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Home My WebLink About08-29-06 I LOPy --.J 15056051058 REV.1500 EX (06-05) PA Department of Revenue *' Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT a I D~ file Number /" D l-(Ci~ Date of Birth 201-07-5153 06/02/2006 11/12/1917 Decedent's Last Name Suffix Decedent's First Name MI NESBIT MRS MARIAN R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI DECEASED Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Ortgtnal Return . 2. Supplemental Retum 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 4a. Future Interest CompromIse (date of death after 12-12-82) 7. Decedent Maintained a Uvlng Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 4. Limited Estate 6. Decedent Died Testate (Attach Copy of WID) 9. Litigation Proceeds Received 0" 8. Total Number of Safe Deposit Boxes THOMAS B NESBIT (615) 322-8440) h.) '-::,";} _J' ,~ --~.T I-."fi. , ('J -'::' :..':) '-J ::3 . ,=:) ',' ~R , -- ':-5 -- ;"'11 _.,~) ,'1 Firm Name (If Applicable) REGISTER OF WIL[S USEC?~LY First Hne of address ;:) 1836 HARPETH RIVER DR Ii Second line of address (.) /~- City or Post Office State ZIP Code DATE FILED BRENTWOOD TN 37027 Correspondenfs e-mail address: TOM. NESBITQV ANDERBIL T. EDU Under penalties of perjury. I declare that I have examined this retum, including accompanying schedules and statements, and 10 the best of my knowledge and belief. it is true. mrrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERS ONSIBLE FOR FILING RETU N DATE 'IS y./"Io, I ~ 3 Go 1-1 A-o.P E r/~ ~.~ Va. SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS i3 ttt ,... rUJII. D 1f\J . ~7"Z.'" DATE ADDRESS PLEASE us. ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ....J ..J 15056052059 REV-1500 EX Decedenfs Name: MARIAN R NESBIT RECAPITULATION 1. Real estate (Schedule A). ... ?~~.~~~. ~"'t.... ~~~.'.-r~~ ~....... 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 2. 3. Closely Held Corporation. Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 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). ..... .. .. ... . .... .. .. .. . .... .. . .. . 11. 12. Net Value of Estate (Line 8 minus line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of line 14 taxable at collateral rate X .15 15. ,6&(( e.:es. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 201-07-5153 Decedent's Social Security Number 159,000.00 13,078.49 0.00 0.00 13,633.07 0.00 169,339.18 355,050.74 7,015.43 18,359.77 25,375.20 329,675.54 500.00 329,175.54 14,812.90 14,812.90 Q~O fb"rl ;) re 0 d/.A! N/tPO REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENrs NAME DECEDENl'S SOCiAl SECURITY NUMBER MARIAN R NESBIT 201-07-5153 STREET ADDRESS 2203 PARKSIDE RD. CITY I STATE I ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditsIPaymenls A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 1&/ J j'1"L . , 0 7,085.00 - '5ch.J"'/... .., tult... E"r~'Tt Total Credits (A + 8 + C) (2) 7,085.00 3. Interest/Penalty if applicable D. Interest E. Penalty Totallnterest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Une 20 to request