HomeMy WebLinkAbout11-01-06
lEV-l500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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DATE OF DEATH (MM.DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
~l-.l) S-
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
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NUMBER
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
J:) 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A} (Attach Sch 0)
(7)
1.\ L\, \S ~ · \ 0 - -
(14)
(19)
COMPLETE MAILING ADDRESS
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(12)
(13)
~ 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy 01 Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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OFFICIAL USE ONLY
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1. Real Estate (Schedule A) ;
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (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)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1 )
(2)
(3)
(4)
(5)
(6)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .0 _ (15)
~..s<1, ';lq~, 7S x .0 ~ (16)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
x .15 (18)
19. Tax Due
20.~
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
\ ce 5
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CITY
\-\ \ 1.L.
STATE
PA
C~m
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 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)
ZIP
l'101
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5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
(5A)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
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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;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or................,............................................,............................................................ 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ......................................................................."............................................... ~
No
o
o
o
o
o
o
o
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 knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
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ADDRESS ,
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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DATE
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ADDRESS
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (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. ~9116 (a) (1.1) (ii):
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even
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 paren'
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. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as 81
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2005-01008 PA No. 21-05- 1008
Estate Of: MRS ANNA P PETERS
(First, Middle, Last)
a/k/a:
Late Of:
ANNA P PETERS
LOWER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No: 171-28-5886
WHEREAS, on the 16th day of November 2005 an instrument dated
September 27th 2004 was admitted to probate as the last will of
MRS ANNA P PETERS
(First, Middle, Last)
a/k/ a ANNA P PETERS
late of LOWER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 3rd day of November 2005 and,
WHEREAS, a true copy of the will as probated
THEREFORE, I, GLENDA FARNER STRASBAUGH
is annexed hereto.
Register of Wills in and
Pennsylvania, hereby
TESTAMENTARY to:
for CUMBERLAND County, in the Commonwealth of
certify that I have this day granted Letters
DARLA N PETERS AKA and DARLA M PETERS
who have duly qualified as EXECUTOR(RIXj
and have agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the
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**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
LAST WILL AND TESTAMENT
BE IT REMEMBERED THAT
1, ANNA P. PETERS, a resident of Cumberland County, Pennsylvania, being of sound and
disposing mind, memory and understanding, do make, publish and declare this to be my LAST
WILL and TESTAMENT, her~by revoking allY and all Wills and Codicils previously made by me.
J declare that I am not married, my beloved husband, GUY W. PETERS having predeceased
me, and that I had two (2) children, WILLIAM G. PETERS and ROBERT G. PETERS, both of
whom have predeceased me.
I have four (4) grandchildren, ROXANN ALBRIGHT, WILLIAM G. PETERS, ROBERT
G. PETERS and ANNMARIE PETERS. References in this Will to my grandchildren include all of
the grandchildren named above. '
II
I direcllhal all my just debts and funeral expenses shall be paid from my residuary estate as
soon as practicable aller my decease.
III
I direct that all taxes that may be assessed in consequence of my death, of whatever nature
and by whatever jurisdiction imposed, shall be paid fron,l my residuary estate as a part of the
expense of the administration of my estate.
...
IV
I hereby make the following specific bequests:
1. To my daughter-in-law DARLA N. PETERS I give, devise. and bequest my
birthstone ring and diamond wedding band; and
2. r hereby direct my executor to sell my home at ] 854 Holly Drive, Camp Hill,
Cumberland County, Pennsylvania, either at public or private sale, and the proceeds from
this sale I hereby give and bequeath to my grandson, WILLIAM G. PETERS.
V
All the rest, residue and remainder of my property, whether real or personal, wherever
situate, including any property over which I may have a power of appointment, I leave to my
daughter-in-law, DARLA N. PETERS and to my grandchildren, namely ROXANN ALBRIGHT,
WILLIAM G. PETERS, ROBERT G. PETERS and ANNMARIE PETERS, in equal shares, per
stirpes.
VI .
I nominate, constitute and appoint my daughter.in.law, DARLA N. PETERS, Executrix of
this LAST WILL, to serve withmit bond. If DARLA N. PETERS is unwilling or unable to act in
that capacity, then I appoint my grandson, WILLIAM G. PETERS Executor of this LAST WILL,
to serve without, bond.
