HomeMy WebLinkAbout07-14-06 (2)
REV-1500 EX (&-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 _ 0 6
018 9
- NUMBER --
COlliTY CODE
YEAR
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INrTlAL)
CASEY, PATRICK J.
DATE OF DEATH (MM-DD- YEAR)
~LSECURrTYNUMBER
DATE OF BIRTH (MM-DD- YEAR)
209-28-2539
!HIS RETURN MUST BE ALED IN DUPLICATE W1ni niE
REGISTER OF WILLS
SOClA.L SECURITY NUMBER
FEBRUARY 25, 2006 JULY 13, 1936
(IF APPLICABLE) SURVfVlNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITlA.L)
w [Xl t Original Return 0 2. Supplemental Return
~~oo 0 4. Umited Estate 0 4a Future Interest Ccmpromise (dale of death after 12-12-82)
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IOO 6. Decedent Died Testate (Attach copy of WO) 7. Decedent />/.aintained a Living Trust (Altach copy ofTrust)
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CL 0 9. Utigation Proceeds Received 010. Spousal Poverty Credit (dale of death between 12.31.91 and 1-1-95)
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o 3. Remainde: Return (date of ,,,Ill poorlo 12-1:\-62)
o 5. Federal t:s:3te Tax Return Reouired
o 8. Total NUfT,t.er of Safe Deposit Boxes
o 11. Election b:ax under See. 9113(A) (Altach Sch 0)
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.THISSECTJONMUSTBECQMPLETED.ALLCORRESpoNDENCE ANpCONFIDENTlALTAX INfORMATION SHOULD BE DlRECTED TO:
NAME COMPLETE MAILING ADDRESS
DANIEL J. CONWAY, ESQ. 508 WASHINGTON ROAD
FIRM NAME (If/lilplicable) PITTSBURGH, P.L_ 15228
TElEPHONE NUMBER
412-561-1487
1. Real Estate (Schedule A)
2 stocks and Bonds (Schedule B)
3. Closely Held Ccrporation, Partnership or Sole-Proprietorship
(1)
(2)
(3)
(4)
{5}
278,000.00
17,095.00
0.00
0.00
873,079.79
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OFFICIAL USE ONLY
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Chvned Property (Schedule F)
o Separate Billing Requested
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,.1
0.00
(6)
(7)
0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total lines 1 . 7)
9. Funeral Expenses & Administrative Costs (S:redule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule Q
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Une 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for whicr. an election to tax res not been
made (Schedule J)
(8)
l,lE8,174.79
(9)
(10)
67,379.60
218,18C.16
(11)
(12)
(13)
285,559.7E
8E2,61S.03
O.OC
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
8E2,61S.03
SEE INSTRUCTIONS FOR APPLICABLE RATES
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15. Amount of line 14 taxable at the spousal tax
rate, or transfers under See. 9116 (a)(1.2)
Xo_ (15) O.OC
XO_ (16) O.OC
441,307.52 X .12 (17) =2,956.9C
441,307.52 X 15 (1E) 66,196.13
(19) 119,153.03
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. 0 I CHEGKHERE IFYOU ARE REQlJESTING A REFUND OF AN OVERPAYMENT I
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SlOE AND R...::cHECK MATH < <
STF PA42021F.1
Decedent's Complete Address:
STREET ADDRESS Ardmore Circle
1
CITY I STATE I ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
119,153.03
1l0,000.001
5,789.47
Total Credits (A + B + C) (2)
115,789.47
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (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
3,363.56
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF ~LLS, AGENT
3,363.56
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
D
D
D
D
D
D
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D IX]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompan0ng schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON ESPONSIBLE FOR Fill G RE U N.
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No
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DATE
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STREET, PITTSBURGH, PA 15227
DATE
7 - // - c.J 0.
, PENNSYLVANIA 15228
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 PS. 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)].
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 retum 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.
STF PA42021F.2
RE:V-15C2 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FilE NUMBER
Patrick J. Casey 21-06-0189
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 facts. Real property which is jointly-owned with right of survivorship
must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
279,000.00
Residence located a~ 1 Ardmore Circle, New
Cumberland, Pennsylvania 17070, Cumberland County,
Pennsylvania - value of property based on proceeds
from sale on April 20, 2006. Settlement sheet attached
as Exhibit A-l.
Less Credit for Roof Repairs reflected in settlement
statement.
(1,000.00)
STF PA42021F 3
TOTAl (Also enter on line 1, Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
278,000.00
REV-1503 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Patrick J. Casey
All property jointly-owned with the right of survivorship must be disclosed l;ln Schedule F.
ITEM
NUMBER DESCRIPTION
FILE NUMBER
21'-06-0189
VALUE AT DATE
OF DEATH
1.
Mellon Investor Services Account #806715243373
Metlife Common Stock - 334 shares - valued at
average of Friday February 24 average high (51.45)
and low (51.00) and average of February 27 average
high (51.52) and low (50.76). See share values
attached as Exhibit B-1.
17,095.00
STF PA42021F.4
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
17,095.00
R::OV-15D6::OX ~ (1-97) (I)
COMMOl'NVcALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Patrick J. Casey
FILE NUMBER
21--06-0189
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
Soverign Bank Saving Account #0574106407 opened
8/4/1998. See Exhibit Attached E-1.
VALUE AT DATE
OF DEATH
54,075.29
2
Soverign Bank certificate of Deposit #2335253254
opened 2/3/1998. See Exhibit Attached E-1.
158,708.78
Plus Interest Accrued on CD#2335253254 to date of
death. See Exhibit Attached B-1.
324.03
3
Wachovia Bank Checking Account #1010126450507
opened 2/10/2006. See Exhibit Attached E-2.
100,122.70
Plus Interest Accrued on Checking Account
#1010126450507. See Exhibit Attached E-2.
20.46
4
Wachovia Bank certificate of Deposit #247402052273766
opened 5/31/2005. See Exhibit Attached E-2.
100,000.00
Plus Interest Accrued on CD#247402052273766 to date
of death. See Exhibit Attached E-2.
2,818.46
5
M&T Bank Checking Account #21853789 opened 6/28/1968_
See Exhibit Attached E-3.
M&T Bank Money Market #15004213067504 opened
4/25/2005. See Exhibit Attached E-3.
307,915.29
14,421. 43
6
Plus Interest Accrued on Money Market
#15004213067504. See Exhibit Attached E-3.
624.29
7
Pennsylvania State Employees Credit Union Account
#8100913584. See Exhibit Attached E-4.
13,462.55
8
Plus Dividends Accrued on Account #8100913584. See
Exhibit Attached E-4.
Citizens Bank Certificate of Deposit #6246747561
opened 7/12/2005. See Exhibit Attached E-5.
102,049.98
8.85
Plus Interest Accrued on CD#6246747561. See Exhibit
Attached E-5.
Total from continuation sheet
144.68
18,383.00
STF PA42D21F.9
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
873,079.79
REV-150B EX + (1-97) (I)
COMMONVVcALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Patrick J. Casey
FILE NUMBER
21--06-0189
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.
1
DESCRIPTION
VALUE AT DATE
OF DEATH
2004 Honda Accord, odometer reading approximately 17,000
miles - valued at Blue Book Value. See Exhibit
Attached E-6.
Personal Goods, Clothing and Household Effects per
appraisal. See Exhibit Attached E-7.
16,000.00
2
2,383.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
STF PA42021F9
R:::V-1511 :ox. (1-97) (I)
COMMONWeALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRAllVE COSTS
ESTATE OF
Patrick J. Casey
FILE NUMBER
21-06-0189
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
2
B.
1.
2.
3.
4.
5.
6.
7.
8
9
10
11
12
13
14
15
16
STF PA42021 F.12
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Parthemore Funeral Home & Cremation Services, Inc.
1303 Bridge Street, P.O. Box, New Cumberland, pp, 17070
Traditional Funeral Service and Casket. See Exhibit
attached H-1.
