000.00
2,947.37
Total Credits (A + B + C)
(2)
58,947.37
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
3,967.06
3,967.06
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;.................................................................................. D 0
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 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?................ .............................. ....... ............... ............. ..................................... ~ D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and
complete. Declaration of 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 DATE
Ann G. obin 104 Ladnor Lane
Carlisle, PA 17013
921 Kilroy Circle
Harrisburg, PA 17111
~QltJ
ATE
134 Sipe Avenue
Hummelstown, PA 17036
c2 - :2?---O <0
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 .5. ~9116 (a) (1.1) (ii)). The statute does not exemot 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 .5. ~9116 (a) (1.3)]. A sibling is
defined under Section"91 02, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev.-1503 EX+ (&-98)
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-05-0296
Garman, Ray E.
ESTATE OF
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 1,977 shares of Alliance Bernstein Municipal Fund - 10.45 20,659.65
held by Smith Barney Account No. 724-24402-17 -
valued per letter dated 5/5/05
2 542 shares of Alltell Corp - held by Smith Barney 56.75 30,758.50
Account No. 724-24402-17 - valued per letter dated
5/5/05
3 4,060.69 shares of Dreyfus Strategic Muns Inc - held 8.3600078 33,947.40
by Smith Barney Account No. 724-24402-17 - valued
per letter dated 5/5/05
4 2,801.26 shares of Eaton Vance Pennsylvania - held by 9.8500139 27,592.45
Smith Barney Account No. 724-24402-17 - valued per
letter dated 5/5/05
5 3,338.22 shares of Gabelli Equity Trust Inc - held by 9.000018 30,044.04
Smith Barney Account No. 724-24402-17 - valued per
letter dated 5/5/05
6 509 shares of Gabelli Util Tr - held by Smith Barney 9.92 5,049.28
Account No. 724-24402-17 - valued per letter dated
5/5/05
7 4,280.87 shares of Municipal High Income Fd Inc - held 7.1800125 30,736.70
by Smith Barney Account No. 724-24402-17 - valued
per letter dated 5/5/05
8 1,950 shares of Nuveen PA Invt Quality Mun Fd - held 15.01 29,269.50
by Smith Barney Account No. 724-24402-17 - valued
per letter dated 5/5/05
Total of Continuation Schedule(s) See attached
pagels)
TOTAL (Also enter on Line 2, Recapitulation) 960,834.19
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc."
Form PA-1500 ScheduleS (Rev. 6-98)
Rtne-1503 EX+ (1-98)
*'
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Garman, Ray E.
FILE NUMBER
21-05-0296
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
9 1,000 shares of PPL Corp - held by Smith Barney 53.83 53,830.00
Account No. 724-24402-17 - valued per letter dated
5/5/05
10 121 shares of Prudential Financial - held in book-entry 58.87 7,123.27
form - valued per public listing
11 900 shares of Puget Energy Inc New - held by Smith 22.15 19,935.00
Barney Account No. 724-24402-17 - valued per letter
dated 5/5/05
12 1,625.94 shares of SB Managed Muni Fd CI C - held by 15.5900341 25,348.46
Smith Barney Account No. 724-24402-17 - valued per
letter dated 5/5/05
13 2,255.04 shares of SB Muni High Income CI A - held by 14.410006 32,495.14
Smith Barney Account No. 724-24402-17 - valued per
letter dated 5/5/05
14 4,610 shares of Sprint Corp - held by Smith Barney 23.26 107,228.60
Account No. 724-24402-17 - valued per letter dated
5/5/05
15 $30,000 Carlisle Boro PA 2%, due 12/15/06 - held by .99085 29,725.50
Smith Barney Account No. 724-24402-17 - valued per
letter dated 5/5105
16 $20,000 Colonial PA Sch Dist Rfdg 2.25%, due 11/15/06 .99576 19,915.20
- held by Smith Barney Account No. 724-24402-17 -
valued per letter dated 5/5/05
Copyright (c) 2002 toRn software only The Lackner Group; Inc.
FORn PA-1500 Schedule B (Rev. 6-98)
R8"(-1503 EX+ (8-98)
.
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Garman, Ray E.
