HomeMy WebLinkAbout03-01-06
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
SNELBAKER RICHARD C
44 W MAIN STREET
MECHANICSBURG, PA 17055
_nn___ fold
ESTATE INFORMATION: SSN: 171-28-1001
FILE NUMBER: 2105-0522
DECEDENT NAME: FERTENBAUGH RUTH L
DATE OF PAYMENT: 03/01/2006
POSTMARK DATE: 03101/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 06/05/2005
NO. CD 006386
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,033.13
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
SNELBAKER & BRENNEMAN
CHECK# 2031
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
$1,033.13
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
R EV-1500 EX (6-00)
OFFICLA.L USE ONLY
. .
COMMONWEAL TH OF
PENNSYL VANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~L
COUNTY CODE
-9!L 0522 _ _ _
YEAR NUMBER
I-
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w
C
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w
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Fertenbau h Ruth
DA1E OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
6/5/2005 1/20/1936
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
L
SOCIAL SECURITY NUMBER
171-28-1001
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
W
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x:~lf.l
CJ O::X:
wll.CJ
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CJ 0::...1
II.m
a.
<(
[X] 1.
04
006
09
Limited Estate
Original Retum
o 2. Supplemental Retum 0 3. Remainder Return (date of death prior to 12-13-82)
D 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (date of death betweeo 12-31-91 and 1-1-95) 0 11. Election to tax under Sec. 9113(A) (Attach Soh oJ
Decedent Died Testate (Attach copy of Will)
Litigation Proceeds Received
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
I-
Z
W
C
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o
ll.
(J)
W
0::
0::
o
U
Richard C. Sne1baker
FIRM NAME (If Applicable)
Snelbaker & Brenneman, P.C.
1ELEPHONE NUMBER
44 West Main Street
Mechanicsburg, PA 17055
717-697-8528
Real Estate (Schedule A)
109,500.00
2,003.04
0.00
0.00
27,788.01
0.00
OFFICIAL USE ONLY
(1)
2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
Z 6. Jointly Owned Property (Schedule F) (6)
0 o Separate Billing Requested
i=
:5 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (7)
::::) (Schedule G or L)
I-
0: 8. Total Gross Assets (total Lines 1-7)
<C
()
W 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
c:::
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
39,583.38
(8)
14,564.71
1,351.37
178,874.43
(13)
15,916.08
162,958.35
0.00
(11)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for lM1ich an election to tax has not been
made (Schedule J)
(12)
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 0.00
z rate, or transfers under Sec. 9116 (a)(1.2)
0
f= 16. Amount of Line 14 taxable at lineal rate 162,958_35
<(
I-
::;) 0.00
a. 17. Amount of Line 14 taxable at sibling rate
:E
0 0.00
() 18. Amount of Line 14 taxable at c.ollateral rate
X
<( Tax Due
I- 19.
(14)
162,958.35
x .0 ~(15)
x .0 45 (16)
x12 (17)
x .15 (18)
(19)
0.00
7,333.13
0.00
0.00
fXl
20. ~
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
7,333.13
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
Decedent's Complete Address:
STREET. ADDRESS
$04 Ba Street, Ham den Townshi
Cumberland County
CITY
Mechanicsbur
STATE
PA
ZIP
~7050-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
7,333.13
0.00
6,000.00
300.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
6,300.00
0.00
0.00
Totallnteresl/Penalty (D + E) (3)
0.00
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)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
1,033.13
A Enter the interest on the tax due. (5A)
0.00
B. Enter the total of Line 5 + 5A This is the BALANCE DUE.
Make Check to: REGISTER OF
(5B)
1,033.13
AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. [KJ
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 ~
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. t 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.
Yes
No
D
D
D
D
~
~
~
~
D
~
SI~~TURE OF P~ON RESPONSIBLE FOR FlUNG RETURN
~tfZ)J/~, (( Xa-
ADDRESS
0~-+-i~
DATE
iJ kvl cio
Mechanicsburg PA
THAN REPRESENTATIVE
<' d'A/L.---
1045 Orrs Bridge Rd., Mechanicsburg, PA 17050
~1;~lob
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%
[72P.S.S 9916 (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. 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. S 9116(a)(1.2)J.
