HomeMy WebLinkAbout08-25-06
REV-1500 EX + (6-00)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
OFFICIAL USE ONLY
21-06-0004
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Bair H n Joo
DATE OF DEATH (MM-DD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
521-60-0892
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
Copyright (c) 2000 form software only The Lackner Group, Inc.
DATE OF BIRTH (MM-DD YEAR)
12/02/2005 07/13/1939
IF APPLICABLE) SURVIVING SPOUSE'S NAME LAST, FIRST, AND MIDDLE INITIAL
NUMBER
REGISTER OF WILLS
SOqALSECUruTYNUMBER
1. Original Return
4. Limited Estate
6. Decedent Died Testate
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Decedent Maintained a Living Trust 0
3. (date of death
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(Attach copy of Wiil) (Attach copy of Trust)
D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit 0 11. Election to tax under Sec. 9113(A)
(date of death between 12-31-91 and 1-1-95) (Attach Sch 0)
(~al!~g~)tt~~iMg$mJ:t~I~~M~~g~Q~~~~'~IBEt~~~~NDgN.~e~~Nfflti!)eNml~~Tg'JfAEQR~~~jQ'N$Rgq4pet::pjae~tifEorl'o:
NAME COMPLETE MAILING ADDRESS
Marlin R. McCaleb Es .
FIRM NAME (If Applicable)
Law Offices-Marlin R. McCaleb
TELEPHONE NUMBER
219 East Main Street
P. O. Box 230
Mechanicsburg, PA 17055
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17 691-7700
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D 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. Net Value Subject to Tax (Line 12 minus Line 13)
OFFICIAL USEDNL Y
(8) 330,517.16
(11 ) 42,178.09
(12) 288,339.07
(13) 288,339.07
(14) 0.00
(15)
(16)
(17)
(18)
(19)
0.00
0.00
0.00
0.00
0.00
(1)
(2)
(3)
181,000.00
None
None
(4)
(5)
None
149,517.16
(6)
None
None
42,041.86
136.23
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15, Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)( 1.2)
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
0.00
x
X
X
X
.0 0
.0 45
.12
.15
Form REV-1500 EX (Rev. 6-00) ~
Decedent's Complete Address:
STREET ADDRESS
76 Old Stone House Road
CITY I STATE I ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
0.00
Total Credits ( A + B + C) (2)
0.00
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)
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 WILLS, AGENT
0.00
0.00
0.00
0.00
0.00
.....~L~i~~..~~~'W€~!!ffA~l!~~!CL[6W,!~!~U[~D!~~iibN~"~ipLACiNG"AN 'I"I~,,,
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or. " ...... .......
d. receive the promise for life of either payments, benefits or care? .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?. ...... . . . . . . . . . . . . . . .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? . . . . . . . . . . . . . . . . . . . . . . . . .. ......
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
i~mf'~!g!X~g~'8~!~il~~~,~tg~i~gWW.W
Yes No
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
"G'g;:;;;:?z;;J;; RHe"
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Marlin R. McCaleb
219 East Main Street
- - -Me;h~ni~-sb~r-g ~ - fA - - :UOSS- - - - - - - - - - - - - - - - - - - --
Law Offices-Marlin R. McCaleb
219 East Main Street
DATE
~-~-' ()€..
DATE
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. 9116 (a) (1.1) (j)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 12)
[72 P.S. 9116(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. 9116(a)(1 3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev 6-00)
REV-1502 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hyung Joo Bair SS# 521-60-0892 12/02/2005 21-06-0004
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 DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 House and 11.986 acres, - Silver Spring Township, Cumberland 181,000.00
County, PA, known as 76 North Old Stone House Road, being the
same tract that Decedent acquired by deed of W.D.C., Inc., dated
08/09/1977, recorded in Deed Book "I", Volume 27, Page 895.
SCHEDULE A
REAL ESTATE
TOTAL (Also enter on line 1, Recapitulation) $ 181,000.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1502 EX (Rev. 1-97)