IN WITNESS WHEREOF, I, ANNA P. PETERS, have set my hand to this LAST \VILL
this~'" day of ~)'ep+enr,/J()l~, 2004.
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ANNA P. PETERS
....
Signed, sealed, published and declared by the above-named ANNA P. PETERS, as and for
her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in
the presence of each other, have hereunto subscribed our names as witnesses.
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, ANNA P. PETERS, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my LAST WILL; that I signed it as my fi'ee and voluntary act for the
purposes therein expressed.
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Sworn or affirm.ee.d d y>. and acknowledged before me by ANNA P. PETERS, Testatrix,
thia"7 day cifjpt[~}!tt:I'/-, 2004.
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AFFIDA VIT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, 'R. fYlO-f-\J-=T"")OO.-ltiS and <JD~\~\..- '~D - Gf"~ 6 ~~ ~~
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 Testatrix sign and execute the
instrument as her LAST WILL; that ANNA P. PETERS signed willingly and that she executed it as
her free and voluiltary act for the purposes therein expressed; that each of us in the hearing and sight
...
of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix
was at the time 18 years of age or more, of sound mind and under no constraint or undue influence.
~~
SWO~ of. affin:.dl.' ) a. n.d. acklH!.wledge .
thl~ day of '/12..:z;t.{b^c&,;i';2004.
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: .'. :.' I.:C mmission Expires Expires Mar. 11, 20Cd
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REV-1502 EX+ <.....
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
seNIDULI A
REAL ESTATE
ESTATE OF
Anna P Peters
FILE NUMBER
2005-1008
All ....1 property owned solely or as a tenant In common mUlt be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a wilting buyer and a wiRing seller, neither being compelled to buy or seD, both having reasonable knowledge of the relevant facts.
Real property which '- jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
1854 HoHy Dr, Camp Hill, Pa. 17011 home selling price July 312006
VALUE AT DATE
OF DEATH
132,900.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
132,900.00
..........."- ~-
.. L. SETTLEMENT CHARGES
700" TOTAL COMMISSION Based on Price $ 132,900.00 @ 6.0000 % 7.974.00 PAID FROM PAID FROM
Division of Commission (line 700) as Follows: BORROWER'S SELLER'S
701. $ 7.974.00 to Re/Max Realty Associates. Inc. FUNDS AT FUNDS AT
702.$ to SETTLEMENT SEITlEMENT
703. Commission Paid at Settlement 7,974.00
704. Transaction Fee to
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan OriQination Fee 0.0000 % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Broker Fee to Capital Mortgage Resources 644.50
806. Tax Service Fee to Mortoage IT, Inc. 69.00
807. Flood Cert Fee to Mortgage IT. Inc. 10.00
808. Administration Fee to Mortgage IT, Inc. 550.00
809. Wire Transfer Fee to Mortgage IT, Inc. 20.00
810. Yield Spread Premium to Capital Mortgage Resources POC:L998.08
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 07/31/06 to 08/01/06 @ $ 27.667500/day ( 1 days %) 27.69
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 vears to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months I j} $ 41.50 per month 124.50
1002. MortQaQe Insurance months ~ il $ per month
1003. CitylTown Taxes months l ~ $ per month
1004. County Taxes 7.000 months il $ 38.95 per month 272.65
1005. School Tax 2.000 months @ $ 86.10 per month 172.20
1006. months ( $ per month
1007. months ( ~ $ Der month
1008. Aooreoate Adiustment months ( $ oer month -236.21
1100. TITLE CHARGES
1101. Settlement or ClosinQ Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Deed Preparation to Kevstone land Transfer. Ltd. 125.00
1106. Notary Fees to CASH 25.00 15.00
1107. Attorney's Fees to
(includes above item numbers: )
1108. Title Insurance to Kevstone land Transfer Ltd. Re-Issue 921.38
(includes above item numbers: )
1109. lender's Coverage $ 132,900.00 PAl#105351483
1110. Owner's Coverage $ 132,900.00 PA0#105117583
1111. Endorsements 100.300.8.1.710 to Keystone Land Transfer. Ltd. 200.00
1112. Closing Protection letter to Keystone Land Transfer, Ltd. 35.00
1113. Tax Certifications to Keystone land Transfer, Ltd. 12.00
1114. Overnight to Keystone land Transfer, Ltd. 20.00
1115. Retrieve E Mail Documents to Keystone land Transfer, Ltd. 25.00
1116. Wire Fee to Keystone land Transfer, Ltd. 10.00
1117.