a refund. (4) B. Enter the total of Line S + SA. This is the BALANCE DUE. (5) (5A) (58) 7,727.90 5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 Ii] c. retain a reversionary interest; or.......................................................................................................................... 0 (i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death oocurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 iii 3. Did decedent own an "in lru$t for" or payable upon death bank account or security at his or her death? .............. ~ 0 4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which contains 8 beneficiary designation? ........................................................................................................................ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [72 P.S. S9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (O) percent [72 P.S. ~116 (a) (1.1) (ii}J. The statute does not exemDt 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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. 19116(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 twelve (12) percent [72 P.S. S9116(a}(1.3}].Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. -':--,. COr.1MONWE.AlTH OF ~.. . ~.' ~.. PEM~SYLVANI,A. _ ~~~." ...... .~ ..... DEPARTMENT OF RE'JENUE ~~.. ,..._.~_.J-, DEDi. 280601 ~~~~~- ~.ARR!.58URG. Ph 17128-0601 r"".-~ ,1. r~1 .-__ REV-1500 I I FILE NUMBER 1---- ! ::,L .i\ ::::;" : ;'J;A:==. SV~i""" dTiJ: ..,.,h 3/iJ L INHERITANCE TAX RETURN RESIDENT DECEDENT . :,...t--i Dc::::::E~"'S >:/:.I,IE il-ST FiR::;, "','W r~iCDL= :N1TI..~L SOCi,~.L SE':iJR:~v :~Ui..1BE? ,z. 7-,)1 i [;' 7 -~-/'~-- ~ #" I- Z UJ o LU ~ ~ u _ ~_ ~. _ _ UJ ,~--- , -al- l ( _IV _ ~ UJ I- ~~(f) :Ja::~ .-Ja..u zOO ~g:a5 a.. <( A I I. , /1/.1 ~ b., it AA. ~ ;i ~ ."'-, u:'TE 0;: ==r:'H [i'AM-DD- iE.",i=(1 i DATE OF BIRTH li',1M-JD-\'E.;~) , / ,I f I "'1:- !.:: 0 rt /, --:::- I I I SUR\Ji'lit'~G SPOUSES NAME ILAST ~!RST ;'ND MIDDLE INITIAL! SOCi;e..L SEC:JRTY ~;lJtABE; THIS RETURN MUST BE FILED IN DUPLlCA TE WITH THE REGISTER OF WILLS ;~ L~j Ii 2. Sup;;!emental Return L--J ' ~.:1 - . ~ LJ . a. n:ture interest ccmprO~lse ICe;e Gi C:eat~ 2~Er 12. '2."2; n 7. Deceden: Maintained a Livlqg Trust ,.'~!!a:r c:;; i cf Trcot: r--l 1~ ~ D (' LJ ,u. :,)pousai. overty ,_.redit ~'j.~:e;,.f(i8a;'" r,er:;€~,; ~:-Jl.9'1 ;:.l(] Ci,ginal Return I'~D Ii- U .j, I\emainuer ;~eturn Ija!~oicea[hprtvrID i2.~3.a2i D 5. Federa! ESlate Tax ReiUrn ,cleqUlred 8 Total Number of Safe Deposit Boxes L-; -+ L:rnjiElJ Esiau; , , c- v Dececent Jied Testate :A!;Qc~ S:C/ ;'jf ';\Iii!) L.:igatlCl! F~.JCeedS Recerr'ed , _ . ~.:r.:; LJ 11. =ieclion to tax under Se::. 9113(Aj IA~i,;'::r, SO-, 01 .- z ~ Z o a.. (f) w a:: a:: o u THIS SECTION MUST 6E COMPLETEDLALLCORR1;SPONPENCEANO CONFlDENTIAt TAX"NFORMATJON,SHOULOBE DIRECTED TO: h COMPLETE MAiliNG ADDRESS C ~ J J f( /.per l1/ I...... r5 "70 hi ..t ~'- P e ;r\.t ~ . ;.:z '- t', .., ,.J' TAl u,,' (.' (?,'V\/. LJ./l,/Ch-, I FiRr'i1 f\,j,A)'ilE if ,!.,c'pl<?:)lr TE!.S'HONE NUMBER .3 ?'oZ-7 1. Real c:state iSenedule ,Ll,) I t) if , C (;/ (i. C"c:;., . (jl .