8,591.72
Reimbursement to Executrix - Wake Expenses
336.36
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
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
State
lip
31,612.43
Claimant
street Address
City
Relationship of Claimant to Decedent
state
Zip
Probate Fees
700.00
Accountant's Fees
Tax Return Preparer's Fees
465.00
Selling Expenses - Residence per Settlement Statement
Wayne L. Myers - Appraisal of Personal Property
Fee - Death certificates
County and Bora of New Cumberland - Real Estate Taxes
(Amount paid $865.07 less $855.10 credit settlement sheet
Travel Reimbursement - Executrix
US Postal Service - Postage, Shipping Expenses
Reimbursement to Executrix - Auto Inspection & Insurance
Reimbursement to Executrix - Truck Rental
Paul Bahn - Casual Labor Packing Uhaul
Total From Additional Paae
20,281.27
100.00
27.00
9.97
717.39
173.53
385.93
214.88
480.00
3,284.12
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
67 379.60
R:::V-1S11 EX + (1-97) (I)
COMMOtWcALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Patrick J. Casey
FILE NUMBER
21-06-0189
Debts of decedent must be reported on Schedule l.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
B.
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
2.
3.
City
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
state
Zip
Claimant
street Address
City
Relationship of Claimant to Decedent
state
Zip
4.
Probate Fees
5.
Accountant's Fees
6.
Tax Return Preparer's Fees
7.
17
utilities on Residence until Sale In April 2006
Service oil Company - Heating oil Billing for March
Verizon - Telephone Billing
Comcast - Cable Billing
PPL Electric - Electrical Billing
PA American Water Company - Water Billing
Lawn Maintenance
Boro of New Cumberland - Sewage Billing (amount: paid of
$70.21 less credit $25.07 per settlement sheet)
Reimbursement to Executrix - Miscellaneous Expenses
268.00
185.37
95.36
81.71
17 6.12
24.00
45.14
18
2,408.42
STFPA42021F.12
TOTAL (Also enter on line 9, Recapitulation) $
(If more space IS needed, Insert additional sheets of the same size)
,EV.1512 EX + (1.97) (I)
COMMONW'..ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Patrick J. Casey
FILE NUMBER
21-06-0189
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
2
3
4
5
6
7
8
9
10
DESCRIPTION
Service oil Company - Heating oil Billing for February
A. Solins Landscaping - Snow Removal
Verizon - Telephone Billing for February
Chase Credit Card - Billing for February
PA American Water Company - Billing for February
PPL Electric Company - Billing for February
Davis Pulmonary Associates - Medical Services
us Treasury - Federal Income Tax Due for 2005 (see
copy 2005 return attached Exhibit 1-1)
South Carolina Department of Revenue - Income Tax 2005
Pennsylvahia Dept of Revenue - PA Income Tax Due for 2005
AMOUNT
268.00
35.00
31.80
82.08
23.11
131.D3
49.14
214,427. DO
2,717.00
416.00
STF PA42021F.13
TOTAL (Also enter on line 10, Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
218,180.16
REV-1513 EX + (9-00)
COMMONVr::ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
?atrlck J. Casey
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)]
Suzanne Kin:;)"
4112 Dalewood Street
Pittsburgh, PA 15227
Michele Lee Casey
59 1/2 South Lake Street
Northeast, PA 16428
Colleen Casey
503 Hagar Drive
Ocoee, FL 34761
FILE NUMBER
21-06-0189
RELATIONSHIP TO DECEDENT
Do Not List T'rustee(s)
Sister
Niece
Niece
AMOUNT OR SHARE
OF ESTATE
50.0%
25.0%
25.0%
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 ELECT/ONTO TAX IS NOT BEING MADE
STFPA42021F14
2
3
1.
B. CHAR/TABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART I1- 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
o
1___ --
LAST WILL AND TESTAMENT
OF
PATRICK J. CASEY
~~~; ':
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--- I ,'-p,ATRICK J. CASEY, having my legal residence at 1 Ardmore
'1.._.::- t._..'-~
Ci~sle, New Cumberland, Cumberland county, Pennsylvania, do
hereby declare this to be my Last Will and Testament, revoking
all other wills and Codicils heretofore made by me.
ITEM ONE: I direct that all my valid debts and the expenses
of my last illness and funeral be paid from my estate as soon as
may be practicable after my death.
ITEM TWO: I give all of the residue of my estate, of
whatsoever nature and wheresoever situate, in equal shares to
such of the following persons who survive my death for a period
of thirty (30) days:
A. My brother, VINCENT M. CASEY, JR., or his issue,
per stirpes; and
B. My sister, SUZANNE KING, or her issue, per stirpes
ITEM THREE: If any such descendant of mine has not reached
legal age under the law of the jurisdiction in which that
descendant is domiciled at the time of distribution under this
Will, then distribution of his or her share shall be made instead
to the custodian for that descendant under the Pennsylvania
Uniform Transfer to Minors Act, and all provisions of that Act as
they exist at the time of this will shall apply to the
distribution. If necessary for legal transfer to that custodian,
my Executor shall convert the assets in that descendant's share
to cash or securities.
ITEM FOUR: I appoint my sister, SUZANNE KING, Executrix of
this my Last will and Testament. In case of her inability or
unwillingness to act or continue to act as my Executrix, I
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appoint my brother, VINCENT M. CASEY, JR., my Executor. In case
of his inability or unwillingness to act or continue to act as my
Executor, I appoint my niece, MICHELE CASEY, my Executrix. I
give to my said Executrix or Executor, in addition to the
authority conferred by law, the power to sell any or all of my
personal and real property at public or private sale, at such
time and for such price and upon such terms and conditions as she
or he may see fit, or in her or his discretion to retain the same
for distribution in kind, and the power, but not the duty, to
invest any cash without being limited to "legaln investments. No
bond shall be required of any fiduciary hereunder in any
jurisdiction. No fiduciary hereunder shall have any liability
for any mistake or error of judgment made in good faith.
ITEM FIVE: I direct that all estate, inheritance and other
taxes in nature thereof, together with any interest and penalties
thereon, becoming payable because of my death with respect to the
property constituting my gross estate for death tax purposes,
whether or not such property passes under this my Last Will and
Testament, shall be paid from the principal of my residuary
estate, and no person receiving or having a beneficial interest
in any such property, whether under this my Last will and
Testament or otherwise, shall at any time be required to
contribute to or refund any part thereof; PROVIDED, however, that
this direction shall not apply to the taxes on any property
included in my estate solely because of a power of appointment
thereover which I possess but have not exercised or on any
qualified terminable interest or to any generation-skipping
transfer taxes.
ITEM SIX: I realize that Executors and ~rrustees are given
discretion by law to make various elections which affect the
income and estate taxes payable by estates, trusts and
beneficiaries, as well as the relative shares of beneficiaries,
such as taking administration expenses as deductions for either
2
1143/11
I' If
estate or income tax purposes, selecting options for the payment
of employee death benefits, electing to take qu.alified terminable
interest as part of the marital deduction, selecting alternate
valuation dates, postponing the payment of taxes, filing joint
income tax or gift tax returns and redeeming corporate stock.
The decisions made by my fiduciaries in any of these matters
shall be binding upon, and not sUbject to question by, any
affected persons; PROVIDED, however, that if a corporate
fiduciary is serving, its decision shall also be binding upon any
individual co-fiduciary. I rely upon my fiduciaries to take into
consideration the total income and estate taxes payable by reason
of their decisions including those payable by my survivors, and
they are authorized in their discretion, but not required, to
make adjustments between income and principal as a result there-
of.
Last
IN WITNESS WHEREOF, I have at Hershey, Pennsylvania, this
day Of~~ 1997 set my hand and seal to this my
Will a Testame t cons1st1ng of four (4) pages.
PAT~~hl' (SEAL)
c?3
SIGNED, SEALED, PUBLISHED AND DECLARED BY PATRICK J. CASEY,
the above named Testator, as and for his Last will and Testament,
in the presence of us, who, at his request and in his presence,
~d in the presence of each other, have hereunto subscribed our
ry~mes as witn sses.
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
.
.
:SS
COUNTY OF DAUPHIN .
We, PATRICK J. CASE~h~ f :;~V and
[(NJJ,# U7It!YJ-t"c;:- , the Testator and tfhe witnesses
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the
instrument as his Last will and Testament 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 purpos-
es 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 their knowledge the Testator was at that
time eighteen years of age or older, of sound mind and under no
constraints or undue
in~~e.