1118.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ 88.50; Releases $ 127.00
1202. City/County Tax/Stamos: S 1,329.00' Mortgage 1.329.00
1203. State Tax/Stamps: Revenue Stamos 1.329.00; Mortaaoe 1.329.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survev to
1302. Pest Inspection to
1303. 2006-07 School Taxes to Bonnie K. Miller 1,033.17
1304.
1305. Inheritance Tax Escrow to Keystone land Transfer L 9,000.00
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103. Section J and 502, Section K) .... 4.346.71 19,488.17
By signingllage ~ of thill statement, the signatories acknOlMedge receipt of a completed copy of page 2 of this two page slalemu .t?tiU..1 D, ( tt
Ke stone Land Trans'fef. Ltd.
y
Settlement Agent
Certified to be a true copy.
( 06409 I 06409 I 25 )
OMB NO 2502 0265 ~
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A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.OF~HA 3. DCONV. UN INS. 4. OVA 5. ~CONV. INS.
6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT 06409 40631578 FINAL
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This fonn is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3196 (06409106409/24)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Philip A. Palese and Daria N. Peters aka Daria M. Mortgage IT, Inc.
Maureen A. Palese Peters, Executrix of the 33 Maiden Lane, 6th Floor
1856 Holly Drive Estate of Anna P. Peters New York, NY 10038
Camp Hill, PA 17011
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1878915 I. SETTLEMENT DATE:
1854 Holly Drive Keystone Land Transfer, Ltd.
Camp Hill, PA 17011 July 31, 2006
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
3421 Market Street
Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 132,900.00 401. Contract Sales Price 132,900.00
102. Personal Properly 402. Personal ProDertv .
103. Settlement Charges to Borrower (Line 1400) 4,346.71 403.
104. 404.
105. 405.
Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seifer in advance
106. CltvlTown Taxes to 406. CitvlTown Taxes to
107. County Taxes 07/31/06 to 01/01/07 197.19 407. CouritiTaxes 07/31/06 to 01/01/07 197.19
108. School Tax 07/31/06 to 07/01/07 948.25 408. School Tax 07/31/06 to 07/01/07 948.25
109. SewerlTrash 07/31/06 to 10/01/06 57.62 409. SewerlTrash 07/31/06 to 10/01/06 57.62
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 138,449.77 420. GROSS AMOUNT DUE TO SELLER 134,103.06
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest monev 1,000.00 501. Excess DepositCSee Instructions)
202. Principal Amount of New Loan(s) 132,900.00 502. Settlement Charaes to Seller (Line 1400) 19,488.17
203. Existina loan(s) taken subiect to 503. Existing 10ariCS)taken subiect to
204. 504. Payoff of first Mortgage
205. 505. Pavoff of second Mortaaae
206. 506.
207. 507. lDeoosit disb. as Droceeds)
208. 508.
209. 509.
Adiustments For Items Unoaid Bv Seller Adjustments For Items Unoaid Bv Seifer
210. CltvlTown Taxes to 510. CitvlTown Taxes to
211. County Taxes to 511. CountvTaxes to
212. School Tax to 512. School Tax to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219'. 519.
220. TOTAL PAID BYIFOR BORROWER 133,900.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 19,488.17
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower (Line 120) 138,449.77 601. Gross Amount Due To Seller (Line 420) 134,103.06
302. Less Amount Paid By/For Borrower (Line 220) ( 133,900.00 602. Less Reductions Due Seller (Line 520) ( 19,488.17
303. CASH ( X FROM) ( TO) BORROWER 4,549.77 603. CASH ( X TO) ( FROM) SELLER 114,614.89
The undersigned hereby acknowledge receipt of a co ed copy of pages 1 &2 of this statement & any attachments referred to herein.
Borrow<< tJ?.#j. /~ Sell~
Philip A. I~~e ,/').'
