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Home My WebLink About07-14-06 REV-1S00 EX. (6-00) . COMMONWEALTH OF PENNSYLVANIA , DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDlE INITIAL) ... z w c w o w c RINE, JAMES M. DATE OF DEATH (IAM-DD-Year) DATE OF BIRTH (MM-DD-Yew) 01/01/2006 10/18/1930 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INIT1Al) W I- lie: :$ en uD::lIe: W O-u %00 " D::...J ~ 0-G1 0- c( ~ 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Allach copyofWiR) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (dare of _ after 12-12-82) o 7. Decedent Maintained a Living Trust (Allach copy oITrusij o 10. Spousal Poverty Credit (dale ofdeall1 between 12-31-91 and 1.1-95) I- Z W Q Z o 0- Il) W D:: D:: o U 'tJ'AX, ,. COMPLETE MAIUNG ADDRESS 3211 North Front Street NAME Jered L. Hock Es uire FIRM NAME (n Applicable) Metz er Wickersham, Knauss & Erb, P.C. TELEPHONE NUMBER 717 238-8187 P_O. Box 5300 Harrisbur z o ~ ....I ::) ... 0: <C o w a::: 1. Real Estate (Schedule A) (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 (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. NelValue Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ... ::) a.. ~ o o ~ ... 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See. 9116 (a)(1.2) 0.00 X _ (15) 147,834.65 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >> fISE $1 (8) OFFICIAl USE ONl. Y FILE NUMBER 2 1 -0 6 0 0 1 0 CQ'ij'NTYOODE' --VEAR- - - N'liMiiER- - SOCIAL SECURITY NUMBER 2 00- 2 2 - 5 893 THIS RETURN MUST BE FLED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (daleofdealll pIiorlll 12-13-82) o 5. Federal Estate Tax Return Required Q.. 8. Total Number of Safe Deposit Boxes o 11. Election to tax under See. 9113(A) (Attach Sch 0) 29,367.54 1'.-....., PA:--~7110-03QO OFFICIAL USE ONLY 0.00 74,391.45 '1 I ! '..) 68,347.45 ,:::) N 6,401.091 178,507 _53 28,353_59 2,319.29 (11) (12) (13) 30,672.88 147,834.65 (14) 147,834.65 0.00 6,652.56 0_00 0.00 6,652.56 r;~~.J "- j Decedent's Complete Address: STREET ADDRESS 190 Rustic Drive CITY I STATE I ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 6,652.56 6.100.00 321.04 Total Credits (A + B + C) (2) 6,421.04 3. Interest/Penalty if applicable D. Interest E. Penalty TolallnterestlPenalty ( 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 231 .52 231.52 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 IX] b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IX] c. retain a reversionary interest; or ...................................................................................................... 0 IX] d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IX] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.. .............. ............... ...... .............. ...... ........... ...... ................ ..... 0 IX] 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 IX] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... IX] 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. PA 17110-0300 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. 99116 (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. 99116 (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-<>ne 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 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. REV-1502 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RINE. JAMES M. 21 06 0010 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 having reasonable knowledge of the relevant faels. Real Drooertv which is jointly-owned with rioht of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION 1990 Fleetwood Mobile Home located at 190 Rustic Drive, Shippensburg, Southampton Township, Cumberland County, PA. SerialNIN #FLK32A01242GH. Sold since 000 to Debbie L. Hanna on April 26,2006 for $29,250. See Settlement Sheet attached. VALUE AT DATE OF DEATH 29,250.00 2. City/town tax pro-ration 2.17 3. County tax pro-ration 51.40 4. School tax pro-ration 63.97 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 29,367.54 Apr 25 2006 3:01PM 6106311300 p.2 AMHF/MMC 1t}< American Mobile Home Fina~ A Division of Mn!.nnium Monu- CaIpomIon A. -MOBILE HOME SETTlEMENT STATEMENT B. T'/118 of Loan ti Mobile Helma in Perlt 0 Mobi" Home on Privet. fl...... Land 0 New JiI U_ C. Thia form Is furnished to give you . __ of IIClU"-' COSh. Amounta ~ to .nd by AIMricen Mabi~ Harne Finetlae en _...... It..... merited 'ID.O.c.I' We<fI ....id oUlllide the clllelr - th.".. altown...... lor informetion __a end .. nit lncIuded In u.1IrtllIe. D_ N..... end Adtftss of Borrow.- E.Neme end Adcnu of Sell.-. F. H.... end Addr... of Landor Debbie L. Hanna Estate of James K. Rine T....c Holdings Corporation Wilkes-Barre ~ PA G. Propertv loclllion H. PIece of Settlement I. Sottlement I 190 Rustic Drive Sailhaae~~Rea1 Estate Oete Shippeusburg. PA 17257 494 E. K:1.Dg St. 4/26/06 Sh:lpp.nsburg. PA 11521 . -c- J. SUMMARY OF BORROWER'S TRANSAcnON K. SUMMARY OF SE1.LER~S TRANSACT10N 100. a- AJliount Due ........ BallOW. 1400, __ ....... 0.. T. .... 101. comrlct Sa'- Plica 29.250.00 :..01. ~ S.... Prlce 29.250.00 102. PerIoRal Pro<*tY <102. PtnDnel ~. t03. Sottlement Ch........ to Bom>wer (line 1400) 112.50 403. 104. 404. 105. .jail. AAI_ ....11... Peld Rv SeIer In AcIvenae ......... PeId .... .-In ~ 106. CitvlTown Tax..4t1.7/06to 12/31/06 2.17 4011. CltvfT--. Texw./21/06tu 12131/06 2.17 107. Counrv T_ 4/21/06 to 12/31/06 51.40 40:1. CauntvT_ 4/21/06 tl:I 12/31/06 51.40 10B. School Tax... 4/27106 to 6/30/06 63.91 401. Sc'-I T_- 4127/06 to 16I30/M 63.97 109.~_ to 4094 "la....meats tu - 110. Lot Rent to 410. l.o1 Rent to 111. 411. 112. 412. -- 120. D__ 29.480.04 .- ~ 29 :'JIi1..s11 200. Amount. PaId Rv or in _of 11"",,- IllOo. ............ 1ft "- 0.. To ... 201. Deaoait or earnest m<mIiv ..no.on 501. Ex.... o-..It 202. l'rincio.1 Amount of New loanl.1 26.412.50 502. ~Clwaee To Sel"lIine 14001 3-379.00 203. 503. Exlstlna LoenIaI T..... So.IbIICt To 204. 504. Pewff of Firet Mort_ lain 205 501. I'eYOff of S-nd Morta_ La.. 206. S.'" COncession ~ Dl'iIint 2 450.00 SOll. SaI... Concealon ,- n.w.n~nt ? L "" nt\ 207. 507. 206. 508. 2DS 509. AcI_ for '-- Unpeld by__ for _ ~..;, SolIet :nIL. CltyIT own Taxeo to I 510. CltvfTown Tex.. tu 211. Co""'" T""ss to I 511. ~T_ to 212. School Taxes to I 512. School Tex. to 213. Assessments to 513.~tI to 214. 514. 2t5. 515. Final Water B1.l1 to be Daid 2t6. 518. by seller . tt"POll final read1ml: 2t7. 517. . . 218. 618. -~ 219~ 519. . 220. T_ PaId Bv/For 8-w.r 29.362.50 520.ToteI ,no__ 5.829.00 300. Cila11 At SottIoo1wIt FramITo 1Iamrw. 100. c... At.____ TG/F_...... 301. Gross Amount Due From Borrower lline 120) 601. Gro.. Amount Du. To Seller II... 420. 302. lasa Amount. Paid Bv/For B~lline 2201 I 602: ..... Reductio.. In Amt. Due Soller 'line 620' . 303. Cila11 flFlIlm o To Borrow. 117.54 303. Ceeh iJ To o "-..... 23,538.54 You haY. ~ I'IMl !hat yau ... atttIlliI'tZad Md pnplnd... Pf"CN'1de - with ...nrtanl>> In qewng ~ ~ and yout ~...,. Inc..... tIut ~ not Ihlfttd tit: 11 ~ en ....1IMe hom. ~,produda. 21 COftMoIiIlnt Oft my cw,*,t dtlbt....woe IIftd 6\M'*'8~. 31 ~ _In.........."., .... ~ 4J Prac.... mv ~n to . J.nd.r. 5) N..-tlng Gir.c:rty M1h . Jendu en, my be...,. S) ADwmg me In mwdng -V C'ClI"IdMIDtl of : your 1Mn~. 7} SeftI...... rUItI1f.... fttIIe. ~ .....,.,...". .._11 WOIlIId" to ..... you tor 1M aOcww ...., purpclII_. I ~ ~ YOU'''' not '...... to _."1M to lIfty .,.-.c lIftdar .... ttwt,., CllIlftQ1 commit any .....0. hi il"'CM8'~ 01 ..... .. Oft ....,..b..... 'adlncMfedO.tt.. "*,~..pu'elracM...,,.nd~1ft ........ 1~_dliQrM'1DPI"_~Iorl'DUf'..mo-"~JlirtMClft"'_ \4)Of1 !DIn ~ and ftwt my Clblaptbwunderd'lta~ .....~,a.po" ~"f'*'IIgr-..-rt. T'IlIlII...-n-t.... COttInu.lneHwtvnilifm...... utY1M' "*' reQUeSd.ll CJI' tlw doI;ing of mp Inn_ Bath partH.5 accept and agree to the above provisions B,nd both partioa acknowledge receipt of . copy of !tv. RlltBment alld IlUtllorize c1.b....-..ment of 1'lMlds as stated. E.ndorsement cof1&'tittltBS payment in fulL Seller Borr(lW$r Borrower Seller o -..............~1...r_1M' "'t Apr 25 2006 3:01PH 6106311300 p.3 AHHF/HHC II ~.. 00. TaalS 's CaInaUsIorI _ on ....... " lIP PBi4 From I'IId F'nlnI 1IomI__. S...... Dhliolon of CclInJQaion (... 7001 _ Fo~: fundalll FInfe at 701. . 10 . SetlIemont S4m1e_ 702. . 1 500.00 to Sa V..al .......... 1.500.QD.... 703. COIIIIhiaIan PIIId at Senlement 71>4. 100. It_ -In ConIwcIIon 'MIll u..n 801..laatI Oriainlltion Fee '" B02.lDu ~ '" 803. A_alMl Fee to AJIIW 300.00 804. ~ ReDGlt 10 806. .....-..1- Fe. 808. M_ ~ A~iClrtion fM to 8m. ~_ Fee 1 200.00 808. l8nder ,.. to AmeriClln Mobh HmN Fm..ce lIOll-. Co Fee to 810.111 ood C~rt... Doc Pre"'. "'~'~n.. ........ ..... '1'......... l!n..... \ 112.50 811. 0 812. 1113. 1114- ~11i -.-"" ~ Ta" PIId iii ""- 901. Inr_ From 10 a, Id- 902. Morta_ rn.ur.noe Premium for moou. tD 903. Hautd Inourw1ce Premium for -to 1ao4. lani< 1000. ....... ~ WIth lender 1001.~1_ _s . w, rnanth 1002. M__ I....r- moncha . _ month 1003. ON ProOllttV T..... monthe . Oft( montII 1004. TIXeI montlw . .-,- 1006. Sc:hlloI- T_ montlw . ...,- 1001/. A-.rr~. monrIW .. . _ month 1007.. lIMA. . 1100. ,,-a..- 1101. S.tt1.mem or CIosl.... Fee to AMBJ.l' 300.00 1102. .......ct 01 Tld. Seen:h 110 1103. Title ~ 110 1104. Title ,......._ Binder 10 1106. !>ocumwTr Prli_ation to 11oe. Not_ Feel 10 ~.07. A_v'. Fees to r"""",,- .bove it_... oombenl: 1108. Title NurIlJlQl 10 r.......... ....... itlJme nUllllloon: . 1109. ......dor.. Cov..... , 1110.0_'. eov..;.,. . 1111. 1112. 1113. 12.00. CJawrmwIt ..e-- ..... T....... a-... 1201 . ReconIna "-= 1202. Citv/CoulU'l rex 1203. State ra. . 1204-. AIr., Fees 1 ?nO< 1300. AddItloneI SettIom.nt c~ 1301.6"-- to , 302. PIIt l.-.octil", to 1303. Short Certificate to Tom. White Re:bliburlleMJ1t 4.00 1304. I!:lmress. Mail 3xS25.00 to AKH}' 75.00 1a06. 1400. T_ ~ C,*- (_ on ..... 103. S-'on J end &02. Seo:1tOll ~I 112.50 3.379.00 I hi"... QI1Ifully nwtowed the Mobile Home Settlement S1BtIement.nd to It.e but of my knowledge end _. It bla _ _ aCCWWlll __ of oil roo;elPts and disburwmor!ts made on my ."""ullt or by me In thie trBnHctlon. I further certify Uu,r I !)aw racel..... . copy of M_ Home. s.ttlement Statemont. Sorrow.- s.... IIclrTtlw", Sellor o ................c--. '-"'-'MoJI REV-1508 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF RINE. JAMES M 0010 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. FILE NUMBER 21 06 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION 1999 Chevrolet Metro, VIN 2C1MR2267X6719295. Sold to H&H Chevrolet, Pontiac & Cadillac, Inc., 730 East King Street, Shippensburg, PA 17257, for $1600 VALUE AT DATE OF DEATH 1,600.00 2003 Chevrolet Impala, VIN 2G1WF52E039165113. Sold to H&H Chevrolet, Pontiac & Cadillac, Inc., 730 East King Street, Shippensburg, PA 17257, for $9200 9,200.00 1997 Thor Hurricane Motor Home - sold since DOD in arm's length transaction to MRZ Family LP/MN Zimmer 16,500.00 Orrstown Bank - Checking Account #651877 25,820.18 Orrstown Bank - Certificate of Deposit #4000002502, DOD Value $5000, Accrued Interest of $12.87 5,012.87 Orrstown Bank - Certificate of Deposit #4000004736, DOD Value $10,000, Accrued Interest of $41 .40 xxx 10,041.40 Orrstown Bank - Certificate of Deposit 5,000.00 Social Security check received 1/3/06, direct deposit into Orrstown Bank Checking Account 917.00 Furniture, old and used 300.00 Miscellaneous personal items, no value (photographs, etc.) 0.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 74391.45 REV-1509 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF RINE. JAMES M. FilE NUMBER 21 06 0010 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. Debra R. Gehris 1311 North Farm Lane Orem, UT 84057 Daughter B c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD"S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1997 Mutual Funds from Prudential Financial, Jennison Dryden 117,939.73 50. 58,969.87 Strategic Partners, Account #04500106782 2. A 1997 Mutual Funds from Prudential Financial, Jennison Dryden 18,755.16 50. 9,377 .58 Strategic Partners, Account #04500106776 TOTAL (Also enter on line 6, Recapitulation) $ 68347.45 (If more space is needed. insert additional sheets of the same size) RE:V-1510 EX + (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON. PROBATE PROPERTY ESTATE OF RINE. JAMES M. FILE NUMBER 21 06 0010 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 ITEM INellJOE THE NAME OF THE TRANSfEREE. THEIR RElATIONSHIP TO OECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE (IF APPUCAIIlEJ 1. Prudential Financial Annuity #BR7077943 6,401.09 100. 6,401.09 Debra R. Gehris TOTAL (Also enter on line 7 Recapitulation) $ 6,401.09 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF RINE. JAMES M. FILE NUMBER 21 06 0010 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Middle Springs Presbyterian Church - donation for funeral 200.00 2. Funeral Home 7,385.00 3. Grave 600.00 4. Open/CloseNault 1,500.00 5. Grave Marker 1,725.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Metzger, Wickersham, Knauss & Erb, P.C. (estimated) 6,000.00 3. Family Exemption: (If decedenfs address is not the same as daimanfs. attach explanation) Claimant Street Address City Slale Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 136.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees Metzger, Wickersham, Knauss & Erb, P.C. (estimated) 300.00 7. Commonwealth of PA - fee to obtain duplicate of Title to home, necessary for sale 22.50 of real estate to settle estate 8. Realtor's commission on sale of real estate, necessary to settle estate 1,500.00 9. David K. Gehris - reimbursement for airfare, lodging, meals, and car rental in order to 3,609.16 prepare real estate for sale and to attend to opening the estate. NOTE: The Executor lives in Orem, Utah, and was required to fly to Pennsylvania to attend to funeral arrangements for decedent, probating of Will, marshalling of assets, emptying home and taking a total of 12 days for same. Air fair was required for two trips ($2209.38), 3 nights interim lodging were required ($217.06), meals for 12 days ($496.64), andl rental car and gas ($686.08). TOTAL (Also enter on line 9, Recapitulation) $ 28,353.59 (If more space is needed. insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent RINE, JAMES M. Decedent's Name Page 1 21 06 0010 File Number Schedule H - Funeral Expenses & Administrative Costs - A. ITEM NUMBER A. DESCRIPTION AMOUNT 6. FUNERAL EXPENSES: Funeral Luncheon 159.84 SUSTOT AL SCHEDULE H-A 159.84 RINE, JAMES M. Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent Page 2 21 06 0010 File Number Schedule H . Funeral Expenses & Administrative Costs. 87. ITEM NUMBER AMOUNT 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. DESCRIPTION David K. Gehris - reimbursement for shipping/mailing of items necessary to sell real estate and for other estate administration 223.06 Final water bills necessary to preserve real estate for sale 128.76 Final gas bills necessary to preserve real estate for sale 218.24 Final electric bills necessary to preserve real estate for sale 59.50 Copy of Death Certificate for sale of decedent's real estate 29.00 Real estate taxes necessary for sale of real estate 78.53 Appraisal fee necessary for sale of real estate 300.00 American Mobile Home Finance - lender fee necessary for sale of real estate 1,200.00 Closing fee necessary for sale of real estate 300.00 Tom White - reimbursement for Short Certificate necessary for sale of real estate 4.00 Express mail necessary for sale of real estate 75.00 Seller's concession of down payment on decedent's real estate (Seller relinquished "down payment" so that Buyer could close deal) 2,450.00 2005 income tax preparation 75.00 Cumberland Law Journal - reserve for publication of Estate Notice 75.00 SUBTOTAL SCHEDULE H-B7 5,216.09 REV-1512 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RINE. JAMES M. FILE NUMBER 21 06 0010 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. GM Credit Card - debt of decedent VALUE AT DATE OF DEATH 647.87 2. Cingular - cell phone service debt of decedent 29.62 3. Shippensburg City - water and refuse service debt of decedent 37.06 4. Sprint - phone service debt of decedent 27.14 5. PP&L - gas service debt of decedent 246.99 6. Com cast - cable service debt of decedent 11.54 7. Penelec - electric service debt of decedent 45.13 8. Medical bills of decedent not covered by Medicaid 603.94 9. U.S. Treasury - 2005 income tax debt of decedent 297.00 10. PA Department of Revenue - 2005 income tax debt of decedent 295.00 11. PFG Gas, Inc. - gas service debt of decedent 78.00 TOTAL (Also enter on line 10, Recapitulation) $ (11 more space is needed, insert additional sheets of the same size) 2,319.29 ~-'''m.l. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER RII\I~ IAUCC M ?1 OR 0010 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee{s) OF ESTATE 1. TAXABLE DISTRIBUTIONS pndude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Debra R. Gehris 147,834.65 1311 North Farm Lane Orem, UT 84057 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. 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. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ .. (If more space IS needed, Insert addlllonal sheets of the same size) LAST WILL AND TESTAMENT OF JAMES M. RINE I, JAMES M. RINE, of 190 Rustic Drive, Shippensburg, Southampton Township, Cumberland County, Pennsylvania, revoke any prior Wills and Codicils and declare this to be my Will. ITEM 1. I give my automobiles, furniture, household and personal effects, and other tangible personalty of like nature, together with any existing insurance thereon to DEBRA R. GEHRIS, if she survives me by thirty days. If she is not living on the thirty-first day after my death, I give these items to DAVID K. GEHRIS, ifhe survives me by thirty days. ITEM 2. I give all the rest, residue, and remainder of my estate to DEBRA R. GEHRIS, if she survives me by thirty days. ITEM 3. (a) If DEBRA R. GEHRIS is not living on the thirty-fust day after my death, then I give all the rest, residue, and remainder of my estate to DAVID K. GEHRIS, ifhe survives me by thirty days. (b) IfDA VID K. GEHRIS is not living on the thirty-first day after my death, I direct that my assets be sold and that after all my just debts and expenses, as set forth in Item 4 hereof, are paid, I give the rest, residue, and remainder of my estate to my living brothers in equal shares. ITEM 4. I direct that all my just debts and the expenses of my last illness and disposition of my remains shall be paid from my residuary estate as soon as practicable after my death and as part of the expense of the administration of my estate. Document #: 243696.1 ITEM 5. In addition to the powers conferred by the common law, by statute, or by any other provisions hereby, my Personal Representative is hereby empowered as follows: (a) To sell at public or private sale, to exchange, to lease, to pledge, to mortgage, to transfer, to convert, or otherwise dispose of, or grant options with respect to, any and all property, real, personal, or mixed, at any time forming a part of my probate or trust estates, in such manner, at such time or times, for such purposes, for such price or prices, and upon such terms, credits, and conditions as shall be deemed advisable or necessary under the circumstances; (b) To make distribution in division of the probate estate in cash, in kind, or partly in both; (c) To compromise any claim or controversy; (d) To apportion between principal and income any receipts and disbursements and to ascertain income and principal in accordance with the statutes and rules of law of the Commonwealth of Pennsylvania; (e) To make, execute, acknowledge, and deliver any and all instruments which may be deemed advisable or necessary to carry out any of the powers herein granted or provided by law; (f) To invest and reinvest the principal of the estate together with any accumulated income thereon in all forms of property without being limited by any statute or rule of law concerning investments by fiduciaries; (g) To disclaim inheritances and interests in property. ITEM 6. No bond shall be required of my Personal Representative, but ifbond is nevertheless required, it shall be without surety. Document #: 243696.1 ITEM 7. I appoint DAVID K. GEHRIS, Executor. Ifhe fails to qualify or ceases to act, I appoint DEBRA R. GEHRIS, Executrix. ITEM 8. F or the convenience of my alternate Executors, I note that this Will has been prepared by Steven P. Miner, Esquire, and the law firm of Metzger, Wickersham, Knauss & Erb, P.C. Executed on o e-t f~ r ,1/ ,2002. Signed, sealed, published and declared the above-named Testator, JAMES M. RINE, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses.. . ~ ~ .~ Address ~ Address Ii. ,.~;>lt7, ~/1 fA. ~Val cS6ut-g r fA- Document #: 243696.1 COMMONWEAL TH OF PENNSYLVANIA COUNTY OF UAuP/1r;:) SS. We, JAMES M. RINE, and .L4.11: J H. m e..,.., ~: '" e.4c.l and You./"\~-Su..Vl. ~o , the Testator and the witnesses, respectively, whose names are sIgned to the attached or foregomg Instrument, bemg first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his last Will and that he had signed willingly (or willingly directed another to sign for him), and that he executed it as his 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 witness and that to the best of our knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. DJ//~L~ - Witness ~0C) WItness - - SWORN to or affirmed and acknowledged before me by the above named Testator and witnesses this 2/ g:: day of [)~77:J13 EJ~_ , 2002. (1~-l t2 :;'Le ~ Notary Public v My Commission Expires: (SEAL) Document #: 243696.1 Noip~TAL SE/u.--.----i CAROL A. LYTER, Notary Public I City of Harrisburg, Dauphin County I My Co~iBSi~::..~1?~~~. Dec. 28, 2004 MW METZGER - WICKERSHAM July 13, 2006 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax: 717-234-9478 Ms. Glenda F. Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Other Offices Colonial Park Lancaster 717-652-7020 717-.BI-OUS Mechanicsburg Shippensburg 717-69]-5577 717-530-7515 Wilkes-Barre York 570-S25-7500 717-S-l3-0502 Re: Estate of James M. Rille No. 2006-00010 Dear Ms. Strasbaugh: Enclosed for filing are original and one copy of Inheritance Tax Return, along with check in the amount of $231.52 for tax due. Also enclosed is check in the amount of $15 for filing of the Return. So that I may be sure this mailing has been received and the filing completed, please stamp the extra copy of the summary page with your clock-in stamp and return it to me in the pre-posted envelope provided. Thank you. Very truly yours, METZGER, WICKERSHAM, KNAUSS & ERB, P.c. J ered L. Hock JLH/amrm.("l\"f('. Enclosures cc: David K. Gehris 356516-] James F. Carl Edward E. Knauss, IV' Jered L. Hock Steven P. \!liner Clark DeVere Francis J. Laffertv, IV Andrew W. Norileet Karen W. Miller Robert!'. Grubb >:- Board Ccrfrhcd ill ['fl.'i! trio/ taiTt/lid the ,\'allolll/! RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Receipt Date: Receipt Time: Receipt No.: 7/14/2006 12:05:39 1045024 RINE JAMES M Estate File No. : Paid By Remarks: 2006-00010 METZGER WICKERSHAM AJW ------------------------ Receipt Distribution ------------------------ Fee/Tax Description INH TAX RETURN Check# 35856 Total Received......... Payment Amount 15.00 Payee Name CUMBERLAND COUNTY GENERAL FUN $15.00 $15.00 COMMCNWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG. FA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GEHRIS DAVID 1< 1311 N FARM lANE OREM, UT 84057 -------- loid ESTATE INFORMATION: SSN: 200-22-5893 FILE NUMBER: 2106-0010 DECEDENT NAME: RINE JAMES M DATE OF PAYMENT: 07/14/2006 POSTMARK DATE: 07/13/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 01/01/2006 NO. CD 006971 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $231.52 I I I I I I I I TOTAL AMOUNT PAID: $231.52 REMARKS: GEHRIS DAVID K CHECI(# 2626 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS . ~. ~ , ..J - <C :is en en <C .J (J t;; a: - LL ~/ -- -- -=:: - -- -- -=: -- -- -- === -- -- -::-. -=: ~ '1f' ~ c.. roO :>: ~ J3 ~ ~ H ;::J a CI:l ~ ~ u o ;:c: H ~ ~ ~ 1--; o o C0 o I If: 0 ~ rl <( t:::: Z rl ::L: <( · tu Z ::>. ;;: :;: <( i= ..J I [J) r ~ f- en '"' :; Z ~ ";;;L ~ 0 LI.J ~......l:>:oc..., :> ~ ~ 0 ;- .> <( :: C0 C] · Cf: t::: II) ~ r - x ~ ~ ~ c 0 ~ c' ./ Z o::l :>: 'iOrlO-:>: ~~rl < OJ ~N -:r: ::::E~C0c..., '1f' ~ CI:l :::> o ::c H ::c ~~ o 5~ ~ u<C") pq :::>,.-< CI:l ~ ~ go ~H5~~ H::ioCl:l CI:l u5< ~f:)p::cp.... ~~~~~ Z~P25C1:l ~H~UH HCI:l H 0~~~~ ~~UOU o Eo-; ~ ~