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HomeMy WebLinkAbout11-07-06 " REV-1500 .EX + (6-00) *' w ,... >::$(1) 00::>:: wQ.o ",00 uO::-' Q.<ll Q. <( OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER II 2006 COUNTY CODE YEAR SOCIAL SECURITY NUMBER I- Z W o w () w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Naylor, Barbara S DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 08-12-2006 06-02-1923 (IF APPLICABLE) SURVNING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) Naylor, Edward N. [!] 1. Original Return o 4. Limited Estate 06. 09 Decedent Died Testate (Attach copy of Will) Litigation Proceeds Received o 2. Supplemental Return o 4a. 07. o Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust (Attach copy of Trust) 10 Spousal Poverty Credit (date of death between . 12-31-91 and 1-1-95) 0741 NUMBER 201-16-1971 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 177 -16-1908 o 3. Remainder Return (date of death prior to 12-13-82) . 0 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Mach Sch O) I- :z w o :z o Q. (I) w 0:: 0:: o o NAME William R. Bunt, Esq. FIRM NAME (If applicable) Law Office of William R. Bunt TELEPHONE NUMBER 717 -582-8195 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o i= :5 ::> l- ii: <( () W 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Sche,dule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 0 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) COMPLETE MAILING ADDRESS 109 South Carlisle Street POB 336 New Bloomfield, PA 17068 (1 ) None OFFIC!AL USE ONLY 1'".' (2) ,--, c:;) None ~ ,:;:::~ ".I c...' I u_ -) (3) None (4) None --l (5) 153,607.07 (6) None (7) None (8) 153,607.07 (9) 17,653.82 (10) None (11) 17,653.82 135,953.25 (12) (13) 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) None (14) 135,953.25 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 0.00 0.00 0.00 0.00 20.0 . RE REQUESTING A REFUND OF AN OVERPAYMENT. 15. Amount of Line 14 taxable at the spousal tax rate, 135,953.25 x .00 (15) or transfers under Sec. 9116(03)(1.2) z 0 0.00 .045 (16) i= 16.Amount of Line 14 taxable at lineal rate x ~ :J (17) a. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 == 0 (.) 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) x ~ 19. Tax Due (19) Copyright 2002 form software only The Lac:kner Group, Inc. Form REV-1500 EX (Rev. 6-00: e I) 1r Decedent's Complete Address: STREET ADDRESS 884 Oak Oval CITY Mechanicsburg I STATE PA !ZIP 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 ) 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPA YMENT. 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 A. Enter the interest on the tax due. S. Enter the total of Line 5 + SA. This is theBALANCE DUE (3) (4) (5) 0.00 (SA) (58) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "XU 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?.............................._..........................................................--.................... 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Steven C Dal~ ~ R~ T7t--= ~C_}Jo-' ~C:>~~ 'SIGNATURE OF PERSON RESPON FOR FILING RETURN N~~ESS No ~ ~ ~ ~ o ~ DATE 622 Elliott Drive Lewisberry, PA 17339 / C/:J-7/(J <c 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. 39116 (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. 39116 (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. 39116 (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. 39116 1.2) [72 P.S. 39116 (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. 39116 (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. ADDRESS 109 South Carlisle Street P.O. Box 336 New Bloomfield, PA 17068 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIV William R. Bunt, Esq. " WilLIAM R. BUNT CHRYSTAL l. PROSSER ATTORNEYS AT lAW 109 S. Carlisle Street New Bloomfield, Po. 17068 Tel (717) 582-8195 FAX (717) 582-7521 LAST WILL AND TESTAMENT OF BARBARA S. NAYLOR :--..:: C:~'..1 C::.J . \ .:;.;........ i '-: . J =2:: . ~;-~.~~ I, BARBARA S, NAYLOR, of Upper Allen Township, Cumberland County, P~l:lnsylv~m?, ._ 1,.;.-.: ~,~ --~ ~: ;=S being of sound mind, memory and understanding, do hereby declare this to be 'my LastWitlq:nH . -.' ---., J:!.;~ ..' ::=;:--~ Testament, revoking all former wills or writings in the nature thereof an_d _~-,-ny: cod!-~ils t~_$.r~~ ""1 ,w .- made, G.) - "-..-/ --j-I FIRST: I direct my hereinafter named Executor or alternate Executor, as the case may be, to pay all of my just debts, funeral expenses, costs of administration and inheritance taxes out of the corpus of my estate as soon after my decease as is practicable to do so, SECOND: I give, bequeath and devise all of my estate, real, personal and mixed and wheresoever situate, unto my husband, Edward N, Naylor. THIRD: In the event that my husband, Edward N. Naylor, predeceases my decease, then and in that event, I give and bequeath the following: A. I give and bequeath my mahogany canopy bed set (including the canopy bed, two night tables, a chest of drawers and a dresser with a mirror) unto my niece, Diane Gutshall. In the event that my niece, Diane Gutshall, predecease my decease, then and in that event, I direct that said bequest shall lapse and become part of my residuary estate. B. I give and bequeath my milk glass collection to my great niece, Patricia Kissinger. In the event that my great niece, Patricia Kissinger, predeceases my decease, then and in that event, I give and bequeath said milk glass collection unto my friend. Martha Robinson. c. I give and bequeath my grandfather clock unto my nephew, Steven C. Daly. Page 1 of 11 Pages .. WILLIAM R. BUNT HRYSTAL L. PROSSER ATTORNEYS AT LAW 109 S. Carlisle Street New Bloomfield. Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 In the event that my nephew, Steven C. Daly, predeceases my decease, then and in that event, I give and bequeath said grandfather clock unto my nephew's wife, Delores A. Daly. FOURTH: In the event that my husband, Edward N. Naylor, predeceases my decease, then and in that event, I give, bequeath and devise all of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate, as follows: A. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto the Salvation Army, a religious and charitable organization with offices at 701 North Broad Street, Philadelphia, Pennsylvania 19123 to be used within the Commonwealth of Pennsylvania for the purpose of feeding the hungry. I specifically direct that said five (5%) percent of my residuary shall be calculated from the net value of my estate after the payment all of my just debts, funeral expenses, costs of administration and inheritance and estate taxes. B. I give, bequeath and devise ten percent (10%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my nephew, Steven C. Daly. In the event that my nephew, Steven C. Daly, predeceases my decease, then and in that event, I give, bequeath and devise one-half of said share of my estate unto my nephew's wife, Delores A. Daly, and one-half of said share of my estate unto my nephew, James Barrick. C. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my nephew's wife, Delores A. Daly. In the event that my nephew's wife, Delores A. Daly, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto my nephew, Steven C. Daly. Page 2 of 11 Pages ), WilLIAM R. BUNT HRYSTAl L. PROSSER ATTORNEYS AT LAW 109 S. Carlisle Street New Bloomfield. Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 D. I give, bequeath and devise five percent (5%) of my estate, real, personal and mixed and wheresoever situate unto my great nephew, Matthew Daly. In the event that my great nephew, Matthew Daly, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. E. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my great niece, Melissa Daly. In the event that my great niece, Melissa Daly, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. F. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my great nephew, Marc Barrick. In the event that my great nephew, Marc Barrick, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto my nephew, Steven C.Daly. G. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my friend, Jan Steele Hammaker. In the event that my friend, Jan Steele Hammaker, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. H. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my friend, Lori Nast. In the event that my friend, Lori Nast, predeceases my decease, then and Page 3 of 11 Pages It WilLIAM R. BUNT HRYSTAl L. PROSSER ATTORNEYS AT lAW 109 S. Carlisle Street New Bloomfield. Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 in that event, I give, bequeath and devise said share of my estate unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. I. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my sister-in-law, Marguerite Henderson. In the event that my sister-in-law, Marguerite Henderson, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. J. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my brother-in- law, Raymond Naylor. In the event that my brother-in-law, Raymond Naylor, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. K. I give, bequeath and devise seven percent (7%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my niece, Dorothy Holley. In the event that my niece, Dorothy Holley, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto Ruth Ann Wright, Barbara Jean Fry and Patricia Kissinger, or the survivors thereof, in equal shares, share and share alike. L. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my niece, Ruth Ann Wright. In the event that my niece, Ruth Ann Wright, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto Dorothy Holley, Barbara Jean Fry and Patricia Kissinger, or the survivors thereof, in equal shares, share and Page 4 of 11 Pages ;. WILLIAM R. BUNT HRYSTAL L PROSSER ATIORNEYS AT LAW 109 S. Corlisle Street New Bloomfield, Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 share alike. M. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto niece, Barbara Jean Fry. In the event that my niece, Barbara Jean Fry, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto Dorothy Holley, Ruth Ann Wright and Patricia Kissinger, or the survivors thereof, in equal shares, share and share alike. N. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my great niece, Patricia Kissinger. In the event that my great niece, Patricia Kissinger, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto her husband, Gregory Kissinger. O. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my niece, Dixie Steigleman. In the event that my niece, Dixie Steigleman, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. P. I give, bequeath and devise three percent (3%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto my niece, Diane Gutshall. In the event that my niece, Diane Gutshall, predeceases my decease, then and in that event, I give, bequeath and devise said share of my estate unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. Q. I give, bequeath and devise five percent (5%) of the rest, residue and Page 5 of 11 Pages 'Jo WilLIAM R. BUNT HRYSTAl l. PROSSER ATTORNEYS AT LAW 109 S. Carlisle Street New Bloomfield. Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 remainder of my estate, real, personal and mixed and wheresoever situate unto Steven C. Daly, in trust, however, to act as trustee upon the following terms and conditions: 1. To create the Gavin Horting Trust. 2. To administer said trust in accordance with terms and conditions of trust enumerated below. 3. To pay the accumulated income and principal to the said Gavin Horting from said trust, on the twenty first (21 5t) birthday of said child. 4. In the event that the said Gavin Horting predeceases my decease or becomes deceased prior to the final distribution of said child's trust share, then and in that event, my said trustee shall transfer the balance remaining in said trust unto the remaining beneficiaries named in this Paragraph FOURTH surviving my decease pro rata. 5. I name, constitute and appoint Matthew Daly, as the alternate trustee of the Gavin Horting Trust. R. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto Steven C. Daly, in trust, however, to act as trustee upon the following terms and conditions: 1. To create the Zachary Criswell Trust. 2. To administer said trust in accordance with terms and conditions of trust enumerated below. 3. To pay the accumulated income and principal to the said Zachary Criswell from said trust, on the twenty first (21 5t) birthday of said child. 4. In the event that the said Zachary Criswell predeceases my decease or becomes deceased prior to the final distribution of said child's trust share, then and in that event, my said trustee shall transfer the balance remaining in said trust unto the Joshua Criswell Trust to be administered in accordance with the My Last Will and Testament. 5. I name, constitute and appoint Matthew Daly, as the alternate trustee of the Zachary Criswell Trust. Page 6 of 11 Pages :> WilLIAM R. BUNT HRYSTAL L. PROSSER ATIORNEYS AT LAW 109 S. Carlisle Street New Bloomfield, Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 S. I give, bequeath and devise five percent (5%) of the rest, residue and remainder of my estate, real, personal and mixed and wheresoever situate unto Steven C. Daly, in trust, however, to act as trustee upon the following terms and conditions: 1. To create the Joshua Criswell Trust. 2. To administer said trust in accordance with terms and conditions of trust enumerated below. 3. To pay the accumulated income and principal to the said Joshua Criswell from said trust, on the twenty first (21st) birthday of said child. 4. In the event that the said Joshua Criswell predeceases my decease or becomes deceased prior to the final distribution of said child's trust share, then and in that event, my said trustee shall transfer the balance remaining in said trust unto the Zachary Criswell Trust to be administered in accordance with this My Last Will and Testament. 5. I name, constitute and appoint Matthew Daly, as the alternate trustee of the Joshua Criswell Trust. FIFTH: I direct that any trust created pursuant to this My Last Will and Testament be administered upon the following terms and conditions: A. To pay said beneficiary out of each beneficiary's respective trust, the income and so much of the principal, as may, in the sole discretion of my trustee, be necessary for the maintenance, support, medical expenses, and college education of said beneficiary. B. The payments authorized in subparagraph A of this Paragraph FIFTH, shall be made without regard to the equality of distribution between said beneficiaries. The amount to be paid for the benefit of said beneficiary shall be determined from time to time by the need of said beneficiary, and the amounts and times of said payments shall be determined by such need. The said payments may be made by my said trustee directly to said beneficiary as may be, in the sole opinion of my trustee, of such age, and ability to handle properly the funds so paid to such beneficiary, or may be made by my said trustee directly to the person having the custody and care of the said beneficiary, or may be made by my said trustee directly to any Page 7 of 11 Pages ) WilLIAM R. BUNT HRYSTAL L. PROSSER ATTORNEYS AT lAW 109 S. Carlisle Street New Bloomfield. Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 institution entitled to such payment by reason of services rendered or to be rendered to the said beneficiary. In making the aforesaid payments, my said trustee shall give primary consideration to the individual needs of said beneficiary and to other sources of income available to said beneficiary, and the individual needs of said beneficiary shall override any consideration as to any equality of distribution for the purposes mentioned in this subparagraph. SIXTH: I direct that no trustee, executor, guardian, or other fiduciary named, nominated, or appointed in this, my Last Will and Testament, shall be required to post any bond or give any security of any type for any purpose whatsoever, any law or rule of court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. SEVENTH: My personal representative and trustee shall have the following powers in addition to those vested in them by law and by other provisions of this Will, applicable to all property, real, personal and mixed and wheresoever situate, including property held for minors, whether principal or income, exercisable without court approval, and effective, with respect to each item of said property, until actual distribution thereof. A. To retain, as investments of my estate or trust, any or all assets of my estate, real, personal, or mixed, without regard to any principal of diversification, and to purchase and acquire real or personal property, and to hold any or all such real and personal property retained or acquired without making the same productive of income. B. To permit a beneficiary, or any of them, to occupy any real estate retained or acquired upon such terms and conditions as my trustee shall deem proper. C. To pay all taxes, charges, and expenses of maintenance, upkeep, improvement, development, protection, preservation and investment of any retained or acquired real or personal property, such payments to be made from either principal or income as my said trustee shall determine. D. To retain or invest any and all funds, whether principal or income, in any real or personal property without restriction to legal investments; to purchase investments at premiums; to exercise all rights of a security holder or shareholder in any corporation; and to Page 8 of 11 Pages ~ WilLIAM R. BUNT HRYSTAl L. PROSSER ATTORNEYS AT lAW 109 S. Carlisle Street New Bloomfield. Po. 17068 Tel (717) 582-8195 FAX (717) 582-7521 lease, mortgage, pledge, give options upon or sell at public or private sale and without approval of any court and without any responsibility to the buyer or buyers to see to the application of the purchase price, any real or personal property, or portion or portions thereof, irrespective of the manner or the means by which the same was acquired by my said trustee. E. To make any payment or distribution herein provided for in cash, kind, or partly in cash and partly in kind, at valuations fixed by my trustees at the time of distribution. EIGHTH: Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to the said beneficiary, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge, or obligations of any beneficiary, and shall not be subject to any execution or attachment. NINTH: In the event that my husband, Edward N. Naylor, predeceases my decease, then and in that event, I direct that all of my fine jewelry be sold and the proceeds therefrom become part of my residuary estate to be distributed in accordance with this My Last Will and Testament. TENTH: Any person who shall have died within thirty (30) days of my death, or under such circumstances that the order of our deaths cannot be established by proof, shall be deemed to have predeceased me. ELEVENTH: I name, constitute and appoint my nephew, Steven C. Daly, as Executor of this my Last Will and Testament. In the event of the renunciation, death, resignation or inability of my nephew, Steven C. Daly, to act for any reason whatsoever, as the Executor of my estate, then and in that event, I name, constitute and appoint my brother-in-law, Raymond Naylor, as the alternate Executor of this my Last Will and Testament. My Executor or alternate Executor, as the case may be, are hereby excused from Page 9 of 11 Pages WilLIAM R. BUNT HRYSTAl l. PROSSER ATTORNEYS AT LAW 109 S, Carlisle Street New Bloomfield. Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 the posting of any bond or security notwithstanding any provisions of the law to the contrary. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this 28th day of June, 2006. N' - j A~~ ~:;~f'vl"':';;~3:::c:-v'1fL f~J__~~~4L-{,-- (SEAL) v Signed, sealed, published and declared by the above named Testatrix, as and for her Last Will and Testament, in our presence, who, in her presence, at her request and in the presence of each other, have hereunto set our names as attesting witnesses. ~V\/~h 1/ -- (I~~d~ Page 10 of 11 Pages WIlLIAM R. BUNT 'iRYSTAL L. PROSSER ATTORNEYS AT LAW 109 S. Carlisle Street New Bloomfield. Po. 17068 Tel. (717) 582-8195 FAX (717) 582-7521 ACKNOWLEDGMENT AND AFFIDAVIT Commonwealth of Pennsylvania SS County of Perry We, Barbara S. Naylor, the Testatrix in, and Chrystal L. Prosser, Esquire, and ..::?!7/'!. ~':i?0... ...l3. !t?~". (/l......... ... .., ... ... ......, the witnesses to the Last Will and Testament of Barbara S. Naylor the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I, Barbara S. Naylor, the Testatrix do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. (b) that we, Chrystal L. Prosser, Esquire, and ..,5h.q~r.!J:.::...7j/g.'1:.~.~.l........ the witnesses, were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. /::5, ,< . /. " /J" 'c'), '" / ,/;/<'t./I-2""(.~ /'''> /{/{J:"---.,. //1"~---' Barbara S. Naylor, Testator d' iI . ~() {jv~ ,~ ChrYstal L. Prosser, Esquire, Witness 4i':::.e~~UdUU Witness Sworn to or affirmed and acknowledged before me this 28th day of June, 2006. ~D \\'\. :S~t,,\ IIIGB.A M. SMILEY. IIOTMrf!l!! 8t.OOMFIEl.D BORG.. PERIn' """"., IV COMMISSlOR EXPtRElS M 22._ Page 11 of 11 Pages , Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Naylor, Barbara S FILE NUMBER 21-2006-0741 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sutvivorship must be disclosed on schedule F. , ITEM NUMBER DESCRIPTION 1 Jewelry (see attached appraisal by Joseph A. Rosi) VALUE AT DATE OF DEATH 24.600.00 2 Messiah Village Apartment - refund of acquisition fee (see attached amortization schedule) 129.007.07 TOTAL (Also enter on Line 5, Recapitulation) 153.607.07 (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) rX~~. 4636 Jonestown Road Harrisburg, Pennsylvania 17109 Phone (717) 652-8477 . Fax (717) 652-9245 ",EMBER ~) Jewelers, Inc. 10/03/06 Joseph A. Rosi, Jr., CGA President Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 [gjC ~JL \'.' Dear Barbara Naylor: This appraisal is being issued by a Certified Gemologist Appraiser of the American Gem Society, an eli.te group of gelologically-trained professional jewelers who subscribe to a strict code of ethics. Great care has been taken to provide you with complete descriptions of your jewelery and accurate estimated ESTATE VALUE. Unless specifically stated, mounting are assumed to be mass produced rather than handmade, and in good repair. Most mountings will not permit us to examine and measure every detail, therefore the appraisal values are based only on estimated quality, weights and measurements of the items, unless otherwise stated. It should be understood by our appraisal clientele that an appraisal is not an all inclusive document, but, rather, that there are many specific types of appraisals suited for specific needs. To avoid misunderstanding, the enclosed appraisal is report number 001271. The total ESTATE VALUE for the jewelry listed is $24,600.00. sincei,71 L' i:~ ~W'kOSi, Jr., CGA Certified Gemologist Appraiser, American Gem Society ESTATE OF BARBARA NAYLOR APPt-U\rtJAC- -- - - --- ESTATE OF BARBARA NAYLUK AjJjJKI~I~AL Appraisal Number: 001271 Date: 10/03/06 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items List Ladies Diamond Engagement Ring Ladies 14K White Gold Diamond Solitare Engagement Ring containing one Round Brilliant CUt Diamond set in 4-prong 14K White Gold with a 14K White Gold Band. The Ring measures approximately 2.0 rom at shoulders and tapers to 1.6 rom at bottom of shank and weighs approximately 3.0 grams. GEMSTONE GRADING REPORT: Type........ ..... Diamond Shape.. .......... Round Brilliant Cut Size. . . . . . . . . . . . . .8.68-8.70 x 6.00 rom Weight....... .....2.83 carat Color...... ... ... .Near Colorless (I) Clarity...........Imperfect 1 ESTATE VALUE: 12,250.00 ... Appraisal continued on next page. Appraisal Number: 001271 Page: 2 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Diamond Engagement Ring Ladies 14K Yellow Gold Diamond Solitare Engagement Ring containing one Round Brilliant Cut Diamond set in 4-prong 14K White Gold Head with 14K Yellow Gold Band. The Ring measures approximately 2.2 rom at shoulders and tapers to 1.4 rom at bottom of shank and weighs approximately 2.4 grams. GEMSTONE GRADING REPORT: Type............. Diamond Shape............ Round Brilliant Cut Size..............7.49-7.52 x 4.00 rom Weight. ...........1.42 carat Color...... ...... . Faint Yellow (P) Clarity.. ....... ..VVS 2 ESTATE VALUE: 3.900.00 Appraisal continued on next page. Appraisal Number: 001271 Page: 3 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Diamond Tennis Bracelet Ladies 14K Yellow Gold Diamond "Line" Bracelet containing forty-eight(48) individual 4-prong links hinged with one Round Brilliant Cut Diamond set in each link. The Bracelet has a Box Catch with undercarriage safty and measures approximately 7 1/4 inches in length and weighs approximately 14.2 grams. GEMSTONE GRADING REPORT: Type............. Diamonds (42) Shape....... ..... Round Brilliant Cut Size. ........... ..48-3.0 rom each Weight............6.13 carat total Color. . . . . . . . . . . . . Faint Yellow (K) Clarity... ........SI 2 ESTATE VALUE: 4.200.00 .. Appraisal continued on next page. Appraisal Number: 001271 Page: 4 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Diamond "S" Bracelet Ladies 14K Yellow Gold "San Marco" Diamond Bracelet containing twenty-nine individual links with one Round Single Cut Diamond set in Bead prongs in each link. rhe Bracelet measures approximately 7 3/4 inches in length and weighs approximately 12.3 grams. GEMSTONE GRADING REPORT: Type............. Diamonds (29) Shape............ Round Single Cut Size. . . . . . . . . . . . . .29-1.7 rom each Weight............ .50 carat total Color. ........... . Faint Yellow (J) Clarity... ........Imperfect 2 ESTATE VALUE: 800.00 Appraisal continued on next page. Appraisal NumbeJ:::: 001271 Page: 5 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Diamond Pendent Ladies 14K Yellow Gold Diamond Solitare Pendent containing one Round Brilliant Cut Diamond set in 6-prong 14K Yellow Gold "Buttercup" Pendent with 14K Yellow Gold 6R Rope Chain measuring approximately nineteen (19) inches in length and weighing approximately 1.9 grams. GEMSTONE GRADING REPORT: Type............. Diamond Shape............ Round Brilliant Cut Size............. .5.65-5.75 x 3.20 nun Weight........ .... .75 carat Color...... .... ...Near colorless (I) Clarity...........Imperfect 1 ESTATE VALUE: 1. 075 .00 Appraisal continued on next page. Appraisal Number: 001271 Page: 6 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Blue Topaz Pendent Ladies 14K Yellow Gold Blue Topaz and Diamond Pendent containing one Oval Facated Swiss Blue Topaz set in 4-prong Oval PEndent with one Round Brilliant Cut Diamond set in 4-prong 14K Yellow Gold Head above Blue Topaz on Bale. The Chain is 14K Yellow GOld Flat Curb style measuring approximately sixteen (1.6) inches in length and lrom in width. CENTER STONE GRADING: Type........ ..Blue Topaz Quartz Shape. ....... . Oval Facated Cut Size..........12.70 x 10.20 x 7.25 rom Weight........5.00 carat Color.........Swiss Blue Clarity... ... . Clean SIDE STONE GRADING: Type....... .......Diamond Shape.. ...........Round Brilliant Cut S i z e. . . . . . . . . .". . . . 3 . 0 rom Weight............ .10 carat Colo~........... ..Near Colorless (H) Clarity .<. . . . . . . . . . SI 1 ESTATE VALUE: 275.00 Appraisal continued on next page. Appraisal Number: 001271 Page: 7 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Pearl Strand Uniform Knotted Fifteen (15) Inch Single Strand of Cultured Pearls containing sixty-nine (69) Pearls with 14K Yellow Gold Filligree Catch. Gemstone Grading Report: Roundness................Slightly Out of Round Size. . . . . . . . . . . . . . . . . . . . .5 1/4 rom Color. . . . . . . . . . . . . . . . . . . . Cream Overtone. . . . . . . . . . . . . . . . . Rose Orient................ ...Moderate Luster.................. .Good Blemish..... ............ .Very Light Nacre Thickness... ...... .Medium Match. . . . . . . . . . . . . . . . . . . . Very Good ESTATE VALUE: 400.00 Appraisal continued on next page. Appraisal Number: 001271 Page: 8 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Pearl/Diamond Ring Ladies 14K White Gold Pearl and Dimond Ring containing one 7 3/4 rom Cultured Pearl set in post surrounded by fourteen (14) Round Brilliant Cut Diamonds set in individual 3-prong settings with a wire undercarriage. The Ring is 14K White Gold measuring approximately 1.5 rom around the shank and weighing approximately 2.8 grams. GEMSTONE GRADING REPORT: Type......... .... Diamonds (14) Shape. ........... Round Brilliant Cut Size..... ........ .14-2.2 rom each Weight............ .60 carat total Color........... ..Near Colorless (G) Clarity........ ...VS 1 ESTATE VALUE: 425.00 Appraisal continued on next page. , . Appraisal Number: 001271 Page: 9 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Diamond Wedding Ring Ladies 14K White Gold "Wrap" Ring containig five (5) Round Brilliant Cut Diamonds set in individual 14K White Gold 4-prong Heads with a wire undercarriage and a 14K White Gold Band. The Ring is CUSTOM-MADE to fit above Pearl and Diamond Ring with a 1.8 rom band and weighs approximately 2.5 grams. GEMSTONE GRADING REPORT: Type........ ..... Diamonds (5) Shape............ Round Brilliant Cut Size..... .,. .... ..1-3.5rom, 2-3.3 rom, 2-3.0 rom Weight............ .64 carat total Color.... ........ . Faint Yellow (L) Clarity...........VS 1 ESTATE VALUE: 600.00 . Appraisal continued on next page. ~ r ,t Appraisal Number: 001271 Page: 10 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies 14K Dome Ring Ladies 14K White Gold Dome Ring containing three (3) Round Single Cut Diamonds set in Star Prongs on a 14K White Gold "Dom~" style Ring. The Ring has a textured top measuring approximately 9.0 rom and tapers to 3.0 rom at bottom of shank and weighs approximately 4.0 grams. GEMSTONE GRADING REPORT: Type............. Diamonds (3) Shape....... ..... Round Single Cut Size. . . . . . . . . . . . . .3 -1.7 rom each Weight........ .... .03 carat total Color. ..... ...... .Near Colorless (G) Clarity.......... .VVS 2 ESTATE VALUE: 175.00 Appraisal continued on next page. . I .. Appraisal Number: 001271 Page!: 11 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies 14K Gold Diamond Wedding Ring Ladies 14K Yellow Gold Diamond Wedding Ring containing five (5) Rose Cut Diamonds set in 14K White Gold Channel on a 14K Yellow Gold Band. The Ring measures approximately 2.5 rom at channle and tapers to 1.0 rom at bottom of shank and weighs approximately .8 grams. GEMSTONE GRADING REPORT: Type.. ....... .... Diamonds (5) Shape..... ....... Rose Cut Size..............5-1.3 rom each Weight............ .05 carat total Color.. .......... .Near Colorless (I) Clarity...........Imperfect 1 ESTATE VALUE: 100.00 Appraisal continued on next page. , 1 ' , 'P Appraisal Number: 001271 Page: 12 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Diamond Wedding Ring Ladies 14K White Gold Diamond Wedding Ring containing ten (10) ROund Brilliant Cut Diamonds set in "Bar Set" design on a 14K White Gold Band. The RIng measures approximately 2.75 rom uniformly around shank and weighs approximately 2.1 grams. GEMSTONE GRADING REPORT: Type... ..... ..... Diamonds (10) Shape........ .... Round Brilliant Cut Size............ ..10-2.3 rom each Weight............ .50 carat total Color..... ...... ..Near Colorless (H) Clarity..... ..... . Imperfect 1 ESTATE VALUE: 300.00 Appraisal continued on next page. /' ' . ,", Appraisal NumbE!r: 001271 Page: 13 Property of: Estate of Barbara Naylor C/O Steve Daly 622 Elliott Dr. Lewisberry, PA 17339 Items list Ladies Birthstone Ring Ladies 10K White Gold Synthetic Blue Aquamari.ne Birthstone Ring containing one Marquise CUt Synthetic Blue Aquamarine set in 4-prong Basket Head wi.th two Round Single Cut Diamonds set in Star Prongs on shoulders on either side of Center Stone. The! Ring measures approximately 6.1 rom at shoulders and tapers to 1.6 rom at bottom of shank. GEMSTONE GRADING REPORT: Type............. Diamonds (4) Shape.. ...... .... Round Single CUt Size............. .4-1.3 rom each Weight............ .04 carat total Color. ........... .Near Colorless (H) Clarity...........Imperfect 1 ESTATE VALUE: 100.00 This is to certify that we are engaged in the business of buying and selling items made from precious metals and precious and semi-precious stones. We certify that the item(s) on this appraisal were appraised using a 10 power gems cope and other gemological equipment in accordance with industry standard procedures. This is not an offer to buy. It represents our evaluation of the replacement value at the ti.me of inspection. / osi, Jr., C.G.A. Ce ified Gemologist Appraiser, American Gem Society ! , . SEP 1 1 2006 ~~~j'jah Continuing Care Retirement Services - Founded 1896 ~r{-1~ September 6, 2006 Chrystal L. Prosser 109 S. Carlisle St. P.O. Box 336 New Bloomfield, P A 17068-0336 Dear Ms. Prosser: I am writing to you concerning the refund due for the apartment occupied by Barbara Naylor at 884 Oak Oval, Messiah Village. The acquisition fee paid for the unit in August 2005 was $148,284.00. The acquisition fee amortizes at the rate of 1 % per month over a contract term of 100 months. As of August 31, 2006, the unamortized and therefore refundable amount of the acquisition fee was $129,007.00. The acquisition fee will continue to amortize at this rate until the unit is released. Per the terms of the contract, the payment of the refund to the Estate will take place after the unit is acquired by another resident. If you have any questions regarding the refund, please call me at (717) 591-7204. Sincerely, 1n fJihel e rr?[lJhCJl rho WA- Michele Maglich Brown Manager of Financial Operations Encl. * 100 Mr. Allen Drive. Mechanicsburg, PA 17055-6100 (717) 697-4666. Fax (717) 790-8200. www.messiahvillage.org Enhancing Life r' . ,. Messiah Vill~;;e Schedule of Entrance Fee Amortization Resident Name Settlement Date Arr 'ation Start Date TolL ,Itranee Fee Total Entrance Fee Refund Percentage Base Refund Amortized Portion $ 148,284 Unamortized Unamortized Amount Unamortized Unamortized Amount Month Date Balance Percentage Refunded Month Date Balance Percentage Refunded 1 Aug-05 146,801 99.00% 146,801.16 51 Oet-09 72,659 49.00% 72,659.16 2 Sep-05 145,318 98.00% 145,318.32 52 Nov-09 71,176 48.00% 71,176.32 3 Oet-05 143,835 97.00% 143,835.48 53 Dee-09 69,693 47.00% 69,693.48 4 Nov-05 142,353 96.00% 142,352.64 54 Jan-10 68,211 46.00% 68,210.64 5 Dee-05 140,870 95.00% 140,869.80 55 Feb-10 66,728 45.00% 66,727.80 6 Jan-06 139,387 94.00% 139,386.96 56 Mar-10 65,245 44.00% 65,244.96 7 Feb-06 137,904 93.00% 137,904.12 57 Apr-10 63,762 43.00% 63,762.12 8 Mar-06 136,421 92.00% 136,421.28 58 May-1o 62,279 42.00% 62,279.28 9 Apr-06 134,938 91.00% 134,938.44 59 Jun-10 60,796 41.00% 60,796.44 10 May-06 133,456 90.00% 133,455.60 60 Jul-10 59,314 40.00% 59,313.60 11 Jun-06 131,973 89.00% 131,972.76 61 Aug-1 0 57,831 39.00% 57,830.76 12 Jul-06 130,490 88.00% 130,489.92 62 Sep-10 56,348 38.00% 56,347.92 13 Aug-06 129,007 87.00% 129,007.08 63 Oet-10 54,865 37.00% 54,865.08 14 Sep-06 127,524 86.00% 127,524.24 64 Nov-1o 53,382 36.00% 53,382.24 15 Oet-06 126,041 85.00% 126,041.40 65 Dee-1 0 51,899 35.00% 51,899.40 16 Nov-06 124,559 84.00% 124,558.56 66 Jan-11 50,417 34.00% 50,416.56 17 Dee-06 123,076 83.00% 123,075.72 67 Feb-11 48,934 33.00% 48,933.72 18 Jan-07 121,593 82.00% 121,592.88 68 Mar-11 47,451 32.00% 47,450.88 19 Feb-07 120,110 81.00% 120,110.04 69 Apr -11 45,968 31.00% 45,968.04 20 Mar-07 118,627 80.00% 118,627.20 70 May-11 44,485 30.00% 44,485.20 21 Apr-07 117,144 79.00% 117,144.36 71 Jun-11 43,002 29.00% 43,002.36 ;n May-07 115,662 78.00% 115,661.52 72 Jul-11 41,520 28.00% 41,519.52 Jun-07 114,179 77.00% 114,178.68 73 Aug-11 40,037 27.00% 40,036.68 :':'''T Jul-07 112,696 76.00% 112,695.84 74 Sep-11 38,554 26.00% 38,553.84 25 Aug-07 111,213 75.00% 111,213.00 75 Oet-11 37,071 25.00% 37,071.00 26 Sep-07 109,730 74.00% 109,730.16 76 Nov-11 35,588 24.00% 35,588.16 27 Oet-07 108,247 73.00% 108,247,32 77 Dee-11 34,105 23.00% 34,105.32 28 Nov-07 106,764 72.00% 106,764.48 78 Jan-12 32,622 22.00% 32,622.48 29 Dee-07 105,282 71.00% 105,281.64 79 Feb-12 31,140 21.00% 31,139.64 30 Jan-08 103,799 70.00% 103,798.80 80 Mar-12 29,657 20.00% 29,656.80 31 Feb-08 102,316 69.00% 102,315.96 81 Apr-12 28,174 19.00% 28,173.96 32 Mar-08 100,833 68.00% 100,833.12 82 May-12 26,691 18.00% 26,691.12 33 Apr-08 99,350 67.00% 99,350.28 83 Jun-12 25,208 17.00% 25,208.28 34 May-08 97,867 66.00% 97,867.44 84 Jul-12 23,725 16.00% 23,725.44 35 Jun-08 96,385 65.00% 96,384.60 85 Aug-12 22,243 15.00% 22,242.60 36 Jul-08 94,902 64.00% 94,901.76 86 Sep-12 20,760 14.00% 20,759.76 37 Aug-08 93,419 63.00% 93,418.92 87 Oet-12 19,277 13.00% 19,276.92 38 Sep-08 91,936 62.00% 91,936.08 88 Nov-12 17,794 12.00% 17,794.08 39 Oet-08 90,453 61.00% 90,453.24 89 Dee-12 16,311 11.00% 16,311.24 40 Nov-08 88,970 60.00% 88,970.40 90 Jan-13 14,828 10.00% 14,828.40 41 Dee-08 87,488 59.00% 87,487.56 91 Feb-13 13,346 9.00% 13,345.56 42 Jan-09 86,005 58.00% 86,004.72 92 Mar-13 11,863 8.00% 11,862.72 43 Feb-09 84,522 57.00% 84,521.88 93 Apr-13 10,380 7.00% 10,379.88 44 Mar-09 83,039 56.00% 83,039.04 94 May-13 8,897 6.00% 8,897.04 45 Apr-09 81,556 55.00% 81,556.20 95 Jun-13 7,414 5.00% 7,414.20 46 May-09 80,073 54.00% 80,073.36 96 Jul-13 5,931 4.00% 5,931.36 47 Jun-09 78,591 53.00% 78,590.52 97 Aug-13 4,449 3.00% 4,448.52 48 Jul-09 77,108 52.00% 77,107.68 98 Sep-13 2,966 2.00% 2,965.68 49 Aug-09 75,625 51.00% 75,624.84 99 Oet-13 1 ,483 1.00% 1,482.84 50 Sep-09 74,142 50.00% 74,142.00 100 Nov-13 (0) 0.00% (0.00) * t ,. . REV-1151 EX+ (12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Naylor, Barbara S Debts of decedent must be reported on Schedule I. FILE NUMBER 21-2006-0741 ESTATE OF ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT See continuation schedule(s) attached 4,341.27 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions B. Steven C Daly Social Security Number(s) I EIN Number of Personal Representative(s): 196380529 Street Address 622 Elliott Drive City Lewisberry Year(s) Commission paid 2006 State PA Zip 17339 7,680.00 2. Attorney's Fees William R. Bunt, Esq. 5,100.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Edward N. Naylor Street Address 884 Oak Oval City Mechanicsburg State PA Zip 17055 Relationship of Claimant to Decedent Spouse 4. Probate Fees 306.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 226.55 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 17,653.82 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) l z. . .. Rev-1502 EX+ (6-98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Naylor, Barbara S FILE NUMBER 21-2006-0741 ITEM NUMBER DESCRIPTION AMOUNT 1 David M. Myers Funeral Home 4,341.27 Subtotal 4,341.27 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) t L , ... Rev-f502 EX+ (6-98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Naylor, Barbara S lFILE NUMBER 21-2006-0741 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal - Estate advertisement 75.00 2 The Sentinel - Estate advertisement 151.55 Subtotal 226.55 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) , ~. . :".." REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Naylor, Barbara S NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not list Trustee s) FILE NUMBER 21-2006-0741 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) ESTATE OF I. Edward N Naylor c/o Steven C. Daly 622 Elliott Drive Lewisberry, PA 173:l9 Spouse 100% of estate 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) - Q) (/) ::J o ..c t:: ::J o ()Q) >.'- '- .-roC") Q) C::J C (/) ::J 0" 0 '-=O(/)I"- ~~()Q)~ ro_-g~<( "'COrnOo... C '- -.::..c _ Q)2Q)t::Q) , n (/)..0 ::J (/) --: "0, E ()o ';: (/) Q)::J ro ::2:o:::()~() ..c 0> ::J rn ..0 (/) rn '- U5 I- Z ::J CO m <D o 0:: I"- :!!:lu 'l'"" <Cw .A' -0:: ...... ..JI- 0.. SCI) 0 >w ..J LL..J W O~<DU: w..JM:!!: uO::Mo u:<Cxo LLOO..J o 'mOl CI) '> ~cno> <C 0 ,w ..J'l'""o..z