,<j)',&~l)iil/U2 {:"i'..,--..(-t(7'O~{{:2~..
Maureen A. Palese
Daria N. Peters aka DarIa M. Peters, Executrix of the
B~f:) t2.. ~ L~
A~~\'\\~ ~~~~
Estate of Anna P. Peters
~
REV-l'" EX. (_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
leNIDULI .
STOCKS & BONDS
ESTATE OF
Anna P Peters
FILE NUMBER
2005-1008
All property joInt1y-owned with right of survivorship must be disclosed on Schedule F.
2
DESCRIPTION
RVS cash managemt fund IDSXX Ameiprise Financical acct. number 0011379439877002
RVS Divsfd equity income fund INDZX Ameriprise Financial acct. number 0010105931520002
RVS Div opportunity fund INUTX Ameriprise Financial acct. number 0010105931538002
RVS Diverse bond fund INBNX Ameriprise Financial acct. number 0011279439878002
RVS High yield bond fund INEAX Ameriprise Financial acct. number 0012579439873002
VALUE AT DATE
OF DEATH
N~!R
1.
5
10,087.77
8,649.40
5,960.18
27,713.62
33,477.18
3
4
TOTAL (Also enter on line 2, Recapitulation) .
(If more space is needed. insert additional sheets of the same size)
85,888.15
Ii
'.
, ,,: ..... -' Uncia Meissner
~. '. ~:o'~"." 11111flOO5 05:04 PM
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To:
John A
BenkovichlFtekllWHlAEFA@AMEX
cc:
Subject: 17820793 2 001
ANNA P PETERS - DEATH
SETTlEMENT REQUIREMENTS -
PLEASE DO NOT DELETE
IDS Life Insurance Company
RiverSource Funds
Amer~ ~.... Company
Ameriprlse Brokerage
70100 AmeripriIte FinIInciaI Center
Minneapol1s, .. 55474
November 11~ 2005
JOHN A BENKOVICH JR
AMERIPRISE FINANCIAL SERVICES
4661 TRlNDLE RD
CAMP HILL. PA 1701 ]-5603
Dear JOHN A BENKOVICH JR:
Thank you for your recent inquiry regarding ANNA P PETERS's accounts. These are the values of the acco\DltS as
of 11/0312005. At the end of1his letter" you will find a list of beneficiaries shown in our initial review oftbe
deceased's accounts. Please provide our office with any contact information you may have, including but not limited
to complete names, addresses, telepbone numbers and Rlationships to the deceased for any beneficiary or claimant
identified on the deceased's accounts.
IMPORTANT REMINDER:
In accordance wi1h various regulatory agencies, A......jJII de Financial Services wJ1l continue 10 mail
monthly/quarterly stateaaents for the deceased to the deceased's address of record. The only individual(s) granted
authorization to change the address of the deceased and thus, redirect the mailing address of the .~ts, is the
Executor(s) of the EsIate of the deceased
Account Information
Mutual Funds
Account Number
OJ 0] 0593152 0 002
0)0]05931538002
011279439878002
011379439877002
01257943987 3 002
OwnershiD
Individual
Individual
Individual
Individual
Individual
Annuities - Post 1985
Account Number
93006207623 5 004
93006873419) 004
OwnershiD
Individual
Individual
-.
Mutual Funds
Account Number
010105931520002
010105931538002
011279439878002
011379439877002
012579439873 002
Annuities - Post 1985
Account Number
93006207623 5 004
93006873419 ] 004
Total Value
$8649.4
$5960.18
$27713.62
$10087.77
S334n.18
# of shares
720.783
808.708
5.818.304
10,081.450
11.731.539
Asset Value Per Share
12.000
7.370
4.760
1.00
2.850
Total Value
$20491.21
$23666.89
\0 ~
. .A. · \.. 9-
ee~,\.(..Ao..~\e'.:. ~ o-"aWl\ L. ~\"o\""\~~\ SO 0
W ...l.l..\ l\yV\. G. ~e'"\E"r"::. so<?" ''"
The date of death values provided are for estate tax purposes and are not values to be paid. Accounts may be subject
to market fluctuation as governed by each product. Please note that the values indicated for.any Life Insurance
product(s) reflect the gross death benefit at date of death, not the cash value. Values for any proprietary mutual
funds include accrued dividends as applicable.