~ Stocks and 8ends (Scheaule 5) (2) 3 C:ose!y He!d Corporarion. Partnersnip or Sole-Proprietorship i)) j k1o'igages & i'~otes Receivable (Schedule OJ (4) z o ~ ...J ::J t: a.. c:( u w a::: Casn. BanK DepOSits & Miscellaneous Personai Property (ScnedUJ9 E) ':" (~' ~I 6 JOlnily rJ't/ned Property (Schedule F) r ' U Seoarate Bill:ng Requesred !6) l'1te';Ir.,'oS Transfers & Misceilaneous Non-Probate Property :Scnedu1e G OJ L) (7) 8 Total Gross Assets (total Lines 1-Ti (8) /5f. (::,,'1['. C?[f 9. ;::,'neral c:xoenses & Admlnislrative Costs I,Schedule H) "/ (} f oz. . C:'t./ (9) 10 Debts ,)f Dececent. Mortgage Labilities, & Liens tSCheOl,;ie il : 101 " Total Deductions :total Lines 9 & 1 D) (11) I 5- '1-~ ~ c,jtj 15"7 112i ____ _ r J 'I '5 fi' (13\ 12. Net Value of Estate !Line 8 ITIIr,US Line 11) ''1 Cna(tacle and Government,,' Bequests/See 9113 Trusts ior which an election :0 tax nas not been made (SC~edU!e J) ; 4 Net Value Subject to Taxl:ne 12 rillOUS Line ~ 3) i S- 7~ Y'5~ , I" !14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::::> a.. :E o u X ~ 15 ~mo'j/1t of Line; 4 taxao'e at tile spousal tax 'ate. Jr 'ransiHs Ui1::er Sec, 91 ~ 6 (a I( 1 21 x 0 _ 115) l <- (, . i/-;;q . ,. o i3; i16i -_/{J 2 ~ aa J o.1,moUilt o~ Line .:..; taxable at hneal ,ate 17.';rnoUnl of Line 14 laxaole at Sibling rate :~ 12 (17) 18 Ar1<QUnl cf Line 14 taxable at collateral rate x 15 /181 ~ 9. Tax Due ('9) _ 70~:;.~ 00 , , 20 ~-.J CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >.->BI;.'$1I~ito;~J($W~At,I!.,,~,ES;1;IQ.Nj.:ol!i;;t.F;VE~Se;~f)EANP;RECHECK. N1AtH'.~..:, Decedent's Complete Address: STREET ~.DDRE3S -;. 2-0 "3 ?a.~-k. ~ ld,c ,~,;"'j " CiTl ,. - -. M,' ( { ..,'1 . .A_,....' V ('/,1 1"..6/ STAT:: ZIP l 7 ~~7 i I Tax Payments and Credits: 1. Tax Due (page 1 Line 19) ..., CreditslPaymenis A. Spousal Poverty Credit 8 Pnor Payments C Discount \ 1 ) 70G!; 7-, 00 Total Credits ( A + B + C ) (2) 3 InterestJPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E ) (3) 4 If Line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ;5) 'J ') 1'2_ ? ! (..> V .- A. Enter the interest on the tax due. (SA) 8 Enter the total 01 Line 5 + 5A. This is the BALANCE DUE. (58) 70fj~ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Old decedent make a transfer and: a retain the use or income of the property transferred:,...".. J. 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? . ,.....,,,....., if je3!1: Dc:urred after December 12. 1982. 'jid decedent transfer proOSity within one jear of death ;vilhout receiving adequate consideration? ..,..." . Did aecedent own an "in trust for" or payable upon death banK account or security at hiS or her dealh? Did jecedent own an individual Retirement Accoum, annuit'f, or other non-probate property which contains a beneficiary designation? . Yes No .. 0 ~ i! ~ n !y: I I I f7..1 ~ ~ rA I ' i f)(1 i.i1 .3. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES! YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE REiURN. Ur:;F.r ;)'?na;ties'J! :'Er,iLii'/. i .:A-c:?r~ t,l~~ ~ ~?)e examtr,ed t'iis r~lUrn_ fv:!udi'1'J accc:npar j!:(J s.r:::-;~.J;;:e~. ;:;~~ Si8ieG1er.!5. .