FILE NUMBER
21-05-0296
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
17 $50,000 Delaware Cnty PA Auth Univ Rev 5%, due 1.01809 50,904.50
12/1/08 - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
18 $50,000 Fort Cherry PA Sch Dist 2.8%, due 10/1/05 - 1.00259 50,129.50
held by Smith Barney Account No. 724-24402-17-
valued per letter dated 5/5/05
19 $50,000 Lower Moreland Twp PA 4.25%, due 611/08- 1.04017 52,008.50
held by Smith Barney Account No. 724-24402-17 -
valued per letter dated 5/5/05 (includes accrued
interest of $607.98)
20 $50,000 Penn St High Edl Facs Auth 5%, due 411/05 - 1.00133 50,066.50
held by Smith Barney Account No. 724-24402-17-
valued per letter dated 5/5/05 (includes accrued
interest of $1,131.94)
21 $50,000 Pennsylvania St Hghr Edl Fac 5%, due 6/15/06 1.02917 51,458.50
- held by Smith Barney Account No. 724-24402-17 -
valued per letter dated 5/5/05 (includes accrued
Interest of $618.05)
22 $50,000 Pennsylvania St Third Ser 4.25%, due 12/1/05- 1.01351 50,675.50
held by Smith Barney Account No. 724-24402-17-
valued per letter dated 5/5/05 (Includes accrued
Interest of $607.98)
23 $100,000 Pennsylvania State G/O 3%, due 9/1/07 - held 1.00465 100,465.00
by Smith Barney Account No. 724-24402-17 - valued
per letter dated 5/5/05 (includes accrued interest of
$108.33)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev-1503 EX+ (6-98)
*'
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Garman, Ray E.
FILE NUMBER
21-05-0296
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
24 $50,000 Pittsburgh PA Sch Dist 4.1%, due 9/1/11 - held 1.02935 51,467.50
by Smith Barney Account No. 724-24402-17 - valued
per letter dated 5/5/05 (includes accrued interest of
$74.02)
TOTAL (Also enter on Line 2, Recapitulation) 960,834.19
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
R..-1503 EX+ (~98)
*'
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Garman, Ray E.
FILE NUMBER
21-05-0296
Schedule C-1 or C-2 (Including all supporting infonnation) must be attached for each closely-held corporation/partnership interest of the decedent, other than
a sole-proprietorship. S98 instructions for the supporting infonnation to be submitted for sole-proprietorships.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Family Home Health Care Products, Inc. - 5% interest in corporation - valued per 31,695.00
stock redemption received (EIN: 25-1817466)
2 Holly Pharmacy, Inc. - 20% interest in corporation - valued per stock purchase price 97,349.00
received per negotiated Stock Purchase Agreement (value is in excess of price
required by Shareholders Agreement) (EIN: 23-2490367)
3 West Perry Pharmacy, Inc. -18.75% interest in corporation - valued per purchase 149,944.00
price received per negotiated Stock Purchase Agreement (value is in excess of
price required by Shareholders Agreement) (EIN: 25-1574045)
TOTAL (Also enter on Line 3, Recapitulation)
278,988.00
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group,lnc.
. Fonn PA-1500 Schedule C (Rev. 6-98)
oREV-1505 EX. (6-9_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
Ray E. Garman
1. Name of Corporation West Perry Pharmacy. Inc.
Address 1102 Montour Road
City Loysville
2. Federal Employer I.D. Number 25-1574045
3. Type of Business Retail Trade
4.
FILE NUMBER
21-05-0296
State of Incorporation P A
Date of Incorporation 05/05/88
State PA _ Zip CodeJ 70~ Total Number of Shareholders 4
Business Reporting Year 2004
ProducUService Prescriptions and medical supplies
STOCK TYPE TOTAL NUMBER OF PAR VALUE NUMBER OF SHARES VALUE OF THE
Voting/Non-Voting SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENT'S STOCK
Common Voting 44,000 1.00 8,250 $ 149944.00
Preferred $
Provide all rights and restrictions pretaining to each class of stock.
5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes KJ No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? ................................. 0 Yes II No
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? . . . .. 0 Yes II No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
DYes ZJ No If yes, 0 Transfer 0 Sale
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....111 Yes 0 No
If yes, provide a copy of the agreement.
Number of Shares
Consideration $_______ Date
10. Was the decedent's stock sold? .................................................. IiCJ Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? ................... 0 Yes IiJ No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . .. 0 Yes IiJ No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
(If more space is needed, insert additional sheets of the same size)
West Perry Pharmacy, Inc.
D. List of principal stockholders at the date of death, number of shares held and their
relationship to the decedent.
Stockholder
Ray Garman
Richard Gobin
Byran Gobin
Victor V. Lis, Jr.
No. of Shares
8,250
8,250
8,250
19,250
Relationship
Deceased
Son-in-law
Grandson
Unrelated
E. List of officers, their salaries, bonuses and any other benefits received from the
corporation.
Officer
Victor V. Lis, Jr., President
Richard Gobin, Vice President
Bryan R. Gobin, Treasurer/Secretary
Compensation
$101,820.00
$0.00
$0.00
F. Dividends (S Corporation)
Year
2004
2003
2002
2001
2000
Declared (Paid)
$190,000.00
$140,000.00
$190,000.00
$180,000.00
$60,000.00
G. Stock subject to option for estate to require redemption by corporation under
Shareholders Agreement dated December 22, 1996 (copy attached). In lieu of distribution in-
kind to heirs, Estate negotiated sale to shareholders under terms of Stock Purchase Agreement
dated December 20, 2005 (copy attached).
'REV-1505 EX+ (6-9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
Ray E. Garman
1. Name of Corporation Holly Pharmacy. Inc.
Address 31 North Baltimore Street
City Mt. Holly Sprinos
2. Federal Employer 1.0. Number 23-2490367
3. Type of Business Retail Trade
4.
FILE NUMBER
21-05-0296
State PA _ Zip Code 17065
State of Incorporation PA
Date of Incorporation 12/14/87
Total Number of Shareholders 4
Business Reporting Year 2004
Product/Service Drug store products
STOCK TYPE TOTAL NUMBER OF PAR VALUE NUMBER OF SHARES VALUE OF THE
Voting/Non-Voting SHARES OUTSTANDING . OWNED BY THE DECEDENT DECEDENT'S STOCK
Common Voting 50 1.00 10 $ 97 349.00
Preferred $
Provide all rights and restrictions pretaining to each class of stock.
5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes I.J No
If yes, Position Annual Salary $___ Time Devoted to Business
6. Was the Corporation indebted to the decedent? ................................. 0 Yes !l No
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? . . . .. 0 Yes I!l.J No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
o Yes ~ No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser __________ Consideration $______ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....aD Yes 0 No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? .................................................. iii Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? ................... 0 Yes Iil No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . .. 0 Yes Iil No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
(If more space is needed, insert additional sheets of the same size)
Holly Pharmacy, Inc.
D. List of principal stockholders at the date of death, number of shares held and their
relationship to the decedent.
Stockholder
Ray Garman
Richard Gobin
Byran Gobin
Victor V. Lis, Jr.
No. of Shares
10
20
10
10
Relationship
Deceased
Son-in-law
Grandson
Unrelated
E. List of officers, their salaries, bonuses and any other benefits received from the
corporation.
Officer
Richard Gobin, President
Victor V. Lis, Jr., Vice President
Bryan R. Gobin, Treasurer/Secretary
Compensation
$133,282.00
$ 0.00
$0.00
F. Dividends (S Corporation)
Year
2004
2003
2002
2001
2000
Declared (Paid)
$60,000.00
$100,000.00
$122,000.00
$59,388.00
$50,000.00
G. Stock subject to option for estate to require redemption by corporation under
Shareholders Agreement dated December 22, 1996 (copy attached). In lieu of distribution in-
kind to heirs, Estate negotiated sale to shareholders under terms of Stock Purchase Agreement
dated December 20, 2005 (copy attached).
-REV-15051:X+ (6-9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
Ray E. Garman
1. Name of Corporation Faml!y Home Health Care Products. Inc.
Address 1 Sprint Drive
FILE NUMBER
21-05-0296
City Carlisle
2. Federal Employer 1.0. Number 25-1817466
3. Type of Business Sales
State PA _ Zip Code 17013
State of Incorporation P A
Date of Incorporation 08/20/98
Total Number of Shareholders 10
Business Reporting Year 2005
ProducVService Medical Equipment
4.
STOCK TYPE TOTAL NUMBER OF PAR VALUE NUMBER OF SHARES VALUE OF THE
VotinglNon-Voting SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENT'S STOCK
Common VotinQ 20,000 1.00 1,000 $ 31 695.00
Preferred $
Provide all rights and restrictions pretaining to each class of stock.
5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes KJ No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent?
If yes, provide amount of indebtedness $
!J Yes 0 No
3.750.00
7. Was there life insurance payable to the corporation upon the death of the decedent? ... .. 0 Yes III No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
o Yes 11 No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....0 Yes IJI No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? .................................................. RI Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? ................... 0 Yes iii No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . .. 0 Yes 121 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax retums (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefrts received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
(If more space is needed, insert additional sheets of the same size)
Family Home Health Care Products, Inc.
D. List of principal stockholders at the date of death, number of shares held and their
relationship to the decedent.
Stockholder
Ray Garman
Richard Gobin
Byran Gobin
Victor V. Lis, Jr.
Ann Gobin
Kirby Burkholder
Steven Burkholder
Keith Burkholder
Harvey Everett
Joy Burkholder
No. of Shares
1 ,000
2,000
2,000
1,000
2,000
4,000
2,000
2,000
2,000
2,000
Relationship
Deceased
Son-in-law
Grandson
Unrelated
Daughter
Unrelated
Unrelated
Unrelated
Unrelated
Unrelated
E. - List of officers, their salaries, bonuses and any other benefits received from the
corporation.
Officer
Steven Burkholder, President
Keith Burkholder, Vice President
Joy Burkholder, Secretary
Kirby Burkholder, Treasurer
Compensation
$85,311.00
$80,769.00
$0.00
$0.00
F. Dividends (S Corporation)
Year
9/2005
9/2004
9/2003
9/2002
9/2001
Declared (Paid)
$168,663.00
$38,020.00
$27,256.00
$0.00
$0.00
G. No shareholder agreement. Corporation negotiated with Estate to purchase minority 5%
interest via redemption (Redemption Agreement attached). Price calculated utilizing
corporation's earnings over five-year period.
Ret-1507 EX+ <,-98)
*'
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Garman, Ray E.
FILE NUMBER
21-05-0296
ESTATE OF
All property JoIntly~ed with right of 8Urvlvorshlp must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1 Family Home Health Care Products, Inc. - loan
VALUE AT DATE
OF DEATH
3,750.00
2 William and Sandra Baum - car loan
1,935.00
TOTAL (Also enter on Line 4. Recapitulation)
5,685.00
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group,lnc.
FormPA-1500 ScheduleD (Rev. 6-98)
R....1508 EX+ (8-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Garman, Ray E.
FILE NUMBER
21-05-0296
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property JoIntly-owned wtth the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Comcast - refund of account 2.95
2 Cornerstone Federal Credit Union Regular Share Account No. 12438-01 - valued per 2,230.64
letter
3 Holy Spirit Hospital - refund of patient account 28.40
4 ManorCare - refund of resident account 2,933.10
5 Smith Barney Account No. 724-24402-17 - bank deposit - valued per letter dated 178,051.84
5/5/05
6 Miscellaneous personal property - valued per Executors 500.00
TOTAL (Also enter on Line 5, Recapitulation)
183,746.93
(If more space is needed, additional pages of the same size)
. Copyright (c) 2002 form softWare onlyThe'Lackner Group,lnc.
Form PA-1500 Schedule E (Rev. 6-98)
R..1509 EX+ (6-98)
*'
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Garman, Ray E.
FILE NUMBER
21-05-0296
If an asset _ made Joint within one year of the decedenfs date of death, It must be reported on schedule G.
SURVIVING JOINT TENANT(S} NAME
ADDRESS
RELATIONSHIP TO DECEDENT
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE Jl:::.~";~l~ IIUN OF .'" y %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 611/1979 16 - $100 Series E U.S. Savings Bonds - 6,099.16 50.000% 3,049.58
valued per Savings Bond Calculator
TOTAL (Also enter on Line 6, Recapitulation) 3,049.58
(If more space is needed, additional pages of the same size)
Copyright(c) 2002 fonn software-only The" Lackner Group, lnc:'
Form PA-1500 Schedule F (Rev. 6-98)
R....1510 EX+ (8-98)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
Garman, Ray E.
FILE NUMBER
21-05-0296
ESTATE OF
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM I It-....' ~wl....IIUN ur- t'KUt'I::K I Y DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE.
1 Private Annuity Agreement between Decedent 0.00 100.000 0.00 0.00
and Richard I. Gobin dated 12/30/1999 - payment
ceased upon Decedent's death
TOTAL (Also enter on Line 7, Recapitulation) 0.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.;1500 Schedule G (Rev. 6-98)
REV-1151 EX+ fo12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Garman, Ray E.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-0296
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 4,844.21
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees James, Smith, Dietterick & Connelly 15,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 752.00
5. Accountant's Fees
6. Tax Return Preparer's Fees 400.00
7. Other Administrative Costs 503.29
TOTAL (Also enter on line 9, Recapitulation) 21,499.50
Copyright (c) 2002 form software only The Lackner Group, Inc.
FormPA-1500 Schedule H (Rev. 6-98)
Rw-1502 !.X+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Garman, Ray E.
FILE NUMBER
21-05-0296
ESTATE OF
ITEM
NUMBER
1
DESCRIPTION
Grace United Methodist Church - funeral reception
AMOUNT
180.00
2
Hollinger Funeral Home & Crematory, Inc. - funeral services
4,630.40
3
Sentinel - fee for article of decedent
33.81
Subtotal
4,844.21
Copylight (e) '2002 'form software'only The Lackner Group, Inc.
Form PA~1-500 Schedule H-A (Rev. 6-98)
Rwa1502 a+ (8-98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Garman, Ray E.
FILE NUMBER
21-05-0296
ESTATE OF
ITEM
NUMBER
1
DESCRIPTION
Cumberland Law Journal - estate notice publication fee
AMOUNT
75.00
2
James, Smith, Dietterick & Connelly, LLP - reservation for estate administration
closing costs
250.00
3
Register of Wills, Cumberland County - filing fee for Return & Inventory
30.00
4
Register of Wills, Cumberland County - short certificates
4.00
5
The Sentinel - estate notice publication fee
144.29
Subtotal
503.29
COpYright (c) 2002 form software only The Lackner Group; Inc.
FormPA.;1500 ScheduleH-B7(Rev. 6-98)
Rev-15;2 EX; (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE liABiliTIES, & liENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Garman, Ray E.
FILE NUMBER
21-05-0296
ESTATE OF
Include unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Andorra Radiology - unreimbursed medical bill 12.68
2 Carlisle Regional Medical Center - unreimbursed hospital bill 690.81
3 Chambers Hill United Methodist - check written prior to death; cashed in after death 50.00
4 Lancaster HMA Phy Management - unreimbursed medical bill 21.97
5 ManorCare - healthcare expense 8.50
6 Masland Associates - unreimbursed medical bill 59.74
7 Masland Associates - unreimbursed medical bill 68.20
8 PA Department of Revenue - 2004 individual income tax (less reimbursement for 725.00
overpayment)
9 PA Department of Revenue - estimated payment made for 2005 individual income 762.00
tax
10 Pinnacle Health Hospice - unreimbursed medical bill 100.00
11 Premier Eye Care - unreimbursed eye examination 50.26
12 Silver Spring Ambulance - unreimbursed ambulance bill 69.94
13 U.S. Treasury - 2004 individual income tax 2,788.00
14 U.S. Treasury - estimated payment for 2005 individual income tax 7,254.00
15 Verizon - telephone service for residence 12.56
16 West Shore EMT - unreimbursed ambulance bill 32.00
TOTAL (Also enter on Line 10, Recapitulation)
12,705.66
.-. (If more space is needed,additionaLpages..ofthesame size)
Copyright (c) 2002 fonn software only The Lackner Group, Inc.
. .... -', ',,", - . .~... ;,_" .4....;
Fonn PA-1500 Schedule I (Rev. 6-98)
RE!-151;: ~+ .19-(0)
*'
SCHEDULE .J
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Garman, Ray E.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
I A][ AKI ~ IUN:) -pnclude outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
RE 4 III TO
DECEDENT
Do Not List Trustee(s)
I.
1
Sandra L. Baum
921 Kilroy Circle
Harrisburg, PA 17111
Stepchild
2
Edwin R. Garman
521 D Street
Carlisle, PA 17013
Son
3
Ann Garman Gobin
104 Ladnor Lane
Carlisle, PA 17013
Deborah S. Miller
913 Peachtree Drive
Mechanlcsburg, PA 17055
Stepchild
Daughter
4
5
Wayne D Shearer
931 South 61st Street
Harrisburg, PA 17111
Stepchild
FILE NUMBER
21-05..0296
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
Joint Savings
Bonds & 1/5 of
Residue (Less:
Prior Gift)
1/5 of Residue
1/5 of Residue
1/5 of Residue
1/5 of Residue
166,459.37
307,909.79
307,909.80
307,909.79
307,909.79
Total 1,398,098.54
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Copyright (c) 2002 fonn software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Form PA-1500 Schedule J (Rev. 6-98)
0.00
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
, Deceased
No. 2005-00296
Date of Death 03/14/2005
Social Security No. 172-01-3643
Estate of Ray E. Garman
also known as
Ann G. Gobin
Sandra l. Baum
The Personal Representatlve(s) of the above Estate, deceased, verity that the Items appearmg m the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of
the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except
that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory
are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S.
Section 4904 relating to unsworn falsification to authorities.
Attorney:
Donna M. Mullin, Esq.
Signature:
~ ~.-e~
&,- E)CJ.u ~,' .-
I t -" ~
Signature:
1.0. No.:
30392
Signature:
Firm: James, Smith, Dietterick & Connelly
Address: 134 Sipe Avenue
Hummelstown, PA 17036
Telephone: 717 -533-3280
Address: 104 ladnor lane
Carlisle, PA 17013
Telephone: 717 -486-4331
Dated:
d 1,;)1; \ dJ
Personal Property
Cash.............................................................................................. .
Personal Property.. ..... .......... ................. .......... ........ ........ .............
Stocks/listed......... ........................................................................
Stocks/Closely Held.... ..... ...... ................ ........ ............. ........ ..........
Bonds............................................................................................ .
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
All Other Property......................... .......... ......... ...... ......... ........ ......
196,246.93
500.00
454,017.99
278,988.00
506,816.20
5,685.00
Total Personal Property.........................................
1,442,254.12
Total R,,~J. Property.................... ........... ............ .....
T~al.Personal and Real Property.........................
1 ,442,254.12 I
GS:1 !'J
_, ". i' I ,.
(~ ~-
Total Out-of-State Real Property..........................
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
Ray E. Garman
No.
21-05-0296
, ueceaseC1
Date of Death 03/14/2005
Social Security No. 172-01-3643
also known as
Cash
Comcast - refund of account
2.95
Cornerstone Federal Credit Union Regular Share Account No. 12438-01 -
valued per letter
2,230.64
Holy Spirit Hospital - refund of patient account
28.40
ManorCare - refund of resident account
2,933.10
Smith Barney Account No. 724-24402-17 - bank deposit - valued per letter
dated 5/5/05
178,051.84
Sprint Life Insurance - estate is beneficiary
13,000.00
196,246.93
Total Cash
Personal Property
Miscellaneous personal property - valued per Executors
500.00
Total Personal Property
500.00
Stock I Listed
1,977.0000 shares Alliance Bernstein Municipal Fund - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
20,659.65
542.0000 shares Alltell Corp - held by Smith Barney Account No. 724-24402-17 - valued
per letter dated 5/5/05
30,758.50
4,060.6900 shares Dreyfus Strategic Muns Inc - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
33,947.40
(Attach additional sheets if necessary)
Total Personal Property and Real Estate,
1 ,442,254.12
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
also known as
Date of Death
21-05-0296
03/14/2005
172-01-3643
27,592.45
Ray E. Garman
No.
Estate of
. ueceased
Social Security No.