Account Disposition
Account disposition is based on how an account is owned (the ownership type). The fonowing infonnation will help
you understand the process that will be used to settle the accounts.
Disposition for Individual ownership
Upon the death of the owner. all mutual fund, certificate. brokerage. and annuity accounts issued before Janumy 19,
1985 and life insurance accounts registered in individual ownership become part of the estate for distribution. If
there is a contingent owner named on a life insurance or ammity account ownership passes directIy to the contingent
owner.
Disposition for Individual ownership
The deceased was the annuitant 00 at least one annuity account previously listed. Upon the death of the annuitant,
account proceeds typically pass to the beneficiaries named at the time of death. If no beneficiary was designated the
proceeds become part of the estate for distribution. DEFERRED ANNUITY NOTICE: The beneficiary(s) has the
option of taking the annuity death benefit either as a full distribution or lDlder an annuity payment plan. If the
beneficiary(s) wishes to elect an annuity payment plan, we must receive written notice of this election within 60 days
of our receipt of due proof of death. Due proof of death is considered to mean our receipt of a certified copy of the
death certificate, a completed death claim statement, and any other required claim documents. Ifthere are multiple
beneficiaries, the 60 day window for electing an annuity payment plan begins for ALL beneficiaries on the date we
receive complete requirements from the first claimant.
Required Documents
In order to take appropriate steps to settle the accounts we will need these documents:
Certified Death Certif'lCBte
(For accounts: 010105931520002, 010105931538002,01127943987 8 002, 011379439877002, 01257943987 3
002, 93006207623 5004. 93006873419 1 004)
..
......,... EX- (1)<IlI) ..
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX REl1JRN
RESIDENT DECEDENT
SCHIDUU I
CASH, BANK DEPOSITS, & MISC.
PERSONAl. PIlQIPBI T
I:STATE OF
Anna P Peters
FI.E NUEER
2005-1008
IrdJde the proceeds d IIigation and the date the proceeds were I8C8ived by the estate.
All pmperty joInIIy-owned willi right of survivorship RIst be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
10,270.78
42.00
6,596.00
115.00
1. M & T Bank 8CCOlI1t number 42715261 checking account balance 11..Q3..05
2. cash
3. prepaid funenII expenses MusseImaIIS Funeral Home
4. rings (2) a. 75.00 b. 40.00
5. sale of 1992 Chevrolet Lumina 11-1&-05
6. sale of chest of drawers 12.()5.()5
2,000.00
100.00
300.00
101.00
906.00
150.00
910.80
76.00
174.07
7. sale ofwasher' & dryer 12.()5.()5
8. Erie Insuranat reIi.nI of auto insurance 12..()5.()5
9. Internal Reveooe Service reftIId of income taxes 05-24-06
10. Cordier Antiques sale of oomic books & cIsh 05-24-06
11. Cordier Antiques auction sale of contents of home 06-21-06
12. Erie Insurance refund of homeowners i1surance 08-1D-06
13. UGI refund of gas 08-25-06
-r rc''''
TOTAL (Also enter on line 5, Recapitulation) ,J c.
(If more space is needed. insert additional sheID of the same size) .. r. 'f
21,741.65
ACCOUNT. NO...
. ..... .AttouIrt.TYPE.:
w~~-m M8ff'Bank
lt2715261 RELATicltSHip CHECK_ WITH INTEREST
OCT;21~NOV;18;21.S
1 OF 2
OD
o 06ii3ft"" 117
115
ANNA PETERS
1852 HObbV DR
CAMP MILL PA 17011
IM'rERES'f PAD. -YEAR lO~DATE
.. 3-~82 .
. .HIGHlAND PARK... ._~
.:lIift~~ >piO
3,709.27
1.66
1,109.97
ACCOUNT
::..DALY:
.. :8AL.AM:E:. ...