~7-"Settlement Statement
U.S. Department of Housing
and Urba~ Devek/pment
~
,r
B. Type of loan
1. D FHA 2. D FmHA 3. D Conv. Unins. 6. File Number
4. D VA 5. D Conv. Ins.
OMB Approval No. 2502-0265
7. Loan Number
I
8. Mortgage Insurance Case Number
133129452
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are
sllown. Items marked n(p.a.c.)" were paid outside closing; they are shown here for informational purposes and not
included in the totals. '
D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender
DARREN E. VALE:NTINE ESTATE OF HYUNG JOO DAIR AMERICA'S WHOLESALE LENDER
CHRISTINA L. VALENTINE MARLIN R. McCALEB, ESQUIRE
6234 HAPPY WAY 219 EAST MAIN STREET P.O. BOX 10266
MARYSVILLE CA 95901 MECHANICS BURG PA 17055 VAN NUYS CA 91410-0266
G. Property Locallon H. Settlement, Agent
TAX PARCEL NO. 38-08-0571-016B MURREL R. WJ'L TERS III, ESQUIRE
76 N. OLD STONE HOUSE ROAD Place of Settlement I. SeUlemenl Date
CARLISLE PA 17013 54 EAST MAIN STREET 5/5/2006
MECHANICSBlJRG IPA 17055 Disbursement Date
Lo!; Block: 5/5/2006
J. Summary of Borrower's Transaction
100. Gross Amount Due From Borrower
K. Summary of Seller's Transaction
400. Gross Amount Due To Seller
101. Contract sales price 181,000.00 401. Contract sales price I 181,000.00
102. Personal property I
402. Personal prope1rty
103. Settlement charges to borrower (line 1400) 6,158.40 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes to 406. City/town taxes to
107. County taxes 5/5/2006 to 12/31/2006 361.55 407. County taxes 5/5/2006 to '12/31/2006 361.55
108. Assessments to 408. Assessments to
109. SCHOOL TAX 5/5/2006 to 6/30/2006 272.20 409. SCHOOL TAX 5/5/2006 to 6/30/2006 272.20
110. to 410. to
111. to 411. to
112. to I
412. to
113. to 413. to
114. to 414. to
'115. to 415. i to
120. Gross Amount Due From Borrower 189,792.15 420. Gros~ Amount Due To Seller 181,633.75
200. Amounts Paid Bv Or In Behalf Of Borrower 500. Reductions in Amount Due To Seller
201. Deposit or earnest monev 5,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 162,900.00 502. Settie(nent charges to seller (line 1400) 14,490.00
203. Existino loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506. I
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. Citv/town taxes to 510. City/torm taxes to
211. County taxes to 511. County taxes to
to , to
212. Assessments 512. Assessments
213. to 513. to
214. to 514. i to
215. to 515. , to
216. to 516. i to I
217. to 517. , to I
218. to 518. to I
219. to 519. to
220. Total Paid By/For Borrower 167,900.00 520. Total Reduction Amount Due Seller 14,490.00
300. Cash At Settlement FromlTo Borrower
600. Cash At Settlement To/From Seller
301. Gross Amount due from borrower (line 120) 189,792.15 601. Gross!amount due to seller (line 420) 181,633.75
302. Less amount paid by/for borrower (line 220) 167,900.00 602. Less reductions in am\. due seller (line 520) ( 14,490.00
,
303. Cash !Xl From D To Borrower 21,892.15 603. Cash \ [gJ To D From Seller 167,143.75
SUBSTITUTE FORM 1099 SELLE~ STATEMENT
The information contained in Blocks E, G, H, and I and on line 401 (or, line 403 and 404) Is importan\ tax information and is being furnished to the Internal Revenue
Service. If you are required to file a return. a negligence penalty or other sanction will be imposed on you If this Item is required to be reported and the IRS determines
that it has not been reported. If this real estate Is your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax
return; for other transactions, complete the applicable parts of Form 4797, Form 6232 and/or Schedule D, Form 1040). You are required to provide the Settlement Agent
(named above) with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be
subject to civil or criminal penalties Imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer Identification number.
I
(Seller's Sig~ature)
...,.nent Charges
--
700. Total Sales/Broker's Commission based on price $ 181,000.00 @ 7.00 Cl/O ::: 12,670.00 Paid From Paid From
Division of Commission (line 700) as follows: I Borrower's Seller's
701. $ to Funds At Funds At
702. $ to Setllement Setllement
703. Commission paid at Setllement M.C. WALKER REAL TV I
12,670.00
704.