=::1-C t:J :he b~::,; of m/ krQ'lm~"'jge and belief. :t :3 :rue. ccrrec! a~:~ c,:;mp;et::; :~c~a:~L::'r. GT [li~:c,a;Si rJiher ~\-;a~ ~;Ie :,~rs::'nal reoresentanv€ :5 oasej (in alll'~fc-rmaii,)n !)1 ''/lnlch pr~Daier has an~ ;",~Q."...;.-=;jge SIGNATURE OF oERQON RESPONSIBLE FOR FiLING RE i URN -;-- g~ ,LlC~ESS) ~3 ~ /-!lJ.rcPt'7/.. KI ~A. Da. SiGNJlTiJRE OF PRE:JARER OThER THAN REPRESENTATIVE DATE 7 /1 >/~ c.. 'i? (l~",-1'-V(J()o, r..tV. :3? d 2- 7 DiliE: ADDRESS Far dates of aeath on Jr after July 1. 1994 and before January 1, 1995. the tax rate imposed on the net value of t'ansfers to or for the use IJf the surviving spouse IS 3% [72 P.S ~9116 (a! 11'lli)j f=or dares of death en or after Januarv 1. 1995. the tax rate Imoosed on the net value of transfers to or for the use of the survivlna spouse is C% fi2 PS ~9116 (ai (11) fii: ihe statute 'Joes not "lemat a transfer to a surviving spouse f~om tax. and the s~atutor,! reqUirements for dlsc!osure of assets and~ nling a tax retur'n are stiU applicable even ~rJe surviving spOL;se !s one only beneficiary. For Jates of death on or after July.. 2000 ine tax rate Imposeo )n the net value of transfers from a deceased cnild twenty-one years of age or younger atjeath to or for the Clse of a natural parent. an adoptive parer or a siepparem of the GnliQ 150% [72 PS ~9116(a)\1.2)]. The tax rate imoosec on the net/aiue of transfers to orlor the use of the decedent's Itneal beneficiaries IS 45%. except as noted In 72 PS S9116(1.2) [72 PS. ~9116(al(1)]. The tax rate mposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS 39116(a)(1.3)]. A sibling is defined, under Section 9102. as a individual who has at least one parent In common With the decedent, whether by blood or adoption. REV 1 b02 EX. (6-981 f, ~~.....~ ~ :' !,.>(' ~..te~ COMMONWEALTH OF PENNSYLVANIA it~HERITANCE TAX RETURN RESIDEf\lT DECEDENT I ! i I ---L " ..;y..I\ pIt 7l J SCHEDULE A REAL ESTATE P (L(.. \h..D 1> ly <S U .~iI" I If ~ cL I I l FILE NUMBER ESTATE OF (Y\ A(\,Av (<, N/~~13 11 All real property owned solely or as a tenant in common must be reported at fair market value, Fair market value is delmed as the price at which p~operly 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 TOTAL (Also enter on line 1 f Recapitulation) $ (11 more space is needed, insert additional sheets of the same size) SCHEDULE "A" REAL ESTATE Esta~e of Marian R. Nesbit File Number ITEM NUMBER DESCRIPTION VALUE AT DEATH 2203 Parks ide Road $159,000.00 Camp Hill, PA ( see attached settlement sheet) TOT ~Z\.L REAL $159,000.00 ESTATE Register of Wills of Dauphin County, Pennsylvania Estate of ~ ,,'\, INVENTORY 1 If' /'",//; --? ~; J No. ..\/\ ;:t. J- R. also known as Date of Death l~ 17.- / .tJ f? I , , Deceased Social Security No. 7...-1 I -' 0 7 - j-r!5-3 Personal Representatlve(s} of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal a,;sets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent. tnat the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. IIWe understand that false statements herem are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authontles. Name of Attorney: P"r2:hVg~ ~d 1.0. No.: -.