.:. .tbltsAtotm.t:oacUPTmli':.:
10-20-IS BEGINNING BALANCE
10-25-0S AMERIPRISE FINe AMP PAYOUT
10-31-0 PP ELEC BILL
10-31-0S CHECK NUMBER 1354
11 ~ 01;: 0 US TREASURY 312 CIVIL SEW
11-03-0 US TREASURY 303 sot SEe
11-04-0 VERIZCIH ~tREC
11-04- CHECK ....ER 1355
11-07- CHECK NUMBER 1356
ii~i7;:i CHECK""':R 1357
11-18-0S INTEREST PAYMENT
6,010.10
$3,709.27
9,709.27
19.87
11.7S
9,677."
10,,031.78
QO,270.~
3M;13
239.10
29.37
12.18
1,120;00
8;111.1'
10,229.31
9,109.31
i,i09;3i
1,109.97
0.66
ENDING BALAlltE
$1,109.91
.... .:, .:.eitEQ(s ,PAm'StIIt.\RY.:.
I
1354
i3.57
10-31-05
ll-i'i-IS
11.7S
a,110.80
im
.. .
11-04-0S
12.10
1356
11-07-0S
1;120.00
AIiltUAI: PERCENTAGE YIEI:D E....ED = . ill 1.
..
CORDIER
ANTIQ1}ES
& fine art
GALLERY
2151 Mmket StfWI
Camp HiJ/, PA 17011
(717) 731-8662
(717) 731-9830 Fax
l.VlVUI.cordierantiqlles.com
APPRAISAL SERVICES
INTERNET SALES
ESTATE LIQUIDATIONS
Estate of Anna Peters Final Report
Income
Auction
Auction (6/21/06)
Gross
Commission (4001'0)
Net Due Consignor
$ 1..518.00
$ 607.20
Settlement
TOTAL DUE CONSIGNOR
Check #2031
$ 910.80
$ 910.80
REV-1510EX+(&-98) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHIDUU .
INTER-VIVOS TRANSfERS &
MISe. NON-fIROBA1E PROPERlY
ESTATE OF FLE NWBER
Anna P Peters 2005-1008
This schedule DUSt be completed and filed if the afl$W8I' to any of questions 1 ~ 4 on Ile reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRPnON OF PROPERTY DAle OF DEATH "OF DECD'S EXClUSION TAXABlE
INCl.UIlE DE !WE OF DE TRMSFEI&. 1ItEIR IlElA11llNMP 10 DECBlEIfl' HID
NUMBS DE lWEOFlIWlSfBl ATTACHArxl'fOFDE I&D FmIl9lESllUE VALUE OF ASSET NTEREST VALUE
1. FIXed retirement annuity VP Ameriprise FIIlan. acct. no. 0930062076235004 20,491.21 100 20,491.21
beneficialies graiddlldren WHam G Peters 50% & RoJCann L AIqht 50%
2. FIXed anfU1ity rale ~ 3 Ameriprise Filan. acct. no. 0930068734191004 23,666.89 100 23,666.89
beneficBies gralldchadren WiIam G Peters 50% & Roxann L Albright 50%
TOTAL (Also enter on Ine 7 Recapilulation) $ 44,158.10
(If mont spa IS needed.1nseIt adIon8I sbIeIs db.... size)
~ .
REV-1511 ex. (lUll).
COMMONWEAlTH OF PEJlH;VLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
&eHEDULI H
RJNERAL EXPENSES &
ADMNSTRA1IYE COS1S
ESTATE OF
Anna P Peters
RLE .-ER
200~ 1008
Debts of decedent must be reported on ScIIeduIe L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
MusseImans Funeral Home
Roling Green Cemetery
Weis Market food flIIeraIluncheon
Giant food funeralloocheon
6,596.00
1,120.00
21.57
149.28
2.
3.
4.
B.
1.