800. Items Payable In Connection With loan
801. loan Origination Fee 162,900.00 %
802. loan Discount 162,900.00 %
803. Appraisal Fee to COLESTOCK APPRAISALS ($225.00 P.O. C.)
804. Credit Report to
805. lender's Inspection Fee
806. Mortgage Insurance Application Fee to
807. Assumption Fee
808. TAX SERVICE FEE COUNTRYWIDE TAX SERVICE 90.00
809. COMMITMENT COUNTRYWIDE 550.00
810. PENNSYLVANIA BROKER FEE ACA MORTGAGE 1,112.25
811. PROCESSING FEE ACA MORTGAGE 350.00
812. FLOOD CHECK FEE LANDSAFIE FLOOD 26.00
813. YIELD SPREAD PREMIUM BY LENDER TO ACA MORTGAGE (P.O.C. $2,239.88)
900. Items RequIred By lender To Be Paid In Advance
901. Interest from 5/5/2006 to 5/31/2006
902. Mortgage Insurance Premium for
903. Hazard Insurance Premium for
904.
Exclude last day in cales - line 901
@$ 29.01 / day
months to
years to
years to
j 763.271
905.
1000. Reserves Deposited With lender
1001. Hazard insurance 3 months@$ 45.83 per month 137.49
1002. Mortgage insurance 1 months@$ 71.95 per month 71.95
1003. City property taxes 4 months@$ 9.04 per month 36.16 .
1004. County property taxes 4 months@$ 31.04 per month 124.16
1005. Annuai assessments months@$ per month
1006. SCHOOL TAX 12 months@$ 147.85 per month 1,774.20
1007. months@$ per month
1008. Aggregate Accounting Adjustment , -297.83
1100. Title Charges
1101. Setllement or closing fee to
1102. Abstract or tille search to
1103. Title examination to 1
1104. Tille insurance binder to
1105. Document preparation to
1106. Notary fees to CASH 15.00 10.00
1107. Attomey's fees to MARLIN McCALEB, IESQ. P.q.C.
(Includes above items numbers: )
1108. Title insurance to MURRIER.. R. WAL TIERS III, ESQUIRE: 1,338.75
(Includes above items numbers: 1101-1104,1108 PENN ATTORNIEYS!TITLE INS. CO. )
1109. lender's coverage $ 162,900.00 Endorsements 100, 300 & 8.1
1110. Owner's coverage $ 181,000.00
1111.
1112.
-
1113. CLOSING PROTECTION LETTER 35.00
1200. Government Recording and Transfer Charges
1201. Recording fees: Deed $ 38.50 ; Mortgage $ 66.50 ; Releases $ 105.00
1202. City/county tax/stamps: Deed $ 1,810.00 ; Mortgage $ 1,810.00
1203. State tax/stamps: Deed $ 1,810.00 ; Mortgage $ 1,810.00
1204.
1205. RECORD POWER OF ATTORNEY 27.00
1300. Additional Settlement Charges
1301. Survey to
1302. Pest inspection to
1303. I
I
1304. I I
I
1305. !
1306. FILSON WATER - ($702.50. $662.50 PAID BY SELLER) BAlLANCE i),UE BY BUYER 40.00
1307. !
1308. RETURN MORTGAGE PACKAGE TO AMERICA'S WHOLESALE LENDER 30.00
1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 8,158.40 14,490.00
CERTIFICATION i
II,ave carefully reviewed the HUD-1 Selllement Statement and to the best of my knowledge and belief, it is a tl ue and accurate statement of all receipts and disbursements
on my account or by me In thiS transaction. I further certify that I have received,. a ~py~o ~"h' HVD1', "em 1 ,rn I _~!:~
Seller ~ rd Borrower
~ES~~~~;Y~~ ~J7~AIR / . ,. RRE . VA T '-"
~4f~4,~~-J!~ Seller ~ . ./ _ ~ orrower
MARLlN'R. cCALEB IESQU!.RE 'l/ ' C.IRI INA L. \rALENTINE
'0 'M h," 01 m,,roo '.'" III ~"",,,,""(,frnm'"' whloh , he"~ pre"", " , 'ru, 'rn ,~""rn ",",,", of.' f,,"" ~~w rti received and have been or Will
be disbursed by;lie ersign. a l1u ~~VJrbetf thiS transaction. .:s'/ 15------ c9
--t ?ft, 'I! Settiement Agent I ,~ Date
MURREL It. AI. RS III, IE 'QUIRE (
WARNING: It Is a crime to. knowingly make false statements to the United States on this or any other, similar form. Penalties upon conviction can include a fine and
imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
u.s. GOVERNMENT PRINTING OFFICE: 19890-944-245
REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Hyung Joo Bair SSD 521-60-0892 12/02/2005 21-06-0004
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
Cash and coins in Decedent's possession.
VALUE AT DATE
OF DEATH
4,890.22
2
PNC Bank, - Checking Acct. D5070100843, principal balance as of
0.0.0.: $8,152.85; interest accrued to 0.0.0.: $0.60.
