HomeMy WebLinkAbout10-31-06
REV-1500 EX (6-00)
OFFICIAL USE ONLY
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COUN1Y CODE
~L 0521 ____
YEAR NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Evans Janet
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
5/16/2006 6/8/1926
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
M
SOCIAL SECURITY NUMBER
149-12-6388
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
[X] 1. Original Return
D 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82)
D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95) D 11. Election to tax under Sec. 9113(A) (Allach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
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Stanle A. Smith, Esquire
FIRM NAME (If Applicable)
Rhoads & Sinon LLP
TELEPHONE NUMBER
PO Box 1146
Harrisburg PA 17108-1146
717 -233 -5731
1. Real Estate (Schedule A)
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OF:FK:IAL USE ONL Y';'
<.-."....
0.00
(1)
2. Stocks and Bonds (Schedule B)
(2)
43,038.6J.
0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
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4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
0.00
122,789.12
0.00
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24,254.06
8. Total Gross Assets (total Lines 1-7)
(8)
7,792.82
190,081.79
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
1 O. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
3,248.07
11. Total Deductions (total Lines 9 & 10)
(11)
11,040.89
179,040.90
0.00
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(12)
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
179,040.90
15. Amount of Line 14 taxable at the spousal tax
z rate, or transfers under Sec. 9116 (a)(1.2)
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~ 16. Amou nt of Line 14 taxable at lineal rate
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!i 17. Amou nt of Line 14 taxable at sibling rate
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o 18. Amount of Line 14 taxable at collateral rate
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~ 19. Tax Due
0.00
x .0 ~(15)
x .0 ~(16)
x .12 (17)
x .15 (18)
(19)
0.00
179,040.90
8,056.84
0.00
0.00
0.00
0.00
8,056.84
20.
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
3W46451.000
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Deced~nt's Complete Address:
SlREET ADDRESS
4837 E. Trindle Road
Cumberland
CITY
Mechanicsbur
STATE
PA
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17055-~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
8,056.84
0.00
7,500.00
394.14
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
7,894.14
0.00
0.00
Total Interest/Penalty (0 + E) (3)
0.00
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)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
162.70
A. Enter the interest on the tax due.
(SA)
0.00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(5B)
162.70
-
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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? . . . . . . . . . . . . . . . . . . . . . . . . . . " [i]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [iJ D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Yes
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No
Declaration of preparer other than th personal representative is based on all information of which preparer has any knOWledge.
SIGNATURE OF PERSON RESP S ~JING RETURN
ADDRESS
ADDRESS
Rhoads
po Box 1146 Harrisburg PA
po Box 1146 Harrisburg PA 17108-1146
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%
[72P.S'9 9916 (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. 9 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 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. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9 9116(1 .2) [72 P.S. S 9116(a)(1)].
The tax rate imposed on the net value of transfers to orforthe use of the decedent's siblings is 12% (72 P.S. 9 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.
3W4646 1000
REV-1503 EX + (6-98)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Janet M. Evans
21 06 0521
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. 124 Shares
BAKER HUGHES INC
CUSIP: 057224107
Dividend accrued on 5/16/2006
VALUE AT DATE
OF DEATH
10,047.72
16.12
2 2,408.748 Shares
DRYDEN GOVT INCOME FD INC
CL A
CUSIP: 26243M103
20,883.85
3 3,232 Shares
LORD ABBET INVT TR
US GOV&GOVSPRA
CUSIP: 543916308
8,112.32
4 76 Shares
METLIFE INC
CUSIP: 59156R108
3,978.60
3W4696 1.000
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
43,038.61
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Janet M. Evans
FILE NUMBER
21. 06 0521.
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
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
PNC Bank Checking account #51.-4026-8474
Interest accrued to 5/1.6/2006
1.1.0,544.03
5.28
2
PNC Bank Savings account #51.-3021.-2231.
Interest accrued to 5/1.6/2006
2,389.44
2.56
3
Wachovia Securites Money Market account #3040-1.500
9,847.81.