ADMINISTRATIVE COSTS:
Personal RepI_.Ildi....s Co....w...s
4,000.00
Name of Personal ReprWlSel\tallt'8(s) Darta N Peters AKA Daria M Peters
Social SeaIly tUm(s)lElf tUnber tl Personal ~_.w.8(s)
StnletAddress
City Camp Hill SIaIe PA ZIp 17011
Y.-(s) CommIssion PaId: 2006
2. A1IDmey Fees
3. Family ExempIion: (If decedenl's address Is not the SlIII8IS cI8lrn8nI's, aIt8ch .........)
CIairraIt
SlnIet Address
City
ReIalIonsHp tl CIainenI to Decedent
Stale
. ZIp
4. Prob8Ie Fees
5. AalomIlri's Fees
6. Tax ReII.m PnlpInr's Fees
7. settlement costs sale of property 1854 Holly Dr. Camp... Pa. 17011
8. James J. Miler pI9pare income taxes
9. Bonnie K Miler treasurer UMer Allen Twp property taxes
10. Erie Insurance homeowners insunmce
lOTAL (Also enter on lne 9, Recapitulation)
(" more space is needed, insert addlIIon81 sheets of the same size)
10.488.17
140.00
467.36
192.00
256.50
1,420.68
$ 24,851.56
11. Lower Alan Township sewer & trash
12. total from page 2
SCHEDULE H
REV - 1511
Page 2
Line 12
Estate of Anna P Peters
file number 2005-1008
a. Verizon phone 77.08
b. Bret Adams lawn service 2006 440.00
c. PPl electric 148.70
d. Weis market& US post office stamps & envelopes 20.97
e. PAWC water 121.51
f. UGI gas 404.42
g. Roxann Albright cleaning house & packing 200.00
contents of house for auction
h. register of wills short certificates 8.00
TOTAL 1,420.68
.'. ~ .~-i.
. ":'~';W
Musselman
Funeral Home
& Cremation
Services, Inc.
Established 1895
Brian C. Musselman, F.D.
SUpervisor
William G. Pagan, F.D.
p.o. Box 137
324 Hummel Avenue
Lemoyne. PA 17043-0137
(717) 763-7440
Fax: 717-730-9798
www.musselmanfuneral.com
To Funeral Expenses of ANNA PETERS (Date ofdeath,Nov.3,2005)
2005
November 8
PROF.SERVICES,FACILITIES,AUTOS
"Provincial" Poplar casket
Cash Advance Items:
Flowers.
Copies of death certificate
Newspaper death notices
Minister'S gratuityx
Organist bench fee
TOTAL
$3,995.00
2,175.00
$6,170.00
$159.00
60.00
132.00
75.00
75.00
$426.00
$6,596.00
,
(These expenses paid in full,per pre-need account 11/23/05)
....' ?
by: &~4~~\
Brian C. Musselman,F.D.
fOR APPOINTMENT PHONE 717-763-7440
James J. Miller
Income Tax Service
105 Old Mill Drive
Camp Hill, PA 17011
(717) 761-5650
April 13, 2006
Daria M. Peters
1852 Holly Drive.
Camp Hill, PA 17011
Dear Ms. Peters,
This is your bill, which is paid in full, for services rendered in the preparation of the
2005 tax returns of Anna P. Peters. An itemization follows:
1040
Sch. B
Sch. D
Sch.R
1310
PA40
sp
U.s. Individual Income Tax Return
Dividends
Capital Gains & Losses
Credit For The Elderly
Claim For Decedent's Refund
State Individual Income Tax Return
State Tax Forgiveness
75.00
20.00
20.00
N/C
N/C
15.00
10.00
Total
140.00
Should you need assistance with estate income tax or any other matter, please feel to
call me at any time. I appreciate you business.
Very truly yours,
James J. Miller
sc:
Control No: 013 - 001098
Assessed Laud
Values 25 000
OF ~A' J....AIm
.00219700
54 . 93
.00018000
4.50
ALLEN
.00140000
35.00
.00050000
12.50
1.00
TAXPAYER COPY Bill No: 3881
2006 ~ .~ of ReId EsIIItIla T_ Bill Date: 3I0112OC
IIIIp..:: u...........t Mineral Total
81 490 0 106 490
DIIcaunI F8ce
.00219700 2' 10
179.03 229.28 233.96 257.3
.00018000 2' 10
14.67 18.79 19.17 21.0
.00140000 2' 10
114.09 146.11 149.09 164.0
.00050000 2' 10
40.75 52.18 53.25 58.5
21.00 21.0
~ TAXES ABE ESCROWED, FORWARD THIS BILL TO YOUR
JRTGAGE COMPANY.
fABlE
0:
~
fER
PETERS. ANNA P
1854 HOLLY DRIVE
CAMP HILL PA 17011
TAX AMOUNT DUE->
=ICE MON. ruES & THURS 9-4 OR BY APPT
JRS: CLOSED WEDNESDAYS, FRIDAYS &
HOLIDAYS
PHONE (717) 975-7575 EXT 1701
11J3011OOf
- SEE REVERSE SIDE OF BIll. FOR A BREAKDOWN OF YOUR COUNTY TAX DOLLARS.
Return Bill witt Payment For a Receipt , Enclose Self Addnl S 9 e rf SIamped Envelope.
_1512EX'(_ ..
CONttDMEALTH OF PEMISYlVNM
Nt8IlMCE TAX RE11R4
RESIJENT DECEDENT
SCHIDUU I
DEBTS OF DECEDENT,
MOIOGAGE UA8IlIIIES, & LENS
ESTATE OF FILE .-eR
Anna P Peters 2005-1008
Report..... incwred by tile decedent prior to.... whIcb ......... .....11I . ~ tile elite of deIIh, including UMtImbIned mecIcII.......
ITEM VAlUE AT DATE
NUMBER DESCRPTION OF DEATH
1.
Messiah VIage
( paid 12-28-05 )
( lawn service Paid 11-18-05 )
( paid 01-18-06 )
480.78
60.00
1.81
2.
Brat Adams
3.
Alert phamac.y
TOTAL (Also enter on Ine 10. RecapiIuIation) $
(If more space is needed. insert addilionaI sheets of the same size)
542.59
...
.
RElJ..1513 EX+ (9-00)
.
leNIDULI J
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESDENT DECEDENT
ESTATE OF
Anna P Peters
FILE NUMBER
2005-1008
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(l)
I TAXABLE DISTRIBUTIONS [InClude ou1rIght spousal dIsIrIbutions. and transfers under
Sec. 9116 (a) (1.2)]
1. WiUiam G Peters PO box 1142, Keystone Heights FL 32656 grandson
AMOUNT OR SHARE
OF ESTATE
161,626.36
2. Roxann L Albright 206 McCoI1de Rd Hershey PA 17033 granddaughter
38,011.47
3. Robert G Peters 1777 Newport Ave Northhampton PA 18067 grandson
15,932.42
4. Annmarie Peters 1777 Newport Ave Northhampton PA 18067 granddaughter
15,932.42
5. Daria N Peters AKA Daria M Peters 1852 Holly Dr Camp Hill PA 17011 daughter-in law
15,932.42
ENTER DOlLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV-1500 COVER SHEET
n 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 $
(If more space is needed, insert additional sheets of the same size)
EXPLANA nON
SCHEDULE J
REV - 1513
~ ~ \\.0- Q ?~rS
r\Le No. ")..oC\S- \ OO~
line 1. William G Peters proceeds from sale of home 1854 Holly Dr, Camp Hill, 161,626.36
Pa. 17011...123,614.89 + proceeds from schedule G REV - 1510 TOD
beneficiary 22,079.05 + balance of residue estate 200.10 after taxes
15,932.42
line 2. Roxann L Albright proceeds from schedule G REV - 1510 TOD 38,011.47
beneficiary 22,079.05 + balance of residue estate 20% after taxes
15,932.42
line 3. Robert G Peters proceeds from residue estate 20% after taxes 15,932.42 15,932.42
line 4. Annmarie Peters proceeds from residue estate 20% after taxes 15,932.42 15,932.42
line 5. DarIa N Peters AKA DarIa M Peters proceeds from residue estate 200.10 15,932.42
after taxes 15,932.42
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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
PETERS DARLA N
1852 HOLLY DRIVE
CAMP HILL, PA 17011
__uun fold
ESTATE INFORMATION: SSN: 171-28-5886
FILE NUMBER: 2105-1008
DECEDENT NAME: PETERS MRS ANNA P
DATE OF PAYMENT: 11/01/2006
POSTMARK DATE: 1 0/31 /2006
COUNTY: CUMBERLAND
DATE OF DEATH: 11/03/2005
NO. CD 007381
ACN
ASSESSM ENT
CONTROL
NUMBER
AMOUNT
101 I $11,858.65
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$11,858.65
REMARKS:
CHECK# 142
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS