HomeMy WebLinkAbout03-03-06
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
o 0
868
COUNTY CODE
YEAR
NlJv1BER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
....
Z BLESSING, DORIS JEAN 201-16-1890
W DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD- YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
C
W 09-06-2005 11-11-1925 REGISTER OF WILLS
0
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
C
w [ZJ 1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of death poor to 12-13-82)
~~(/) D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required
UO:::~
wCl.U [ZJ D
IOO 6. Decedent Died Testate (Attach copy of WiU) 7. Decedent Maintained a Living Trust (Attach copy of Trust) ~ 8. Total Number of Safe Deposit Boxes
oO:::....J
Cl.a:l
Cl. D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch O)
<(
~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
z NAME COMPLETE MAILING ADDRESS
w
0 DONN L. SNYDER, ESQUIRE P.O. BOX 1291
z
0 FIRM NAME (If Applicable)
Cl. HARRISBURG, PA 17108-1291
U) SAUL EWING LLP
w
0:::
0::: TELEPHONE NUMBER
0
u 717.257.7524
1. Real Estate (Schedule A) (1 ) 0.00 OFFICIAL USE ONLY
- "
2. Stocks and Bonds (Schedule B) (2) 324,583.00
0._,"1
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.00 ' .
_.. ....
0.00 --
4. Mortgages & Notes Receivable (Schedule D) (4) ,
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1,900.00
Z (Schedule E) -----:t
"-~-, .
0 77,834.96 "<"- .
6. Jointly Owned Property (Schedule F) (6) --......
~ D Separate Billing Requested - -
. '-. , ,
---
..J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 22,317.52 C)
::::)
.... (Schedule G or L)
c:: 8. Total Gross Assets (total Lines 1 - 7) (8) 426,635.48
<l
0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 29,784.36
W
0:: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 10,984.38
11. Total Deductions (total Lines 9 & 10) (11 ) 40,768.74
-..-. - -.- . - ------
12. Net Value of Estate (Une 8 minus Line 11) (12) 385,866.74
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) ._ no - 12,460.93
made (Schedule J) - ------- - . - ~.. - --. --_.~ --- - -
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 373,405.81
SEE INSTRUCTIONS FOR APPLICABLE RATES
Z
0 15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) X.O_ (15) 0.00
!C( 373,405.81 X ,0 45 16,803.26
.... 16. Amount of Line 14 taxable at lineal rate (16)
::::)
a.. 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00
:E
0 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00
0 -
>< 19. Tax Due (19) 16,803.26
~ 20. D I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
STF PA42021F.1
vi
Decedent's Complete Address:
STREET ADDRESS 7 HUNTER LANE
CITY CAMP HILL I STATE PA I ZIP 1 7 0 11
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
16,803.26
3,500.00
Total Credits (A + B + C) (2)
3,500.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + 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)
0.00
0.00
13,303.26
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
13,303.26
PLEASE ANSVVER THE FOLLOVVlNG 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
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [XI
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
~-te~
ADDRESS
7 HUNTER ANE, CAMP HI
SIGNATURE OF PARER OTH AN R
No
[1Q
[ZJ
[1Q
[ZJ
[1Q
[Xl
DATE
()rl~ (.~ 0 ~ 4?
ADDRESS
P.O. BOX 1291,
DAT~ ".
~);J - (2 (J. C(:)
F or dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate im posed 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. s9116(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.
STF PA42021F.2
REV-1503 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
All property jointJy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
LPL FINANCIAL SERVICES
VALUE AT DATE
OF DEATH
27,304.19
2.
AMERIPRISE
170,897.37
3 .
AMERIPRISE
126,381.44
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
324,583.00
STFPA42021FA
REV-1508 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
GE CAPITAL ASSURANCE
1,890.00
2.
EAST PENNSBORO AMBULANCE
10.00
STF PA42021F.9
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,900.00
REV-1509 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. RICHARD R. BLESSING
7 HUNTER LANE
CAMP HILL, PA 17011
SON
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Inclooe name of financial institution and bati< accoLnt runber or similar identifying number DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT Attach deed for joint~-held real estate VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 1989 7 HUNTER LANE, CAMP HILL, PA 1701~ 128,900.00 50 64,450.00
DEED BOOK Y, VOL. 33, PAGE 528
2. A 1976 PSECU
SAVINGS 10/857.19 50 5/428.60
CHECKING 7/919.73 50 3/959.87
1983 SAVINGS 7/992.98 50 3/996.49
TOTAL (Also enter on line 6. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
77/834.96
STF PA42021 F.1 0
REV-1510 EX + (1-97) (I)
COMMONINEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
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 %OF
ITEM It\CLlDE TI-E NAME OF TI-E TRANSFEREE, TI-EIR RELATIONSHP TO DECEDENT AND TI-E DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER OF TRANSFER. ATTACH A COPY OF TI-E DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1. LPL FINANCIAL - IRA 14,856.59 100 14,856.59
2. AMERIPRISE 7,460.93 100 7,460.93
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on line 7, Recapitulation) $ 22,317.52
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F.11
REV-1511 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
1.
2.
3.
4.
5.
6 .
7.
8 .
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
DESCRIPTION
AMOUNT
CREEKSIDE FIRE COMPANY - DONATION FOR HALL USE - FUNERAL RECEPTION
ROLLING GREEN CEMETERY - GRAVE MARKER FOR LOT
CREEKSIDE FIRE COMPANY - FOOD FOR FUNERAL RECEPTION
CHANCEL CHOIR - HONORARIUM FOR FUNERAL SERVICE
RUSSELL SULIVAN - ADDITIONAL HONORARIUM FOR FUNERAL SERVICE
ANNE MYERS - HONORARIUM FOR FUNERAL SERVICE
TOM CLARK-JONES - ADDITIONAL HONORARIUM FOR FUNERAL SERVICE
JUNE FERGUSON - HONORARIUM FOR FUNERAL SERVICE
150.00
2,269.00
287.39
150.00
50.00
50.00
50.00
50.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Sodal Security Number(s) I EIN Number of Personal Representative(s}
Street Address
City
State
Zip
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant RICHARD R. BLESSING
Street Address 7 HUNTER LANE
City CAMP HILL State PA
Relationship of Claimant to Decedent SON
21,330.00
Zip 1 7 0 11
3,500.00
Probate Fees
448.00
Accountant's Fees
Tax Return Preparer's Fees
STATE EMPLOYEES RETIREMENT - REIMBURSEMENT
1,218.39
CUMBERLAND LAW JOURNAL
75.00
SENTINEL
122.51
SAUL EWING LLP - COPIES, POSTAGE, MILEAGE
34.07
STF PA42021 F.12
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
29 784.36
REV-1512 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
2 .
3.
4 .
5 .
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
DESCRIPTION
ALERT PHARMACY
DISCOVER CARD
PINE STREET PRESBYTERIAN CHURCH - 2005 PLEDGE
FIRST HORIZON - AUGUST MORTGAGE
PHILHAVEN
UNIVERSAL CARD - DONATION TO INTERNATIONAL RESCUE COMMITTEE
VERIZON
PINE STREET PRESBYTERIAN CHURCH - 2005 PLEDGE
CARE FOR THE CHILDREN - 2005 PLEDGE
DOCTORS WITHOUT BORDERS - 2005 PLEDGE
SOUTHERN POVERTY LAW CENTER - 2005 PLEDGE
WILDERNESS SOCIETY - 2005 PLEDGE
MESSIAH VILLAGE
FIRST HORIZON - SEPTEMBER MORTGAGE
UNIVERSAL CARD - DONATION TO INTERNATIONAL RESCUE COMMITTEE
ALERT PHARMACY
CARE FOR THE CHILDREN - 2005 PLEDGE
DOCTORS WITHOUT BORDERS - 2005 PLEDGE
CINGULAR WIRELESS - CLOSING OF ACCOUNT
MESSIAH VILLAGE - FINAL BILL
DOCTORS WITHOUT BORDERS - 2005 PLEDGE
CARE FOR THE CHILDREN - 2005 PLEDGE
H & R BLOCK - 2004 TAX RETURN
UNIVERSAL CARD - DONATION TO INTERNATIONAL RESCUE COMMITTEE
AMOUNT
82.08
58.00
203.66
544.25
37.88
15.00
32.12
203.66
12.00
31.00
30.00
20.00
7,601.25
544.25
15.00
14.00
12.00
31.00
0.08
1,170.15
31.00
12.00
269.00
15.00
STF PA42021F.13
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10,984.38
REV-1513 EX + (S-DO)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
RICHARD R. BLESSING
1. 7 HUNTER LANE
CAMP HILL, PA 17011 SON
AMOUNT OR SHARE
OF ESTATE
100% RESIDUE
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. PINE STREET PRESBYTERIAN CHURCH
HARRISBURG, PA 17101 - CASH
2. PINE STREET PRESBYTERIAN CHURCH
HARRISBURG, PA 17101 - AMERIPRISE ACCOUNT
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F.14
5,000.00
7,460.93
12 460.93
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of
DORIS JEAN BLESSING
No.