3W46AD 1.000
TOTAL (Also enter on line 5 Recaoitulationl $
(If more space is needed, insert additional sheets of the same size)
1.22,789.1.2
REV-151O EX + (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Janet M. Evans
FILE NUMBER
21 06 0521
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM
NUMBER
1.
loo..lDE Tl-t N4ME OF TI-E TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
TI-E DATE OF "JR.l\NSFER. ATTAQ-lACQPf OF THE DEED FOR REAL ESTATE
DATE OF DEATH
VAlUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
Gift to Thomas D. Evans,
grandson of decedent on
7/12/2005
5,000.00 100.0000
3,000.00
2,000.00
2
Ladies Diamond Ring gifted to
Kristen E. Evans, granddaughter
of decedent on 1/31/2006
7,500.00 100.0000
3,000.00
4,500.00
3
MetLife Annuity, contract
#940029532
Owner: Decedent
Beneficiary: David L. Evans
17,754.06 100.0000
0.00
17,754.06
TOTAL (Also enter on line 7, Recapitulation) $
24,254.06
3W46AF 1.000
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYL VAN IA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Janet M. Evans
FilE NUMBER
2J. 06 052J.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
1.
FUNERAL EXPENSES:
Mahwah Redeemer Cemetery
Expenses related to burial plot
550.00
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
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
5,250.00
3. 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
4.
Probate Fees
333.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
J.
RESERVES: US Treasury
2006 Personal income tax
J.,056.00
2
RESERVES: PA Dept of Revenue
2006 PersonaJ. income tax
J.02.50
Total from continuation schedules
SOL 32
3W46AG 1000
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
7,792.82
Estate of: Janet M. Evans
149-12-6388
Schedule H Part 7 (Page 2)
3
RESERVES: Cumberland County Register of Wills
Reserves for additional filing fees
40.00
4
Patriot News
Legal advertising
149.22
5
Cumberland Law Journal
Legal advertising
75.00
6 RESERVES: Rhoads & Sinon LLP
Out of pocket expenses to include: Telephone - $.55;
Federal Express - $11.60; Postage - $9.00; Stock
evaluation - $6.20; Copies - $9.75; Reserve -
$200.00
237.10
Total (Carry forward to main schedule)
501.32
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Janet M. Evans
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 06 0521
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Kohl's
Credit card expense 231. 79
2 Perfect Match Boutique 325.00
3 Kinetic Concepts 111. 37
4 Choice Nursing
Medical expense 700.38
5 Verizon
Utility expense 11. 69
6 Country Meadows Retirement Community
Nursing home expense 1,867.84
3W46AH 2.000
TOTAL (Also enter on line 10. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,248.07
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Janet M. Evans
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)]
David L. Evans
204 Cherokee Drive
Mechanicsburg, PA 17050
MetLife Annuity, contract #940029532
Owner: Decedent
Beneficiary: David L. Evans
Inventory Value: 17,754.06
75% of Residue: 116,090.13
2 Kristen E. Evans
Ladies Diamond Ring gifted to
Kristen E. Evans, granddaughter of
decedent on 1/31/2006
Inventory Value: 4,500.00
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21 06 0521
AMOUNT OR SHARE
OF ESTATE
Son
Granddaughter
133,844.19
4,500.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46AI 1.000
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)
$
0.00
Estate of: Janet M. Evans
149-12-6388
Schedule J Part 1 (Page 2)
Item
No. Description
Relation
Amount
3 Thomas D. Evans
1202 Port Elissa Landing
Mid1othian, VA 23114
Gift to Thomas D. Evans, grandson of
decedent on 7/12/2005
Inventory Value: 2,000.00
25% of Residue: 38,696.71
Grandson
40,696.71
ESTATE OF JANET M. EVANS
SSN: 149-12-6388
DOD: 5/16/2006
FILE NO.: 21-06-0521
PENNSYLVANIA INHERITANCE TAX RETURN
INDEX TO EXHffiITS
Document
1. Last Will and Testament
2. Codicil to Last Will and Testament
3.
