HomeMy WebLinkAbout10-30-06
REV-1500 EX + (6-00)
COMMONWEALTH OF i REV.1500
PENNSYLVANIA I'N~
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601 I 21 06 0173
HARRISBURG, PA 17128-0601 _ RESIDENT DECEDE~T-L_couN~oDE ~"----_ NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) -. '~OCrAL SECURITY NUMBER----- ----
I Kautz, Howard L. __ I 1-8'0--'09-4431 ________
r6ATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) ~URN MUST BE FILED IN DUPLICATE WITH THE
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02-03-2006
06-19-1918
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
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[i] 1. Original Return
D 4. Limited Estate
[i] 6. Decedent Died Testate (Attach
copy of Will)
9. Litigation Proceeds Received
n 2.
Supplemental Return
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,NAME
Michael L. Bangs
FIRM NAME (If applicable)
TELEPHONE NUMBER
717/730-7310
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)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) 1.J Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
OFFICIAL USE ONLY
--L- REGISTER OF WillS
I SOCIAL SECURITY NUMBER
i
~'-'--'---"---'-"~--"-----
IJ 3. Remainder Return (date of death priorto 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
MAILING ADDRESS
11. Election to tax under Sec. !l113(A) (Attach Sch 0)
429 South 18th Street
Camp Hill, PA 17011
(1 ) 143,343.55
(2) None
(3) None
--'-'--
(4) None
---
(5) 6,907.01
~-_.-
(6) 65,952.10
----..
(7) 27,828.57
(9) 18,353.98
(10) 2,121.76
13. Charitable and Governmental Bequests/Sec 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)
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15.A e 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
0.00
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
120. D
x .00 (15) 0.00
---------.-
x .045 (16) 10,060.00
x .12 (17) 0.00
x .15 (18) 0.00
(19) 10,060.00
------...--------
223,555.49
0.00
0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
OFFICIAL USE ONLY
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n4,031.23
(11 )
20,475.74
223,555.49
(12)
(13)
None
(14)
223,555.49
>> BE SURE TO ANSWER All QUESTIONS ON REVERSE SIDE AND RECHECK MATH<<
Copyright 2002 form software only The Lackner Group, Inc.
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Form REV-1500 EX (Rev. 6-00;
Decedent's Complete Address:
STREET ADDRESS
2200 Yale Avenue
CITY Camp Hill
-~-------r---...--r------------
'STATE PA IZIP 17011
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
Total Credits (A + 8 + C)
(2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is theBALANCE DUE (58)
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
a. retain the use or income of the property transferred;............................................................................. [J
b. retain the right to designate who shall use the property transferred or its income;................................ IJ
c. retain a reversionary interest; or............................................................................................................ []
d. receive the promise for fife of either payments, benefits or care?.......................................................... [-I
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?............................ ............................... __............................ __.....................
10,060.00
0.00
10,060.00
10,060.00
No
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3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ I i
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ,_
contains a beneficiary designation?............................ ............................... __........................... ....................... I~
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 pe~ury. 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 knowledQ.e. ______.___. _
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
Marilyn E. Kautz 2095 Clarendon Street
CampHiII,PA 17011
ADDRESS
---_!~~
DATE
tl~ ./
SIGNATURE OF PREP E 6/f
Michael L. Bangs .
ADDRESS
429 South 18th Street
Camp Hill, PA 17011
IO/~JhL
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. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)]. The statutedoes 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. 99116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.
99116 1.2) [72 P.S. 99116 (a) (1)].
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. 99116 (a) (1.3)]. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1502 EX+ (6-98)
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
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
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Real Estate - 2200 Yale Avenue, Camp Hill, Pennsylvania (sold on 6/28/06; see
settlement sheet attached)
143.343.55
TOTAL (Also enter on Line 1, Recapitulation)
143.343.55
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
A. Settlement Statement
U.S. Department of Housing
and Urban Development
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~: Ej":~O!;.D FmHA 3. DC~~V.-~i~s.-I6FileNumber
~~__V_~__~:_~_:o~v'~~__~___LH
OMB Approval No. 2502-0265
Loan Number
18. Mortgage Insurance Case Number
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the setUement agent are
shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not
n n__inc;luQ~lnthe~~~. .
O. Name and Address of Borrower .-'----r E~N_.;;;;.;~d.Add;eS$-ofS;,,;ef Name and Address or lende<
1
I Marilyn E. Kautz Estate
....----..-----~------ ---.-~--__------ __ _..1 . __.____
H. Settlement Agent
Gerald K. Morrison, Esquire
---------...-.-.-..-------.- --_._~.__._._-
Place of Settlement
2200 Yale A venue, Camp Hill,
Camp Hill Borough, 16 West Main Street
Cumberland County, Pennsylvania New Bloomfield
Dennis L. Yarlett
Julia C. Mentzer
! The Bank of Landisburg
G. property Location
II. Settlement Date
PA
17068
6/28/06
J. su~~~~~,~ ~~~!~~ _~~~~ctlon _'__~______'___~____n ______ _ ._.___ _ _ ._~~~ummary of Seller'~!!~~sactlon
100. Gro.. Amount Due From Borrower 400. Gross Amount Due To Seller
101 ~~~~a~~~~c;-_~~_~==~_==~~-~l_-=-=f54:~~cfoo~~~~t;ct sal~';':"~- -------
~c.?erson~.I'.roper1j< ____ m _ _________ _ ---J---- __.__ __. __._ ~o.?c I'''~nalp_'''ee..r:'}'__
1ll3:_~Ie'!""'t.cIlar\!lls_to_tx>rrow~il:e!4()()L_ _ ---I _____l,68'0QQ -",03,,--_
104. 404.