-( I z-;{ . /(I/O{-' Address: Dated Telephone: ~ ,-'7.... t)> COt. ~V\..j-:> p. ,!r . , f~ .'-- ~___ .e:,. DeSCription D/' {4le f'-.C r/4 Value I ~1 c;';t;?P. .~/?; f II 'II J Total: 1;'- ..;; cl i?~:J c.~? 71 .. (,Ll. tT3Ch Additional Sheets If necessary) NOTE- Th" Memorandum of real estate outSide the Commonwealth 01 Pennsylvania may, at tne election 01 the pelsonal representat,-:" ",elude the value 01 each .tem, bur such l'gures should not be extended into the total or the Inventory RW_~ ,-\E'i-1 :;()3 EX-,- :6-98) ~~'9~ ~",,~{,."i/~ COMMON'NEALTI OF PENN~,YLVP.Nlh INHERITANCE TAX FiETURN i'iESiDENT DEC~D[r~T SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER fnAl"L,AIV ~. N&SS/r' All property jointly-owned with right of survivorship must be disclosed on Schedule F VALUE AT DATE OF DEATH YO 2. t*. '1'1 J"'-'Z' I a-- '1~'ICJ.lff 'f("f~ --" lTE 111\ NUMBER 1. DESCRIPTION Co A~ 1 TA ~ , f'J (~(. g u\ lei ~^- A 1... 7/. ?S7St..s 53. $"' 3 ~~.s /N V"~Tfl\*- T Cu. ') I :J. ? 4) D C. S kS D {\'1o-t,wrn UfV& PA PI It '1 ~ ..... y IY\ Jlrt.. ft.... ~ TOTAL (Also enter on line 2. Recapitulation) $ I 3 0 7 i . ~ C; (If more space is needed, insert additional sheets of the same size) -:C: ~t~:-'<) ~ ~j. !"\. i t ~, II! ,.. P--1"-- July 20, 2006 Mr. Thomas Nesbit 1836 Harpeth River Drive Brentwood, TN 37027-4851 RE: Estate of Marian R. Nesbit Dear Mr. Nesbit: Please be advised that Marian R. Nesbit maintained an Individual Investment account at Wachovia Securities as of 6/2/2006. Listed below are the investments held in streetname for her, valued as of her date of death on June 2, 2006. Quantity 71.757 shs 53.513 shs 727.006 shs Description Capital Income Builder A I nvestment Co Dryden Muni PA Fd A Money Market Symbol CAIBX AIVSX PM PAX 6/2/06 Val ue $4,028.44 $1,762.18 $7,240.98 $ 46.89 $13,078.49 Acct Title: Acct #: Opened: Marian R. Nesbit 6228-4230 April 10,1987 I have opened an estate account and sent the necessary paperwork to you to transfer the assets. Also included were the forms to then transfer to assets to you and your brother and sister. If you have any questions, please don't hesitate to call me. Si ncerely, f t1 , ; '. ~. .', .~ ( ," ;,/, j ! ! / ;..' "I! '-t i! / X..' /,'.-":'.,' ./ '.' 1/''-:; ?f.'j/ ' .' 'I" t. ," ".~i'" .'. ....""~' " !U'~'A/t,1 ',,' c,. ~ ,.J" ,--(~. "j~1 Shelly A. Weibley Senior Registered Acct. Administrator REV-'50f. EX... :6-9P) _~.:::~,~ ;-'9~. ~W :OMIIJIONWEAL.TH OF PENNSYLVANIA I~HER!TANCE TAX RETURN RESIDENT DECEDENT /Y\ Art IIi /'oJ 1<. N e ~ S rr I SCHEDULE E I 'CASH, BANK DEPOSITS, & MiSC./ 1 PERSONAL PROPERTY L ..-. . _.:--_.--:::-='='::"'==-_-=-===-~-=--"::::_"':"':",:.=:-.:=::;:----- FILE NUMBER ESTATE OF Inelude the proceeds of litigation and the date the proceeds were received by' the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER I DESCRIPTION C J.....c Ie I A. ~ A c.(.01/"'/" - Fva.",.., 6 A,...1c Ae C'T '"1. 