T~TA OR u~LJ~iQ
j)jJ:h~ [; ~ 1& 7
MN~S / v
~b-C7~ ·
WITNES~
Subscribed, sworn to and acknowledged
~. ., .~ASEY, . th~ T~sla or, and subscribed and
7JlwlJO,-,,~ ~ ( SWJ\ and
witnesse~:~~s _~3 ~ay of ~~~
before me by PATRICK
sworn to before me by
rWT ':.FdAL S:::.AL
CO~1f~::: L. REESE, r'Jotary Pub!is
Hershey, Pf>. Daupfiin CDunty
\fJy Comm~s~~cn Expires ~\.n:lY -I D, 19~;Sl
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SETTLEMENT STATEMENT
1.UFHA 2.0FmHA
6. F1Lt: NUMBER:
1 ARM0006-1 RE CIRru=
8. MORTGAGE INS CASE NUMBER:
B. TYpe: OF LOAN:
3. DCON\!. UNINS. 4 OVA
I 7 LOAN NUMBER:
~'.,'-' I~"""', ""'...,IU'-U':'O::;:i
"'-.
U.S. DEPAR.-'-MENT OF HOUSING & URBAN DEVELOPMENT
5.DcDNV INS.
~ NOTE. ThIS form IS fur::71she~..to gIve you a statement .':)f actual settlement costs. Amounts paId to and by the settlement agent are shown.
Items marked [POCI were paId outside the closmg; they are shown here for mformational purposes and are not included m the totals.
1 0 3/98 I' ARMC'RE CIRCLE PFD/l ARM0005 1 RE CIRCLE/s)
D NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: r::. NAME AND ADDRESS OF LENDER:
;-!oward E Pflugfelder and Estate of Patrick J. Casey
Margaret R. Pflugfe!der - --.. -
:; PROPERTY LOCATION: H. SE I I LEMENT AGENT: I. SETTLEMENT DA T::
1 Ardmore Circle Stephen C. Nudel, PC
New Cumberland, PA 17070 April 20, 2005
Sumberland County, Pennsylvania PLACE OF SETTLEMENT
219 Pine Street
i Harrisburg, PA 17101
! J. SUMMARY OF BORROWER'S TRANSAC liON K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400, GRnc::c:: AM UNT DUE TO SELLER:
: 1 01. Contract Sales PriL;e 279,000.00 401. C01tract Sales Price 279,000
i 1 02. Personal Property 402. Personal Property
i 1 03. Settlement Charges to Borrower (Lme 1400) 3.404.50 403.
1104. 404.
105. 405.
I Adustments For Items Paid Bv Seller In advance Adiuotments For Items Paid Bv Seller In advance
1106 City/Town Taxes to 406. City/Town Taxes to
i 107. County Taxes 04/20/06 to 01/01/07 554.36 407. County Taxes 04/20/06 to 01/01/07 554.
i 1 08. School 04/20/06 to 07/01/06 300.74 408. School 04/20/06 to 07/01/06 300.
! 109. Trash 04/20/06 to 07/01/06 30.54 409. Trash 04/20/06 to 07/01106 30.
,110. 410.
",. 4". ,
: 112. 412. .
,120. GROSS AMOUNT DUE FROM BORROWER 283,290.14 420. GROSS AMOUNT DUE TO SELLER 279,885
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
i 201. Deposit or earnest money 10,00000 501. Excess Deposit (See Instructions) .
1202. Principal Amount of New Loanls) 502. Settlement Charaes tl) Seller (line 1400) 20,275
i 203. Existina loan(s) taken subject to . 503. Existina loan(s) taken subject to
204. 504. Payoff of first Mortgage
205. 505. Payoff of second Mortgage
1206. 506. ,
207. 507. (Deposit disb. as proceeds)
1208. 508.
:209 Credit for Roof Reapir 1,000.00 509. Credit for Roof Reapil' . 1,000
I Adiustments For Items Unoald Bv Seller Adiustmenrs For Items Unpaid Bv Seller
! 21 O. City/Town Taxes to 510. Citv/Town Taxes to
211. County Taxes to 5". County Taxes to
212. School to 512. School to ;
1213 Sewer 04/01/06 to 04/20/06 5.47 513. Sewer 04/01/06 to 04/20/06 , 5
!214. 514. I
i215. 515.
1216 516.
1217. 517.
i218. 518.
:219. 519.
, 220. ,0 IAL PAID BY/FOR BORROWEF~ 11,005.47 520. TOTAL REDUCTION AMOUNT DUE SELLER 21,281
! 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
1301 Gross Amount Due From Borrower (Line 120) 283,290.14 601. Gross Amount Due To Seller (Line 420) 279,885
302. Less Arnount Paid By/For SorTcwer (Line 220) ( 11,005.47) 502. Less Reductions Due, Seller (Line 520) ( 21,281
,303, C';SH ( X FROM) ( ,0) 30RROWER 272,28467 603. CASH ( X TO) ( FROM) SELLER . 258,604
The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of thiS statement & .any a~'achm.ents referred t?ti ~e,in.
Borrower Seller V' JII.); !~ .-' 0 .J,:.J ;!r ','. .
~^ '-.l ..(,..;/i -I..L- V1,..; ~, ~(;i
Howard E. Pflugfelder . :::staJe of ,Pl>trick J. Casey J '
/ J)' 7) ",,- /
f/!///ZA/ [7 IU/---
f( ./ .~ . ;tT:-.
v t'---c..'- LL--~S,{~
Margaret ?:. :Oflugfelder
/.t.
';"f"f AO .
,"UD-l (3-86) RESPA. ,"84305
1700. TOTAL COMMISSION Based on Price S)79 .DOC 00 IaJ 50000 %
DIVISIon af Cammissior; (line (00) as ,=a//aws:
1701 $ 16.74000 to ERA-NRT Inc.
70'<:' $ to
703. Commission Paid at Settlement
704. Transaction i"ee to ERA-NRT Inc.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801 Loan On Inalion Fee % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
305. Lenders Inspection Fee to
806. Mortaage Ins. AOD Fee to
807. Assumption Fee tD
308. Flood Certification
809. Application i"ee
810.
811.
1 6 740 DO
"AID ~ROM
3QRROWER'S
FUNOS '" T
SETTeEMENT
"AID FROill
SEeLER'S
'::UNCS ,; T
SC:TTlEMEN
'5.741
12:
I
125001
I
I
I
I
I
I
I
I
1900. ITEMS REOUIRED BY LENDER TO 8E PAID IN ADVANCE
901. Interest i"rom to @ :5 /day ( days %) I I
I
902. MIP Totlns. for LifeOfLoan for months to I I
903. rlazard Insurance Premium for 1.0 years to I I
904. I I
905. I
1000. RESERVES DEPOSITED WITH LENDER
',001. Hazard Insurance months @ :5 per month I I
1002. Mortgage Insurance months @ :5 per month : I
1003. CitylTown Taxes months @ :5 per month
1004. County Taxes months @ :5 per month I I
1005. School months @ :5 per month
1006. months @ :5 per month I I
1007. months @ $ per month
1008. Aooreoate Adjustment months ~ $ per month
1100. TITLE CHARGES
1101. Settlement or Closing Fee to Stephen C. Nudel, PC 250.00
1102. Abstract or Title Search to Stephen C. Nudel. PC 175.00
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to Stephen C. Nudel. PC 125
1106. Notary Fees to Cash
1107. Attorney's Fees to
(includes above item numbers. )
1108. Title Insurance to Stephen C. Nude!. PC. Aoent for FNTINY
(includes above item numbers: )
/1109. Lenders Coverage S
1110. Owner's Coverage S
1111.
1112. Home Inspection Enviroquest POC Buyer
1113.
11200 GOVERNMENT RECORDING AND TRANSFER CHARGES
11201. Recording Fees: Deed S 38.50; Mortgage S Releases S 38.501
i '202. City/County Tax/Stamps: Deed 2,79000; Mortgage 2.790.00 -
11203. State Tax/Stamps: Revenue Stamps 2.790.00: Mortgaae 2,790.
11204. Wire to Cumberland Countv Recorder of Deeds 1100 22.
i 1205. Overnight Courier to Cash 1500
11300. ADDITIONAL SETTLEMENT CHARGES
11301. survey:~ I
11302. Pest Inspection '.
: 1303. Trash/April May June to New Cumberland Borough ,
1304. Home Warranty to AON Home Warranty Services, inc. 11522878
: 1305. Sewer/Jan Feb March to New Cumberland Borough "
1<100. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) I
By signing page 1 of this statement. the signatories ackncwledge receipt of a completed copy of page 2 of thiS two page statement.
I
I
I
3,i04501 -
38.
409.
25
20,275
Certified to be 3 true copy.
Stephen C Nudel. PC
Settlement Agent
( 1 ARMC005-iRE C1RC~E 11 ARMC005-1RE C:RC:...=- is;
Historical Quotes: Charting Tools for Looking Up a Security's Exact Closing Price - BigC... Page 1 of 2
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This Historical Quotes tool allows you to look up a security's exact closing price.
Simply type in the symbol and a historical date to view a quote and mini chart for that security.
;Jjj
Enter Symbol: MET
Enter Date: 2/24/06
.........................
..........................
.............-................................,..
...,-.............................................
-
"'- . .........
High:
51.04
51.35
[ 51.45
'i' I. ...-v~
51.00
Metlife Ine
Friday, February 24, 2006
Closing Price:
Open:
Low:
Volume:
1,582,900
Go To Charting ~fJM~ ~
No Splits
2-Month Daily Chart of Metlife Inc
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http://bigcharts.marketwatch. com/historical) default. asp? detect= 1 &symbol =MET &close dat... 5/4/2006
Historical Quotes: Charting Tools for Looking Up a Security's Exact Closing Price - BigC... Page 1 of 2
_i
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This Historical Quotes tool allows you to look up a security's exact closing price.
Simply type in the symbol and a historical date to view a quote and mini chart for that security.
Xt!
Enter Symbol: MET
~ Enter Date: 2/27/06
....... .........d.....
.............-..........
..
High:
50.81
51.18
( 51.52
5' I. I If
50.76
1,861,900
Go To Chart,'ng ~V [tf: !Jt, ~~
~._ ;s.r. tY.. _
Metlife Inc
Monday, February 27, 2006
Closing Price:
Open:
Low:
Volume:
No Splits
2-Month Daily Chart of Metlife Inc
SPONSORED LINKS
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http://bigcharts.marketwatch.comJhistorical/default.asp?detect=l &symbol=MET &c1ose dat... 5/4/2006
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Patrick J. Casey
209-28-2539
February 25, 2006
Account #: 0574106407 Type:
In the name of: Patrick J. Casey
Date of Death Balance:
Int.(YTD) from 1/1/2006 to
Accrued interest to date of death:
Other Info: Closed 3/27/06
Savings
Open date: 8/4/1998
$54,075.29
2/25/2006
$0.00
$0.00
Account #: 2335253254 Type:
In the name of: Patrick J. Casey
Date of Death Balance:
Int.(YTD) from 111/2006 to
Accrued interest to date of death:
Other Info: Closed 3/2/06
CD
Open date:
2/3/1998
$158,708.78
1/31/2006
$324.03
$371.16
Page 1 of 1
II!
~~~
W~CHOVIA
Reference ID: 1632600
Wachovia Bank N.A.
Balance Confirmation Services
POBox 40028
Roanoke, VA 24022-7313
May 25,2006
MARKOVITZ DUGAN & ASSOCIATES
1001 EAST ENTRY DRIVE SUITE 200
PITTSBURGH, PA 15216
SUBJECT: Verification / Confirmation of Account and Balance Information provided for:
Customer: PATRICK J CASEY (SSN# 209-28-2539)
Date of Death: February 25, 2006
Deposit Account Information
Account
Type
Account
Number
Date of Death
Balance
Average
Balance*
Date
Opened
Maturity Interest Accrued YTD Date
Date Rate Interest Interest Paid Closed
CERTIFICATE OF DEPOSIT 247402052273766
LEGAL TITLE: PATRICK J CASEY
$100,000.00
5/31/2005
$2,818.46
$0.00
3/2/2006
CHECKlNG 1010126450507
LEGAL TITLE: PATRlCK J CASEY
$100,122.70
2/10/2006
$20.46
$122.70
312/2006
* Due to system limitations, we can only provide a twelve month average balance on depository accounts.
No Safe Deposit Box found for customer.
* Date of death balance does not include accrued interest.
* If date of death oceufl':; on a weekend or a holiday, date of death balance does not inc1lude any transactions that were
"ID de, during ;; time period.
~ '&)~~
Audrey Trou
Servicenter Associate
Phone: (540)563-7323
cf; at
r! M&fBank
1200 Market Street, Lemoyne, PA 17043
717 731 1730 FA)( 717 761 6497
May 15, 2006
Markovitz Dugan & Associates
100 I East Entry Dr., Suite 200
Pittsbu.;'gh, PA 15216-2943
Re: Patrick J. Casey, deceased
Dear Sir or Madam:
Per your request, please [md the following information with regard to Mr. Casey's accounts with our bank.
1. Registered owner- Patrick J. Casey, in his individual name alone
2. The checking account was established June 28, 1968, money market was established Apri125,
2005
3. No change in ownership or registration
4. No interest on the checking, the money market had an effective rate of 2.96%
5. Date of death was February 25,2006
6. Interest accrued on the money market account was $624.29 through February 24, 2006
Should you have any questions with regard to the above information, please do not hesitate to contact me at
717-731-1730.
uti
r;4t~
Carl . Myers f/
Assistant Vice President
~
PSECIt
the financiallinkTM
May 22, 2006
Account # 8100913584
SAMUEL J GERNITNARO
1001 EAST ENTRY DRIVE
SUITE 200
PITTSBlJRGH, PA 15216-2943
Dear MR GERNITNARO:
The following is the status ofPATRlCK J CASEY's account with PSECU as of the date of death.
Joint Owner's Name
Date of Death
Date of Birth
NONE
02.25.2006
07.13.1936
Share
SOl
Description
Regular Shares
Open date
03.21.2002
Balance
$13,462.55
Accrued Dividend
$8.85
Rate
1.00%
The dividend earned from January 1, 2006 through the date of death was $20.27. The decedent had no loans with us.
We do not have safe deposit boxes for our members.
If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu
prompt, enter 6 and then extension 2227.
Sincerely,
, /I1J~5tt. p
~ffItJ(J.A
Meacie Fa' ~x .
Member Service Representative
Finance Support Unit
Pennsylvania State Employees Credit Union
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 . (717) 234-8484 . (800) 237-7328
_lv'ioili~gAddress: P.O. Box 6701 Harrisburg,PA 171 06-7013. 1 777-21OD(TDD). (800) 472-1 967(TDD)
c_. .M_I~~~.~II" ;n<mpM >on tn ~ 100000 bvthe Notional Credit Union Administration www.psecu.com
~.~. Citizens Bank'"
Account Number 6246747561
Account Title PATRICK J CASEY
Date Opened 7/12/2005
Account Type Time Deposits
Principal Balance as of DOD $102049.98
Interest fro1!1 Last Posting to DOD $144.68
Account Balance as of DOD $102194.66
YTD Interest to DOD $595.43
Kelley Blue Book - Suggested "Petail Pricing Report - Honda, Accord
ley Blue Book
lHE nUHEV ft:E50URCf
""""""""""""""""""""""""""k~,t~iIi
Page 1 of 3
advertisement
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Home> Used Cars> 2004 > Honda> Accord> EX Coupe 2D > Equipment
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2004 Honda Accord EX Coupe 20
Trade-In Value
Private Party Value
.. Suggested Retail
Value
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BLUE BOOK";: SUGGESTW RETAIL VALUE ,':
Condition
Value
Excellent
$20,000
(Selected)
Suggested Retail Value Assumes
Excellent Condition... " More
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Vehicle Details
Engine: 4-Cyl. 2.4L VTEC
Transmission: Automatic
Drivetrain: FWD
Mileage: 17,402
Selected Standard Equipment
'::: Change Equipment
Air Conditioning
Power Steering
AM/FM Stereo
ABS (4-Wheel)
Blue Book Suggested Retail Value
The Kelley Blue Book Suggested Retail Value is representative of dealers'
asking prices and is the starting point for negotiation between a consumer
and a dealer. This Suggested Retail Value assumes that the vehicle has been
fully reconditioned and has a clean title history. This value also takes into
account the dealers' profit, costs for advertising, sal'es commissions and
other costs of doing business. The final sale price will likely be less
depending on the vehicle's actual condition, popularity, type of warranty
offered and local market conditions.