Estate V al security valuation
4.
PNC Bank valuation letter
620517.1
Return Reference
Schedule B
Schedule E
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~APOLlTANO & NAPOLITANO
COUNSELLORS AT LAW
180 E. MAIN STREET
RAMSEY, N, J.
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I, JANET M. EVANS of the Borough of Ramsey in the County of Bergen
and State of New Jersey being of sound and disposing mind and memory, but
realizing the uncertainty of this life, and intending to dispose of all my
property of whatsoever kind and nature upon my death, do hereby make,
publish and declare this to be My Last Will and Testament, hereby revoking
all other Wills and Codicils by me at any time heretofore made.
FIRST:
I direct that my just debts, funeral and testamentary
expenses be paid as soon after my decease as is practicable.
SECOND:
All the rest, residue and remainder of my property
and estate, as well real as personal, and wheresoever the same may be
situate, which at the time of my death shall belong to me or be subject to
my disposal by Will, I give, devise and bequeath unto my husband, David J.
Evans to have and to hold the same unto his heirs, executors, administrators
and assigns, absolutely and forever, whether or not there are any children
hereafter born unto me or adopted by me.
THIRD:
In the event that my husband, David J. Evans, shall
fail to survive me, I direct that my residuary estate be divided into four
(4) equal parts, or shares, and such equal parts, or shares, I give,
devise and bequeath as follows:
(a) Three (3) equal parts, or shares, unto my
son, David L. Evans, or if he shall not survive me, to his issue
surviving me, equally, per stirpes. If my son, David L. Evans fails
to survive me, leaving no issue surviving me, the parts or shar'es set
aside herein shall lapse and shall pass pursuant to subparagraph (b)
below.
(b) One (1) such part or share unto my grandson,
Thomas David Evans. If my grandson, Thomas David Evans, has not
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NAPOLITANO & NAPOLITANO
COUNSElLORS AT lAW
180 E. MAIN STREET
RAMSEY, N. J.
attained the age of eighteen (18) years at the time of my death, the
parts or shares set aside for him I give, devise and bequeath to the
Trustee hereinafter named, IN TRUST NEVERTHELESS, to be held, administered
and distributed as a separate Trust for the benefit of my said grandson
in accordance with the provisions of Article Fourth hereof.. If my
grandson, Thomas David Evans, has attained the age of eighteen (18)
years at the time of my death, I give, devise and bequeath the share
set aside herein to my said grandson and direct that it. should be
paid over and distributed to my grandson as soon as reasonably
practical, free of trust. If my grandson, Thomas David Evans, shall
fail to survive me his parts or shares shall pass to his issue surviving
me, equally, per stirpes. If my grandson, Thomas David Evans fails
to survive me, leaving no issue surviving me, the part or share set
aside herein shall lapse and shall pass pursuant to subparagraph (a)
above.
FOURTH:
The Trust created under the foregoing Article of this
will shall be held, administered and distributed to my grandson as follows:
A. The Trustee herein shall receive, hold and manage
the property as a Trust Fund, with full power to retain, sell, transfer
or lease, forever or a day, and exchange all or any part of the said
property as though the absolute owner thereof, and shall collect,
receive and recover the rents, issues, income and profits thereof.
B. During the period that the child fm: whom the
Trust was created shall not have attained the age of eighteen years,
such portion of the income received from the Trust Fund, or the principal,
shall be used by the Trustee herein for the said child's support,
maintenance and education as the Trustee shall deem best, and the
remainder of such income, if any, shall be accumulated, with or without
interest, until the said child shall have attained the age of eighteen
-2-
years.
c. Upon the eighteenth birthday of the child for
whom the Trust was created, the Trustee shall convey, assign, transfer
and set over unto the child the entire balance, if any, of the Trust
Fund remaining at that time together with any accumulated income,
absolutely and forever.