2. ,It. 3 (. /9'1 p.C). 4 *t,' 1-~/VcA$r#((.J fA. /7'oC( VALUE AT DATE OF DEATH cr (, 3 3 . ~7 '1.. Av'T'''tv'oo,,-c - l'itt"l ,.,.. ~ ^c: U""y 3 ,.,.., · S G ell Ii (II -.. d F (.) 1\ "'" I 7 U /\-t' "( ~ /5c.(, I/A-{\J#~(;' J-e &Not ( (l y ;1 t-. 's~.IIA(V"'~~ c fDT~,-6 fi'OO Ifd~ 12w S- u c:) TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. ins en additional sheets of the same size) r,ft,? ~,67 REV~15lO EX> (6~98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NU MBER rn PI f'\. I A f\J ')<. V.e S t3 If" This schedule must be completed end filed if the answer to any of questions 1 through.. on the reverse side ~ the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY " ft.;'/) Go ITEM INCtlJllE TIE NAME OF TIE TRANSFEREE. TIE1R RElATIONSHIP 10 DECEDENT N6J DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER TIE DATE OF"lRANSFER, Aw.cH" COP'l' Of 'M llEEO FOR RE1L ESTATE VALUE OF ASSET INTEREST lIF API'lICAlllFt VALUE 1, H Af\., Fo 1\ 0 ~"'NU' 1"1.5 ,q c,'" ",. t- z a t..VZJo I'-~ IS'.'''' ,~Q c:) ''''/33'. TOTAL (Also enter on line 7 Recapitulation) $ /~f~'33tt./~ Ii' (If more space IS needed, insert additional sheets of the same size) -4 -4 C:PTI C! ;:. :1: :'::: (l > =- :r: ~ CJ <: 58~ " \ 0 0 ozr~ cz-:-. 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'-< ~ c:: :) p. ~ ~ :) ~ o ~ o rJl .... .... rfl ~ (? :a > n ,.... ..... <. .... . ~ ~ \3~l I \ I \ \ \ I o (J1 w -" o t$ (J) ::r o (J1 N en o l\J (J) ::r ~ igi~ N \0 ro en \~ \ > n ,..... .... . <. 8: o t"':> -- ~ ..... - \J:' \g 10 :\5 o ~ I ::r\ i \ '.:2 I \"'i?, \ \ \ \ \ \ \01\ \\ \g \ \ \ \ \ \ \ \0 \ \\ -< " I i \% \~ \~\.g ~\ \~ \ \ \ \ \ , I \ \ \ I \ I \ I \J \ \B \ro \ \ \ \ \ ! \ \ \ ~\ 0\ co ):>0-00 (J)(J1m:rJ o';j.z-< "T'Iozo Cll(J)m (J1 -<z t;\ '<~ O-l"'c Ol~~~ " ", (J) oUlm grn:o 0:0- o()~ III ",0 I.D ~ .;:.. o o p o IJ'l N -" o :;j:) ,f'>. c'\ ;:':) ,......l 1'1 ,', ~ 5 ~ "'" ~ rJ} ~ o rj a ..... ~ ~ m OW OC .J-tr ~ > .~ ;; z :n % rn (/) OJ ~ ~g: ..(.~ " ::r ~i!? ..(.-0 .l:>> (J1 O\~ ~" O)g . ::l .l:>>~ fo,)Z c.JD o J> 3 J ~ ;.:. I~'''''' r'" i j;:... \ \ ._,~. \ '- ~:' 0 ~~} \ :1 :':> .~ g ~~ ,:~ 1'.] ,...,' C,:.::;: C:") !: j).I ...c: I ...,.. > Ir ~ (,.l ,~; REV.'511 EX+ ('2.99). COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF MARIAN R. NESBIT ALE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER A. DESCRIPTION AMOUNT 2 FUNERAL EXPENSES: DEATH NOTICE-HBG PATRIOT DEATH NOTICE -YORK 40 DEATH CERTIFICATES HAIRDRESSER CLERGY ROLLING GREEN CEMET ARY -DIG HOLE 241. 23 183.15 240.00 40.00 250.00 1.195.00 1. 3. 4. 5 6 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Represenlative(s} THOMAS 8 NESBIT Social Security Number(s}JEIN Number of Personal Representative(s} 175 34 8293 StreetAddress 1836 HARPETH RIVER DR City BRENTWOOD . State TN Zip 37027 Year(s) Commission Paid: EXECUTOR 2. Attorney Fees 1.562.00 3. Family Exemption: (" decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State .Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. AIRFARE 8 HOTEL 9 RENTAL CAR 10 GAS & PARKING 11 FOOD 12 POSTAGE 350.00 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 680.50 822.33 476.33 349.24 469.15 156.51 $ 7,015.44 ,:', -..