8,153.45
3
PNC Bank, - Certificate of Deposit D31200263312, principal
balance as of 0.0.0.: $8,818.60; interest accrued to D.O.D.:
$121. 40.
8,940.00
4
PNC Bank, - Certificate of Deposit D31500262623, principal
balance as of D.O.D.: $10,171.00; interest accrued to D.O.D.:
14.93.
10,185.93
5
PNC Bank, - Certificate of Deposit D31500262624, principal
balance as of 0.0.0.: $22,586.87; interest accrued to D.O.D.:
$36.51.
22,623.38
6 1987 Ford Escort automobile. 175.00
7 Allstate Life Insurance Co. , Annuity Contract DGA274090, - 43,476.40
balance as of 0.0.0.
8 Allstate Life Insurance Co. , Annuity Contract DGA274091, - 23,267.86
balance as of 0.0.0.
9 Allstate Life Insurance Co. , Annuity Contract DGA276974, - 21,118.37
balance as of D.O.D.
10 Hartford Life Insurance Co. , - Annuity Contract D7102588852, 5,815.55
balance as of 0.0.0.
n Household contents, - furniture, furnishings, etc. 871. 00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
149,517.16
f"........."..iriht {r\ 1QqF; form software only CPSystems, Inc.
Form REV-15GB EX (Rev 1-97)
~ PNCBr\N<
January 24, 2006
Marlm R. ~rcCaJeb
Frankerlberger Place
219 East Main Street
PO Box 230
Mei.:hanicsburg, P A 17055
RE: Estat~ of H)'"ung Joo Bair, deceased
SSN: 52HiO-0892
DaD: 12/2/2005
Dear lVI.\". McCabe:
In [i~s?onse. to your ;request for Date of Death balances for the customer noted above, our
records show the following:
CertiIicates of Deposit
t~ccount#3t200263312
Estabhshed 01/13/1997
HY1JNG JOO BAIR
DOD balani~e: $8,818.60'" $J 21.40 accrued interest
Ac()ount #31500262623
Established 01/13/1997
HYUNG JOO Bf.JR
DOD balance: $'10,1il00 + $14.93 accrued interest
ACI~ount #31500262624
Established 01 /J.1I2002
HYUNG JOO BAlR
DOD balance: $22,586.87 + $36.51 accrued interest
Checking A<:,{;ount
Account #5070100843
Established 04/21/ 1986
H"{(JNG JOO BAlli.
DOD balance: $8,152.85 + $,60 accrued interest
Page 1 of2
.J 1..oJI 1 t..."-.' '-".:"-"-' 1.-'-........
The decedent maintained Investment Account (Ii\rv #\2783688). For furt;'cr information,
YOll may contact t!1e Brokerage Department at 1-800-762-6111.
Please l1CJte that this offlce only provides date of death balances for deposit accounts
(lRAs, CDs, Checking and Savings accoUtlts). We do not process an~' financial
trans:.\ction~ or prO'lljde statements. If you need assistance with any of these items,
please call j.888-PNC-BA).lK (1-888.762.2265) or stop by your local PNC Bank branch
office.
Smcerely,
C5JQiiflJJ.jJ.- (;JLlh.--
Rachelle Wells
1-800-762-1775
P7.PFSC-04-F
500 first Ave.
Pirtsb'Jrgh '? A. 15219
Page 2 of2
Member FOrC
TOTAL- D.02
Allstate Life Insur:mce Compa.ny
544 Lakeview Parhay
Vemon Hills, Ii 6006t
Telephone: (8771499-6418
Facsimiie: (866) 635-4523
~Anstate.
FINANCIAL
J anu ary t g, 2006
Marlin R, ::vfcCaleb
219 E !dain Street
!vlechanicsburg, P.-\. 17055
Re:
Contract No:
HyungJoo Bail'
G:\274 09 0
Dear 1'1'11', McCaleb:
\\' e have been requested to complete IRS FOlm 712 with regard to the above referenced contract. The
purpose of Forni 712 is to provide an estate or dOllor with the value of a life insurance contnlet or its
p~()ceed~ as of a certain date (usually the ovmer's date of death or date of transfer of the contract),
This contract is Illl ammity contract, 'which is not reportable on IRS Form 712, The following information is
provided for estate p1ll})oses only as of the date specified:
Date of Death:
Annuity Value" as ofDatr of Deat:h:
Cost Basis:
Named Beneficiary:
12/02/2005
$ 43,476.40
$ 0.00
Estate ofHyung Bair
*Th~ actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges ,
If you have any questions, please contact our Cllstomer Care Unit at 1-877-499-6418,
Sincerely,
lvlargaret Dow
Sf. Clai...rrl RepresenL:'ltive
_.J.Jhlale Lite Insurance COmp:1llY
5~4 l.akeview Parb\il)'
Vernon Hills, 11 600M
Telephone: i.~n7i 499-6418
fac~imiJe: (866) 635-4523
~ Allstate.
FINANCIAL
Jannary U!, 2006
~'1(nlin R. "fcCaleb
219 E 'Main Sheet
r..lechanicsburg, P.".. 17055
Re: Hvu!lrt. .100 Bair
COlltract ~o: (;/\274091
Dellr !vlr. McCaieb:
\Ve IUlve bt~cn requested to complete m.s Form 712 \"ith regard to th(' above referenced contract. The
puq!ose of F;0n11 7 J 2 is: to provide an estate or dOllor with ihe villue of a Ide insurance contract m its
proceeds ,'IS of it se:iain date (~lsually tht; owner's date of death or date of transfer oUhe contraCl)
This contract is an annuity contract, vihich is not repol1able on IRS Form 712. The folloy.,jI1g information is
provlded for estate pllll!oses only as aftlle date specified:
Date of Death:
Ammity Value" as ofDllte of DCI'Jh:
Cost Basis:
1\amed Beneficiary:
12/02/2005
~ 23.26'7-86
S 23,26:5.98
Estate ofHyungBllil'
t."fhe a~mai amCUIJ1. ;)f!.id IllftY differ due to Market Value Adju8tments MId/or any applkable Surrender
Charge,,>,
11' ye.,] lwve any questions, p1eas{\ contact our Customer Care Unit at 1 -877-499-64] 8.
Sincerely.
IVlargm-et Dow
Sr. ClalIn Represellt11tivc
AHstilte Life Insurance Company
544 Lakeview Parkway
Vemoll Hills;, It 60061
Telephone: (8771499-6418
F[jc~imile: (866) 6;5-4523
~AlIstate.
FINANCIAL
Jannary 18, 2006
Marlin R. .\lcCaleb
2 i 9 E Main Stred
l\'lechunjcsburg, PA 17055
Re:
Contract No:
HyungJoo Bail'
G/v.76974
Dear Mr. .McCaleb:
\\/e have been re.questcd to complete IRS FOITfl 712 with regard to the above referenced cant"ilCt. The
purpose of FOIm 712 is to provide fill estate or donor with [he valU(~ of a life insurance contract or its
proceeds as of a cer1ain date (usually the owner's date of death or date of transfer of the contract).
'1111s contract is an mmuity contract, \-vhich is not repor1able on IRS Form 712. The following information is
provided lar estate purposes only as of the date specified:
Date of Death:
AllIluity Valuc* fl.S of Date of Dealh:
Cost Basis:
~al11ed Bcneficimy
12/02:'2005
5) 2lJ18.37
S 18,451.54
Estate ofH)llng Bair
'"The actual amOlmI paid may differ due to Market Va1ut Adjustments and/or any applicabie Surrender
Charges.
If Y0U hnve any questions, please contact our Customer Care Unit at 1-877-499-6418.
Si.ncerely.
Margaret Do,>',
Sr. Claim Representative
Hartford Life
March 10, 2006
Any. Marlin R. McCaleb
Law Offices of Marlin R. :\kCaleb
Mechanicsburg, PA 17055
Fax: 717-691-7772
Dear Atty. McCaleb:
Re: Hartford Annuity Contract # 7102588852
Decedent: Hyung J. Bair
Thank you fO! your correspondence regarding the abo\'e annuity contract.
The death benefit payable uncer this contract is not considered "life insi.lrance'?.re.portable
on IRS Form 712, (life insurance statement). Please find the below informa'tionIn respollse:
to your request.
Sincerely.
7102588852
Hyung J. Bair
521-60-0892
Hyung J. Bair
December 2, 2005
$5,815.55
Contract J\lumber:
Ow ner:
O,vner's 5.5.\/#:
Deceased:
Date of Death:
Date afDeath Value:
If you have any questions or
professional, or one of our
Thursday from 8 a.m. to 7
Time. We will be happy to
your finandalnceds.
Rachel B. Pasternack
Investment Product Services
Contract rvlanagement
Hartford Life Insurance Company
REV-1511 EX +(1-97)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Hyung Joo Bair
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
SS1ft 521- 60 - 0892
FILE NUMBER
21-06-0004
12/02/2005
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES:
Richardson Funeral Horne, - funeral expense.
