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HomeMy WebLinkAbout11-15-06 REV-1500 EX + (6-00) . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 i OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FilE NUMBER II 06 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 183-07 -8395 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W I- lll:~1n olt:lll: wA.g %~..1 OA.III A. <C t- Z UJ C UJ o UJ c 1 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Wolfe, Mabel P. DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-OD-YEAR) 08-21-2006 ! 12-18-1917 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) [!] 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received I- Z W Q Z 2 In W It: It: o o NAME Adam R. Schellhase, Esq. FIRM NAME (If applicable) SALZMANN HUGHES PC TELEPHONE NUMBER 717-263-2121 o D o o 2. Supplemental Return 810 NUMBER REGISTER OF WILLS SOCIAL SECURITY NUMBER ! o o 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10 Spousal Povertv Credit (date of death between . 12-31-91 and 1-1-(5) Copyright 2002 form software only The Lackner Group, Inc. 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) 0 Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) z o t= ~ ::l t- o: 01( o UJ 0:: 11. Total Deductions (total Lines 9 & 10) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 12. Net Value of Estate (Line 8 minus Line 11) 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 455 Phoenix Drive, Suite A Chambersburg, PA 17201 None OFFIC'A!- USE ONLY c::::> c::::> c::1"' (1) (2) (3) (4) (5) (6) (7) 3,345.60 None None o ~ ~145 '-.2~~g .-: c;/) ;2 .1 (j (_) ~) C) -h ,\r- j:J] 0-1 ....-:.- 10,501.54 34,957.74 None (8) (9) (10) 10,464.00 101.40 (11) (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) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) z or transfers under Sec. 9116(a)(1.2) 0 i= 16. Amount of Line 14 taxable at lineal rate 38,239.48 x .045 (16) ~ ::l Q. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :IE 0 0 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18) )( x ~ 19. Tax Due (19) 20_ D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ..".. C5 ...c: -J:J rr-\ C") 1:=) :TJ __ i=} i'it CJ C:J -".-:--1 :Cl -C) P-l U1 ;:!:Jlo :l: ex:> W C) t: ...~..-.\ 48,804.88 10,565.40 38,239.48 0.00 38,239.48 0.00 1,720.78 0.00 0.00 1,720.78 Form REV-1500 EX (Rev. 6-00~ ~. Decedent's Complete Address: STREET ADDRESS 201 East Surd Street CITY Shippensburg I STATE PA I ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 1,720.78 86.04 Total Credits (A + 8 + C) (2) 86.04 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (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 the TAX DUE. (5) A. Enter the ihterest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 1,634.74 1,634.74 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.................................................................................. D [!] b. retain the right to designate who shall use the property transferred or its income;.................................... D [!] c. retain a reversionary interest; or.................................................................................................................. D [!] d. receive the promise for life of either payments, benefits or care?.............................................................. D [!] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................... ............................................................................... D [!] 3. Did decedent own an "in trust for" or payable upon ~eath bank account or security at his or her death?......... D [!] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?...................................................................................................................... 