Vehicle Condition Rating
Check Vehicle Title History
Excellent (Selected)
$20,000
httD://www.kbb.com/kb/ki. dlllkw.kc.ucp?kbb& 17070&; 4 73020&; ;ucr;&3 ;HO;AC
at
URL:
5/4/2006
Kelley Blue Book - Suggested TZ.etail Pricing Report - Honda, Accord
Page 2 of 3
"Excellent" condition means that the vehicle looks new, is in excellent
mechanical condition and needs no reconditioning. This vehicle has never
had any paint or body work and is free of rust. The vehicle has a clean
title history and will pass a smog and safety inspection. The engine
compartment is clean, with no fluid leaks and is free of any wear or visible
defects. The vehicle also has complete and verifiable service records. Less
than 5% of all used vehicles fall into this category.
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Blue Book Retail Value Assumes Excellent Condition
This value assumes the vehicle has received the cosmetic and/or mechanical
reconditioning needed to qualify it as "Excellent". This is not a transaction
value; it is representative of a dealer's asking price clnd the starting point
for negotiation.
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Copyright @ 2006 by Kelley Blue Book Co., AJI Rights ReselYed. May-Jun 2006 Edition.
The specific information required to determine the value for this particular vehicle was
supplied by the person generating this report. Vehicle valuations are opinions and may
vary from vehicle to vehicle. Actual valuations will vary based upon market conditions,
specifications, vehicle condition or other particular circumstances pertinent to this
particular vehicle or the transaction or the parties to the transaction. This report is
intended for the individual use of the person generating this report only and shall not
be sold or transmitted to another party. Kelley Blue Book assumes no responsibility for
errors or omissions. (v. 06050)
http://www.kbb.com/kb/ki. dll/kw.kc.ucp?kbb& 17070&473 020&;ucr;&3 ;HO ;AC
5/4/2006
,
ppraiJer J
Cef'ti icate
I, the undersigned, do hereby certify that I have personally
inspected the property appraised, that I have no present or
contemplated future interest therein, that the fee received for
this assignment is in no manner contingent upon the value
reported, and that no important factors affectin~J the value of
this property were knowlingly overlooked or withheld.
The information contained in this report is not guaranteed;
however, it has been gathered from sources we believe to be
reliable. The appraiser certifies that to the best of his knowl-
edge and belief, the statement, information, and materials
contained in the appraisal are correct as set forth.
I certify that this report has been completed in conformity with
recognized industry standards. The appraisal assignment was
not based on a requested minimum valuation or specific valu-
ation for approval of a loan.
Signed Appraiser #2408
Firm Wayne Myers Auction Service
Date March 28. 2006
-~
KAS-66G @ 1996 Kiefer Supply Co. Fergus Falls, MN (800) 435-2726
~pprai5aI
TO: Suzanne King. Executrix
4112 Dalewood street
Pittsburgh, Pa. 15227
DATE: March 28, 2006
RE: Patrick J. Casey Estate
Pursuant to your request, I have inspected certain personal property located at 1 Ardmore Circ Ie,
New Cumberland, Pa. 17070
for the purpose of appraising its fair market value as of the
28 th
day of Mrlrrn
4J:9 2 0 0 6
Based upon the information contained in this report in the attachments and schedules attached hereto and hereby made a part hereof and upon
my general experience as an appraiser and auctioneer, it is my opinion that said personal property had a estimated fair market value on the
above date of
Two Thousand-Three Hundred-
Eighty Tllree Dullc:1.L b
The term "Fair Market Value" as used in this report is defined as follows: the highest price estima.ted in terms of money which the property
will bring if exposed for sale in the opea market by a seller who is willing but not obligated to sell, allowing a reasonable time to find a buyer
who is willing but not obligated to buy, both parties having full knowledge of all the uses to which it is adapted and for which it is capable of
being used.
( $
$ 2,383.00
).
This appraisal is based upon the following assumptions, limitations and conditions:
1. That title to the property appraised is good and merchantable or that is will be prior to the time of sale.
2. That all liens and encumbrances, if any, have been satisfied and the property has been appraised as though free and
clear under responsible ownership and competent management.
3. That matters of a legal nature have not been considered in this appraisal.
4. That this appraisal report is made for the use of the named recipient only and that no part of it may be used or relied
upon by any other person without the previous written consent of client and/or the appraiser.
5. That the fee for this appraisal does not provide for or include compensation for conference or testimony and/or
attendance at any court proceeding.
This undersigned appraiser hereby certifies:
1. That he has no interest now, heretofore or contemplated in the future in the personal property covered by this appraisal.
2. That he has personally inspected the personal property to the extent that it was reasonably necessary and possible to do so.
3. That, to the best of his knowledge and belief, all statements and information included in this appraisal are true and are
based upon his objective findings and that no pertinent information has been knowingly withheld or deleted in this report.
4. That neither his employment to make this appraisal nor his compensation for so doing is contingent upon the value of the
property.
Even though it is the firm belief of the appraiser that the information furnished in this appraisal report and the conclusions drawn from this
information are true and correct they are not guaranteed.
Valley
Street Address
Landisburq,
City
Pri
State
17040
Zip Code
KAS-654
Kiefer Auction Supply
(800) 435-2726
...--....:..:..:-:-~---
WAYNE
MYERS
,
SERVICE
A OCTION
· AUCTIONEER
· APPRAISER
Appraisal Report
Of
Personal Property
Prepared For: Suzanne King, Executor
4112 Dalewood Street
PittsQurgh, Pa. 15227-3428
Estate Of:
Patrick J. Casey
1 Ardmore Circle
New Cumberland, Pa. 17070
As Of:
March 28,2006
P~ose:
Estate Settlement
By:
Wayne L. Myers
Auctioneer/Appraiser #AU-2408-,L
92 Greens Valley Road
Landisburg, PA 1 7040
Phone: 717-789-4264
Fax: 717-789-4692
:; -
)/1'-;1?-1 I t "7
~r
C-(_/l/~
~ /f
I ~ IUC-I t-L
--',
/ )
i1Lj-
/ ~ - ,
- /
COifJ
~/
Foyer:
Wall/Sofa Table, Ornate
Wall Pictures
Wood Carving, Figurine
Pottery
Total
Living Room:
Upholstered Love Seat With Matching Sofa,
Fair Condition, Dirty
Wall Pictures
Pair Glass End Stands With Matching Coffee Table
Two Glass Stand Lights
Red Upholstered Side Chair
Two Designer Upholstered Chairs
, Wood Glass Table, Poor Condition, Worn
Metal Base Table Light
Lady With Baby, Figurine, West Germany
Carved Wood Dog
Two Mahogany Side Chairs, Upholstered
Entertainment Cabinet With 20" Sony TV, Sony Disc
Player, Assortment Of CD's And Cassettes
Beasystem Cassette Player
Brass Candle Holders
Wall Hanging, Sunburst
Total
Dining Room:
Glass Top Dining Room Table With 4 Upholstered Chairs
Pair Crome Candle Holders
Colburt Blue Fruit Dish
Weather Station
Two Wall Painting
Red Dad Buffet/Cabinet
Misc. Items In Buffet, Silverware, Glassware, Etc.
Glass Candle Holders
Large Blue Urn
Total
(~)
$ 50.00
20.00
10.00
10.00
90.00
25.00
30.00
30.00
20.00
20.00
30.00
5.00
10.00
10.00
3.00
40.00
125.00
25.00
10.00
15.00
398.00
50.00
10.00
10.00
5.00
15.00
40.00
25.00
5.00
20.00
180.00
(V
Kitchen:
Porcelain Dish Set, Portugal
Red/Blue Stemware
Misc. Dishes, Bowls, Corningware, Plasticware
Kitchen Drawers With Knives And Misc.
PotsfPans/T oasterlBlender/T oaster Oven!
Coffee Pot! Misc. Small Appliances
Misc. Small Items On Kitchen Cabinets
Senitaine Upright Vacuum
Two Handheld Vacuums
~ Eleven Small Wall Hanging Pictures
Artificial Tree
$ 20.00
12.00
25.00
10.00
35.00
Total
10.00
15.00
10.00
.' 22.00
18.00
177.00
Bedroom #2:
Four Pc. Bedroom Suite: 2 Dressers, Night Stand,
Double Bed With Box Springs And Mattress
Stand Light
Picture
Mushroom Light
Misc. Smalls On Dressers, Car, Dogs, Elephant, Etc.
Total
150.00
12.00
20.00
12.00
10.00
202.00
Hallway:
Six Pictures
15.00
Total
15.00
Bedroom #3:
Single Bed With Box Springs And Mattress, Metal Headboard
Metal/Glass Night Stand
Clock Radio
Black Chest Of Drawers With Desk/Cabinet
Stand Light
12" Television
Computer Desk
Picture
Total
45.00
8.00
5.00
40.00
8.00
15.00
25.00
10.00
156.00
Large Bathroom:
jPictures
Bath Scales
~
Master Bedroom:
Double Bed With Box Springs And Mattress
Two Night Stands
Dresser With Mirror
Chest Of Drawers
Pair Of Crome Stand Lights
Pictures
Alarm Clock
Total
Total
$
25.00
10.00
35.00
225.00
10.00
15.00
3.00
253.00
(~J
Basement Room #1:
Three RedlWhite Table Lights
Two Blue Sofas, Poor Condition
Two Small White End Tables With 2 Matching
Smaller Stands
Glass Brown Vase
Dog Pictures
Nordic Trac Treadmill
.... Two Black Leather Chairs With Ottermans
Tan Gooseneck Floor Light
Cabinet With Light
Assorted Pictures
Two White Bookcases
Assortment Of Books
Mug Assortment
Hoover Upright Vacuum
Linen In Closet
Four Folding Chairs
~Dog Picture
26" Television, Floor Model
Basement Room #2:
Metal Utility Cabinet
Folding Table
.Tool Box With Few Hand Tools
Ironing Board With Iron
"- Metal Step Ladder, 2 Step
..,Boxes Of Assorted Christmas Decorations
, Green Luggage
Shop Vac
Metal Cabinet
Maytag Washer And Dryer
Furnace Room:
Patio Set, Glass Top Table With Chairs
And Umbrella
Misc. Assortment Of Folding Lawn Chairs
Total
Total
Total
(J]
$ 25.00
20.00
20.00
5.00
10.00
25.00
50.00
10.00
20.00
25.00
10.00
5.00
25.00
15.00
10.00
20.00
25.00
30.00 /
I
350.00 /
15.00
10.00
7.00
4.00
5.00
10.00
12.00
10.00
7.00
125.00
205.00
45.00
20.00
65.00
Utility/Tool Shed:
Two Hose Reels With Hose
5 Ft. Stepladder
Assortment Of Garden Tools,Rakes, Shovels, Etc.
., Honda Gas Lawn Mower With Bagger
Metal Wheelbarrow
~ Gas Motor Snowblower, Small Sidewalk Style
JBag Cart
Total
Deck Area:
\" Gas Grill
Total
$
15.00
20.00
25.00
55.00
12.00
75.00
5.00
207.00
50.00
50.00
r0
l/)
Summary
Contents:
Foyer $ 90.00
Living Room 398.00
Dining Room 180.00
Kitchen 170.00
Bedroom #2 202.00
Hallway 15.00
Bedroom #3 156.00
Large Bath 35.00
Masterbedroom 253.00
Basement Room #1 350.00
Furnace Room 65.00
Basement Room #2 205.00
Utility/Tool Shed 207.00
Deck 50.00
Total $ 2,383.00
A Family Tradition .OjCaring
.., ",
. . -
PARTHEMOREFuneral Home & Cremation Services, Ine
Mrs. SuianneKing.
4112 Dalewood Street
Pittsburgh, PA15227
2/27/2006
1303 Bridge Street
P.O. Box 431
New Cumber-land, PA 17070
(717j 77 4-7721
(Fax) 774c5546
www.parthemore.com
For the services of Patrick 1. Casey
We sincerely appreciate"the corifidenceyou have placed in us ,rod will continu~ to assist you i~ everyway .
we can. Please feel free to contaCt us ifyo-q have any questionsinregaid fo~s statement. The following
is an itemized statement of the serVices, facilities, automotive equipni~ntand merchandise that you selected.
when making the funeral arrangements.. .
Description
SERVICES & MERCHANDISE
Traditional.Funeral Servi~e
18 Gauge Steel; Pieta Casket
Due Date
. 3/29/2006
Account #
2006017.0
Amount
5,405.00
2,550.00
Gilbert W. Parthemore,
Founder
Total SerVices imd Merchandise
7,955.00
Stephen K. Parthemore,
CFSP
CASHADV ANCE ITEMS
Death Notice, Harrisburg Patriot
20 Certitie4 Copies of Death Certificates
Clergy Honorariilrri .
Organist Honorarium
Solofst 'Honorarium
Altar Servers
Flowers, (2) Fireside Baskets
Total Cash Advanges
160.82
120.00
150.00
100.00
75.00
15.00
175.00
Gilbert 1. Parthemore,
Supervisor
. Bruce R, Parthemore,
Pre-NeedCoordinator, CPC
.795.82
Imme~iate Pay' Discount - Thank you!
-159.10
Professional Memberships:
NFpA . 'PFDA .
DCFDA . COFDA
. .
I~Drderflffht
G~.QD.E.~. N......
'~
The 'Rule You Know,'
The People You Trust
Total
PaymentslCredits
Balanse Due
:. '"U' '..'
~\0 t.A--. *L
Vv.-- XL. .'#\:'
-?--h) 'lfJ) ._~\L '.
$8,591.72
$0.00
Label
(See
instructions
on page 16.)
Use the IRS
label. H Home address (number and street). If you have a P.O. box, see page 16. Apt. no. ... You must enter
Otherwise, E 4112 DALEWOOD STREET
please print R our SSN s above.
or type. E City, town or post office, state, and ZIP code. If you have a foreign address, see page 16. Checking a box below will not
Presidential PITTSBURGH PA 15227 change your tax or refund.
Election Campaign ~ Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 16) ~ 0 You 0 Spouse
1 X Single 4 Head of household (with qualifying person). (See page 17.) If
the qualifying person is ;a child btit not your dependent, enter
Filing Status 2 Married filing jointly (even if only one had income) this child's name here. I~
3 Married filing separately. Enter spouse's SSN above 5 0 Qualifying widow(er) with dependent child (see page 17)
and full name here.
Sa X Yourself. If someone can claim you as a dependent, do not check box 6a .
Souse
d Total number of exemptions claimed
7 Wages, salaries, tips, etc. Attach Fonn(s) W-2 .........
8a Taxable interest. Attach Schedule B if required ..
b Tax-exempt interest. Do not include on line 8a
Sa Ordinary dividends. Attach Schedule B if required
b Qualified dMdends (see page 23) ..................::::.:.:::::::::...~......... i 7 8
10 Taxable refunds, credits, or offsets of state and local income taxes (see page 23)
11 Alimony received...........................................................
12 Business income or (loss). Attach Schedule C or C-EZ. . . .. ........... . .. . . . . . . . . ..
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ~ : : : : : : : : : . '0
~:a ~:e~i;::~~~:n~o~~~S). .A~~~h. FOG:J7. ................... '1' . b' 'i-~~bi~ ~~~~~t .(~~~. p~g~' 25)
16a Pensions and annuities ~ b Taxable amount (see page 25)
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .........
18 Farm income or (loss). Attach Schedule F ...................................................
;~a ~:;i:P~:~::t::~::sation. 'l~~~J""""'" "f,f; 042l'b'i-~bi~ ~~~~~t'(~~~'P~9~'27)
21 Other income. Ust type and amt. (see page 29) ...................................
22 Add the amounts in the far ri ht column for lines 7 throu h 21. This is our total income.
23 Educator expenses (see page 29) ............................... 23
24 Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 21 06-EZ . . . . . . .
25 Health savings account deduction. Attach Form 8889
26 Moving expenses. Attach Form 3903 .. ..........................
27 One-half of self-employment tax. Attach Schedule SE
28 Self-employed SEP, SIMPLE, and qualified plans ..
29 Self-employed health insurance deduction (see page 30)
30 Penalty on early withdrawal of savings. . . . . . . . . . . . . . . . . . . . . . . . . . . .
31a Alimony paid b Recipienfs SSN ~
32 IRA deduction (see page 31) . . . . .. . . . .... . . _ . . .
33 Student loan interest deduction (see page 33) . . . . . . . . .
34 Tuition and fees deduction (see page 34) . . . . . . . . . . . . . . _ . . . . . . . . . .
35 Domestic production activities deduction. Attach Form 8903 ........
36 Add lines 23 through 31 a and 32 through 35 _ . . . . . . . . .
37 Subtract line 36 from line 22. This is your adjusted gross income
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 78.
DM
E
(5
u.
1040
Check only
one box.
Exemptions
If more than four
dependents, see
page 19.
Income
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a W-2,
see page 22.
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.
Adjusted
Gross
Income
Department of the Treasury - . /lal Revenue Service
U.S. Individual Income Tax Return
2005
L
A
B
E
L
Forthe ear Jan. 1-Dec. 31, 2005, or other tax ar
Your first name and Initial Last name
Your social security number
209-28-2539
.2005, endin 20
DECEASED
2/25/0
OMB No. 1545-0074
PATRICK
CASEY
If a joint retum, sp. first name & initial
Last name
Spouse's social security number
...
b
} Boxes checked
. . . . . . . . . . on 6a and 6b
No. of children
on 6c who:
. lived with
or child you
ax cr. (see . did not live with
. 19 you due to divorce
or separation
(see page 20) _
Dependents on
6c not en-
tered above
Add numbers
on lines
above
1
c
Dependents:
First name
Last name
(2) Dependents
social security number
(:1)
..~
13 068
178
10
11
12
13 43 665
14
15b
16b 638 417
17 13 920
18
19
20b 11 936
21
22 721 184
~
721 184
Form 1040 (20J5)
24
25
26
27
28
29
30
31a
32
33
34
35
~
Form 1040 r2005)
Tax and
Credits
Standard
Deduction
for-
. People who
checked any
box on line
39a or 39b or
who can be
claimed as a
dependent,
see page 35.
. All others:
Single or
Married filing
separately,
$5,000
Married filing
jointly or
Qualifying
widow(er),
$10,000
Head of
household,
$7,300
Other
Taxes
Payments
If you have a
qualifying
child, attach
Schedule EIC.
Refund
Direct deposit?
See page 59
and fill in 73b,
73c, and 73d.
Amount
You Owe
Third Party
Designee
Sign
Here
Joint return? ..
See page 17. r
Keep a copy
for your
records.
Paid
Preparer's
Use Only
DM
PATRICK CASEY
-
Pa e 2
184
38 Amount from line 37 (adjusted gross income) ......... . . . . . . . . . . . . . . . . . . . . . . . . . .. ....
39a ~heck { ~ You were bom before January 2,1941, 0 Blind.} Total boxes
If. D Spouse was bom before January 2, 1941, D Blind. checked ~ 39a
If your spouse itemizes on a separate retum or you were a dual-status alien, see page 35 and check here ~ 39b
Itemized deductions (from Schedule A) or your standard deduction (see left margin)
Subtract line 40 from line 38
If line 38 is over $109,475, or you proVided 'housing ici a 'person 'd'isplaced by 'Huriicane 'Katona: . . . . . . . . . . . . . . . . . .
see page 37. otherwise, multiply $3,200 by the total number of exemptions claimed on line 6d ................
43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter-O-
44 TaX[jee page 37). Check if any tax is from: a 0 Form(s) 8814 .
b Form 4972
....,......... ..... -..
Alternative minimum tax (see page 39). Attach Form 6251
Add lines 44 and 45 . . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign tax credit. Attach Form 1116 if required
Credit for child and dependent care expenses. Attach Form 2441 . .
Credit for the elderly or the disabled. Attach Schedule R .
Education credits. Attach Form 8863
. ... ......
Retirement savings contributions credit. Attach Form 8880 .........
Child tax credit (see page 41). Attach Form 8901 ifrequired
Adoption credit. Attach Form 8839
Credits frum: a D Form 839;3 .
Other credits. Check applicable box(es):
b D Form 8801 c D Form
56 Add lines 47 through 55. These are your total credits . . . . . . . . . .
57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- .
58 Self-employment tax. Attach Schedule SE ............
59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137
60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required. ...........
61 Advance earned income credit payments from Form(s) W-2 ........ ..............
62 Household employment taxes. Attach Schedule H ................. . . . . . . . . .
63 Add lines 57 - 62. This is our total tax
64 Federal income tax withheld from Forms W-2 and 1099
........ ....
65 2005 estimated tax payments and amount applied from 2004 return
f-
f- 66a Earned income credit (EIC) ......... ..... ..........
b Nontaxable combat pay election ... 66b
67 Excess social security and tier 1 RRTA tax withheld (see page 59). . . 67
68 Additional child tax credit. Attach Form 8812 .. .. ........... . ..... . 68
69 Amount paid with request for extension to file (see page 59) ............... 69
70 Payments from: a 0 Form 2439 b 0 Form 4135 c 0 Form 8885 70
71 Add In. 54, 55, 65a, & 57 - 70. These are your total payments ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
72 If line 71 is more than line 63, subtract line 63 from line 71. This is the amount you overpaid. . . . . .
73a Amount of line 72 you want refunded to you. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~
~ b Routing number I I ~ c Type: D Checking 0 Savings
~ d Account number . I
74 Amount of line 72 you want applied to your 2006 estimated tax ~ I~
75 Amount you owe. Subtract line 71 from line 63. For details on how to pay, see page 60 . . . . . . . . . . ...
76 Estimated tax penalty (see page 60) . . . . . . . . . . .. ........... 76
Do you want to allow another person to discuss this return with the IRS (see page 61)7 X Yes. Complete the following.
Designee's Personal identification number (PIN) ~ I I
name ~ PRE PARE R Phone no. ...
Under pena~ies of pe~ury, I declare that I have examined this retum and accompanying ~ules and statements, and to the rest of my knowledge and
belief, they are true, correct, and complete. Declaration of pre parer (other than taxpayer) IS based on all Information of which preparer has any knoWledge.
Your signature Date Your occupation Daytime phone number
PERSONAL REPRESENTATIVE
b
_ 40
41
42
6
714
250
934
o
934
714
221
928
45
46
47
48
49
50
51
52
53
54
55
221
928
. 'b agj~tr:::oo
47
48
49
50
51
52
53
54
55
~
221
928
221
928
64
65
66a
~
7,501
Spouse's signature. If a joint retum, both must sign.
Date
Spouse's occupation
Prepare(s ..
signature r
Date
3/22/06
& ASSOCIATES
STE 200
o
Prepare(s SSN or PTIN
P00367167
25-1851188
Check if
self-employed
Firm's name (or ..
yours if selJ-employed), ,-
address, and ZIP code
MARKOVI TZ DUGAN
1001 E ENTRY DR
PITTSBURGH
412-571-0500
Form 1040 (2005)
EIN
Phone no.
PA 15216-2943
Schedules A&B (Form 1040) 2005
Name(s) shown on Form 1040. Do not enter name and social security number if shown on other side.
PATRICK CASEY
OMS No. 1545-0074
Your social security number
209-28-2539
Paae 2
Schedule B-Interest and Ordinary Dividends
Attachment
Sequence No. 08
1 List name of payer. If any interest Is from a seller-financed mortgage and the Amount
Part I buyer used the property as a personal residence, see page B-1 and list this
Interest interest first. Also, show that buyer's social security number and address ~
PSECU 105
(See page B-1 CITIZENS BANK OF PA 1,455
........ . ...... ..
and the M&T BANK 6,503
instructions for .. ... .....
Form 1040, SOVERE IGN BANK 4,557
.... ......
line 8a.) CHARLES T SCIOTTO LIVING TRUST 20-64 194 67 448
1
Note. If you
received a Form
1099-INT, Form
1099-0ID. or
substitute
statement from
a brokerage firm,
list the firm's
name as the ..
payer and enter
the total interest
shown on that
form. 2 Add the amounts on line 1 2 13,068
3 Excludable interest on series EE and I U.S. savings bonds issued after 1989.
Attach Form 8815 3
4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a ~ 4 13,068
Note. If line 4 is over $1 ,SOD, you must complete Part III. Amount
5 List name of payer ~
..
Part II METLIFE 174
.. .. ..
Ordinary CHARLE S T SCIOTTO LIVING TRUST 20-64 194 67 4
Dividends ..
..
.. .. ..
(See page 8-1 ..
and the . ..
instructions for . .. ..
Form 1040, ..
line 9a.)
..
.. 5
Note. If you ..
received a Form
1 099-DIV or .. .. .
substitute
statement from ---- ..
a brokerage firm, .. ..
list the firm's ..
name as the
payer and enter .. . ..
the ordinary .. ..
dividends shown
on that form.
. ..
.. . ..
6 Add the amounts on line 5. Enter the total here and on Form 1040, line 9a ~ 6 178
Note. If line 6 is over $1 ,500, you must complete Part III.
You must complete this part if you (a) had over $1,500 of taxable irierest or ordinary dividends; or l[b) had
Part III a forei n a=unt; or c received a distribution from, or were a rarror of, or a transferor to, a foreicn trust.
Foreign 7a At any time during 2005, did you have an interest in or a signature or other authority over a financial
Accounts account in a foreign country, such as a bank a=unt, securties account, or o(her financial a=unt?
and Trusts See page B-2 for exceptions and filing requirements for Form TO F 90-22.1
b If "Yes," enter the name of the foreign country ~ . . . . . . . . . . . . . . . . . . . . . . . . .
8 During 2005, did you receive a distribution from, or were you the grantor of, or transferor to, 2
foreign trust? If ''Yes," you may have to file Form 3520. See page B-2.
For Paperwork Reduction Act Notice, see Form 1040 instructions.
DM
(See
page B-2.)
Schedule B (Form 1040) 2D'"..6
SCHEDULE D
(Form 1040)
OMS No. 1545-0074
Capital Gains and Losses
~ Attach to Form 1040. ~ See Instructions for Schedule D (Form 1040).
~ Use Schedule D-1 to list additional transactions for lines 1 and B.
2005
12
Department of the Treasury
Internal Revenue Service 99
Attachment
S uence No.
Your social security number
209-28-2539
Name(s) shown on Form 1040
PATRICK CASEY
E,aiD.
Short-Term Capital Gains and Losses-Assets Held One Year or Less
(a) Description of property
(Example: 100 sh. XYZ Co.)
(b) Date
acquired
(Mo., day, yr.)
(f) Gain or (loss)
Subtract (e) from (d)
(d) Sales price
(see page D-6 of
the instructions)
(e) Cost or other basis
(see page D-6 of
the instructions
(c) Date sold
(Mo., day, yr.)
2
Enter your short-term totals, if any, from Schedule 0-1,
line 2 2
. .................. ...... .....
Total short-term sales price amounts. Add lines 1 and 2 in
column (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824
Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-l . . . . . . . . . . . . . . . . . . . . . . . . . . .
Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss
Carryover Worksheet on page 0-6 of the instructions . . . . . . . . . . . . .
3
4
5
4
5
6
6
7 Net short-term capital gain or (loss). Combine lines llhrough 6 in column (f) . . . . . .
lBa:lIltil Long-Term Capital Gains and Losses-Assets Held More Than One Year
7
o
(a) Description of property
(Example: 100 sh. XYZ Co.)
(b) Date
acquired
(Mo., day, yr.)
(f) Gain or (loss)
Subtract (e) from (d)
(d) Sales price
(see page D-6 of
the instructions)
(e) Cost or other basis
(see page D-6 of
the instructions
(c) Date sold
(Mo., day, yr.)
B
9
Enter your long-term totals, if any, from Schedule 0-1,
line 9 9
............... ......... .......................
Total long-term sales price amounts. Add lines 8 and 9 in
column (d) . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . .. .. . . . .. . . 10
Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or
(loss) from Forms 4684, 6781, and 8824 . . . . . . . . . . .
Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from
Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . .. . .. .. .. . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . .. . . .. . . .
10
11
11
12
12
43 665
13 Capital gain distributions. See page 0-1 of the instructions .................................
14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss
Carryover Worksheet on page 0-6 of the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15 Net long-term capital gain or (loss). Combine lines 8 through 14 in column (f). Then go to
Part III on the back ........................................... . . . . . . . . . . . . . . .. .............
For Paperwork Reduction Act Notice, see Form 1040 instructions.
13
14
15 43 665
Schedule D (Form 1040) 2005
DAA
PATRICK CASEY
Schedule D (Fonn 1040) 200S
~;.""'~ ~JI"I"~
~J.I~ Summary
16 Combine lines 7 and 15 and enter the result. If One 16 is a loss, skip lines 17 through 20, and
go to line 21. If a gain, enter the gain on Fonn 1040, line 13, and then go to line 17 below
17 Are lines 15 and 16 both gains?
129 Yes. Go to line 18.
D No. Skip lines 18 through 21, and go to line 22.
18 Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet on page D-7 of the
instructions
19 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet on
page D-8 of the instructions
20 Are lines 18 and 19 both zero or blank?
129 Yes. Complete Fonn 1040 through line 43, and then complete the Qualified Dividends and
Capital Gain Tax Worksheet on page 38 of the Instructions for Fonn 1040. Do not complete
lines 21 and 22 below.
D No. Complete Form 1040 through line 43, and then complete the Schedule 0 Tax Worksheet
on page D-9 of the instructions. Do not complete lines 21 and 22 below.
21 If line 16 is a loss, enter here and on Fonn 1040,line 13, the smaller of:
. The loss on line 16 or
. ($3,000), or if married filing separately, ($1,500)
}.
Note. When figuring which amount is smaller, treat both amounts as positive numbers.
22
Do you have qualified dividends on Fonn 1040, line 9b?
o
D
Yes. Complete Fonn 1040 through line 43, and then complete the Qualified Dividends and
Capital Gain Tax Worksheet on page 38 of the Instructions for Fonn 1040.
No. Complete the rest of Form 1040.
DAA
209-28-2539
Page 2
43 665
~
~
Schedule D (Form 1040) 2o-J5
Schedule E (Form 1040) 200S
Name(s) shown on retum. Do not enter name and social security number ff shown on other side.
,ttachment Seauence No. 13
Your social security number
Paae 2
PATRICK CASEY
209-28-2539
Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.
.'(111 Income or Loss From Partnerships and S Corporations Note. If you report;3 loss from an at-risk activity for
which any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 619B. See page E-1.
27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed
loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? 0 Y es ~ No
If au answered ''Yes,'' see a e E-6 before com letin this section.
28
(a) Name
(b) Enter P
for partnership;
S for S cor .
(d) Employer
identificalion
number
(e) Check ff
any amount is
not at risk
A
8
C
D
Passive Income and Loss
(f) Passive loss allowed
(attach Form 8582 ff required)
(g) Passive income
from Schedule K-1
(h) Nonpassive loss
from Schedule K-1
(i) Section 179 expense
dedcdlon from Form 4562
Ul Nonpassive income
from Schedule K-1
A
8
C
D
29a Totals
b Totals
30 Add columns (g) and OJ of line 29a
31 Add columns (f), (h), and (i) of line 29b . . . . . . . . . .
32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the
result here and include in the total on line 41 below . .
IP.Ji'iIlUli Income or Loss From Estates and Trusts
30
31
32
33
(a) Name
(b) Employer
identification number
A
8
CHARLES T SCIOTTO LIVING TRUST
20-6419467
Passive Income and Loss
(c) Passive deduction or loss allowed
(attach Form 8582 ff required)
(d) Passive income
from Schedule K-1
Non assive Income and Loss
(e) Deduction ,or loss
from Schedule K-1
38
(b) Employer
identification number
e Investment Conduits
(c) Excess inclusion from
Schedules Q, line 2c
(see page E-6)
(f) other income from
Schedule K-1
13 920
13 920
35 13 920
36 0
13 920
(e) Income from
Schedules Q, line 3b
A
8
34a Totals
b Totals
35 Add columns (d) and (f) of line 34a . . . . . . . . . . " . . . . " . . . . " " . " . . .
36 Add columns (C) and (e) of line 34b . " . " . . " . . . . . . . . . " " " . . " . . . . . " .
37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and
include in the total on line 41 below .........
Ilm"'ttWI Income or Loss From Real Estate Mort a
o
(a) Name
(d) Taxabe income (net loss)
from Sch",dules Q, line 1 b
39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below
1.aa.tt1l1l Summary
40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below
41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Form 1040,line 17
42 Reconciliation of farming and fishing income. Enter your gross farming
and fIShing income reported on Form 4835, line 7; Schedule K-1 (Form
1065), box 14, code B; Schedule K-1 (Form 112OS), box 17, code N; and
Schedule K-1 (Form 1041), line 14, code F (see page E-7)
43 Reconciliation for real estate professionals. If you were a 'real"estate "
professional (see page E-1), enter the net income or (loss) you reported
anywhere on Form 1040 from all rental real estate activities in which
ou material! artici ted under the assive activO loss rules
DAA
Schedule E (Form 1040) 2005