-:...::;.: r,: ~- :7' ':.J ff '~....i.":"'" :._ ',_, _.,-' ~"'-.J~<~"F:,..~ ~_ E~(~:2~'.J"SL2, A='M= ='3~C~~~~~~~7~ CC~'~S ANC >:~ ~3CE=":=-.;_~.,T2C;T_i5 ~ -" " - , --, -,., ;' 1-- -:-~ ,---. .!:~./....:."'::"".\2~::"'-: PR""'."vs1y ~IJ"''''', rf ~ I ~_',2~:.~tS s: ~\'~a~lc,-T: ~:"A ~\lE:S~~2-t ~ "1 ,~ I,7~~rn}=-e r : ~ -~;-"}..T [) E S ': :?'. = p~' I C) 1\,J ~.~1\) GI,IT \7: ~T\/?,~,; - '- -~ , Fun r 1 ':' L<: p e T1 s e ~ c ,~ - - ~ ?e .... s " n a. -; ;,ee "Y" s e r - 2<- , -- - '- ~ ~ - " C)rnml c: n '--- ~. ~ ~ :, S () C l , c: C:J r v Numbs r - ~ - c: - - 4 '/.:::. r ,-. (j'rnr1l. s C r 2 a ~ d ~ '-- ~ ~ .. - ::: ,~ '"' 1:" am , y E e ;n ~) 'C fl " - ~ n~,?,n L - - , - ~ ~ '-' - I He t 2.0 n s n ~ 0 - c' Ce c e s e a - '-' -, ~ - ;.dd .... s "" -F C , man t t - ~ '-' - Cl Cl De c e den r , s Lje ::h - c ':; ? r cbc +- e '-;2- -' -' C J...;,.:j--cJ r ..L ''f e 0 - ~ - - ~ - . . '':1 ~ - - , - r S e Y' \,.lS '" - c= - CJ .c: C - c r ":F' e r +- j S 1 ::: 6 2 '"\ IJ .; ~ - ~ - ~ - .:- '- I ,.J ,J I I I I "TO ~ - .- - 2 - - " ::: -, n .l - - - ~ - - - ~ '. - , - - ~ ,..) - REV.! 51 , EX. (12~~ .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LlABILmES, & LIENS FILE NU MBER ESTATE OF MARIAN R NESBIT Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 10. 2 WATER 17.47 PGI ELECTRIC 49.91 UGI GAS 143.19 VERIZON TELEPHONE 32.22 LAWN CARE -MAY 06 125.00 HARTFORD HOME INS 200.70 HOME APPRAISAL 300.00 MANOR CARE 1,089.21 ELITE HOME CARE 6,776.40 LEGAL AD-HBG PATRIOT 196.37 VERIZON TELEPHONE-FINAL BILL 44.69 UGI-BALANCE MaNTHEY PAYMENTS-GAS 310.53 HEALTH SOUTH 19.08 EAST PENNSBORO AMBULANCE 30.00 FEDERAL INCOME T AX-Estimated 7,556.00 PA INCOME TAX Estimated 1,469.00 3. 4. 5. 6. 7. 8. 9. 11 12 13 14 15 16 18,359.77 TOTAL (Also enter on line 10, RecapilulaUon) $ (If more space is needed, insert additional sheets of the same size) R~\V::<: EX- ro' OJ) ~ (:. ~:~~..' .I~:'-{fk~~~ CO\A\i~'O"JV~f,,\~_~;:~ ~.;: f:~r~::- LVI \ ..... 1'\~t-<r~17 fl-'\CL 'T;,.>( ht-i" v '=ir,.; SCHECU~~ J BENtFlClARIES FES0[',: D- C:f:Jf NT I ____.__----:;::.._==:, --;.;:.::.::=;;._:;:~ :+=~=-:":'~..:~::::-_-., ":",::-,,,::~;:;::'~:._::.::;:==-======--:':""-=:;'';'-::='-:.'::'''.~=~-====-~_-:,==--=---==-_-:=:;;::::::-:,:..~_~:."':''':': ;:::.:.:...::;:===:!....=::====-:::;.:::.:;c;..-:-_-=-=--:=.~.;.-=---:..:...._--=-~::..=-==-~~ ESTt.TEOF FILE NUMBER (r\. {\ (\, A- 0 /2. N tZ~ f!:, " f" _ _._____ ---1------------------..------.-....------------------.FELATiJNSHIP-TO DECEDENT!' f:..:v'~l!i{T-OR SHARE-- NUIV~S~R i !~:),.1E...::0~~~[.P[~S OF p~~sC'r\j,.s: HECEI'Jir~G PRO~~~~__._.....L Do Not List Trustee(sl. ---!-__ OF ESTATE .. I TAXABLE Dlsn~IB:;1 ~c)r,s :;:. )L.ce OLl:rJ. ht SP.OUS21 CiS1'lbutlons. "no l'ansfers Jnae: l' I 1 i 2.ec 9116 (ai (;2i] I h I r;;7:'~;~p:~SQ;,~ D~ I s. ~ B CleA.:Tcv/)c O~ IV "J /0 z. "') J ~ /)"\e.-, ;3. IV tfStJ ~ z. z..,., jI/ftl Ie .; /' # J( cI. C,4P1 P 1/, l-l.. (PI? I 7t> I' SOtV /') 1- ) AJ .0 t:I 1'/ (! ~ 6) t 7'" c; ~'I 'Z 4 /9/Yt.t!/V())< 57. '- A r-.