D. If the child dies before attaining the age of
eighteen years, the Trustee shall transfer, convey and pay o,rer the
principal of the Trust, as it is then constituted, to the child's
executors or administrators.
E. The Trustee is authorized and empowered to hold
as a part of the child's trust any and all articles of tangible per-
sonal property at any time forming a part thereof. The Trust:.ee shall
have no duty to convert such articles to productive property, and the
expenses of the safekeeping thereof, including insurance, shall be a
proper charge against the Trust.
F. If the Trustee, in the exercise of his :sole and
absolute discretion, determines at any time not to hold or to continue
to hold any property in trust, as hereinabove, provided, he shall have
full power and authority to transfer and pay over such property,
without bond, to the child's guardian or to the person with 'whom such
person resides.
G. The receipt of the guardian or other above-
described person to whom any principal or income is transferred and
paid over pursuant to the above provision' shall be a full discharge to
the Trustee from all liability with respect thereto.
FIFTH:
If any of the aforementioned legatees or devisees
G.
shall fail to survive me for a period of thirty (30) days, I direct that he
. APOLITANO & NAPOLITANO
. . . COUNSELLORS AT lAW
180 [,MAIN STREET
RAMSEY, N. J.
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NAPOLITANO & NAPOLITANO
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180 E. MAIN STREET
RAMSEY, N. J.
or she shall be deemed to have predeceased me and that the provisions of
this will shall be construed upon that assumption.
SIXTH:
All estate, inheritance, succession, legacy, transfer,
and other taxes of the same nature which are payable because of D1Y death,
including any interest or penalties thereon, with respect to the property
comprising my estate for such tax purposes, whether such proper~r passes
under this Will or outside of this Will, and whether such taxes are payable
by my estate or by any recipient or beneficiary of any such propl:!rty, shall
be paid entirely out of my residuary estate as part of the expenses of
administration of my estate, with no right of reimbursement from any recipient
or beneficiary of such property.
SEVENTH:
I hereby nominate, constitute and appoint my husband,
David J. Evans, Executor of this my Last Will and Testament, and I direct
that my said Executor shall not be required to furnish any bond or security
whatsoever for the faithful performance of his duties as such Executor any
law to the contrary notwithstanding. In the event that my husband, David
J. Evans, shall predecease me, shall fail to qualify, die or re~;ign, then,
in that event, I hereby nominate, constitute and appoint David L. Evans,
Alternate Executor of this, My Last will and Testament and I direct that my
said Executor shall not be required to furnish any bond or security whatsoever
for the faithful performance of his duties as such Executor any law to the
contrary notwithstanding.
EIGHTH:
In the event that my husband, David J. Evans, shall
predecease me, and in the event further that my grandson, Thomas David
Evans shall not have attained the age of eighteen years at the time of my
death, then, in that event, I hereby nominate, constitute and appoint my
son, David L. Evans, the Trustee of the Trust herein created, and I direct
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NAPOLITANO & NAPOLITANO
COUNSELLORS AT LAW
180 E. MAIN STREET
RAMSEY, N. J.
that no bond or other undertaking shall be demanded or required of my said
Trustee any law to the contrary notwithstanding.
IN WITNESS WHEREOF, I have on this ~ '-I qay of 0 d~
, in
the year One Thousand Nine Hundred Eighty signed, sealed, published and
declared the foregoing Instrument as and for My Last Will and Testament, in
the presence of each and all of the subscribing witnesses, each of whom I
have requested, in the presence of the others, to subscribe his name (with
his address), as an attesting witness, in my presence, and in the presence
of the others.
WITNESSETH:
d~~t hI. ~,
JANET M. EVANS
of five typewritten pages, including
this page, was subscribed by the above-named Testatrix, Janet M. Evans, at
the Borough of Ramsey, in the County of Bergen and State of New Jersey, on
this '(). Ll ctlay of 0 ~~ , in the year One Thousand Nine Hundred
Eighty in our presence and was at the same time and place published and
declared by her to us to be her Last will and Testament, and, thereupon,
we, at her request, in her presence, and in the presence of each other, did
subscribe our names as attesting witnesses.