8,177 .00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
3.
Attorney's Fees Law Offices -Marlin R. McCaleb
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
13,665.51
4.
Register of Wills
388.00
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Brett Lechthaler, Appraiser, - appraisal of real estate.
275.00
2
Chuck Bricker, Auctioneer, - commission on public sale of
furniture and car.
306.00
3
Community Banks Insurance Services, - premium for homeowner's
insurance.
404.43
4
Community Banks Insurance Services, - homeowner's insurance
premium
281.00
5
Cumberland Law Journal, - advertising Letters.
75.00
Total of Continuation Schedule(s)
18,469.92
TOTAL (Also enter on line 9, Recapitulation) $ 42,041.86
(If more space is needed, insert additional sheets of the same size,)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev.. 1-97)
Estate of: Hyung Joo Bair
Soc Sec #: 521-60-0892
Date of Death: 12/02/2005
Item
#
Continuation of Schedule H-B7
(Other Administrative Costs)
Description
Amount
6
Dan White Plumbing, - winterizing house in preparation for sale.
74.00
7
Dan White Plumbing, - restoring water service to house in
preparation for sale.
120.00
8
Debra Basehore Wiest, Tax Collector, - 2006 County and Township
real estate taxes.
549.86
9
Dillsburg Excavating & Septic, - locate and inspect septic system
in preparation for sale.
248.00
10
Filson Water, LLC, - install water filter in preparation for sale
of house.
662.50
11
Glass Lock & Key, - installation of deadbolt locks to protect
house, in preparation for sale.
154.00
12
Glass Lock & Key, - repair lock on car door in preparation for
sale.
35.00
13
Karl Stine, - refuse removal from house in preparation for sale.
150.00
14
M. C. Walker Realty, - Realtor's commission on sale of real
estate.
12,670.00
15
Murrel R. Walters, III, Esquire, - fee for notarizing documents
for sale of real estate.
10.00
16
PA Auto License Brokers, - replace lost title for car with
duplicate title in preparation for sale.
34.50
17
Penn Waste, Inc. - refuse removal in preparation for sale.
39.18
18
PP&L, - electric service to heat house in preparation for sale.
217.38
19
PP&L, - electric service to heat house in preparation for sale.
219.93
20
PP&L, - electric service to heat house in preparation for sale.
256.00
21
Recorder of Deeds, - Realty Transfer Tax on sale of real estate.
1,810.00
22
Register of Wills, - filing Inventory and Appraisement.
30.00
Estate of: Hyung Joo Bair
Soc Sec #: 521-60-0892
Date of Death: 12/02/2005
Item
if
Continuation of Schedule H-B7
(Other Administrative Costs)
Description
Amount
23
Register of Wills, - Reserve for filing Account, Releases, etc.
Register of Wills, - Short Certificates.
Register of Wills, - Short Certificate.
Register of Wills, - Short Certificates.
8.00
500.00
24
8.00
25
4.00
26
27
Russell Klinger, - cleaning car in preparation for sale.
48.00
28
Sandra Kitle, - cleaning house in preparation for sale.
60.00
29
Silver Spring Ambulance & Rescue Assoc., - medical expense,
ambulance and life-support services.
390.00
30
State Farm Insurance Co., - auto insurance premium.
80.94
31
The Patriot-News, - advertising Letters.
90.63
18,469.92
REV-1512 EX + (1-97)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hyung Joo Bair
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SSil 521-60-0892
12/02/2005
FILE NUMBER
21-06-0004
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
PP&L, - account payable, utility service (electric).
AMOUNT
136.23
TOTAL (Also enter on line 10, Recapitulation) $ 136 . 23
(If more space is needed, insert additional sheets of the same SIZEl)
Copvriqht (c) 1996 form software only CPSystems, Inc. Form REY-1512 EX (Rev. 1-97)
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Hyung Joo Bair SS# 521-60-0892
SCHEDULE J
BENEFICIAR IES
12/02/2005
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-06-0004
AMOUNT OR SHARE
OF ESTATE
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Commonwealth of Pennsylvania - statutory heir pursuant to 20
Pa.C.S. 2103(6) (Decedent died intestate and she was not survived
by a spouse, or issue, or parents or their issue, or grandparents
or their issue)
TOTAL OF PART 11- 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)
CoovriQht (c) 2000 form software only The Lackner Group, Inc.
288,339.07
288,339.07
Form REV-1513 EX (Rev. 9-00)