The URL can be used to link to this page

Home My WebLink About05-04-06 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 HOUSEAL PEGGY M PO BOX 7 DOVER, PA 17315 _nn___ fold ESTATE INFORMATION: SSN: 184-12-2073 FILE NUMBER: 2105-0840 DECEDENT NAME: MELLINGER FRANCES W DATE OF PAYMENT: 05/04/2006 POSTMARK DATE: 05/04/2006 COUNTY: CUMBERLAND DATE OF DEATH: 08/06/2005 NO. CD 006656 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1 ,322.02 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1057 INITIALS: MG SEAL RECEIVED BY: REGISTER OF WILLS $1,322.02 GLENDA FARNER STRASBAUGH REGISTER OF WILLS ~ ~\ ::D n %\ '" ~ '" n '" '" '" n c <: '" J: ;, \ '" z ;i \ o 0 ~ ~ \'- 0 ~\ 0 "- "T\ ~\ :0 ~\ \~ z \\ "'0 \~ 0 ~ -I () g\ ~\ 0 m ~\ ~ rn (J) h;; ~ ~\ ~ 'O~ (") i\ :I: 0 ~; ::t: ~ ~\ ~ ~~ ~ m 0 ~~ = E ~\ C .;:. ?,::D !/) ~\ (J) ~~ <. .. \~ ~\ m \\ ~ CJ.:\ gw, 0 0 t::t ~? C ~\ ~i ("l 0 " ... ::t: ~\ ';; rn .... ~\ ~ '" :D 0 "\ \J1 \\, -:1 .. 0-4"'0 0 ~O~ - ~ 0-4:<' ('t) m:1: .. ~rn ~ n.J -t 0 r >",-1 -;:s- ." zz~ y.J <og~ 0 ;0 o<.:a(') c: rT'\ y.J og~~ Vl Ci> gmz -V (')Q(') s:u l-"'4 _:r. ~ ~ V> :lo r -n;~~ C\- -t n.J ~!i:a~ rT'\ ~Z1S -\ ;0 .... -Ir-"'""" -;:s- ~Q ):10"'<'< ~ -t OJ (')~;~ """S 0 ~m ~~~6 ('t) .." - ct> :mX .. O~!/)~ ~ ~~~ :x: ...... ~~~ ru c: r- r ~ r- ~m C\- V> ru """S CD tP ('t) 0.- ')::a -t 0 \ \ Ci> 0 \ \ \ -t rn ~ :z rr> \~ ('t) -t CJi I ~ ;::::- c-T .." ';~' r . \ ~ " , \ ~~\ ~ \J\ . ~ \ "'0 ~ \ m 0 0 :;; t \ ~ s:u ~ ~~ ; \ ~ rn ~\ "T\ ~\ '\ :0 ~ 0.- ~ \ ~ C> \ :t C> .$> () 0 rv , \ m c w (J) r;,Wt ~ ~ C> \ -I')> C> , \ ~ ~.r C> rv \ {'T\ ~{'T\ , 0 \ r- ~ , 0 \ C , 0"1 Z \ Z 0 , 4::ft \ G> c 0 9 \ -\ 0 \ ~ :0 \ )( I"'" ~ I"'" 'Jl' .. \ :D W ~\ \ rJ) rv ~\ rv ~\ \ . ~ ~ ~\ \ 8> \ C> , 0 -..I \ \ rv ~ \ or at \ \ ~ \ "'- "" -J \ \, g. ." t;, \, i \ '" -------- --------- REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVEN UE DEPT. 280601 HARRISBURG, PA 17128-0601 r.R'EV-'11500 INHERITANCE TAX RETURN ,RESIDENT'DECEDENT OFFICIAL USE ONLY FILE NUMBER COlNTY COtE YEAR N..MI:ER SlF PA42021F.1 to- Z W C W o W C DECEDENTS NAME (lAST, ARST, AND MIDDLE INITIAl...) MELLINGER, FRANCES W. DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD- YEAR) 08-06-2005 04-20-1924 (IF APPUCABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) N/A [Xl 1. Original Return D 4. United Estate [Xl 6. Decedent Died Testate (Attach copy of 'Mil) D 9. Utigation Prcx:eeds Received W I- :::.:::~C/) uO::::::'::: wa.u :::coo uO:::-l a. CD a. <: D 2. SUpplemental Return D 4a. Future Interest Compranise (dale of death after 12-12-82) D 7. Decedent Maintained a Uvirg Trust (Attach copy of Tnst) D 10. Spousal Poverty Credit (date of death between 12-31-91 an:l1-1-95) SOCIALSECURI1YNUMBER 184-12-2073 THIS RETURN MUST BE ALED IN DUPUCATE Wlni THE REGISTER OF WILLS SOCIALSECURI1YNUMBER D 3. Remainder Return (dale of dealh pOOr to 12-13-82) D 5. Federal Estate Tax Return RequirED _ 8. Total Number of Safe Deposit Boe D 11. Bedioo to tax under See. 9113{A) (AttachSchO) I- Z W o Z o a. C/) w 0::: 0::: o U .....nTHls...SECTION.MUST(BE....CQM~li'AL.ttCCJRRESRONDENCE.ANDj:~()NEIDENTlA1.:trA)C'ItFORM:A1lC)NtSMeliJmiae'imlRECrrEDn70; NAME COMPLETE MAILING ADDRESS PEGGY M. HOUSEAL P.O. BOX 7 FIRM NAME (If Applicable) DOVE R, P A . 1 7 3 15 TELEPHONE NUMBER 717-767-9490 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 147,000.00 0.00 0.00 0.00 96,179.95 z o 5 :J t- o: < o w ~ 3, Closely Held Corporatioo, Partnership or Sole-Proprietorship 4. Wortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly ONned Property (Schedule F) D Separate Bilting Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Unes 1 - 7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Uabilities, & Uens (Schedule I) 11. Total Deductions (total Unes 9 & 10) (9) (10) OFFICIAL USErElNLY '-:> -c: I r-- ----0 (6) 70,893.61 0' (8) 1,885.00 1,410.38 (11) (12) (13) X.O_ (15) 0.00 3 0 9 , 3 7 8 . 18 X.O 4 5 (16) 13,922.02 X .12 (17) 0.00 X .15 (18) 0.00 (19) 13,922.02 19. TaxDue 20. 0 \ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT/ > >>BE SlJRE TOANSWERAL:.L.QlJESTIQNS,ON REVERSE.. SIDE AND RECHECK. MATH < < (7) 12. Net Value of Estate (Une 8 minus Une 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an e1ectioo to tax has not been made (Schedule J) 14. N&tValue Subject to Tax (Une 12 minus Une 13) SEE INSTRUCllONS FOR APPUCABlE RATES z o ~ ~ :J a. :E o o ~ 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under See. 9116 (a)( 1.2) 16. Amount of Une 14 taxable at lineal rate 17. Amount of Une 14 taxable at siblirg rate 18. Amount of Une 14 taxable at cdlateral rate ..,," ' 0.00 314,073.56 3,295.38 310,778.18 1,400.00 (14) 309,378.18 .~ ..... . .; ;<~~,) "'> r:~" ~;"'" ,) r~.>\" \- '<:b \", '", ) :l.-_ -(. - :'::?.. '. -~..::. (.>-- t.~) ~ . \'~ ~) "s... Decedent's Complete Address: STREET ADDRESS 16 CENTER DRIVE CIlY CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 1 STATE PA I ZIP 1 7 0 11 (1 ) 13,922.02 12,000.00 600.00 Total Credits (A + 8 + C) (2) 12,600.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 1,322.02 A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 1,322.02 PLEASE ANSWER THE FOLLOVVlNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use orincome 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, 1 982, 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 I ndividual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... . . . . . . . .. . . . . . . . .. D [XJ 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 pe~ury, 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. ~REOFP R~ONRES =GN&UR~ ADDR P.O. BOX 7, DOVER, PA 17315 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE No [XJ [XJ [XJ ~ [XJ [Xl DATE .y-30- DATE ADDRESS For 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 orforthe use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2)[72 P.S. 99116(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. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. STFPA42021F.2 r- LO o -r-t (0) ~ N ~ r- I o <0 o Z \.0 o o N I o M I ~ o w I- <x: o I- Z t- l.J,.J c:.!J OJ <( W~ (./) ~Z6 -l -l J: <(~ """""' m~ ::3: I-lD~ L..L- II t!) ~ 0 c::: O~~ w.J ~Cl. ....... Z~~ (/) UJ~ 10-4 ~ ~ w.J c::: u. 0 wct :I:UJ >-1-0 <(oct 0.1-0 i ~i1 ,~\ ;;; a: i~ W I;;' X ~i ; ~ .CJ z'" '~ j ~ ::l J.., \~ a: aa; 0 "'G ~ ~ \~ uJ :;> ~~ <( C) w : ~ z 1Il -::t-i (fJ ~~ ::l ~ :::i X i ! ~ ....J I- jU 0 LU x ~~ I ., :2 13 ,r CJ ~~ ~ ~ c{ I ~ I- G~ - 'fl;- , I >- l::-' W CJ ,,,- (j) 0 C"-.! UJ I- \~I: CJ 0 w z 0 a.. <:( z ~\ a: 0 u... 0 \ N o i ! ill C8 . N N (Y) en a: < ..! -1 o C I I I I o o ~ ~ x a: I- ::l o W >< 1l.I"- o J~ ~~ Cf)W N ::l o ~ '"0 :E c >- n:s CJ CJ o UJ ~ a.. +.J I uq. l +.J C aJ ~ t- -c OJ s... -c c ~ :::c aJ OJ s... ..c I- -c c n:s Vl ~ o ..cl :\ 5\ IE ii I I \ a: Il.I (!) Z ::i ....J Il.I ~ s: en w o z <( a: u.. \ I I I I ,VI; I -~ I~jl~. I ~ I ;~ I \;;. ~: {:~ : ,CC I \ dl \ \ \ 0 o t.D ru .J n.J -' w . ~e~ ::llll ~O\ e~iii~. r::C. ;i~t:u ~~~~ ... oa:I-W ~z~o n.J _ow~ ~~~~ ~~go !!!go> xzZ I-Wc{ .:r r'- rn rn .:r n.J .. - ~ ['- Lf1 o ... o o ~ ~ \:::,,\~ l R ~f)~~'... . V') ',- ('~ "--0\ \ ~I ).J:l C, c: w ::I: Z ~ Ul ~ ~ ~ z REV-1502 EX + (1-97) (I) COMM~LTH OFPE~SYLVANlA INHERlTAI'CE TAX RETtRN RESIDENT DECEDENT SCHEDULE A 'REAL ESTATE ESTATE OF FILE NUMBER All real property owned sotely or as a tenant in common must be reported at fair market vaJue. Fair market value is defined as too prire at which propertywCllid beE!)Changed between a willirg buyer and a willing seller, neither being compelled to buy or sell, both having reascmble krnNledge of too relevant fcds. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Personal Residence-16 Center Drive, Camp Hill,Pa Assessed Valuation times CLR 147,000.00 STFPA42021F.3 TOTAL (Also enter on line 1 f Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 14 7', 0 0 0 . 0 0 REV-1508 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FRANCES W. MELLINGER FILE NUMBER 21-05-0840 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 NUMBER 1. DESCRIPTION M & T Bank Checking Account No. 59508183 0.0.0. Balance Accrued Interest VALUE AT DATE OF DEATH 71,680.36 2 . Member's 1st FCU Money Management Account No. 223141-05 0.0.0. Balance Accrued Interest 20,871.04 3.55 3. Automobile - 1996 Oldsmobile Ciera Sedan 0.0.0. Appraised Value 1,000.00 4 . Cash on Hand 125.00 5. Personal Property 2,500.00 TOTAL (Also enteron line 5, Recapitulation) $ (If m ore space is needed, insert additional sheets of the same size) 96,179.95 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 FRANCES W. MELLINGER FILE NUMBER 21-05-0840 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. PEGGY M. HOUSEAL P.O. Box 7 Dover, PA 17315 Daughter B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of finan::ial institution and bark accoLllt number or similar identifyirg number. DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 2000 Commerce Bank Savings Account No. 0.00 0616160264 0.00 0.0.0. Balance 100,570.62 50% 50,285.31 0.0.0. Accrued Interest 143.04 50% 71.52 0.00 2 A 2002 Members 1st FCU Checking Account 0.00 No. 223141-11 0.00 0.0.0. Balance 13,654.70 50% 6,827.35 0.0.0. Accrued Interest .47 50% 0.24 0.00 3 A 2002 Members 1st SCD Savings Account 0.00 No. 223141-00 0.00 0.0.0. Balance 27,380.86 50% 13,690.43 0.0.0. Accrued Interest 37.51 50% 18.76 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL (Also enteron line 6, Recapitulation) $ 70,893.61 (If m ore space is needed, insert additional sheets of the same size) STF PA42021 F.1 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280&01 HARRISBURG, PA 17128-0&01 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 05-0840 ACN 06001441 DATE 03-29-2006 REV-1543 EX AFP (09-00l TYPE OF ACCOUNT [X] SAVINGS D CHECKING D TRUST D CERTIF . EST. OF FRANCES W MELLINGER 5.5. NO. 184-12-2073 DATE OF DEATH 08-06-2005 COUNTY CUMBERLAND PEGGY M HOUSEAL 16 CENTER DR PO BOX 7 DOVER PA 17315 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE) PA 17013 COMMERCE BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 616160264 Date 08- 08-20 0 0 Established PART [!] 100}570.62 50.000 50}285.31 .045 2}262.84 TAXPAYER RESPONSE .........................................-.................................................-.................................-...............................................................'.............................-...-..................._.........................-.-.-.........................-....:....-.-,.,........-...-...-...-...........-...-...-...............................-.-............................ ;: ;:;:~!Jt;;!I! ~gnR"'" ~';"'?!r.:;!ii;;:;:'R"" i!i.! 's"" i!i:;!iij,J?ri;:;:' j~:;r.!I!EK ,,;:, .R".. 'E'" 'l:!!I;jt;;i!r.;'::;: il!j,J';:: '!itj,J;';:;:;!ii:!!!'j!!!;;r. :t.i!:;r.;Jt;t;!'::;:i!I!:ftiiY.:; ::::fti 'S"'!C:!;~!C:!S"'" jj'E.... j,Ji!i!;:';: D:itS..... ~?ri;:;::ri j,J" ,;: i!l!H"'''; ;r.S"'" ;:;:: iJn1ir.;;r. ~i!!' ;:;:;: HHmr:,"ii&i!~~ ; '~Hm;!I;;Wm~i ;;.;;: ;r:,;WI,'Iiw;mhnii&i~:a;imm:' .:gw:,ih2H1i&in~m1~J:'ImH;w:r:,:r:,ii&i~ii&i";a;i1mH;il;"~1iH1~: ;g~: n: 'ng.!HmiA~: ;.;;;."iH1iwl;tmH;!I;; :i&i: mHnW!;I:;i&i~iI;;mmj .......-.......................,...................-...............-...................................-.......-.....-.............................-...........-...........-...................-.-.......................-.................................-....................................,..,.......-.....-.................-...................................-.............-,-.........-................................ ........................,...........................................,...................'.....................................-.........-...............-.-...............................-.........................................................-.............................................-...................-...............................,....................._n....................................._............. .....................-.....,...................-.,.-...............................................................................................................-.......-.....'.....................,.,.......-...........................................,.............-...................-...........-.........................-..................................,..,.........-.........-.-........,........'...'......,.. . ...... - . .. . .. .... . - . . . . . . . .. ............... -. . . . . . . . . . . . . . . . .. .. - - . . . . . . . . . - . . - . . . . . . '. .........,. - , . . . . . . . . . . . . . . . . . . - . . , - . . . . . - . . - . . . . . . . . - - . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . - . . . . . . . . . Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. ~The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED RETURN - COMPUTATION OF 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true} correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TELEPHONE NUMBER DATE TAXPAYER SIGNATURE REV.1511 EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FRANCES W. MELLINGER FILE NUMBER 21-05-0840 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. 2 . B. 1. 2. 3. 4. 5. 6. 7. 8 . DESCRIPTION FUNERAL EXPENSES: Musselman's Funeral Horne, Inc. - Funeral Expenses Security Choice Pre-Needs Contract Ck #92 09-07-2005 Shippen Hotel - Funeral Meal Ck #96 09-17-2005 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address AMOUNT 8,767.80 (8,751.00) 206.80 1,100.00 355.00 131.40 75.00 STF PA42021 F.12 State Zip City Yea~s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Accountant's Fees Tax Return Preparer's Fees The Patriot News - Legal Notice Ck #100 10-15-2005 Cumberland County Law Journal - Legal Notice Ck #99 09-25-2005 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,885.00 REV-1512 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FRANCES W. MELLINGER FILE NUMBER 21-05-0840 Include unreimbursed medical expenses. ITEM NUMBER 1. Ck #87 08-19-05 2 . Ck #88 08-19-05 3 . Ck #89 08-19-05 4 . Ck #90 08-20-05 5 . Ck #91 08-20-05 6. Ck #93 09-07-05 7 . Ck #94 09-07-05 8 . Ck #95 09-17-05 DESCRIPTION Michael Sopp - Lawn Service Cingular - Cell Phone Verizon - Phone PA American Water - Water & Refuse P P & L - Electric A T & T - Phone Bonnie Miller - OPT Tax Essex House - August Rent AMOUNT 300.00 36.27 25.76 29.80 60.94 15.31 9.80 932.50 STF PA42021 F.13 TOTAL (Also enter on line 10, Recapitulation) $ (If m ore space is needed, insert additional sheets of the same size) 1,410.38 REV-1513 EX + (9-QO) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FRANCES W. MELLINGER FILE NUMBER 21-05-0840 RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ust Trustee(s) 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] PEGGY M. HOUSEAL 1. P.O. Box 7 Dover, PA 17315 Daughter 2. SHARON E. LUDT 1104 Walnut Lane Lansdale, PA 19446 Daughter 3. GLENDA M. MELLINGER 1900 Beckley Drive New Cumberland, PA 17070 Daughter AMOUNT OR SHARE OF ESTATE 1/3 Share 1/3 Share 1/3 Share 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. GRACE UNITED METHODIST CHURCH 309 Herman Avenue Lemoyne, PA 17043 2. AMERICAN LUNG ASSOCIATION 3001 Old Gettysburg Road Camp Hill, PA 17011 3. AMERICAN HEART ASSOCIATION/AMERICAN CANCER SOCIETY 1517 Cedar Cliff Drive/P.O. Box 896 Camp Hill, PA 17011/Hershey, PA 17033-0896 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (Ifmore space is needed, insert additional sheets of the same size) STFPA42021 F.14 500.00 500.00 400.00 1,400.00 I, FRANCES W. MELLINGER, of 16 Center Drive, Camp Hill, Cumberland County, Pennsylvania, do make and publish this as and for my last will and testament, hereby revoking any and all. wills heretofore made by me. FIRST: Debts and Funeral Expenses: I direct my executor to pay all of my debts, funeral and adminstrative expenses as soon as convenient after my decease. SECOND: Personal and Household Effects: I give all my auto- mobiles and all other articles of personal or household use, together with all insurance relating thereto, to my husband, GLENN W. MELLINGER, if he survives me by sixty (60) days. If he does not so survive me, I give all such property and insurance to such of my children as so survive me, to be divided among them as they may agree or, in the absence of agreement, articles unsuitable for division may be sold and the proceeds thereof added to my residuary estate. THIRD: Residuary Estate: remainder of my property, GLENN w. ~lliLLINGER, if he If he does not so survive all my property, real and I give all the rest, residue and real and personal, to my husband, survives me by sixty (60) days. me, then I give, devise and bequeath personal, as follows: A. To each of my grandchildren, living at my death, the sum of $2,000.00. If any grandchild is under the age of twenty-one (21) years at my death, his or her bequest shall be held in trust for said grandchild by his or her parents or surviving parent. It is my desire that this bequest be used for providing an education for said grandchild beyond high school. B. $500.00 to the Grace United Methodist Church, Lernoyne, Pennsylvania. C. $500.00 to the South Central Tuberculosis Society. D. $200.00 to the American Heart Association and $200.00 to the American Cancer Society. E. The balance thereof to my children, PEGGY M. HOUSEAL, SHARON M. LUDT and GLENDA M. KISHBAUGH, to be divided among them share and share alike. - 1 - FOURTH: Protective Provision: No interest in income or principal shall be assignable by, or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. FIFTH: Death Taxes: All federal, state and other death taxes payable because of my death on the property forming my gross estate for tax purposes, whether or not it passes under this Will, shall be paid out of the principal of my probate estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. Any death taxes on future interests may be paid whenever my executor may think best. SIXTH: Manaqement Provisions: I authorize and empower my executor to sell any realty and/or personalty owned by me at my death, at either public or private sale or sales, and therefor, in fee simple, as I could do if living. My execu- tor is authorized and empowered to continue to engage in any business in which I may be engaged at my death, for a period one year after my death. I authorize and empower my executor to use administrative or other expenses of my estate as income tax' or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die. SEVENTH: Executor: I nominate and appoint my husband, GLENN W. MELLINGER, to be the executor of this my last will and testament without the filing of bond. Should he die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint the aforesaid children, who are living at my death, as substitute executrices with the same powers as are given herein to my executor, and also without filing of any bond. ~' aZ WITNESS my hand and seal this! day of November, 1983. '-1 '/ j"\....~~ "1"(} /1.r:r-tx..J..---o>~v I.J ( SEAL) In our presence the above-named Testatrix signed this and declared it to be her last will and testament, and now at her - 2 - request, in her presence, and in the presence of each other, we sign as witnesses: /:./>/.j:..~ "'~t;/YH.Ad&,~ ! ~I ~ t/ (( '-/'9~ '-I'" c-VVL. ~~~IJ( }J- P;J . . 1/ Res idence J 0 / tLt:', "&li <f~ -4-t -4",ftLi11t~~"t.?,: ! - /" Y' . /'(" /j 1.1 j i7 n Residence tfj':l (?JJ~AJ1~' ..J/L./fi'rso, (/ - 3 -