<\ P I-~, (.. P P . I (() II VA'" ~ '" T~..... ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS ShOWN A.BOVE ON LiN:::S 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET II NON-TAXABLE DISTRIBUT!ONS: A. SPOUSAL DiSTRiBUTIONS UNDER SECTiON 9113 FOR WHICH AN ELECTiON TO TAX 1$ NOT BEING MADE 1. B CHAR;TABLE AND GOVERNMENTAL DiSTRiBUTiONS , C. Lo .., ~-t' S ... ~c_U"''fY\ ~ ~ S Ii I..... I -r ~ J-e)7~ Sr /-J 4n(\t $ B(JIl~ , 911. S-OlJ I __J . .. 1 TOTAL OF PART " - [NTE R T():"'~ NO~":.'.~~fl.~S.TR~~", LiN E "-<:'" R EV.,500 COVER SHEET S (if mOre space is needed. insert additional sheets of the same size) , , SCHEDULE J 3ENEFICLz\P:;:SS Es~ate of Marian R. Nesbi~ File No. P'l / ~ a ,/ elhO.J~ 'y (,J ifill rr./ . I TEIvl NUMBER NAME JI.ND RELATIONSHIP AMOUNT OR P-_DDRESS OF TO DECEDENT SHARE OF BENEFICIARY ESTATE 7\ Taxable n. Bequests Thomas B. Son 1/3 Nesbit fL."'"? -Oil.. ! '0 '=j " f4a..:j":'!::-: - v"\ ~E 1Iif' .~. ~ '-0'. f l.Vc.'.:IJ I/{II ;;'7CZ. 7 ./ ~- ~4'" - _ James B. Son 1/3 Nesbit ~ '7-to~ ~...t:. ~ l.j~ C ., f) H , ( ( , P-1 !7vtl ~it --i? " Linda S. N. Daughter 1/3 Galiza /'1 f '-1 L.e IIt10 JiJ A:" '?~ ( ..t-......,p i-I:(( '""'4 j' '.Of! r/' I ITEJ:-1 NUHBER N P-l.1E JIJ~ D ADDRESS OF A110UNT OR S HP.~RE OF BENEFICIARY ESTATE IL Charitable and Go-vernmental Bequests 5"00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17G13 Recetpt Date: Rece+pt Time: Recelpt No. : NESBIT MARIAN R Estate File No. : Paid By Remarks: 2006-00495 NESBIT M CMM 8/29/2006 15:39:55 1045536 ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name INH TAX RETURN 15.00 ---------------- Cash $15.00 Total Received......... $15.00 CUMBERLAND COUNTY GENERAL FUN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NESBIT THOMAS B 1836 HARPETH RIVER DR BRENTWOOD, TN 37027 -------- fold ESTATE INFORMATION: SSN: 201-07-5153 FILE NUMBER: 2106-0495 DECEDENT NAME: NESBIT MARIAN R DA TE OF PAYMENT: 08/21/2006 POSTMARK DATE: 08/17/2006 COUNTY: CUMBERLAND DATE OF DEATH: 06/02/2006 NO. CD 007126 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $7,727.90 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#136 SEAL INITIALS: JA RECEIVED BY: -' ) ("f; .... :1 i r...,' (, I ~ jiJ ~d Cj l; :~.1 ~ :J TAXPA YER ~]~~lJjl,~) $ 7, 727.90 ..,.. 1 oS'S' -, ~ , 8" z. , 0 GLENDA FARNER STRASBAUGH REGISTER OF WILLS Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esquire Solicitor (717) 240-6345 FAX (717) 240-7797 One Courthouse Square Carlisle, Pa. 17013 OFFICES OF l\egi~ter of _iU~ anti QC(em of tfJe erpban~t QCourt qcouutp of qcumberlanb Date: ~\ ()\.p Weare unable to process the enclosed document. It is being returned to you Jqr'tihe .:~:..,. following reason: '-" D Must be filed in duplicate. ~ Did not include the filing fee of $ I 5 .00 Register of Wills) (Made payable to I) Other: \0 ~ f''' ~-1""~ * LA. 'tIl\ upu>rl '!}... ~J... 8/u10IJ If you have any questions or concerns, please call the office at 717-240-6345 between 8:00 a.m. and 4:30 p.m. "'- ~ . r-" -...,./ (....,) U1 0- rn U1 ....=I .:T ....=I U1 rn Cl Cl Cl Cl ....=I I r:[J Cl ..D Cl Cl ~