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. S 9116(1.2) [72 P.S. S 9116(a)(1 )J.
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. 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.
3W4646 1.000
. REV-1502 EX + (6-98)
. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Ruth L. Fertenbauoh
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 ha~ng reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
21 05 0522
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Property known and numbered as
604 Bay Street, Hampden
Township, Cumberland County,
Mechanicscburg, PA, sale value
(settlement sheet attached)
109,500.00
3W4695 1000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
109,500.00
A. Settlement Statement
U.S. Department of Housing
and Urban Development
~
,r
OMS Approval No. 2502-0265
B. Type of Loan
D D D 6. File Number
1. FHA 2. FmHA 3. Conv. Unins.
4. D VA 5. 00 Conv. Ins.
7. loan Number
8. Mortgage Insurance Case Number
208822
C. Note: This form is furnished to give you a statement of actual setUement costs. Amounts paid to and by the settlement agent are
shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not
included in the totals.
O. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of lender
MARK A. HAMILTON
JULIE A. HAMILTON
85 WALMAR MANOR
DILLSBURG PA 17019
GAIL F. HESS AND MEMBERS 1 ST
LISA R. McKINNEY, EXECUTRICES FEDERAL CREDIT UNION
ESTATE OF RUTH L. FERTENBAUGH 5000 LOUISE DRIVE
MECHANICSBURG PA 17055
H.SelllementAgent MEMBERS 1ST SETTLEMENT SERVICES, LLC
G. Property location
TAX PARCEL NO. 10-22-0521-008
604 BAY STREET
MECHANICSBURG
Place of Settlement
I. Settlement Date
PA 17050
5000 LOUISE DRIVE
MECHANICSBURG
PA 17055
1 0/25/2005
Disbursement Date
10/25/2005
lot;
Block:
J. Summary of Borrower's Transaction
------- -
K. Summary of Seller's Transaction
400. Gross Amount Due To Seller
109,500.00 401. Contract sales price
402. Personal ro e
2 781.67 403.
404.
405.
Adjustments for Items paid by seller in advance
406. City/town taxes to
42.15 407. Coun taxes 10/25/2005to 12/31/2005
109,500.00
100. Gross Amount Due From Borrower
101. Contract sales price
102. Personal property
103. SeWement charges to borrower (line 1400)
104.
105.
~c:Ij!Jstments for items aid by seller in advance
106. City/town taxes to
107. County taxes 10/25/2005 to 12/31/2005
108. Assessments to
109. SCHOOL TAX 1 0/25/2005 to 6/30/2006
42.15
408. Assessments
to
629.99 409. SCHOOL TAX 1 0/25/2005 to 6/30/2006
629.99
110.
111. SEWER
112.
113.
114.
115.
to
10/25/2005to 12/31/2005
to
to
to
to
410.
83.75 411. SEWER
412.
to
10/25/2005to 12/31/2005
83.75
to
120. Gross Amount Due From Borrower
413. to
414. to
415. to
113,037.56 420. Gross Amount Due To Seller
200. Amounts Paid By Or In ,Behalf Of Borrower
201. Deposit or eamest money
202. Principal amount of new loan(s)
203. Existin loan(s) taken subject to
204.
205.
206.
207.
20B.
209.
110,255.89
8,770.00
506.
507.
50B.
509.
Adjustments for items unpaid by seller
210. City/town taxes to
211. Coun taxes to
Adjustments for items unpaid b seller
510. Ci /town taxes to
212. Assessments to
213. to
214. to
215. to
216. to
217. to
21B. to
219. to
511. Coun taxes to
512. Assessments to
513. to
514. to
515. to
516. to
517. to
51B. to
519. to
220. Total Paid By/For Borrower
96,500.00 520. Total Reduction Amount Due Seller
600. Cash At Settlement To/From Seller
113 037.56 601. Gross amount due to seller (line 420)
96,500.00) 602. Less reductions in amI. due seller (line 520)
8,770.00
300. Cash At Settlement FromlTo Borrower
~---~._.