NAMES
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RESIDENCES
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NAPOLITANO & NAPOLITANO
COUNSElLORS AT lAW
180 E. MAIN STREET
RAMSEY. N. J.
I, JANET M. EVANS, the testatrix, sign my name to this instrument this
:J'fd day of Ocht1J..w ' 1980, and being first duly sworn, do hereby
declare to the undersigned authority that I sign and execute this instrument
as my Last will and that I sign it willingly (or willingly direct another
to sign for me), that I execute it as my free and voluntary act for the
purposes therein expressed, and that I am 18 years of age or older, of
sound mind, and under no constraint or undue influence.
(l
/- y/ \....7 ~
Jt..?7;zt., r, ,: L~..?1"~
Janet M. Evans
We, the undersigned witnesses, being first duly sworn, do each hereby
declare to the undersigned authority that the testatrix signs and executes
this instrument as her last Will and that she signs it willingly (or willingly
directs another to sign for her), and that each of us states that in the
presence and hearing of the testatrix, he hereby signs this will as witness
to the testatrix' signing, and that to the best of his knowledge, the testatrix
is 18 years of age or older; of sound mind, and under no constraint or
undue influence.
170'0 ~ Ii LJjA~h 1.;.)
W~tness
~ ~
.. ~'--- J:L '.
.. Witness ~
THE STATE OF NEW JERSEY)
COUNTY OF BERGEN
Subscribed, sworn to and acknowledged before
testatrix, and subscribed and sworn to before me
this ;~day of ad ~ 1980.
(Seal)
LA W Ul'l'lCJ:.::S
"_~AIDIS,GUIDO & MA:SLAN~
26 W. HIGH STREET ·
CARLISLE, PENNA. 17013
PHONE (717) 243-6222
SAIDIS, GUIDO
& MASLAND
26 W. High Street
Carlisle, Pa.
"...
CODICIL
OF
JANET M. EVANS
I, JANET M. EVANS, of Hampden Township, Cumberland County,
Pennsylvania, the within named Testatrix, do hereby make and
publish this Codicil of my Last Will and Testament dated October
24, 1980.
FIRST
I hereby replace the Trustee appointed by paragraph Eight of
the aforementioned Will from David L. Evans to CCNB Bank, N.A..
SECOND
I hereby direct that said Trustee will hold that portion of
my Estate in Trust for my grandson, THOMAS DAVID EVANS " until he
has attained the age of twenty-two (22) years. All reference to
the age of eighteen (18) in the body of the Testamentry Trust
shall be amended to twenty-two (22) years of age.
In all other respects I hereby ratify, confirm and republish
my Last Will dated October 24, 1980 together with this sole
Codicil as and for my Last Will.
IN WITNESS WHEREOF, I, JANET M. EVANS, have hereunto set my
hand and seal this my Last Will and Testament this /~-f;.(
day of 50e.plem), er
, 198 Y".
QUUP~L m. ~72--J4<!__
.fanet M. Evans
Signed, sealed, published and declared by the above-named
Testatrix, as and for her Last Will and Testament in the presenc
of us, who have hereunto subscribed our names at her request as
SAIDIS, GUIDO
& MAS LAND
26 W. High Street
Carlisle, Pa.
witnesses thereto, in the presence of said Testatrix and of each
other.
~t:7
//1)"d~ V,VC -f ~~Ov!\L~
'-
ADDRESS JG W /.-h:SA,
/ I;:~' (7<J('i
C ~ Cc.s '-< '-'- l
ADDREss;2Co ~0b l:hfjb 3trPct
~(A(' Ii sle I VIA [/(\13
SAIDIS, GUIDO
& MASLAND
26 W. High Street
Carlisle, Pa.
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS
WE, JANET M. EVANS, ROBERT C. SAIDIS, AND MICHEL:LE L.
SHEARER, the Testatrix and witnesses, respectively whose names
are signed to the foregoing or attached instrument, being first
duly sworn, do hereby declare to the undersigned authority that
the Testatrix signed and executed the instrument as her Last
Will and Testament and that she signed willingly and that she
executed as her free and voluntary act for the purposes: therein
expressed, and that each of the witnesses, in the presence and
hearing of the Testatrix signed the Will as witness and that to
the best of their knowledge the Testatrix was at the time 18 or
more years of age, of sound mind and under no constraint or undue
influence.
~' JJI &~~
J~net M. Evans, Testatrix
~
Rob t C. Saidis, Witness
~(~0; V & .1 :11 Gev12/~
Mic elle L~ Shearer, Witness
SUbscribed, sworn to and acknowledged before me by JANET M.
EVANS, the Testatrix, and subscribed to and sworn or affirmed to
before me by ROBERT C. SAIDIS, AND MICHELLE L. SHEARER,
witnesses, this I~ day of --J;O&~-..
, 1981.
/"\
Ii r/7<M.-[. Ma
No'E ry Public
JOAN E. ~lnLV; :'~:::>:;ry Public
C~,.lj('!=- i-''';!-'iC~.: .:~ -;"'; Co., Pa.
N;; 'C~~;;js'sion E;;p:;-s:. Iv'iarch 23, 1992
Date of Death: 05/16/2006
Valuation Date: 05/16/2006
Processing Date: 10/20/2006
Shares
or Par
Security
Description
1)
2408.748 DRYDEN GOVT INCOME FD INC (26243M103)
CL A
Mutual Fund (as quoted by NASDAQ)
05/16/2006
3)
3232 LORD ASBET INVT TR (543916308; LAGVX)
US GOV&GOVSPRA
Mutual Fund (as quoted by NASDAQ)
05/16/2006
4)
76 METLIFE INC (59156R108; MET)
COM
New York Stock Exchange
05/16/2006
5)
124 BAKER HUGHES INC (057224107; BHI)
COM
New York Stock Exchange
05/16/2006
Estate Valuation
High/Ask
Low/Bid
8.67000 Mkt
2.51000 Mkt
52.55000
52.15000 H/L
82.24000
79.82000 H/L
6)
Div: 0.13 Ex: 05/04/2006 Rec: 05/08/2006 Pay: 05/19/2006
9847.81 Cash (CASH)
Total Value:
Total Accrual:
Total: $52,886.42
Page 1
Estate of: Estate of Janet M. Evans
Report Type: Date of Death
Number of Securities: 5
File ID: evans
Mean and/or Div and Int Security
Adjustments Accruals Value
8.670000
20,883.85
2.510000
8,112.32
52.350000
3,978.60
81.030000
10,047.72
16.12
9,847.81
$16.12
$52,870.30
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4)
JUL-05-2006 17:33
PNCBRNK
412 768 34S8
P.01/01
~
G PNCBAN<
July 5, 2006
Shawn D. Funk
Twelfth Floor
One South Market Square
P.O. Box 1146
lIarrisburg,PJ\ 17108-1146
RE: Estate of Janet M. Evans, deceased
SSN: 149-12-6388
DOD: 5/16/2006
Dear Mr. Funk:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checking Account
Account #5140268474
Established 10/28/1986
JANET M EVANS
DOD balance: $110,544.03 + $5.28 accrued interest
Savings Account
Account #5130212231
Established 11/05/1986
JANET M EVANS
DOD balance: $2,389.44 + $2.56 accrued interest
The decedent maintained Investment Account (INV #30386971). For further information,
you may contact the Brokerage Department at 1-800-762-6111.
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not process any financial
transactions 0" provide statements. If you nced assistance with any of these items,
please call1-888-PNC-BANK (l~888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
@(1Q~ LJW~
Rachelle Wells
1~800~762-1775
P7-PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
Member FDIC
TOTAL P. 01