21-05-00868
also known as
Date of Death SEPTEMBER 6, 2005
I Deceased
Social Security No.
201-16-1890
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate 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 Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this~'n tory. I/We verify that e statements made in this Inventory are true and correct. I/We understand that
false statements h are made ubject t he penalties of 18. Pa. C.S. Section 4904 relating to unsworn falsification to
authorities. &
DO N~L. S · IR~E Personal Representative
Name of ~-J/) · A A..Af)~'
Attorney: ~~
1.0. No.: 06858
Address: P.O. BOX 1291 Dated: Od'.) (\.. C(.~
HARRISBURG, PA 17108-1291
(717) 257-7524
Telephone:
Description
PERSONAL ESTATE:
See Schedule "B" Attached
See Schedule "E" Attached
See Schedule "F" Attached
See Schedule "G" Attached
: V~lue
3241,583_.00
1 , 9 0 0 :-"C) 0
77,834.96
22,317.52
TOTAL
(Attach Additional Sheets if necessary)
426,635.48
121 M85 I 2/20/06
REV-1503 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
LPL FINANCIAL SERVICES
2.
AMERIPRISE
3.
AMERIPRISE
VALUE AT DATE
OF DEATH
27,304.19
170,897.37
126,381.44
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
STFPA42021F 4
324,583.00
REV-1508 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
Indude 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
GE CAPITAL ASSURANCE
1,890.00
2.
EAST PENNSBORO AMBULANCE
10.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,900.00
STF PA42021 F 9
REV-1509 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
If an asset was 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
A. RICHARD R. BLESSING
7 HUNTER LANE
CAMP HILL, PA 17011
SON
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bari( accolllt runber or similar identifying number DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 1989 7 HUNTER LANE, CAMP HILL, PA 1701] 128,900.00 50 64,450.00
DEED BOOK Y, VOL. 33, PAGE 528
2. A 1976 PSECU
SAVINGS 10,857.19 50 5,428.60
CHECKING 7,919.73 50 3,959.87
1983 SAVINGS 7,992.98 50 3,996.49
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
77,834.96
STF PA42021F10
REV-1510 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
DORIS JEAN BLESSING
FILE NUMBER
21-05-00868
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 %OF
ITEM INCLUDE WE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
NUMBER OF TRANSFER ATTACH A COpy OF THE DEED FOR REAL ES1A1E VALUE OF ASSET INTEREST (IF APPLICABLE)
1. LPL FINANCIAL - IRA 14,856.59 100 14,856.59
2. AMERIPRISE 7,460.93 100 7,460.93
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on line 7, Recapitulation) $ 22,317.52
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F 11
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~ccount #: 0000 0010 1097 0641 5 002
Ownership: AMERICAN EXPRESS TRUST COMPANY
CIO DORIS JEAN BLESSING
AS CUSTO FOR THE DORIS JEAN BLESSING
IRA
Value As of 09/06/2005
Shares NAV Principal Value
746.840 9.990 $7,460.93
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Ownership Information
Account #: 00000000569224793021
Account Status: ACTIVE
Opened Date: 06/04/1997
Ownership: DORIS JEAN BLESSING TOO
Plan Type: NON-QUALIFIED
Associated TIN: 201-16-1890
Taxpayer's Current Age: 79.7
Associated Group IDs - Select Group Account List
Group 10 Group Type
0392 7146 5 001 HOUSEHOLD