2,801.2600 shares Eaton Vance Pennsylvania - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
3,338.2200 shares Gabelli Equity Trust Inc - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
30,044.04
509.0000 shares Gabelli Util Tr - held by Smith Barney Account No. 724-24402-17 -
valued per letter dated 5/5/05
5,049.28
4,280.8700 shares Municipal High Income Fd Inc - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
30,736.70
1,950.0000 shares Nuveen PA Invt Quality Mun Fd - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
29,269.50
1,000.0000 shares PPL Corp - held by Smith Barney Account No. 724-24402.17 - valued
per letter dated 5/5/05
53,830.00
121.0000 shares Prudential Financial - held in book-entry form - valued per public listing
7,123.27
900.0000 shares Puget Energy Inc New - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
19,935.00
1,625.9400 shares SB Managed Muni Fd CI C - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
25,348.46
2,255.0400 shares SB Muni High Income CI A - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05
32,495.14
4,610.0000 shares Sprint Corp - held by Smith Barney Account No. 724-24402-17 - valued
per letter dated 5/5/05
107,228.60
454,017.99
Total Stock / Listed
,2
,
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
No.
21-05-0296
Ray E. Garman
also known as
Date of Death 03/14/2005
Social Security No. 172-01-3643
I ueceaseCl
Stock I Closelv Held
Family Home Health Care Products, Inc. - 5% interest in corporation - valued
per stock redemption received
Holly Pharmacy, Inc. - 2001c. interest in corporation - valued per stock purchase
price received per negotiated Stock Purchase Agreement (value is in excess of
price required by Shareholders Agreement)
West Perry Pharmacy, Inc. - 18.750/0 interest in corporation - valued per
purchase price received per negotiated Stock Purchase Agreement (value is in
excess of price required by Shareholders Agreement)
Total Stock / Closely Held
Bond
$30,000
Carlisle Boro PA 2%, due 12/15/06 - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$148.33)
$20,000
Colonial PA Sch Dist Rfdg 2.250/0, due 11/15/06 - held by Smith Barney Account
No. 724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$148.75)
$50,000
Delaware Cnty PA Auth Univ Rev 5%, due 12/1/08 - held by Smith Barney
Account No. 724-24402-17 - valued per letter dated 5/5/05 (includes accrued
interest of $715.27)
$50,000
Fort Cherry PA Sch Dist 2.8%, due 10/1/05 - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$633.88)
3.
31,695.00
97,349.00
149,944.00
278,988.00
29,725.50
19,915.20
50,904.50
50,129.50
,
Estate of
also known as
$50,000
$50,000
$50,000
$50,000
$100,000
$50,000
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Ray E. Garman
No.
21-05-0296
03/14/2005
Date of Death
. ueceasea Social Security No. 172-01-3643
Lower Moreland Twp PA 4.250/0, due 6/1/08 - held by Smith Barney Account No. 52,008.50
724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$607.98)
Penn St High Edl Facs Auth 5%, due 4/1/05 - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$1,131.94)
Pennsylvania St Hghr Edl Fac 5%, due 6/15/06 - held by ~mith Barney Account
No. 724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$618.05)
Pennsylvania St Third Ser 4.250/0, due 12/1/05 - held by Smith Barney Account
No. 724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$607.98)
Pennsylvania State G/O 30/0, due 9/1/07 - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$108.33)
Pittsburgh PA Sch Dist 4.1 ok, due 9/1/11 - held by Smith Barney Account No.
724-24402-17 - valued per letter dated 5/5/05 (includes accrued interest of
$74.02)
50,066.50
51,458.50
50,675.50
100,465.00
51,467.50
Total Bond
506,816.20
Mortaage I Note Receivable
Family Home Health Care Products, Inc. -loan
William and Sandra Baum - car loan
3,750.00
1,935.00
Total Mortgage / Note Receivable
5,685.00
4
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
BAUM SANDRA L
921 KILROY CIRCLE
HARRISBURG, PA 17111
-------- fold
ESTATE INFORMATION: SSN: 172-01-3643
FILE NUMBER: 2105-0296
DECEDENT NAME: GARMAN RAY E
DATE OF PAYMENT: 03/02/2006
POSTMARK DATE: 03/01/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 03/14/2005
NO. CD 006388
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,967.06
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1025
SEAL
INITIALS: MG
RECEIVED BY:
REGISTER OF WILLS
$3,967.06
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
I
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CD
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