301. Gross Amount due from borrower (line 120)
302. Less amount paid b /for borrower (line 220)
303. Cash
00 From
D To Borrower
16,537.56 603. Cash
00 To
D From Seller
110,255.89
8,770.00)
101,485.89
SUBSTITUTE FORM 1099 SELLER STATEMENT
The information contained in Blocks E. G, H, and I and on line 401 (or, line 403 and 404) is important tax information and is being furnished to the Intemal Revenue
Service. If you are required to file a retum, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines
that it has not been reported. If this real estate is your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax
retum; for other transactions, complete the applicable parts of Form 4797, Form 6232 and/or Schedule D, Form 1040). You are required to provide the Settlement Agent
(named above) with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be
subject to civil or criminal penalties imposed by law. Under penalties of pe~ury, I certify that the number shown on this statement is my correct taxpayer identification number.
(Seller's Signature)
L. Settlement Charges
700. Total Sales/Broker's Com_mission based on price $ 109,500.00@ 7.00 'Yo = 7,665.00 Paid From Paid From
Division of Commission (line 700) as follows: Borrower's Seller's
701. $ 3,285.00 to C-21 HERITAGE REALTY Funds At Funds At
4,380.00 COLDWEll BANKER HOMESAlES Settlement Settlement
702. $ to
703. Commission paid at Settlement 7,665.00
704.
800. Items Payable In Connection With Loan
801. Loan Origination Fee 94,500.00 %
802. Loan Discount 94,500.00 %
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee
806. Mortgage Insurance Application Fee to
807. Assumption Fee
808. APPLICATION FEE MEMBERS 1ST ($50.00 P.O.C.) 300.00
809.
810.
811.
812.
813.
. d B L d T B P 'd I Ad
Ex I did
900. Items Require y en er 0 e al n vance cu east ay 10 ca cs - me 901
901. Interestfrom 10/25/2005 to 10/31/2005@$12.2979 / day 86.09
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for years to
904. years to
905.
1000. Reserves Deposited With Lender
1001. Hazard insurance 3 months@$ 26.00 per month 78.00
1002. Mortgage insurance months@$ per month
1003. City property taxes months@$ per month
1004. County property taxes 9 months@$ 19.14 per month 172 .26
1005. Annual assessments months@$ per month
1006. SCHOOL TAX 5 months@$ 77.27 per month 386.35
1007. months@$ per month
1008. Aggregate Accountina Adiustment -514.28
1100. Title Charges
1101. Settlement or closing fee to
1102. Abstract or title search to
1103. Title examination to
1104. Title insurance binder to
1105. Document preparation to SNElBAKER & BRENNEMAN P.O.C.
1106. Notary fees to CASH 10.00 10.00
1107. Attorney's fees to
(Includes above items numbers: )
1108. Tille insurance to MURREl R. WALTERS, III, ESQUIRE 983.75
(Includes above items numbers: 1101-1'104,1108 PENN ATTORNEYS TITLE INS. CO. )
11 09. Lender's coverage $ 94,500.00 endorsements 100,300,8.1
1110. Owner's coverage $ 109,500.00
1111.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Recording fees: Deed $ 39.00 ; Mortgage $ 68.50 ; Releases $ 107.50
1202. City/county tax/stamps: Deed $ 1,095.00 ; Mortaaae $ 1,095.00
1203. State tax/stamps: Deed $ 1,095.00 ; Mortgaae $ 1,095.00
1204. RECORD ASSIGNMENT OF MORTGAGE 27.00
1205.
1300. Additional Settlement Charges
1301. Survey to
1302. Pest inspection to TElE-PEST 50.00
1303.
1304.
1305.
1306.
1307.
1308.
1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 2,781.67 8,770.00
Borrower
Borrower
ccount of the funds which were received and have been or will
Settlement Agent
/0 /.2 *7 fe-7
Date
e statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and
e Section 1001 and Section 1010.
U.S. GOVERNMENT PRINTING OFFICE: 1... ...44-245
REV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Ruth L. Fertenbaugh
21 05 0522
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
2,003.04
1. Electronic Data Systems Corp (EDS)
104 shares of common stock valued
at $19.26 per share
TOTAL (Also enter on line 2, Recapitulation) $
2,003.04
3W46961.000
(If more space is needed, insert additional sheets of the same size)
'REV,1508 El< + (e.-9S)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Ruth L. Fertenbauqh
ITEM
NUMBER
3W46AD 1000
FILE NUMBER
21 05 0522
I nclude 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.
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Central Pennsylvania Conference of
the United Methodist Church
certificate of deposit #15935
2
Community Banks
certificate of deposit #348153108
3
CVS Pharmacy, Inc,
refund on prescriptions
4
Haar's Auction
net proceeds from sale of
household goods
5
Hospice of Central PA
refund on hospice care
6
Household goods
sale value of Kitchen table,
chairs and recliner
7
Household goods retained by family
8
Jewelry
consisting of pearl stud earrings .
and garnet ring, appraised value (appra~sal attached)
9
Patriot-News
refund on newspaper subscription
$
(If more space is needed, insert additional sheets of the same size)
5,027.13
10,004.05
29.88
856,77
1,512.50
75.00
10,209.00
25.48
48.20
27,788.01
w~ '_c"
. "
MUNN'S
diamond gallery
Gail Hess
1045 Orrs Bridge Road
Mechanicsburg, P A. 17050
Estate Value Appraisal
,
First Item for Appraisal: One (1) pair ofIadies' pearl stud earrings:
Major Stones: Two (2) round shape pearls:
Measurements: 4.7mm each. Very badly worn, No luster left due to deterioration
of outer layer of nacre. One pearl has a hole where post is showing through.
14K yellow gold mountings and screw backs. Mountings very worn and dented.
Weight: .08dwt. / pair. Scrap value: $ 6.85 per dwt.
Estate Value of this Item: ..... ..... ............... ......... ...................... ...........
$ 5.48
Second Item for Appraisal: One (2) pear shape garnet ring:
Measurements: 10mm x 7.0mm. Shows signs of wear. Chipped and abraded.
Mounting: 10k yellow gold mounting, with garnet set in 3-prong basket style setting.
Very worn, prongs very thin. Weight: 1.3dwt." Scrap value: $6.85 per dwt.
1203 Market Street
Lemoyne, PA 17043
$ 20.00
Estate Value of this Item.... 0........0.................... 0..... 0.............................
~#~'
October 10, 2005
'~~'
r (717)-
Fax (717)-
1-877-DI
'REV.-1510 EX + (\}98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruth L. Fertenbauqh
FILE NUMBER
21 05 0522
ITEM
NUMBEF
1.
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
IN::LLOE n-E NAME OF TI-E TRANSFEREE, ~HEIR RELATIONSHIP TO DECEDENT AND
TI-E DATE OF TRMSFER ATTACH A COPY OF Tf-E DEED FOR REAL ESTATE
3W46AF 1000
Community Banks
checking account #148005163
opened 10/14/2004 jointly with
Gail F. Hess
DATE OF DEATH % OF DECO'S
VALUE OF ASSET INTEREST
23,506.98 100.0000
2
Community Banks
certificate of deposit
#348152966 opened 10/14/2004
jointly with Lisa R. McKinney
10,144.48 100.0000
3
Community Banks
certificate of deposit
#348153019 opened 12/23/2004
jointly with Donald E.
Fertenbaugh, Jr.
8,931.92 100.0000
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
EXCLUSION
(IF APPLICABLE)
3,000.00
0.00
0.00
TAXABLE
VALUE
20,506.98
10,144.48
8,931. 92
39 583.38
REV-1511 EX + (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruth L. Fertenbaugh
ITEM
NUMBER
A.
B.
4.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
1.
Auer Memorial Home & Cremation
Services
funeral services
Total from continuation schedules
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
Snelbaker & Brenneman, P.C.
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
5. Accountant's Fees
Probate Fees
7.
6. Tax Return Preparer's Fees
1
2
3W46AG 1.000
Comcast Cable
cable TV service
Cumberland Law Journal
advertising Executrices notice
Total from continuation schedules
FILE NUMBER
21 05 0522
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
AMOUNT
85.00
525.00
2,000.00
311.00
90.38
75.00
11,478.33
14,564.71
Estate of: Ruth L. Fertenbaugh
171-28-1001
Schedule H Part 1 (Page 2)
Item
No.
Description
Amount
2
John Kurtz & Janis Glosenger
services provided during funeral
200.00
3
Mechanicsburg Cemetary Assoc.
opening/closing of grave
200.00
4
United Methodist Church
donation to hospitality fund for
funeral luncheon
125.00
Total (Carry forward to main schedule)
525.00
Estate of: Ruth L. Fertenbaugh
171-28-1001
Schedule H Part 7 (Page 2)
3
L.G. Connor Real Estate Appraisers
real estate appraisal fee
300.00
4
Munn's Diamond Gallery
jewelery appraisal
50.00
5
Patriot News
advertising Executrices notice
151.59
6
PP&L Electric
electric service
290.77
7
R.F. Fager
insulation and tape required for
basement
256.52
8
Register of Wills
short certificate
4.00
9 Settlement charges associated with
the sale of property
a. Realtors Commission -
$7,665.00
b. Notary fees - $10.00
c. Transfer tax - $1,095.00
8,770.00
10
The Home Depot
tape for sealing packing boxes
10.40
11
U-Haul
packing boxes
59.53
12 Uni ted Water PA
water service
28.92
13
Verizon
phone service
30.78
14
Walmart
light for stove and weed killer
13.14
15
York Waste Disposal
trash dumpster fee
512.68
16
Reserve
for filing fees, accounting fees
and other costs associated with
the administation of Decedent's
estate
1,000.00
Total (Carry forward to main schedule)
11,478.33
'RE'{-1512 E'X+ (/2-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruth L. Fertenbaugh
FILE NUMBER
21 05 0522
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
3W46AH 2.000
DESCRIPTION
AT&T
phone service
2
Chase Card Services
credit card expense
3
Comcast Cable
cable TV service
4
EKG Associates
medical services
5
Hampden Township
sewer/refuse service
6
Holy Spirit Hospital
medical expense
7
Keystone Oil
fuel oil
8
Marie Huber, Tax Collector
Real estate taxes
9
Oakwood Center
resident care
10 PP&L Electric
electric service
11 United Water PA
water service
12 Verizon
phone service
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
46.38
26.50
45.19
3.54
115.00
29.60
65.00
927.21
14.03
45.68
6.76
26.48
1,351.37
,REV-1513.EX+ (9-00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruth L. Fertenbauah
NUMBER
I
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Donald E. Fertenbaugh, Jr.
4253 Deacon Court
Concord, NC 28025-3752
33.333333 of Residue: 54,319.45
2 Gail F. Hess
1045 Orrs Bridge Road
Mechanicsburg, PA 17050
33.333333 of Residue: 54,319.45
3 Lisa R. McKinney
22 Lilac Drive
Mechanicsburg, PA 17050
33.333333 of Residue: 54,319.45
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
Daughter
Daughter
FILE NUMBER
21 05 0522
AMOUNT OR SHARE
OF ESTATE
54,319.45
54,319.45
54,319.45
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46AI 1000
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)
$
0.00
LAW OFFICES
SNELBAKER.
McCALEB & ELICKER
-=;'~--
LAST WILL AND TESTAMENT
I, RUTH L. FERTENBAUGH, of the Township of Hampden,
County of Cumberland and Commonwealth of Pennsylvania, being
of sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament,
hereby revoking and making void all former wills and codicils
by me any time heretofore made.
FIRST.
I order and direct that all my just debts and
funeral expenses be paid by my Executor or Executrices, as
the case may be, hereinafter named, as soon as conveniently
may be done after my decease.
SECOND. I give, devise and bequeath all the rest,
residue and remainder of my Estate, real, personal and mixed,
whatsoever and wheresoever situated, unto my husband, DONALD E.
FERTENBAUGH, absolutely and in fee simple, if he survives me
by as many as sixty (60) days.
THIRD. If my husband, DONALD E. FERTENBAUGH, does not
survive me by as many as sixty (60) days, then and in that event,
I give, devise and bequeath all the rest, residue and remainder
of my Estate, real, personal and mixed, whatsoever and where-
soever situated in equal shares unto my three children,
namely, DONALD E. FERTENBAUGH, JR., GAIL F. HESS and LISA R.
WERT, share and share alike, absolutely and in fee simple.
If any of my said children should predecease me
and leave lawful issue to survive me, I order and direct that
the foregoing share of any such deceased child shall be
distributed unto his or her lawful issue per stirpes by
representation and not per capita, but subject, however,
LAW OFFICES
SNELBAKER.
MCCALEB Be ELICKER
to the protective provisions of Item Fourth hereinbelow.
FOURTH. I order and direct that the distributive share
of any beneficiary hereunder who has not attained the age of
twenty-three (23) years at the time for distribution of said
share shall be paid over and delivered unto THE FIRST BANK
AND TRUST COMPANY OF MECHANICSBURG, PA., (or its successor by
merger or other corporate consolidation) as my testamentary
trustee, IN TRUST, NEVERTHELESS, to hold, manage, invest and
reinvest the same until said beneficiary attains the age of
twenty-three (23) years, upon which latter event said trust
shall be terminated and the then remaining net balance thereof
shall be distributed unto the beneficiary absolutely. During
the existence of any such trust, I authorize and empower my
said Trustee to use, expend and apply from time to time such
amounts of both income and principal as only said Trustee in
the sole exercise of its discretion shall determine to be
necessary and proper for the beneficiary's support, maintenance
and education, including college or other post high-school
training.
LASTLY. I nominate, constitute and appoint my husband,
DONALD E. FERTENBAUGH, to be the Executor of this, my Last
Will and Testament, but if for any reason he shall fail to
qualify as such Executor or cease so to serve, then and ln
that event, I nominate, constitute and appoint my son, DONALD E.
FERTENBAUGH, JR., to be the Executor hereof. If both of the
above named persons should fail to qualify as my personal
representative hereunder or cease so to serve, then and in
that ultimate event, I nominate, constitute and appoint my
daughters, GAIL F. HESS and LISA R. WERT, to be the Executrices
.,
LAW OFFICES
SNEI.BAKER.
McCAI.EB Bt EI.ICKER ,
of this, my Last Will and Testament.
larder and direct that none of the above named persons
shall be required to post bond or other security in order to
qualify as my personal representative hereunder.
IN WITNESS WHEREOF, I, RUTH L. FERTENBAUGH, have hereunto
set my hand and seal to this, my Last Will and Testament which
I
consists of three (3) typewritten pages to each of which I have
affixed my signature this '%9~. day of l1(jlt~-/~v ,A.D.
One Thousand Nine Hundred Eighty-four (1984).
.a,a/- hA:d;--t7--? (SEAL)
The preceding instrument, consisting of this and two (2)
other typewritten pages, each identified by the signature of the
Testatrix, was on the date thereof signed, sealed, published and
declared by RUTH L. FERTENBAUGH, the Testatrix therein named,
as and for her Last will and Testament, in the presence of us,
who, at ,her
in the presence of eac:
other, have subscribed our
s ereto.
.'LLa-p__.r~J
. m, (-t (\AP-A(}
.......~"..
COlf~ONWEALTH OF PENNSYLVANIA
COUNTY
SS.
OF
CUMBERLAND
We, RUTH L. FERTENBAUGH, RICHARD C. SNELBAKER and JANET M.
FORRY, the Testatrix and the witnesses, respectively, whose name
are signed to the attached or foregoing instrument, being first
duly sworn, do hereby declare to the undersigned authority that
the Testatrix signed and executed the instrument as her Last
will and Testament and that she had 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 Testatrix, signed the Will as witnes
and that to the best of his or her knowledge the Testatrix was
at that time eighteen years of age or older, of sound mind and
under no constraint or undue influence.
~o.Jvd,-t YJ'l.
.' . Witness
J .. '. .
+~
Subscribed, sworn to and acknowledged before me by RUTH L.
FERTENBAUGH, the Testatrix, and subscribed and sworn to before ml
by RICHARD C. SNELBAKER and JANET M. FORRY, witnesses, this
C2 9/1.
'I,
day of /Z<-'--V-I!.-?JLi_fI.-,v
, 1984.
,'/') . c:.{' '\L)' . /
~;. .I:I-/'-k?'-c(/~ , \~ /~_<.. ,~(/ J
- Notary Public
rt t i\;r~ ~~ ~~~~:': f:.:;:~;~~, ~ ~ :n;~!;.:~:~ ';~;'~jTY
r'. __ :".
!'.:. ~ :~.; ;~.: f~: ;,):.?i,~; ~,~7i
LAW OFFICES
SNELBAKER.
McCALEB Be ELICKER