Associated Client IDs - Select Client Profile
Client 10 Client Name Role
136933983 001 MS DORIS JEAN BLESSING OWNER
TAXPAYER
Beneficiary Information
PRIMARY BENEFICIARY
RICHARD R BLESSING SON 100.000/0
Value
Cash Value: $8,131.06
Margin Value: $0.00
Total Securities Value: $118,250.38
Valuation Date: 09/06/2005
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t
ITotal Account Value:
$126,381.441
Positions Held
Ticker Quantity Estimated
Description Price Price Date Market
Symbol Held Value
AGERE SYSTEMS AGR 23.000 $10.98 09/06/2005 $252.54
AT&T CORP NEW T 155.000 $19.75 09/06/2005 $3,061.25
AVAYAINC AV 73.000 $10.00 09/06/2005 $730.00
BELLSOUTH BLS 868.000 $26.54 09/06/2005 $23,036.72
CORP
COMCAST CORP CMCSA 252.000 $30.69 09/06/2005 $7,733.88
A
LUCENT TECH LU 884.000 $3.06 09/06/2005 $2,705.04
INC
QWEST COMM Q 249.000 $3.91 09/06/2005 $973.59
sec COMM INC SBC 1604.000 $24.24 09/06/2005 $38,880.96
VERIZON COMMS VZ 736.000 $32.90 09/06/2005 $24,214.40
VODAFONE VOD 600.000 $27.77 09/06/2005 $16,662.00
GROUP
Address
Address: 7 HUNTER LN
CAMP Hill, PA 17011-2403
Notes:
. There are no active arrangements for this account.
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~ccount #: POOO 0011 5392 7146 7 002
Ownership: DORIS JEAN BLESSING
RICHARD R BLESSING-~-t'(\~1: \( 'lCA-r \/
I
Value As of 09/06/2005
Shares NAV Principal Value
38232.073 4.470 $170,897.37
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PSEC4P
OCT 1 8 2005
the financiallinkTM
October 17, 2005
Account # 0201161890
MARONETTA F MILLER
C/O SAUL EWING
2 NORTH SECOND ST 7TH FLOOR
HARRISBURG, PA 17101-1604
Dear MS MILLER:
The following is the status of DORIS J BLESSING's account with P8ECU as of her date of death.
J oint Owner' s Name
Date of Death
Date of Birth
RICHARD BLESSING, JOINT TENANT W/ROS SINCE 06/07/1996
09.06.2005
11.11.1925
Loan
L09
Description
VISA
Open date Balance Accrued Dividend
07.15.1976 $10,857.19 $1.12
7,919.73 0.27
Open Date Balance Accrued Interest
01.25.1999 $ 0.00 $0.00
Share
SOl
S 04
Description
Regular Shares
Checking
The dividend earned from January 1,2005 through the date of death was $51.81. We do not have safe deposit boxes
for our members. Enclosed is printout of her checking showing transactions done within 60 days of her death.
The following is the status of RICHARD BLESSING's account with PSECU as of the date of death of Doris J.
Blessing.
Joint Owner's Name
DORIS J BLESSING JOINT OWNER W/ROS SINCE OPENED
Share
" S 01
804
Description
Regular Shares
MoneyHandler
Open date
07.01.1983
07.25.2002
Balance
$7,992.98
0.00
Accrued Dividend
$0.82
0.00
The dividend earned from January 1, 2005 through the date of death was $41.84. If you have any questions, please
call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then
extension 2227.
Sincerely,
Meacie F . fax
Member Service Representative
Finance Support Unit
!
I
Pennsylvania State Employees Credit Union I
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 · (717) 234-8484 · (800) 237-7328 I
~____.__.__..___..______________~~~9_~~~~~~~~.~~~J~Ol~~17) 7~-21~~_.{80~~~96~~~_
~.j Savings federally insured up to $100,000 by the National Credit Union Administration www.psecu.com I
Page 1 of 1
Detailed Results for Parcel 09-19-1590-123. in the 2004 Tax Assessment Database
DistrictNo 9
parcel_ID 09-19-1590-123.
MapSuffix
HouseNo 7
Direction
Street HUNTER LANE
Owner1 BLESSING, DORIS JEAN
Owner2 & RICHARD R BLESSING
PropType R
PropDesc & BRENTWOOD ROAD
LivArea 1616
CurLandVal 30650
CurlmpVal 98250
CurTotVal 128900
CurPrefVal
Acreage 0.25
CIGrnStat
TaxEx 1
SaleAmt 35000
SaleMo 5
SaleDa 18
SaleCe 19
Sale Yr 89
DeedBkPage 0033Y -00528
YearBlt 1955
HF _File_Date 1/12/2005
HF ~pproval_Status A
http://taxdb.cCDa.net/details.asp?id=09-19-1590-123.&dbselect= 1
9/1/2005
I, DORIS JEAN BLESSING, of Cumberland County, Pennsylvania, declare
this to be my Will and revoke all prior Wills.
First:
Tangible Personal Property: I give all of my tangible personal
property, including any automobiles, together with all insurance on such property, to my son,
RICHARD R. BLESSING, if my son survives me by sixty days; otherwise I direct that such
property be sold and the proceeds added to the residue of my estate, for distribution as part
thereof. My Executor shall pay, as an expense of settling my estate, the costs of packing, _,
storage, shipping and insurance incurred in connection with the distribution of the":gifts ot~-~ -
tangible personal property made above.
"~
Second:
Cash Legacy: I give the sum of five thousand dollars ($5,O~2) to
the ENDOWMENT FUND OF THE PINE STREET PRESBYTERIAN CHURCH OF CLj
HARRISB URG with the use of the income to be designated by the Mission Commi ttee.
Third: Residue: I give, devise and bequeath all of the residue of my
estate, of whatever nature and wherever situated, to my son, RICHARD R. BLESSING, if my
son survives me by sixty days; otherwise my Executor shall divide the same into as many
equal shares as there shall be children of my son living at my death and children of my son
deceased represented by issue then living and shall distribute one such share to each child of
my son then living and one such share, per stirpes, to the issue then living of each such child
of my son then deceased. In the event that my son should not survive me by sixty days and
leave no surviving issue, I give the residue of my estate to the Trustee herein named, and the
Trustee shall hold for the benefit of my grandnieces and grandnephews living at the time of my
death as follows:
74990 I 1/2/01
a. Funds may be borrowed interest free by a beneficiary from the
trust for post high school education. In such event, no repayment shall be required
until two years after leaving the institution of higher education;
b. Any beneficiary who does not proceed to higher education may
borrow interest free from the fund for such purposes as making a down payment on a
home, beginning a business, etc., and shall be required to begin to make repayment of
such loan two years from date of such loan;
c. The legitimacy, appropriateness and approval of all applications
for participation in this fund shall be subject to the sole discretion of the Trustee whose
decision in all cases shall be final. It is anticipated that different members of the class
may be treated differently due to individual needs and requests, and changing economic
conditions. Participants shall comply with requirements of security, method of
repayment, rates of interest and all other conditions imposed from time to time by the.
Trustee;
d. Strict compliance with terms of repayment of one-half of the total
amount borrowed shall result in forgiveness of the other half. The Trustee, upon good
cause shown, (For example: unemployment, extended illness or return to school), may,
at his discretion, suspend, postpone or otherwise alter the repayment schedule in
individual cases; such forbearance will not act to disqualify borrowers from the benefit
of this provision;
e. Entitlement to participate in this program shall terminate as to
each applicant upon his or her attaining the age of twenty-five (25) years. At the time
the last surviving potential applicant shall have reached the age of twenty-five years,
this trust shall terminate and any remaining principal, accrued interest and unpaid
repayment obligation(s) shall be given, setover and assigned to the PINE STREET
PRESBYTERIAN CHURCH OF HARRISBURG ENDOWMENT FUND. In
addition, any obligation assigned to the PINE STREET PRESBYTERIAN CHURCH
OF HARRISBURG ENDOWMENT FUND will be subject to the provisions in
subparagraph d. above. Upon the transfer, the PINE STREET PRESBYTERIAN
CHURCH OF HARRISBURG will be responsible for the decisions regarding
outstanding loans.
Fourth: Minority Provision: Any income or principal which becomes
distributable to a minor (and for purposes of this Will, the term "minor" shall refer to a person
under age twenty-one) shall be held in a trust fund by the Trustee during minority. The
Trustee shall apply such amounts of income and principal as the Trustee, in the Trustee's sole
discretion, deems proper for the support, health, education and welfare of such minor and
shall accumulate any unexpended balance of income. Such amounts may be applied directly or
74990.1 1/2101
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,
may be paid to the person with whom such minor resides or who has the care or control of
such minor, without the intervention of a guardian. The Trustee shall not be obliged to
supervise or inquire into the application of such amounts by such person, and the receipt of
such person shall be a complete release of the Trustee. Should any such fund, in the sole
opinion of my Executor or Trustee, be or become too small to warrant continuing such fund in
trust, or should its administration be or become impractical for any other reason, my Executor
or Trustee, in the Executor or Trustee's sole discretion, may pay such fund, absolutely, to the
parent or other person maintaining said minor or may deposit such fund in the minor's name in
an interest-bearing account in a financial institution of the Executor or Trustee's choosing,
payable to the minor at majority. If such minor dies before attaining age twenty-one, s~ch
fund shall be distributed to such minor's estate.
Fifth:
Disability Provision: If any beneficiary shall, in the sole opinion of
the Trustee, become mentally or physically incapacitated, the Truste~ may apply the share to
which such beneficiary is otherwise entitled hereunder for such beneficiary I s support, health
and welfare, directly, without the intervention of a guardian.
Sixth:
Protective Provision: All principal and income shall, until actual
distribution to the beneficiary, be free of the debts, contracts, alienations and anticipations of
any beneficiary, and shall not be liable to any levy, attachment, execution or sequestration
while in the hands of my Executor.
Seventh:
Tax Clause: All estate, inheritance, succession and other taxes,
imposed or payable by reason of my death, and interest and penalties thereon, with respect to
all property owned by me at the time of my death and passing under this Will or under any
Codicil hereto, shall be paid out of the principal of my residuary estate, without apportionment
74990. I 1/2101 -3-
,
or right of reimbursement. Such taxes shall be paid at such time or times as may be deemed
advisable.
Eighth:
Powers of Fiduciaries: In addition to the powers given by law,
my Executor or Trustee, and any successors, without any order of court and in their sole
discretion, may:
a. Retain any real or personal property, as long as deemed
advisable.
b. Invest in any real or personal property in accordance with the
prudent investor rule.
c. Subscribe for stocks, bonds or other investments; join in any plan
of lease, mortgage, merger, consolidation, exchange, reorganization, foreclosure or
voting trust and deposit securities thereunder; and generally exercise all the rights of
security holders or employees of any corporation.
d. Register securities in the name of a nominee or in such manner
that title will pass by delivery.
e. Vote securities in person or by proxy, and in such connection
delegate discretionary powers.
f. Repair, alter, improve or lease, for any period of time, any real
or personal property, and give options for leases.
g. Sell at public or private sale, for cash or credit, with or without
security, exchange or partition any real or personal property, and give options for sales
or exchanges.
h. Borrow money from any person, including any fiduciary, and
mortgage or pledge any real or personal property.
i. Disclaim any interest or power granted to me under any
instrument or by operation of law.
j. Employ investment and legal counsel, accountants, brokers and
other specialists, and, whenever there shall be no corporate fiduciary in office, a
corporate custodian, and compensate them and reimburse their expenses out of income
or principal or both (in addition to fiduciary commissions), and delegate to investment
counsel (including an account executive at a securities firm) discretion with respect to
the investment and reinvestment of any or all of the assets held hereunder.
74990.1 1/2/01
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k. Use administration expenses as deductions for federal estate tax
purposes or fiduciary income tax purposes or partly for each, without making
adjustments between principal and income in consequence of the exercise of such
discretionary power.
I. Conduct any business in which I am engaged or in which I have
an interest at the time of my death, for such periods as may be deemed advisable and
with power to borrow money and pledge the assets of the business and do all other acts
which I, in my lifetime, could have done, without liability for any loss occurring
thereby; provided, however, that no asset of my estate which I have not devoted thereto
in my lifetime shall be liable for the debts and contracts of such business.
m. Organize a corporation, without leave of court, to carryon any
such business, alone or with others, and contribute all or part of the assets of such
business as capital to such corporation and accept stock in the corporation in exchang~
therefor.
n. Delegate authority in the conduct of any such business to any
director, stockholder, manager, agent, partner or employee, and approve payment from
the business of adequate compensation to any such person.
o. Accept as correct, in the absence of actual notice to the contrary,
financial and other statements rendered from time to time by the managers of any such
business or the surviving partners of any partnership as to its conditions and
operations.
p. Execute partnership agreements and amendments thereto.
q. Modify and renegotiate any agreements for the sale of any real or
personal property, including partnership interests, or waive the provisions of any such
agreements if it is beneficial to do so.
r. Compromise claims.
s. Make distribution in cash or in kind or partly in each.
t. Exercise all power, authority and discretion given hereby after
the termination of any trust created herein until the same is fully distributed.