105. 405.
u____________ ._._____~
___ A<lju.!.bJl.8-,,~_rorJ!OI11!J>illl!>)' .eller In a~.v~nce __ __,-- _ ~ _ __ _ A~JIl!Imen~~ Items paid by .elleLln advance
;C~~::.::es-6128/06 - ~-12131/~ --t-~ ~}09]6 :~~~::es ~/281ll6 _~-'@11/06
108 Assessments to 408 Assessments to
109-S~h()()1 - 6128106 _ ~IO 613010'6"- ---=--.==-=:-_ ~.2].2.~~~~~~?L=-6128106-_~06/3litoT
110. to 410. to
111. to ..-1-------. -- ------ ---- ...".-----------.---- to
to ---- -~-~t~ ~~~ -= ~~;~-_ -------
120. Gros. Amount Due From Borrower I 158,005.55 420. Gross Amount Due To Seller
154!OOO~)0
__.. __.i
309.116
9.39
112.
to
154,318.55
~~_Amounta ~~~.~~By Or I~ Beh!!f Of Borrow~___ _____ ___0.__ 5O~~_!!_!ductlons In ~mount ~~~.To S.Ill!~._._
:: ~~::~~:~r~~~;)- Lil~iSbUrg~~=5J~Q~~~~~~-~~:::~:;~;~~~~~~~~QO)_
~~,E~isll"llloan(s)tal<en subject_to___ ___ _ _ . .....;.__ . _ 503,..E-"is.tlnl!loan~l<e.n_5ubjectt~
~~- i ~:_.E~rr of first mo!t~9.~I~~~___
:: = _____~_=.=--- _-=-=-[=~~__ __ ~=-~~~~n:_~~l!a~e~=~___
:: -------~---~-----~-t----__ ::__________ ____ -~-----
209. _m_.______ ,,~____~__~___~______._ 5~1l~_ _~__~ _ _,,___.._.__
210=:~~:~~~'~=f!)'!~_lIer --~-=__==--=_--= ~1;;~:~:e::~:or_lt:'"~=unpal~0!>Ynller..
22-11-21..-cA--EssUe-~stys.metaxn"-tSs- -- - - tt'o~ -----.._-- ---------1.1 ?~_1_._ 9~lJ~ty~~~~_.__._ to
.__.___________u___ ---------------t---------- ~!U~~~!..~~~~_ to
~:::----- -~ - ~:~=----:~--~~---=f=-~~ ---~= m~=-------=------- :
;:: .......~-:-~~==------i-~-~~~= . :~:~=-__=_~__--__~n ::
~9 m~' ~a m
. -----...-------~__r_-~-~--------. '---'-' .-.--.--
220. Tolal Paid By/For Borrowor I 165,900.00 520. Tolal Reduction Amount Due Seller
10,975.00
10,975.00
300. Ca.h At Settlement FromITo Borrower BOO. Cash At Settlement To/From Seller
301. Gross ~~~ due r;';'i!<>_rTl>We; (li'Cll1 ;;-=~==--l _=~8:;Qo'5=5 5_ 601. _Gross a':;;ount du~lo sellerjiine 4202_-__-__
302. L~!'.""'"nt.paid_br/ror bor:r:ower (line ~.L_~. _( __.~.~~OO.()(,) 6~~ Les..~uclions in .!!rn~.<lU"_ ~""-Qil1e_S.20)
J
154,318.55
__~O.975.(0)
143,343.55
303. Ca.h
From
~ To Borrower
-7,894.45 603. Cash
[ZJ To
o From Seller
The undersigned hereby acknowledge the receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein.
I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF. IT IS A TRUE AND ACCURATE
STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE
RECEIVED A COpy OF THE HUD-1 SETTLEMENT STATEMENT
BORROWER K J44::{f _~___..._______. SELLER f<..~.t',J<~.~
BORROWER '5. _ (~~ _ ______.::._____ __ SELLER
TO THE BEST OF. KNOWL THE HUD-1 SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS
WHICH WERE EIVED AND EBEN OR WILL BE DISBU Y THE UNDERSIGNED AS A PART OF THE SETTLEMENT OF THrS TRANSACTION
WARNING: IT IS ACRIME TO KNOWI LY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMiLAR FORM PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 16 U.S. CODE SECTION 1001 & SECTfON 1010
Previous Edition Is Obsolete HUD-1 (3-86)
RESPA. HB 4305.2
~..~eUh:~me!ll_~~_a_riittS_ ________ _ _ _____
JOO. Total SaleslBrok.r"~oonmi"lol111a.ed"n_I"lc.~$ -~__154~~QO:OOjL6j)0- ~_"
_ Djvj~ion of Comrpission _mn~_ZO~}_as_fol_I_Q~~;
701. $ - 4-:-645.00-I~CentrY 21 Plscioneri
702$ _~~~5:-6t[=I~~EeMax---- ----
703. GOn:'m~~siol1_PCli_~_Clt_~_e~~~~rlt______ _."____
704 Service fee - Century 21 Piscioneri
%. -9~240.0_0]-
,
---I
I
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Paid From
Borrower's
Funds At
Settlement
Paid From
Selle(.
Funds At
Settlement
~~____lterns_Pay'a~!e_I_~_ ~C?_~ne~Uoll_~!~~_~O_C1Il
801 Loan Ongination Fee_ ___% _:!:l1.e_l3~n~()LL.an.cJisb~rJl
802. ~0~rlP'j5_c:ount %
803. ~pp~~_isal_Fee to
804 Credit Report 10
805 Lendf}(~__II.l~pection~.~e._
806 _ Mortgag~ ,rnsur<3rlce__App'li~tjon Fee 10
807 As~umption Fee
9,240,00
195,00
=l
n_~_
I
-t--
-.1 -
i
-----1
1,000.00
. ----------.-- ---.
808
809.
810
811.
---._- -------"---- ---1
. .---. ___non_u --~=~~-~- -.~-=~. ~-~-----~1~~=~--
---+ .-.-- .-- .--.
I
~I!. ___It!ITI~__~~qu_lred_ ~_y ~_e_I!~It~_ ~ o_Be_ _FJC1I~ _~n_ ~~~i!~~~ __ _. ~ _______ ___
901 Intere.t from to .________@$.____
902 Mort9aQ..e.rn~l1ra~~_~r~mjL.lmJor
903. Hazard L':l_su~n~_~-,-em_j_llm for, _ _ _ _ _________
904
905
___l.d~y'
___ ___l"!!9nl~s.t~
--T----
--j
----j-
nun' 1-----
-. i
. _y'earsto_
____._y~ars.to__._...
~.~~_~. __~~~e~el_ P~p~_~!~~~t~I!h~~nde.r
1001. Hazard insurance
-----~-----.------------------------ ---
1002, Mort9~~e i_,:,surance_
1003. Cilyproperty laxes
1004. Countypropertylaxe._
1005. Annual assessments
1006,
1007.
1008.
1100,-T"Ie_C1,.rge.__..
1 ~01.. Settlement ~r_~_~~~~~e___
1102. Abstract or title search
1103. Title examination
11 04. _~itle .insuri:lnG~ _bi~~~r_
1105. 9~':l~EJ~e~epa_r~tion
1106.. Notary lee.
1107, Attom~lsfeesmm__
U~~~u_~~s _abol-'~ iter~s l1umQers:
. _ _ ______...rn"ntl1s@i_.
.. __onC>nths~._.
rn.ont"~~@~__ __ ____~~.r__~or:~____
_ ____mollt~.@L _ __.?"': rn~th. ____ ____
._____.n___m<>n'hs@li_ .________...1"" month..__
. _______.lllol1ths@i_________.JElr_'"""II1__
. ________m<>nths.@L_n.____.._,IJEl-'-~h__._.. _____ __.._
____1"', m~tl1....____._.
to
to
to . (Jer~ld_j(._~()rrison, ~sqlliI".e_______
.. - =[-~~-
_ I
995.00,
to
____.to~<:Je~i!I<..MOl'I'isoIl,!lS<iw:.re=_===
-75-:00 [
,
to
- .. _ to- _l\1ich-'ierBanis_La\V2tflce~~ POC;
1108 Title insurance
Qn<::_ll:I~esabove items numbers;
1109 Lender's covera\Je
1110 ()wne(s co"er~~e
1111
1112.
1113
to
___L
$
.L__
--I
u. -~~-='-=~=~-~=~~~~r==--=-
1~OO. __ Government__Re~()r~ln9 _and Trans_fe~~h_C!'Jle~
1201 Recording fee., D~ed $ -.. - 38.50'; Mortgage $ 38.50 ; Relea.e. _ $
1202 Cily/county tax/stamrs_ Deed. $ }:540~0<>"i.M;rt~e_.~-_=______
1203 Stale. tax/stamps DEled $ 1,540:~0_-,-M~~_...!.___.__. ____
1204.
1205
--~r
i
77.00i
-1--
---l'
1,540.00
.. .1,540.00,
1300..~ddIUon.1 Settle",enl Ch!rg..
1301, Survey
1302. ~e5t jns~~on
1303.
1304.
1305
to
to
1400. Total Settlement Charge. (enter on line. 103, Section J and 502, Section KJ 3,687.00 i 10,975.00
i::~~d~~~~nt.'r~WEt~~~~~~J~~~i~tE'#L~~~~+~TC;;:~~~l~~~Nlt~gt+~~ ':~TO~ t~n~~~EO~~ ~g~Et~lmTIS A TRUE AND ACCURATE
STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE
RECEIVED A COPY OF THE HUD-1 ENT STATEMENT.
BORROWER \( 1" SELLER ~c..K~, ~
BORROWER >- --' L L - ~{. "'C~._-_. SELLER _ _ _ _ _,
TO THE BEST OF MY NOWL D UD SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS
WHICH WERE REC ED AND _ _ ~ERSIGNED AS A PART OF THE SETTLEMENT OF THIS TRANSACTION
WARNING: IT IS A CRIME TO KNOWINGLY AKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U,S, CODE SECTION 1001 & SECTION 1010 .
Public Reporting Burden for this coilection of information is estimated to average 0.25 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and compleling and reviewing the coilection of information. Send comments
regaroing this burden estimate or any other aspect of this coilection of information. including suggestions for reducing this burden, to the Reports
Management Officer, Office of Information Policies and Systems, U.S. Department of Housing and Urban Development, Washington, D,C. 20410-3600;
and to the Office of Management and Budget, Paperwork Reduction Project (2502-0265), Washington, D.C. 20503
U.S. GOVEKHMEHT PftlHnNG OffICE: un 0-*246
Rev-1508 EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
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
1 Funeral Reimbursement from Cumberland County
VALUE AT DATE
OF DEATH
100.00
2 Highmark Insurance - Refund of unearned premium
101.83
3 Refund - Refund from PA Department of Revenue
6.00
4 Refund - Refund from PP&L Electric
19.95
5 Refund - Refund from PP&L Electric
13.00
6 Refund of 2005 Income Tax Overpayment (IRS)
57.00
7 Sale of 2000 Ford Windstar Automobile
4.800.00
8 Sale of freezer
25.00
9 Sale of Miscellaneous Personal Property
1.511.95
10 State Farm Insurance - Refund of unearned automobile insurance premium
109.86
11 Proceeds from sale of miscellaneous personal property
143.85
12 Refund from PA American Water
18.57
TOTAL (Also enter on Line 5, Recapitulation)
6.907.01
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
BILL OF SALE
I, Marilyn E. Kautz, Executrix of the Estate of Howard L. Kautz, agree to sell the
decedent's 2000 Ford Windstar, VIN 2FMZA5143YBA50254, to G. James Davis for the sum of
Four Thousand Eight Hundred and 00/100 ($4,800.00) Dollars.
Date: _1 r-I~ ~c0
~A~Z KCV-dj
Executrix of the Estate of Howard L. Kautz
Rev-1509 EX+ (6-98)
*'
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Marilyn E. Kautz
2095 Clarendon Street
Camp Hill, PA 17011
Daughter
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH
FOR JOINT MADE DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 4/18/1989 PNC Bank - Account #5140033157. 16.899.76 50.000% 8.449.88
Joycelyn E. Apgar predeceased the
decedent on 12/1/03 whereby the accounl
vested in Marilyn E. Kautz as the
surviving joint owner.
2 A 2/5/2004 Wachovia Bank - Account 90.587.83 50.000% 45.293.92
1010084283379. This account was joint
with the right of survivorship.
3 A 2/5/2004 Wachovia Securities - Investment 24.416.60 50.000% 12.208.30
Account #6647-7455 (Evergreen PA Tax
Free Fd, Class B). This account was
joint with the right of survivorship.
TOTAL (Also enter on Line 6, Recapitulation) 65.952.10
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
~
" II!
-""~
~~-
WACHOVIA
Wachovia Securities, LLC
Retail Investment Group
NC1164
401 South Tryon Street
Charlotte, NC 28288
May 01, 2006
Bangs Law Office
Attn: Michael L. Bangs
429 South 18th Street
Camp Hill, PA 17011
RE: Mr. Howard L. Kautz
Dear Mr. Bangs:
Thank you for contacting Wachovia Securities, LLC regarding the account(s) ofMr. Howard L.
Kautz.
Attached is the information regarding the date of death valuation requested.
If you have any questions regarding this matter or if you need further assistance, our Estate
Processing Specialists are available 8 a.m. to 6 p.m. Monday through Friday at 1-866-874-2717.
Sincerely,
())) -r-- ;)
c.7l:ic~ Yht"rZ7Z
Rick Shinn
Estate Processing Specialist
Wachovia Securities
Securities and Insurance Products:
Not Insured By FDIC Or Any MAY LOSE VALUE Not A Deposit Of Or Guaranteed By
Federal Government A enc A Bank Or An Bank Affiliate
Brokerage services offered through Wachovia Securities, LLC, a registered broker-dealer and a separate, non-bank
affiliate ofWachovia Corporation. Member NYSE and SIPe.
BKDQA.rtf 502552130 7452520 66477455
#
Estate Valuation
Howard L. Kautz and
Marilyn E. Kautz JTWROS
Date of Death: 0 /03/2006
Valuation Date: 0 /03/2006
Processing Date: 0 /01/2006
Estate of: Howard L. Kautz
Account: 6647-7455
Report Type: Date of Death
Number of Securities: 1
FHe ID: 66477455
Shares
or Par
Security
Description
High/ASk
Low/Bid
Mean and/or Div and Int
Adjustments Accruals
Security
Value
1 )
2160.761 EVERGREEN PA TAX FREE FD 1300326204)
CL B
Mutual Fund las quoted by NASDAQ)
02/03/2006
11.30000 Mkt
11.300000
24,416.60
Total Value:
Total Accrual:
Total: $24,416.60
$24,416.60
$0.00
Portfolio Endnotes
Ti tle:
HOWARD L KAUTZ AND
MARILYN E KAUTZ JTWROS
2095 CLARENDON ST
CAMP HILL PA 17011-3828
THE INVESTMENT ACCOUNT OPENED ON 02/10/2005.
Page 1
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. IRevision 7.0.4)
..
~~4
~--""}1
WACHOVIA
Reference ID: 1553001
Wachovia Bank N.A.
Balance Confirmation Services
POBox 40028
Roanoke, VA 24022-7313
March 16, 2006
BANGS LAW OFFICE
429 SOUTH 18TH STREET
CAMP HILL, PA 17011
SUBJECT: Verification I Confirmation of Account and Balance Information provided for:
CilstOillt:l": HOWARD L KAUTZ (SSN# lljO-09-4431)
Date of Death: February 3, 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
CHECKING
1010084283379
$90,587.83
2/5/2004
$54.68
$0.00
LEGAL TITLE: HOWARD L. KAUTZ
MARIL YN E. KAUTZ
ACCOUNT IS JOINT WITH RIGHT OF SURVIVORSHIP
- ---_..~- -_._----_._-"_.._-~-_..__..._~- ----.-....-.-.----.-------.-.------ ------
" Due to system limitations, we can only provide a twelve month average balance on depository accounts.
No Safe Deposit Box found for customer.
CAP, BROKERAGE and SELF-DIRECTED IRA ACCOUNTS HAVE BEEN CONVERTED TO W ACHOVIA SECURITIES.
YOUR REQUEST HAS BEEN FORWARDED FOR PROCESSING and WILL BE MAILED UNDER SEP ARA TE COVER.
FOR QUESTIONS REGARDING CAP, BROKERAGE, or SELF-DIRECTED IRA ACCOUNTS
PLEASE CALL WACHOVIA SECURITIES at 1-866-874-2717.
· Date of death balance does not include accrued interest.
· If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were
.l made during th~t time periiYfod.
I /, '.
-fCA...-L,~( K..i.C!.~tf/-..__ ../' --.
,_ Teresa Bennett
Servicenter Associate
Phone: (540)563-7323
abs; tb
0000 ClOUG 1.1
MA~-26-2006 20:42
PNCBANK
412 768 3458
P.01/01
o PNCBAN<
March 27, 2006
Michael L Bangs
429 South 18m Street
Camp Hill, P A 17011
RE: Estate of Howard L. Kautz, deceased
SSN: 180-09-4431
DOD: 2/3/2006
Dear Mr. Bangs:
ill response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checking Account
Account #5140033157
Established 04/18/1989
HOWARD KAUTZ
JOYCEL YN E APGAR
MARILYN E KAUTZ
DOD balance: $16,899.76 + $.09 accmed interest
Interest Paid 1/1/2006 - 2/3/2006 - $2.58
Please note that this offiee only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not pro~ess any rmandal
transactions or provide statements. If you need assistance with any of these items,
please call1-888-PNC-BANK. (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~~
Rachelle Wells
1-800-762- 1775
P7-PFSC-04-F
500 first Ave.
Pi[t.~burBh PA 15219
Member FDIC
TOTAL P.0l
BANGS LAY/. OFFICE
429 SOUTH 18TH STREET
CAMP HILL, P A 17011
E-mail: mikebangs(Q}verizon.net
PHONE: 717-730-7310
FAX: 717-730-7374
MICHAEL L. BANGS, Attorney-at-Law
WENDY K. STRAUB, Paralegal
WILLIAM E. MILLER, JR.
Of Counsel
October 27,2006
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
RE: Estate of Howard 1. Kautz
File No. 21-06-0173
Dear Mrs. Strasbaugh:
c..)
CI
-0
Go)
Enclosed for filing you will find the following:
N
o
1. The original and one copy of a Pennsylvania inheritance tax return;
2. The original inventory;
3. A check in the amount of$10,060.00 to pay the tax shown to be due; and
4. A check in the amount of $30.00 to pay the filing fee.
Please return a paid receipt to me in the enclosed, stamped, pre-addressed envelope. If you have
any questions or require anything further, please contact me.
~JtA:'
Michael L. Bangs
wks
Enclosures
cc: Ms. Marilyn E. Kautz
COMMONWEAL TH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
,
DEPT 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CO 007374
BANGS MICHAEL l
429 S 18TH STREET
CAMP Hill, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
__nun fold ---------- --------
101 I $10,060.00
ESTATE INFORMATION: SSN: 180-09-4431 I
FILE NUMBER: 2106-0173 I
DECEDENT NAME: KAUTZ HOWARD l I
DATE OF PAYMENT: 10/31/2006 I
POSTMARK DATE: 10/27/2006 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 02/03/2006 I
I
TOT Al AMOUNT PAID: $10,060.00
REMARKS:
CHECK# 529
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REGISTER OF WILLS
..
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
Howard L. Kautz
No.
21-06-0173
, Deceased
Date of Death 02/03/2006
- ~-- -._--------
Social Security No. 180-09-4431
also known as
Marilyn E. Kautz
The Personal Representative(s) of the above Estate, deceased, veritY that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of
the Decedent's death, and that the 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. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S.
Section 4904 relating to unsworn falsification to authorities.
I.D. No.:
lVIichael L.Bangs
41263
Personal Representative
Signature: 'f'"'rLr, Il~ ioJ e. K ~
. Ma;ilYn- E. Kautz' ---------
Attorney:
Signature:
Signature:
Firm:
Address: 429 South 18th Street
Camp Hill, PA 17011
Telephone: 717n30-7310
Address: 2095 Clarendon Street
Camp Hill, PA 17011
Telephone: 717/737-0614
Dated:
I O~l1)~
Personal Property
Cash.............................................................................................. .
Personal Property.........................................................................
Stocks/Listed .................................................................................
Stocks/Closely Held......................................................................
Bonds.............................................................................................
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
All Other Pro perty.........................................................................
6,907.01
D
;~~
~,
C':,)
~;.::.:)
0....
~-:)
C'J
-i
(.)
<:::)
, ,
i<..-:
~~ :~j ~~~?
-0
Total Personal Property.........................................
:.\...!
--;
61907.01
':...)
'..0
Total Real Property ..................................... ...........
143,343.55
Total Personal and Real Property.........................
1501250.561
Total Out-of-State Real Property..........................
..:r
..
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
Howard L. Kautz
No.
21-06-0173
02/03/2006
also known as
Date of Death
, Deceased
Social Security No. 180-09-4431
Cash
Funeral Reimbursement from Cumberland County
100.00
Highmark Insurance - Refund of unearned premium
101.83
Proceeds from sale of miscellaneous personal property
143.85
Refund - Refund from PA Department of Revenue
6.00
Refund - Refund from PP&L Electric
19.95
Refund - Refund from PP&L Electric
13.00
Refund from PA American Water
18.57
Refund of 2005 Income Tax Overpayment (IRS)
57.00
Sale of 2000 Ford Windstar Automobile
4.800.00
Sale of freezer
25.00
Sale of Miscellaneous Personal Property
1.511.95
State Farm Insurance - Refund of unearned automobile insurance premium
109.86
6.907.01
Total Cash
Real Estate
Real Estate - 2200 Yale Avenue, Camp Hill, Pennsylvania (sold on 6/28/06; see
settlement sheet attached)
143.343.55
Total Real Estate
143.343.55
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
150.250.56
Ill\.,~U) f\,r. \ 'II,',>
. This is' to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will he forwarded to the State Vita] Records Office f~J1' permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee rl)l' this certificate, $2.00
p
9811236
No.
18v,2J87
~;h(~
Local Registrar .._~
DEe 0 3 LD03
Date
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NAME Of DECEDENT lFlr~1. MKJtJIe, ld5f1
SEX
1.
UNDER 1 DAY
Hour~ MinuI"
.. FpJTlale
S rATE filE NUMBEA
SOCIAL SECURITY NUM~--
J. 186
38
BIRTHPLACE IC.I-r df'ld PlACE Of DEATH ICb<<It. Oi"y t)ntt -- ...w ,nSlf"ChtH'''' I)fl OInt'1 ~'ddl
Stale 01 Fcre'9fl COUrllfy) HOSPITAL:
H . b Inpolionl IKI
1. arrlS urg ...
FACILITY NAME (11 not InsNullon. Ollie Slre!!l and number.
54
VII.
..
COUNTY OF OERH
Dauphin
Ie.
DECEDENT'S USUAL OCCUfYJlON
(~;=k~~I;:;X:O ~u~:Zil~~
110. Account Executive 11..
DECEDENT'S MAILING ADDRESS (SI,eet. CitylTown, Stalv. lip COdel
248 North 21st Street
Camp Hill, Pa 17011
WAS OeCEDENT EVER IN
SJ-S' ARMED fORCES?
Vo. D No DlI
12.
DECEDENT'S
ACTUAL
RESIDENCE
(See InSlructlOf\S
on 01/101 Sldel
Pa
17.. SllIl.
g'~,D
17c.D v...d8c~Ir..-.c.i,..
1..
FATHER'S NAME (filsl. MlOdIe. laSlI
I.. Howard Kau tz
INFORMANT'S NAME (T ypelPllnl)
200. David Apgar
METHOO OF DISPOSITION
Burial KK ClemalKln 0
OIher (SpdCrty\
""'
__de",
liveir,.
Currber land township? 17d.CX :h=~j=Of
MOTHER'S NAME lFlIsI, MIddle, Malden Su,name)
11. Marguerite March
INFORMANT'S MAILING ADDRESS 15"..1. C'lyfTown. SIa'o, lip Codo)
2Ob. 248 l'brth 21st Street Camp Hill, Pa 17011
PLACE Of DISPOSITION. Name 01 Cem.cory, Crematory LOCATION CllylTown, 51"'.. lip Code
Of OUWIf Place
1lb. County
DATE OF DISPOSITION
(Month, Day, Year)
D
....December 5,2003
RSON ACTING AS SUCH LICENSE NUMBER
2... 01l654-L
AemovlIllrom Slale 0
"'"
Camp Hill
Cltylboro
11c.
Rollin Green CeJnetery
NAUE AND ADDRESS OF FACILITY
2'c. ers-Harner Funeral
LICENSE NUMBER
To It.. beSI 01 my know
(SI'.I".:rwotiUld TOItttl
go, death occurred allhe limo, dill. ami place 5UIled
lIom124.26 muSl be compleled by
permn woo pronounces l18alh
IUMeOIATE CAUSE (final
OIS8ilS8 01 condlllOl1
teSUlW1g In ciealh)_
WAS AN AUTOPSY
PERFORMED?
o Ccirr.1rC>Vvt7C;"oJl.c<r / 1L~I!'rf'1fv.; -F",dw-e Ihet11Nffrv'b(
, ^ ADUE IfllOR AS t C"SEOUEfCE 2fl: (
b ---.YLJ -P_.!:::fl ~i:"'.ir c (lJl;) (r c1 Y7 c. YI. ,-
Ide DUE TO lOR ASA CONSEQUENCE QF)'
OUE TO 'OA AS A CONSE~UENCE OF)'
WERE AUTOPSY FINDINGS M,6,NNEA OF DEATH
AVAILABLE PRIOR TO
COMPlETION OF CAUSE
OF DEATH?
SequtintlaMv U.. conchbons
il any. leading La invnedlale
cause. Enl., UNDERlYINQ
CAUSE. {Otsuse OIlf\JOIy
IhalllllCialed 811en1S
resuHeng '" O8aIhllAST
DATE OF INJURY
(Moom. Day, Yeatl
N20luraJ
1&
D
D
Could nol be delsrmlned
23b. 2Je.
WAS CASE REFERRED TO MEDICAL EXAMINER/COAONER?
velD
~
2..
I Approximat.
: int.rv.. berween
I onael and death
,
i
,
,
I
PART";
Other $igniflc;:,aol condllions COfllribuUng 10 death, buc
/lot resultlng,n Ih. Uf\I:Mltylng cause given in PART I.
3 ,Q~ '1.5
.;l etVS
HUE OF INJURY
INJURV AT WORK?
DESCRIBE HOW INJURY OCCURRED.
Accld8nl
Pending Invesligallon
D
D
o ;~CE OF IN.JUAY. Al hom..laf..;.O~~eet.lactOl"f'. aUk. ~.
building, elc, 1$poc,M
JOo.
JOcI. .
LOCATION ISlleet, C,ty/fown, SlalQ)
Homicide
Voo D
No \il
Ve.D
No ~
SUICide
21a. 21b.
CERTIFIER IChttCk oni.., 00"\
.CERTlFYING PHYSICIA.N (PhYSIC.an CArlllymg caU$8 of (lea.lh when dOOlh", PhYSiC,an has pronounced death ano cOIl1p1eted Uem 231
To Iha beat 01 my know'-doe, d.ath OCCUlted due to the cause(l,and mann.r ae stated, , . , . . . . , . . . . . . . . . . . . . . . . . . . . .
,..
.PRONOUNCING AND CEATIFVINQ PtiV$ICIAN tPhY'j"uan hOlh ..U()fl0Unc,o~J lJ8dlh dfld l:etl,IY"lg 10 l:dUSe 01 dedlhl
Toth. ~I o. my koow..dgn, d..th o<:c.nr.d _1 'ha II",., da.a, .Hld plac., .od due 10 the causefs' .ilnd m.nll.r.. a'OIled...
'MEDICAL EXAMINER/CORONER
On the b..I. or ....mlll.llon and/orInvesllgallon.In my opinion, dulh occurred _.'he limo, dale, and place. and duo 10 Ihe c.use(s) and
manner.. sta'ed.. . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , . . . . . , , . . , . . . . . , . . . . , . . . . . . . . . . . . . . . . . . , , , . . , . , . . . . , . . , . . .
Jl.
REGISTRAR'S SIGNATURE AND NUMBER
~ 7/( ~~/P
I~/I~/ I IJ
JJ
Ves 0
NuD
'}lJ
Jot.
OF CERTlFtE~ /
. (17)]'71(: rVl0
. DATE SIGNED (Mol'lUl. Dav. Yearl
o Jl.. Oq\f06-::.~ J'd. I L- .- 0 I -.J Oil 3
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(lIem 27) Type Of Print (9 reL.;t:!. 1.1 ~ j (.A,.....-' r I [70
D 202> +'M no109'1 p t.Il"). 5t '36 cl
J'. "r.. ,{ 1705'0
DATE FILED j on/h. Day. Yaatj
J4. D~ :3
2 (N) 3
Rey.1510 EX+ (6-9B)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
This schedule must be completed and filed ~ the answer to any of questions 1 through 4 on the reverse side of the REV.1500 COVER SHEET is yes.
ITEM DE~l,;RIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 ING USA Annuity - Contract No. KOOO012849. 27.828.57 100.000 27.828.57
Attached is a statement from the registered
representative for Comprehensive Financial
Associates, Inc., and from ING. The value on the
date of death per the statement is $27,828.57.
There is additional interest on the claim from the
date of death to the date of the claim which was
5/15/06 in the amount of $221.74. The entire
value is subject to inheritance tax as indicated.
TOTAL (Also enter on Line 7, Recapitulation) 27.828.57
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleG (Rev. 6-98)
'SEP. 6.2006 2:19PM
- -. ~~........ ........ ........., ,_, I ,. ....
PA PENSION PLANNERS
NO, 0631 p, 2 ~ 21 2
c-
~. INO j)a)
P'~
~~I)
'0
~/)
~
:~) May 16. 2006
:,J'l
"'1'
;.,; MARilYN e KAUTZ
,.,) 2095 CLARENDON ST
~; CAMP HILL PA 17011
~~~
~>
~'rI
~l
~(,J RE: Decedent HOWARD L KAUTZ
. \' Contract Number: KOO0012849
\,.J Explanation of Benefits
;...)
, Below is the explanation of your benefit payment fram the move refemnoed contract as
of 05/15/2008. If you are the banefieisry to more than gnE' contract owned by HOWARD
L KAUTZ. addItional explanations of benefita for each conl 'act wiD be sent under
separate cover. Your information regarding your pet'$onal tmInslUon aecount will foll.ow
under separate cowr.
Basic Vafue
Interest on Claim
Other Additions
Loan Balance Due
Slate Tax Withheld
State Premium Tax Withheld
Federal Tax Withheld
Other Deductions
Net Death Benefit
$27.828.57
$221.74
$O.CO
$0.00
$0.00
$0.00
$0.00
iP.&2
$28.050.31
If you have any questions please call our Customer SoNiC';) Center at 1.a00-369-5~\03.
Sincerely,
Claims Department
AMUlty Set'Yiees
~
I/'IG USA ,411tlt41l)! arid lAj'i: /.rrsrmmc. Co,."paJlY
[:109 f.cclJlt S/~t:1
Des M()IIJ~, IA JO!JI'9.289!J
131100 01/221:1004
1~ -
11
-
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-0173
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
938.14
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Marilyn E. Kautz
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
Year(s) Commission paid
See continuation schedule(s) attached
PA
Zip 17011
5,000.00
2.
Attorney's Fees
See continuation schedule(s) attached
8,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
314.00
See continuation schedule(s) attached
5.
Accountant's Fees
500.00
See continuation schedule(s) attached
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
3,601.84
TOTAL (Also enter on line 9, Recapitulation)
18,353.98
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Myers-Harner Funeral Home, Inc.
635.00
2
Trinity Evangelical Lutheran Church - Funeral luncheon
303.14
Subtotal
938.14
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-81
PERSONAL REPRESENTATIVE'S
COMMISSIONS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Marilyn E. Kautz
5.000.00
Subtotal
5.000.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B1 (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-B2
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Michael L. Bangs, Esquire
8.000.00
Subtotal
8.000.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-84
PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Register of Wills
314.00
Subtotal
314.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B4 (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-B5
ACCOUNTANT'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Boyer & Ritter
500.00
Subtotal
500.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B5 (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Chad Gallaher - Removal of trash from residence
160.00
2
Chad Gallaher - Lawn maintenance
405.00
3
Cumberland Law Journal
75.00
4
Postmaster - Mailing of Decedent's 2005 Income Tax Returns
8.85
5
RCS Construction - Snow Removal
25.00
6
Register of Wills - Additional Short Certificates
20.00
7
Robert Losh - Painting at house and removal of carpet
1.950.00
8
Robin Gochenauer - Cleaning of residence for sale
100.00
9
The Carpenter's Shop - Removal of personal property items to auction house
750.00
10
The Sentinel
107.99
Subtotal
3.601.84
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 American Red Cross
VALUE AT DATE
OF DEATH
37.50
2 AT&T
4.63
3 AT&T
17.29
4 Camp Hill Borough - Sewer bill (January through June)
85.00
5 Central PA Radiation Oncology, PC
124.00
6 Discover Card
22.93
7 Free Flow
135.00
8 Holy Spirit Hospital
31.03
9 Janet Miller, Tax Collector - 2006 County/Borough Real Estate Tax
606.69
10 Janet Miller, Tax Collector - 2006 Personal Tax bill
5.00
11 Marilyn E. Kautz - (payment for sweeper)
63.59
12 Marilyn E. Kautz - (reimbursement of one-half electric bill)
33.87
13 Michelle Long
70.00
14 Montour Oil Company
92.00
15 Montour Oil Company
66.31
16 Montour Oil - Final Bill
279.37
17 PAWC - 3/10/06 to 4/12/06
18.66
Total of Continuation Schedule(s)
See attached page
TOTAL (Also enter on Line 10, Recapitulation)
2,121.76
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
Rev-1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kautz, Howard L.
FILE NUMBER
21-06-0173
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
28
29
30
31
32
18
PAwe -1/13/06 to 2/9/06
16.87
19
PAwe - 2/9/06 to 3/10/06
18.05
20
PAwe - 5/11/06 to 6/12/06
18.57
21
PAwe - Final bill
30.40
22
P A we - 4/12/06 to 5/11/06
18.66
23
Penn Waste, Inc. - April - June, 2006
42.61
24
PP&L Electric - 2/13/06 to 3/15/06
29.46
25
PP&L Electric - 3/15/06 to 4/13/06
32.99
26
PP&L Electric - 5/15/06 to 6/14/06
32.95
27
PP&L Electric - Final Bill
13.00
PP&L Electric - 4/13/06 to 5/15/06
32.97
Travelers Insurance - Homeowners insurance installment (May)
49.33
Travelers Insurance - Homeowners insurance installment (June)
49.33
Verizon
9.96
Verizon
33.74
TOTAL (Also enter on Line 10, Recapitulation)
2.121.76
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (9-00)
.
SCHEDULE ,J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Kautz, Howard L.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee/sl
FILE NUMBER
21-06-0173
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Jeffrey D. Apgar
5616 Heather Lane
Laurys Station, PA 18059
Grandson
One-quarter
2
Sonja J. Brunner
155 Strickler Drive
York Haven, PAl 7370
Marilyn E. Kautz
2095 Clarendon Street
Camp Hill, PA 17011
Granddaughter
One-quarter
3
Daughter
One-half
Total
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleJ (Rev. 6-98)
6)#jj
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I, HOWARD L. KAUTZ, of 2200 Yale Avenue, Camp Hill, Cumberland County,
},.
Pennsylvania, declare this to be my last will and revoke any will previously made by me.
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ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
& part of the expense of the administration of my estate.
~~
-, \j ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all
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other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto as follows:
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A. Fifty (50%) Percent to my daughter MARILYN E. KAUTZ provided
she survives my death by 30 days. Should she predecease me or not survive my
death by 30 days, then her share shall be evenly divided among her issue, per
stirpes, as survive my death by thirty (30) days.
B. Fifty (50%) Percent, to be divided evenly among my grandchildren,
SONJA L. BRUNNER and JEFFREY D. APGAR, provided they survive my
death by 30 days. Should either of them predecease me or not survive my death
by 30 days, then his or her share shall go to the survivor of them.
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ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate as follows:
A. Fifty (50%) Percent to my daughter MARILYN E. KAUTZ provided
she survives my death by 30 days. Should she predecease me or not survive my
death by 30 days, then her share shall be evenly divided among her issue, per
stirpes, as survive my death by thirty (30) days.
B. Fifty (50%) Percent, to be divided evenly among my grandchildren,
SONJA L. BRUNNER and JEFFREY D. APGAR, provided they survive my
death by 30 days. Should either of them predecease me or not survive my death
by 30 days, then his or her share shall go to the survivor of them.
ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
('.)
ITEM V. I appoint my daughter MARILYN E. KAUTZ executrix of this my last will.
.~
ITEM VI. In addition to the other powers and authorities granted to my personal
representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
approval and until actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations finally to be fixed by them; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
2
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this! t{4-tcz..a1_i. day of
l
,2004.
vi ---(.,----t(,~.t'L~~~' )\
HOWARD L. KAUTZ
3
.' 1
The preceding instrument, consisting of this and THREE other typewritten pages, each
identified by the signature of the testator was on the date thereof signed, published, and declared
by HOWARD L. KAUTZ, the testator therein named, as and for his last will, in the presence of
us, who at his request, in his presence, and in the presence of each other, have subscribed our
names as witnesses hereto.
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COMMONWEAL TH OF PENNSYLVANIA
)
( SS:
)
COUNTY OF CUMBERLAND
The undersigned, being the testator whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, does hereby acknowledge that I signed and executed the
foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
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/ !-O---fV-?:i!/lr' (~ ) I J a.uf>
HOWARD L. KAUTZ' i/
Sworn or affirmed to and acknowledged
b~,fpT n, by the t.t tor named ,bove
J. ~ da of' ,~tlJ:t-, 2004.
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No ary Pl:bl ~;' NOTARIAlSEAL
_NOY S. CHESBRO, f<<*ry PIbtc
LQ\Ii\1II' AItM Twp., Cumbertand Cauntv
My Comml3Slon Ex;lIres May 10. 200?
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COMMONWEAL TH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND )
WE, M..J"-e.I L ~"'t..J and J)()Ll6LA~ --l. c_l\.:~s:'1 iT , the
witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the testator sign and execute the instrument as his
last will; that he signed it willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the testator signed the will as witnesses; and
that to the best of our knowledge, the testator was at that time 18 or more years of ~e, of sound mind,
and undcr no constraint or undue influence. ~j)))? N')
I ~TARiAl SEAl
WENDY 2. CHESBRO. ' I, No4ari PlJb~c
lJ.:.ll)fJ2!!' Moo Twp., C""mbeOOnd' Coonty
. My Commbslcn Exp~ May 10, 200i
,,~_ ~_:Alo~.~~
5
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AMOUNT
UNITED STATES
PO.sTAt. SAVI"
$3.03
0000
'111 11I111 11I11111I' '11111 '11'1'
Glenda Famer Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
U.S. POSTAGE
PAID
CAMP HILL.PA
17011
OCT 27. '06
00016596-22
17013
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