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 thai I have examined this return, including accompanying schedules and statements, and 10 the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer olher than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS William W. Wolfe K~ SIGNATURE OF PERSON RESPON Richard E. Wolfe DATE 420 Scott Drive Shippensburg, PA 17257 , 1- 9'" Ob ADDRESS DATE P.O. Box 54 Roxbury, PA 17251 1/- ,-()" DATE ADDRESS 455 Phoenix Drive, Suite A Chambersburg, PA 17201 /1-9-()f; 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 exemot 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. ~9116 (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. ~9116 1.2) [72 P.S. ~9116 (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 an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1503 EX+ (6-98) '* SCHEDULE B STOCKS & BONDS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Wolfe, Mabel P. FILE NUMBER 21-06-810 ESTATE OF All property jolntly-owned with right of survivorship must be disclosed on SChedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 US Savings Bonds, Series EE, $501$100 issued 3,345.60 03/1991-07/1992 - (inventory attached) TOTAL (Also enter on Line 2, Recapitulation) 3,345.60 (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 B (Rev. 6-98) Rev-1508 EX+ (6-98) * SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Wolfe, Mabel P. FILE NUMBER 21-06-810 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 M& T Bank - certificate of deposit VALUE AT DATE OF DEATH 10,501.54 TOTAL (Also enter on Line 5, Recapitulation) 10.501.54 (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) ....,... EX' ,..... * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY Wolfe, Mabel P. FILE NUMBER 21-06-810 ESTATE OF If an asset was made Joint within one year of the dec:edent'. date of death, It must be reported on sc:hedule G. SURVIVING JOINT TENANT(S) NAME A. William W. Wolfe ADDRESS RELATIONSHIP TO DECEDENT 420 Scott Drive Shippensburg, PA 17257 son B. c. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENTS INTEREST JOINTLY-HELD REAL ESTATE. 1 A 6/16/1999 M& T Bank - certificate of deposit 15.506.96 50.000% 7.753.48 2 A 8/4/1998 M& T Bank - certificate of deposit #9168 40.091.27 50.000% 20.045.64 3 A 1/28/1980 M&T Bank - checking account 6.184.32 50.000ok 3.092.16 4 A 2/4/1961 M& T Bank - savings account 8.132.92 50.000% 4.066.46 TOTAL (Also enter on Line 6, Recapitulation) 34.957.74 (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) REV-1151 EX+ (12-99) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Wolfe, Mabel P. FILE NUMBER 21-06-810 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: fogelsanger Bricker Funeral Home 6,766.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I ErN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees SALZMANN HUGHES PC 3,411.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 177.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 110.00 See continuation schedule(s) attached - TOTAL (Also enter on line 9, Recapitulation) 10,464.00 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.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Wolfe, Mabel P. IFILE NUMBER 21-06-810 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal - estate notice publication 75.00 2 Register of Wills - filing fees 35.00 3 The News Chronicle Co. - estate notice publication 0.00 Subtotal 110.00 Copyright (c) 2002 fonn software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) ReY-1512 EX+ (6-98) * SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COt/MONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Wolfe, Mabel P. FILE NUMBER 21-06-810 ESTATE OF Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1 WSEMS-Chbg. VALUE AT DATE OF DEATH 101.40 TOTAL (Also enter on Line 10, Recapitulation) 101.40 (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.1513 EX+ (9 00) w SCHEDULE .J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Wolfe, Mabel P. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal C1istributions.t and transfers under Sec. ~116(a)(1.2)] FILE NUMBER 21-06-810 ESTATE OF RELATIONSHIP TO DECEDENT Do Not Ust Trusteelsl SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. 1 Richard E Wolfe P.O. Box 54 Roxbury, PA 17251 William W Wolfe 420 Scott Drive Shippensburg, PA 17257 Son 2 Son 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 Schedule J (Rev. 6-98) LAST WILL AND Tf:STM'IENT 1, MABEL P. WOLFE, of 143 [vlainsville Road, Southampton TOl'lllShip, Franklin County, Pennsylvania, being of sound mind, memory ilnd understanding, do make and publish this my Last \'Ii 11 and Testament, hereby revoking and maki.lig void any and all formel' wi lIs and codici Is by me at any time heretofore made. FIRST. direct my hereinafter named Executor to pay all my just dehts and funeral expenses as 50011 as conveni ent ly may be after my deceasl;; I fu ether direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expensl~ of t.he administration of my estate, SECOND, give, devi.se and bequeath all my property, real, persona'! Clnd mixed, Ivhatsoever and wheresoever situate, to my beloved husband, ELWOOD L. WOLFE, absolutely. TliIRD. I herehy nominate, constitute and appoint my said husband, EJ.\VOOD L. IvOLFf:, the sole Execlltor of this my Last lVi 11 and Testament. FOURTH. Provided, hOl'leve1', that in the event Ill)' sai.d hu;;band, EI.\'IOOf) J.. WOLfE, should predecease me, .01' if we should die ill a cammon dis3ster, then in either of said events, I give, devise and bequeath all my property, real, personal unci mixed, \vhatsoever and wheresoever si.tuute, in t\Vo (2) eql.1a'! shares, s}13rc and shure alike, one (n equal share to my son, IV1LLI..'\M Iv. \I)OLFE, and one (1) equal share to my son, RTCIIJ\fW E. \VOLFE, absoIHtely; provided fUTther, ,that ill the event ei the1' of my said sons should predecease me, then in that event, T gi.ve, devj se :md heguE'nth the share of lilY decNlsed son to the chi Tel or chi Idl'en of my deceased SOil, equally; provJ ded further, that in the event c i. ther of my said sons predecease me and leave no chi ldn'n surviving, then in that event I givc, devise and bequeath the share of the sai.d deceased son to my survjdng son, ahsoluteIy_ - 1- f'IFTI-L I'nwid0d, hOlliE-Vel', that in the event any of my aforcnal1lE'd legatees are not of full legal age at tile time of my ell'cease, then in that. event, I bereby nonLin3te, constitute and appoint THE PEOPLES N.t\TIONAL BANK OF SlIIPPENS- BURG, Shippenshurg, Pennsylvani8, and my surviving son, as the Guardians of the estate of the said minor child or children, the said Guardians to take and receive t!H.O shan~ of the said minor child 01' children, and invest and reinvest the same in legal OF non-legal ill\.'8stments, h'h'ichever i.n their discretion they deem proper, and the said Guardians to have fllll pO\IICT and uuthol'i ty in their discretion to pay such amounts of income and principal as are necessary for the 5UppOTt, maintenance and education of the said minor child or children, and upon the said minor chi lel or chi Idren each reaching full legal 3ge, to pay the said share to the said child or chi IdTcn rt'<.lching full legal age. SIXTII. Provided further, tha.t In the event my said husband, ELWOOD L. WOLFE, should predecease me, or if ~"e should die in a common disaster, then in Ii either of said events, I hereby nominate, constitute and appoint my said son, i~ !j 'I ':i :\ WfLLli\M 1'1. WOLFE, and my said son, IUCHi\RD E. WOLFE, or the survivor of them, as the r:xecutors of th i.s my Last Wi 11 and Testament, my said Executors to have full power and authority to do any and all things necessary for the complete administrat.ion of my estate, including the power to sell any and all real and personal property of ~Jhich T lIlay die seized, at public or pTivate sales, in their discretion, IlIithout any Order of any Court; I further direct that my said Executors not be required to file any Bond in conne,:tion with the settl0111ent of my estate. [N WI1NESS WHEREOF, I, MAREL P. WOLFE, have hereto set my hand and seal to this illY Last Will. and Testament, \.,rritten on two (2) sheets of paper, this 17th day of July 1980. .--.1/ ._____~___:~,.~..'____z..;;;:~~~~~,_ -, f~ '.. .(, (t:lEAl.) Signed, sealed, published and declared by MABEL P. WOLFE, th~ Testatrix, as andfo~ her L(lst Will Imd Testament., \,;r-itten on two (2) sheets of paper, in the prcsencl' of us I"ho have, at her request, signed our names as \~itllesses heret.o in.the presel1('e of thq said Testatrix and of each other. ~~:)\~~~~~~i~~=~~.=- - 2- <oJ t../ ~ M&fBank 499 Mitchell Street, Millsboro, DE 19966 September 16,2006 Salzmann Hughes, P.C. 354 Alexander Spring Road, Suite 1 Carlisle, PA 17015 RE: Estate of Mabel Wolfe Date of Death: August 21, 2006 Social Security No.: 183-07-8395 Dear Mr. Schellhase: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type......... .. . .. . .. . .. . ., . '" Certificate of Deposit Account Number. . .. . .. . .. . . . . .. . .. . ...31003911817343 Ownership (Names oj)...............Mabel P. Wolfe Opening Date. . .. . .. . .. '" . .. . .. . .. . .. . .04/25/05 Balance on Date of Death. . .. . ... . .$10,000.00 Accrued Interest $ 501.54 Total.. ...... ........ .... ... ............ ....$10,501.54 2. Account Type.............. ... . ... .. . ." Certificate of Deposit Account Number..... ..... ... ... .......31003913794549 Ownership (Names oj)............... Mabel P. Wolfe, William W. Wolfe Opening Date. ... . .. . .. . .. . .. . .. . .. . .. . .06/ 16/99 Balance on Date ofDeath.........$15,370.55 Accrued Interest $ 135.41 Total........... ..... ................... ....$15,506.96 . Page 2 3. Account Type...........................Certificate of Deposit Account Number.. .. ... . .. . .. . .. . .. . .. .31 003914619168 Ownership (Names oj}............... Mabel P. Wolfe, William W. Wolfe Opening Date. ... . .. . .. ... . .. . .. . .. . ... .08/04/98 Balance on Date of Death......... .$40,000.00 Accrued Interest $ 91. 27 Total.... ................ ............... ....$40,091.27 4. Account Type........................ ...Checking Account Account Number....................... 97584029 Ownership (Names oj}............... Mabel P. Wolfe, William W. Wolfe Opening Date. . .. . . .. .. . .. . .. . .. . .. . .. . .01/28/80 Balance on Date of Death......... .$6,184.14 Accrued Interest $ O. 18 Total................................... ....$6, 184.32 5. Account Type......................... ..Savings Account Account Number.. .. ... ... . .. . .. . .. . .. .21 00000 1218511 Ownership (Names oj}............... Mabel P. Wolfe, William W. Wolfe Opening Date. . .. ... . ... .. .... .. . .. . .. . .02/04/61 Balance on Date of Death......... .$8,130.60 Accrued Interest $ 2.32 Total.. .. ... . .. . .. ... ... . .. . .. . ... ., . .. . ... .$8,132.92 The above named decedent did not have a safe deposit box. September 16,2006 . Page 3 September 16, 2006 For any additional information on the above accounts, including ownership, statements and closures please contact our Walnut Bottom branch at 717-532-2414. Sincerely, , aIJLV'I\J- lJUI'Vl ~ Charlene Warrington, Records Management 1-888-502-4349 () ~ CJ o o c 3 (1) ::] - (f) Q) ::] Co en (1) ::; S' ee (f) ..:::: Co ..., Q) ~ c- O) c ee ::T ~ '< CJ o o c 3 (1) ::] en - s: 0) c- ~ :E o ?D' (f) c- ~ ww ww w U) U) ww '" "'''' '" '" '" "'''' '" '" ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... to CD -..10) 01 ~w '" ...... 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I>>o.;.c:. .m ~ (/) c: %.)( <o~::)-g. o..~~,l>> ooSa::) ...oalOIO ~ aO'a$ ~OlO::r9: 1>>.2 a I>> ~ :) aI -' (/) 0 10 0.. (/) %.... ~~(J'lg.~ ~ !:!,~ ~ ::r. ",,""Ol>>-::r. (I)::)~aa oalo _<0:) 0..:)0.. fj) (/) c: aI -0 0.. Q) to co f',) 9.- f',) Register of Wills, Cumberland County, Pennsylvania INVENTORY , Deceased No. 21-06-810 Date of Death 08/21/2006 Social Security No. 183-07-8395 Estate of Mabel P. Wolfe also known as William W. Wolfe Richard E. Wolfe The Personal Representatlve(s) of the above Estate, deceased, verify 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. 1.0. No.: Adam R. Schellhase, Esq. 82648 Personal ReDresentative Signature: ~ e7. r William W. Wol~ Signature: 1~L--.A1f'w~ N~ ichard E. olfe Attorney: Signature: Firm: SALZMANN HUGHES PC Address: 455 Phoenix Drive, Suite A Chambersburg, PA 17201 Telephone: 717-263-2121 Address: 420 Scott Drive Shippensb rg, PA 17257 Dated: Telephone: Personal ProDertv Cash....................................................... .,....................................... Personal Property......................................................................... Stocks/Listed................................................................................ . Stocks/Closely Held......................................................................' Bonds............................................................................................ . Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... All Other Property... ....................................... ...... ....... .... .............. 1 O,~1.54 ~o .,':;:0 ','-0 r;~ i=2 '";:""rTl --:--' =0 (.I) -',- 3~~~ __~~ ~ -=n. -v ::p --1 -.....,::;.. I'..J C:> C::> c:::n 2: a --c ::u ZJ_~ (::> TJ C.J j-it f:J ~') j -n C') _" n-] 1_._....) U1 :bo ::z 9? w <::) Total Personal Property....... ...... ..... ...... ....... .......... 13,847.14 Total Real Property... ....... ...... ....... ...... ....... ...... ...... Total Personal and Real Property......................... Total Out-of-State Real Property.......................... v'