Ninth: Release of Trustee; Court Accountings:
a. Upon the resignation, removal, death or incapacity of any Trustee,
the adult income beneficiary or beneficiaries of the trust, if then sui juris, shall have
the power to release the former Trustee and the Trustee I s estate and the renlaining
Trustee from all liability to every present or future beneficiary with respect to the
administration of the trust during the period that the former Trustee acted. I direct that
74990.1 1/2101
-5-
,
such release shall be binding on all present and future parties in interest without the
necessity of a court accounting.
b. In the event that a court accounting of the administration of any trust
hereunder ever becomes necessary, I request that the Court dispense, to the maximum
extent permitted by law (whether under the doctrine of virtual representation or
otherwise), with the necessity of the appointment of any guardian or trustee ad litem.
Tenth:
Appointment of Fiduciaries: I appoint my son, RICHARD R.
BLESSING, Executor of this Will. Should my son, for any reason, fail to qualify or cease to
act as such during the administration of my estate, I appoint DONN L. SNYDER, Executor
of this Will.
I appoint DONN L. SNYDER, Trustee under this Will. Should DONN L.
SNYDER, for any reason, fail to qualify or cease to act as such during the administration of
any trust under this Will, I appoint MARONETT A MILLER, Trustee.
Each successor Executor or Trustee named herein shall serve with the same
duties, powers and discretion as if originally appointed and any Trustee may resign without
court approval. No Executor named herein shall be required to give bond or furnish sureties
in any jurisdiction.
IN WITNESS WHEREOF I have hereunto set my hand and seal this ~rt'J
day of ~' 2001.
19~~ ~t
DORIS J N BLESSING'
(SEAL)
74990.1 112/01
-6-
SIGNED, SEALED, PUBLISHED and DECLARED by the above named
DORIS JEAN BLESSING as and for her last Will and Testament, in the presence of us, who,
at her request, in her presence and in the presence of each other, have hereunto subscribed our
Jd:~~ <<A-
ADDRESS ~
&-t
UJ//_~'" I
J ' .
/ V{j nil lll,! It 1. I(J
/ 9RESS
Prl
7499011/2/01
-7-
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF DAUPHIN
We, DORIS JEAN BLESSING, the testator, and nONN L. SNYDER
MARONETTA F. MILLER h' h . d h+"
and , t e wItnesses, W ose names are slgne to t e loregolng
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
testator signed and executed the instrument as her last Will and that she signed willingly, and
that she executed it as her free and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness'
and that to the best of the witnesses' knowledge the testator was at that time over eighteen
years of age, of sound mind and under no constraint or undue influence.
~~~,
DO JEf\N BLESSI u
--
Subscribed, sworn to and acknowledged before me by DORIS JEAN
BLESSING, the testator, and subscribed and sworn to before me by
DONN L. SNYDER
and MARONETTA F. HILLER , the witnesses, this .z
day of ~. 2001.
-11nJLl ~. '1J-ft:~
Notary Public
NOTARIAL SEAL
TERRI L METIL. Notary Public
Harrisburg. Dauphin County, PA
M Commission Ex ires Jur 28,2001
74990. ( 1/2/01
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BLESSING RICHARD R
7 HUNTER LANE
CAMP HILL, PA 17011
______n fold
ESTATE INFORMATION: SSN: 201-16-1890
FILE NUMBER: 2105-0868
DECEDENT NAME: BLESSING DORIS JEAN
DATE OF PAYMENT: 03/03/2006
POSTMARK DATE: 03/03/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 09/06/2005
NO. CD 006393
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $13,303.26
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$13,303.26
REMARKS: R R BLESSING
CHECK# 115
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS