HomeMy WebLinkAbout05-12-06
REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Oberdick, Leon Sr.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
21 05
1088
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
130 W. Church St
Dillsburg, PA 17019
(1 ) None
(2) None
(3) None
(4) None
(5) 16,071.51
(6) None
(7) None
(8)
(9) 5,540.81
(10) 3,746.39
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
09-16-2005
07-22-1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
X 1 Original Return
4. Limited Estate
2 Supplemental Return
NUMBER
135-01-0085
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
3. Remainder Return (date of death prior to 12-13-82)
x 6. Decedent Died Testate (Attach
copy of Will)
9. Litigation Proceeds Received
4a. Future Interest Compromise (date of death after
12.12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal Poverty Credit (date of death between
12-31-91 and 1-1-95)
8 Total Number of Safe Deposit Boxes
5 Federal Estate Tax Return Required
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
11. Election to tax under Sec. 9113(A) (Attach Sch 0)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
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'IH..!S._~ECTIC)NMUST BE C()MPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Jan M. Wiley
FIRM NAME (If applicable)
Wiley, Lenox, Colgan, & Marzzacco, P.C.
TELEPHONE NUMBER
717 -432-9666
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
.-.)
16,071.51
(11 )
9,287.20
6,784.31
0.00
15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z
0 (16)
i= 16 Amount of Line 14 taxable at lineal rate 6,784.31 x .045
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a. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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() 18, Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
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I- 19. Tax Due
(19)
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(12)
(13)
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6,784.31
0.00
305.29
0.00
0.00
305.29
SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00:
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Decedent's (;Omplete Address:
STREET ADDRESS
967 W. Trindle Rd., Lot 22
CITY Mechanicsburg
STATE P A
ZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
Total Credits (A + B + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
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
5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to REGISTER OF WILLS, AGENT
(1 )
305.29
(2)
0.00
(3)
(4)
(5) 305.29
(5A)
(5B) 305.29
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
1. Did decedent make a transfer and: Yes
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?..
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?..
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.. x
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 clare t 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. De~ll3rl3tion of parer othe than the personal representative is based on all information of which preparer has any knowledge
S ATURE OF PER N RESPONS BLE FOR FILING RETURN ADDRESS
L on: ~~ ickJr. Q f
TURE OF PERSON RESPONS LE F~G RET R ADDRESS
I C
SIGNATU~F PR~tA~ER OTJR~~ R~~~TIVE
J~n M. Wiley
25 Gettysburg Pike
Mechanicsburg, PA 17055
ADDRESS
130 W. Church St
Dillsburg, PA 17019
x
x
x
x
x
x
DATE
5-lo-c0
DATE
.s-- I 0 - ,j b
DATE
S-/D-['{p
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. S9116 (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. S9116 (a) (1.1) (ii)l. 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 S9116 (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.
S9116 1.2) [72 P.S. S9116 (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.
LAST WILL AND TESTAMENT
OF
LEON OBERDICK, SR.
I, Leon Oberdick, Sr., now or formerly of 967 West Trindle Road, Lot 22,
Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind
and memory, do make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate taxes becoming due by
reason of my death, whether such taxes may be payable by my Estate or by any recipient
of any property, shall be paid by my Executor out of the property passing under this Will,
which is not specifically devised or bequeathed, as an expense and cost of administration
of my Estate. My Executor shall have no duty or obligation to obtain reimbursement for
any such tax paid by my Executor even though on proceeds of insurance or other
property not passing under this Will.
ITEM II: I hereby exercise all powers of appointment which I may have at
the time of my death in favor of my Executor, and all property subject to all such powers
shall be included in my Estate.
ITEM III: I give and bequeath all my household furniture and furnishings,
automobiles, books, pictures, jewelry, china, linen, silverware, wearing apparel, and all
::>ther like articles of household or personal use and adornment to my children, Leon
Oberdick, Jr., now or formerly of 25 Gettysburg Pike, Mechanicsburg, Cumberland
County, Pennsylvania, and Bruce Axt Oberdick, now or formerly of 1002 Gettysburg
Pike, Mechanicsburg, Cumberland County, Pennsylvania, and Susan Elizabeth
Moskrey, now or formerly of 333 Calvary Road, Carlisle, Cumberland County,
Pennsylvania, to be distributed to them in equal shares by my Executor.
ITEM IV: I give, devise and bequeath all of the rest, residue and remainder of my
property, real, personal and mixed, to my children, to be distributed to them in equal
shares by my Executor.
ITEM V: In the settlement of my Estate, my Executor shall possess, among
others, the following powers to be executed for the best interest of the beneficiaries:
(a) To sell, either at public or private sale and upon such terms and
conditions as my Executor may deem advantageous to my Estate, any or
all real or personal estate or interest therein, whether owned by me
severally or in conjunction with other persons or acquired after my death by
my Executor, and to consummate said sale or sales by sufficient deeds or
other instruments to the purchaser or purchasers, conveying a fee simple
title, free and clear of all trust and without obligation or liability of the
purchaser or purchasers to see to the application of the purchase money or
to make inquiry into the validity of said sale or sales; also, to make, execute,
acknowledge and deliver any and all deeds, assignments, options or other
Page 2 of 8
writings which may be necessary or desirable in carrying out any of the
powers conferred upon my Executor in this Paragraph V (a) or elsewhere in
my Will.
(b) To pay all costs, taxes, expenses and charges in connection with
the administration of my Estate. My Executor shall pay expenses of my las1
illness and funeral expenses.
(c) To distribute my Estate in kind or in money. If any assets are
distributed in kind, they shall be distributed at their respective value(s) on
the date(s) of their distribution.
(d) To retain any investments I may have at my death so long as my
Executor may deem it advisable to my Estate so to do.
(e) To vary investments, when deemed desirable by my Executor
and to invest in such bonds, stocks, notes, money markets, real estate
mortgages or other securities or in such other property, real or personal, as
he shall deem wise, without being restricted to so-called "legal
investments. "
(f) To mortgage real estate and to make leases of real estate.
(g) To borrow money from any party to pay indebtedness of mine or
of my Estate, expenses of administration or inheritance, legacy, estate and
other taxes.
Page 3 of 8
(h) To vote any shares of stock which form a part of the Estate and
to otherwise exercise all the powers incident to the ownership of such stock.
(i) In the discretion of my Executor, to unite with other owners of
similar property in carrying out any plans for the reorganization of any
corporation or company whose securities form a part of the Estate.
U) To distribute my personal property directly to the Guardian of the
person of any minor beneficiaries hereunder.
(k) To elect such settlement options as deemed most appropriate by
my Executor with respect to any pension, profit sharing or other retirement
plan in which I am a participant.
(I) To do all other acts in the judgment of my Executor necessary or
desirable for the proper and advantageous management, investment and
distribution of my Estate.
ITEM VI. Any person who shall have died at the same time as Testator or
In a common disaster with him, or under such circumstances that it is difficult or
impossible to determine who died first, shall be deemed to have predeceased him.
ITEM VII: I nominate, constitute and appoint my son, Leon Oberdick, Jr., tc
be my Executor (herein referred to as "Executor"). In the event of the death, resignation,
refusal or inability of Leon Oberdick, Jr. to serve as my Executor, I nominate, constitute
and appoint my son, Bruce Axt Oberdick, to serve as Executor. My Executor anc
Guardian are specifically relieved from their duty or obligation of filing any bond or bonds.
Page 4 of 8
IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will
and Testament, consisting of this, the next three (3) pages and the preceding four (4)
pages this/)day of A'5L.Y/ , 1999.
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Page 5 of 8
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named
Testator, Leon Oberdick, Sr., as and for his Will, in the presence of us, who, at his
request, in his presence and in the presence of each other, have hereunto subscribed our
names as witnesses in attestation thereof.
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1521 Penn Street
Harrisburg, PA 17102
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72 South Pin Oak Drive
Boiling Springs, PA 17007
128 Liberty Avenue
Carlisle, PA 17013
Page 6 of 8
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
SS.:
COUNTY OF CUMBERLAND
I, Leon Oberdick, Sr., the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before me by Leon Oberdick, Sr.,
the Testator, this 1.3 day of ,A"j ,/ '7 f ' 1999.
J~~$1~t,
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No lie
My Commission Expires:
(SEAL)
NOT ARtAL SEAL
CONNIE R. SHUL TZ.N6tary Public
Mecnanicsburg. Cumoo~~h~ County
Mv Commission Expires Au'g.-J 9, 2002
PaQe 7 of 8
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.:
COUNTY OF CUMBERLAND
We, Mark K. Emery, Robyn Cronin and David A. Jones, II, the witnesses
whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the Testator sign and
execute the instrument as his Last Will; that the Testator signed willingly and executed it
as his free and voluntary act for the purposes therein expressed; that each subscribing
witness, in the hearing and sight of the Testator, signed the Will as a witness; and that to
the best of our knowledge, the Testator was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed to before me by Mark K. Emery,
Robyn Cronin and David A. Jones, II, witnesses, this IS day of ~'-5<' ~ J , 1999.
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Witness c__..
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ublic
My Commission Expires:
(SEAL) NOTARIAL SEAL.
CONNIE R. SHULTZ. Nolary.PlJplic
Mechanicsburg. Cumberiaod~ty _
M Commission Ex . as A . 19, ,2002 I
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Page 8 of 8
~ev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Oberdick, Leon Sr.
FILE NUMBER
21-05-1088
ESTATE OF
Include the proceeds of lillgation 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 Citizens Bank Account Number 6100577147: 7.010.51
2 Eleven Silver Dollars: 11.00
3 Sale of 1970 Schultz Mobile Home: 5.800.00
4 Sale of 1998 Saturn: 3,250.00
TOTAL (Also enter on Line 5, Recapitulation)
16,071.51
(If more space IS needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc
Form PA-1500 Schedule E (Rev. 6-98)
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Bank
Account Number 6100577147
Account Title LEON OBERDICK
Date Opened 10/21/1994
Account Type Checking
Principal Balance as ofDOD $7010.51
Interest from Last Posting to DOD $.00
Account Balance as of DOD $7010.51
YTD Interest to DOD $12.49
-A
REV-485 EX (05-04)
SAFE DEPOSIT
BOX INVENTORY
PA Department of Revenue
Social Security or Death Certificate Number
-C'..' ~."'., ;r.;.
48500041046
DraS'~
Date of Death
~ltJ.cit;
PLEASE USE ORIGINAL FORM ONLY
County Code Year File Number
13:'5 : O'~ I /,,:,0:0 ~:5 :..
A', "
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
c. NAME:
RELATIONSHIP:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
~
i
.:Ell.
b. NAME:
STREET ADDRESS:
STATE:
ZIP CODE:
f::-
If yes,
b. Name and address of personal representative, if named in the will
NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
c. Name and address of attorney, if any
NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
"
L
48500041046
48500041046
--I
REV-485 EX
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
Page
of
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by
name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership,
i.e., jointly held, payable on death, etc.
Bonds: Designate by name,amount, serial number, or other designation. (Bearer Bonds)
Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank
and branch, and balance.
Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
Deeds, Mortgages, Current Insurance Policies or other evidences of in,.debtedness: List and describe as fully as possible.
All other contents.
Return completed form to:
(4)
(5)
(6)
(7)
(8)
(9)
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
ITEM DESCRIPTION
PERSON RECEIVING COPY OF
SAFE DEPOSIT BOX INVENTORY:
SIGNATURE
PRINT NAME AND CHECK APPROPRIATE BOX BELOW:
CHECK APPROPRIATE BOX:
o Executor(trix) 0 Administrator(trix)
o Estate Representative 0 Joint owner of safe deposit box
NOTE: ~ttach additional 8'1>" x 11" sheet(s) if ne es ary or use duplicates of this page of form.
The Department is authorized by law, 42 U.S.C. 9405 (c)(2)(C}(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the
Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax infonmation agreements
with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes.
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ttificate of Title must be subr
t-lG- FEDERAL AN(
[El"ER READING) It'-
,qE TO COMPLETE (
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! AND/OR IMPRISON
I
r be advised that in I
me by an issuing a~
. oard 01 \I ehic\e Ma
~ab\e. The signature
ee, date ofverific~
nUI'1,1~er (PiN) and I
". >Nehi(?l~ selle
diTiinister
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REV-1151 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Oberdick, Leon Sr.
FILE NUMBER
21-05-1088
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Oberdick
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address 25 Gettysburg Pike
City Mechanicsburg
Year(s) Commission paid 2006
State P A
Zip 17055
800.00
2
Attorney's Fees
Wiley, Lenox, Colgan, & Marzzacco, P.C.
2,200.00
3. 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
4.
Probate Fees
110.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
2,430.81
TOTAL (Also enter on line 9, Recapitulation)
5,540.81
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
KeV-lbU;":: tA.T (b-~:HSJ
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Oberdick, Leon Sr.
FILE NUMBER
21-05-1088
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Citizens Bank:
14.23
2
Floyd's Garage:
306.47
3
Register of Wills (filing fee):
30.00
4
TREBOR (Mobile home park - 6 months lot rent):
1,770.00
5
TREBOR (water and sewer):
196.92
6
West Shore EMS:
113.19
Subtotal
2,430.81
Copyright (c) 2002 form software only The Lackner Group, Inc
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Oberdick, Leon Sr.
FILE NUMBER
21-05-1088
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 American Home Medical Servies:
2 Assoc. Cardiologist:
3 Charles Inners, MD:
4 Comcast (cable):
5 Conner Rich Associates (physicians):
6 Exg. Associates:
7 Foremost (Mobile Home Insurance):
8 Holy Spirit Hospital:
9 Kanton & Tkatch:
10 MA Murray (taxes):
11 Met Ed:
12 PA Gastro. Consultants:
13 Patriot News Co.:
14 Praxair:
15 PRISM:
16 Pulmonary and CCMA:
17 Quantum Image Systems:
18 Shephardstown Family Practice:
VALUE AT DATE
OF DEATH
93.00
3.54
30.84
42.66
616.28
3.54
186.75
1,670.30
87.77
4.53
120.51
30.04
4.80
4.84
6.63
97.79
4.05
10.05
Total of Continuation Schedule(s)
See attached page
TOTAL (Also enter on Line 10, Recapitulation)
3,746.39
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc
Form PA-1500 Schedule I (Rev 6-98)
"(eV-lol4:" ~^... Ib-~ts.1
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Oberdick, Leon Sr.
FILE NUMBER
21-05-1088
ESTATE OF
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
19
UGI:
707.93
20
Verizon:
20.54
TOTAL (Also enter on Line 10, Recapitulation)
3.746.39
Coovriaht (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9-00) ~
;I SCHEDULE ..
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Oberdick, Leon Sr. 21-05-1088
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
1 Leon M. Oberdick, Jr. Son one-third
25 Gettysburg Pike
Mechanicsburg, PA 17055
2 Bruce A. Oberdick Son one-third
1002 Gettysburg Pike
Mechanicsburg, PA 17055
3 Eric Maskrey Grandson one-ninth
293 Bonny Brook Road
Carlisle, PA 17013
4 Alfred Maskrey IV Grandson one-ninth
224 Jacksonville Road
Lincoln Park, NJ 07035
5 Kristen Eskelson Granddaughter one-ninth
3741 E. Sheffield Road
Higley, AZ 85236
Total
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc
Form PA-1500 Schedule J (Rev 6-98)
Register of Wills of
Cumberland
County, Pennsylvania
INVENTORY
Estate of Leon Oberdick Sr.
also known as M. Leon Oberdick, Leon M. Oberdick,
Sr.
No. ~ I-os -10 i-Y
, Deceased
Date of Death 09/16/2005
Social Security No. 135-01-0085
Leon M. Oberdick Jr.
The 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 located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of
the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except
that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory
are true andcorrect. I/We understand that false statements herein are made subject to penalties of 18 Pa. C. S.
Section 4904 relating to unsworn falsification to authorities.
'_ vv-. l~,~ Personal Repre.se~tive/ "
Attorney: Jan M. Wiley slgnature/ .' M~ ~ .
/ ~ on M. Oberdick Jr.
1.0. NO.I~.., 0&298 Signatu~e
!
f
Firm:
Wiley, Lenox, Colgan, & Marzzacco,
P.C.
. ,j
Signature:
Telephone:
130 W. Church St
Dillsburg, PA 17019
717 -432-9666
Address:
25 Gettysburg Pike
Mechanicsburg, PA
Telephone: 717-697-7133
17055
Address:
Dated:
--~~-lt4-~QO[P
Personal Property
Cas h...............................................................................................
Miscellaneous Property................................................................
Stocks/Listed................................................................................ .
Stocks/Closely Held......................................................................
Bonds............................................................................................ .
Partnerships and Sole Proprietorships .....................................
Mortgages a nd Notes Receiva ble...............................................
16,071.51
; "",.","
---1
"",
1
~ .,..,
I
f'0
Total Personal Property.........................................
16,071.51
Total Rea I Property....... .........................................
16,071.51 I
Total Personal and Real Property.........................
Total Out-of-State Real Property..........................
(7"'\
~ \J.L
" ,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
WILEY JAN M
130 WEST CHURCH STREET
DILLSBURG, PA 17019
--~---- fold
ESTATE INFORMATION: SSN: 135-01-0085
FILE NUMBER: 2105-1088
DECEDENT NAME: OBERDICK LEON SR
DATE OF PAYMENT: 05/12/2006
POSTMARK DATE: 05/1 0/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 09/16/2005
NO. CD 006688
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $305.29
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 0570
SEAL
INITIALS: MG
RECEIVED BY:
RFGISTFR OF Will S
$305.29
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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